UTERINE HÆMORRHAGE PRECEDING DELIVERY

R. Forster Wells
1841 The Lancet  
The above-named woman was found dead in a shallow pond near the Chalk-road, Islington, and an inquest sat upon the body on the 20th of April. There were no external marks of violence, nor any appearance of putrefaction. The surface of the body was quite clean, having been washed previous to the examination. The eyes were half open, and the pupils in a state between dilatation and contraction. The nostrils were dry, and the mouth empty. The hands were not clenched, and the fingers were nearly
more » ... aight. Head.—A considerable quantity of fluid blood was found between the scalp and the skull, and on removing the latter a large portion flowed from the sinuses and veins of the dura mater, which exhibited great sanguineous congestion. The brain itself was excessively congested, its veins and capillaries being turgid with blood ; the ventricles of the brain contained only a small quantity of serous fluid. With the exception of the con gested state of the vessels, the membranes of the brain and the brain itself were perfectly healthv. Chest.—The lungs were voluminous and filled the cavity of the chest. The right lung was partly adherent to the parietes of the chest, indicating some previous attack of pleurisy ; this lung was also emphysematous at its edges. In other respects the substance of both lungs was healthy and crepitant throughout. The trachea and bronchial tubes were then examined ; the former contained no fluid, but the latter, particularly towards their smaller ramincations, were filled with a soapy tenacious mucus, exactly corresponding in character with thatdescribed by authors as peculiar in the bronchial tubes of the drowned. The mucous membrane of these tubes was healthy. The heart appeared, externally, of its natural size, but the walls of the left ventricle were thickened and its cavity diminished in size. The right ventricle and auricle were of the natural size and appearance, both contained a large quantity of fluid blood, as did also the pulmonary artery. The venæ cavse, the vena azygos, and their smaller tributary veins, were all much distended with fluid blood. Abdomen.—On maliing an accidental incision into the oesophagus, that tube was seen to be tilled with a clear watery fluid ; the stomach and oesophagus were included in two ligatures, removed from the body, and examined. The internal membrane of these organs was perfectly healthy, and of its natural colour. The stomach contained about three ounces of clear fluid, quite destitute of smell and colour, with the exception of a minute quantity of green vegetable matter, resembling the confervœ found in ponds. The liver was of the natural size, but its subi , -'noce was tirm, dense, and of st dark colour, owing to excessive congestion. The intestines were healthy, except that they exhibited a highly-congested state of their vessels. In both these cases drowning appears to have been the cause of death, but no evidence was offered to prove that in either case violence had been committed towards the deceased, or in what manner they had come into the water, and verdicts to that effect were returned. At five o'clock in the afternoon of the 21st of the present month, at the request of a practitioner of midwifery, I visited Mrs. Croley, a'tat. 33, of a nervous temperament, in the ninth month of her second pregnancy, who had been seized with haemorrhage at four o'clock in the morning of the same day, which had continued unabated up till eleven o'clock, without the supervention of labourpains, and had recurred about half an hour previous to my seeing her. I found her lying in the usual obstetric position ; the surface of the body covered with a cold perspiration ; the pulse could scarcely be felt ; the countenance was deathly pale; the eyes and mouth surrounded by a dark-coloured areola; the pupils were dilated, and the tongue white and moist. The state of the bed did not indicate the loss of much blood. Upon examination I found the vagina filled with coagula, and the os uteri sufficiently dilated to admit the points of two fingers ; the liquor amnii had been evacuated naturally in the early part of the day, and the vertex was presenting. Under these circumstances I considered it impossible to attempt the operation of turning, and recommended the administration of the ergot in two-scruple doses every hour, until the mouth of the womb should be sufficiently dilated to admit the perforator, and warm brandy and water freely in the intervals. Upon seeing her again at seven o'clock two doses of the ergot in powder had been rejected, there was still an " oozing " of blood, and the general symptoms were much the same.
doi:10.1016/s0140-6736(02)97267-3 fatcat:amzbq5gdhbhldlv7w2c4d2qqmm