Galvanism, applied to the treatment of uterine haemorrhage / by Thomas Radford.

  • Radford, Thomas, 1793-1881.
Date:
1844
Catalogue details

Licence: Public Domain Mark

Credit: Galvanism, applied to the treatment of uterine haemorrhage / by Thomas Radford. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    ant in the suppression of the bleeding, may become, indirectly, an evil instead of an advantage, by deterring the practitioner from making a proper investigation of the case, under the idea that “ the disturbance of these coagula is death.” In my opinion, the coagula which are more particularly to be depended upon, are those in the immediate neighbourhood of the venous orifices that have been exposed, and I repeat that these are of no avail in the more serious cases; and therefore we must solely trust for the suppression of these large discharges of blood to that most important agent, contraction of the uterus. The ordinary means of producing uterine contrac- tion are so well known that I need merely refer to them before the present audience. We have the bandage, friction applied briskly over the uterus, grasping pressure, secale comutum, the application of cold, and in the after haemorrhages the introduc- tion of the hand into the uterine cavity. But all these means may fail in producing this desirable change, and will fail and do fail in the extreme cases. A fatal case having recently occured in this town, which produced a considerable sensation at the time, where delivery was adopted, contrary to the prin- ciples which I had always publicly inculcated in my lectures, I was led to investigate the arguments of those who advocate that practice, more closely than I had perhaps ever before done; and it struck me that we were deficient in a means on which we might always depend for inducing uterine con- traction, and so placing the woman in such a state of safety that the operation of delivery might be deferred. Whilst my mind was so much occu- pied upon this subject, I was consulted by my friend Dr. Goodwin, in a case of protracted labour, where the long forceps were required. The lady recovered well, with the exception of not being able to pass her urine. We administered all the usual remedies for a fortnight or more, using the ca - theter twice, sometimes three times a day, but with- out the least amendment Upon Dr. Goodwin’s suggestion, we decided upon the application of gal- vanism, which was undertaken by him, and the result was most gratifying, for the first application proved permanently successful. The decided efficacy of this plan in restoring the energy of the bladder, immedi- ately led me to conclude that it was the very agent that I have already stated was a desideratum to ensure uterine contraction in cases of severe flooding, attended with exhaustion. We have here a woman reduced by loss of blood, with an atonic state of the uterus, either primary or as the result of the dis- charge. Now, as the advocates of delivery (Vide Burns and Hamilton) say that this proceeding gives the woman the only chance of living, because, so long as the uterus remains distended by its contents, and its parietes atonic, those large venous orifices which have been exposed by the separation of the placenta, are so situated that the chances of further effusion of blood exist, it occurred to me that the application of galvanism would so effectually act upon the uterine tissue as to induce firm contrac- tion of its fibres, and thereby at once lessen those large openings, and bring the walls of the uterus into firm apposition with the body of the child, so as to entirely close them. This great object having been attained, we might safely procrastinate the delivery, and adopt such means as would tend to raise the vital powers of our patient, such as the administration of opium, stimulants, and support; and the performance of the important operation of transfusion. With the uterus in this favourable condition, our restorative means, and particularly transfusion, would be far more likely to be attended with successful results than if the organ were dis- tended and atonic; for in this case, the blood which is introduced into the system, either directly by transfusion, or indirectly by nourishment, produces no permanent benefit, because it is rapidly dis- charged again. Analogy further led me to believe that my conjectures would not prove unfounded, for galvanism is particularly impressive in its influence upon the muscles of recently killed animals, and we know how strictly allied in action, if not in structure, the uterus is to muscle. I mentioned my views to a number of medical friends who generally much approved of them; and I was soon enabled practically to prove their correctness, by being called in consultation to a case of frightful internal haemorrhage during labour, attended with extreme exhaustion, and where the os uteri was so rigid that the advocates of delivery could not possibly have carried their views into practice, without lacerating the os and cervix uteri. By this case I ascertained that gal- vanism produces an effective and powerful con- traction of the uterus; and not only so, as regards its tonic contraction, but it has also the power of energetically exciting alternate contraction when applied at intervals. I can tell you most seriously and most solemnly, that it produces these two im- portant changes upon the uterus in such a degree as in my previous reflections on the subject I had no conception of. The alternate contraction excited by this agent is analogous to, and as power- ful as, that which is observed in normal labour, and the tonic contraction is greater. I shall not relate cases in detail, because it would occupy too much time; but I may state that I applied galvanism in a case where the membranes were unruptured, and the uterus in a state of great inertia, and alternate contraction was immediately produced. Before this the membranes were very flaccid ; but as soon as the galvanic circle was completed, they became extremely tense and protruded low down into the vagina; and this state of tension did not subside when the alternate contraction ceased, as is observed in some degree in normal labour; for although the gal- vanic conductors were removed, so great a degree of tonic contraction of the uterus had been induced that this membranous bag could not collapse.