REPRODUCTION 521 



is expelled by powerful contractions of the uterus, assisted by 

 those of the muscles in the abdominal walls. When the child is 

 born, it has attached to its navel the umbilical cord, which is 

 then usually ligatured and cut across: some good authorities, 

 however, maintain that this should not be done until after the 

 contractions which expel the placenta, as otherwise a quantity 

 of the infant's blood remains in that organ; the loss of which 

 might be serious to a feeble infant. Shortly after the birth of the 

 child renewed uterine contractions detach and expel the placenta, 

 both its fetal or allantoic and maternal or decidual part, as the 

 afterbirth. Where it is torn loose from the uterine wall large blood 

 sinuses are left open; hence a certain amount of bleeding occurs, 

 but in normal labor this is speedily checked by firm contraction 

 of the uterus. Should this fail to take place profuse hemorrhage 

 occurs (flooding) and the mother may bleed to death in a few 

 minutes unless prompt measures are adopted. 



For a few days after delivery there is some discharge (the 

 lochid) from the uterine cavity: the whole decidua being broken 

 down and carried off, to be subsequently replaced by new mucous 

 membrane. The muscular fibers developed in the uterine wall in 

 such large quantities during pregnancy undergo rapid fatty de- 

 generation and are absorbed, and in a few weeks the organ re- 

 turns almost to its original size. The parturient woman is es- 

 pecially apt to take infectious diseases; and these, should they 

 attack her, are fatal in a very large percentage of cases. Very 

 special care should therefore he taken to keep all contagion from 

 her. 



There is a current impression that a pregnancy, once com- 

 menced, can be brought to a premature end, especially in its early 

 stages, without any serious risk to the woman. That belief is 

 erroneous. Premature delivery, early or late in pregnancy, is 

 always more dangerous than natural labor at the proper term; 

 the physician has sometimes to induce it, as when a malformed 

 pelvis makes normal parturition impossible, or the general de- 

 rangement of health accompanying the pregnancy is such as to 

 threaten the mother's life; but the occasional necessity of decid- 

 ing whether it is his duty to procure an abortion is one of the most 

 serious responsibilities he meets with in the course of his pro- 

 fessional work. 



