MIDWIFERY. 
but of schirrous adhesion we know nothing. 
However we stiould always do a thing per- 
fectly : if we set out with the intention of 
doing it at all, we should do it completely. 
It is better to leave the whole than a part ; 
because if the whole be left, most probably 
the uterus will contract upon it, since it 
is a stimulus which the uterus is able to act 
upon, while part of it cannot be acted upon 
by the uterus with the same facility. 
Consequences of a portion of the Placenta 
remaining. Pursuing the subject, we come 
next to the consideration of that state which 
arises from a portion of the placenta being 
left. No great inconvenience seems to 
arise till the third or fourth day, when the lo- 
cliial discharge increases and becomes more 
offensive ; the after pains, which generally 
cease about the third day, remain after that 
time, arising from the tendency in the ute- 
rous to throw off what it cannot get rid of. 
There is occasionally a shivering lit, suc- 
ceeded by heat, but rarely ending in per- 
spiration. The pulse rises to 120 or 130, 
the patient becoming emaciated and very 
pale, though when the fever is upon her she 
looks as if painted: by degrees the hectic 
flush lessens ; the pulse becoming smaller, 
acquires a wiry hardness, and this continues : 
the woman becomes tender at the lower 
part of the belly when it is pressed upon, 
tlmugli it is not violent pain as in puerperal 
inflammation ; frequent retching and vomit- 
ing now arise ; and if she live long enough, 
hiccup succeeds to the last symptom, toge- 
ther with which the mouth and tongue be- 
come sore : she is at length worn out by all 
this, and lays down her head and dies. 
The discharge becoming greater and more 
offensive is the best marked symptom, and 
frequently causes the death of the woman. 
This does not strike those people who hap- 
pen to attend without being practitioners 
in midwifery; they see the fever, which 
they attribute to the effects of lying-in, and 
they hope it will soon get better. 
Inverted Uterus. This happens most fre- 
quently in the practice of female midwives, 
they being more in the habit of pulling away 
the placenta; and they in this way invert 
upon the same principle that the finger of a 
glove is inverted when a string is passed up 
the inside knotted to the end of the finger, 
and then drawn down the interior. 
In pulling at the cord it will often hap- 
pen that the placenta will separate froqi the 
uterus at the same time that the inversion 
takes place, and the operator is not aware 
of what has happened; now, however this 
is produced, the effect is in all cases the 
same ; it may be attended with profuse 
flooding, or the uterus may contract ; it is 
lucky if a flooding come on, since it may 
lead to an examination, when the tumour 
will be felt in the vagina, and must be re- 
turned, the fundus being reduced first. It 
should be done as early as possible. The 
difficulty consists in the os uteri forming a 
sort of ligature behind, which prevents the 
return of the uterus through it. AVhen the 
os uteri is before us it is easily dilated ; but 
when we liave to work through a substance 
to it the case is changed. Sometimes hae- 
morrhage will take place early after deli- 
very ; and whenever it does, we should 
always examine: there is no difficulty in 
examining, and it ensui’es the safety of our 
patient. If we know of the case directly 
it has happened, and we return it, there is 
an end of the mischief; but if we neglect 
to ascertain its existence till the next day 
only, we stand a very fair chance of losing 
our patient: it will be. hardly possible to 
reduce it unless attempted directly. It is 
then of the utmost consequence that the 
practitioner be careful in extracting the 
placenta ; and that he never pull the cord 
forcibly', till upon passing his finger up the 
vagina he feel the root of the placenta ; for 
he may be then satisfied that it has separat- 
ed. 
Reviewing then what has been said upon 
this division of labours, we find that it com- 
prises difficulties of two descriptions; the 
one resulting from what has been called 
cases of arrest, or of impaction; and the 
other from merely collateral circumstances. 
It is rarely that the aid of instruments can 
be of service, or even employed in the lat- 
ter description : while they may very fre- 
quently be of the utmo.st assistance in the 
former. We call it a case of arrest when 
the head is got down into the pelvis, and 
remains unmoved, not because there is too 
much resistance, but because the woman is 
too weak for any further exertion. The 
state of things in arrest is very different 
from that which happens in impaction ; in 
arrest we find the head not compressed, nor 
the scalp drawn into folds or swelled ; the 
stools come away naturally, and the w'oman 
makes water easily : and with regard to the 
constitution, it is languid and weak ; in short 
she is a very debilitated woman. AVhat 
then will be the consequence in this view of 
the case ? Is the woman likely to overcome 
the difficulties now the powers are worse? 
No. Is there any danger with regard to 
