MANAGEMENT OF THE CORD. 565 



even although it should be cut off clean, and not contused or torn. 

 However, as the contrary may happen, as a mere compression of 

 the chest, or an embarrassed state of the function of any organ suf- 

 fices to disorder the general circulation and enable the blood again 

 to pass through the umbilical ring; as cases are reported of children 

 who have died from bleeding in consequence of the cord being not 

 well secured; and lastly, as there is no danger occasioned by the 

 application of a ligature, as it presents no difficulty, we are not au- 

 thorised to dispense with it; we should even be culpable to neglec* 

 it. Although the observations of Fautoni and Schultz prove that it 

 is not indispensable, those of Daniel prove, that it would not always 

 be safe to omit it even after a rupture of the cord; and the cautery, 

 made use of in Turkey, will always be less safe and more trouble- 

 some. 



Further, whether tied or not, the cord constantly separates from the 

 abdomen at the same place, that is to say, at the spot where it joins 

 the skin, and consequently, a few lines beyond the surface of the 

 belly; and I do not think it my duty to combat the old women's no- 

 tion, which was derived from the physiology of the ancients, and 

 which requires that the cord should be cut very near the umbilicus 

 if the child is a girl, and very far from the abdomen if it is a boy, 

 such a mode of cutting it being supposed to exert a great influence 

 upon the development of the organs of copulation! 



1215. I always make one turn of the ligature, which I tie with a 

 single knot sufficiently hard to close the vessels; I then carry the 

 two ends behind, cross them and bring them back again in front, 

 where they are secured by a double knot which is tied somewhat 

 more firmly. I pursue this method because it is very simple, and 

 because I have never seen it followed by any accident. But if the 

 cord were a very large one, I would willingly, for the sake of 

 greater security, imitate the conduct of M. Desormeaux and Plenck, 

 that is to say, that after tying the first knot, I would make a loop of 

 the cord, and secure it in the second turn of the ligature. Besides 

 this ligature, some practitioners apply one to the placental end of the 

 cord, to prevent, as they say, any hemorrhage from taking place 

 from the woman. But what I have said concerning the uiero-pla- 

 cental vascular system, proves that this is an unnecessary precaution 

 It can be of no use except in twin cases, and even there, to make it 

 necessary, the vessels of one placenta ought to communicate directly 

 with those of the other as appears to have been the case in two 

 instances met with by M. Mancel, but which must be a very rare 

 occurrence. 



