MIDWIFERY. 
if the conti-action be strong. Certain symp- 
toms fake place wliicli are evidences of its 
having happened ; one is a sensation of a 
sudden and most excruciating pain, wliich 
always comes on at the moment of the rup- 
ture. A lady, when in labour, was attended 
by a most respectable practitioner, and a 
man in years ; this case is an example of the 
manner in which it may come on. The la- 
bour went on perfectly well, and it being 
late at night, he proposed that the husband 
should go to bed, as his wife would be deli- 
vered in three or four hours more. The 
gentleman then sat down by the bedside of 
his patient, and in about three quarters of 
an hour she began to scream suddenly ; he 
supposed the head was in the vagina, as the 
labour had gone on so well, when to his 
astonishment he found the head was not to 
be felt, it had entirely receded. She would 
get up, and he in vain prayed and begged 
her to lie still. This state of pain and rest- 
lessness was succeeded by faintness from 
two causes, limmorrhage, and pain. These 
are attended with another, which is the 
sudden loss of labour pains. There is a 
faint inclination in the uterus to keep them 
up, but they are sure to sink. The organ is 
destroyed, and its functions must neces- 
sarily be destroyed too. There is great 
restlessness, accompanied with a sense of 
pain different from that lately felt : there 
will be faintness, but without loss of blood 
externally, for it generally passes into the 
abdomen ; there will be vomiting of a te- 
nacious chocolate coloured fluid ; the head 
or other presenting part recedes usually, 
and the child can be no longer felt. 
All these symptoms combined, become a 
proof of ruptured uterus ; but any one of 
the symptoms may occur alone ; the patient 
may be in violent pain without rupturing the 
uterus; she may faint, but it does not follow 
that her uterus is torn : there must be all 
these things in common ; excruciating pain, 
a fainting, sickness, and vomiting of that 
singular kind, and the retiring of the pre- 
senting part ; these in the aggregate will 
determine our opinion. If in a case of this 
kind we find tlie head has only entered the 
upper aperture of the pelvis, we cannot get 
the forceps applied ; here it has been said 
we might turn and bring down the feet : but 
this should never be attempted ; it only oc- 
casions more mischief ; the only chance is 
to open the head of the child. If, however, 
from the head being high up, and loose, we 
think that we can embrace it with the for- 
ceps, we may try, for we by tins mean 
give another chance for tlie delivery of 
a living child, which is a great object at all 
times. 
Suppose a case where the child lia.S 
actually retired from the cavity of the 
uterus into the cavity of th.e abdomen, what 
is to be done ? there have been different 
opinions ; some say it is best to bring the 
child back, while others leave it to nature. 
It should always be returned and delivered 
by the feet. The chance is something in fa- 
vour of the mother, whose case cannot be 
worse, and largely in favour of the child. 
Uterine Hcemorrhttge. Flooding cases 
belong naturally to this section, h'cemorrhage 
being one of the constant attendants on 
the last mentioned accident. We have al- 
ready considered the history and manage- 
ment of trifling floodings occurring in the 
six first months of pregnancy, when speak- 
ing of the management of abortion ; what 
we are now going to treat of, relates to the 
three last inonth.s, the commencement of 
labour, during the progress of labour, or 
after the delivery of the child, and before 
that of the placenta ; and each of these 
divisions, as regards time, will run into the 
rest. 
The proximate cause of puerperal flood- 
ings is in all cases the same thing, consisting 
of a partial separation of the surface of the 
placenta from that of the uterus. The dif- 
ference existing in structure, between the 
human placenta, and that of brutes, ac- 
counts for it happening less frequently in 
them than in us. In quadrupeds, the fmtal 
part separates from the maternal portion, as 
was before explained ; while in us the 
whole jdacenta comes away entire, leaving 
vessels with open mouths ; so that when 
any portion of the placenta is separated by 
any mischance, a consequent haemorrhage 
attends, which is proportioned in violence 
and duration to the extent of the part so 
exposed. The vessels are largest towards 
the middle of the placenta ; and some of 
them are very large indeed on the inner sur- 
face of the uterus. 
The occasional causes of the uterine h®- 
morrhage may be any circumstance capa- 
ble of separating a portion of the placenta 
from the inside of the uterus. These were 
enumerated when speaking of abortion : all 
acute diseases, passions of the mind, as 
rage, &c. strong liquors in large quantities ; 
and besides these, if the placenta be attach- 
ed close to, or over the os uteri, it will be 
very likely to produce ha;morrhage, either 
before or in labour. When it is attached 
