Reprinted from 7he Denver Medical Times, 
OMPHALORRHAGIA—UMBILICAL HEMORRHAGE. 
By C. B. LyMan, M. D., 
DENVJER, jCOIjO. 
Adjunct Professor of Fractures and Dislocations in the Medical Department of 
Denver University; Visiting Surgeon to St. Joseph’s Hospital. 
This is a subject whch our writers on obstetrics have considerably 
slighted. In looking over a large number of standard authorities 
from 1840 down to the present time, I find that less than one-half 
of them make any mention at all of the subject; and many of those 
give it but a passing and casual notice. 
Probably the first case reported was by Mr. Watts, of Kent, who 
in 1752 published its history in the Gentlemen’s Gazettte nearly a cen- 
tury then passed by before any further publications on this subject 
appeared. 
Dr. Francis Minot, of Boston, in 1852, published, in the Ameri- 
can Journal of Medical Sciences, the histories of 41 eases in the prac- 
tice of himself and others; these cases occurred from the first to the 
thirteenth day after birth. In 1855 Stephen Smith read a monograph 
embodying the histories of 79 cases; in 1858 J. Foster Jenkins read a 
paper before the U. S. Medical Association, which was published in 
the transactions for that year, in which he gave the histories of 178 
cases; of these 34.5 per cent, were females and 65.5 males; the hem- 
orrhage started in from the first to the 56th day; the days were re- 
corded in 99 of these cases as follows; 
ist day, five cases; 2nd day, seven cases; 3rd day, six cases; 4th 
day, three cases; 5th to 7th day inclusive, thirty-two cases; 8th to 
10th day inclusive, twenty-five cases; nth to 15th day inclusive, 
sixteen cases; 16th to 21st day inclusive, four cases; 22nd to 56th day 
inclusive, one case. 
In 1859 Grandidier reported 202 cases; in 135 of them the time 
of occurrence of hemorrhage was noted, in 38 it came on before the 
cord had separated, in 26 at the time of separation and in 71 after that time. From that time up to the present there have been frequent re- 
ports of cases. Jardin, in the British Medical Journal for March, 1891, 
reports a case of fatal hemorrhage on the 20th day; R. H. Montgom- 
ery in the New York Medical Journal for 1892, reports a case occur- 
ring on the eighth day, four days after separation of the cord, it re- 
covered. lyUgeol, in the Journal de Medecine de Bordeaux, for Nov. 
22nd, 1891, says that in 4,000 deliveries in the Maternity of Bordeaux, 
he had seen but one case and considers it a very serious condition. 
Chas. Craig reports one case in the Medical News of Philadelphia for 
Nov. 24, 1894. 
When hemorrhage occurs during the first three days of life, the 
source is, in all probability, from the walls of the umbilical fossa out- 
side the line of attachment of the cord. The most common time for 
hemorrhage to take place is between the 5th and 15th day, namely, 
after the cord has fallen. 
Symptoms: The first symptom which is noticed in most cases is 
the fact that the binder is saturated with blood, the hemorrhage does 
not come in spurts, but as a gentle oozing and is, therefore, very dan- 
gerous; it saturates the binder and clothes, and if it should chance to 
come on at night may become so great, before being discovered, that 
recovery is impossible. If the loss of blood has been considerable, we 
will have the usual symptoms which accompany severe' hemorrhage; in 
very many cases we will have hemorrhage from other parts of the 
body, such as the mucous membrane of the nose, mouth, vagina, 
stomach and rectum. '• 
Causes: Standing foremost in the list of causative agents is the 
condition of haemophilia; in a very large proportion of cases this con- 
dition has been found to exist; it may or may not be an inherited 
condition; when this hemorrhagic diathesis is present other symptoms 
will usually accompany that of hemorrhage from the umbilicus, such 
as epistaxis, haematemesis, haeraaturia, and hemorrhage from the va- 
gina, rectum and into the subcutaneous tissue. Next in importance 
as a causative agent comes inherited syphilis. Parvin reports a case 
where the child died in 24 hours from hemorrhage; the parents were 
syphilitic; they were placed on anti-syphilitic treatment and the 3 
mother subsequently gave birth to four healthy children. Mracek, in 
1886, reported 19 cases due to syphilis. J. G. Simpson, of Edinburgh, 
in an article on this subject, says that it is his opinion that in many 
of the cases the cause is to be found in a thickened condition of the 
vessel walls, which interferes with their contractile power, the infiltra- 
tion being due to an inflammatory condition. Some cases seem to be 
due to a debilitated condition of the mother during the carrying period 
due to tuberculosis, cancer, etc. 
