No.216.

LONDON, SATURDAY, MAY 31. [1827-8.

LECTURES

ON THE

THEORY AND PRACTICE OF MIDWIFERY,

DELIVERED AT GUY’S HOSPITAL BY

DR. BLUNDELL.

LECTURE XXX.

Retention of the Placenta.

BEFORE I proceed to the subject of ourinquiries this morning, I mean the retea-non of the placenta, it may be well to pre-mise an observation omitted yesterday, andwhich, though brief, is not without its im-portance. Of laborious labours it is not tobe forgotten, that though they sometimesarise from one cause only, yet, however,they are occasionally refertible to the co-operation of several ; thus, rigidity of theparts may concur with unfavourable posi-tion of the fcetus, or both may be met withwhere there is a coarctation of the aperturesof the pelvis.

In the earlier, as in the latter months, inthe laborious and flooding cases, and in na-tural labours, the placenta does not alwaysescape with the usual facility ; difficultiessometimes impede its abstraction, and it maybe retamed for days, weeks, not to say oneor two months.Where the placenta in this manner re-

mains in the uterus after the expulsion ofthe fcetus, occasionally for days together,rot a single alarming symptom occurs, sothat if you were not acquainted with thehistory of the case, you would scarcelysuspeet that the placenta was still lodgedin the uterine cavity. It is a great mis-t.i4e to imagine, because tlie placenta islying in the uterine cavity, that the womanmust necesar ily do ill ; and from this erro-neous impression I would wish your mindsto be liberated. So long, however, as theplacenta is retained in the uterine cavity, solong the patient is liable to various symp-

toms more or less alarming, of which theprincipal are pains, bleedings, uterine dis-

charges, and constitutional irritation.When the placenta is retained in the

uterus, it will sometimes give rise to

cutting, grinding, sawing pains, felt inthe back or the front of the abdomennear the symphysis pubis, not to men-tion the hips and thighs, the pains beingvery like the first pains of labour, or thoselatter pains felt after the birth of the foetus,and which are usually denominated the ajterpains. These pains it is by no means dif-ficult to alleviate by the use of opium, butthey are rather to be sought than deprecat-ed, for by these pains it is, or rather by thecontractions which produce them, that theplacenta is ultimately expected. Again.When the placenta is retained in the

uterus, whether in the earlier or the lattermonths, and in the latter months, more fre-quently, the patient is always liable to flood-ings more or less copious ; and, indeed, thisis the most dangerous symptom to which sheis obnoxious. From my own personal ob-servation, I am prepared to state, that the

placenta may lie quiet-innocuous in the

uterus—for one or two weeks together, largeeruptions of blood ultimately occurring not-withstanding ; and you may, therefore, setdown, among the dangers to which women arealways exposed, whether in the earlier or thelatter months, but in the latter months moreespecially, these copious eruptions of bloodfrom the uterine cavity. After what has beensaid so largely on the subject of floodings,you will not be at a loss as to the manage-ment of discharges of this kind. For a fullerexposition of the method of treatment, Imust refer you to the principles before laiddown ; suffice it to remark here, that theonly effectual remedy for putting a stop tothe discharge, is the removal of the placenta,and, therefore, if a woman is liable, not

merely to small shows of blood, but to thelarger eruptions, the sooner the placenta,whether by manual operations or otherwise,is, in an easy manner, extricated from theuterus, the better.When the placenta is retained in the

uterus, you will sometimes find that thepatient remains, in good measure, or en-

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tirely, free from any offensive or foetid dis- rather, because, having paid a good dea2 ofcharge ; but so long as the placenta is lying attention to this subject, I had noted morein the uterine cavity, so long is she liable to than one case, in which the placenta htdr.:-all the effects of its putrescence there and mained for a long time in the uterus, with-sometimes the discharges become offensive out a single conspicuous symptom of irnt!-in a high degree, the chamber, though spa- tion becoming manifest; but from observa-cious, becoming iiifecte(i with the offensive tions since made, I have been induced :]odour, which may, by a delicate sense, be believe, that independently of all manualnow and then perceived in the adjoining’ practice, these irritations may be produced,apartments. A girl, in St. Thomas’s, aborting about tLeWhy it is in some cases, that the pla- fourth month, I was requested to see her,

