MARYLAND MEbl CAL JOURNAL 275 
BALTIMORE MEDICAL and SUR- 
' GICAL SOCIETY, 
MEETING OF 22u.'D SEPTEMBER. 
DISCUSSION ON POST PARTUM 
HEMORRHAGE. 
REPORTED BY GEORGE H. ROHE, M. D. 
Dr. Aug. F. Erich opened the discus- 
sion of the appointed subject, post-par- 
turn hemorrhage, by calling attention to 
the interest which the subject niust 
always have for the general practitioner. 
The occurrence of hemorrhage after 
delivery is frequently so alarming in 
character that the life of the patient de^ 
pends upon quick decision and prompt 
action. 
Under post-partum hemorrhage, Dr. 
Erich includes all hemorrhages occurring 
after delivery of the child. These may 
be divided into a, hemorrhage occuring 
with the uterus contracted, and b. with 
the uterus uncontracted. 
Dr. Erich said he should devote more 
time than is usually given to the consi- 
deration of hemorrhages occurring when 
the uterus is contracted. The possibility 
of dangerous hemorrhage under this 
condition did not usually occur to the 
practitioner who considered a contracted 
uterus a guarantee of the mother’s safety. 
He regarded this as sufficient excuse for 
dwelling at some length upon the causes 
of post-partum hemmorrhage with con- 
tracted uterus. 
First of these causes demanding notice 
is rupture of the uterus. This is easy of 
diagnosis. The finger inside of the ute- 
rus and counter-pressure on the abdom- 
inal walls from without will readily dis- 
cover any rent in the uterine tissue. 
Signs of collapse are also present, such 
as a pale, anxious expression, fluttering 
pulse, &c. The treatment consists in the 
hypodermic injection of fluid extract of 
ergot. To obtain a rapid effect, and 
avoid danger from abscess, the ergot 
should be deeply injected. The speaker 
has never seen an abscess following a 
hypodermic injection well performed, A 
good, reliable preparation of ergot is 
necessary ; Squibb’s should always be 
used if obtainable. The fluid extract 
answers all purposes. Ergotine is not 
necessary. 
Hemorrhage may also occur from 
rupture of the cervix y the uterus being 
well contracted. The rent is easily de- 
tected by the finger. A Sims’ or Erich’s 
speculum should be introduced and the 
bleeding vessel seized with forceps and 
twisted. If this cannot be done, lint or 
absorbent cotton, rendered styptic ^ by 
saturating it with Monsel’s solution, 
should be firmly pressed upon the bleed- 
ing point and kept in place by a tampon. 
Rupture of the vagina may also give 
rise to hemorrhage. This accident not 
rarely occurs in difficult labors, especially 
in forceps or version cases. E. has rup- 
tured the vagina in removing a large 
uterine polypus. The treatment is the 
same as in the condition last mentioned. 
Vessels of considerable size are some- 
times torn through in rupture of the pe- 
rineuniy and give rise to considerable 
bleeding. The source of the hemor- 
rhage in these instances is directly under 
the eye, and the treatment is evident ; 
torsion or ligature of the vessels, or if 
much oozing be present, packing the rent 
with styptic lint. 
The plexus of vessels composing the 
bulbs of the vestibule may be ruptured 
during labor and give rise to no incon- 
siderable hemorrhage. This is easily 
controlled by pressure and styptics. 
A piidendal hematocele may form dur- 
ing the progress of a labor and rupture 
at its termination. On account of the 
rich vascular anastomosis in the female 
pelvis, hemorrhage from this source may 
be very troublesome. The treatment 
consists in slitting open the tumor, turn- 
ing out the blood, packing the cavity 
with styptic lint and applying pressure 
from without. This soon arrests the 
bleeding. 
In all of these instances, the actual 
loss of blood may be small and insignifi- 
cant under ordinary circumstances ; but 
the patient may be so much weakened 
from previous hemorrhage, that the loss 
of even a small quantity would be an 
element of great danger which should be 
guarded against by all means in the 
hands of the practitioner. 
Intra and sub -peritoneal rupture of a 
utei^tne vessel may rapidly cause collapse 
and death. In the former case, no abso- 
lute diagnosis could be made, and even 
if so, there is no treatment that can be 
applied, except laparotomy and tying 
the vessel. Fritsch reports a case in 
the Archiv fuer GyncekologiCy Bd, J2j 
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