ENCYSTED PLACENTA. 549 



the hypogastrium, and judicious pulling at the cord. In fine, there 

 ought to be no haste; we must wait. If there is any threatening 

 appearance of hemorrhage, convulsions, &;c., or the safety of the 

 woman appears to be in any way compromised, we must, on the 

 contrary, make haste to act. The fingers are to be introduced one 

 after the other into the mouth of the cyst, which is to be dilated 

 gendy and carefully, and afterwards passed by the whole hand in 

 search of the placenta; should there be a second opening, it is Xo 

 be treated like the first, and in all cases the cord is a sure guide to 

 the after-birth, which is detached and separated by passing the 

 fingers, flattened, between it and the uterus, and which is lastly ex- 

 tracted by pushing it with the palmar surface of the hand down into 

 the top of the vagina. Should the placenta be found only partially 

 encysted, we might after dilating the mouth of the cyst, dispense 

 ■with going any further, take hold of it with the fingers, and immedi- 

 ately extract it. But it is in general, both a surer and quicker 

 method to go into the very cavity of the cyst itself; it being well 

 understood that, during this operation, the hand that remains out- 

 side shall be employed in supporting the fundus of the uterus, in- 

 clining it to either side, and depressing it towards the one that is 

 within the organs. 



1188. The rupture of the cord, in itself considered, does not com- 

 plicate the delivery of the placenta except by rendering the usual 

 tractions impossible: it may be prevented by ceasing to pull as soon 

 as there is any threat of its giving way; but it can only be remedied 

 by going in search of the placenta with the hand; and as long as 

 there is nothing to fear for the woman, this' recourse is unnecessary, 

 and we ought to trust to the organism itself. It is particularly apt 

 to lake place when the cord is inserted near the circumference of 

 the placenta, or when its vessels divide too soon, and separate like 

 the rays of an umbrella upon reaching the placenta. In the first 

 case the efforts concentrate almost wholly upon the root of the 

 cord, which yields before they can be transmitted to the after-birth; 

 in the second, the vessels are weaker than if they were united to- 

 gether; further, as the force cannot act equally upon them all, they 

 break very readily one after the other. 



118'J. The morbid or preternatural adhesion of the placenta may 

 be either total or partial, slight or intimate. The ancients, Smellie, 

 and others, refer it to a scirrhous state of the womb or after-birth; 

 many modern writers have preferred to attribute it to inflammation. 

 But proofs are wanting on each side of the question. I have seen 

 the placenta hard, thick, and yellowish, having lost its spongy ap- 

 pearance, sometimes in a few points, sometimes throughout the 



