HEMORRHAGIC DYSTOCIA. 371 



womb, fibrous and other tumors in the substance of the parietes, 

 or in the neighborhood of the external surface of the uterus, cri- 

 minal maneuvres, and every thing calculated to produce a determi- 

 nation of fluids towards the pelvis; violent exertions, the jolting of a 

 rough-going carriage, riding on horseback, efforts to carry or lift a 

 heavy burthen, coughing, vomiting, shocks communicated to the 

 trunk of the body by falls upon the feet, the knees or seat, blows 

 on the abdomen or pelvis, diseases of the rectum and bladder; in 

 one word, all conditions, whether of temperament or of disease, all 

 circumstances, whether natural or eventual, that are capable of 

 producing a sanguine congestion, a raptus towards the vessels of 

 the womb, and all the causes of abortion; so that pregnancy and 

 labor in themselves constitute one of its most powerful causes. 



804. In some particular cases, an entirely special cause of hem- 

 orrhage is superadded to the preceding ones, and may of itself pro- 

 duce the flooding; I mean the implantation of the placenta upon the 

 cervix uteri. 



Whether the placenta corresponds to the orifice by its very cen- 

 tre or by some point more or less near its circumference, there re- 

 sults nevertheless a hemorrhage whose distinctive character is, that 

 it occurs only in the last months of gestation, or from the period 

 when the cervix uteri begins to dilate from above downwards. The 

 authors who attribute it to the rupture of the utero-placental vessels 

 have certainly been deceived by theoretical prejudices, or false ana- 

 tomical appearances. I offer the following as the results of several 

 observations collected with great care. 



When the placenta is inserted upon the neck of the womb, these 

 two parts proceed together in their development until about the fifth, 

 the sixth, the seventh, and sometimes even until eight months and a 

 half; but from that time forwards, the environs of the orifice are so 

 rapidly withdrawn from the centre, that a constantly increasing por- 

 tion of the ovum necessarily remains without any adherence to the 

 womb, and this portion, which is soft, vascular, and constantly on the 

 stretch, may crack or even tear, and thus give rise to a hemorrhage 

 which puts the child's life much more at hazard than the mother's. 

 On the other hand, this displacement does not in general take place 

 without the inferior portion of the womb being more or less irritated 

 by it, and soon becoming the seat of an affluxion, a more or less 

 decided congestion, and thencefoth, the general efficient cause of 

 floodings is superadded to the peculiar cause constituted by the 

 presence of the placenta on the cervix. Is it necessary for me to 

 remark that these two causes, the rupture of some vessels of the 

 placental parenchyma, and a state of congestion of the uterus, may 



