706 PARTU 
“after having emptied the veffels by bleeding, and the 
bowels by clyfter, an emetic will frequently be found of 
great ufe, particularly if the ftomach is diitended, or it 
fhould appear that the patient had eaten freely not long 
before the accefs of the 
The head fhould be fhaved, and a cold wadi fhould be 
kept conftantly applied upon it. Dr. Denman recom¬ 
mended to have the face of the patient frequently dallied 
with cold water, by means of a bundle of feathers, more 
efpecially'on each attack of the convulfions. Dr. Ha¬ 
milton, of Edinburgh, fays, that both this remedy and 
the vomiting aggravate the fymptoms ; but Mr. Hogben 
recommends, in addition, the “ringing a large bell, 
fpringing a watchman’s rattle, or beating a drum, clofe 
to the woman’s bedfide.” 
In our opinion, the exhibition of naufeating dofes of 
antimonium tartarizatum will be highly conducive to the 
reduction of vafcular action; and with this intention 
may be conjoined with the purgative medicines. 
2. The fecond indication is to be fulfilled after afcer- 
taining the exciting caufe, which it is often very difficult 
to do. It will always be prudent to empty the bladder 
and bowels; and it will fometimes happen, that, after 
one or two copious and extremely-offenfive and dark- 
coloured motions have been obtained, the paroxyfms 
ceafe. But the condition of the uterus is the point now 
demanding the moll attentive confideration ; and it is to 
be feared, that in many inftances too much importance 
has been attached to the immediate emptying of this 
organ, when it lias led to the omiffion of blood-letting 
and purging. The refult of careful obfervations made on 
the influence of delivery over puerperal convulfions feems 
to be, 
Firft. That, if the os uteri be rigid and undilated, any 
attempt to empty the uterus by the introduction of the 
hand into the uterus to expedite delivery, aggravates 
the convulfions; and, even when the mouth of the womb 
isopen, fuch an attempt will often bring back the pa¬ 
roxyfms. 
Secondly. In moll inftances, the os uteri dilates ra¬ 
pidly in thefe mournful cafes, or is eafily dilatable; and 
in general, the parturient efforts are fo powerful and 
frequent, that little advantage can be gained by any 
manual interference, until the head defcends fo low in 
the cavity of the pelvis, as to be eafily embraced by the 
fhort forceps. 
Thirdly. Should very urgent fymptoms appear to juftify 
delivery before the head of the child has defcended fo 
low as to be within the reach of the fhort forceps, either 
the long forceps or perforator are to be preferred to the 
introduction of the hand into the uterus, fhould the at¬ 
tempt to turn produce any recurrence of convulfions. 
It does not always happen, that the convulfions ceafe 
upon the termination of the labour; on the contrary, 
they often continue after the birth of the child, and fome¬ 
times increafe in violence, and at length produce death. 
If, however, the intervals between the fits become longer, 
a more favourable prognofis may be formed ; but it will 
be expedient to continue our exertions in relieving the 
fymptoms. The application of the cold walli to the head 
fliould therefore be perfevered in : a blifter may be ap¬ 
plied to the back, to the inlides of the thighs, or calfs of 
the legs : finapifms may be applied to the feet; and, if 
the patient can fwallow, aperient medicines, antifebriles, 
and light cordials, fliould be given. Great attention 
muft be paid to the ftate of the bladder, as the patient 
fometimes fuffers under an inability of expelling her 
urine ; in which cafe, the catheter fliould be introduced 
twice a-day. 
When at length the patient recovers, file remains ge¬ 
nerally infenfible of all that has happened to her; her 
ftrength flowly returns, and eventually no trace remains 
of the difeafe, nor is there much danger of its recurring 
in a future labour. But Dr. Merriman mentions two or 
three cafes of mania occurring, as foon as the convulfions 
II I T I O N. 
ceafed, and remaining for fome weeks, yet the patients 
ultimately got well. 
Dr. Merriman has ftated the refults of 36 cafes of 
puerperal convulfions which came under his care, and in 
which the lancet was ufed with great freedom, as here 
recommended. Twenty-eight of the women recovered; 
and “feveral of them, from apprehenfion of a fimilar 
attack in their next pregnancy, were bled at their own 
requeft, when approaching the full term; and to others 
it was recommended, on account of fevere pains in the 
head; and there has been no inftance of a return of con¬ 
vulfions in their future labours.” Synopfis, p.14.1. 3d 
edit. 
Of Uterine Hemorrhage. 
Hemorrhage from the uterus is always an alarming oc¬ 
currence. In the unimpregnated ftate, it frequently 
evinces a difeafe of that organ. In the early months of 
pregnancy it often terminates in abortion; in the latter 
months it is full of peril both to mother and child ; and, 
even after labour has been accompliffied with, apparently, 
the utmoft fuccefs, it fometimes burfts forth with fudden 
and uncontrolable violence, and almoft inftantaneoufly 
deprives the mother of her life; fo that there are no 
cafes within the range of obftetric fcience that demand 
more prompt, judicious, and vigorous, treatment, than 
labours of this order. 
There are fome general rules for the management of 
uterine hemorrhage, applicable to all cafes in which it 
may occur. The patient is to be kept perfectly cool, in 
a recumbent pofture, in a ftate of great quietude. If 
coftive, the bowels are to be opened by faline aperients, 
or clyfters of cold water, or fait and water, or vinegar 
and water, in the proportion of two table-fpoonfuls to a 
pint. The diet muft be very Ample, taken in very fmall 
quantities, and often repeated. No ftimulants of any 
kind are to be allowed. Refrigerant, fedative, and re- 
ftringent, medicines muft be exhibited internally; and 
in the event of profufe difcharge, the topical application 
of cold water and vinegar, iced water, or ice, to the 
uterine region, muft be made. Other plans of manage¬ 
ment apply only to peculiar ftates of hemorrhage. Thus 
bleeding, which may be fometimes ufefullv employed in 
the hemorrhages of unimpregnated women, or in thofe 
of early pregnancy, muft be cautioufly ufed in the flood¬ 
ings which accompany labour, and are altogether inad- 
miffible in the cafes of placental prefentations, and in 
the hemorrhages after delivery. And the plumbi acetas, 
and many other internal remedies, which are efficacious 
in reftraining chronic hemorrhages, cannot be at all re¬ 
lied upon in the floodings of parturition. 
The hemorrliagies which accompany labour may be 
either, 1. Accidental, as the confequence of fome occur¬ 
rence which partially detaches the placenta from its con¬ 
nexion with the uterus, to which it is ufually fixed at 
fome part of the fundus or corpus uteri. 2. Unavoidable ; 
as the confequence of the implantation of the placenta 
over the os and cervix uteri. 3. Atonic ; i. e. from the 
want of contraCtile power in the uterus after the child is 
born. 
1. Accidental hemorrhage may be brought on by va¬ 
rious caufes ; fuch as, paffions of the mind ; violent ex¬ 
ertions in jumping; dancing; coughing, &c. It has 
alfo followed a blow or fall; and the lifting of a heavy 
weight. The quantity of hemorrhage and the degree of 
danger greatly depend on the area of furface of the pla¬ 
centa detached from the uterus ; the force of the general 
circulation; and the degree of pain; thofe cafes being 
inoft dangerous in which there is little or no uterine con¬ 
traction. 
Sometimes the placenta will adhere to the uterus at 
every point of its circumference, whilft it is fo loofened at 
its centre, that a quantity of blood may be poured out 
into the fpace thus formed fufficient to produce fyncope, 
or even death ; and yet there may be very little appear¬ 
ance 
