Florence Eveleen Eleanore Olliffe Bell.

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seen, when it was wished to prcvent u perilom loss of blood after
confinement — I mean the ergot of rj^e, given immediately before
the expulsion of the child, and cold injections into the timbUieal
vein in order to effect the detachment of the placenta.

The causes which produce hemorrhage after accouchement
are also those which predispose to the persistence of lUerine
pains; and it would seem that a priori we should advise re-
course to the same successful mode of treatment, t may state,
however, that observation alone has conducted me to this val-
uable discovery, and that I made it in pursuing my observations
upon the means of guarding against these hemorrhages. The
first observation is, therefore, relative to a woman evidently
threatened with grave hemorrhage after accouchement :

Case I. — ^Aprilll, 1847, at 5 P. M., I was called to a woman
who had been having labor pains about three hours. She was
at the term of her ninth pregnancy. She told me that all her
labors had been very easy and fortunate, but that all, and espe-
cially the last, had been followed immediately by a considerable
loss of blood, and by violent pains lasting for two or three
days, with the expulsion of clots of blood, which had extremely
fatigued her and left her feeble for more than a month after. The
waters began to fiow early in the evening. It was a head pre-
sentation with the occiput in advance ; the neck oi the womb
was entirely dilated ; the pains, though feeble, recurred every
three minutes, and made the perineal tumor very prominent
Everything, therefore, announced that the labor would soon
terminate. However, an hour after, things remained in the
aame state. I administered one gramme an4 a half of the

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M»} Uterine Pains and Hemorrhage after Delivery. 176

eigot of rye (about 25 grains.) The pains became more ener-
getic a quarter of an hour after, and at 7 o'clock the head was
at the point of passing the vulva, I repeated the dose of ergot ;
and some minutes atler, the child, strong and well-formed, was
eipelled. The uterus remained sensibly contracted upon the
placenta, but no pains were at first experienced. It was not
until half an hour had elapsed that some slight alternating con-
tractions became manifest. Traction upon the cord was, how-
ever, made without result. I then injected some cold water
into the umbilical vein, and almost immediately a cold sensa-
tion was experienced in the uterus, which contracted strongly,
and two minutes after slight traction upon the cord brought
away the placenta without resistance. The womb maintained
a state of eonibiued contraction for at Iciist half an hour, and
then moderate expulsive efforts, scarcely painful, began to be
experienced at long intervals, denoting the escape of a little
blood; no clots werQ expelled. She passed a comfortable
night. The following morning the sliin was moist ; the san*

fnineous lochia were less abundant, and already a little serous.
lie mother nui-sed her child during the day, and eat two
Bonps. The ulerbie pains wcrt- hisu/nifieonL The patient rose on
the seventh day.

I was impressed in this case with the mild character ot the
uterine pains, and their short continuance ; the woman hersell*
was surprised. After having i^eflecteo, thei'efore, deliberately
upon all the circumstances of the case, and after having re-
called other similar examples in which the same means had
been followed by the same results, I came to the resolution for*
the future to excite uterine contractions not only in order
to avoid dangerous hemorrhage after, the ^escape of the placenta^ but
^so to preventj or greatly to dimimsfi, tUeritie pai/is. It has been
remarked, as I said above, that a twin birth was followed by
longer-continued and more severe pains, but no one has sought
as mr as we know to explain the cause. Dr. AVindrif reported
in the Medico-Chirurgical Journal for December, 1849, a very
interesting case of superfo&tation. It occurred to a lady who
was confined on the same day of two children, one of which
was at term, the other at 7 months, and he added, '' though
this was a first confinement, the mother had verj' strong pains,
which continued for fifteen hours after delivery, vnth the ex-
pulsion of clots and abundant lochia.*' Thus this author con-
firms two things — 1st, longer-continued and more severe ute-
rine pains after twins ; 2d, that the ordinarv pains attending a
first cond&nement are less persistent than those attending suc-
ceeding ones. He evidently recognized, by the astonishment
which it caused him, the prolongation of these pains, but he
did not attempt to account for the phenomenon.

