707 
PARTU 
ance of difcharge from the vagina. The following ex- 
tra6l fliows not only the poflibility of this fa< 5 l, but like- 
wife that fometimes the lofs of a quantity of blood, by 
no means exceflive, will produce fatal confequences : “A 
very lingular cafe of uterine hemorrhage occurred a few 
months ago in the praftice of Mr. Saumarez, which was 
alfo feen by Doftors Denman and Dennifon. A lady, of 
a weakly conftitution and delicate habit, was attacked in 
the latter months of pregnancy with a flight difcharge of 
blood from the vagina, not amounting all together to half 
an ounce, accompanied with alarming fymptoms of ex- 
hauftion and debility. The os uteri was fcarcely dilated 
to the fize of a fixpence, and was in fuch a ftate of rigid¬ 
ity as precluded the poflibility of affording any manual 
afliftance. The lady in confequence died ; and on exa¬ 
mination after death, it was found that a feparation of 
the centre of the placenta from the parietes of the uterus 
had taken place, wliilft its edges were completely adherent, 
forming a kind of cul de fac, into which blood had been 
poured, to the amount of a pint and half, which had be¬ 
come coagulated within the cavity thus formed.” New 
Med. and Phyf. Journal, December 1813. 
From whatever caufe flooding may arife, it fliould 
always be viewed as a perilous fymptom, and as one de¬ 
manding prompt and active interference. The following 
general dire£tions muft be univerfally and rigidly obferved. 
The woman fliould be laid on a mattrefs in a horizontal 
pofture, having the pelvis raifed higher than the ihoul- 
ders by fome fupport lefs yielding than a feather-pillow. 
The doors and windows fliould be'opened, and the pa¬ 
tient have no other covering than fuch as decency de¬ 
mands. No fire fliould be permitted to be in the room, 
and every talkative friend ought to be excluded. As lit¬ 
tle food as poflible is to be given, and that neither warm 
nor fpiced. In fa£l, every thing that can diminifh the 
momentum of the circulation of the blood muft: be fedu- 
loufly employed. The pubes, abdomen, and loins, muft 
have cloths dipped in the coldeft vinegar or fait water 
applied to them repeatedly; or pounded ice in a bladder 
may be allowed gradually to diflolve on thefe parts. In 
addition to thefe means, fait, or vinegar, and water cold, 
may be injected into the re£lum ; and a piece of ice, if it 
can be eafily obtained, may be introduced into the va¬ 
gina- 
Diluted fulphuric acid may be given freely, either in 
-rofe-infufion, mint-water, weak cinnamon-water, or any 
other convenient liquid. But little reliance can be placed 
upon the other vegetable and mineral aftringents ; for, 
though efficacious in cafes of chronic uterine hemorrhage, 
their aftringent virtues are not fufficiently aftive in the 
fudden and violent hemorrhages which accompany the 
feparation of the placenta during labour. 
Bleeding from the arm was formerly pra&ifed in thefe 
cafes, with a view of making a revulfion from the uterus; 
but, unlefs the pulfe is very hard, ftrong, and aftive, it 
can hardly be required ; at all events, where the flooding 
accompanies labour, blood-letting muft be very cau- 
tioufly employed, as it is likely, under many circum- 
ftances, to be more injurious than beneficial. 
Fortunately, in many cafes of fudden and accidental 
feparation of the placenta, a difpofition to expel its con¬ 
tents is immediately imparted to the uterus, and the ex- 
pulfion is facilitated by the relaxation which the hemor¬ 
rhage has produced. The action of the uterus tends 
likewife to fupprefs the hemorrhage ; if therefore pains 
come on, if the flooding in confequence diminiflies, and 
if the patient in fome meafure recovers her ftrength and 
fpirits, it may not be neceflary to have recourfe to any 
further means of relief; but the patient muft ftill be very 
carefully watched, for the hemorrhage may fuddenly in- 
creafe, and a very little additional lofs of blood may 
prove fatal. 
