554 DELIVERY OF THE PLACENTA. 



mistake which in the hands of ignorant and unskilful persons would 

 be dangerous. 



When found, we should endeavor to get hold of some point of 

 its circumference; if there is one which does not continue to be 

 adherent; it is then detached by turning it over towards its mem- 

 branous surface, or the advice given by Baudelocque may be fol- 

 lowed: the ends of the fingers flattened out may be slipped between 

 it and the womb; then by carefully moving them from side to side 

 it may be detached just as we would separate two sheets of paper 

 slightly adhering together: where the adhesion is found to be gene- 

 ral, the hand, disposed as before mentioned, is passed along the ex- 

 ternal surface of some portion of the membranes, and then gradually 

 to the circumference of the placenta; when there, it should act as 

 has been described. Should the circumference alone have con- 

 tracted morbid adhesions, as seems to have been noticed by Leroux, 

 and the middle portion of the cake be depressed by the blood, as 

 Baudelocque states to have happened under his own observation, 

 we might, after the example of that practitioner, penetrate through 

 the placenta, and then proceed as in the other cases. When its 

 separation is eflfected, the hand brings it away by pushing it down 

 before it; we ought to take care to leave no portion of it behind, and 

 at the same time remove all the coagula that may be contained in the 

 uterus. 



1196. In acting thus, it very rarely happens that the adhesions 

 cannot be safely destroyed. However, they are sometimes so firm 

 that it is wholly impossible to make them yield. In such a case, the 

 plan pursued by Smellie, Levret, &c. should be adopted, namely, to 

 destroy the adhesions wherever they are not too firm, and tear and 

 bring away all that we can detach, and leave the remainder to the 

 natural powers. In peeling off the placenta we can go no further 

 than this, and it would be extremely dangerous to persist in endea- 

 voring to bring away the whole of it, and not leave the smallest por- 

 tion behind in the female organs. 



1197. Sometimes the portion of the placenta which we have been 

 unable to detach separates spontaneously after a few days, and 

 escapes along with the coagula; sometimes it becomes decomposed 

 and comes away with the lochia; at others it is not discharged for 

 a long time; Smellie asserts that one of his patients did not expel it 

 until two months had elapsed, and it was then hard and quite dried 

 up; Kerkring relates another instance where it was not passed away 

 till full eight months. M. Prost has related two cases not less re- 

 markable: in one, the after-birth was not expelled until the five 