centa putrifies rapidly, while, in others, it when I found that the placenta could not beremains unchanged, I am not able, in a got away without force and danger; and 1satisfactory manner, to explain, though the deemed it wise, therefore, not to make thesubject is well worth investigation ; I strong- attempt. On the fifth day putrid dischargesly suspect, however, that the placenta will appeared, and, at this time, there was abe found to putrify much more readily, if deal of constitutional irritation; a cheekit is completely detached from the uterus, flushed, a countenance anxious, a pulse u.’than in those cases in which it continues 140, vomiting, purging, and copious perspi-to adhere to the uterine surface ; for detach- rations. Urged by the symptoms, I removedment from the uterus, seems to imply a the placenta at this time, for it appeared toconsequent extinction of vitality. be pushed some little way into the vagina;

Lotions may be found of service here, all the symptoms giving way very rapidlyprovided, by means of a long tube syringe, afterwards, and the girl ultimately recover.they are thoroughly injected into the ing. Is the putrid placenta alone liable to

uterine cavity. For the performance of this occasion these irritations 1 doubt; for it is’injection, the accoucheur will be found the a matter of fact, well worthy of notice, notbest- operator; and it is desirable, that the only in midwifery, but in surgical sciencefluid be injected repeatedly in the course of also, that substances may become wrythe day, unless bleeding, or other symp- putrid, and yet they may lie in the vaginatoms, forbid. Warm water, decoction of for a length of time, without occasioningbark, or other injections, diluent or anti- much constitutional irritation. And thus

septic, may be recommended in these cases. much then respecting the various symptoms,The fluid being absorbed, you bear the more or less alarming, which may resultsyringe in the right hand, carrying the from a failure in the abstraction of the pla-fingers of the left, in the way of a director, to centa-pains, floodings, putrid discharges,the mouth of the uterus, and then the tube and violent constitutional irritation. Let us

being passed along the finger into the uterine now consider what these cases require.cavity, by the action of the syringe, it may be It is, I believe, agreed on all hands,very completely washed out. After all, how- among practical men, that as the woman isever, the only effectual mode of arresting these always obnoxious to these symptoms, so longdischarges so offensive, is the abstraction of as the placenta is retained, it is always de-the placenta, either by manual operation, or sirable that the placenta should be got away.the deobstruent remedies, of which I shall Now the means to be employed for this pur-hereafter treat ; and to this remedy we pose, are divisible into two kinds: the de-must ultimately have recourse, should symp- obstruents, as they are called, and thosetoms become pressing, and should other which require active manual operation.means fail us. When the placenta is retained III theWhen the placenta is retained in the uterus, independent of any very active ma-

uterus, we sometimes have the satisfaction nual operation, we may, sometimes, obtainto find, that no active symptoms of consti- its expulsion, merely by laying the hand ontutional irritation occur, but the woman lies the womb externally, feeling it through theperfectlyquiet,her appetite good,her bowels abdominal coverings, grasping it, and thU5regular, and her general health undisturbed,; stimulating its fibres to contract; the pla-so long-, however,as the placenta remains, so centa being expelled, or, to use a coarse

long constitutional symptoms, of the most but significant expression, this viscus beitralarming kind, are liable, sooner or later, to squeezed forth by the action of the hand.supervene ; purgings, vomitings, sweatings, This is a very simple mode of riddin- thea pulse of 140, a cheek of typhoid tint, and a uterus of its contents, proper, more especial-tongue that is brown. Now, I once imagined ly, where it is retained in the later months,that these constitutional symptoms might nor is much active manual exertion requiredlather be ascribed to violence, used to get for the purpose.away the placenta—occasioning contusions ( When the placenta is retained in the ute-and lacerations of the genitals, than to the rus, whether in the earlier or latter montLi.mere action of the placenta itself, and the we may sometimes ensure its expulsion by