Casb IL — ^At the end of November^ 1847, Mrs. D— p. was

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176 SeketbiiK fNovMber.

delivered naturally, after a labor of fifteen hours, of a strong,
well-formed boy. The uterus afterwards remained very dis-
tinctly developed, and evidently contained a second tcetus, but
the uterine contractions were suspended for twelve hours. Then
after a renewed labor of three hours a second bag of waters
became very prominent and was opened, and soon a foetus was
expelled. It bore all the signs of death dating several days
prior to the birth. This lady informed us that eight days pre-
vious to her confinement she had met with a fall from her
stairway, in which the right side of the abdomen had been N-io-
lently struck. Thus during all this time the uterus was able to
contain a healthy, well-formed child, and one for several days
dead. It only concerns us to state that the uterine painspre-
sented a persistence and a violence very extraordinary, lliey
ceased only on the third day, despite the application of emol-
lients and narcotics, employed perseveringly and in large doses.
This was the third labor with tins woman. The pains in other
cases, where there hiis been but one child, had seldom persist-
ed more than twelve or fifteen houi*s.

Qase m.— April IG, 1847, at 9 1\ M., 1 was called to a
woman who had been having labor pains for several hours.
For the last half hour they haa been very severe, and the labor
was near terminating. In short, hardly- twenty minutes aft^r
my arrival, I received a veiy strong child, which immediately
began to cry sharply. This was the seventh time I had assist^
ed this woman upon similar occasions, and I knew that the
placenta always detached itself slowly and with difficulty, be-
cause of the feeble uterine contractions, and that its extraction
was followed by a considerable loss ot blood, and by very se-
vere and prolonged pains. In the two last accouchements, par-
ticularly, the pains had continued tor three days and three
nights, during which time she had been unable to obtain either
quiet or sleep. Twenty-five minutes after the escape of the
child some sUffht pains began to be felt. 1 made feeble traction
upon the cora ; the placenta was adhei^ent, and I at once de-
sisted, and immediately threw a cold injection into the umbili-
cal vein. A sensation of coldness manifested itself in the
uterus, and almost immediately this organ began to contract
The contractions gradually increased, and the placenta was ex-
pelled by the aid of slight traction. Alterwards there escaped
some spoonsful of red, fluid blood. The womb remained con-
tracted, without pain, and under the influence of this prolong-
ed but not painful contraction, its volume gradually diminished
and sleep was refreshing. Only a few very distant pains were
perceivea towards morning, and they disappeared entirely in
the course of the doy. This woman nursed ner child ; she was
up on |the fifth day, 2l8t April, and her health and strength
were immediately re-established.



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Mtti Uterine Pains <md Hemorrhage after DeUxery. 177

In this case we have at once a double success — ^both the ab-
sence of hemorrhage and of uterine pains, the occurrence of
which the experience of her former labors would almost cer-
tainly indicate. ^

Casb IV. — ^Mrs. E. D., aged 36, of a sanguine, lymphatic
temperament, and a good constitution, had borne four children.
I attended her in her two last confinements, and in both in-
stances the uterine pains following were violent and pro-
lonj^ed for two or three days, so that the patient expressed her
suf^rings as being greater subsequent to, than preceding, her
confinement At the last, particularly, the pains continued
through two days and ni^ts, so as to entirely deprive her of
sleep. In the month of January, 1848, some years after her
iouith confinement, she found herself at the term of her fifth
jHT^nancy. In the night of the 20th or 21st, after one feeble
uterine pain, the memDranes ruptured, and the waters flowed
abundantly ; this was succeeded by a long repose. At 6 o'clock
the contractions became very energetic and re^lar, and at 8
o'clock a strong girl was bom naturally, and without the least
accident. Ten minute^ after a slight contraction manifested
itself; the. placenta, however, remained firmly adherent. I
then injected 400 grammes (about 12 fluid ounces) of cold wa-
tea* into the umbuical vein. The uterus contracted at once
strongly, and the placenta was removed by slight traction up-
on the cord. Dunng the two hours next following, the pains
succeeded each other at short interv^s, accompanied by abun-
dant sanguineous lochia, which disgorged the uterus and di-
minished its volume considerably. These pains became grad-
ually slighter until aft;emoon, and during the night she was al-
most completely exempt from them. On the morning of the
22d, they returned suddenly. The patient having been placed
upon a night-vessel to urinate, a large clot was expelled, and
from that time the pains, were scarcely felt, and disappeared
entirely thirty hours after confinement.

