376 DYSTOCIA. 



stage of pregnancy is more advanced ; in that, during labor, the 

 blood flows especially during the contractions, and not in the inter- 

 vals, as in the other species. When it commences early, as the 

 blood flows in small quantity, the woman becomes exhausted but 

 slowly, the muscles become oedematous, the face is bloated, the lips 

 grow pale, and the skin soon assumes a dull yellow tint, the color of 

 wax, through its whole extent. These, however, are only rational 

 signs, which may even not be met with near the commencement of 

 the flooding; whenever, therefore, it becomes desirable to remove 

 all doubt upon the subject, recourse should be had to the touch. The 

 orifice is, in general, very soft, and somewhat dilated; instead of the 

 membranes, a spongy body is felt, engaged, as the point of a cone 

 "with a large base might be, in the upper part of the cervix; but care 

 should be taken not to mistake a coagulum of blood for the placenta, 

 and in order that the operation should not be performed unnecessa- 

 rily, to recollect that this exploration may possibly reproduce the 

 hemorrhage, by disturbing the concretions by means of which the 

 economy had succeeded in suspending it. 



872. Instead of following the course that I have just indicated as 

 the most general one, the hemorrhage sometimes pursues a very 

 different one. M. Duparcque has seen a case which came on as early 

 as the sixth month, which ceased spontaneously, and did not retura 

 until the appearance of the labor. M. Desormeaux has met with it 

 once in the tilth month; and it became su profuse in the sixth, that it 

 was found necessary to deliver the woman. I have seen a case where 

 it did not appear until the end of the ninth month, in a woman to 

 whom I was called by M. Baroilhet, and where it did not become 

 serious until the approach of her confinement, although the centre 

 of the placenta was situated over the orifice. In other cases, espe- 

 cially in first pregnancies, and where the uterus is very much in- 

 clined in front, the os uteri is sometimes so little opened, and so high, 

 up, that the blood may accumulate below it, to a certain amount, and 

 in some sort produce an internal hemorrhagy. Did the flooding de- 

 pend upon the rupture of some of the vessels of the placenta or cord, 

 it would be characterised by causing the sudden death of the foetus, 

 and by debilitating the mother secondarily. Moreover, it would 

 doubtless produce, as in cases where the blood is effused into the in- 

 terior of the membranes, a feeling of weight in the pelvis and hypo- 

 gastrium, with dragging in the loins, the groins, and about the pit of 

 the stomach. 



873. Prognosis. The dangers that follow in the train of uterine he- 

 morrhage necessarily vary according to a multitude of circumstances, 

 according to the species and amount of the flow, the stage of the 



