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ON THE SECALE CORNUTUM IN UTERINE HÆMORRHAGE.
656 From the wheezing,
(vale sibilante,) from
some little time after delivery, she appeared with the pulse,to be doing well; but from some original from the " bruit de scie," the aorta within thedebility the uterus did not contract comblood was poured out into its capericardium, and at its arch, is most probaso as to redistend it, although no hæof the some and dilated, vity, bly presses upon bronchi. morrhage appeared externally. From the The regularity of the motions of the heart, pallid expression of my patient’s counteand the total absence of palpitations, would nance, with her extreme restlessnes, I was convinced haemorrhage was taking place. seem to show that the valves are perfect. From the increased size of the left caro- Upon placing my hand on the abdomen, I tid, and from the absence of pulsation in found the uterus very considerably distendthe right, I would say that the former is ed, demanding prompt and active measures. uniformly dilated, and the latter obliterated, I immediately introduced one hand into the or nearly so. uterus, removed the grumous blood, and Prognosis.-From all the above considera- gently stimulated it to contract, applying ex. tions, and from others not strictly mecha- ternal pressure with the other, at the same nical, I would say, that this case must ter- time thatcold water was dashed on the exminate fatally, but perhaps at a very distant ternal parts by an assistant.’ The exhans. period, and that no operation on the right tion of the powers of the system was such, carotid can be of service. that life could scarcely be supported by reJuly 7th. The right subclavian artery peated small doses of brandy and water, has been tied, as it passes between the scawere given, whilst cold water was leni muscles. The vessel appeared, I am occasionally sprinkled on the face. As there little disposition about the uterus told, perfectly healthy. July 8th. Saw the patient this morning, to contract, and as the woman was labourunder extreme debility, so truly distressshe appears to go on well ; slight pulsation discoverable at the right wrist. Tumour ing and highly alarming, 1 determined to try the ergot of rye, the good effects of which not examined. Saw the patient two days after the ligature I had seen in protracted cases of labour; had come away ; countenance, though pale, reasoning from analogy, that if it excited a much improved in expression and appear- specific influence over the uterus in excit. ance ; pulsation and enlargement of the left ing those contractions necessary to the ex. carotid diminished. Motion of the heart pulsion of the child, it ought to produce feeble but regular. No impulse at the prae- contraction and restrain the uterine haemorcordial region. Impulse below and behind rhage. Twenty-five grains of the powderthe right clavicle much less than when last ed ergot of rye were infused in an ounce of examined. Motion at the sterno-clavicular water, with a drachm of spirit, and given to articulation not perceptible. Tumour be- the patient, and ordered to be repeated in tween the clavicle and the rest of the neck twenty minutes. A few minutes after takstill pulsates, but feels to me hard. It is ing the powder it was rejected by vomiting, certainly diminished in size. Bronchial but the woman appeared a little revived, wheeze no longer perceptible by the pa- and the uterus began to contract. The me. tient, but still slightly heard through the ste- dicine was repeated at the time prescribed, thoscope. Percussion not applied. Sleep and this remained on the stomach. The at night tranquil ; respiration easy; pains patient now complained of pain in the ab. felt in the right side of the head and neck, domen ; the uterus continued its contracright shoulder and arm, before the opera- tions on my hand, and a few minutes aftertion, no longer troublesome. Says she feels wards it was well contracted, resembling a hard ball, and the haemorrhage ceased. A * quite another woman.’ » " D. B." bandage was afterwards placed over the uterine region moderately tight, and the patient eventually did well. I have since ON THE SECALE CORNUTUM IN UTERINE met with a similar case, although not so HÆMORRHAGE. alarming. In this instance I gave half a drachm of the ergot of rye in powder every To the Erlitnr of THE LANCET. twenty minutes ; the result was favourable. SIR,—I shall feel obliged by your giving How far the insertion of the above, as the insertion to the following observations made result of my personal observation and exon the use of the ergot of rye, in reply to a perience, may prove useful respecting the question in a letter which appears on p. 368 benefit to be derived from the secale corof your 12th volume, " On the Secale Cor- nutum in uterine haemorrhage, I must leave nutum in Uterine Haemorrhage :"— you to determine. to attend J. S., æt. 32, I was called I am, Sir, your obedient servant, taken in labour, of a spare and debilitated SAMUEL MILLARD. habit. Her labour was natural, and for Bristol, 15th August, 1827.