But, fliould the means employed to fupprefs the he¬ 
morrhage prove unavailing; fliould no pains come on, 
or fliould they be infufficient toreftrain the flooding, and 
RITIOl 
the danger of the patient augments; fomething more 
muft be attempted : and, in this perilous lituation, two 
modes of proceeding have been propofed. Firft, to deli¬ 
ver the woman by turning the child in utero, and bring¬ 
ing down the feet; or, fecondly, merely to rupture the 
membranes that the liquor amnii may efcape, and thus 
the Uterus, by contracting on its contents, will fo far di- 
minifti the hemorrhage, that the patient may go on with 
fafety until the natural uterine contractions expel the 
child. 
The firft method appears to be bell adapted to thofe 
melancholy cafes in which there is an abfence of all con¬ 
traction of the uterus, or in which the pains are extreme¬ 
ly feeble and inefficient, with a relaxed condition of the 
cervix uteri. When thefe tw'o dangerous attendants on 
uterine hemorrhage are prefent, the operation of turning 
often produces fome contractile exertions of the uterus, 
by which the danger is materially leflened. The fecond 
method is applicable to thofe cafes in which there are 
labour-pains ; and, from the concurrent experience of 
practical accoucheurs, it may be depended on as fuc- 
cefsful. 
s. Unavoidable hemorrhage is the name given by Dr. 
Rigby to that fpecies which is produced when the pla¬ 
centa is attached over the cervix uteri, fo as to block up 
the paflage.—This fpecies of hemorrhage was not gene¬ 
rally underftood till of late years. It was formerly fup- 
pofed, when the placenta was found prefenting, that, 
having been accidentally feparated from the fundus, it 
had fallen by its own weight to the os uteri, which it 
clofed up, fo as to prevent the child from paffing. More 
accurate obfervations and difleCtions have proved, that, 
when the placenta prefents, it has been ah origine im¬ 
planted over the cervix uteri, fo that flooding very natu¬ 
rally occurs at any time after the fifth month, when the 
expanfion of the cervix uteri lacerates thofe veflels which 
pafs between it and the placental mafs. Hemorrhage 
from this caufe places the woman in moll imminent 
danger; for, on the acceffion of pains which dilate the 
os uteri, other veflels are torn, and the bleeding recurs. 
This is a cafe in wdiich we ought never to confide in 
the powers of nature, becaufe expulfatory uterine efforts 
only augment the peril of the patient, as will be extremely 
evident from confidering, or figuring to yourfelf, the 
pofition of the parts : the child’s head prefenting for de¬ 
livery, but preffing upon the interpofed placenta which 
fills up the paflage. Dr. Hunter’s 13th Plate is a repre- 
fentation of this cafe of unavoidable hemorrhage, which 
proved fatal. The engraving has been copied by Dr. 
Merriman and Dr. Conqueft, wliofe works are in every 
body’s hands; it has alfo been copied in Dr. Parr’s Medical 
Didlionary, but (very unfortunately) to ffiow the natu¬ 
ral pofition of the foetus in utero at the commencement 
of labour! 
We have feen that, in the preceding fpecies, the acci- 
dental, the hemorrhage is checked at leaft, if not flopped, 
by the labour-pains; but, in this, every pain tends to 
produce more dilatation of the os uteri, and confequently 
a greater feparation of the placenta, and an increafe of the 
hemorrhage; it is therefore in vain to expefl that the 
natural pains will effe6l the delivery. The interpolition 
of art is called for, and muft be timely applied, or the 
patient will be loft. In all cafes then of attachment of 
the placenta over the os uteri, it is incumbent upon the 
accoucheur to make up his mind to the operation of 
turning the child, and bringing it into the world by the 
feet. 
Here and there women do well without the interfe¬ 
rence of art, but much more commonly nature is une¬ 
qual to the talk, and the patient would be loft for want 
of timely afliftance; fo that all the bell practical writers 
are unanimous on this point, that the cafe of a placenta 
adhering over the cervix uteri is not to be trufted to na¬ 
ture. “This prafticeis no longer amatter of partial opi¬ 
nion, on the propriety of which we may think ourfelves 
at 
