HEMORRHAGIC DYSTOCIA. 369 



SECTION 1. 

 Accidental Dystocia. 



§. I. Of Hemorrhagic Dystocia. 



Whether the hemorrhage be an epistaxis, an hemoptysis, an he- 

 matemesis, a hematuria, or a metrorrhagia, any one may conceive 

 that the efforts of child-birth must to a considerable degree augment 

 the danger which accompanies it. In the five first named cases we 

 are to act as we should do in relation to all hemorrhages in general; 

 and if the blood still continues to flow, we should begin to think of 

 terminating the labor as promptly as possible; the sixth-named case, 

 uterine hemorrhage, is met with so frequently, constitutes an acci- 

 dent of so serious a nature, that it becomes necessary, in this place, 

 to examine it, not only as a complication of labor, but also as one of 

 the essential and distinct diseases of pregnant women. 



860. This hemorrhagy is called internal, latent, or concealed he- 

 morrhage, when the blood that flows from the vessels is retained in 

 the womb and does not escape from the genital organs; it is, on the 

 contrary, denominated external, apparent, when the sanguineous 

 fluid escapes from the genital organs as fast as it is poured out by the 

 mouths of the vessels. It is owing to two kinds of causes: efficient 

 causes, and occasional or determining causes. 



861. From the time of Puzos, accoucheurs have generally placed 

 the efficient cause of flooding in the detachment of the placenta; 

 they state that the placenta separates itself from the internal surface 

 of the womb, and thenceforth the blood flows abundantly from the 

 large and numerous vessels which open on it; this opinion appears 

 to me to be ill-founded. Puzos and his partizans have mistaken the 

 effect for the cause. It is not the detachment of the placenta that 

 produces the hemorrhage, but the hemorrhage on the contrary that 

 detaches the placenta: blows, falls and great shocks may certainly 

 affect the womb and its contents; but as the ovum constitutes a full 

 bladder in immediate contact with the whole extent of the cavity of 

 the organ that contains it, the most violent commotions would not 

 be able to detach it. While ever the membranes remain unrup- 

 tured, it cannot be conceived how the adherences of the placenta 

 can be destroyed otherwise than by the efforts of a fluid endeavor- 

 ing to effuse itself into the cavity of the womb. It is astonishing 

 that such a doctrine should have been maintained so long by so 

 many celebrated men; for even admitting a previous detachment of 

 the placenta, we should still have given no explanation of floodings. 

 In fact this detachment takes place every day, either wholly or par- 