the
impulse synchronous
pletely ;
which
appeared
ing
--
(vale sibilante,) from
some little time after delivery, she appeared with the pulse,to be doing well; but from some original from the " bruit de scie," the aorta within thedebility the uterus did not contract comblood was poured out into its capericardium, and at its arch, is most probaso as to redistend it, although no hæof the some and dilated, vity, bly presses upon bronchi. morrhage appeared externally. From the The regularity of the motions of the heart, pallid expression of my patient’s counteand the total absence of palpitations, would nance, with her extreme restlessnes, I was convinced haemorrhage was taking place. seem to show that the valves are perfect. From the increased size of the left caro- Upon placing my hand on the abdomen, I tid, and from the absence of pulsation in found the uterus very considerably distendthe right, I would say that the former is ed, demanding prompt and active measures. uniformly dilated, and the latter obliterated, I immediately introduced one hand into the or nearly so. uterus, removed the grumous blood, and Prognosis.-From all the above considera- gently stimulated it to contract, applying ex. tions, and from others not strictly mecha- ternal pressure with the other, at the same nical, I would say, that this case must ter- time thatcold water was dashed on the exminate fatally, but perhaps at a very distant ternal parts by an assistant.’ The exhans. period, and that no operation on the right tion of the powers of the system was such, carotid can be of service. that life could scarcely be supported by reJuly 7th. The right subclavian artery peated small doses of brandy and water, has been tied, as it passes between the scawere given, whilst cold water was leni muscles. The vessel appeared, I am occasionally sprinkled on the face. As there little disposition about the uterus told, perfectly healthy. July 8th. Saw the patient this morning, to contract, and as the woman was labourunder extreme debility, so truly distressshe appears to go on well ; slight pulsation discoverable at the right wrist. Tumour ing and highly alarming, 1 determined to try the ergot of rye, the good effects of which not examined. Saw the patient two days after the ligature I had seen in protracted cases of labour; had come away ; countenance, though pale, reasoning from analogy, that if it excited a much improved in expression and appear- specific influence over the uterus in excit. ance ; pulsation and enlargement of the left ing those contractions necessary to the ex. carotid diminished. Motion of the heart pulsion of the child, it ought to produce feeble but regular. No impulse at the prae- contraction and restrain the uterine haemorcordial region. Impulse below and behind rhage. Twenty-five grains of the powderthe right clavicle much less than when last ed ergot of rye were infused in an ounce of examined. Motion at the sterno-clavicular water, with a drachm of spirit, and given to articulation not perceptible. Tumour be- the patient, and ordered to be repeated in tween the clavicle and the rest of the neck twenty minutes. A few minutes after takstill pulsates, but feels to me hard. It is ing the powder it was rejected by vomiting, certainly diminished in size. Bronchial but the woman appeared a little revived, wheeze no longer perceptible by the pa- and the uterus began to contract. The me. tient, but still slightly heard through the ste- dicine was repeated at the time prescribed, thoscope. Percussion not applied. Sleep and this remained on the stomach. The at night tranquil ; respiration easy; pains patient now complained of pain in the ab. felt in the right side of the head and neck, domen ; the uterus continued its contracright shoulder and arm, before the opera- tions on my hand, and a few minutes aftertion, no longer troublesome. Says she feels wards it was well contracted, resembling a hard ball, and the haemorrhage ceased. A * quite another woman.’ » " D. B." bandage was afterwards placed over the uterine region moderately tight, and the patient eventually did well. I have since ON THE SECALE CORNUTUM IN UTERINE met with a similar case, although not so HÆMORRHAGE. alarming. In this instance I gave half a drachm of the ergot of rye in powder every To the Erlitnr of THE LANCET. twenty minutes ; the result was favourable. SIR,—I shall feel obliged by your giving How far the insertion of the above, as the insertion to the following observations made result of my personal observation and exon the use of the ergot of rye, in reply to a perience, may prove useful respecting the question in a letter which appears on p. 368 benefit to be derived from the secale corof your 12th volume, " On the Secale Cor- nutum in uterine haemorrhage, I must leave nutum in Uterine Haemorrhage :"— you to determine. to attend J. S., æt. 32, I was called I am, Sir, your obedient servant, taken in labour, of a spare and debilitated SAMUEL MILLARD. habit. Her labour was natural, and for Bristol, 15th August, 1827.
the
impulse synchronous
pletely ;
which
appeared
ing
--