1920s Medical Treatment for Postpartum Hemorrhage

I am researching a book and have an unusual question. Does anyone know
what treatment would have been given to a woman in the early 1920s in
the USA who hemorrhaged at home, 15 hours after birth, to a stillborn
baby? The woman died, and the secondary diagnosis was uterine atony on
the death certificate. Could anything have been done to save a person
suffering from hemorrhage at home in those days? In this person's case
the doctor who had delivered the baby had left was not present when the
hemorrhage occurred, and only the husband was there.
Any help would be appreciated. Thanks!
Laura

Lara wrote:
wrote:

I am researching a book and have an unusual question. Does anyone
know what treatment would have been given to a woman in the early
1920s in the USA who hemorrhaged at home, 15 hours after birth, to a
stillborn baby? The woman died, and the secondary diagnosis was
uterine atony on the death certificate. Could anything have been
done to save a person suffering from hemorrhage at home in those
days?

I'm not sure whether you're asking what treatment would have been
likely to have been given, or whether there might have been something
that could theoretically have been done to help (but wasn't routine
in the day)? The most obvious answer to the latter would be urinary
catheterisation (if the bladder was overfull and there was a silver
straight-cath available), gentle uterine massage, and manual nipple
stimulation, though there's no guarantee it would have saved her. They
did have ergot, too, though I'm not sure whether it would be
available in the home.

"Vitalogy", a home-treatment manual of 1926, has a section on
"Flooding" (postpartum haemorrhage). Recommended remedies include:
- a mixture of oil of cinnamon and four tablespoonfuls of alcohol,
half a tsp every15-60 minutes depending on urgency.
- equal parts of alum and nutmeg
- hot irons to the feet if they were cold
- plugging of the vagina with soft cotton cloth or an old silk
handkerchief or linen, replacing the compress every 6-7 hours. There
is a warning about concealed hemorrhage if this technique is used.
- one-fourth of an ounce of alum added to a pint of warm milk; one
tablespoonful every 30-60 minutes
- one part of well-powdered charcoal and six parts of powdered white
sugar, rubbed together in a mortar and pestle. One quarter of a tsp
every hour.
- a powder called "bebeerine", one-half grain three times a day (it
doesn't say what this is, just that it may be purchased at drug
stores)
- a tea of witch-hazel or beth-root, or both combined
- external uterine massage, combined with cold-water vulvar compresses
and ice chips placed in the vagina or rectum while swallowing chunks
of ice frequently
- keeping the woman horizontal, no head pillow, with slight elevation
of the hips
- if she appears to be on the point of death, brandy, slightly
diluted, small quantities frequently

After the haemorrhage has ceased:
- allowing the woman to sleep (closely monitored) in a dark cool quiet
room with plenty of fresh air but no drafts
- a diet of gruel, cold boiled milk, chicken broth, arrowroot, beef
tea, custard, calf's-foot jelly, cand cold drinks


I also have a copy of "Practical Obstetrics" from 1902. It opens the
PPH section by exhorting the obstetrician to differentiate between
bleeding from the uteroplacental site and bleeding from torn vessels
in the "soft parts", by the appearance of the blood.
* Haemorrhage from lacerations: it is recomemnded to inspect carefully
(there is a detailed description of the mechanics) and repair the
lacerations

* "True PPH":
1. Prophylaxis: constant gentle external fundal uterine massage from
the birth of the baby till ten minutes after the delivery of the
placenta
- avoiding too-rapid "extraction of the child"
- if a firm contraction isn't immediately forthcoming with massage,
application of ice to the abdomen, emptying of the bladder (with
catheter if necessary)
- administration of ergot, a drachm of fluid extract orally (there is
a warning about its hypodermic adminstration because of a risk of
subcutaneous abscesses). Intramuscular admin recommended if urgent

