In most cases flooding is preceded by dull pain in the loins and groins, and a sensation of weight and dragging. Similar sensations however are often produced by other causes, which makes it difficult to predicate, with any degree of certainty, whether the patient is about to flood or not. The very first appearance of blood from the vagina must therefore be watched for carefully, as that removes all doubt, and warns us to be prompt with the proper remedies. Sometimes a female will flood internally, the blood being retained by the passage being closed or plugged up by clots, or by its passing behind the membranes, or under the centre of the placenta. These internal or concealed hemorrhages are very dangerous, as the patient may lose much blood before her condition is suspected. It is therefore necessary to bear this in mind, and carefully use every means to ascertain whether such an accident has occurred or not. In general the indications are pretty plain, the patient suffering from deep seated and distressing pains in the back and groins, with great weakness in the limbs, faintness, weak pulse, dimness of sight, ringing in the ears, coldness of the hands and feet, swelling of the abdomen, and finally fainting, particularly if the retained blood suddenly escapes, which it usually does.
In the early months there is more danger to the child from flooding than there is to the mother, because it is nearly certain to lead to abortion. In the latter months, on the contrary, the mother runs the greatest risk, as the child may then live if it be expelled, while the mother may sink and die from excessive loss of blood. There are many females of a very full habit, who suffer but little from hemorrhage, unless it be excessive, indeed some seem to be benefitted by it, and are thus relieved from headache and convulsions. It should, however, be carefully watched, and its effects duly noted.
The treatment of flooding must depend materially upon its severity, and the time when it occurs. In the early months, when the discharge is slight, and when it causes little distress, simple means will answer. The patient must lie on her back, on a hard mattress, with the pelvis raised, by means of a pillow, higher than the rest of the body. The air must be kept fresh and cool around her; she must keep herself quiet in body and mind, live rather low, and drink freely of cooling drinks, such as soda water, lemonade, tamarind tea, or ice water. [The fullest directions for making and using all these drinks will be found in my "Diseases of Woman.">[
If the flooding does not stop with these simple means, external applications must be made, of cold, wet cloths, or even ice, over the abdomen, and inside the thighs. Finally, if further treatment is still needed, cold astringent injections may be carefully thrown into the vagina. Cold water is perhaps as good as anything for this purpose, and I have frequently known a most severe flooding checked immediately by injecting cold water into the vagina and rectum, and applying cold wet cloths over the abdomen, and inside the thighs. Some astringent drink may also assist, such as a little syrup of comfrey, or extract of Rhatany, and particularly a tea made of the root of the black currant, as recommended in my "Diseases of Woman."—[A handful of the root may be boiled in two quarts of water, for twenty minutes; it should be sweetened to taste and drunk freely. The common blackberry, or the dew berry, is also excellent, though not so good as the black currant.]—If the patient be nervous and irritable, or suffer much from pain, an opium pill may be taken, or from ten to twenty drops of laudanum.
The general practice in these cases is to bleed freely and give opium! And as this practice certainly does succeed in many extreme cases, I should certainly recommend, if the simpler means fail, to resort to it at once. I dislike bleeding very much, in any cases, and here it seems particularly inappropriate; I should therefore say try almost anything and everything first, but never obstinately refuse to do it if nothing else succeeds.
In some cases a plug or tampon is used, to fill up the vagina. It may be made of a roll of cloth, cotton, or a piece of sponge. This practice, however, is useless in the latter months of pregnancy, and very often fails even at other times. When it succeeds it causes the blood to coagulate, and thus closes up the mouths of the vessels. Quite as often, however, it only keeps it in, and makes it accumulate in the womb till it all rushes away at once; still it may be tried.
If the hemorrhages should occur so frequently, or be so excessive, in spite of all treatment, as to endanger the safety of the patient, there is no other resource left to save her life but to produce abortion, because the presence of the fœtus and its appendages is evidently then the irritating cause which keeps up the discharge, and it cannot be expected to stop till the womb is emptied.
ABORTION, OR MISCARRIAGE.
When the fœtus is prematurely expelled before it can survive, it is called an Abortion, but if its expulsion take place so late that it can live, it is called Miscarriage. Both these are serious accidents. In abortion the child is lost, as a matter of course, but in miscarriage it may live, after the seventh month. The danger to the mother is considerable from both, though greatest probably from abortion. It is probable that many very early miscarriages take place unperceived, the female suffering but little from the accident, and the embryo being too small to be seen, unless carefully looked for.
The most frequent periods for such accidents are found to be six months, five months, and three months; and what is very singular, a much greater number of male children are aborted than females, the proportion being about sixteen to eleven.