. An American text-book of obstetrics. For practitioners and students. 31 Hart, in expressinghis dissent, gave the following statement: I must now state the view Iadvocate for the occurrence of placenta praevia. It is that of primary implan-tation of the impregnated ovum low down, or even over the os internum. Theforcible objection that Kaltenbach urges against this view seems to me notquite valid. He holds that the small ovum would pass into the cervical canaland be lost. We must remember, however, that the hypertrophied and foldeddecidua there will practically obliterate the os internum, and
. An American text-book of obstetrics. For practitioners and students. 31 Hart, in expressinghis dissent, gave the following statement: I must now state the view Iadvocate for the occurrence of placenta praevia. It is that of primary implan-tation of the impregnated ovum low down, or even over the os internum. Theforcible objection that Kaltenbach urges against this view seems to me notquite valid. He holds that the small ovum would pass into the cervical canaland be lost. We must remember, however, that the hypertrophied and foldeddecidua there will practically obliterate the os internum, and thus implantationover it may occur. But why should such a low implantation happen? We * Winckel remarks, referring to the views of Hofmeier and Kaltenbach : Ahlfeld hasjustly disputed the correctness of this explanation, and from a case in which the placenta wasentirely situated in the lower uterine segment has given ground for the old opinion of theprimary grafting of the ovum in the inferior third of the uterine cavity (Lehrbuch der Geburts-hiilfe, 2d ed., 1893).. Fig. 383.—Placenta previa in pregnancy with twins (Hofmeier). DYSTOCIA. 583 only know that it is mox-e apt to occur in cases where the mucous membranehas been unhealthy. The hypothesis I would advance, but merely as anhypothesis, is that the human ovum can graft only on a surface denuded ofepithelium, and that thus it does not graft in the Fallopian tube, but in somepart of the uterine cavity where the epithelium has been removed by menstru-ation. If, then, the ovum does not meet with the connective-tissue surfaceuntil it has passed low down in the uterine cavity, some form of placentapraavia will happen. Dr. Robert Barnes first announced in 1847 his theory of placenta praevia,and he has made several contributions to the subject since, the most recent ofthese being a paper read by him in 1892 before the International Congressof Diseases of Women and Obstetrics, in Brussels. In justice to one of themost eminent an
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