Lectures on the principles and practice of midwifery / [James Blundell] ; edited by Charles Severn.

  • James Blundell
Date:
1842
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Licence: Public Domain Mark

Credit: Lectures on the principles and practice of midwifery / [James Blundell] ; edited by Charles Severn. Source: Wellcome Collection.

    173/456 (page 165)
    a near reliance to the stoppage of bleedings from other parts of the body; but you ought to be aware, that eruptions of blood from the uterus may be restrained, more or less effectually, by the operation of a third cause, peculiar to gestation, and that cause is the discharge of the liquor amnii. Even when that fleshy mass, the placenta, is lying over the mouth and neck of the uterus, the discharge of the liquor amnii, when practicable, might perhaps tend to diminish the hemorrhage. But, however facts may here- after dispose of this question, there seems to be little doubt, that if no portion of the placenta be lying upon the mouth of the uterus, the membranes alone covering it in the ordinary manner, and discharge of the waters will, in most cases, arrest the flooding, or so far diminish it, that it becomes no longer dangerous. Peculiar to the uterus, there is yet a fourth means by which the bleeding may be arrested, and that is, the complete evacua- tion of the uterine cavity, effected by the spontaneous expulsion, or the artificial removal of the ovum, foetus, and secundines. The thorough contraction of the muscular fibres of the uterus, and of consequence the effectual constriction of the bloodvessels, greatly diminish the risk of hemorrhage, and in the earlier or later periods of gestation, when floodings occur, if the ovum be expelled the uterus contracts itself, so as to become permanently round and firm, and hard like the head of a foetus, in general further hemor- rhage ceases, and thenceforth the patient is secure. How it is that discharge of the liquor amnii has the effect of diminishing and stopping the bleeding effectually, I am not able satisfactorily to explain, though I suppose something may be attributed to the partial constriction of the vessels by the sur- rounding fibre,and something again to the pressure which the contracting uterus makes upon the placenta. After the liquor amnil is discharged the uterus always contracts itself, and indeed expels the ovum within an uncertain period of one, two, or three days, so that the escape of the water is not only immediately effectual in checking the hemorrhage, but ultimately brings the patient a still more certain security —that, I mean, which is derived from the complete evacuation of the womb. When the ovum is away we can more clearly understand how the stoppage of the hemorrhage is effected. The uterus then decidedly con- tracts, the muscular fibres contract too, and of course necessarily cause a constriction of the uterine vessels, which are ramifying among the fibres. By the thorough contraction of the uterus, therefore, you insure at the same time a thorough contraction of the vessels, which, by the constriction of the muscular fibres round them, are closed as effectually as if they were secured by a set of ligatures, and compressed much in the same manner as when the fingers of one hand are pressed upon the fingers of the other. Here, then, are the four principal causes which, operating sepa- rately or in connexion, seem to stop the discharge of the uterine blood:—-the formation of clots under faintness; the closure of