Prognosis: The prognosis in these cases is decidedly bad; five 
out of every six die. When due to a distinct hemorrhagic diathesis 
or when accompanied by jaundice they seldom recover; the average 
duration of these cases is three and one-half days, according to 
Jenkins. 
It has been my fortune to see two of these cases, brief histories of 
which I give: 
Case i. This case I saw in 1887, the child, a male, was born 
apparently healthy, the parents were healthy; owing to their poverty 
there was no experienced nurse in attendance; the hemorrhage came 
on at the time the cord fell off, or rather at the time when the old 
woman in attendance pulled it off; the hemorrhage was quite severe. 
I reached the patient in two hours, when I found it almost bloodless; 
compression controlled the flow of blood, but the child died before 
anything further could be done. 
Case 2. Mrs. A., a primipara, gave birth to a female child 
weighing nine and three-quarter pounds. The cord separated 
and fell on the sixth day. On the thirteenth day I was called on ac- 
count of oozing of blood, which had stained through the binder. I 
filled the umbilical fossa with liquor ferri subsulphatis, covered it. with 
styptic cotton and applied pressure by means of a tight bandage, 
there was no further hemorrhage until the next day, when I was 
again called. At this time I found fresh and quite alarming hemorr- 
hage, amounting to half an ounce. I removed all dressings, took a 
medium sized curved needle threaded with medium sized silk, stitched 
the umbilical fossa completely up, passing the thread from one side to 
the other and back, tying it securely, but not tight enough to cause 4 
any danger of subsequent sloughing of the delicate tissues; in crossing 
the base of the fossa the stitches did not include any of the tissues at 
that point, but were passed just above the base. This completely 
controlled the hemorrhage; a dressing was then applied of aristol 
powder, a small pad of absorbent cotton saturated in flexible collodion 
was secured to the skin by the abundant use of collodion. This dres- 
sing was not disturbed for five days, when it was removed; the stitch 
was cut out and a simple dressing of aristol and cotton applied. It is 
now four weeks since the dressings were removed and there has been 
no return of the hemorrhage; the child is perfectly healthy in every 
respect. 
In this case I feel that the cause of the hemorrhage was a lack 
of contractile power in the walls ol the vessels, together with a lack of 
coagulative power in the blood. The parents were both perfectly 
healthy; showed no evidences of hsemophilia, syphilis or other con- 
stitutional disease. The interest in this case of course, centers in the 
treatment. 
Burns, in his “System of Midwifery,” published in 1843, recom- 
mends the use of astringents, nitrate of silver, the actual cautery, 
plastering over the umbilicus a solution of gutta percha, and digital 
pressure kept up, if need be, for days by frequent changes of nurses; as 
a last resort he suggests that one might make an incision upwards 
from the umbilicus aud down to the peritoneum for the purpose of li- 
gating the umbilical vein, and an incision downward from the umbili- 
cus for the purpose of securing the arteries. In the literature at my 
command I find that the varieties of treatment are not extensive and 
consist first in the application of astringents and styptics such as alum, 
liquor ferri subsulphatis, styptic cotton, etc. Second comes the use of 
caustics, such as nitrate of silver and the actual cautery. Third, 
compression either by means of the finger or by means of pads prop- 
erly applied and held in place by a bandage or by the application of 
such adhesive materials as a solution of gutta percha or flexible col- 
lodion, or pressure by plaster-of-Paris applied over the umbilicus and 
held there until dry. lastly we come to what may be called opera- 
tive measures, consisting in the first place of cutting down on the 5 
arteries and vein and tying them, a procedure alike difficult and 
dangerous in the new-born child; next, the use of hare-lip pins is sug- 
gested, two of them being used and passed through the fossa at right 
angles to each other, just escaping its base, and then applying a liga- 
ture around them, either in a figure of eight or circular manner. 
Lastly I would suggest the method used in this particular case. 
It is the universal opinion of all authorities that the application 
of astringents, styptics and caustics is of little avail and that com- 
pression is uncertain; my own idea is, that they are all uncertain and 
are dangerous to use. In this case reported, the result was due as 
much to the careful watching on the part of the nurse as to the efforts 
of the physician. Hereafter I shall not waste valuable time or run 
any risk by making use of applications or compression, but when first 
called shall make use of the suture, applied as it was in this case, 
which I consider as efficient and much safer than the method laid 
down in most of the text-books by the use of the hare-lip pin; there 
will not be the danger of sloughing from pressure; a suture can be 
left in longer than the pins and leaves no large holes; the dressing of 
absorbent cotton saturated in flexible collodion adds to the security of 
the method. 
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