Vol. 60, 1909 - University of North Carolina at Chapel Hill

268 THE CHARLOTTE MEDICAL JOORNAL.
the two.sides of the heart is effectively main- a foreigrn body, why are not the placenta •
tained drugs are, as a rule, unnecessary, itself and the clots which form in the ulerus
except to regulate the blood pressure; when just as good for this puipose? A very large
this is high decalcifying agents and mod- amount of gauze may be inserted, and this ^
erate cathartics answer best. For cardiac soon becomes entirely soaked with blood, i
failure such tonics as digitalis, squills, stro- Thus the compression of the blood vessels j
phanthus, caffeine, strychnine and the lime is impossible, since they can be compressed !
salts answer best; their use should be dis- only against a hard substance, and the '
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continued immediately compensation is re- tampon becomes very soft as soon as it is
stored. For tendency to thrombosis or soaked with blood. If the uterus would ;
embolism such decalcifying agencies as contract the vessels might be compressed, j
phosphoric and citric acids and their solu- but in these cases there is no muscular con- i
ble salts are to be used. In cases of throm- traction. When the tampon is used the ]
bosis and pulmonic embolism with urgent danger of infection is much increased. The
symptoms strong ammoi'ia should be freely sterized hand is a much more effective in- j
used. (Ammonia and spirits of chloroform, strument, and much less likely to produce J
aa five minims, in a wineglassful of barley sepsis, besides giving the operator a chance j
water every hour or half hour. ) In mitral
stenosis we may have free hemoptysis.
to massage the uterus freely with the hands. ;
The narrower the space in which thrombo- .
which should not be checked; it is an ex- sis has to occur the quicker will coagulation
cellent form of blood-letting. In all spas- take place. The tampon distends the uterus,
modic affections, such as angina pectoris, which is the opposite of the effect desired.
the best remedies are nitroglycerine, morphine,
atropine, amyl nitrite, ethyl iodide
and other preparations of iodine. With
This is truly a last refuge in postpartum
^
hemorrhage. In the Woman's Hospital at
j
Basel, out of 10,000 women confined, seven (
very high blood pressure, among a host of
remedies Barr mentions especially decalcifyhave
died of hemorrhage after labor, six 1
with the tampon. He has tried injections'^
ing agents, the benzoates, the hippurates, of adrenalin in two cases, without result. J
iodine and thyroid. He believes from his microscopic examina- |
tions that there is a pathological condition
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Treatment oi Postpartum Hemorrhage, of the uterine muscles in these cases. The J
— Herff ( Munch. Med. Woch.) deals with only effective method left seems to be the i
the treatment of postpartum hemorrhage removal of the uterus by vaginal total ex-
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when the ordinary means of producing con- tirpation, or supravaginal amputation. The
traction, such as ergot and hot applications adominal operation takes but two minutes,
fail. The number of deaths from complete and then the bleeding stops at once, and
uterine atony is considerable. The causes the patient may be cared for at leisure. The
are of several kinds; changes in the blood question of sterilizing a woman is a serious j
which lessen its coagulability; changes in one in a young primipara, but itmustbei
the musculature of the uterus which pre- solved quick! or it will be too late,
vent effective contractions; changes in the
walls of the blood-vessels which hinder ^Interpretation oi the Poro Uterus
their contraction; changes in the tissues
-^
Relation to tbe Tliird Stage ot Labor.
around the uterus, such as peritonitis; an- Hart ( Fdin Med Jour. ) deals wUh the
j
omalies of position of the placenta render- ^^^^"^^ I
^^^ mechanism of the third stage
"f,,
oHabor. I he arguments against the theory
ing a portion of the walls less contractile;
functional changes which weaken the mus- "^^^P^'-^^'o^of ^^^ placenta bydirec
culature. Henkel's method of compression shrinkage of the placenta si e are that it .
of the abdomen mav be of use in a few ^^^ " acknowledged by its chief advo-
^°f
cases. A valuable method of exciting con- ^ates that the p acenta does not separate at ^
shrinkage to
traction is rubbing and kneading
4x4 inches and ,t has never i
the uterus
f
with one hand
b^^" demonstrated hat a greater shrinkage
within and the other without
than his occurs^
the uterus on the abdomen, and
He ho ds that when a
compress-
ion of the uterus against the pupic bene. Pani has died off the elastic. ty of the mus- ,
The aorta can be compressed against the ce, and especially of the interpenetrating 1
spine, leaving the lower portion of the bodv elastic tissue, asserts itself, and we g^t the ,.
bloodless. The tampon advocated by ^°^^'''' '^^'^^'' ^^^7^' ,^"'^'
.^"' ''^"
^^°''f
Duhrssen is of doubtful value. According '"crease of area of the opposed internal ;(
to its originator, it acts as a foreign body, ^^erine surfaces, the two surfaces shding ,
compressing the lumina of the vessels and
on one another without separation This ;:
'"crease m area is not participated ni by j
aiding coagulation. He has made use of
this method in six cases, without any sue- ^^'^ nonvascular, non-elastic placenta, and I
thus we get the disproportion between pla- t
cess, all the women dying. He criticises
the action of the tampon. If the gauze is cental cite and placental area, and the tear- ^
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