COMPLICATED DELIVERY OF PLACENTA. 553 



front, we shall make use of the fingers arranged like a pulley, as has 

 been before mentioned, whereas, if it be situated on the posterior 

 part of the womb, this pulley becomes useless, and it must be car- 

 ried to the right or left, provided it be situated laterally. 



This reasoning would doubtless be very correct, provided we 

 were acting in a free space, or if the placenta were not attached to 

 walls of the womb very much distended at the time; but it seems 

 to be overlooked, that the fingers only support the cord below the 

 mouth of the womb; that the after-birth touches the womb, both 

 by its spongy and its membranous surface; that, in whatever man- 

 ner we may take hold of it, the cord will always be parallel and 

 not perpendicular to the great diameter of the womb, from its very 

 insertion till it passes through the orifice of the organ; that by 

 pushing it strongly backwards, in front, or sideways, as is recom- 

 mended, we compel it to rub and slide on the corresponding point 

 of the OS uteri as on the groove of a pulley, without in any way 

 changing its relation of direction to the placenta itself. It is as 

 well, therefore, and even better, to place the three fingers in such 

 a way that they may act at the same time like a lever and like a 

 pulley, and draw the cord and rest of the after-birth down in the 

 longitudinal axis of the womb; but as this axis may vary, may differ 

 more or less from that of the strait, by inclining in front, to the right 

 or the left: as it may remain straight, or become curved, or even 

 zigzag, according to the position, form and direction affected by the 

 womb, it will be consequently necessary to pull sometimes more, 

 sometimes less towards the back or side, as I have already shown, 

 in speaking of cases of natural delivery of the placenta. It is not 

 until we have pulled at the cord, with all proper prudence, or where 

 the cord will no longer bear the requisite force to be applied, that 

 we may proceed to enter the womb in search of the after-birth. 

 Provided the cord is still not broken entirely off", we make use of it 

 as a guide; when it is completely separated, the hand will distin- 

 guish the placenta by its greater soflnpss, its unevenness, if the ex- 

 ternal surface be touched, and provided the fingers come in contact 

 with its foetal surface, by its polished and slippery feel, and the vas- 

 cular ramifications with which it is overspread; and in all cases 

 by the less vivid sensation experienced by the woman when the 

 hand is pressed on it, than when pressed on the womb itself. 

 There is generally no difficulty in this exploration for an experienced 

 person; but by carelessness it would not be impossible to mistake 

 the projections, sometimes presented by the interior of the womb 

 when it is irregularly contracted, for the reliefs of the placenta, a 



