ENCYSTED PLACENTA. 547 



dents appear; such are the measures that may be required by such 

 a state as we have indicated: it is only when pressing and grave 

 circumstances arise, that we are allowed to introduce a finger into 

 the orifice to dilate it, while with the other hand we pull gently at 

 the cord. 



1185. The encysted state of the placenta, which Solinger calls 

 hernia of the after-birth, has not been understood in the same man- 

 ner by the difTerent authors who have spoken of it; Levret never 

 saw but one case of it, to which he was called by a midwife, who 

 supposed she was treating a case of rupture of the womb. Accord- 

 ing to that author the encysted state of the placenta is occasioned by 

 that portion of the womb which corresponds to the placenta re- 

 maining in a state of inertia, whilst the other parts of the organ con- 

 tract with more or less force after the birth of the child. Simson, on 

 the contrary, attributes it to the simple tendency of the womb to re- 

 cover its primitive shape, a tendency which causes the internal orifice 

 to produce, instantly, a real strangulation, above which is found the 

 after-birth enclosed within the cavity of the body, as if it were in a 

 small cell, while the cavity of the cervix remains open below. Pless- 

 mann has reproduced the idea started by Levret, but he has modified 

 it: according to his view the womb must be much more highly irri- 

 tated at those points which press directly upon the fcEtus than those 

 which only touch it through the placenta during the efforts of labor; 

 whence it follows that the former contract eooner than the latter, and 

 the formation of a separate sac for the after-birth is very easy to un- 

 derstand. Peu seems to think that the encysting depends upon a 

 peculiar conformation of the uterus; Leroux and Kok, that it most 

 frequently depends upon the rupture of the nervous filaments, which 

 occasions an afflux of humors, and, in consequence of that, a spas- 

 modic contraction of some portions of the organ. All these explana- 

 tions may be true in some particular cases; but Baudelocque prefers 

 Simson's theory; M. Desormeaux, resting on a fact related by 

 Meyeld, seems to be not far from adopting, at least in part, the view 

 taken of the subject by Levret and Plessmann, 



An encysted state of the placenta is always the result of irregular 

 contractions of the womb, after the escape of the foetus, but I do not 

 think that these contractions can be explained upon the hypotheses 

 of Simson, Levret, &c. In a woman to whom I was called by Ma- 

 dame Bevalet, the internal orifice of the cervix offered but a feeble 

 resistance, whereas, a little higher up, I found a very decided con- 

 striction, and after penetrating into a cavity situated to the left of the 

 womb, in which cavity a greater part of the placenta was contained, 

 I was obliged to pass through another stricture, to get to the fundus 