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the use of some remedy which may stimu- cocted to an ounce and a half, you may givelate the bowels, as purgatives, for example. the patient a table spoonful as a dose, re-Mr. Faga, a practitioner of experience, in- peating it every twenty minutes, unless youterms me, that he has found the injection perceive that the action of the womb hasoi senna and salts into the rectum to be of been previously brought on. Besides thesea.) small use ; six or eight ounces of the deobstruent remedies, and which requiretufusion of senna, with an ounce of salts, but little manual operation, the hand or fin-formed into an injection, and thrown into gers of the accoucheur may be used with ad-the rectum, have, apparently, had the effect vantage for the removal of the placenta. Inof exciting the pains, and thereby accele- the earlier months, perhaps, we may removerating the expulsion of the foetus ; and, on the remains of the ovum, by passing twohis authority, I recommend the remedy to fingers into the vagina ; or, if it lie too highyour attention. The action of the womb to admit of abstraction in this manner, then,may be brought on by the application of if the hand be small, the vagina large, andcold ; not that I should recommend you to the parts relaxed, we may introduce theadnse vour patient to plunge her hips into whole hand into the vagina without thecold water, but you may venture to admi- risk of tearing, and the two fingers beingnister the cold as if you were applying it in carried into the cavity of the uterus, secur-flooding cases, sprinkling the napkin, and sud- ing a hold of the ovum in this manner bydenly and smartly dashing up on the abdomen the action of the fingers, you may often atand thighs; aud perliaps the stimulus of this once bring it away. In the later months,sudden impulse may cause the womb to con- also, independently of the introduction of thetract. I think it proper to mention this, as hand into the uterus, the placenta may some-one of the deobstruents which may be re- times be abstracted, as it often lies down insorted to in these cases; but, after all, it is the vagina ; and when it lies there you mayone that is not to be relied on. Coughing, lay hold of it, careful not to tear any part. Thesneezing, blowing on the back of the hand, whole may then be abstracted at once; thenot to mention voluntary bearing, may bring mass being diligently inspected afterwards,on the action of the womb, and these, there- so as to ascertain that no part have been leftfore, may be recommended where deobstru- behind in the uterus. It very frequentlyents are required ; but of all deobstruents of happens, however, in difficult cases, that thethis kind, the most efficient is retching; bulk of the after-birth is lying in the womb,the placenta sometimes speedily escaping and you must then, though unwillingly, carrywhen the patient begins to vomit. In the the hand into the cavity of the uterus, wherecommencement of practice, you may occa- you may first detach it by passing the fingerssioually be at a loss to know how to get the between the womb and the viscus, and hav-placenta away, not because there really is ing detached it, you may lay hold of its sub-difficulty, but because you are timid, and stance, and cautiously bring it away. Nor isvery properly so, while yet unexperienced. it difficult to perform this operation, whereIn these difficulties you very unwisely leave the accoucheur has been long in practice,the patient, instead of writing to procure and has the perfect use of his fingers.further assistance, and while you are away, When the placenta is retained, it some-

perhaps an old woman comes into the room, times becomes a point of great nicety to

puts a candle into the throat, excites retch- decide when you are to operate manuallying, and liberates the placenta at once. Nor and when you are not. And sometimesis retching to be despised as a deobstruent my obstetric friends come to me in great-not that I would advise you to nauseate perplexity, asking what they are to do;the patient with a candle, but you may in- whether they are to leave the patient tosert a feather into the back of the throat, as her natural powers to trust to deobstruentthe emetic is, perhaps, no less efficacious, remedies, or to interfere manually 1 thinkand is certainly more elegant. it may be observed with truth, that it is

In cases where the placenta is retained, always highly desirable the placenta shouldif the ergot is at hand, 1 would recommend be got away, if it can be withdrawn withoutyou to make a trial of this ; not that I have violence ; because, as I before explained tosuch experience of it in these difficulties, you, though it may lie in the uterus quietas enables me to state positively that it has for a time, so long as it lies there the patientmuch effect; but I have reason to believe, is liable to floodings and other dangerousthat in many cases, it has been used with symptoms. Now, this being the case, I haveadvantage. The ergot, or secale cornutum, endeavoured to establish certain principlesyou may now purchase in any quantity at for my own guidance here, and they are, in

Batler’s in Covent Garden, and, I believe few words, the following:—If the placenta beat most or the respectable druggists. A retained, and I can, by manual operations,drachm of this ergot, coarsely powdered, may abstract it without violence, without the riskbe mixed with three ounces of boiling -, water, of bruising or tearing I mean, and if thereto b: poured upon it ; and this being de- be no reasonable hope of liberating it by

