«*■• ?iL1 * ^ "K iu •/--/nK SURGEON GENERAL'S OFFICE ;:; LIBRARY. ft * 0 t Section, JJti\)lOfcMfi&f*&' KJP^S ^w^&rcji E5jL*?jj i|H |«'2jgj S*jfl&K B^w A N ATTEMPT * TO EXPLAIN AND JUSTIFY ;, ^t THE \ > ^ 3 • TT' "*N USE OF COL D^-^J^ ' I N UTERINE HEMORRHAGIES, * A View to remove the Prejudices which prevail among the Women of this City, againft the Hit of this fafe and necefiary Remedy. . N.E W . - Y O R K: Printed by H. Gaine, at the Bible, in Hanover-Square. M.DCC.LXXXVIIl. • # An A *.T T E M P T, &c. HAVING found by repeated occur- rences in my own pradice, as well as from converfation with my friends, that a growing prejudice has taken root among the Ladies of this city, againft the ufe of cold applications in uterine bemorrbagies, I think it a duty I owe my fellow citizens in general, but particularly thofe who repofe any confidence in me, to endeavour to flop the progrefs of fo erroneous and dangerous an opinion: and by ftating in as concife and clear a manner as I am capable, the reafon and authorities upon which this ufe- ful and necefiary pradice is built, endeavour to preferve to them a remedy, upon the timely application of which, their own lives and the well-being and happinefs of their families, may fome time or other depend. A 2 A pub- ( 4 ) A publication like this, upon a fubjed of equal delicacy and importance, fhould, I confefs, in fome meafure be warranted by neceflity, as well as recommended by utility; and I flatter myfelf that when the real efficacy of this remedy is known, and the urgency of the cafes in which it is applied, is confidered, 1 fhall not be thought needlefsly to have undertaken its defence, or officioufly to have obtruded my opinions on the public, No one is unacquainted with the ufe of cold in checking hemorrhagies from the nofe or other parts of the body; even in amputations it is allowed to be one of the moft ufeful remedies, and it is frequently found impoflible to flop the bleeding from a flump by any art or application, while it is kept warm by dreffings and bed-clothes. Dodor Cullen, profeflbr of the pradice of phyfick at Edinburgh, fpeaking of hemorr- hagies in general, has thefe words, * " 1 he * Cullen's praflice, § 8oo. «moft C 5 ) " mod powerful of all aftringents appears " to me to be cold, which may be employ- " ed either by applying cold water to the " furface of the body, or by throwing it " into the internal parts." But I believe the general principle has never been contefted j I will therefore confine my enquiry to the application of this remedy in child-bed cafes, and that I may be as clear and intelligible as poffible, I will fuppofe the moft fimple cafe—a flooding after a complete and perfeSi delivery. All hemorrhagies proceed either from too great force in the heart and arteries, by which all refiftance in the coats, or at the extremeties of the fmall vefiels is overcome; or from too great weaknefs in the coats, or too great relaxation in the mouths of the extreme vefiels themfelves; whence they make little or no refiftance to the ordinary force of the circulation. Uterine hemorrhagies in the cafe I have ftated, are always of the latter kind. The womb, C 6 ) womb, which is capable of a moft wonder- ful diftention during pregnancy, has all it's veflfels proportionably enlarged; and parti- cularly at the part by which the connedion between the mother and child is kept up. By delivery this connedion is fuddenly broken, and but for the immediate con- tradion of the womb, by which the mouths of fo many ruptured veffels are clofed, the birth of every child muft inevitably occafion the death of its mother. This fudden contradion of the womb is the provifion which nature has made to prevent the fatal confequences which muft otherwife enfue; and when (as fometimes happens in delicate and relaxed women, who have been debilitated by previous complaints, or exhaufted by tedious and laborious births) the womb does not poffefs thefe ftrong and vigorous powers of con- tradion, the moft profulie and violent he- morrhagies, fuch even as to occafion death in a few minutes, are fometimes the con- fequence. I be- ( 7 ) I believe it will readily be allowed, that in every cafe of this kind, it is the duty of the phyfician to aid the efforts of nature, by endeavouring to bring about as foon as pofiible, the