MEDICINE IN MODEBN TIMES. 719 



in the uterus; a phenomenon which indicates either that in the 

 earlier stages of pregnancy the placenta materna is less lacerable, 

 or that the motor power of the uterus is a relatively smaller one, 

 and one which finds its analogy in the occurrences which take 

 place in abortions and premature deliveries in the human subject.' 

 Heft i. p. 5ij. In his second Heft, p. i66, Dr. Kehrer, in speaking 

 of the retention of the placenta being sometimes followed by 

 symptoms like septic poisoning and sometimes not, has wise words 

 to the following effect : — ' What chemical changes may be set 

 up in the retained placenta is clearly dependent hereon, whether 

 the after-birth is shut off from contact with the air by the genitalia 

 or not; for, if air find access to it, the membranes of the ovum 

 putrefy; if the air be excluded, a process of decomposition, prob- 

 ably identical with one of maceration of the foetus, but wanting 

 further chemical investigation, is set up. The occurrence of the 

 one or the other eventually is so far of importance, as thereupon 

 hangs the after-effect of a retention of the placenta upon the 

 general health. In fact, we observe in women, just as in the 

 animals mentioned, sometimes only insignificant symptoms, some- 

 times emaciation and sickness ; sometimes, as after the absorption 

 of putrilage from the decomposing membranes, a violent, even a 

 fatal pyaemic fever. In the face of these facts, it seems to me to be 

 rational in ruminants, in which the cotyledon can only be detached 

 from the uterus by considerable violence, and scarcely even then, 

 completely to avoid all introduction of the hand into the cavity of the 

 uterus after delivery^ just with the object of keeping it free from the 

 ingress of air, and to leave the separation of the placenta rather to 

 the natural forces. We shall thus best avoid putrefaction being 

 set up in the cavity of the uterus, and so expose the animal the less 

 to the risk of pyaemia.' I have not quoted from the recently pub- 

 lished works of Dr. Matthews Duncan and of Dr. Graily Hewitt, 

 though I have specified in my notes the pages of those works 

 which bear upon what I have just quoted from a foreign source. 

 I have forborne to do this, not because I think those works less 

 valuable, but because I think them more so, and I presume they 

 will be in your hands as they have passed through mine ^. 



^ Dr. Graily Hewitt, *The Diagnosis, Pathology, and Treatment of Diseases of 

 Women,' second edition, 1868, pp. 32, 342, 393 ; Dr. Matthews Duncan, * Researches 

 in Obstetrics/ pp. 276, 284, 285 ; Cazeaux, 'Traite des Accouchemens/ pp. 334. 349- 



