on the use of the secale cornutum in utebine hqmorrhage

1
592 ON THE USE OF THE SECALE CORNUTUM IN UTEBINE HÆMORRHAGE. To the Editor of THE LANCET. SiR,—In the 199th Number of THE LAN- CET, a Correspondent asks if the 11 secale cornutum" has been used by any one in cases of flooding ; for his information I beg leave to state, that I have used this sub- stance in several cases of alarming uterine haemorrhage with decided success, when all other means seemed to have failed. Indeed it is with perfect confidence I recommend a trial of it to your Correspondent, and to the profession at large, as it is not by a few cases in the practice of an individual alone, which can establish the value of a remedy, but the united testimony and experience of many. I have administered it in those cases with the view of exciting the con- tractile efforts of the uterus, or, as Dr. Dewee terms it, the 16 tonic contraction," which never fails to put a check to the haemorrhage, and place the patient speedily out of the imminent danger which threat- ened. But to effect this purpose, as it is essential to put a stop to the discharge with the greatest possible celerity, so it is necessary to ensure success, that the medi- cine be given in efficient doses, as it must be considered that the patient is generally in a debilitated or weakened state, and the action of the uterus probably has entirely ceased, and therefore requires a more pow- erful stimulus than it would in the earlier stages of the process of child birth. I am in the habit of using a concentrated tinc- ture of the ergot, in the dose of two tea- spoonfuls, repeated as often and as spee- dily as the circumstances of the case will admit, till the 11 tonic contraction" is in- duced, which in general is very soon, if the stomach will retain the medicine, which when given in cold brandy and water, (my practice,) it seldom fails to do. In flood- ing succeeding to the delivery of the child, and before the entire separation of the pla- centa, I prefer extracting the latter ; but if the uterus continue inactive, of course I immediately have recourse to the secale cornutum. I have now used this substance for the last six years, and have no hesitation in saying, I consider it one of the most va- luable and powerful agents (medical) which the accoucheur possesses ; in tedious or lingering labours, and in uterine haemor- rhages, provided that in the former it be administered with due precautions, and in cases favourable for its administration. Wlien the os uteri is peculiarly rigid and an3·ieldinL, or inflamed, I think there can be little doubt that itg administration would be improper, it would indeed be likely to prove injurious, if not fatal, to the child, and greatly exhaust the mother, by inducing powerful contraction of the womb, before the os uteri was disposed to dilate. In this case if venesection, fomentations to the external parts, and an opiate, be had recourse to, in order to procure a short in- terval of rest, the ergot will then, if the action of the uterus has not come on, be found to terminate the case safely and expe- ditiously. I may here allude to the opinion some practitioners maintain, viz. that the ergot exerts a specific or deleterious effect on the child in utero. I can only say, that I have used it extensively and largely, (I will even admit, that in some cases it might be unnecessary,) but the time of a country practitioner is of importance, and feeling satisfied of the innocence of the medicine when cautiously administered, I have not hesitated to give it whenever I have thought the labour would be a tedious one ; there are of course circumstances of constitution, or disease in some patients, which may preclude its use ; but I can safely assert, that in no case in which I have used it has the child appeared to suffer from it, and the only cases in which the child has been still born, when the secale was used, were those which had been lingering for a considerable time before I was called in, and in no case could the death of the child be attributed to the medicine. I think if an accurate in- vestigation were made by practitioners of experience, the average of still birth would be found to be much on the side of prac- tice in which the secale was not used, but the cases (I allude to tedious ones) left to nature, than in the practice of those who prescribed this substance. I could add a great deal more on this interesting subject, did I not feel that I was intruding myself too much on your valuable pages. " Should you deem this communication worth inser- tion or not," I shall at any time be ready to communicate any infoimation I may pos- sess, at all likely to benefit my profession or fellow creatures, or worthy of your in- sertion. I am, Sir, Yours cbediently, HEKRY R[;DGF, M.D. Surgeon, &c. Leominster, Herefordshire, Aug. r), :[827.

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Page 1: ON THE USE OF THE SECALE CORNUTUM IN UTEBINE HqMORRHAGE

592

ON THE USE OF THE SECALE CORNUTUM IN

UTEBINE HÆMORRHAGE.

