558 DELIVERY OF THE PLACENTA. 



1204. This remedy might be tried in a case of supposed adhesion, 

 with inertia and flooding, after having vainly employed the ordinary 

 resources, and previously to introducing the hand into the uterus. 

 Its action must be both mechanical and chemical; it unwrinkles and 

 swells the placenta, distends the womb, and occasions a sudden re- 

 duction of temperature, a contraction of the vascular mouths, and a 

 more or less powerful constriction, admitting, always, that the fluid 

 injected reaches as far as the uterine surface of the placenta. It must 

 in fact combine a part of the advantages attributed by certain authors 

 to injections thrown directly into the womb, or through bladders, and 

 to the tampon, so much lauded by Leroux, without having any of 

 the inconveniences. 



1205. The operation is, besides, very simple: after having disen- 

 gaged the cord, the pipe of a syringe containing six or eight ounces 

 of very weak brandy and water, vinegar and water, or any suitable 

 medicinal liquid, may be introduced into the vein; the injection may 

 be pushed up with sufficient force to make it penetrate throughout 

 the placenta, and, to hinder it from escaping before it has produced 

 its effect, a ligature must be thrown round the cord. The woman is 

 soon seized with tenesmus and colic; the uterus and abdominal mus- 

 cles contract; the os uteri yields, and the after-birth is promptly ex- 

 pelled. M. Guillon recommends that instead of all these means, we 

 should inject some bouille, a sort of liquid cataplasm, astringent, or 

 emollient into the interior of the womb itself, and I see not why we 

 might not follow his example where the intervention of the hand is 

 not allowable. 



1206. Convulsions, and repeated fits of syncope which come on 

 after the birth of the child, may, like flooding, be occasioned by 

 various causes; but the presence of the after-birth, being of itself 

 sometimes sufficient to produce them, we should begin by delivering 

 it in women so aflfected. For the remainder, we are to act as has 

 been advised in speaking of convulsions in general. The same is 

 true of the simple debility or exhaustion that sometimes supervene 

 upon a protracted labor, or succeed to other accidents. Provided the 

 after-birth seems to have any influence in occasioning this state, we 

 should make haste to extract it; nothing but the necessity of leaving 

 the woman in a state of quiet, or the fear of bringing back a flooding, 

 should induce us to temporise, in a case where no other accident was 

 at the moment present. 



1207. In twin pregnancy the delivery of the placenta ought not 

 to be solicited until after the complete termination of the child- 

 birth. As the appendages of the two children always adhere to- 

 gether, at least by some of their points, the one could not be ex- 



