MIDWIFERY. 
»n the cervix uteri, it must in the course of 
tlie labour be separated by the dilatation of 
the uterus at its neck ; this is so plain, that 
it cannot require illustration. Such a si- 
tuated placenta will almost ensure uterine 
haemorrhage in the last months of preg- 
nancy, which may be more or less in quan- 
tity. 
If it be very slight, the necessary means 
to restrain it need be nothing more than 
what is used in slight hamorrhage from any 
other part ; but when violent, and the pa- 
tient either gets one gush of blood, or it 
comes in quantity till she faints, and then it 
is restrained, and she gradually recovers ; 
and then it recurs from her taking some sti- 
mulus into her system, either food or drink ; 
she has no sooner recovered a little strength, 
than another bleeding comes on, and she will 
faint and recover, and the flooding again 
recur, and so on ; the faintness causing the 
restriction of the vessels ; the restriction of 
the vessels allowing the circulation time to 
restore its own equilibrium ; and when 
once tliat has arisen, the force of the circu- 
lating blood again overcomes the slight re- 
sistance formed by the contraction of the 
vessels, and the formation of the coagulum. 
When once a woman has had an uterine 
haemorrhage, from whatever it has proceed- 
ed, she is never safe ; and must remain in 
jeopardy every hour, until she is delivered, 
for the slightest circumstance may repro- 
duce it after it has once happened. The 
danger in this state is not from the quantify 
of blood lost, so much as the manner. A 
bleeding has come on at the third month, 
which was exceedingly large in quantity, 
but in consequence of its not flowing very 
quick, the womanhas survived. Miscarr iages 
occur in which a large quantity of blood is 
frequently lost, without the woman dying j 
insomuch, that where abortion takes place 
in the tenth week, she very rarely dies from 
loss of blood, though sometimes this is ex- 
cessive. What then does this depend upon ? 
tire time in which it is lost, and the way in 
which it comes on ; for although lost from 
the constitution, it is from small vessels. But 
when there is a sudden gush of blood from 
large vessels, the case is quite different. 
From experience we know that large vessels 
do not contract so soon as small ones ; 
there is not time for faintness to intervene 
and the patient consequently dies immedi- 
ately. 
One symptom of the greatest danger in a 
flooding case is a want of labour pains, 
when it occurs in laboui-, which is the rea- 
son that the midwife hardly ever sends for 
us till it is too late ; she thinks nothing can 
be 060688317 to be done till the pains go on 
as they should do, while in fact their sub- 
siding is one of the worst symptoms. It 
shows that the uterus has not energy enough 
left to expel the child ; so that we always 
judge uterine hamiorrhage to be worse when 
not attended with pain than what it is. 
Another bad symptom is, when the os uteri 
feels relaxed and flabby like a piece of 
dead meat, with a hole through the middle 
of it. It resembles an inanimate opening ; 
w'e may without resistance move its lips in 
any direction. When the haemorrhage con- 
tinues long, the face loses its colour, the 
mouth and lips become quite pale, and the 
little projection at the inner canthus of the 
eye is a very significant part with an atten- 
tive observer ; it is not often attended to, 
but if it be sunk, it is a symptom of decided 
danger ; these are followed by want of 
rest ; the patient will be moving about in 
bed, and that notwithstanding all that we 
can say, if we even represent the risk of her 
producing her own death by it, still she 
will be throwing her arms in every direc- 
tion, and rolling backwards and forwards in 
the bed. In this way then will she pro- 
ceed, one fainting fit succeeding another, 
at last, so rapidly, that it can scarcely be 
conceived until seen : fits of vomiting to- 
wards the end will occur, together with a 
sort of convulsive raising and lowering of 
the pomum adami ; and life will at last 
leave her suddenly ; perhaps after she has 
been speaking she will lay her head down 
and die. The next danger is, that she may 
drain to death, by a slow progressive state 
of the complaint. To day she shall lose a 
pint of blood, to-morrow half a pint, next 
day none, the day after that again a quart, 
and so on, till the powers of life are ex- 
hausted. Thus is she drained to death ; for 
the stomach is not capable of supplying 
nourishment quick enough to counteract so 
rapid a consumption. 
There are still other dangers arising from 
uterine haemorrhage, the consequence of 
which we have great reason to fear. Sup- 
pose a woman in labour loses two quarts of 
blood by the vessels of the uterus, that wo- 
man will, about the fourth day, have a per- 
fect fever in all its characters, somewhat re- 
sembling the milk-fever, the pulse 120, the 
countenance flushed, the skin hot and 
parched, though we should naturally enough 
expect, that instead of producing fever 
tlie loss of tw'o quarts of blood might more 
