552 COMPLICATED DELIVERY OF PLACENTA. 



indifference in a majority of women; the sanies and putrescence 

 which result from its decomposition, will not remain in contact with 

 the interior of the womb without penetrating, by means of imbibi- 

 tion or absorption, in greater or smaller quantity into the veins of 

 that organ; and who will venture to affirm that it would not under 

 such circumstances be dangerous? Although it has chanced that 

 the hand by being introduced within the uterus has sometimes lace- 

 rated the parts of the woman instead of detaching the placenta, it 

 must be attributed to a want of skill in the accoucheur, and not to 

 the operation in itself considered; besides, the question is not 

 whether we shall tear away or destroy, at all hazards, the intimate 

 adhesions of the placenta, whether we sha\[ peel it offzs the ancients 

 did, but merely whether we shall carefully separate it and extract it 

 w^henever we can do so without lacerating the uterus. Upon this 

 point I agree with M, Duchateau, and unless the child have been 

 delivered for a long time, it would be a mistake to suppose that the 

 introduction of the hand must be very painful and irritating to the 

 womb. Is it reasonable to fear any bad effects from the gentle fric- 

 tions of the fingers, or moderate tractions exerted with the hand 

 upon an organ that has been for several hours contracting without 

 any inconvenience, and with much violence before? Let me not 

 however be understood as recommending here the introduction of 

 the hand as soon as the placenta resists a little, and that I approve 

 of those who, by conforming to the advice of Kushler, never fail to 

 resort to it with the mere intention of removing coagula and other 

 substances that may be contained within the uterus. My opinion 

 is, that we ought to wait a few hours, and if there be no pressing 

 haste from any other cause, we may wait even longer, if the 

 woman is of a good constitution and has no troublesome disease of 

 any sort; but in the other circumstances we should act witlyjut 

 waiting too long. 



1195. If the cord remains whole, we should pull at it in the way 

 indicated when speaking of simple delivery of the placenta; when 

 the cord is broken, we must attempt to hook a portion of the placenta 

 itself in the fingers. Levret, Baudelocque and all the moderns 

 insist very much on the necessity of drawing the cord down perpen- 

 dicularly to the plane of the placenta. Tlie following comparison 

 has been made use of. If you pull at a piece of wet paper in a 

 direction parallel to the plane on which it is applied, you will not 

 detach, but you will tear it, says Levret; but if you take hold of one 

 of its edges and turn it up, you may easily detach it without breaking 

 it. According to the last named author we must first endeavor to 

 ascertain the spot on which the placenta is seated, for if it be in 



