562 MANAGEMENT OF THE CHILD. 



Levret it has been established as a general rule, among accoucheurs, 

 to separate the child from the mother as soon as it has passed through 

 the vulva, and that it is never necessary to wait for the expulsion 

 of the fostal appendages. At first view the conduct of the ancients 

 appears to be more rational and more physiological than that of the 

 moderns; it seems that the placenta ought immediately to follow the 

 foetus, or at least be separated from the uterus before the cord can be 

 prudently cut; that before it is divided, the circulation ought to be 

 permitted gradually to take on its new type, which soon becomes 

 similar to that of the adult; but in reality it is not perceived that the 

 present mode of practice produces the least inconvenience to the 

 fcstus, and is certainly better for the mother. It would be in vain 

 to object that this conduct is not natural, for it is followed by most 

 of the animals themselves, who tear off the umbilical cords of their 

 young as they escape from the vulva. Not only should we not wait 

 until the placenta is delivered, but it is of no use to wait until the 

 pulsations have ceased, before we cut the cord, as recommended by 

 Denman and A. Leroy. Neither is there a general agreement as to 

 whether the cord should be cut or tied first. 



1210. If we begin by applying the ligature, we have to do it 

 under the bedclothes; and on the lying-in bed, it is not so easy to 

 examine the umbilicus, and we deprive ourselves of the advantage 

 of disengorging the viscera of the blood with which they are some- 

 times overloaded. In fine, as soon as respiration is established, the 

 placental circulation becomes completely useless. If we cut the 

 cord before we tie it, we are at liberty to carry the foetus to any 

 convenient place, attend to it if it be not well, and examine it with 

 all desirable attention. However, it must be confessed that if the 

 child present nothing peculiar as to its condition, one of these modes 

 of proceeding is scarcely preferable to the other, and that each prac- 

 titioner is at liberty to adopt the one that pleases him best, without 

 its having any influence upon the result of his practice. 



1211. The place where the cord is to be divided is altogether a 

 matter of choice. If it be cut at the distance of four or five inches 

 from the navel instead of nearer to or farther from the placenta, it is 

 done in order that what is left of the cord may not be troublesome 

 by its quantity, and may admit of the ligature being applied at a cer- 

 tain distance from the abdomen. Any cutting instrument may be 

 made use of, and the scissors are used only because they are rather 

 more convenient than a bistoury. Although a rusty instrument can 

 not possibly occasion any redoubtable accident, such as tetanus, as 

 A. Leroy supposed, it is nevertheless best to make use of such only 

 in cases where sharper ones cannot be obtained; on the other hand, 



