child with sufficient facility. The cut was, of course, through the most vascular part of the organ. I need not say, that the blood bubbled up from the incised surfaces very rapidly; but it wholly ceased to flow as soon as the placenta was removed from the womb, so as to permit that organ to contract. The condensation of the womb, in contracting, shut up the cut vessels as completely as if ligatures had been applied to them. I repeat again, that a very firm clot, shutting the mouth of the womb, may serve as a tampon which shall wholly prevent the escape of blood from the cavity, which expands as it continues to receive the effusion, until the womb becomes fully as large as at the sixth month; and the larger the womb, the more capacious its vessels. Such clots should be broken up, and removed. They are as dangerous as, but not more so than the artificial tampon, when used after delivery at term. I have never used a tampon after delivery at term; but I have seen them used, which came very near causing the patient to sink, by detaining the effusion within the cavity. The principle is false, and the practice dangerous, which resorts to such a mode of arresting uterine hemorrhage, at term; he who resorts to it, does so under the ignorant presumption that uterine, like chirurgical, hemorrhage is to be arrested by coagulation of the outflowing blood. If it should be said here, that women very commonly do discharge utero-morphous clots after delivery, I admit the fact; but I insist that but for a sufficient degree of irritability in such uteri, the clots would become so large as to require for their formation a wasteful, and even dangerous or fatal extravasation of the vital fluid. Strong uteri never permit them; weaker ones allow pretty large ones to be formed, and very feeble wombs fill until the woman faints or dies..

Turn out the Clot.-I should feel happy if I could impress upon the mind of the Student, in such a manner as to make it ever present to him when the occasion demands, that the only certain mode of arresting uterine hemorrhage is to empty the womb and cause it to contract. If a woman have alarming discharges of blood before the delivery of the child, let him take away the child, if he can. If she bleed before the after-birth is withdrawn, let him withdraw it. If she bleed after delivery, let him introduce his fingers into the uterus and break to pieces the firm coagula that he will find in it, or in the vagina; and then by frictions of the hypogaster, or by cold, by pressure, by ergot, and by all the means in his power, let him compel the womb to contract; then, and not until then, will his patient be safe. He should always turn out the clot, if the patient is sickened by it.

The weakening effect of a sudden removal of pressure or support from the contents of the abdomen, is noticed not only in labors, but in tapping the abdomen for dropsy. It is always deemed necessary, in tapping very distended persons, to pass a broad roller round the abdomen, so as to constrict it in proportion as the water flows off. In cases of paracentesis, where this precaution is not observed, the patient is very apt to faint, and evidently from the same cause I have mentioned, namely, the want of pressure on the contained organs. I had occasion, more than two years ago, to verify this principle in a case. A young woman, excessively distended with ascites, was tapped; the water flowed off very rapidly; in proportion as it escaped, I tightened the bandage, and she made no complaint of faintness. In order to test the effect of relaxing it, I withdrew all pressure for a very short time, the water still flowing, and she immediately began to grow sick and faint; which symptoms ceased as soon as I renewed the pressure with the bandage. It is with the greatest confidence, both as to its necessity and efficacy, that I therefore recommend, that a bandage should be early placed around the abdomen of such patients as are prone to fainting after delivery, as the compression, all things being thus ready prepared, may be applied soon after the birth, and without disturbing the patient.

It is well worth the Student's while to bestow some sober thought upon the subject of the binder for a newly delivered woman. As a general precaution, it is doubtless a laudable one to bind up the weakened and exhausted abdominal region. But, it is questionable as to how long it should be used. Dr. White, of Manchester (Treatise on the Management of Preg. and Lying-in Women), says very properly, at p. 116, "Much mischief is often done by binding the belly too tight. If there be any occasion for support, a thin napkin pinned very slightly around the waist, is all that is absolutely necessary, and the sooner this is disued the better." Certainly after the first days of the confinement, it is not to be held necessary as a preventive of syncope or hemorrhage; nor has it any special usefulness beyond the doubtful one of restoring the woman's shape. But as to this, I think that Asdrubali is very correct in his assertion, that it cannot at all restore the figure, whose restoration depends upon the vital contraction of the muscular and other tissues that have been relaxed by the gestation. I fear that much of the too general complaint of prolapsus and retroversion of the womb among American women may be attributed to the use of bandages worn so tight, and so long, as to drive the recovering uterus to the bottom of the pelvis, or even overset it backwards into the hollow of the sacrum. Dr. A. F. Hohl,

Lehrbuch der Geburtshilfe, 8vo., Leipzig, 1855, says, at p. 1113, "The application of a binder for the abdomen, with a view to preserve the shape, to obviate the sense of emptiness in the belly, or to prevent fainting or flooding after delivery, we have by experience found to be unnecessary as long as the woman lies in bed."

