On the prevention and treatment of haemorrhage after delivery / by Thomas More Madden.

Date:
1880
Catalogue details

Licence: Public Domain Mark

Credit: On the prevention and treatment of haemorrhage after delivery / by Thomas More Madden. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    or Dr. R. McDonnell’s operation with clefibrinated blood, however superior in a physiological or theoretical aspect—afforded much better practical results than Dr. Blundell accomplished. Of six cases of transfusion, narrated in the Dublin Obstetrical Trans- actions, within the last few years, three were successful, and in three the patients died. Cases of Transfusion. Authority. Method Employed. Amount of Blood Transfused. Result. Dr. Beatty. Dr. R. McDonnell’s. Recovery. Drl A. H. Ringland. Dr. R. McDonnell’s. 8 oz. Death. Dr. J. Ringland. Dr. R. McDonnell’s. 12 OZ. Recovery. Dr. Atthill. Dr. R. McDonnell’s. 14 OZ. Death. Dr. Kidd. Dr. R. McDonnell’s. 12 OZ. Recovery. Dr. Kidd. Not stated. TO or 12 OZ, Death. Any treatment adopted in a case of threatened death from haemor- rhage should be prompt, feasible, safe, and effectual; and, in all these respects, transfusion is defective. Even in one of the best methods of transfusion—namely, that of Dr. R. McDonnell—much time, when it can be ill spared, is lost in the process of defibrinating the blood to be injected. Moreover, in this, as also in other recent plans, the success of the operation is made to depend so much on exceptional skill as to take it out of the reach of the ordinarily well-qualified practitioner, to whom it should be of most value, and who at any moment, and perhaps in remote districts or under unfavourable circumstances, may meet with a case requiring its performance. Transfusion is useless as long as active haemorrhage is going on. Nor would it be generally justifiable to subject the patient to the special risks of this operation until, after the failure of other treatment, she shows symptoms of collapse. The majority of patients may lose from twenty- five to forty ounces of blood before collapse is produced. In successful cases of transfusion, there are seldom more than from eight to ten ounces injected. This, being obviously insufficient to refil the empty vessels, can act only as a physiological vital stimulus. It is sometimes, as I have seen, a matter of difficulty to obtain the necessary supply of blood. And irt such circumstances, when every moment is of vital importance, we might in the first instance have recourse to the venous injection of a saline solution, as suggested by Dr. H. Kennedy, and employed in one case by Dr. Kidd, so as to fill the emptied vessels, and give the heart some pabulum to act on, and, by affording a mechanical resistance to its rapid contractions, bring back the pulse towards its normal rate and volume. We might thus at least gain time to obtain a supply of blood for venous transfusion, should that be still necessary. Hypodermic Use of Ether.—In a few cases that came under my ob- servation, the subcutaneous injection of sulphuric ether, which was suggested in the treatment of collapse from flooding by Professor von Hecker of Munich, and first brought before the profession in this country by a case reported by Dr. Macan of Dublin, was tried with great advantage. In one instance, where I was called in when the patient was already pulseless, cold, unconscious, and apparently moribund, from haemorrhage after delivery, a drachm of sulphuric ether was injected into the gluteal region, and almost immediately the pulse