708 
PARTURITION. 
at liberty to debate ; it has for near two centuries met itfelf to its former vigour 5 or the foundation may be laid 
the content and approbation of every praCVitioner of judg- for chronic and fatal difeafe. 
ment and reputation in this and many other countries.” The primary objeCt in the management of thofe cafes 
Denman. of flooding which refult from a lofs of contraCtile energy 
Should the flooding be fuch as threatens to proftrate in the uterine fibres, is to re-excite the contractions of 
the powers of the fyftem, the operation ought not to be the uterus, if they {hall have entirely ceafed ; and to 
deferred, or one gufti of blood may clofe the painful fcene; quicken their activity if they be continued feebly, 
and, whenever it becomes eflential to the fafety of the Whether then the placenta be detached or not, the 
patient to proceed immediately, although the os uteri praCtice is the fame; for furely nothing can be more 
may not be open, it will be found in fo dilatable a rtate culpable than the dangerous cuftom of fome men, who 
as not to oppofe any hindrance to the introduction of the recommend “ that the hand mult be immediately intro- 
hand into the uterus. When the hemorrhage occurs be- duced within the uterus to grafp the placenta, and in¬ 
tween the fifth and eighth months, it is ufually not very ftantly extraCl it.” The confequences of fuch irrational 
formidable at firft, fo that, if the os uteri be not dilated practice is an augmentation of peril; for the very obvious 
or dilatable, the operation may generally be deferred for reafon, that the open mouths of a great number of vef- 
fome hours with fafety; whilft at the fame time it is of fels are expofed. In fome rare inftances, the placenta 
the higheft importance not to permit the woman to be is thrown off, and lies loofe in utero, preventing the 
exhauited by the lofs of blood before turning is effeCled. complete contraction of the organ. Whenever that is 
If, on examination per vaginam, every part of the os the cafe, there can be no hefitation about the propriety 
uteri be found covered by the placenta, and no point be of carefully withdrawing it; but not unlefs the uterus 
found at which it is thinner than another, the fingers has firmly contracted on it. 
rauft perforate the fubftance of the mafs, and, the hand of Internal irritation of the uterus with the hand ; and 
the accoucheur being paffed through, the feet of the child external preffure and friction, with the application of 
are to be brought dowm through the aperture, and the cold; are the principal remedial means on which our de- 
woman delivered as foon as circumftances will admit, pendance muft be placed, to re-excite the aCtion of the 
Sometimes the os uteri is only partially covered with the uterus ; and without which a woman is not fecure. 
placenta, fo that the hand can be paffed by its edge to the Whenever the uterus is found to be uncontraCled, the 
membranes without difficulty. Whenever this can be hand is to be gently paffed into it; and, when introduced, 
accomplifhed, it fhould be preferred to the pafiage of the to be freely but tenderly moved about within its cavity, 
hand through the fubftance of the placenta. Whilft this is being done, an afliftant may employ fric- 
In whatever way admiffion may be obtained into the tion to the abdomen or ioins, round which the broad 
uterus, the operation of turning is to be performed un- bandage has been previoufly applied, that it may be 
der the guidance of thofe directions which have been gradually tightened without difturbing the patient; or, 
already given. whilft the left hand of the accoucheur is in utero, the 
The child being extracted, the placenta is generally right may grafp the uterus externally ; a meafure which 
found quite feparated : this may therefore be removed, is often eminently conducive to the attainment of the 
and the practitioner fhould then fatisfy himfelf that the objeCt fo much to be defired. The hand is never to be 
uterus is duly contracted. The patient will require very withdrawn from the uterus, until it begins to contract, 
afiiduous attention after fuch a labour, and is generally except it be to empty the organ of coagula, which, by 
very long before fhe recovers. diftending it, will frequently prevent its contractions al- 
3. Atonic hemorrhage. —The diforder here referred to together until they are removed, 
is not that lofs of blood which very frequently attends In lefs dangerous cafes of hemorrhage, the application 
the contraction of the uterus which expels the child, and of cold to the pubes, perineum, abdomen, and loins, 
at the fame time loofens a fmall portion of the placenta ; will frequently arreft its progrefs. This remedy may be 
nor that which merely circulated through the uterus, and applied by cloths wrung out of cold vinegar or fait and 
which on the complete detachment of the placenta, and water; or by the more impreflive method of dalhing the 
the contraction of the organ, is expelled from its veflels, parts with cold mixtures; or by the ftill more efficacious 
now fo diminifhed in their fize ; but it is thofe fucceflive ufe of pounded ice in a bladder, allowed to difiolve gra- 
gufties, or more infidious but not lefs dangerous ftillici- dually on the abdomen ; or a piece of ice introduced into 
dium, of the vital fluid, which, if not arrefted fooner or the vagina or reCtum, as directed in the firft feCtion. 
later, fatally exhaufts the fubjeCt of them. Should there be irregular contraction of the mufcular 
Torpor of the uterus, or irregular contraction of its fibres of the uterus, either conftituting the hour-glafs 
fibres, is almoft an eflential feature of uterine hemor- contraction, when the circular fibres are affeCted with 
rhage occurring after the expulfion of the child; except fpafm about the centre of the organ; or the oviform 
in thofe cafes which arife from the placenta being par- contraction, when all the circular fibres aCt fpalmodically, 
tially detached, whilft the mafs being ftill adherent and whilft thofe which take a longitudinal courfe appear to 
retained in utero, prevents the complete contraction of be more than ufually relaxed ; the hemorrhage will be 
the uterus. ' checked by fuch means as relax fpafm, and induce re- 
Some women are fo liable to floodings, as to be attacked gular and univerfal contraCtile efforts. Flooding from 
with them after every labour: fuch patients fhould always this caufe muft be attacked by a full dofe of opium, (not 
have a bandage placed round their body, before they lie lefs than forty minims of the tinClure, or three grains of 
down on the bed for the purpofe of being delivered, the gum;) and immediately on theceffation of fpafmodic 
This bandage fhould be made with feVeral ftraps, which aCfion, which is manifefted by the diminution of pain 
may be gradually and fufficiently tightened as foon as the in the back, the hand of the accoucheur muft be intro- 
child is born: by this means profufe hemorrhage will duced into the uterus, for the purpofe of gently dilating 
often be prevented. the ftriClure, emptying the organ of its coagula, and 
Although the lofs of a fmall quantity of blood is com- ftimulating it to more healthy contraction, 
mon on the detachment and expulfion of the placenta, Syncope, or fainting, is not an unfrequent confequence 
and does not demand interference; it is of the highell of flooding ; and, although it is beneficial when contrafted 
moment not to defer the adoption of energetic meafures with continued hemorrhage, yet it muft ever be viewed 
until formidable confequences begin to appear, becaufe, as an evidence of danger, and as indicative of extreme 
if hemorrhage is allowed to proceed, although it may not lofs of energy in the vafcular fyftem. 
Immediately endanger the life of the patient, the conftl- It may be here obferved, that there are three impor¬ 
tation may be fo enfeebled as to be unable to reftore tant agents concerned in retraining uterine hemorrhage ; 
6 ^ —uterine 
