546 COMPLICATED DELIVERY OF PLACENTA. 



We should, moreover, have reason to suspect the existence of this 

 state of things should the womb be found to preserve a larger size 

 than common above the pubes, although not deficient either in firm- 

 ness or energy; were the after-birth already in the vagina, the diag- 

 nosis, and the application of suitable means would be too easy to be 

 spoken of at greater length in this place. Upon the whole, exces- 

 sive volume of the appendages of the foetus scarcely constitutes one 

 of the accidents of delivery, unless, indeed, it be coincident with 

 some other complication. 



1183. I may say the same of the spasmodic contraction of the as 

 uteri. In fact, it is difficult to conceive that an opening, through 

 which a child has just passed, can contract spasmodically to such a 

 degree as to oppose the escape of the placenta. To admit such an 

 obstacle, we ought, which is not the case, to have some very authen- 

 tic instances of the kind.* Besides, as it is not a part of the nature 

 of spasm to persist, we might, should such a case occur, refer it to 

 the effect of time, and content us with administering some composing 

 or antispasmodic medicines, according to circumstances. 



1184. It is evidently the natural, but somewhat precipitate closure 

 of the OS uteri, which has been qualified as the spasmodic contrac- 

 tion: considered under this point of view it is a circumstance de- 

 serving of attention. When the delivery of the child is completed, 

 the OS uteri in general contracts more speedily than the body of the 

 organ, and if in this case we endeavor to deliver the woman before 

 the fundus is prepared to overcome the resistance of the orifice, the 

 placenta passes through it with difficulty, which may induce a belief 

 that it is spasmodically contracted. 



A bleeding from the arm where the woman is strong, and there 

 are any signs of irritation; emollient or slightly narcotic injections; 

 the belladonna ointment, or even a bath, if she is very nervous, not 

 strong, or has a vivid sensibility of the sexual organs, and there 

 are any indications of the approach of convulsions or flooding ; 

 patience, and gentle frictions upon the hypogastrium, should no acci- 



* A spasmodic closure of the orifice of the womb after delivery, is a very com- 

 mon consequence of the use of ergot. It has so frequently followed the adminis- 

 tration of that medicine, that it constitutes for me, one of the objections to its 

 employment. I have, on several occasions, been obliged to dilate the os uteri 

 by the introduction of the whole or one half of the hand, in order to admit of the 

 escape of the placenta, which I found completely detached and compressed by a 

 contracted womb. 



I may take this opportunity to say, that when the placenta does not come off 

 in an hour after the birth of the child, there is little hope of its discharge being 

 effected in two hours, or four, or six — and that it is belter to remove it at most 

 in an hour after the child is born. — M. 