necefiary contradion of the womb, by which alone the difcharge can be checked; to prevent, if pofiible, the patient from fainting, which more than any thing befide relaxes the human body, and from which fhe may never revive; and to loofe no time in the application of the necefiary remedy: and fortunately the re- medy is at hand, cold in whatever way it is applied, anfwers all thefe intentions; it roufes the languid powers of life; prevents fainting; ftimulates the womb to immediate and effectual contradion ; is ready upon all occafions; eafy in its application, and fpeedy and powerful in its effeds. And accor- dingly we find it recommended by every writer of eminence, from the earlieft ac- counts we have of the pradice of midwifery, rp the prefent day ; at firft I confefs with more caution than of late years; but like ' . every ( 8 ) every other efficacious remedy, its ufe has become more general, and its application more fimple, as time and experience have confirmed its efficacy and fafety. Mauriceau a French writer of reputation, who publifhed fo early as 1668, direds the women to be laid on frefh ftraw covered with a fingle fheet, to avoid heating the loins, and to apply to the fmall of the back and fides, cloths dipped in cold vine- gar and water: adding thro' an excefs of caution, that in winter it ihould be a little warmed*. •f- La Motte another French writer, direds the hands and face to be wet with vinegar and water, compreffes dipped in it to be applied to the abdomen and loins, and as few coverings to be left on the patient as pofiible. * Mauriceau, fur le acouftiment. Tom. 1. p. 387. f Treatife of midwifery by La Motte, tranflated by Tomkyns. p. 4.78. Smelleyy ( 9 ) Smelley% one of the beft Englifli writers, fays " in thefe cafes fuch things muft be u ufed as will aflift the contradile power '* of the uterus, and hinder the blood from " flowing fo fait into it and the neighbour- " ing vefiels; for this purpofe cloths dipped " in any cold aflringentfluid, fuch as oxycrate " (vinegar and water) or red tart wine may "be applied to the back and belly*." Spencey a ledurer of reputation at Edin- burgh, afiirts, that " what is principally to be relied on is the application of cold to the fmall of the back and external parts, for which purpofe a towel folded and clipped in cold vinegar, or in cold fpring water alone, is as good as any thing elfe;" which pradice he confirms by an account of fome fuccefs- ful cafes in which this method was purfuedf. DoSlorJobn Leake, phyfician to the Weft- minfter lying-in hofpital, befides the liberal ufe of cold air, cold applications to the back * Smelley's midwifery, vol. I. p. 398. t Syftem of midwifery, p. 308. B and ( io ) and loins, and frequent draughts of cold water, which he ufes in all cafes of flooding, -—recommends where the flooding becomes fo profufe as fuddenly to endanger life, to plunge the feet and legs into cold water; and in proof of the fafety of this pradice aflerts that out of three thoufand women delivereq^in the Weftminfter lying-in hof- pital, feveral of whom were feized with dangerous hemorrhagies, but two failed under this free ufe of cold*. He quotes Leveret, a French writer, " who hit upon " an ingenious expedient to flop a violent " difcharge of this kind, which otherwife " would foon have proved fatal, by intro- " ducing a piece of ice into tbe womb, which " being ftruck with a fudden chill, imme- " diately contraded and put a flop to the " hemorrhagyj" |] The ninth volume 6f the medical commentaries publiftied at Ed- inburgh, contains, in a letter from dodor Fitzpatrick, of Dublin, to dodor Duncan * Leake's difeafes of women, vol. II. p. 322. 