106 OBSTETRICS. 



mend that Instead of turning in these cases, the whole placenta 

 should be detached and extracted if possible, before the child. The 

 following are Dr. Simpson's conclusions, based on tho examination 

 of a large number of cases. 



1st. That the complete separation and removal of the placenta 

 before the child, is very seldom followed by any great hemorrhage. 



2d. That on the other hand, the previously existing hemorrhage 

 almost always ceases from the moment the placenta is perfectly and 

 completely detached from its connexions with the uterus. 



3d. That the cessation of the hemorrhage is explicable, not on 

 the idea that the descending head of the child acts as a plug or com- 

 press upon the exposed orifices of the uterine sinuses, but on the 

 mutual vascular economy of the uterus and placenta, and the circum- 

 stance that the hemorrhage principally comes from the partially de- 

 tached surface of the latter. The practice has been condemned by 

 other eminent authorities, and it is recommended, even if it be 

 adopted, to seize and bring down a foot if it can be readily found; if it 

 be determined not to turn, it is also recommended to give a scruple 

 of ergot at the moment of separating the placenta, so as to bring on 

 early uterine contractions. 



Hemorrhage after delivery. — The discharge in this case also pro- 

 ceeds from the mouths of the vessels exposed by the separation 

 (either partial or complete) of the placenta. A certain amount is 

 lost after the birth of the child ; it is only when it becomes so pro- 

 fuse as to threaten serious consequences, that interference becomes 

 necessary. It may occur after the escape of the head, while the 

 body is retained ; immediately after delivery ; or at an interval of 

 ten or twelve days after. 



The hemorrhage may arise from inaction of the womb ; from an 

 absence of that contraction which is the only safeguard. The uterus 

 is felt large and flabby in the abdomen ; the pulse becomes weak and 

 tremulous; the patient restless; there are constant and deep sighings 

 and groanings, and frequent syncope, dimness of sight, and ringing 

 in the ears, and even convulsions. These symptoms, together with 

 the escape of the blood, will be sufficient to establish the diagnosis. 



Treatment. — In every case, the indication is to m,ake the womb 

 contract. This may be done in various ways, viz., by friction to 

 the abdomen ; by the application of cold to the genitals, or abdo- 

 men ; by grasping the womb through the abdominal parietes ; at 

 the same time ergot should be administered to the same end. If 

 these means fail, the hand should be introduced into the cavity of 

 the organ, with the hope of exciting contraction. It has also been re- 

 commended to introduce ice into the uterus; or a freshly cut lemon, 

 and then to squeeze out the juice upon the internal surface. 



Among the internal remedies are, acetate of lead and opium ; 



