POST I'Airn'M H.KMOnilllAGK. 575 



In what Cox has designated " pre-placental presentation,"' we may 

 have hiDinorfhage ensuing. According to this authority, such pre- 

 sentations are rare, and if they occur at the termination of gestation 

 maybe looked upon as unfavourable ; though they are most frequent in 

 cases of abortion, and are then seldom followed by serious results, 

 Metrorrhagia ensues \vhen the usual period of parturition has been 

 exceeded, and the " water-bag" has been presented and ruptured, tlie 

 entire ^/(ictw;/a /«7a//s coming away before the f(etus itself. '^ in some 

 cases, a considerable portion of the membranes envelop the fore- 

 parts of the foetus, and occasionally to such an extent as to retard 

 delivery ; this may be shredded off and removed without risk, but it 

 will be found that the posterior portion remains attached. Tiie fatality 

 attendant upon these cases is due to neglect of examination and proper 

 aid, and this negligence, again, is owing to the absence of 'pains.' 

 After the removal of the fatus, it is found that hfemorrhage has taken 

 place from the open vessels, and the quantity of blood indicates that it 

 commenced immediately after separation of the placenta. I have seen 

 these cases only in cattle." 



In certain instances there can be no doubt that, as in woman, insuf- 

 ficient contraction of the uterus is a cause oi post part utn hicniorrhage ; 

 and, according to Schrader, this atony of the organ is especially 

 observed after a rapid emptying of its cavity, whetiier artificially or 

 naturally produced, also after a previous and very considerable disten- 

 tion. It therefore occurs in her after very rapid delivery, too early 

 turning and extraction, in hydramnios, and at the birth of twins. The 

 ha}morrhage is sometimes also due to general debility, and feeble 

 development of the uterine muscles — either congenital or depending 

 upon previous very difficult labours. Partial adhesions of the placenta 

 to the uterine wall, which, however, are rarely caused by real connec- 

 tive-tissue bands, may also give rise to profuse haemorrhage, as the 

 separated places in the vicinity of the adlaesious can only imperfectly 

 contract. 



Symptoms. 



The symptoms of p)osL partum iKemorrhage are not well marked 

 unless the bleeding is visible, though they are those of profuse h;emor- 

 rhage in general. There is the quick, weak, running-down pulse, which 

 becomes imperceptible as death approaches, and the tiirobbing, irregular 

 contractions of the heart ; the decoloration of the mucous membranes, 

 rapidly increasing prostration of the animal, with the unsteady stagger- 

 ing gait on movement, and the difficulty of maintaining the standing 

 position towards the end ; the haggard fades ; with chilliness of the 

 surface, cold clammy perspiration breaking out over the body ; and, 

 finally, the recumbent position, convulsions, and death. 



Sometimes there are indications of abdominal pain-indicated by paw- 

 ing and looking anxiously at the flanks ; but these indications are only 

 likely to be present when the hiemorrhage is due to traumatic influences. 

 When the hicmorrhage per vnlvavi is discernible — coming away in a 

 fluid condition or in masses of clots — then, of course, there can be no 

 difficulty in diagnosing the accident ; but when it is entirely internal, 

 the manifestation of the symptoms above indicated should give rise at 

 once to a suspicion of the state of affairs, and lead to a manual explora- 

 tion of the uterus. 



* VtUrivary Journal, March, 1S77, p. 178. 



