MIDWIFERY. 
cessarily be perfectly ignorant where the 
ruptured vessel is, and consequently as per- 
fectly unable to stop it. Should it ulcerate, 
the treatment should be the same as that of 
an ulcer in any other part of the body. 
Lochial Discharge. By this is meant that 
discharge which follows the expulsion of the 
placenta, continues for several days, and di- 
minishes in proportion as the uterus con- 
tracts. A .short time after delivery the ves- 
sels which before poured out red blood, 
will, from the womb having contracted to a 
certain degree, only ooze forth serum. 
When small pieces of tlie maternal part of 
the placenta remain with fragments of the 
membranes, &c. and mix with the lochial 
discharge, they constitute what the nurses 
call the green water ; and these discharges 
generally subside in six or eight days, more 
or less. They will, however, often be repro- 
duced by very slight causes ; such as sitting 
upright, endeavouring to walk, eating stimu- 
lating food, or indeed any thing which may 
increase the action of the heart and arteries. 
In a strong woman of tense fibres the dis- 
charge will be of shorter duration than in a 
weak woman of lax fibres ; if a woman be 
quiet it will not continue so long as if she be 
restless. Where the quantity is profuse, 
and it flows for too long a period, the con- 
stitution becomes weakened, and it is ne- 
cessary to give bark with the vitriolic acid, 
or the conserve of roses. 
Lacerated Perinceum. The intermediate 
part of the body situated between the 
vagina and rectum, is called perinaBum j 
and from its peculiar situation is very liable 
to accident from the violence of pressure in 
labour ; this will sometimes happen with 
the most careful practitioner ; it will now 
and then give way in a trifling degree, and 
is in such cases of no further consequence 
than from its leaving the parts a little sore 
and weak for a few days. The only la- 
ceration of consequence is that from before 
backwards to the rectum, by which the os 
externum and rectum are laid into one, and 
the sphincter ani consequently torn asunder. 
This accident is, however, extremely rare, 
and may always be prevented by supporting 
that part of the perinaeum with the hand. 
In case of an actual laceration of the pe- 
rinaeum, the first step is to empty the 
bowels by a brisk purge ; after the medi- 
cine has operated, the parts should be per- 
fectly cleansed from all foeculent matter, 
and then the thighs should be bandaged to- 
gether, by which there is a probability of 
the parts uniting by the first intention, and 
in some cases this has succeeded. Should 
this fail, the only chance is not to allow the 
parts to heal except by uniting with each 
other. If considerable inflammation takes 
place, it must be reduced by the use of fo- 
mentations and cataplasms, and of cooling 
laxative medicines, and if the pain be violent, 
opiates may be given. When suppuration 
occurs, bark must be administered. The 
dressings may be superficial. 
After Pains. Every woman who has 
been in labour is subject to what are called 
after-pains, though they do not always occur 
equally. They come on at regular inter- 
vals, and are more or less violent. These 
pains are very rarely felt after a first lying- 
in ; and they are less when the labour has 
been retarded, allowing the uterus to con- 
tract gradually behind the body of the 
child, than where the expulsion of the child 
has been hastened, the uterus then con- 
tracting suddenly but not perfectly. In 
consequence of these pains, and the fatigue 
which the woman has sustained throughout 
the labour, it is a very general and excellent 
practice to give an opiate of from twenty to 
thirty drops of laudanum, and afterwards to 
repeat it in such a diminished quantity as 
shall allay the irritation, but not the contrac- 
tion of the uterus. 
An after-pain will perhaps come on an 
hour after delivery, by which a large coa- 
gulum may be expelled ; and after that 
others, by which smaller coagula will be se- 
parated ; and then an after-pain as violent 
as any of the rest, to throw oft' one of the 
smallest possible size. To some women 
these are very distressing, "and are borne 
with less patience than the labour-pains, as 
the latter they know are for a good pur- 
pose, while the pains after delivery aftbrd 
no such consolation, and yet are sometimes 
as violent as the worst pains of labour can 
be. These pains may be moderated by 
warm application to the abdomen, and by 
small doses of laudanum. 
General Treatment of a Woman after De- 
livery. Practitioners formerly had various 
ways of treating a woman after delivery. 
Of these the principal were the high or sti- 
mulating mode of treatment j and the low 
or starving system. 
The best practice is to avoid both of 
these extremes, and to treat the woman 
entirely according to her situation ; if 
strong and healthy, she may be kept for a 
few days upon gruel, barley-water, and toast 
and water; and then, if she be perfectly 
free from fever, she may eat a little animal 
