PARTURITION. 
709 
— uterine contraction; the formation of coagula, which 
block up the mouths of the bleeding velfels ; and the 
contraction of the velfels themfelves ; for, although muf- 
Cular irritability may have ceafed, the contractility of 
thearteriescontinues. It is therefore of great importance 
not to interfere with either of thefe powers; and, as 
fyncope never exifts without that diminilhed aCtion of 
the heart and arteries, which cannot fend the blood to 
the brain or extremities with fufficient power to prevent a 
collapfe of them, it becomes highly momentous to regard 
moderate fainting as a falutafy fymptom, becaufe, during 
its continuance, the mouths of the velfels may and often 
do become fo fealed by the formation of coagula, that 
hemorrhage ceafes. 
Syncope, then, being ufeful in checking the momen¬ 
tum of the circulation, and, as a confequence, in putting 
a ftop to flooding, ought never to be raflily interfered 
with, as it too frequently is by the exhibition of large 
and repeated dofes of brandy, and other powerful fti- 
mulants. Still a woman mult not be permitted to die 
from exhauftion, if it can be prevented; and therefore, 
when extreme proftration of the vital powers exifts with 
fyncope, final! and repeated dofes of fuch ftimuli as 
brandy, or ammonia, rriuft be given. Under fuch cir- 
cumftances, fprinkling cold water on the face and chell 
will fometimes roufe the almoft ex-animate woman. 
Ammonia may alfo be applied to the region of the heart, 
whilft the flow of blood is invited back to the extremities 
by the application of warmth. 
In a few words then, it tnuft be admitted that the ad- 
•miniftration of ftimulants and cordials to a woman in a 
greater or lefs degree exhaufted by uterine hemorrhage, 
is one of the niceft points in obftetric practice ; and, as a 
general rule, it may be laid down, that they are admif- 
fible but in few inftances, and only to be exhibited to 
fuch an extent as may be neceffary to fupport or to reftore 
the circulation. 
It is not unufual for a woman to be apparently doing 
very well for forne little time after delivery; and yet, 
although the uterus lhall have contracted in a great 
meafure, blood may be poured out into its cavity fo as 
to re-diftend it, and, in confequence of the coagula block¬ 
ing up the mouth of the womb, no hemorrhage lhall ap¬ 
pear per vaginam. Such a woman will complain of being 
faint, with tinnitus aurium ; her countenance becomes 
pallid ; naufea and vomiting, with extreme reftleflnefs, 
fometimes follow; the pulle finks; and if fhe be not 
fpeedily relieved, after a flight convulfive paroxyfm, or 
one or two gafps, Ihe expires. 
Such fymptoms naturally lead to an external and in¬ 
ternal examination, which deteCt a re-diftended uterus 
filled with coagulated and fluid blood. Under thefe cir- 
cumftances, no time muft be loft, or vacillating and in¬ 
efficient treatment may foon place the patient beyond 
the reach of means. One hand fhould be immediately 
introduced within the uterus, to empty it of coagula, 
and to ftimulate it to contract, whilft preflure is made on 
the abdomen, and the uterus grafped with the other. 
Befides this, fuch other means as have been already re¬ 
commended to reftrain the flow of blood, fhould be 
promptly and perfeveringly adopted. 
The exhibition of very large dofes of opium, to reftrain 
uterine hemorrhage, has been recommended by feveral 
defervedly-eminent accoucheurs. Both reafon and ex¬ 
perience appear to concur in condemning this practice; 
for, whilft it is admitted that under fome circumftances 
opium is highly beneficial, its indifcriminate employment 
is undoubtedly fraught with mifchief. The refult of 
calm and difpaflionate inveftigation on this fubjeCt is, 
that opium in large dofes in cafes of uterine hemorrhage 
generally does harm, by paralyfing the contraCtile ener¬ 
gies of the uterine and arterial fibres; and that this va¬ 
luable medicine is ufeful, and only ufeful, under the 
exiftence of fome fuch circumftances as the following. . 
