Venesection, on the appearance of hemorrhage, we cannot quite counsel, although, if the woman is plethoric, and has a full pulse, with signs of congestion, we do not hesitate to withdraw a slight amount of blood from the arm.
Hold has advised the use of the sulphate of quinine. Plantard, on the other hand, absolutely rejects it. The Italians have advised tannic acid. Richardson, and Barnes, the nitrite of amyll. We prefer, above everything, laudanum, and if this fails, but little can be expected from other means.
[The viburnum prunifolium in drachm doses, repeated every few hours, is oft,en of value in attempted misc,arriage. Chloral hydrate may also be tried, particularly where the main symptom is uterine contraction. Quinine should not be used, for whilst it has not the property of evoking uterine contractions, it certainly may intensify them when present.—En.] Unfortunately, in many cases. all treatment fails, either because the fcetus is dead or the ovum has partially separated, or because the membranes have ruptured. Then misc,arriage is inevitable, and the proper treatment is all-important.
Miscarriage, as we have seen, necessitates hemorrhage, and, whilst usually this is moderate in amount, it may be profuse, and compromise not only the health, but the life as well, of the woman. Whilst, further, in the early weeks, the ovum may be expelled entire, it may also be shed in two portions, and the remaining membranes, placenta, or decidua, may undergo degeneration, and entail puerperal accidents of grave import to the he,alth, and the life, of the woman. When we bear in mind the concise description, already given, of the manner in which the OVUM is expelled, and how the phenomena differ according as the ovum is shed entire or not. according as the fcetus is alive or not, it is at onre apparent that our efforts lie in two directions: 1. To fight against hemorrhage. 2. To end the misearriage as soon as possible, and to avoid retention of any portion of the ovum, and the deplorable consequences. These precise indications are met very differently by different aecoucheurs. Certain ones limit their endeavors to the control of the hemorrhage, assisting, as far as may be, uterine contractions, and thus accelerating the separation, and the expulsion of the ovum, never resorting to instrumental or manual intervention, except where placental retention entails serious accidents. Others, on the other hand, insist on the necessity of speedy interference, in order to stop at once the hemorrhage, and to render impossible the retention of the afterbirth, and tha accidents this entails. These two methods of action are
championed and opposed with zeal. It is in particular in connection with retention of the afterbirth that opinion varies most markedly, the practice in regard to hemorrhage being nearly uniform.
Methods of Controlling Hemorrhage.—When it is not profuse, and stays within moderate limits, it is usually sufficient to insist on absolute rest, to administer cold drinks, and to apply cold cloths over tha abdomen, and over the thighs. But, if it be serious, if it be profuse, more enerptic action is requisite, and three methods are at our disposal: 1. Administration of ergot. 2. The tamponnade. 3. Ergot and the tamponnade associated. We prefer this method.
(a). The Administration of Ergot.—This drug, it is claimed by those who advocate it, has a double action. On the one hand by exciting, and increasing uterine contractility, it quickens the separation of the ovum, and the dilatation of the cervix: on the other hand, by causing con traction of the blood vessels, it stops hemorrhage. These two actions call for brief consideration. In order that ergot may act forcibly on the uterine muscle, this must have acquired its full development, and contraction be already present. And these two conditions are rarely present in case of miscarriage. The uterine muscular fibre is but little developed during the early months of pregnancy, and, on the other hand, hemorrhage is often profuse, before contraction sets in. Again, the contractility evoked by ergot differs notably from that which is peculiar to the uterus; it is a species of tetanic retraction, which, when it affects the cervix, not only does not cause dilatation, but causes rigidity. Ergot then may act directly opposite to the desired end, and, by interfering with dilatation of the cervix, shut up the ovum, or its remnants, in the uterine cavity. On the other hand, it has been proved by the researches of Parola, of Beatty, of Laborde, and, above all, of Lee, and his pupils, that ergot acts on the blood vessels, causing considerable, although transitory, diminution in the force of the circulation; that it further acts on the heart, making its pulsations more feeble, and slower; and that it also acts on the capillary network, determining its contrac tion, and diminishing the amount of blood it contains in a notable manner. Finally it produces a contraction of the vessels of the spinal cord, and of its membranes, decreasing the amount. of blood there circulating.