AN ATTEMPT TO EXPLAIN AND JUSTIFY THE USE OF COLD IN UTERINE HEMORRHAGIES, WITH A View to remove the Prejudices which prevail among the Women of this City, against the Use of this safe and necessary Remedy. BY SAMUEL BARD, M.D. NEW - YORK: Printed by H. Gaine, at the Bible, in Hanover-Square. M.DCC.LXXXVIII.  An ATTEMPT, &c. HAVING found by repeated occur- rences in my own practice, as well as from conversation with my friends, that a growing prejudice has taken root among the Ladies of this city, against the use of cold applications in uterine hemorrhagies, I think it a duty I owe my fellow citizens in general, but particularly those who repose any confidence in me, to endeavour to stop the progress of so erroneous and dangerous an opinion: and by stating in as concise and clear a manner as I am capable, the reason and authorities upon which this use- ful and necessary practice is built, endeavour to preserve to them a remedy, upon the timely application of which, their own lives and the well-being and happiness of their families, may some time or other depend. A2 A PUB- (4) A PUBLICATION like this, upon a subject of equal delicacy and importance, should, I confess, in some measure be warranted by necessity, as well as recommended by utility; and I flatter myself that when the real efficacy of this remedy is known, and the urgency of the cases in which it is applied, is considered, I shall not be thought needlessly to have undertaken its defence, or officiously to have obtruded my opinions on the public. No one is unacquainted with the use of cold in checking hemorrhagies from the nose or other parts of the body; even in amputations it is allowed to be one of the most useful remedies, and it is frequently found impossible to stop the bleeding from a stump by any art or application, while it is kept warm by dressings and bed—clothes. Doctor Cullen, professor of the practice of physick at Edinburgh, speaking of hemorr- hagies in general, has these words, * “ The * Cullen's practice, § 800. “ most (5) “ most powerful of all astringents appears “ to me to be cold, which may be employ- “ ed either by applying cold water to the “ surface of the body, or by throwing it “ into the internal parts.” But I believe the general principle has never been contested; I will therefore confine my enquiry to the application of this remedy in child-bed cases, and that I may be as clear and intelligible as possible, I will suppose the most simple case—a flooding after a complete and perfect delivery. ALL hemorrhagies proceed either from too great force in the heart and arteries, by which all resistance in the coats, or at the extremeties of the small vessels is overcome; or from too great weakness in the coats, or too great relaxation in the mouths of the extreme vessels themselves; whence they make little or no resistance to the ordinary force of the circulation. UTERINE hemorrhagies in the case I have stated, are always of the latter kind. The womb, (6) womb, which is capable of a most wonder- ful distention during pregnancy, has all its vessels proportionably enlarged; and parti- cularly at the part by which the connection between the mother and child is kept up. By delivery this connection is suddenly broken, and but for the immediate con- traction of the womb, by which the mouths of so many ruptured vessels are closed, the birth of every child must inevitably occasion the death of its mother. THIS sudden contraction of the womb is the provision which nature has made to prevent the fatal consequences which must otherwise ensue; and when (as sometimes happens in delicate and relaxed women, who have been debilitated by previous complaints, or exhausted by tedious and laborious births) the womb does not possess these strong and vigorous powers of con- traction, the most profuse and violent he- morrhagies, such even as to occasion death in a few minutes, are sometimes the con- sequence. I BE— (7) I BELIEVE it will readily be allowed, that in every case of this kind, it is the duty of the physician to aid the efforts of nature, by endeavouring to bring about as soon as possible, the necessary contraction of the womb, by which alone the discharge can be checked; to prevent, if possible, the patient from fainting, which more than any thing beside relaxes the human body, and from which she may never revive; and to loose no time in the application of the necessary remedy: and fortunately the re- medy is at hand, cold in whatever way it is applied, answers all these intentions; it rouses the languid powers of life; prevents fainting; stimulates the womb to immediate and effectual contraction; is ready upon all occasions; easy in its application, and speedy and powerful in its effects. And accor- dingly we find it recommended by every writer of eminence, from the earliest ac- counts we have of the practice of midwifery, to the present day; at first I confess with more caution than of late years; but like every (8) every other efficacious remedy, its use has become more general, and its application more simple, as time and experience have confirmed its efficacy and safety. Mauriceau a French writer of reputation, who published so early as 1668, directs the women to be laid on fresh straw covered with a single sheet, to avoid heating the loins, and to apply to the small of the back and sides, cloths dipped in cold vine- gar and water: adding thro' an excess of caution, that in winter it should be a little warmed*. † La Motte another French writer, directs the hands and face to be wet with vinegar and water, compresses dipped in it to be applied to the abdomen and loins, and as few coverings to be left on the patient as possible. * Mauriceau, sur le acoushment. Tom. I. p. 387. † Treatise of midwifery by La Motte, translated by Tomkyns. p. 478. Smelley, (9) Smelley, one of the best English writers, says “ in these cases such things must be “ used as will assist the contractile power “ of the uterus, and hinder the blood from “ flowing so fast into it and the neighbour- “ ing vessels; for this purpose cloths dipped “ in any cold astringent fluid, such as oxycrate “ (vinegar and water) or red tart wine may “ be applied to the back and belly*.” Spence, a lecturer of reputation at Edin- burgh, asserts, that “ what is principally to be relied on is the application of cold to the small of the back and external parts, for which purpose a towel folded and clipped in cold vinegar, or in cold spring water alone, is as good as any thing else; ” which practice he confirms by an account of some success- ful cases in which this method was pursued.