Casb V. — Mrs. Germain, aged 26 years, of a nervous, san-
guine temperament, was confined with her third child June
14th, 1848, at noon, after a labor of two hours and a half, with
good pains (at her second accouchment, 16 months before, the
uterine aft;er-pains had persisted for three days.) At twenty
minutes past 12, no uterine contraction announced the ap-
proaching expulsion of the placenta, which remained com-
pletely adherent, and I made an injection of 120 grammes of
cold water into the umbilical vein. A slight sensation of cold-
ness was produced in the uterus. Four minutes after, things
remaining in the same state, another injection was made. The
sensation of coldness was greater, and the womb contracted
energetically. Slight traction was made upon the cord, which
brought away the placenta, the lobules of which were a little
5

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178 Selections. [November,

cold, evidently infiltrated by the liquid injected. The womb
remained contracted during tiie entire afternoon, but there
were no uterine pains. The crying of the child, during the
night, kept the mother almost constantly awake ; but the fol-
lowing morning she did not complain to me of any after-pains;
and it was not until I had particularly questioned her regard-
ing it, that she told me it was true she had felt some colic
pams, but very slight She experienced a few more pains du-
ring the 15th ; but the following night, after having nursed
her child, it was removed to another apartment, and she slept
soundly and felt no more of the ^ains. On the 16th, and the
following days, the lochia flowed m the usual manner. On the
17th she sat up four hours. She was able to walk out on the
eighth day.

In this case, as in all others where I have not anticipated
hemorrhage, I have employed injections only. In the follow-
ing case I arrived too late to employ the ergot before the de-
livery of the child ; but it will be seen that by the injections
alone, I succeeded equally well. I believe, therefore, it is pos-
sible to attain our purpose with this means alone, but yet pru-
dence ought to lead us to adopt the two modes of treatment in
grave circumstances.

Case VL— I wa^ called at 2, P. M., Oct. 7, 1848, to go im-
mediately to visit a woman who was the subject of the first ob-
servation related in this second part of my paper. The case
was a very urgent one. I found, on my arrival, that the child
had been expelled some minutes (it was her tenth confinement)
I hantened to liffate and divide the cord ; then I waited about
ten minutes without any uterine contractions becoming appar-
ent . This woman spoke to me of her fears of hemorrhage and
after-pains, to which she had been subject. I encouraged her
by reminding her of the success of her last accouchement, and
informed her that I had since been successful in. many other
cases. I threw three successive injections into the umbilical
vein, each of 145 grammes of water at the common tempera-
ture fit was a warm day ;) after the second, there was ejcperi-
encea a slight sensation of coldness ; after the third, uterine
contraction was energetic. Feeble traction sufficed to bring
away the placenta ; it wjis a little cool in all its parts, and very
much distended by the water injected. I remained about an
hour after this with the woman. There was no hemorrhage ;
the womb remained firm, without any painful contractions. * *
The following morning she assured me she had experienced no
eoUc. She had no fever, had already given the breast to the
child several times, and the uterus was much less voluminous
than on the evening before. The lochia were slightly sangui-
neous and flowed vvell. This woman rose on the seventh dav,
and now (Dec, 1848) the mother and child are in good health.



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m.1



Uterine Pains and Hemorrhage after Delivery. 179



Case VII. — ^An English lady was taken with labor pains on
the morning of the 26th October, 1848. It was her second
confinement, the first having occurred seven years before. The
child was bom without instrumental aid at 3 o'clock, P. M.,
after two hours of very hard pains. As this lady had met with
a very alarming loss of blood after her first confinement, I ad-
ministered two grammes of the ergot of rye, near the termina-
tion of the labor, and, in order to detach the placenta, I inject-
ed 150 granmies ^bout 5 fluid ounces) ot cold water into the
cunbilical vein. The cord was very short, and this single in-
jection excited immediately a sensation of cold in the uterus,
and produced the expulsion of the placenta, which was not
succeeded by hemorrhage or after-pains. Lochia natural and
free. This lady was up on the seventh day.