2. "Arrest of haemorrhage":
- Emptying the uterus: delivery of the placenta by "Crede's method" or
by manual removal
- Massage of the uterus: bimanual massage is described
- Intra-uterine applications of ice followed by an intrauterine douche
of boiled water or 1 to 5000 corrosive sublimate, at a temperature of
110-115 deg F
- Packing of the uterus with sterile gauze (which may or may have been
impregnated with iodoform), removed after 12-24 hours followed by
washing out of the uterus with antiseptic solution
- Styptics: the intra-uterine injection of a 1 to 100 solution of
acetic acid, or a mixture of "the ordinary corrosive sublimate" with
enough vinegar to "give the fluid a distinctly brownish tinge". If
this fails, two other solutions are recommended, Churchill's or
Monsel's, diluted with four times their quantity of water
- Faradism: "If a faradic battery be at hand, its use, either by
placing both electrodes on the abdominal wall, or by the passage of
one within the uterus while the other is applied to the abdomen, may
produce efficient contractions. As an addition to these measures time
may often be gained by compressino of the aorta against the lumbar
vertebrae by deep external pressure with the hand through the
abdominal wall" - Subcutaneous administration of either ether or
brandy

3. Treatment of collapse from haemorrhage:
- raising the foot of the bed with blocks, covering the woman warmly,
hot water bottles, fresh air, brandy (at first hypodermic then orally
or rectally); strychnine and digitalis + morphine, nitroglycerine and
cocaine hypodermically; in extreme cases "an intraveous injection of
fifteen to thirty minims of the officinal solution of ammonia, diluted
with an equal quantity of water"
- Saline infusion, subcutaneous or IV (lots of detail on how this is
accomplished)

4: Afterca
- Absolute rest, "deprivation of society", frequent doses of eggnog,
fresh raw oysters, and iron supplements.


Wow. I'm guessing that most women who hemorrhaged after birth died, whether
in the precence of a doctor or midwife or not. Yikes!
--

Jamie
Earth Angels:
Taylor Marlys, 1/3/03
Addison Grace, 9/30/04

Check out the family! -- www.MyFamily.com, User ID: Clarkguest1,
Password: Guest Become a member for free - go to Add Member to set up
your own User ID and Password

Lara, this is extremely helpful and I appreciate it. I had no idea at
all what would have been done in those days or where to look. It is
fascinating to find that they used ergot, among other things. I did not
know there were so many treatments but unfortunately for this lady in
question there was no midwife or Dr on hand in time.
Thanks again and this adds much to my research.
Laura

Lara wrote:
wrote:

I am researching a book and have an unusual question. Does anyone know
what treatment would have been given to a woman in the early 1920s in
the USA who hemorrhaged at home, 15 hours after birth, to a stillborn
baby? The woman died, and the secondary diagnosis was uterine atony on
the death certificate. Could anything have been done to save a person
suffering from hemorrhage at home in those days?

I'm not sure whether you're asking what treatment would have been likely
to have been given, or whether there might have been something that
could theoretically have been done to help (but wasn't routine in the
day)? The most obvious answer to the latter would be urinary
catheterisation (if the bladder was overfull and there was a silver
straight-cath available), gentle uterine massage, and manual nipple
stimulation, though there's no guarantee it would have saved her. They
did have ergot, too, though I'm not sure whether it would be available
in the home.

"Vitalogy", a home-treatment manual of 1926, has a section on "Flooding"
(postpartum haemorrhage). Recommended remedies include:
- a mixture of oil of cinnamon and four tablespoonfuls of alcohol, half
a tsp every15-60 minutes depending on urgency.
- equal parts of alum and nutmeg
- hot irons to the feet if they were cold
- plugging of the vagina with soft cotton cloth or an old silk
handkerchief or linen, replacing the compress every 6-7 hours. There is
a warning about concealed hemorrhage if this technique is used.
- one-fourth of an ounce of alum added to a pint of warm milk; one
tablespoonful every 30-60 minutes
- one part of well-powdered charcoal and six parts of powdered white
sugar, rubbed together in a mortar and pestle. One quarter of a tsp
every hour.
- a powder called "bebeerine", one-half grain three times a day (it
doesn't say what this is, just that it may be purchased at drug stores)
- a tea of witch-hazel or beth-root, or both combined
- external uterine massage, combined with cold-water vulvar compresses
and ice chips placed in the vagina or rectum while swallowing chunks of
ice frequently
- keeping the woman horizontal, no head pillow, with slight elevation of
the hips
- if she appears to be on the point of death, brandy, slightly diluted,
small quantities frequently

After the haemorrhage has ceased:
- allowing the woman to sleep (closely monitored) in a dark cool quiet
room with plenty of fresh air but no drafts
- a diet of gruel, cold boiled milk, chicken broth, arrowroot, beef tea,
custard, calf's-foot jelly, cand cold drinks


