Operative tractions, which should be made on the cord, must be made after strict rule. Formally, authorities were in favor of seizing the cord, covered by a cloth to prevent slipping, in the right hand; then, to follow up the cord as far as possible with two fingers of the left hand, and through traction to make, the cord glide along these fingers which are pressing it down against the vagina. For our part, we lieve this procedure useless, and our method is as follows: The left hand ( is applied on the fundus of the uterus, in order to follow the retreat of ) this organ, and to make sure that "this retreat is normal and regular; whilst the right hand seizes the cord, a towel intervening, approaching the vulva as the placenta descends. As soon as the placenta reaches the vulvar cleft, the cord is released, and, seizing the placenta with the entire hand, it is twisted several times on itself in order to form, with the branes, a species of cord more resisting, and therefore less likely to break.
We are thus assured that these membranes are entirely intact when they issue with the placenta, and that no shred remains within the uterus or the vagina. The placenta delivered, it is laid on its uterine surface, and the membranes are lifted off the foetal surface, that we may assure our selves that they and the placenta are intact.
In Germany, Cred( has given his name to a method of delivery, which, after having been accepted with enthusiasm, is to day decried, and with just reason, by a large proportion of the authorities. This method is called Credo's method of placental expression, but in reality it belongs to Hardy and McClintock, and consists in the following steps: Wait for the first uterine contractions occurring after the expulsion of the foetus, and grasp with the entire hand the fundus of the uterus, massaging it, compressing it with the fingers, thus causing an artificial separation of the placenta, which, according to Credi, will make its exit from the uterus, driven from the uterine cavity, and expressed, so to speak, even as a cherry-stone is squeezed from between the compressing fingers.
According to Cred6, we thus avoid the hemorrhage of the third stage of labor and this manoeuvre adds in no wise to the woman's suffering.
For our part, we are opposed absolutely to this method, which not only cannot be resorted to as Credo wishes, but, furthermore, is far from be ing non-injurious to the patient. Placental delivery (practised after Credo's method) is no longer natural delivery, but is to the highest de gree artificial delivery. The rules laid down by Credo are in reality the following: Await not only the retraction of the uterus, but the return of the contraction, and then only to act. Now, if we analyze the tables prepared by Ore& and his pupils, those of Chantreuil, for instance, who for a time was a pronounced partisan of this method, we see that delivery by expression is resorted to even within three or four minutes after labor.
Now all authorities agree, and with reason, that if uterine retractility manifests itself within the first few minutes after the birth of the fetus, the same does not hold true of uterine contractility, which does not recur, ordinarily, before eight to ten minutes have elapsed. This theory therefore, is strikingly opposed to practice.
Furthermore, we would add that we do not believe that massage of the uterus, exercised at a time when this organ, worn out by the efforts which it has made to give birth to the foetus, needs gentle management, is inof fensive to the woman. Further still, the very German authorities who have shown themselves partisans most loyal to this method, have reported a number of cases of metritis and of peritonitis consecutive to such inter ference more or less brutal. Let us add, finally, that this method in no sense protects women against hemorrhage, and that, in many instances, there have remained within the uterus shreds of membrane, and even portions of the placenta.
[In view of the nearly uniform belief, teaching, and practice of distin guished accoucheurs throughout the world to-day, with whose writings every physician must be familiar, it seems unnecessary to give here the convincing arguments which at once suggest themselves in reply to the position so forcibly held by Charpentier. Furthermore, the description 'given by him of Credo's method is the reverse of the truth, as we under stand and practise the method, and as we know it to be understood and practised by Credo and his followers in Europe and in this country. Cred'o's method, rightly followed, is, above all other methods of placental delivery, rational, in that it simply assists the natural process of separa tion of the placenta, and further is safer for the woman, in that it secures those desiderata which every accoucheur aims at—a thoroughly emptied and au efficiently contracted uterus. Delivery of the placenta by traction on the cord cannot be too strongly condemned. It does not imitate Na ture's method, which is one of vis a tergo, not of vis a fronte. It is es pecially dangerous in those not very rare instances where there exist mor bid adhesions between placenta and uterus. Here there is possibility of uterine inversion, there is strong probability of plavental or membranous shred remaining in the uterus. And, be it remembered, in no given case does the accoucheur know that such morbid adhesions do not exist. For such reasons, mainly, have the majority of obstetricians rejected traction on the cord, and substituted placental expression. The wood-cut, there fore, descriptive of the former, it is hoped, will prove a warning as to what the accoucheur ought not to do.