judgment oftentimes fatal error, is to rely on the use of Ergot, hence as soon as it is ascertained that hemorrhage exists, this remedy is resorted to under the conviction that it will provoke contraction, and thus arrest the flooding. The cardinal objection to this practice is, that although Ergot does unquestionably exercise a positive and marked influence on the muscular action of the uterus, yet its effects are not immediate, frequently ten, fifteen and twenty minutes elapsing before there is the slightest therapeutic manifestation. With this agent,

therefore, as the sheet-anchor of hope, death will often ensue before the remedy acts; and I have no hesitation in saying to you that Ergot should not be classed among the heroic agents in the treatment of uterine hemorrhage after the birth of a child. There can be no harm in administering it, but do not let it take the place of other and more reliable means," which have been alluded to. On this subject Playfair wrote: "I believe it is thoroughly good practice to administer a full dose of the liquid extract of Ergot in all cases after the placenta has been expelled, to ensure persistent contraction and to lessen the chances of blood clots being retained in the utero." This is, with others, "a precaution which should be used in all cases alike; but whenever we have reason to fear, from the history of previous labors, or other cause, the occurrence of hemorrhage, special care should be taken. The Ergot should be given before the birth of the child when the presentation is so far advanced that we estimate that labor will be concluded in from ten to twenty minutes." As to its use after hemorrhage has supervened, he added: During the time that pressure is being applied attention can be paid to general treatment. A full dose of Ergot should be administered, and if one have already been given it should be repeated. We can not, however, look upon Ergot as anything but a useful accessory, and it is one which requires considerable time to operate."

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Cazeauz and Tarnier say: In an alarming hemorrhage, one dependent on a complete inertia of the womb, for example, the patient would certainly die unless the means at hand act promptly. In such cases the hypodermic injection of Ergot or Ergotin are most important. In some females the uterine hemorrhages have a marked tendency to relapse. Consequently Ergot ought to be administered as soon as it has occurred, whether it seems to be finally arrested or not." In a paper read before the Kings County Medical Society, less than one year since, by Dr. Joel W. Hyde, of Brooklyn, and entitled, "Ergot: A resumé of its use and dangers in Obstetrics," is found the following: "The theory of an indiscriminate use of Ergot in every case of parturition,

based on the fear that possibly there may be a post-partum hemorrhage, seems to me to be so contrary to the spirit of nature, so distrustful that the womb does not know its business, that for one I am compelled to take exceptions to it. To prescribe Ergot immediately after all deliveries for fear of hemorrhage presupposes that it is a law of Nature for all uteri to be afflicted with atony or inertia immediately they are relieved of their contents." "In actual post-partum hemorrhage-i. e., where any sudden and great loss of blood has occured, the first condition of the patient is that of shock. In all probability a dose of the fluid extract of Ergot administered by the stomach would be immediately rejected; if it should be retained, it would not be absorbed, hence it would be useless. If the hemorrhage should be so alarming as to threaten the life of a patient, hypodermic injections of Ergotin, of course, should be added to any other measures deemed advisable; but it is almost incredible for so serious a condition of offairs to obtain, except in the delay of the arrival of the medical attendant." In summing up the points of his paper Dr. Hyde numerically stated his reasons why the use of Ergot should be curtailed or discontinued, and gives the eighth reason thus: "Ergot is never necessary. If there is no more than the usual moderate hemorrhage which ordinarily accompanies a delivery the uterus will take care of itself." It is just to add that while the tenor of Dr. Hyde's paper was decidedly against the use of Ergot in obstetrical practice, other practitioners of equal eminence and experience demurred, in the discussion which followed, from the positiveness of some of his conclusions, yet all showed by their remarks that the methods of the use of Ergot had very materially changed during the past few years. In a paper presented by the writer, to this Society, at a former meeting, it was stated that: "Ergot has been very seldom used during this obstetrical experience, for any purpose, and particularly for the purpose of controlling hemorrhage. In those cases which have received doses of from one-half to a teaspoonful of the fluid extract, for the purpose of exciting or increasing labor pains, its use has generally been found to be followed by a more offensive lochia than has been present in cases in which the drug was not used. The administration of a full dose of a fluid extract of Ergot, as is taught and largely practiced by our old school brethren, is a practice which my experience has shown to be unsound in teaching, uncalled for in execution, and for worthy reasons much to be deprecated." Such were the opinions uttered then, and now introduced only that they may receive greater emphasis. In the foregoing, allusion has been made to the most prominent means and measures depended upon

for the immediate control of post-partum hemorrhage. Time will not permit an extended presentation of other means, but in passing may be mentioned the use of intra-uterine injections of hot water at a temperature of 110°. With this no personal experience has obtained. In the paper of Dr. Hyde, already quoted from, is the statement, that instead of depending upon the effects of Ergot, "Any prompt intrauterine use of the hot douche would be likely to control satisfactorily all excessive hemorrhage," and also that, "the hot water intra-uterine douche is efficient and preferable for controlling hemorrhage."

