The discharge becoming greater and more offensive is the best marked symp tom, and frequently causes the death of the woman. , This doeti not strike those people who happen to attend without be ing practitioners in midwifery ; they see the fever, which they attribute to the ef fects of lying-in, and they hope it will soon get better.
Inverted Uterus. This happens most frequently in the practice of female mid wives, 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 from the uterus at the same time that the inver sion takes place, and the operator is not aware of what has happened; now, how ever this is produced, the effect is in all cases the same ; it may be attended with profuse flooding, or the uterus may con tract; it is lucky if a flooding come on, since it may lead to an examination, when the tumor will be felt in the vagina, and must be returned, the fundus being re duced 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. When the os uteri is before us it is easily dilated ; but when we have to work through a substance to it the case is changed. Sometimes hemorrhage will take place early after delivery ; and whenever it does, we should always ex amine : there is no difficulty in examining, and it ensures the safety of our patient. If we know ceche case directly after 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 separated.
then what has been said upon this division of labours, we find that it comprises difficulties of two descrip tions; the one resulting from what has been called cases of arrest, or of impac tion: and the other from merely collateral circumstances. It is rarely that the aid 9f instruments can be of service, or even employed in the latter description : while they may very frequently be of the ut most assistance in the former. We call it a case of arrest when the head is got down into the pelvis, and remains unmov ed, not because there is too much resist ance, but because the woman is too weak for any further exertion. The state of things in arrest is very different film 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 wo man makes water easily : and with re gard to the constitution it is languid and weak ; in short, she is a very debilitated woman. What then will be the conse quence in this view of the case ? Is the Amman likely to overcome the difficulties now the powers are worse ? No. Is there any danger with regard to the constitu tion ? No. While there is a number of little pains which last four or five days, is it right to leave a woman ? No. Then why not deliver her with the forceps, in which there is no danger? It is only bring ing along the child, while the mother has not sufficient power to do it herself. In a case of impaction the powers of a woman may be as good as those of any woman in the highest health. But there is &resist. once which cannot be overcome, so that things are very differently situated to what occurs in arrest only. The bones of the head are wrapped over each other, the scalp is swelled Mid wrinkled, and is so altered, that upon any person feeling it who had never been at a labour, he would guess it to be any part bet what it is. If it be a genuine case of impaction, the head will be locked in the surrounding parts, producing a stoppage of the eaacuations of stool and urine; so that on this account it would be clear that the head filled the aperture of the pelvis.