ADHESION OF THE PLACENTA. 551 



peated contractions, hardness, and globular shape of the uterus, we 

 find by passing the finger up through the os uteri that the placenta 

 does not present, and does not yield to tractions suitably exerted 

 upon the cord; by remembering, besides, what has already been said 

 viz. that a morbid adhesion is extremely rare, we ought to avoid con- 

 founding it Avith the cases in which the extraction of the secundines 

 is rendered difficult by some other cause. 



1193. Two very diff'erent modes of proceeding have been follow- 

 ed by accoucheurs in cases of pathological adhesion of the placenta: 

 one party think it ought to be left wholly to the natural effbrts; the 

 others, on the contrary, think that we cannot too soon take mea- 

 sures to overcome it. On the one hand it has been thought that, by 

 allowing the after-birth to remain for an indefinite period within the 

 uterus, we expose the woman to the danger of flooding, or convul- 

 sions; that by becoming decomposed, by putrefying, this substance 

 must act injuriously upon the whole system, and particularly upon 

 the genital organs and peritoneum, giving rise to fever of a bad 

 character. On the other hand, it is asserted that these accidents 

 are far more the eflect of ill-timed manoeuvres than of the pro- 

 tracted presence of the placenta. Haller, Sandifort, and M. de 

 Saint-Amand, have reported cases of wombs that had been la- 

 cerated, inflamed, or gangrened, in consequence of attempts to 

 break up preternatural adhesions of the placenta; the after-birth 

 has been known to remain two, four, six, eight, fifteen or thirty 

 days, or for months together, Avithin the genital organs, without 

 causing the smallest accident; if it become putrid, the lochias wash 

 it away piecemeal, and its absorption may be easily prevented by 

 means of injections; in fine, the dangers which, it would seem, 

 ought to follow its forced detachment, have appeared to be much 

 greater than those that might be involved in its retention for a 

 greater or smaller period of time. 



1194. There is reason on both sides of this question: although it is 

 undeniable that the placenta may in some cases remain for several 

 days in the womb without causing any accidents, it is very frequently 

 the cause of very severe ones. It has a thousand times been seen 

 to carry the woman to the very brink of the grave, and all the bad 

 symptoms disappear as by magic, immediately upon its expulsion: 

 were new proofs of it wanting, I could refer the reader to two cases 

 recently published by M. Goupil, and might cite those that have 

 fallen under my own notice. As a foreign body, it irritates the womb, 

 invites the blood to it, and is a constant cause of floodings, nervous 

 affections, and pains of all kinds; the acrimony which it contracts in 

 putrefying, and the odor which it developes, cannot be matters of 



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