I also have a copy of "Practical Obstetrics" from 1902. It opens the PPH
section by exhorting the obstetrician to differentiate between bleeding
from the uteroplacental site and bleeding from torn vessels in the "soft
parts", by the appearance of the blood.
* Haemorrhage from lacerations: it is recomemnded to inspect carefully
(there is a detailed description of the mechanics) and repair the
lacerations

* "True PPH":
1. Prophylaxis: constant gentle external fundal uterine massage from the
birth of the baby till ten minutes after the delivery of the placenta
- avoiding too-rapid "extraction of the child"
- if a firm contraction isn't immediately forthcoming with massage,
application of ice to the abdomen, emptying of the bladder (with
catheter if necessary)
- administration of ergot, a drachm of fluid extract orally (there is a
warning about its hypodermic adminstration because of a risk of
subcutaneous abscesses). Intramuscular admin recommended if urgent

2. "Arrest of haemorrhage":
- Emptying the uterus: delivery of the placenta by "Crede's method" or
by manual removal
- Massage of the uterus: bimanual massage is described
- Intra-uterine applications of ice followed by an intrauterine douche
of boiled water or 1 to 5000 corrosive sublimate, at a temperature of
110-115 deg F
- Packing of the uterus with sterile gauze (which may or may have been
impregnated with iodoform), removed after 12-24 hours followed by
washing out of the uterus with antiseptic solution
- Styptics: the intra-uterine injection of a 1 to 100 solution of acetic
acid, or a mixture of "the ordinary corrosive sublimate" with enough
vinegar to "give the fluid a distinctly brownish tinge". If this fails,
two other solutions are recommended, Churchill's or Monsel's, diluted
with four times their quantity of water
- Faradism: "If a faradic battery be at hand, its use, either by placing
both electrodes on the abdominal wall, or by the passage of one within
the uterus while the other is applied to the abdomen, may produce
efficient contractions. As an addition to these measures time may often
be gained by compressino of the aorta against the lumbar vertebrae by
deep external pressure with the hand through the abdominal wall"
- Subcutaneous administration of either ether or brandy

3. Treatment of collapse from haemorrhage:
- raising the foot of the bed with blocks, covering the woman warmly,
hot water bottles, fresh air, brandy (at first hypodermic then orally or
rectally); strychnine and digitalis + morphine, nitroglycerine and
cocaine hypodermically; in extreme cases "an intraveous injection of
fifteen to thirty minims of the officinal solution of ammonia, diluted
with an equal quantity of water"
- Saline infusion, subcutaneous or IV (lots of detail on how this is
accomplished)

4: Afterca
- Absolute rest, "deprivation of society", frequent doses of eggnog,
fresh raw oysters, and iron supplements.

Hope that helps!

Lara

wrote:

Lara, this is extremely helpful and I appreciate it. I had no idea at
all what would have been done in those days or where to look. It is
fascinating to find that they used ergot, among other things. I did not
know there were so many treatments but unfortunately for this lady in
question there was no midwife or Dr on hand in time.
Thanks again and this adds much to my research.

No problem. If I had a scanner here I'd send you the relevant pages,
sadly there is not a one in the house. Let me know if you need formal
references.

Lara
--
www.ozclothnappies.org

there are all sorts of treatments for PPH, other than the standard oxytocin,
people need to know them because even now, people die from PPH even when
oxytocin is available. A friend of mine's mum died after her younger sister
(my age, born late 70s) was born, despite oxytocin, I do not know if other
techniques were employed. My gran nearly died in 1957 from a PPH, it was not
drugs that saved her, but the oldest midwife performing uterine massage.
They are not reliable and even with all the knowledge in the world, some
women are going to die from PPH, but it's certainly possible in this case
that something could have been done, but it is interesting that it was
preceded by a stillbirth, it makes one wonder had something happened in
labour that killed the baby and was ulimately fatal to the mother.

Cheers

Anne

Thanks for the information, Anne. I wish I had more information and
records after all these years on exactly what happened during the
birth. I just have the death certificate and nothing else official. The
only explanation I can think of is that we know the father was a very
large man, very tall for the time period, nearly 6'4". Perhaps the baby
was big and the mother was petite, and it was just a difficult labor
for this reason.

