The occasional causes of the uterine hemorrhage may be any circumstance capable of separating a portion of the placenta from the inside of the uterus. These were enumerated when speaking of abortion : all acute diseases, passions of the mind, as rage, he. strong liquors in large quantities; and besides these, if the placenta be attached close to or over the os uteri, it will be very likely to pro duce hemorrhage, either before or in labour. When it is attached on the cer vix uteri, it must in the course of the labour be separated by the dilatation of the uterus at its neck; this is so plain, that it cannot require illustration. Such a situated placenta will almost ensure uterine hemorrhage in the last months of pregnancy, which may be more or less in quantity.
If it be very slight, the necessary means to restrain it need be nothing more than what is used in slight hemorrhage from any other part: but when violent, and the patient either gets one gush of blood, or it comes in quantity till she faints, and then it is restrained, and she gradually recovers ; and then it recurs from her taking some stimulus into her system, either food or drink; she has no sooner recovered a little strength, than another bleeding comes on, will faint and recover, and the flooding again recur, and so on ; the faintness causing the re striction of the vessels ; the restriction of the vessels allowing the circulation time to restore its own equilibrium; and when once that has arisen, the force of the circulating blood again overcomes the slight resistance formed by the contrac tion of the vessels, and the formation of the coagulum.
When once a woman has had an uterine hemorrhage, from whatever it has pro ceeded, she is never safe ; and must re main in jeopardy eve hour, until she is delivered, for the slightest circumstance may reproduce it a er it has once hap pened. The danger in this state is not from the quantity of blood lost, so much as the manner. A bleeding has come on at the third month, which was exceeding ly large in quantity, but in consequence of its not flowing very quick, the woman has survived. Miscarriages occur, in which a large quantity of blood is fre quently lost, without the woman dying; place in the tenth week, she very rarely dies from loss of blood, though some. times this is excessive. What then does this depend upon ? the time in which it is lost, and the way in which it comes on ; for although lost from the constitu tion, it is from small vessels. But when
there is a sudden gush of blood from large vessels, the cue is quite different. From experience we know that large vessels do not contract so soon as small ones; there is not time for faintness to in tervene, and the patient consequently dies immediately.
One symptom of the greatest danger in a flooding case is a want of labour pains, when it occurs in labour, which is the reason that the midwife hardly ever sends for us till it is too late ; she thinks nothing can be necessary to be done till the pains go on as they should do, while in fact their subsiding is one of the worst symptoms. It shows that the uterus has not energy enough left to expel the child; so that we always judge uterine hemor rhage to be worse when not attended with pain than when it is. Another bad symp tom is, when the os uteri feels relaxed and flabby like a piece of dead meat, with a hole through the middle of it. It re sembles an inanimate opening : we may without resistance move its lips in any direction. When the hemorrhage con tinues long, the face loses its colour, the mouth and lips become quite pale, and the little projection at the inner canthus of the eye is a very significant part with an attentive observer ; it is not often at tended to, but, if it be sunk, it is &symp tom of decided danger; these are follow ed by want of rest; the patient will be moving about in bed, and that notwith standing all that we can say, if we even represent the risk of her producing her own death by it, still she will be throw ing her arms in every direction, and roll ing backwards and forwards in the bed. In this way then will she proceed, one fainting succeeding another, at last so rapidly, that it can scarcely be conceived until seen; fits of vomiting towards the end will occur, together with a sort of convulsive raising and lowering of the pomum adami : and life will at last leave her suddenly , perhaps after she Ilas been speaking she will lay her head down and die. Thos next danger is, that she may drain to death, by a slow progressive state of the complaint. To-day she shall lose a pint of blood, to-morrow half a pint, next day none, the day after that again a quart, and so on, till the powers of life are exhausted. Thus is she drain ed to death ; for the stomach is not ca pable of supplying nourishment quick enough to counteract so rapid a con sumption.