Immoderate Disclaim:re of the Leckie. The next view of uterine hzmorrhage is that where it does not stop on the extrac tion of the placenta. Such cases as these are very rare; there may be a sudden gush of blood, and often is, following the placenta; the reason of which is, that the uterus, at the time it expels the placenta, forces down every particle of blood with it ; and in this way, a pound or a pound and a half may escape, but that need not be regarded in the least it does not af.
fact the constitution, because it was not evacuated immediately from vessels; it was lying in the uterus. So when we amputate a limb, there is no loss of blood to the constitykon, because the whole of the blood whikli is taken away is necessa ry to the limb, and no longer necessary than while the limb was to be supplied. But supposing that, from the vessels not being properly secured in the operation, there is a bleeding afterwards from the stump ; then it is that the constitution suffers; there is a demand made upon the mass of circulating fluids, which must be replaced before the heart can recover its proper balance in the system. Apply this to the uterus, and we shall consider the blood as belonging to the gravid ute rus, and not to the circulating system. This is what is, in the practice of physic, called an immoderate discharge of the lochia. Such hzmorrhages frequently arise from the cord being pulled with too great violence, by which the placenta comes to be injured; and this happen ing when the uterus is not disposed to contract, the vessels will, for a time, remain exposed, and bleed. This is the reason why it happens so frequently in the hands of bad practitioners as mid wives ; and that it is so rare when no im proper treatment is adopted in regard to the placenta.
Now supposing the hzmorrhage yet remains, that it, after the uterus is emp tied, the child born, and the placenta come away ; what are the means next to be employed to restrkin the hzmorrhage? the application of cold, and the abstrac tion of heat, in every possible way ; we should take the clothes from the bed, leave nothing but a sheet to cover, and that from motives of decency alone. If there be a fire in the room it must be put out ; the windows kept open to pre serve a cool and fresh air, and if the pa tient be faint she may have a cup of cold water.
Cold water and ice are the proper ap plications both to the parts themselves and the hotly round them. The coldest water ma d2 colder by throwing two handsful of salt into a couple of quarts of it, may be used by cloths many times doubled dipped in this, and laid over the back and abdomen; besides which, we may with the greatest advantage expose the body to a great degree of cold, if it can be done.
If these means do not answer, we must introduce ice into the vagina, or even uterus; this will often succeed; if 04 be ineffectual, we must, as the last re source, plug up the vagina with lint or tow, or something capable of entangling the blood ; for while there is a clear channel there will be no coagulum form ed. if the flooding still continue, the best plan is that of carrying something permanently cold into the uterus itself; a large dossil of lint, dipped in the cold solution, will carry up a degree of cold : but the best thing is to carry up a piece of ice, and allow it to thaw in the uterus. Dr. Baillie, of New York, who was the first who introduced the use of cold ap plications here, was in the habit of using a ball of snow for this purpose, which often stopped it directly, when nothing else would. Ice being introduced into the vagina, will often prevent abortion ; this then is the best and last remedy in flood inga ; if none of these things will stop it, there is nothing else that will.
After the hxmorrhage has ceased, the patient will be so reduced, so exhausted, the action of the heart so weak, and the quantity of blood circulating so deficient, that our first care must be to supply the waste, and remove the greatest danger, which is that of the patient's having been exhausted beyond the point at which The constitution is able to rally, and recover Itself. These cases must be supported find stimulated ; boiled milk, with grated crumbs of bread in it, must be quickly cooled by spreading it on a flat dish, and when cool may be given as one of the most nutritious things that can be had ; or good broth in which the grated bread is mixed; and if these remedies do not stimulate the heart and arteries, the pro bability is, that the patient will die. In ;nail of these cases the best stimulant is the volatile alkali, next to which brandy and water, or the ammonia, which is pre ferable, because, although the first effects of the spirits is good, it produces too much heat in the system at large, while that effect never arises from the volatile alkali. It is sometimes two, or even three hours, before we can leave such a patient in the certainty of her living.