1540 examined the abdomen which was globular. I could not make out the foetus, but what aroused my suspicions was the fact that immediately I put my hand on the patient's abdomen there was an obscure feeling of crepitus of a similar character to that which is felt in a severe bruise with extravasated blood but by no means distinct. I concluded that the uterus might contain blood and found on inquiry that tt patient was, as a rule, "fullblooded " ; also that she had been stretching herself while

more »

... papering a room on the previous day and had not felt well since I asked to see all the clothes and cloths she had used and all th-blood she had lost, if any. I was shown about 40 drops on a clean linen cloth which she had used ; there was no blood serum or mucus. This was what the attendant had in her mind when she told me that the 11 colors had broken. " The blood drops were perfectly clear and fresh. Un examination per vaginam the passages were found to be normal ; the os was normal and dilated to admit two fingers while nothing unusual was to be felt in the vicinity. The presentation was normal and the membranes were intact but my fingers after the examination had on them a little fresh blood. There was no hemorrhage taking place externally. Taking into consideration the patient's previous day's work, her pulse, her pallor (which was not abnormal but for the fact that the woman in health was "full-blooded"), the fact that her pains were not in character what they ought to be according to the patient's statement, the freshness of the few drops of blood which were external, and more especially the slight obscure crepitus on palpation and the globular appearance of the abdomen, I concluded that this was a case not often met with by the general practitioner-namely, a case of concealed accidental haemorrhage. I decided that immediate delivery was the best course to adopt, so I sent for assistance and proceeded to dilate the os with my fingers ; during this time no blood escaped externally. By the time assistance had arrived the os was well dilated. We ruptured the membranes and liquor amnii escaped mixed with blood. By this time the pulse was occasionally imperceptible, so we put on forceps and when the first blade passed the head blood poured out ; the child was immediately delivered and along with it the cord, membranes and placenta came away all in one. The child was dead and the placenta looked as if it had been separated for some time. Following this the uterus, which was full of large clot-, was emptied of blood and well contracted by manipulation and ergot. No blood was lost after this and contraction was obtained immediately the uterus was emptied. ' The patient had the same appearance and her mind remained very clear. Her pulse varied, being sometimes perceptible and sometimes imperceptible. I gave her z , stimulants constantly. Saline rectal injections were given but the poor woman gradually became pulseless and collapsed. Crieff, N.B.