Another sad part to this story is that in trying to locate the grave of
mother and child, I found they recently closed up the cemetery, due to
terrible conditions the

http://www.glendalenewspress.com/new...7p-73425c.html

I appreciate your comments very much--very helpful to me!
Regards,
Laura
www.karl-dane.com


Anne Rogers wrote:
there are all sorts of treatments for PPH, other than the standard oxytocin,
people need to know them because even now, people die from PPH even when
oxytocin is available. A friend of mine's mum died after her younger sister
(my age, born late 70s) was born, despite oxytocin, I do not know if other
techniques were employed. My gran nearly died in 1957 from a PPH, it was not
drugs that saved her, but the oldest midwife performing uterine massage.
They are not reliable and even with all the knowledge in the world, some
women are going to die from PPH, but it's certainly possible in this case
that something could have been done, but it is interesting that it was
preceded by a stillbirth, it makes one wonder had something happened in
labour that killed the baby and was ulimately fatal to the mother.

Cheers

Anne

Sorry, but one more question, everyone, that I just thought of--would
the bleeding be all at once and catastophic? I am wondering how long it
would take for death to occur without treatment, if the husband rushed
to get help. Would it be minutes, hours, or depends on the situation?
Thanks, I appreciate it!
Laura

wrote:
Thanks for the information, Anne. I wish I had more information and
records after all these years on exactly what happened during the
birth. I just have the death certificate and nothing else official. The
only explanation I can think of is that we know the father was a very
large man, very tall for the time period, nearly 6'4". Perhaps the baby
was big and the mother was petite, and it was just a difficult labor
for this reason.

Another sad part to this story is that in trying to locate the grave of
mother and child, I found they recently closed up the cemetery, due to
terrible conditions the

http://www.glendalenewspress.com/new...7p-73425c.html

I appreciate your comments very much--very helpful to me!
Regards,
Laura
www.karl-dane.com


Anne Rogers wrote:
there are all sorts of treatments for PPH, other than the standard oxytocin,
people need to know them because even now, people die from PPH even when
oxytocin is available. A friend of mine's mum died after her younger sister
(my age, born late 70s) was born, despite oxytocin, I do not know if other
techniques were employed. My gran nearly died in 1957 from a PPH, it was not
drugs that saved her, but the oldest midwife performing uterine massage.
They are not reliable and even with all the knowledge in the world, some
women are going to die from PPH, but it's certainly possible in this case
that something could have been done, but it is interesting that it was
preceded by a stillbirth, it makes one wonder had something happened in
labour that killed the baby and was ulimately fatal to the mother.

Cheers

Anne

Sorry, but one more question, everyone, that I just thought of--would
the bleeding be all at once and catastophic? I am wondering how long it
would take for death to occur without treatment, if the husband rushed
to get help. Would it be minutes, hours, or depends on the situation?
Thanks, I appreciate it!

hmm, it can be very fast, or a least very fast to the point it is
irreversible though life might continue for a while longer

Anne

wrote in message
oups.com...
Thanks for the information, Anne. I wish I had more information and
records after all these years on exactly what happened during the
birth. I just have the death certificate and nothing else official. The
only explanation I can think of is that we know the father was a very
large man, very tall for the time period, nearly 6'4". Perhaps the baby
was big and the mother was petite, and it was just a difficult labor
for this reason.


I doubt that would result in a still birth though, prolonged labour, yes,
but it would be more likely if the baby was plain stuck that it would never
be born and that the mother would die first and they could have opened her
and saved the baby (or that they died at a similar time), that was how
c-sections were invented, if the mother died, they just went in for the
baby, 15th or 16th century when it is first recorded that mother survived a
c-section.

Anne

Thank you both very much! I really appreciate it and have a much
clearer picture now.
Regards,
Laura
Anne Rogers wrote:
wrote in message
oups.com...
Thanks for the information, Anne. I wish I had more information and
records after all these years on exactly what happened during the
birth. I just have the death certificate and nothing else official. The
only explanation I can think of is that we know the father was a very
large man, very tall for the time period, nearly 6'4". Perhaps the baby
was big and the mother was petite, and it was just a difficult labor
for this reason.


I doubt that would result in a still birth though, prolonged labour, yes,
but it would be more likely if the baby was plain stuck that it would never
be born and that the mother would die first and they could have opened her
and saved the baby (or that they died at a similar time), that was how
c-sections were invented, if the mother died, they just went in for the
baby, 15th or 16th century when it is first recorded that mother survived a
c-section.

Anne