I could relate many similar cases, but it is useless to do so
when reason and sound physiology so clearly demonstrate the
principles which it is intended to illustrate. In all these cases,
after employing the means I have indicated, the labor progres-
sed precisely as does that ot a first accouchment. The uterine
walls opposed each other firmly, and prevented the accumula-
tion of blood, and the formation of coagula. The after-pains,
sometimes absent, were in other cases quite severe, but soon
diminished, and disappeared entirely. The flowing of the san-
l^oineous lochia was unobstructed and quite easy, less in quan-
tity and continued a shorter period of time than when the in-
jection was not used. In fact, in place of being prolonged to
30 or 40 hours, the lochia were seen to diminish 10 or 12 hours
after the accouchement; the vermillion color gradually grew
less, and aft^r the second day there was ilot more than a red-
dish serosity, which soon constituted what is called the serous
lochia. This last secretion, in its turn, was natural and with-
out pain, and was soon succeeded by the white discharge,
which is more prolonged and more abundant, if the woman
does not nurse her child, and if she has not the care of attend-
ing it. In this case, a less nourishing regimen, and one less
less exciting to the secreting and depurating organs, and to the
perspiratory system, is generally indicated. The lochia are af-
fected, too, by age, temperament, season, climate, &c.

Physicians have formerly made long and ridiculous calcula-
tions respecting the quantity of blood a woman ought to lose
after parturition, in order that the system may be siifficindly
pitrged. The blood that a woman loses after the expulsion of
the placenta, uselessly enfeebles her, if it flows in the absence
of uterine contractions ; it takes from the vital forces, of which
she will have indispensable need, in pcrfonning the importa^nt
function of nursing her child. There is no further flow of
blood needful than tliat which accompanies the uterine contrac-
tions, and which serves to disgorge the walls of this organ, and



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180 Seledions, fNovembOT

to restore them to their normal or physiological limits. It is
conceived, then, that some hundreds of grammes are amply
sufficient; now by the means which we counsel, this double
result is obtained promptly, and almost without pain.

As to the mode of making these injections, since it is so
readily understood^ I have not entered into a very detailed de-
scription. It will be well to have a syringe containing at least
150 grammes (4 or 5 fluid ounces) having a long, fine nozzel,
or oanula. Before introducing it into the vein make a clean
section of the cord, for the purpose of distinctly seeing the
vessels. The cord should not he, at the most, more than 12
or 15 inches long. In mv first trials I used water acidulated
with vinegar, especially when I anticipated hemorrhage. For
some ^ears past I have employed only simple cold water, and
its action has appeared to me sufficiently powerfiil.

Whenever a dissection has been made of a placenta, detach-
ed by injection into the umbilical vein, it has been remarked
that wherever the ramifications of the vessels have been fol-
lowed, the liquid injected has been met with. The two faces
of the placenta present a very diffijrent aspect The internal
or foetal face is traversed throughout its extent by the transpa-
rent divisions of the vein distended by the cold water ; the
uterine surface, on the contrary, is red and injected by the
blood contained in it. The liquid of the injection does not
penetrate to the external surface; hence the temperature of
this surface is found more elevated than the other, and the sen-
sation of cold experienced by the woman is not so great as, a
priori, would have been supposed. It is important that the
sensation of cold in the uterus should be felt, since it announ-
ces,* and determines, the uterine contractions, indispensable to
the success of the operation. It is evident that if the water be
very cold, a much less quantity will need to be injected; at the
common temperature, in winter, 150 grammes will often suffice,
while in summer two or three times that quantity may be re-
quired — Boston Med. ^ Surg. Jovmai.



On the Treatment of Cholera with Strychnia, Bj A. P. Meiuull, M.
D., Professor of Principles and Practice of Medicine in the Memphis
McdidJal College.

After the vast variety of plans and remedies which have been proposed
for the successful treatment of cholera, and the failure of the profession,
upder any system of treatment to cure, as a rule, more than one-half tho
cases that occur, showing scarcely greater success at the present time
than when the disease first invaded Europe and America, it is with diffi-
dence that we venture to make even a single suggestion upon the subject;



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uA} Mebrill — Treatment </ Cholera wUh Strychma. 181

tttd tiie m<«e, as the modscate number of oaaefl we baye mot with ia this
mtjy wkere the disease has prevailed o&lj sporadicaUj, has not given ns i
veiy fall oj^rtonit j to put the practice we are abovt to propose, to an
ample test. For several years past it has been our practice to rely large-
ly upon strychnia in the treatment of diarrhea, particularly in its incipi-
ent stage ; and we have found it, both with white people and with plan-
tation slaves, a most efficient and convenient remedy in this disease. It
has proved especially useful, in the relief of those sudden derangements
of ^e digestive organs, consequent upon imprudence in eating, whether
d^iendent upon an excessive quantity of food, or upon such as is of an
indigestible character ; leading, in ue first place, to sensations of fnll-
neas and expression in the epigastrium, then to commotion and more or
less pain in the intestinal caniS, followed by copious alvine discharges and
sometimes by exhausting serous stools.

