The bradycardia of the puerperium / by Frank W. Lynch.

  • Lynch, Frank W. (Frank Worthington), 1871-1945.
Date:
[1911]
Catalogue details

Licence: In copyright

Credit: The bradycardia of the puerperium / by Frank W. Lynch. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    THE BRADYCARDIA OF THE PUERPERIUM By frank W. lynch, M D., Chicago, Illinois Assistant Professor of Gynecology and Obstetrics, Rush Medical College The first description of the slowing of the pulse during the puerperium is frequently ascribed to Blot in 1864, yet it requires but the briefest review of the literature to indicate that the credit is not rightfully his. It is difficult to isolate the one who first described it, yet we have strong suggestions that it was known to the ancients. That the phenomenon was known to the ancient Chinese may be evinced by the diction in Pfizmaier’s “Die Pulslehre Tschang Ki:” “1st die Geburt soeben erfolgt, so ist Kleinheit und Langsamkeit; bei Vollheit Straffheit, Festigkeit, Grosse ist das ungliick nicht zu vermeiden.’’ “Der Kleine und langsame puls wird in der Erklarung als von guter vorbeutung bezeichnet.” In more re- cent time we find many who also mention this phenomenon, unaware doubtless that it had been described by others. Thus we find reference made of it by Levret (1766), Cirillo (1802), and Capuron (1811). In 1857 W. E. Montgomery wrote of it in a Dublin journal under the heading of “Retardation of the pulse after labor,” and MacClintock’s much quoted observations appeared four years later. Moreover immediately preceding the paper of Blot appeared the publications of Levy (1862) and Pastorello (1863). Yet credit is due Blot for first presenting in a complete and careful manner his many observations concerning this phenomenon. His paper, which was based upon the study of 246 parturient women, created a profound sensation when read before the Paris Academy in 1863. It was published the succeeding year. Blot presented the following conclu- sions: I. That there generally ensues in normal puerperal women a more or less clearly marked slowing of the pulse. 2. It is not limited to women who nor- mally have slow pulses at other times. 3. The range of the pulses varies consider- ably, yet commonly oscillates between 44 and 60. In three cases the pulse fell to 35 per minute. The phenomenon is not in- fluenced appreciably by the alimentary tract. 4. The condition is more common in multi- para than primipara, doubtless because of the greater tendency to complications in the latter. 5. The duration of the fall varies from a few hours to ten or twelve days, and is usually more prolonged in the cases which present the slowest pulses, provided always that there are no complications. 6. It begins usually in the 24 hours follow- ing delivery, becomes accentuated, remains stationary, and gradually disappears. It may persist even while there is “milk fever,” a term often erroneously applied. 7. The duration of labor does not pro- foundly influence the phenomenon, which dis- appears, however, upon the advent of path- ological conditions. The pulse is retarded not only after labor at term, but also after abor- tions and premature labors, wffiether spontane- ous or incluced. The ordinary afterpain does not influence it, yet hcemorrhage may, unless the amount is very slight. 8. Changes in the posture of the patient cause marked changes in the rate. 9. The slow pulse is a most favorable symp- tom, and its frequent occurrence in a hospital reflects the excellence of the sanitary condi- tions. The reverse condition, a rapid pulse, often proclaims the advent of morbid condi- tions w'hich so frequently appear in epidemic form. 10. Whatever is the cause, it cannot be ascribed to nervous exhaustion, because the sphygmographic tracings indicate an increase of arterial tension. Shortly following Blot’s publication, the literature became flooded with the observa- tions of many investigators who recorded their findings with the sphygmograph which was then becoming a favorite instrument with students of the circulation. Naturally there accumulated a great number of obser- vations, which together with their interpre-