MIDWIFERY. 
readily be expected to take fever otF wliere 
it existed before. Supposing even tliat the 
patient gets quite clear from any l eturn of 
the haemorrhage, the fear that remains is, 
whether she liave not ah'eady too much for 
the constitution to repair ; and we must 
again wait in expectation of the fever ; if 
that do not come on, so much the better ; 
that is another danger got over. But she 
may die at the end of twelve months, and 
that from the effects of a single attack of this 
complaint. This will in most instances 
happen in women who are of a flabby loose 
texture, and have a heavy fat body, Hy- 
drothorax, or ascites, will in these persons 
supervene at a great distance of time, 
entirely from the debilitating effects of the 
loss of so large a quantity of blood has in- 
duced. 
With regard to the powers by which hae- 
morrhage is naturally restrained in different 
parts of the body, we may say that tliey are 
two in number ; one of which is the con- 
traction of the blood vessels themselves, the 
other is the coagulation of the blood in the 
mouths of the vessels which are ruptured. 
With regard to the contraction of blood 
vessels, it is well known that an haemorrhage 
is frequently stopped by that power atone. If 
we prick our finger, or shave a bit off, it 
would bleed everlastingly, were it not for 
the contraction of the divided branches, 
which stops it, and that so effectually, that 
if from time to time we even wipe away the 
blood with a sponge to prevent any assist- 
ance which might arise from the formation 
of coagulum, yet the bleeding will stop. 
But as the vessels contract gradually and 
slowly, the blood which forms on the sur- 
face being exposed to the air coagulates, 
and becomes the second cause of the blood 
ceasing to flow from the divided vessels. So 
that liEcmorrhage, considered in general, 
may be said to be restrained partly by the 
contraction of vessels, and partly by the 
coagulation of blood in the vessels. The 
natural powers by which hasmorrhage is 
usually restrained are the coagulation of the 
blood as it flows, and the contraction of the 
vessels. To these a third power is added 
in the uterus ; it is the contraction of the or- 
gan itself, and it is not only one of the 
three, but the most important, as being the 
most effectual power of them all, in stopping 
the hemorrhages which flow from the inter- 
nal suiface of the uterus. It should appear 
also from the experiments of Hewson, that 
the coagulation of the blood is more rapid 
in animals when dying than at any other pe- 
riod ; hence he argues that coagulation is 
always in proportion to necessity. 
With regard to treatment we may ob- 
serve, that in slight cases, where the quan- 
tity of blood lost is very trifling, it will not 
be necessary to notice the existing state of 
pregnancy, but to make use of the common 
remedies for the checking of slight hoemor- 
rhage from any internal part. But if there be 
increased action of the heart and arteries, 
and weiknow the constitution will bear it, 
we may take away ten ounces of blood, 
and suppress the animal food ; moderating 
the sanguiferous action, so that there shall 
be no risk of displacing the newly-formed 
coagidum, in its recent state, a tender 
jelly. If these things are attended to, the 
blood will perfectly cork up the bleeding 
orifices of the ruptured vessels. We should 
at the same time empty the bowels, pro- 
hibit all stimulating aliment, and advise a 
horizontal position. All this, however, re- 
fers to slight cases, and an early period ; if 
after this period, or during labour, we must 
seldom be beguiled from more active mea- 
sures. The only solid security is a deli- 
very of the child, which in all cases of pro- 
fuse or continued hsemorrhage we should im- 
mediately prepare ; and in the process to be 
pursued we are of course to turn the child. 
Wherever, in doing this, the os uteri very 
easily gives way, it is the very essence of 
danger, proving the want of contraction in 
the uterus. In the present instance, how- 
ever, we do not want to empty the uterus 
so much as we wish for its contraction ; for 
if we get away its contents at a time when 
it cannot or will not contract, we do no 
good. If the placenta seal up the os uteri, 
we must go directly through : we may 
eeisily, indeed, screw, our hand through it, 
for it is a loose pulpy mass easily torn. We 
should not wait long, nor be afraid, and, if 
the labour be recent, we may turn the 
head and bring down the feet : if the head 
be low enough to apply the forceps, we may 
deliver in this manner. The whole of this 
practice lies in a very small compass ; in 
detennining to deliver early, and in deter- 
mining that our patient shall not die ; and 
it is founded on the principle that haemor- 
rhage from the nterus cannot be restiained 
by the two powers which are sufficient for 
stopping a flow of blood in most other parts 
of the body, by the contraction of the ves- 
sels, and the coagulation of the blood in 
them j and that nature has here appointed 
