134 BOTINE OBSTETRICS 



healtli need not necessarily suffer. It sometimes happens^ 

 during pregnancy that quite a quantity of blood is evacuated. 

 After losing about one liter, the hemorrhage ceases and the 

 patient recovers ; but the course may be a different one. As a 

 result of the hemorrhagia and loss of blood, a collateral anaemia 

 of other organs sets in, the cow is attacked in a few hours by 

 anaemic convulsions, and dies. Such a virulent termination 

 follows rupture of a larger blood vessel. The prognosis of such 

 a hemorrhagia uteri must be a cai'eful one. Hemorrhages quite 

 small at first often develop serious sequels. This depends on 

 the limited dilatation of the cervix uteri, thus interfering with 

 the free flow of blood, at the same time a good deal of blood 

 may be contained within the uterus. We must also remember 

 that in the standing posture the extravasated blood does not 

 discharge through the vagina, but accumulates in the uterus, 

 a,nd only in the recumbent position is it discharged in a 

 rstream. All this must be considered and a guarded prognosis 

 imade. 



Therapeutics. — When the local examination and the correct 

 'diagnosis are made, the treatment depends on the amount of 

 •extravasated blood. Small hemorrhages only call for absolute 

 rest. Frequent explorations are dangerous, while irrigations 

 are apt to destroy the life of the foetus. Therefore an expect- 

 ant treatment is indicated, of course only, I repeat, in small 

 hemorrhages which do not endanger the life of the mother. 

 When the hemorrhage endangers the mother's life, prompt 

 interference is required. In these cases the os uteri is usually 

 sufEciently dilated to pass the hand into the cavity of the 

 uterns. 



The treatment next consists in producing, as quickly as 

 possible, uterine contractions, and, in consequence, cessation 

 of the hemorrhage. These contractions, of course, are only 

 possible when the foetus has been previously removed. 

 Artificial abortion, therefore, is to be instituted, together with 

 application of such remedies as are enumerated under post 

 partum hemorrhage (" Metrorrhagia Post Partum "), to which 

 the reader is referred. 



