"Uterine hæmorrhage, with retention of the placenta"

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To the Editor of the Medical Gazette.

Sir,

I some time ago saw an article in one of the medical journals on a method of expediting delivery. I have forgotten in which publication it was, and have spent a great deal of time in looking for it, in order that I might refer to it in this communication, but have not succeeded. It was, however, to the effect that the author, in cases of protracted labour from inefficient pains, had found benefit from introducing two fingers into the vagina, and pressing against its posterior part during a pain, in imitation of the bearing down of the child's head on the perineum; and he attributed the good effects--no doubt rightly--to what is called the excito-mototry function of the nerves.

I have not tried this plan previous to the birth of the child, but I have found it useful on what is, I think, a more important occasion--retention of the placenta from inaction, or insufficient action, of the uterus, especially when this is complicated with hæmorrhage. The following is an outline of one out of two or three cases:--

I attended Mrs. D. in labour about a month ago. She is the mother of a number of children, and her last four labours have been accompanied with flooding after the birth of the child. At her last previous confinement, two years ago, I was present, and the hæmorrhage between the delivery of the child and that of the placenta was [224/225] such as to cause debility, and greatly to retard her recovery. On the present occasion she was in a very weak state from an affection of the hip-joint, and, owing to the feebleness and inconstancy of the pains, the child was not expelled till a fortnight after the os uteri first began to dilate. After the birth of the child, gentle traction of the funis, and firm pressure over the region of the uterus, were made for some minutes, without inducing any uterine contraction; and as there was considerable and increasing hæmorrhage, I introduced two fingers into the vagina, and made firm and continued pressure on the perineum with them. The uterus commenced to contract the instant this pressure was applied, and the contraction continued till the placenta, together with some coagula, were expelled, when the hæmorrhage at once ceased, and the uterus remained properly contracted.

This is a very easy measure, which can be put in force in a moment, and need not interfere with any other efforts either to promote contraction of the uterus or to check hæmorrhage. I feel satisfied, however, that it may often be of service, and that it may occasionally obviate the necessity of introducing the hand into the uterus. The liability of tenesmus to induce premature labour, and the increase of uterine action from plugging the vagina, are, no doubt, physiological phenomena indentical [sic] with the one under consideration. I do not, however, propose that the above expedient should supersede the plug on any occasion where the plug is admissible.--I remain, sir,

Your obedient servant,

John Snow

Frith Street, Soho Square,

Nov. 3, 1842.