SECT. LXXV.—ON RETENTION OF THE SECUNDINES.
Often, after the removal of the fœtus, the placenta (which is also called the secundines) is retained in the uterus. When the mouth of the uterus is dilated and the placenta separated, and rolled into a ball in some part of the uterus, the extraction is most easy. The left hand warmed and anointed is to be introduced into its cavity, and the secundines extracted as they present. But if they adhere to the fundus uteri we must introduce the hand in like manner, and grasp them and pull them along, not straight down for fear of prolapsus, nor with great violence, but they are to be moved gently, at first from this side to that, and afterwards somewhat more strongly, for thus they will yield and be freed from their adhesion. If the mouth of the uterus be found shut we must have recourse to the same treatment. If the strength is not sunk, sternutatories and fumigations with aromatics in a pot may be used; and if the mouth of the womb dilate, the hand is to be introduced and an attempt made to extract the placenta, as aforesaid. If even in this way it cannot be extracted, one need not be alarmed, for after a few days it will putrefy, dissolve into sanies and drop off. But since the fetid smell affects the head and disorders the stomach, we must use suitable fumigations, among which cardamom and dried figs are much approved.
Commentary. We have mentioned in another place that Hippocrates’ practice in retention of the placenta consisted in suspending weights from the end of the umbilical cord.
Celsus directs us, when the placenta is not cast off soon after the delivery of the child, to draw down the umbilical cord gently with the left hand, taking care not to break it. The right hand is then to follow it up to the secundines, and their veins and membranes being separated from the womb, the whole are to be extracted along with whatever coagulated blood may be in the uterus. (vii, 29.)
Our author merely abridges a fuller account of the subject given by Aëtius from the works of Philumenus. (xvi, 24.)
Moschion reprobates the ancient practice of using sternutatories, pessaries, and fumigations, and of suspending scales or weights from the cord, because these means sometimes occasion hemorrhage. He recommends the midwife, if the mouth of the womb be still open, to introduce her left hand, and to take hold of whatever part of the placenta presents: then, if it does not adhere to the fundus uteri it is to be extracted; but if it is not separated it is to be moved gently hither and thither without violence. When the mouth of the uterus is contracted, he advises her to use those liquors and injections which are applicable for inflammations of the womb. (Section liv.) His method of securing the umbilical cord after delivery is nearly the same as that now adopted. After the child has been allowed to lie on the ground for a few minutes, two ligatures are to be applied round the cord, the nearest being four fingers from the belly; it is then to be cut with a scalpel or any sharp knife. He disapproves of using instruments of wood, glass, or reeds, and hard crusts of bread, as practised by the ancients. (lxv.) He directs lacerations of the perineum to be treated by applying ointments composed of wax, oil of roses, litharge, ceruse, and alum, with suitable bandages. (lvii.)
The practice of Soranus in these cases is most judicious, and such as can scarcely be improved upon at the present day. He disapproves of all violent attempts at extraction, but when the placenta cannot be got otherwise removed from the womb, he approves of introducing the hand well lubricated to extract the secundines gently. He directs us when the mouth of the womb is shut to open it if possible with the fingers in a gentle manner. This is the case now incorrectly called the hour-glass contraction.
Avicenna repeats the directions given by Paulus and Aëtius, but seems to have considered the introduction of the hand into the uterus as a painful, and, in general, an unnecessary operation. (iii, 21, 2, 16.)
Albucasis follows our author’s practice. (Chirurg. ii, 78.)