Reprinted from The Medical News, February n, 1893.] 
A CASE OF “ACCIDENTAL” HEMORRHAGE 
WITH UTERINE INERTIA. 
By F. W. LOWRY, M.D., 
OF IRON MO. 
In the early morning of June 11, 1891, I was called to 
see Mrs. O., twenty-eight years old, at term in her fourth 
pregnancy. In the latter part of the night she had had 
pains characteristic of beginning labor, which became 
suddenly more intense about 4 a.m., when a flow of blood 
was noticed. When I arrived, the hemorrhage, which 
was slight, had ceased, and the patient complained only 
of slight pain in the back. 
Vaginal examination discovered the cervix low in 
the vagina; the os dilated to about the size of a silver 
quarter; the cervix flaccid ; the membranes intact; the 
head presenting. On abdominal palpation the uterus 
was found lax. 
After an hour, there being no increase of pain and no 
further show of blood, I left; but called twice during the 
morning—the last time just before noon, when the pain 
had ceased entirely. Examination revealed no change 
since my first visit. 
I did not hear from the case again till the evening of 
June 15th, when I was sent for in great haste, and 
informed that the patient was flooding badly. I found 
her with pallid countenance, cold extremities; moist, 
clammy skin ; sighing respiration, weak and rapid pulse. 
The clothing and bedding were saturated with blood, 
which was dripping on the floor beneath. There was 2 
still a slight flow of blood from the vaginal outlet. Ex- 
amination revealed about the same condition as was 
present in the first instance. The head occupied the 
right oblique diameter. Two fingers could be passed 
their full length through the os and swept entirely around 
without reaching the placenta. There was not, nor had 
there been, any pain. 
The question of treatment now presented itself. Im- 
mediate delivery was imperative. I believed the uterine 
inertia, so marked in this case, to be due, partly at least, 
to over distention ; and later developments proved this 
to be true. 
First ascertaining that the bladder and rectum were 
empty, and being satisfied that the os would not impede 
delivery, I gave a dram of fluid extract of ergot in hot 
water, to insure contraction after the escape of the liquor 
amnii, and to secure permanent contraction after empty- 
ing the uterus, intending to rupture the membranes 
and deliver immediately with forceps. In ten or twelve 
minutes the effect of the ergot became manifest in vigor- 
ous uterine contractions, a widening os, and tense mem- 
branes. I now ruptured the membranes, when it became 
apparent that the use of the forceps was precluded, spon- 
taneous delivery occurring in a few minutes. The child, a 
ten-and-a-half-pound boy, was very slightly asphyxiated. 
The placenta was delivered immediately by expression, 
a little less than an hour after my arrival at the house. 
It was very large and extremely friable. The uterus 
contracted firmly—the tonic contraction of ergot. The 
mother’s pulse now was nearly normal in rate and ten- 
sion. Before leaving, I repeated the dose of ergot as a 
safeguard against relaxation. The patient’s lying-in was 
altogether normal. She informed me that between the 
nth and 15th she attended to light household duties as 
usual; that on the evening of the 15th, she was sitting 
in her room sewing and talking with some friends who 
had called, when, without warning, the hemorrhage 3 
occurred. She lost consciousness, was removed to her 
bed, and restoratives were applied. 
In the latter months of pregnancy there was consider- 
able daily loss of blood per rectum, which ceased a few 
days before labor and did not return afterward. It did 
not cause any perceptible impairment of health. It may 
have served the useful purpose of relieving tension in the 
friable utero-placental vessels. 
This case is reported solely because it presents some 
unusual features. While ergot accomplished the de- 
livery, it was not administered for that purpose. In spite 
of the fact that this case seemed specially adapted for 
the peculiar action of ergot and of the remaikably rapid 
expulsion of the child, there was some asphyxia, due, I 
am convinced, to continuous pressure upon the cord and 
placenta after the membranes were ruptured. Neverthe- 
less, I believe that in selected cases of uterine inertia 
ergot is indicated—provided the hand that administers 
the ergot can also, if necessary, reinforce or modify its 
action with the forceps. The ability to select the cases 
would presuppose the latter qualification.