323. X-----------;—•----------------p. 288. I| page 227. a very ( » ) a very inftrudive cafe, of a woman redu- ced to the loweft extremity 6y means of a prof ufe and tedious flooding, faved from otherwife inevitable death, by immerfing her back and loins in a cold bath, and pour- ing cold vinegar upon the abdomen imme- diately after delivery. V I am credibly informed that this pradice is generally admitted in France; and that the prefent profefibrs in Edinburgh and London, conftantly teach and recommend it. Mr. Walch, particularly, an eminent teacher in London, not only recommends the liberal ufe of cold water, but advifes that in the fumrner feafon it fhould be rendered ftill colder, by difiblving in it fal ammoniac. Thus we fee that the ufe of cold in thefe cafes, is not only confiftent with the clearefl; reafon, and very applicable to the caufe and nature of the complaint, but that it has adually been pradifed for upwards-of an hundred years; that, it has ftood the teft B 2 of C " ) of long experience, and gained reputation by frequent ufe, and that every writer of eminence (particularly thofe of late years) conftantly recommend it, and vouch for its efficacy and fafety. A trifling, and in fo far as it obfcures the principle, a prejudicial diftindion, has, I hear, been fet up between the effedsof vinegar and water in thefe cafes: the truth is, neither can do good but in fo far as it is cold, and that altho' equally beneficial in winter, fpring water muft in fummer, ma- nifeftly have* the advantage over vinegar j which being commonly kept in a warm clofet, is at that feafon feldom much col* der than the human body. And fhould fo weak and erroneous an opinion in favour of vinegar, and againft Water, prevail; it muft necefifarily on many occafions, particularly in warm weather, deprive this noble remedy of all efficacy; and leave the Unhappy pa- tient, in an hour of extreme danger and diftrefs,to be trifled with and amufed, when vigour ( IJ ) vigour and decifion, are eflential to he* prefer vation.. It is almoft unneceffary to add that fuch is the difference in the female confutation, that one woman may loofe her life by an evacuation of blood, which will occafion little or no injury to another; and that a fatal internal hemorrhagy may fometimes occur, which is manifefted by no extraor- dinary external difcharge. In fuch inftances we muft judge of the danger by the conco- mitant fymptoms, fuch as pale lips, a feeble pulfe, great languors, and frequent fainting; and where fuch fymptoms occur, it is un- queftionably our duty to prevent the farther effufiion of blood, by every means in our power. Nor is the ufe of cold confined to hemorrhagies after delivery; but will be found the moft effedual paliative in all in- ftances of flooding which precede delivery j And I can affert from the teftimony of the moft unequivocal experience, that in thofe critical and dangerous cafes which fome- times ( H ) times occur at the very latter end of preg- nancy, the judicious application of cold, will more than any other remedy moderate the difcharge, and at the fame time promote the pains of labour and haften delivery, by which only an effedual ftop can be put to the hemorrhagy. I hope it will not be fuppofed that I mean to difcountenance the ufe of every other remedy which may be called in to our aid in thefe very dangerous cafes, or that I would propofe to immerfe every woman who is taken with an uterine hemorrhagy, into a cold bath. Other remedies may unqueftionab'y be of ufe, and this moft important one muft ever be proportioned to the urgency of the fymptoms which call for it. All I aim at is to remove from the minds of my female friends and fellow citizens, a dangerous error; which from my own experience I have found interfere with their fafety in more than one inftance; and to fave my brethren from the painful dilemma dilemma to which I have been reduced, when I have been under the neceffity of doing my duty to my patient, in oppofitioa to the fcntiments of her parents and moft tender connedions. Should it be thought that I have^ de- scribed the danger to which women are fometimes expofed in thefe cafes, in terms which may poffibly imprefs a timid mind with too much apprehenfion; let it be my. apology, that the knowledge of the reme- dy, is the only means by which the dan- ger can be mitigated ; and that in every fuch cafe of great and*4mmediate hazard, it is not only necefiary that the proper remedy fhould be weft afcertained, and generally underftood, but that all prepof- feffion and prejudice againft it, in the minds of the patient or her friends fhould be removed; that the phyfician being left to the cool excrcife of his own judgment, may not be compelled to watte in argument and difpute, thofe precious moments, in which only he can fave the life of his patient. f J n i £., "* >■ M national library of medicine ; NLfl DIDDlbTM A »' " * "H \"' ?-^ J. -"V r^ ^ ?'V.iWfc NLM010016948