550 COMPLICATED DELIVERY OF PLACENTA. 



whole extent of its uterine surface; I have seen it full of homogene- 

 ous masses, as large as nuts or partridge eggs, hard, and elastic; 

 but, in all these cases the adhesion, instead of being stronger, was 

 much weaker; although rugose and tuberculated, its surface was 

 smooth, and exhibited no trace of any laceration. I have also met 

 with the yellowish alteration, the placentas gras as they are called, 

 and almost all the alterations pointed out by M. Brachat of Lyons, 

 and M. Gendrin. But, in common with M. Desormeaux, I have 

 never observed any preternatural adhesion to accompany them. 

 Besides, I have not found, by consulting the authors, that scirrhus 

 has been noticed in the womb, exactly at the place where morbid 

 adhesions existed, and every body knows that ihe placenta generally 

 contracts a less intimate union with the fibrous tumors on which it 

 is sometimes attached and developed, than with the uterus itself. 



1190. As to inflammation, it may be admitted as a probable 

 cause, in a certain number of cases; for example, when in conse- 

 quence of a blow on the belly, a dull pain and sense of heat are 

 found to continue for several weeks, in the corresponding part of 

 the womb, and an adhesion of the placenta to exist at the period of 

 delivery; but these phenomena often continue during the whole course 

 of a pregnancy without any adhesion taking place; and indeed ad- 

 hesions are most frequently met with without any such precedent 

 symptoms having been noticed. Moreover it is known that the special 

 character of inflammation of the mucous membranes is, to augment 

 their secretions, and to terminate but very rarely in adhesion of their 

 surface to the bodies with which tliey are in contact. Prudence, 

 therefore, requires that we should wait for some new researches, 

 before we pronounce upon this point of pathology. 

 ^ 1191. When the adhesion is partial, it occupies sometimes one 

 portion, and at others the entire circumference of the placenta ; 

 sometimes, on the contrary, the edges of the cake are free, and it 

 adheres to the womb at one or more points of its surface or at its 

 middle. When the adhesion is general, a circumstance but rarely 

 noticed, but which has notwithstanding been seen by several practi- 

 tioners, and particularly by M. Desormeaux, it exhibits difllerent 

 degrees of the aflfection like the preceding case. It may in certain 

 cases be overcome by simply pulling at the cord, without our being 

 obliged to enter the womb; in other instances it is so strong that 

 the tissues seem to be confounded together, and it is impossible to 

 overcome it without tearing the parts. 



1192. I will not, with M. Desormeaux, say that we can recognise 

 but that we may suspect, or have a right to suspect, the existence of 

 a morbid adhesion of the after-birth, when, notwithstanding the re- 



