542 DELIVERY OF THE PLACENTA. 



can We conceive, in fact, that they could give way so easily under 

 the feeble contractions that take place after the expulsion of the child, 

 after having resisted the violent efforts of the close of the expulsive 

 stage of the labor? I believe, therefore, that if it is not prudent to 

 deliver the after-birth immediately after the escape of the child, we 

 ought to look for another reason for the caution, than the non-detach- 

 ment of the placenta; that the object of the uterine contractions and 

 their effect is far more to push this body gradually through the os 

 uteri and into the vagina, than to break up its union to the womb; 

 that it is not indispensably necessary for the woman to have colic 

 pains and dragging sensations in the loins before the accoucheur de- 

 livers her; and that there are some disadvantages in not acting as soon 

 as a favorable opportunity presents itself. 



Being (in 1823) still imbued with the prevailing ideas on this sub- 

 ject, I used to wait until the pains came on before I proceeded to act, 

 and I stopped as soon as I perceived the slightest resistance; and in 

 the short space of six months I was obliged to wait, on one occasion 

 ten hours, on a second twenty-four, on a third thirty-six, and on a 

 fourth forty-eight hours, before the placenta was delivered, and in the 

 last case, was even obliged after all to introduce the hand in search 

 of the placenta. Since that time I have never been obliged to wait 

 more than one hour: for me it suffices when the womb has contract- 

 ed and become hard, even although the woman have felt no pain, nor 

 dragging sensation, and up to the present time 1 have had good 

 reason to be satisfied with my mode of proceeding. 



1179. Thus, after having given the first necessary attentions to 

 the child, we return to the mother, and if the hand applied to the hy- 

 pogastrium feels the womb contracted with a certain degree of force, 

 we assist the delivery of the placenta; when the uterine globe does 

 not form, we ought to wait, or make use of the measures proper to 

 remove inertia. 



To favor the expulsion of the after-lairth, the cord is to be taken 

 hold of with the right hand, twisting it round the root of the mid- 

 dle and ring fingers, and then bringing it betwixt the thumb and 

 index finger; or it is merely taken hold of with the hand after 

 being wrapped in a piece of linen, and, always, as near as possible 

 to the vulva; two or three fingers of the left hand are then to be 

 slipped into the vagina, passing them under the symphysis of the 

 pubes to the orifice of the womb, or as far as the root of the cord; 

 as these fingers are to form a sort of gutter or pulley, I prefer 

 three rather than only two fingers, because as the medius forms the 

 bottom of the groove, the index and annularis easily prevent the 

 cord from slipping off to the right or left, whereas, if only two are 