To the Editor of THE LANCET.

SiR,—In the 199th Number of THE LAN-CET, a Correspondent asks if the 11 secalecornutum" has been used by any one incases of flooding ; for his information I begleave to state, that I have used this sub-stance in several cases of alarming uterinehaemorrhage with decided success, when allother means seemed to have failed. Indeedit is with perfect confidence I recommend atrial of it to your Correspondent, and to theprofession at large, as it is not by a fewcases in the practice of an individual alone,which can establish the value of a remedy,but the united testimony and experience ofmany. I have administered it in thosecases with the view of exciting the con-tractile efforts of the uterus, or, as Dr.Dewee terms it, the 16 tonic contraction,"which never fails to put a check to the

haemorrhage, and place the patient speedilyout of the imminent danger which threat-ened. But to effect this purpose, as it isessential to put a stop to the dischargewith the greatest possible celerity, so it is

necessary to ensure success, that the medi-cine be given in efficient doses, as it mustbe considered that the patient is generallyin a debilitated or weakened state, and theaction of the uterus probably has entirelyceased, and therefore requires a more pow-erful stimulus than it would in the earlier

stages of the process of child birth. I amin the habit of using a concentrated tinc-ture of the ergot, in the dose of two tea-spoonfuls, repeated as often and as spee-dily as the circumstances of the case willadmit, till the 11 tonic contraction" is in-duced, which in general is very soon, if thestomach will retain the medicine, whichwhen given in cold brandy and water, (mypractice,) it seldom fails to do. In flood-ing succeeding to the delivery of the child,and before the entire separation of the pla-centa, I prefer extracting the latter ; but ifthe uterus continue inactive, of course I

immediately have recourse to the secalecornutum. I have now used this substancefor the last six years, and have no hesitationin saying, I consider it one of the most va-luable and powerful agents (medical) whichthe accoucheur possesses ; in tedious or

lingering labours, and in uterine haemor-

rhages, provided that in the former it beadministered with due precautions, and incases favourable for its administration.Wlien the os uteri is peculiarly rigid andan3·ieldinL, or inflamed, I think there can

be little doubt that itg administrationwould be improper, it would indeed be

likely to prove injurious, if not fatal, to thechild, and greatly exhaust the mother, byinducing powerful contraction of the womb,before the os uteri was disposed to dilate.In this case if venesection, fomentations tothe external parts, and an opiate, be hadrecourse to, in order to procure a short in-terval of rest, the ergot will then, if theaction of the uterus has not come on, befound to terminate the case safely and expe-ditiously. I may here allude to the opinionsome practitioners maintain, viz. that theergot exerts a specific or deleterious effecton the child in utero. I can only say, thatI have used it extensively and largely, (Iwill even admit, that in some cases it mightbe unnecessary,) but the time of a countrypractitioner is of importance, and feelingsatisfied of the innocence of the medicinewhen cautiously administered, I have nothesitated to give it whenever I have thoughtthe labour would be a tedious one ; thereare of course circumstances of constitution,or disease in some patients, which maypreclude its use ; but I can safely assert,that in no case in which I have used it hasthe child appeared to suffer from it, and theonly cases in which the child has been stillborn, when the secale was used, were thosewhich had been lingering for a considerabletime before I was called in, and in no casecould the death of the child be attributedto the medicine. I think if an accurate in-

vestigation were made by practitioners ofexperience, the average of still birth wouldbe found to be much on the side of prac-tice in which the secale was not used, butthe cases (I allude to tedious ones) left tonature, than in the practice of those who

prescribed this substance. I could add agreat deal more on this interesting subject,did I not feel that I was intruding myselftoo much on your valuable pages. " Should

you deem this communication worth inser-tion or not," I shall at any time be readyto communicate any infoimation I may pos-sess, at all likely to benefit my professionor fellow creatures, or worthy of your in-sertion.

I am, Sir,Yours cbediently,

HEKRY R[;DGF, M.D.

Surgeon, &c.

Leominster, Herefordshire,Aug. r), :[827.