midwifery. 
the action of the heart so weak, and the 
quantity of blood circulating so deficient, 
that our first care must be to supply the 
waste, and remove the greatest danger, 
which is that of the patient’s having been 
exhausted beyond the point at which the 
constitution is able to rally, and recover 
itself. These cases must be supported and 
stimulated ; boiled milk with grated crumbs 
of bread in it, must be quickly cooled by 
spreading it on a flat dish, and when cool 
may be sjiven as one of the most nutritious 
things that can be had ; or good broth in 
which the grated bread is mixed ; and if 
these remedies do not stimulate the heart 
and arteries, the probability is that tlie pa- 
tient will die. In many of these cases the best 
stimulant is the volatile alkali, next to which 
brajidy and water, or the ammonia, which is 
preferable, because, although the first effects 
of the spirits is good, it produces too much 
heat in the system at large, while that effect 
never arises frpm the volatile alkali. It is 
sometimes two, or even three hours, before 
we can leave such a patient in the certainty 
of her living. 
After the flooding has stopped, we are 
not to consider the patient as safe. The 
fever eoming on about the third day, may 
be troublesome ; nothing is so efficacious 
for this as the saline draughts, with laudanum 
to the amount of a grain of opium in the 
twenty-four hours. Immersing the hands 
and feet in warm water to about 80 ° Fah- 
renheit is useful ; it brings down the pulse, 
and does a great deal of general service. 
After flooding, another circum.stance re- 
quires attending to, a throbbing of the bead 
and loss of memory, which will remain for 
weeks: in such cases there is nothing so 
good as purging, although the cause of the 
complaint be hemorrhage. The best way 
is to give infusion of senna with the Epsom 
salts, after which a draught of the decoction 
of bark. 
Consequences of the Placenta remaining, 
and its treatment. The general treatment 
of the placenta has been already explained, 
where nothing "more than ordinary attends 
it, together with the proper time which it 
may be allowed to remain. We will now 
consider the consequence of its remaining, 
and its treatment when it does remain. 
It was said before, when it remained too 
long, it was necessary to pass up the hand, 
and bring it away by separating it from the 
uterus. Some say, that immediately after 
tlie child is born we should go up and bring 
it away, if the same pain which expelled the 
child do not separate and bring down the 
placenta. This is said to save another unne- 
cessary pain. It is said that the uterus will 
afterwards contract, and all will be w'ell. 
The trath is, the uterus is meant to expel 
the placenta as well as the child : if it were 
necessary to have extracted the placenta 
directly as the child was born, nature would 
have made some further provision : all the 
works of nature are perfect in all their parts. 
There is a case in Haller where it was left 
to nature, and remained, it is said, thirty 
days. AVe should never think of leaving 
our patient while the placenta remains be- 
hind. When a w'oman is properly manag- 
ed, it will rarely be necessary to separate 
witli the hand. In this Dr. Hunter’s prac- 
tice was exceptionable ; he was in the habit 
of leaving this to nature: he used to leave 
the woman upon the child’s being born, de- 
siring the nurse to put the placenta into the 
bason when it did come away ; that was 
enough for him. 
We should never leave the placenta in 
the uterus ; and if we have left it two hours, 
we should never leave it beyond tliat time. 
It is always right to bring it away. If it 
adhere to the uterus, we may introduce our 
hand as in turning, guiding the hand by the 
cord ; we should then separate the edges of 
the placenta from the uterus, peeling it gra- 
dually and carefully off. After the whole 
is separated, we may make a feint to with- 
draw our hand to observe if the uterus will 
contract; if it do not, we should use a 
degree of pressure against its side, and it will 
generally bring on its action. 
The placenta may be retained by a con- 
tracted uterus, of which there are two kinds, 
one in which the uterus is as long as before 
delivery, but narrower. This state will de- 
pend on too speedy delivery. We must 
patiently overcome the contraction with 
our hand, and separate and bring-away the 
placenta, as in other situations. There is 
little hazard in this case, as the ready con- 
traction gives us little reason to fear the ill 
effects of hseraorrhage after we have got 
away the placenta. The other sort of con- 
traction is that in which the uterus may be 
said to resemble an hour glass, called there- 
fore the hour glass contraction ; this must 
be overcome in the same way as the other. 
AVhenever we introduce our hand to bring 
away the placenta, we must take care to 
bring away the whole ; it has been stated 
that a part of it has been found in a state of 
schirrous adhesion to the uterus ; now it 
certainly will adhere, tliat often happens: 