It is decidedly beneficial, when hemorrhage has gone 
Vol. XVIII. No. 1276. 
on until the vital powers have become reduced extremely 
low; and when, with other fymptoms of exhauftion, the 
ftomach manifefts great irritability. It is no lefs valuable 
an agent, when hemorrhage is the confequence of irre¬ 
gular contraction of the uterine fibres, wdiether of the 
circular or longitudinal. In either of thefe cafes, it is a 
very efficacious article of the materia medica; but it ap¬ 
pears moft dangerous to attempt to maintain its utility, 
or to rely on its efficacy, in cafes of aftive and alarming 
uterine hemorrhage. When exhibited under the before- 
mentioned circumftances, to fecure its full effeCt, it is 
neceffary to give it in dofes of four or five grains, repeat¬ 
ing it every fecond or third hour whilft neceffary, with a 
diminution of one grain from each fucceffive dofe. 
Dr. Copland (Lond. Med. Journal, Aug. 1821.) lays, 
“ I ftrongly entertain the opinion that the oleum tefebin- 
thinae is calculated to be of the moft eflential benefit in 
puerperal menorrhagia, or flooding, if given in a dofe of 
an ounce or upwards. If exhibited in this quantity, I 
have no doubts of its influence in promoting the contrac¬ 
tions of the uterus; and by thefe means, producingthe 
conftriCtions and varied inflections of the veflels, affords 
a mechanical, but at the fame time a natural, obftruCtion 
to the flow of blood, and foon terminates the mifchief. 
Againft this moft alarming of all natural hemorrhages, I 
alio confider an enema of at leaft two ounces of this fub- 
ilance ought to be immediately adminiftered. I recom¬ 
mend this, with the utmoft confidence of fuccefs, to thofe 
whole practice affords them opportunities of putting it 
to the teft of experience.” 
Laftly, fome writers have ftrongly recommended to 
plug-up the vagina with tow, lint, a foft napkin, or other 
convenient fubltance: and thus to prevent the blood 
from efcaping through that paffage. The advantages of 
this practice muft be very limited. It may be ufeful in 
fome of the flighter hemorrhages, that occur in the early 
months of pregnancy, when the uterus has neither ac¬ 
quired any great fize, nor is very diftenfible. But it can 
never be relied upon, after the uterus has acquired much 
bulk, or is capable of being largely dilated ; for, however 
completely the vagina may be clofed, as no preflure can 
be made upon the open veflels within the uterus , thefe 
might continue to pour out blood into the uterine cavity, 
fufficient to deftroy the patient’s life, though not a drop 
of difcharge was vifible without the vagina. The arte¬ 
ries of the uterus cannot be clofed, except by a due de¬ 
gree of contraction of that vifcus ; whenever the uterus 
is in a diftended ftate, the arteries will continue pouring 
blood; and, the greater the accumulation of coagula 
within it, fo much the greater will be the amount of 
hemorrhage. The prefence of the plug then, by pre¬ 
venting the efcape of the coagula, fo far from benefiting 
the patient, adds to her peril. The plug, therefore, is 
inapplicable in all cafes where the bulk of the uterus ex¬ 
ceeds that of a pregnancy of three or four months, or 
when the parietes are fo eafy of diftenfion as to yield 
readily to the accumulation within it. 
Mr. Bifhoprick of York, in a letter to Dr. Duncan, 
gives the following account of a medicine which he has 
found highly efficacious in cafes of uterine hemorrhage. 
“ I have had confiderable experience and fuccefs in the 
practice of mid wifery in this city and its neighbourhood 
for more than forty years; and, having in that time met 
with many very troublefeme, and fome very dangerous, 
cafes of uterine hemorrhagy, I beg leave, through your 
ufeful repofitory, to communicate to the public, for the 
benefit of mankind, a medicine which I have found of 
great efficacy in relieving fuch cafes. This confideration, 
I flatter myfelf, will render it not unworthy of attention, 
efpecially as the health of that clafs of patients, who are 
the fubjeft of this complaint, is of the utmoft confequence 
to the happinefs and welfare of both themfelves and fa¬ 
milies.” 
Before we copy the formula, we muft obferve, that no 
great reliance can be placed upon the power of any ine- 
8 S dicine 