Compression of the abdominal aorta is a measure for the control of hemorrhage which has found some ardent supporters, and yet, "notwithstanding the numerous successes which have been attributed to this operation, several authors, amongst whom M. Jacquemier is conspicuous, contest its utility, and even go so far as to consider it injurious." Injections of active astringents, like the Iron preparations, into the uterine cavity have also been used, but the use of them has not received the unqualified support of those eminent in obstetrical practice, because the chief result attained is not the production of uterine contraction, but instead thrombosis of the uterine veins and sinuses, which might prove to be an injurious element in the subsequent condition of the patients, therefore when intra-uterine injections have been deemed imperative, some more bland preparations have usually been selected, among which Vinegar may be mentioned. Its commendation for internal use should also be borne in mind.

This paper has been quite hastily prepared, with no thought to encompass the whole subject, and with no other desire than to submit something upon which might be based an energetic discussion embodying, if agreeable, personal thought and experience. It is submitted with the injunction that we are to remember that with the control of a post-partum hemorrhage our duty is not completed. We will have before us an exsanguinated patient whose life is yet in the balance; whose death may be momentarily feared because of fatal syncope; whose system may be so thoroughly shocked as to require our most constant and intense vigilance to keep alive the vital spark, which spark may have to be cautiously dealt with for an extended time before we can pronounce the wonted vigor rehabilitated. If permitted to speak of the means by which this result is to be attained, it would be suggested that for the first few hours alcoholic stimulants be cautiously used; that the foot of the bed or couch whereon the patient lies be elevated, the degree of elevation to be from one inch to one foot or more, this to be determined by the quantity of blood remaining in the

body, and which must be kept coursing in the more vital parts. Food must be judiciously selected for the qualities of easy assimilation and substantial nutrition. Systemic disorders must be met as they arise, and for these will you be gratified by the beneficient action of the homœopathic remedy.

ANESTHETICS IN LABOR.

BY B. S. PARTRIDGE, M. D.,

EAST BLOOMFIELD, N. Y.

The discovery of anaesthetics marks an era in the progress of surgery. All through the ages, attempts had been made to relieve the pain of surgical operations, but to little purpose.

Science at last pointed to an agent that gave promise of supplying the long-felt want. Experiments were made, and in October, 1846, a state of unconsciousness to pain was produced so effectually, and by an agent so reliable, that artificial anaesthesia was placed upon a truly scientific basis.

It was only a step from surgical to obstetrical anesthesia. Simpson, of Edinburgh, first administered Ether for the purpose of facilitating labor. He wisely chose for his first experiment, a case of version. Here it mattered not if, under the influence of the new agent, all uterine contraction should cease. To his delight he found that neither the rhythm nor the power of uterine action was at all disturbed, while the patient enjoyed complete immunity from conscious pain. This discovery, upon which depended the whole gist of the matter, having been verified by repeated experiments as well in natural as in preternatural labors, placed obstetrical anesthesia among the established methods.

In a short time, the new practice found many followers, not only in England but upon the Continent. In our own country, the first administration of Ether in obstetrical practice took place April 7, 1847.* Simpson had already used it over fifty times.

The results of the new method in the hands of Dr. Channing were highly satisfactory, and furnished material for a monograph upon the subject.

*N. C. Keep, Boston.

The discovery by Simpson in 1847, of the anesthetic properties of Chloroform, marks the second period in the history of obstetrical anæsthesia. This new agent was found to possess many advantages over Ether, and but for the few cases of deaths reported when given for surgical operations, it would have superseded the use of Ether in obstetrical practice.

While many, both in Europe and America, were inclined to look with favor upon the use of anæsthetics in preternatural labors, their use in natural labors met with a storm of opposition upon all sides.

The acceptance of the new method by Her Majesty, Queen Victoria, in her seventh, and again in her eighth labor, carrying with it the influence which royalty always exerts, gained for it an early acceptance in Great Britain.

The administration of anaesthetics in obstetrical operations and painful manipulations, inasmuch as it differs in no essential respect from that in surgery, has the approval of the medical profession of to-day. Their use also in natural labors is endorsed by many practitioners. I desire to enter a protest against their indiscriminate use in these cases.

Labor is a physiological process, and under normal conditions, and with natural antecedents, the pain and suffering is very slight. Among the lower races there is no more necessity for the use of anæsthetics in child-birth than in the act of deglutition. We find a portion of the women of our own civilization in whom labor approximates the physiological type. With these neither anaesthetics nor any other agent

should be used.

But the larger number of so-called natural labors are attended with pathological conditions. It becomes the duty of the physician to relieve these conditions by the best means at hand. Here the homoeopathist possesses a great advantage over his brethren of the dominant school. In very many cases the carefully selected remedy will prove the most potent agent for mitigating the suffering incident to parturition.

But the accoucheur will sometimes be disappointed in his efforts thus to relieve the pangs of child-birth. They are dependent many times upon conditions beyond his control, as, for example, a diseased condition of the uterus, or a disproportion between the foetal head and the maternal parts; or a peculiarly susceptible nervous system; or the enervating influences of fashion and luxury. Here the similar remedy will often fail to mitigate the suffering of the parturient woman. It then becomes the duty of the physician to bring to her relief all the benefits of an anæsthetic.

The careful study of the physiological action of anæsthetics, dis