[In these late varieties of hemorrhage, the cause is almost invariably sub-involution, and the treatment called for is similar in nature. If the woman were otherwise in good condition, we would not put a stop to lac tation, and we believe that the necessity for this is very exceptional. We would treat the case as follows: Place the woman in Sims's position, and through the speculum determine the cause of the hemorrhage. Often the prime cause is a lacerated cervix, frequently an erosion of the everted mucous membrane. Here, unless it seem appropriate to repair the cervix, applications of nitrate of silver 3 j to S j to the erosion, will temporarily check the flow, In case the hemorrhage comes from the uterine cavity, the dull curette should be passed over the endometrium to satisfy our selves-that there is no foreign body (polyp, shred of placenta, vegetation, etc.), and then, on a cotton-wrapped applicator, Sims's slide applicator may be used when we wish to temporarily tampon the cervix, a stypic solu tion, (the compound tincture of iodine, or alum and glycerine, or iron and glycerin) should be applied to the endometrium. Rarely will the hemor rhage of sub•involution pure and simple not yield to this measure. The best after-treatment is ergot and cannabis indica, five grains of the one and grain of the other, by the mouth or rectum, or else ergot combined with the fluid extract of cotton root (gossypii radicis), and, every other day, for fifteen minutes, faradization of the uterus, or, what answers as well, the interrupted galvanic current. The hot douche, twice daily, is
a valuable adjuvant.
We plead, in particular, for non-interruption of lactation, except where these measures fail or there is other indication.
As a not uncommon cause of secondary puerperal hemorrhage, we would note the premature resumption of sexual intercourse. We have in mind two cases, one on the fifteenth day the other on the twenty-sixth, where the congestion induced by copulation was the only possible cause for the hemorrhages.
Mund(, in a paper read before the Academy of Medicine in January, 1883, on the subject of secondary hemorrhage, in his review of the causes, mentions, in addition to those which we have already noted: hemophilia, functional disease of the liver, malarial poisoning, and disease of the inner surface of the uterus.—Ed.] Finally, the mere presence of the husband in the wife's bed may pro voke secondary hemorrhage, even as late as the fourth week. I have seen two instances in young hyperiesthetic women. The treatment, of course, consists in banishing the cause.
At the end of six weeks, rarely earlier, the woman again has a flow, but this time it is physiological, being the return of the menses, and very fre quently they are more profuse than was customary before conception, and ergot in small doses, with rest in bed, are called for.