After the flooding has stopped, we are not to consider the patient as safe. The fever coming on about the third day, may be troublesome; nothing is so efficacious for this as the saline draughts, with lau danum to the amount of a grain of opium in the twenty-four hours. Immersing the hands and feet in warm water to about 80° Fahrenheit is useful ; it brings down the pulse, and does a great deal of gene ral service.
After flooding, another circumstance requires attending to, a throbbing of the head and loss of memory, which will re main for weeks : in such cases there is nothing so good as purging, although the cause of the complaint be hzmorrliage. 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 explain ed, 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 imme diately after the 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 unnecessary pain. It is said that the uterus will afterwards contract, and all will be well. The truth is, the uterus is meant to expel the pla centa as well as the child : if it were ne cessary 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. We should never think of leaving our patient while the pla centa remains behind. When a woman is properly managed, it will rarely be neces sary to separate with the hand. In this Dr. Hunter's practice was exceptionable ; he was in the habit of leaving this to na ture : he used to leave the woman upon the child's being born, desiring the nurse to put the placenta into the basin 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 that 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 gradually and care fully off. After the whole is separated, we may make a feint to withdraw 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 ge nerally, 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 depend on too speedy delivery. We must patiently overcome the contrac tion with our band, and separate and bring away the placenta, as in other situations. There is little hazard in this case, as the ready contraction gives us little reason to fear the ill effects of hzmorrhage after we have got away the placenta. The other sort of contraction is that in which the uterus may be said to resemble an hour glass,called therefore the hour glass contraction; this must be overcome in the same way as the other. Whenever 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 scirrhous adhesion to the uterus ; now it certainly will adhere, that often happens : but of scirrhous adhesion we know no thing. However, we should always do a thing perfectly: if we set out with the in tention 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 con tract 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.
Conieguences 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 lochial discharge increases and be comes more offensive ; the after pains, -which generally cease about the third day, remain after that time, arising from the tendency in the uterus to throw off what it cannot get rid of. There is occa sionally a shivering fit, succeeded by beat, but rarely ending in perspiration. The pulse rises to 120 or 130, the patient be coming emaciated arid very pale, though when the fever is upon her she looks as if painted : by degrees the hectic flush les sens; the pulse becoming smaller, ac quires a wiry hardness, and this continues: the woman becomes tender at the lower part of the belly when it is pressed upon, though it is not violent pain as in puer peral inflammation; frequentretching and vomiting now arise ; and if she live long enough, hiccup succeeds to the last amp tom, together with which the mouth and tongue become sore : she is at length worn out by all this, and lays down her bead and dies.