Obstetrics

The prevention and treatment of post-partum hemorrhage is a subject of never-failing interest to the practitioner, and in view of the sudden and frequently fatal catastrophe which may ensue as the result of its occurrence, every attempt to suggest new or improved methods for either its prevention or cure demands careful examination. Stanmore Bishop,1 as the result of an article on this subject, has been the cause of a considerable correspondence. In his original article he produces man}' arguments for the employment of a method certainly not new, and sufficiently well known, although not widely taught or practised as a primary method of dealing with this complication, namely compiession of th 3 abdominal aorta. He gives a resume of the different causes of post-partum hemorrhage as generally taught, under the following headings, namely primary external atonic, primary concealed atonic, secondary external traumatic and secondary concealed traumatic, and states that while the attendant is endeavouring to satisfy himself under which of these heads the particular case falls, the patient is being rapidly exhausted by bleeding. He also states that in addition to the delay while the exact cause is being mentally decided on, a prolonged search for tears of the viscera, uterus or vagina is necessary, which has to be-carried out in the midst of a torrent of blood, the clots from which obscure everything, and only after this exploration can anyone feel certain that the cause is not traumatic ; and all through this tedious and difficult exploration the patient's vitality is rapidly becoming less. Next, he states the student is taught that there are fourteen distinct causes of atonic post-partum hemorrhage, the first of these being improper management of the third stage, and describes the student as often exciting irregular and ineffectual uterus contractions by squeezing the uterus during its intervals of partial relaxation, and then removing the placenta by the hand introduced into the vagina or uterus. After giving a list of the fourteen causes of atonic post-partum hemorrhage, he proceeds to eliminate a large number, such as haemophilia, which is, as he states, rare, inversion of the uterus, which does not occur if the third stage is properly managed, and adherent or retained placenta, as regards which he considers that any attempt at removal whilst bleeding is going on is to court disaster, since it is certain to be attempted with unsterilised hands, while the presence of …