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, Geojige ^ 
276 MARYLAND MEDICAL JOURNAL 
in which death took place from intra-pe- 
ritoneal hemorrhage consequent upon 
rupture of a uterine vein. In sub-peri- 
toneal hemorrhage from this cause, a 
pelvic hematocele would be formed. No 
treatment is necessary, unless collapse 
should call for the employment of stimu- 
lants. 
The uterus may be contracted to a 
considerable degree, and yet a vexa- 
tious oozing may continue in subjects of 
tke hemorrhagic diathesis. Hypoder- 
mic injections of ergot may stop the 
bleeding. If not, mopping the cavity 
with a styptic, the most effectual being 
Monsel’s solution, is indicated. The 
clots formed by the iron sometimes 
undergo decomposition in the uterus 
and are resorbed, causing septicaemia. 
This is not likely to occur, however, 
when the uterus is only mopped out 
with the sub-sulphate instead of the so- 
lution being injected, because the coagu 
la are brought away with the mop. A 
sponge probang may be saturated with 
the styptic, carried into the uterus and 
the whole cavity thoroughly swabbed 
with it. 
In certain, somewhat rare, cases of 
labor, that portion of the uterus to which 
the placenta is attached fails to contract, 
and expel the afterbirth. This condition 
is due to a fatty degeneration of that 
portion of the uterine wall, resulting in 
a paralysis of the muscular tissue. Ger- 
man writers recognize this condition as 
^Jaralysis of the placental sitel Play- 
fair speaks of it as encystment of the 
placenta.” The paralyzed portion of the 
uterus fits into the rest of the organ like 
a piece of soft sole leather. The uterine 
contraction may force the placental site 
to bulge outward or inward, forming 
either a tumor or a depression on the 
external surface of the uterus. If the 
placenta is let alone, in these cases, there 
will be no hemorrhage, and it will gradu- 
ally undergo fatty degeneration and 
resorption. If, however, it is already 
partly detached, it should be at once 
removed, lest it give rise to troublesome 
hemorrhage or septicaemia. If the pla- 
centa is detached and there is hemor- 
rhage from the site of its attachment, 
Monsel’s solution should be applied with 
a sponge or other mop. 
In cases of divided placenta^ where 
one or more of the cotyledons remain 
behind in the uterus, there may be dan- 
gerous hemorrhage. Prof. Wm. T. Lusk 
has recently reported a fatal case of this 
kind to the New York Obstetrical Society. 
The finger introduced into the uterus 
will readily discover it. The placental 
fragment should be at once detached, 
either with the finger nail if that be prac- 
ticable, or by means of Thomas’ vaginal 
depressor, used as a curette. Properly 
used, this instrument is perfectly safe, 
and is certainly most effective for this 
purpose. In several cases of metrorrha- 
gia of several months standing, from 
partial retained placenta, E. used it with 
the happiest effect. 
Submucous and intra mural fibroids^ 
and peritoneal adhesions may prevent 
entire contraction of the uterus, and thus 
cause persistent, and in some cases dan- 
gerous hemorrhage* In these conditions, 
the consistent application of styptics is 
the only therapeutic resource. 
Pu rperal inversion of the uterus is a 
rare accident, but when it occurs death 
may result from hemorrhage before repo- 
sition. When partial the upper portion 
of the tumor will be found surrounded 
by a collar or jacket, which is the cervix. 
Th^s should be dilated by Thomas’ dila- 
tor, an instrument somewhat resembling 
a glove-stretcher, and the uterus restored 
by steady, firm pressure. In a recent 
case of complete inversion to which the 
speaker had been called, the uterus was 
restored by first dilating the cervix from 
above, the fingers of the left hand form- 
ing a cone, and pressing the abdominal 
wall down into the narrow cup-shaped 
depression of the cervix. The vaginal 
tumor was then grasped with the right 
hand and one horn of the uterus forced 
back through the cervix. The other 
horn was then pushed up in the same 
manner, completing the reduction. In 
cases where reduction cannot be accom- 
plished, Monsefs solution should be 
applied. 
B. Hemorrhage from an uncontracted 
uterus. Non contraction of the uterus 
causing hemorrhage may be due to 
retained placenta. The patient should 
be anaesthetized, the hand introduced into 
the uterus and the placenta detached 
from above. It can be detached much 
more readily in this way than from below. 
Expression of the placenta (Crede s 
method) may also be tried. 
, , , Botanical 
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