† Doctor John Leake, physician to the West- minster lying-in hospital, besides the liberal use of cold air, cold applications to the back * Smelley's midwifery, vol. I. p. 398. † System of midwifery, p. 308. B and (10) and loins, and frequent draughts of cold water, which he uses in all cases of flooding, —recommends where the flooding becomes so profuse as suddenly to endanger life, to plunge the feet and legs into cold water; and in proof of the safety of this practice asserts that out of three thousand women delivered in the Westminster lying-in hos— pital, several of whom were seized with dangerous hemorrhagies, but two failed under this free use of cold*. He quotes Leveret, a French writer, “ who hit upon “ an ingenious expedient to stop a violent “ discharge of this kind, which otherwise “ would soon have proved fatal, by intro- “ ducing a piece of ice into the womb, which “ being struck with a sudden chill, imme- “ diately contracted and put a stop to the “ hemorrhagy‡” Π The ninth volume of the medical commentaries published at Ed- inburgh, contains, in a letter from doctor Fitzpatrick, of Dublin, to doctor Duncan, * Leake's diseases of women. vol. II. p. 322. 323. ‡— p. 288. page 227. a very (11) a very instructive case, of a woman redu- ced to the lowest extremity by means of a profuse and tedious flooding, saved from otherwise inevitable death, by immersing her back and loins in a cold bath, and pour- ing cold vinegar upon the abdomen imme- diately after delivery. I AM credibly informed that this practice is generally admitted in France; and that the present professors in Edinburgh and London, constantly teach and recommend it. Mr. Walch, particularly, an eminent teacher in London, not only recommends the liberal use of cold water, but advises that in the summer season it should be rendered still colder, by dissolving in it sal ammoniac. THUS we see that the use of cold in these cases, is not only consistent with the clearest reason, and very applicable to the cause and nature of the complaint, but that it has actually been practised for upwards of an hundred years; that, it has stood the test B2 of (12) of long experience, and gained reputation by frequent use, and that every writer of eminence (particularly those of late years) constantly recommend it, and vouch for its efficacy and safety. A trifling, and in so far as it obscures the principle, a prejudicial distinction, has, I hear, been set up between the effects of vinegar and water in these cases: the truth is, neither can do good but in so far as it is cold, and that altho' equally beneficial in winter, spring water must in summer, ma- nifestly have the advantage over vinegar; which being commonly kept in a warm closet, is at that season seldom much col— der than the human body. And should so weak and erroneous an opinion in favour of vinegar, and against water, prevail; it must necessarily on many occasions, particularly in warm weather, deprive this noble remedy of all efficacy; and leave the unhappy pa- tient, in an hour of extreme danger and distress, to be trifled with and amused, when vigour (13) vigour and decision, are essential to her preservation. It is almost unnecessary to add that such is the difference in the female constitution, that one woman may loose her life by an evacuation of blood, which will occasion little or no injury to another; and that a fatal internal hemorrhagy may sometimes occur, which is manifested by no extraor— dinary external discharge. In such instances we must judge of the danger by the conco— mitant symptoms, such as pale lips, a feeble pulse, great languors, and frequent fainting; and where such symptoms occur, it is un— questionably our duty to prevent the farther effussion of blood, by every means in our power. Nor is the use of cold confined to hemorrhagies after delivery; but will be found the most effectual paliative in all in— stances of flooding which precede delivery; And I can assert from the testimony of the most unequivocal experience, that in those critical and dangerous cases which some— times (14) times occur at the very latter end of preg- nancy, the judicious application of cold, will more than any other remedy moderate the discharge, and at the same time promote the pains of labour and hasten delivery, by which only an effectual stop can be put to the hemorrhagy. I HOPE it will not be supposed that I mean to discountenance the use of every other remedy which may be called in to our aid in these very dangerous cases, or that I would propose to immerse every woman who is taken with an uterine hemorrhagy, into a cold bath. Other remedies may unquestionably be of use, and this most important one must ever be proportioned to the urgency of the symptoms 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 safety in more than one instance; and to save my brethren from the painful dilemma (15) dilemma to which I have been reduced, when I have been under the necessity of doing my duty to my patient, in opposition to the sentiments of her parents and most tender connections. SHOULD it be thought that I have de- scribed the danger to which women are sometimes exposed in these cases, in terms which may possibly impress a timid mind with too much apprehension; 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 such case of great and immediate hazard, it is not only necessary that the proper remedy should be well ascertained, and generally understood, but that all prepos- session and prejudice against it, in the minds of the patient or her friends should be removed; that the physician being left to the cool exercise of his own judgment, may not be compelled to waste in argument and dispute, those precious moments, in which only he can save the life of his patient. FINIS.