4.56
Mr. Bartley in Reply, to Mr. Togo.
To the Editors of tire Medical and Phyfical Journal.
GENTLEMEN,
Jl HE reason of my now troubling you, is to remark
some critical observations of Mr. logo, in your Journal,
No. 5Q, p. 67, on a paper of mine concerning the delivery
of the placenta, which you have clone me the honour to
insert in a former number.
In the first place, he seems dissatisfied with the applica-
tion
Mr. Hartley in Reply to Mr. Fogo,
457
lion of the term morbid. I cannot, I confess, agree with
him as to its impropriety, notwithstanding all "the argu-
ments he has advanced on the subject. 1 conceive mor-
bid and diseased to be synonimous terms. Mr.F. supposes
it probable that " the placenta remained partly attached
to the uterus from its atonic state" He will not surely
contend that atony is not a disease. Every circumstance
occurring contrary to the usual economy of Nature, so as
to derange the animal system, may be justly, I think,
called morbid or diseased. The retention of the placenta,
arising from an (C atonic state of the uterus," is not cer-
tainly to be considered as a natural circumstance, and
might therefore with propriety be termed morbid. As it
is, however, ot little use to cavil about words, I shall pro-
ceed to consider the more important parts of the case.
Mr. F. is of opinion, that haemorrhage-still continued to
exist during the four hours the placenta was retained, and
that 1 gained no advantage by the delay, as the patient
could not increase in strength. Both these positions I
positively deny. The placenta adhered to the fundus
uteri, and did not " block up the vagina." If haemorrhage
did exist, there w,as sufficient room for the blood to have
escaped in a fluid state, and consequently it would have
appeared externally. The clots 1 removed did not, as
Mr. F. has Conjectured, nearly amount in weight to " two
rounds or one." It did not exceed what might be ex-
pected to have coagulated (during the haemorrhage, which
succeeded the birth of the child) from the recumbent
posture of the patient, and was afterwards propelled into
the vagina by slight contraction of the uterus.
As to the strength of my patient, it evidently increased
to a very considerable degree; during the time I waited,
she had recovered in a great measure from that debility I
observed on my first arrival, before I attempted to remove
the placenta; her pulse, at first excessively weak, was be-
come tolerably strong and regular; her spirits repaired,
and her countenance no longer exhibited that cadaverous
appearance I described. 1 may therefore, I think, fairly
presume from these circumstances, that no haemorrhage
did then exist. Her importunities for the removal of the
placenta (to which Mr. F. attributes her salvation) were
the effects of weariness from remaining so long on the bed
in an uneasy posture, and a consequent wish of being
changed and placed in a more comfortable situation. The
subsequent fail)tings were, 1 conceive, occasioned partly
by the pain felt from the introduction of my hand into the
uterus, which had somewhat receded and contracted, and
partly by her dread of the operation/ ff J
" I also (as Mr. F. expresses himself) am one of those
who can see no safety in allowing the placenta to remain
four hours, (or one) in case of an existing though not
apparent haemorrhage." If I had the slightest cause to
suspect its existence, I should remove every thing which
would impede the contraction of the uterus without hesi-
tation, and whether I suspected it or not, I should not, as
Mr. F. pleasantly supposes, " sit pulling the cord," there-
by increasing or perhaps causing the evil I wish to avoid.
In the case in question, I gently strained the funis five or
six times in the course of the four hours (for about so often
the pains occurred) in order to ascertain whether contrac-
tion (indicated by pain) had at all furthered the expulsion
of the placenta. Mr, F. may probably be a greater adept
at pulling a cord than myself, for he seems to.have rung
round the changes merrily on me and Mr. Marson; I leave
others to determine with how much judgment.
I shall only add, that the arguments of Mr. F. are not at
all calculated to convince me of any impropriety of con-
duct in this particular, and that if a similar case should
occur in my practice, attended with like circumstances, I
should, notwithstanding the plausibility of his reasoning,
act in just the same manner without dreading the result.
I am, &c.
O. W. BARTLEY,
Nailsworth, Gloucestershire,
April 10,1804,


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