These symptcmis, so readily relieved by strychnia, simulate cholera to
a sufficient extent to justify the expectation, that a similar treatment '
might be applied to both. Accordingly we have occasionally experiment-
ed^ upon well developed cases of cholera, with moderate doses of strych^
nia, as an accompaniment to other remedies, and sometimes with appar-
ently useful results. In the treatment of the premonitory symptoms,
choleraic diarrhea, we have rarely ever prescribed any other remedy ; and
this stage of the disease being almost identical with the diarrhea above
doMribed, we have found this prescription equally effectual in both. In-
deed its remedial action is so prompt and decided in such cases, that more
than one or two doses are seldom necessary.

These and other observations upon the remedial efficacy of this reme-
dy, as well as favorable reports from other quarters, led us to give it a
more thorough trial in cases of cholera, than we had hitherto done. At
first we alternated it with large doses of calomel, and successfully, but
without the prompt suspension of the alvine discharges, which it accom-
plishes in diarrhea. This led us to suspect, that the cathartic operation
of the calomel counteracted, to some extent, the remedial power of the
strychnia. Subsequently, therefore, we used the strychnia alone, giving
no other medicine while the cholera symptoms prevailed, but following
the subsidence of cholera with a few small doses of calomel to excite the
secretions, and produce moderate catharsis. Our experience with this
treatment, although somewhat limited, has been sufficient to convince US|
that strychnia possesses antidotal powers to die action of the cholera pois-
on, to a much greater extent than any other remedy in use, and to an ex-
tent to render it of great value in the treatment of the disease.

The first effect of strychnia used in this way is, to check or wholly sus-
pend the rice-water discharges from the bowels. The most striking re-
lief however, afforded by it, arises from its influence over the capillai^
circulation ; and it is only after its effects over this function are* percepti-
ble, that its remedial power becomes decided. That degree of capillary
congestion which causes the purple skin, and enables it to retain the
manES occasioned by pressure upon the surface for a considerable length
of time after the pressure is removed, is gradually relieved as the patient
comes under the operation of the remedy, accompanied by an ec^uaUe
and wholesome glow of warmth over the whole body. Cramps m the
Hmbe subside as soon as this influence is fully exerted, and the pulse im-



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182 SetecHcm. ctcoreaw^

proves in follness and sttenfftli. Unless the toxical effects of the reme-
dy follow, there is also an abatement of thirst; and a retom of warmUi
to the tongue and month. Hoskiness of the voice gradnallj subsides and
the patient is relieved of the extreme prostration, which coustitutes one
of the most dbtressfn^ symptoms of cholera.

These are remedial influences scarcely less decided and remarkable than
those which follow the use of quinia in periodic fever. But it is no small
disadvantage, that the toxical effects of strychnia are so easily produced,
and are of such serious character, as very much to lessen the value and
importance of the remedy, unless some means are discovered for obviating
the evil. The antidotal power of camphor docs not appear yet to be weU
established, and it b doubtful whether any other has been discovered
which promises even so much as this. The toxical effects are the more to
be feared because of the difficulty in ascerUdning, while frequent vomit-
ing continues the exact quantity of the medicine retained, or the quanti-
' ty which may lie dormant in the stomach and bowels, from a temporary
suspension of the assimilative powers, and thus endanger the patient ft^om
its cumulative action whenever assimilation is restored.

For the curb of diarrhea, whether constituting the early stage of chol-
era or not, we have generally given strychnia in crystals, made up into
pills, with gum arable and simple sirup, and in doses of one-twentieth to



Online LibraryFlorence Eveleen Eleanore Olliffe BellAtlanta medical and surgical journal → online text (page 14 of 81)