540 DELIVERY OF THE PLACENTA. 



strongly in proportion as it empties itself, simultaneously throws 

 out both the child and placenta. In the second, the promptitude of 

 the delivery of the child is so great, that the womb has not had time 

 to break up the adhesions of the ovum, or to contract sufficiently. 

 Until the cavity of the womb becomes so diminished that tlie after- 

 birth fills it quite up, it may remain above the orifice. When the 

 child has just passed through the os uteri, provided the placenta be 

 detached at the time, and urged onwards by the uterus, nothing can 

 prevent it from descending: but if the orifice closes before the body 

 of the organ becomes reduced in proportion, the after-birth remains 

 shut up as it were in the uterine cavity, and cannot escape for a 

 considerable length of time, although its adhesions may have been 

 broken up from the beginning. 



1 178. Although the organism generally suffices to finish the ex- 

 pulsion of the after-birth when it has reached the excavation, some 

 cases are, however, observed in which it would remain there for an 

 indefinite period, provided its escape were not promoted by artificial 

 means. It is on account of this tedious slowness, and to relieve 

 the woman of her fatigue and uneasiness of mind, that a natural or 

 simple case of delivery of the placenta is scarcely ever wholly aban- 

 doned to the efforts of nature. De la Motte, Deventer, Peu, and 

 some modern authors, are scarcely willing that we should wait for 

 it for half an hour: according to them, if we do not act at once, the 

 orifice closes, and may retain the after-birth, from whence accidents 

 of greater or less severity may ensue. Levret and Smellie, Baude- 

 locque, and almost all practitioners of the present day, advise us, 

 on the contrary, not to act until the placenta is completely detached, 

 and presents itself spontaneously at the orifice of the womb. 



Both of these doctrines, if taken according to the very letter, ap- 

 pear to me to be equally incorrect. The practice of the ancients, 

 if followed without exception in all cases, would doubtless some- 

 times be dangerous; but I am induced to believe that at the present 

 day we have fallen into an opposite extreme; by endeavoring to 

 follow nature as closely as possible, the end which the accoucheur 

 ought to hold in view has been lost sight of. 



Besides, if it is proper to act as soon as the placenta is detached, 

 I do not see wherefore the delivery should be so frequently deferred; 

 for except in a few cases, this detachment takes place previously to 

 the expulsion of the child. I can scarcely conceive, indeed, how 

 the womb can be reduced to a fourth or fifth part of its volume, 

 without destroying the delicate filaments which connect it to the 

 ovum. Most of the facts that are cited to show that the adhesions 

 of the placenta continue to exist after the birth of the child, are any 



