384 DYSTOCIA. 



with so much reserve, and not to terminate the delivery as soon as 

 possible. 



Forced delivery. When a labor proceeds with a certain degree 

 of regularity, notwithstanding the hemorrhage may continue, and the 

 powers of the woman may diminish too rapidly, it generally suffices 

 to accelerate the contractions as hath been mentioned, and to en- 

 gage the women to keep up her courage and use her best efforts to 

 enable the womb to get rid -of its contents as well as to put a stop to 

 the flooding. Provided, on the other hand, the infrequency of the 

 pains does not permit him to rely upon the powers of the economy, 

 the accoucheur should hasten to deliver the child. If the head be 

 already engaged in the superior strait, and the os uteri sufficiently 

 open, and a fortiori if it have already reached the excavation, it 

 should be seized with the forceps: otherwise the child should be 

 turned; but in order to admit of the hand being carried into the 

 womb, the orifice must have reached a certain degree of dilatation, 

 or at least be in a very dilatable state. Therefore, it is only in the 

 last stages of pregnancy, and where nature or the means hereto- 

 fore pointed out have forced the labor to begin, that we may 

 resort to this method, which is particularly applicable to cases of 

 hemorrhagy from implantation of the placenta over the cervix uteri. 

 Happily, when there is a flooding; the orifice is commonly very soft, 

 and admits of a ready passage. Moreover, it is manifest that \yhere 

 the danger is pressing, it would be better to make use of some 

 violence in overcoming the resistance, than to abandon the woman 

 to the so frequently fatal chances of an overwhelming flooding. 



886. The termination of the labor should never, under any pre- 

 text, be left to the powers of nature, when the hemorrhagy is in- 

 contestably occasioned by the insertion of the placenta upon the os 

 uteri. 



In this particular case, many practitioners have recommended, 

 that as soon as the fingers have got within the os uteri, we should 

 try to find that part of the edge of the placenta that is nearest, so 

 as to pass up the hand in that direction; others have thought that 

 in difficult cases, or where there is no time to temporise, it would be 

 better to neglect this minute research, and to perforate or rupture 

 that point of the ovum that corresponds to the orifice, so as instantly 

 to lay hold on the child's feet. The former of these two modes of 

 practice would occupy too much time; and the latter would not 

 fail to augment very greatly the violence of the hemorrhagy, and 

 seriously endanger the life of the foetus, should its extraction hap- 

 pen to be tedious or difficult. Besides, the child would have to be 

 withdrawn through the opening in the placenta, which, being pulled 



