There are still other dangers arising from uterine haemorrhage, the conse quence of which we have great reason to fear. Suppose a woman in labour loses two quarts of blood by the vessels of the uterus, that woman will, about the fourth day, have a perfect fever in all its cha racters, somewhat resembling the milk fever, the pulse 120, the countenance flushed, the skin hot and parched, though we should naturally enough expect, that instead of producing fever, the loss of two quarts of blood might more readily be expected to take fever off where it existed before. Supposing even that the patient gets quite clear from any return of the haemorrhage, the fear that remains is, whether she have not already lost too much for the constitution to repair ; and we must again wait in expectation of the fever ; if that do not come on, so much the better ; that is another danger got over. But she may die at the end of twelve months, and that from the effects of a single attack of this complaint. This will in most instances happen in women who are of a flabby loose texture, and have a heavy fat body. Hydrothorax, or ascites, will in these persons supervene at a great distance of time, entirely from the debilitating effects the loss of so large a quantity of blood has induced.
With regard to the powers by which hemorrhage is naturally restrained in dif ferent parts of the body, we may say that they are two in number ; one of which is the contraction of the blood-ves sels themselves, the other is the coagula tion of the blood in the mouths of the vessels which are ruptured. With re gard to the contraction of blood-vessels, it is well known that an hemorrhage is frequently stopped by that power alone. If we prick our finger, or shave a bit off, it would bleed everlastingly, were it not for the contraction of the divided branch es, which stops it, and that so effectually, that if from time to time we even wipe away the blood with a sponge to prevent any assistance which might arise from the formation of coagulum, yet the bleeding will stop. But as the vessels contract gradually and slowly, the blood which forms on the surface being exposed to the air coagulates, and becomes the se cond cause of the blood ceasing to flow from the divided vessels. So that hz morrhage, considered in general, may be said to be restrained partly by the con traction of vessels, and partly by the co agulation of blood in the vessels. The natural powers by which haemorrhage is usually restrained are, the coagulation of the blood as it flows, and the contraction of the vessels. To these a third power is added in the uterus; it is the contraction of the organ itself, and it is not only one of the three, but the most important, as being the most effectual power of them all, in stopping the hzmorrhages which flaw from the internal surface of the ute rus. It should appear also from the ex periments of Hewson, that the coagula tion of the blood is more rapid in ani mals when (lying than at.any other peri od; hence he argues that coagulation is always in proportion to necessity.
With regard to treatment, we may ob serve, that in slight cases, where the quan tity of blood lost is very trifling, it will not be necessary to notice the existing state of pregnancy, but to make use of the common remedies for the checking of slight haemorrhage from any internal part. But if there be increased action of the heart and arteries, and we know the con stitution will bear it, we may take away ten ounces of blood, and suppress the animal food ; moderating the sanguife rous action, so that there shall be no risk of displacing the newly formed coagu lum, in its recent state a tender jelly. If
these things are attended to, the blood will perfectly cork up the bleeding ori fices of the ruptured vessels. We should at the same time empty the bowels, pro hibit all stimulating aliment, and advise a horizontal position. All this, however, refers to slight cases, and an early period; if after this period, or during labour, we must seldom be beguiled from more ac tive measures. The only solid security is a delivery of the child, which in all cases of profuse or continual hemorrhage we should immediatelyprepare for; and in the process to be pursued we are of course to turn the child.
W herever, n doing this,the os uteri very easily gives way, it is the very essence of danger, proving the want of contraction in the uterus. In the present instance, however, we do not want to empty the uterus so much as we wish for its con traction; for if we get away its contents at a time when it cannot or will not con tract, we do no good. If the placentaseal up the os uteri, we must go directly through ; we may easily indeed, screw our hand through it, for it is • loose pulpy mass easily torn. We should not wait long, nor be afraid, and, if the labour be recent, we may turn the head and bring down the feet : if the head be low enough to apply the forceps, we may deliver in this manner. The whole of this practice lies in a very small compass; in deter mining to deliver early, and in determin ing that our patient shall not die ; and it is founded on the principle that hzmor rhage from the uterus cannot be restrain ed by the two powers which are sufficient for stopping a flow of blood in most other parts of the body, by the contraction of the vessels, and the coagulation of the blood in them ; and that nature has here appointed a third power, by the presence of which the human uterus differs front that of all other animals. It is right, how ever, after turning and bringing down the feet, to allow the child to remain un delivered for a short time, attending to the least pain that may be felt, and gently assisting in the forwarding the ex pulsion ; and Ni hen the child is born, to wait the action of the uterus again for the expulsion of the placenta ; for we must still recollect, the grand object is the con traction of the uterus, without which, its being emptied would produce very little good. It will then happen that the same contraction which expels the placenta will diminish the area of the vessels, and the danger from flooding ceases. But if this contraction do not take place soon, and the lizmorrhage continue for some minutes after the extraction of the child, we must consider whether the strength will not be lost, and the safety of our pa. tient endangered ; if so, the hand should be introduced into the uterus, not forci bly to bring away the placenta, but by its presence to cause the uterus to contract. The application of cold to the abdomen will Featly assist in promoting the con traction. The placenta should be gently detached, and when the uterus contracts, both the placenta and hand will be ex pelled.