[We cannot fully coincide with the author in the treatment be advo cates for postpartum hemorrhage. There is no emergency which calls for prompter action on the part of the accoucheur, and there is none which may be met more successfully, if met in time. In the face of pro fuse hemorrhage from an inert uterus, it is simply fooling with life to waste time in giving laudanum enemata, ergot, or applying cold to the abdomen. The safety of the woman depends on our obtaining immediate uterine contractions, and these may almost infallibly be obtained by the injection directly into the uterus of ice water, hot waiter F.), or a styptic such as vinegar or iodine. Iron we do not like, with due defer ence to the opinion of Robert Barnes, for the reason that the clots which it forms are hard, and therefore irritating to the uterus, and readily de compose. Our own preference is for ice water and vinegar, equal parts, or hot water, injected directly into the uterine cavity. These agents are always in the house. No one need fear the passage of fluid through the Fallopian tubes, for the reason that, in the cases of which we are speak ing, the cervical canal is widely open, and the water will unquestionably flow out by the widest orifice. Besides, no force need be used. As for the syringe, we prefer the fountain to the Davidson, which is similar to the Iligginson, although the recently introduced bulb syringe, called the " Alpha," is an excellent one, seeing that the outflow is continuous, and not intermittent, as in the Davidson. The uterine tube should have the terminal end closed, and the openings should be bevelled downwards. It should be passed well to the fundus. The Chamberlain glass tube is as good as any which has been devised. While the injection is being administered, it stands to reason that other measures should be used, but they are all subordinate to the former. The patient's head is to be lowered, the uterus compressed through the abdominal wall, ergot is to be given subcutaneously, and faradization resorted to. This meas ure we have great faith in. Barnes, in his Obstetric Medicine and Sur gery, thus expresses himself in regard to the interrupted current: "Of the remedies that present themselves, the most scientic is faradization. The experiments of Radford, Robert Barnes and Mackenzie, demonstrate, that under its power the uterus can be made to contract, even when it resists the influence of what may be called the diastaltic remedies." His only objection to it is that, except in hospital practice, the apparatus is not likely to be ready, or at hand. This objection should not hold, for in view of the great value of the faradic current in obstetrics, a battery should be carried in the obstetric bag, and the Gaiffe or similar pocket battery will answer perfectly, and not take up much space.
In case the measures outlined above succeed only when the patient in collapse, the accoucheur should be prepared to resort to transfusion of blood direct, of milk, or a saline solution. A convenient formula for pre paring the latter is: Chloride of sodium, 60 grains, chloride of potass 6 grains, phosphate of soda, 3 grains, carbonate of soda, 20 grains, dis tilled water to 20 ounces, the whole heated to 90° F.
In case of hemorrhage of moderate severity, and not calling for such stringent measures, it is a good plan to place the patient on her side, in troduce Sims' speculum, and tampon the cavity of the uterus by means , of Sims' slide applicator (see Vol. II., under Miscarriage) the cotton beim', saturated with the compound tincture of iodine. The cotton plug, if not expelled spontaneously, should be removed at the end of twenty-four hours. —Ed.] In addition to the measures mentioned, Chassagny has advocated the tampon by means of a special instrument which he has devised. It con sists of two balloons united by a narrow isthmus and each may be inflated independently of the other. The one is for insertion into the cervix, and the other into the vagina. When distended by fluid, the uterine balloon compresses directly, according to Chassagny, the uterine sinuses.
and thus checks hemorrhage. The instrument, however, is open to the objection, that being in the uterus it prevents retraction, and it can hence be only of transitory utility. This instrument Chassagny has latterly re placed by another, to which he gives the name In Fig ure 154 this instrument is seen in profile and in action. The bladders adapted to it are from the pig, and are prepared with sulphur, which adds to their lasting properties. It is of use, according to the inventor, 1, in case of placenta prrevia, 2, to induce labor, 3, to increase pains and bring about the rapid termination of labor in case of eclampsia, 4, to dilate the uterus, 5, to check, instantly, ante-and postpartum hemorrhages.
The instrument consists of a speculum provided, internally, with two wings. As the bladder, inserted in the speculum, is distended, the wings separate and oppose the expulsion of the bladder. The inventor is still experimenting with it, and in his hands it has given good results.
There is a further means at our disposal in contending against post partum hemorrhage, and. this is the compression of the aorta. By this means we aim to prevent the affiux of blood to the uterus. According to Jacquemier, the first to practise it was Budiger, of Tubingen. He intro ducod his hand into the uterus and compressed the aorta through the pos terior wall. Boer used the same procedure, but Max &atm-ph preferred to compress the vessel through the abdominal wall, and this was advocated, in 1825, by IIIsamer. It is the method in use to-day. Authorities, how ever, are not at all agreed as to its efficacy, and Jacquemier is one of its decided opponents. Assuming that postpartum hemorrhage is largely venous, he contends that the effects will be different according to the level at which the vessel is compressed. " When compression is applied directly above the ovarian arteries, the slight amount of arterial blood furnished by the utero-placental arteries is cut off, but, at the same time, the stasis of the venous blood in the vena cava inferior is increased, and conse quently in the veins of the uterus, and the situation is simply aggravated. The real way of checking provisionally, and more or less completely, the hemorrhage from the utero-placental vessels, is to compress at one and the same time the aorta and the vena cava." Jacquemier further adds that the advice everywhere given to administer ergot, while compression of the vessel is being made, is " both superfluous and irrational. How can this act when the arterial blood does not reach the uterus?" However much I respect the opinion of Jacqttemier, whatever the value of his theoretical objections, this theory must yield to facts, and I beliere that compression of the aorta is an excellent means of checking hemor rhage, since it has succeeded well in three cases where I have resorted to it. I will not say that the result was due to compression alone, since others means were used, but it proved an excellent adjuvant. I to compression as follows: The woman lies on her back, the legs and thighs flexed, and the left hand depresses the abdominal wall above the fuudas, a little to the left of the mid-line. As soon as the vessel is found, it is compressed against the vertebrae by three fingers, for about fifteen min utes, when an assistant relieves the operator if his fingers are tired. The pressure exerted should be uniform, not forcible. To be of use, com pression should be prolonged for fully one hour, until, in a word, the uterus is well and thoroughly contracted.
The last method at our disposal, and which should be resorted to when all other meana have failed, is transfusion. This has given satisfactory results.
We have now passed in review the main cause of postpartum hemor rhage--inertia of the uterus. For other causes, rupture of a thrombus, tumors, polypi, cancer, the reader is referred to the sections treating of them. We pass at once to a further prime cause, the