Diet. The diet of a woman recently delivered, ought to be very light, and of easy digestion. Tea, bread, gruel, vegetable jellies, and panada suffice, and are the safest materials during the three or four first days of the accouchement. Circumstances may demand a more liberal allowance; but for persons who have small lochial evacuations, or who are of an excitable constitution, the simplest elements of nutrition only should be prescribed. For a surgical patient, both before and after the completion of the operation, a regimen is deemed of vital importance; and yet the shock to the constitution, and the irritative. influences of the wound, in severe or capital operations, being not greater than those developed by many instances of labor, are not dietetic precautions equally proper, then, in both cases? In addition to these considerations, it ought to be remembered that, during the months of gestation, the fluxional determinations have been towards the uterus; but now the wave of vital fluids is marching towards another set of organs, and great disturbances are, many times, occasioned by this mutation of directions. The effort of the constitution produces fever, which commences simultaneously with the irritation of the mammary glands; but, happily, when those glands are enabled to throw off an abundant secretion, the whole constitution is relieved by the evacuation, and the fever undergoes a crisis, as well marked as that of a bilious remittent, or any other febrile disorder that goes off by a profuse diaphoresis or diarrhoea. Let the body, then, be prepared for this fever, by a correct course of diet; and when that crisis has been completed, much of the hazard of an accouche ment will be already over-passed, and a reasonable indulgence in stronger food becomes safe and proper.

Suckling. The child should be put to the breast as soon as the mother has recovered sufficiently from her fatigue and exhaustion. This is a natural course-it is, therefore, the best one; for by the act of suckling, the new determinations, about to arise, are directed to, and restrained within their proper bounds: the vital wave ought to come hitherto, but no farther. Such a course is useful for the child, which generally procures, from the earliest lactation, some saline fluids that have a favorable influence on its digestive tube; and for which ought

not to be substituted that pernicious compound, molasses and water, which every child in the country is doomed to swallow, at the cost of a sour stomach and flatulent bowels, displayed in the almost universally resulting symptoms of colic, green stools, and vomiting. The antediluvian mothers had no molasses and water for their children, who lived nevertheless, a thousand years. Certainly nothing can be more conformable to the dictates of nature, than an early application of the infant to the mother's breast. If we could suppose a woman in a state of nature, to be delivered alone, under the shade of some primeval forest, and unsuspected observe her conduct, we should witness the instinctive movements and promptings of nature, that would far better guide us in the management of such affairs, than the crude conceptions of those who are ever ready to boast of the excellence of art or skill over the sure suggestions of instinct. Such a mother would soon be aroused from the weakness and languor that succeed the pangs and throes of childbirth, by the cries of her helpless offspring. She would take it, as soon as a little returning strength should permit, into her arms, and the newly-born child would probably not nestle a moment on the maternal bosom, without finding the source of its future aliment: the very anatomical structure, both of the maternal arms and breast, and the instinctive motions of the child's head, would bring its lips speedily in contact with the nipple. But we, wiser than our great instructress, often keep the new-born child away from its natural resting-place, and deprive it of the most appropriate nutriment for two or three days, in order to eschew sore nipples, or to propitiate some other imaginary evil; while we allow the breast to fill almost to bursting, and actually to inflame from distension, before we admit that preparation to be complete, which our presumptuous interference, in this manner, vitiates and troubles. The child ought to be put to the breast as soon as the mother is strong enough to take it.

Medicine. It is a good custom to give an aperient medicine on the third day, or about seventy hours after delivery; while, in most cases, it is safest to defer the administration, at least up to this period. The perturbations of vital action in the abdominal viscera, occasioned by medicines administered too early, are observed to result in symptoms of congestion, and of peritoneal fever, in not a few instances, particularly where an epidemic tendency to the latter malady exists. It should be well understood in the lying-in apartment, that no medicines are to be given to the mother or the child, without the sanction or advice of the medical attendant. In our part of the

country, it is exceedingly common for the nurse to take upon herself the function of prescriber, and administer a dose of severe cathartic medicine, upon her own responsibility; which, however great and important she may deem it, remains after all, with the physician. He it is who bears the burden, and undergoes all the trouble and anxiety and responsibility of the management. He ought, therefore, always to direct that no interference with his rights should be suffered to take place. There are many reasons why he should be the sole director of the case; for it is not a matter of indifference what particular article is selected, any more than it is of little consequence at what moment the medicine (if any) should be administered.

Castor oil is the article in most request for this period of the confinement; and in a dose of half an ounce operates sufficiently well. Where the castor oil is particularly disagreeable, a proper quantity of magnesia and rhubarb; of infusion of senna; of Epsom salts; of Seid litz powders, may be substituted; but, in general, the oil is to be preferred, because of the great certainty and moderation with which it operates on the bowels.

Lochia. The lochial discharges grow gradually less abundant, and of a paler color. The tone of the womb itself must determine, in a great measure, the duration and amount of the discharge. It dis appears in the third week, and sometimes earlier. Not a few women. continue to have a show in the fifth week; and, in fact, the Jewish women had their purification at the fortieth day, which probably might be founded on observations as well suited to the inhabitants of this country as those of the Holy Land.

Etherization. In speaking of the various points in the Conduct of a labor, I cannot well eschew to say something upon the employment of those anaesthetic agents whose recent irruption into the domain of Medicine and Surgery has been so sudden, violent, and overbearing.

To avoid altogether any notice of these agents would have been more consonant with my taste as well as with my views of medical duty; but as I feel that those who may please to have this book will surely expect to find a record of my opinions on anæsthesia as an obstetric resource, I feel constrained to overcome my reluctance to say anything concerning it.

In Philadelphia, the use of ether and chloroform in Surgery and Midwifery has made no great progress, notwithstanding the very numerous reports upon the benefits derived from those agents in