By the premature induction of labor, Thomas saved 10 out of 11 women and 6 children. However satisfactory these results may be, they are not, in our opinion, sufficiently numerous to induce us to abandon the tampon.
Treatment after Delirery.—We should not forget that hemorrhage may recur after delivery, from uterine inertia, as the inferior segment does not always contract sufficiently to obliterate the utero-placental vessels.
Ergot, the introduction of the hand, or of ice, into the uterine cavity, douches on the abdomen, electricity, massage of the uterus, intra-uterine injections, compression of the aorta, compression of the abdomen by an india-rubber bandage, and tamponing, have all been recommended. Per chloride of iron applied to the cervical cavity and inferior uterine segment, will cause contraction and arrest the hemorrhage, after which the patient should be stimulated with hypodermic injections of ether, brandy and ergotin. [We object strongly to the sub-sulphate of iron, for reasons given later.—Ed.] .3. Internal Hemorrhage.
Hitherto we have been studying external uterine hemorrhage, but there is another form in which the blood is effused into the interior of the genital canal, and does not appear externally. During the early months of pregnancy, these extravasations take place in the midst of the decidna or placenta, constituting what was formerly called " placental apoplexy," but is now known as hasmatoma of the placenta or decidua. This leads to abortion after the lapse of a certain interval.
We shall, with Jacquemier, regard internal hemorrhage as one in which the blood is retained, wholly or partially, within the uterus, together with the product of conception; but this will include only hemorrhage that occurs before the beginning of labor. Hemorrhage from placenta prtevia is usually external, but it may become internal, if a tampon is in troduced after rupture of the membranes, but it is only hemorrhage which is internal from the first that really deserves this name. During the first months after conception, the blood accumulates between the uterus and the placenta, stripping off the latter more or less extensively, penetrating between its cotyledons, and infiltrating the tissue, being either circum scribed in it, or extending beyond it, even making its way into the ovum in rare instances. This bleeding is of little consequence, and does not
endanger the mother still there are cases on record in which the hemor rhage has been so profuse that the patient succumbed in a short time.
Internal hemorrhage occurs not infrequently before labor, when it gives rise to characteristic symptoms, such as lumbar pains, uterine colic, anremia, and an increase in the size of the uterus, which is too sudden to be attributable to anything except intra-uterine hemorrhage. In rup ture of the uterus, or the sac of an extra-uterine pregnancy, the extrava cation takes place into the abdominal cavity, and the symptoms are quite different. Internal hemorrhage is called by some writers " accidental," in distinction from that which attends placenta prievia, which they term " unavoidable." When due to separation of the placenta, the hemor rhage may be either internal, external, or mixed, it resulting, according to Jacquemier from: 1. The uterine contractions, which disturb and sever the connections between the placenta and the uterus. 2. Excessive hy peraemia of the uterus and placenta in consequence of violent emotions. 3. Direct violence. 4. Acuto diseases of a grave character, as small-pox, scarlet, or typhoid fever, acute yellow atrophy of the liver, etc. The hemorrhage may occur either before, or during labor, and may manifest itself by symptoms of external or internal bleeding. As to hemorrhage during labor, it may be said that women frequently lose a little blood at the beginning of labor, and also after the cervix is completely dilated, but this possesses no significance; moreover, in long labors, or when the perineum is quite resistant, blood may escape externally without causing alarm. In normal lalior the placenta does not begin to separate until after the expulsion of the child, but sometimes it becomes detached pre maturely, and thus gives rise to slight hemorrhage. This rarely assumes serious proportions, but we should observe carefully the condition of the woman and the foetal heart-beats, and interfere if necessary, employing the forceps or extraction, though this is rarely required.