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the use of deobstruent remedies, there being result from obstetric violence. Much, how-an obvious necessity for manual operation, ever, must depend on the individual ch.)-I abstract it in this manner. I repeat this i racter of the accoucheur ; a skilful pra°-if the placenta be retained, I say, and there titioner may venture to operate where oneis reason to believe, on a careful examina- who is wanting in dexterity ought to r:-tion of all circumstances, that it may be re- frain. It is often better to fail into th_moved without violence, without the risk of hands of nature than those of nature’s much.bruising or tearing, and if there is no rea- favoured, but often misguided, son.sonable hope of liberating it by the deob- Having said thus much, generally, ig.

struent means before mentioned, I then by specting the symptoms and management ofall means endeavour to remove it manually. the retained placenta, we will now, if youOn the. other hand, if the placenta be re- please, proceed to the consideration of thetained, and I find the hand cannot be carried different varieties of this accident.

up so high as to secure the command of the After the birth of the child, the umbilicalplacenta without the risk of bruising or la- chord in some cases breaks away, close uponcerating, I then leave it in the uterine the after-birth, so that you lose your hold ofcavity, not because it is not an evil to leave the placenta, and, in other cases, where theit there, but because, to leave it in the placenta is large, in attempting to abstract,uterus, is a smaller evil than to abstract it you may leave a third or a half of it be.with violence, and we had better abide by hind ; this portion being torn off from thethe smaller evil, than expose ourselves to rest. Now, in those cases in which the pla.the greater evil, that of lacerating, bruising, centa is lying in the uterus wholly or par.and killing. But to proceed : If, acting on tially, your hold being lost, some drffieultythis principle I leave the placenta behind may attend its abstraction ; and if you havein the uterus, which I have sometimes done never reflected on it before you meet thefor days or weeks, and with success too, I accident, you may be at a loss as to thewatch the patient diligently during the whole mode of procedure. When, in this manner,term of retention; and if any alarming symp. you lose your bearing on the placenta, a

toms supervene, I again examine ; and al- portion of it being left behind in the nterbethough I could not before have removed cavity, it may sometimes be expelled from tilethe placenta, I now, perhaps, find that I uterus, nevertheless, by the unaided effortscan abstract it with facility; should the ab- of the womb, Waiting for one or two hours,straction of the placenta, however, still re- more especially if you give some of the ergatmain difficult, provided the danger be great, in the way formerly advised, you may rea.I urge my endeavours to remove it more sonably hope, that, under the uterine ef.

diligently than before, in flooding casesespe- forts, the placenta will be expelled com-cially, the most dangerous, and those too hap- pletely from the uterus, or, at any rate, tl,atpily in which the parts are the most relaxed. it will be pushed into the upper part of the

In fine, the rule of practice here is this : vagina, so that the fingers may reach it.

First,-Immediately after the birth of the’ Suppose, however, that the pains are feeblechild, when the placenta is retained, pro- or failing’! in these cases the expulsion ofvided it can be removed without consequent the placenta may be effectively assisted, bydanger, let it, by all means, be taken from merely laying the hand on the abdomenthe uterus. Secondly,—When the placenta above the symphysis pubis, and feeling foris retained for days together, and no symp- the uterus, and pressing it, the placentatoms of danger appear, examine occasionally, being urged out of the uterine cavity byremoving the placenta at the time of’ exa- compression, in the same manner as yetmination, provided it can be withdrawn, as might, by well-directed pressure, expel anyit were, by a mere touch, and committing other substance from a bag. Tenderly—the expulsion of it to the natural efforts, resolutely—dexterously—prudently pro-provided it cannot be abstracted with faci- ceedinginthisway, you may press the en-lity. Lastly,-When dangerous symptoms tire mass into the vagina, or at any rate soappear, and the placenta is lying in the large a portion of the placenta may fre-

uterus, the symptoms being clearly referrible to quently be detruded, that, lying under thethe retention of the placenta-if the symptoms action of the fingers, the whole of it mayare not urgent, you had better leave the be easily got away. Should these means

placenta, if it cannot be abstracted without further fail you, however,, there is vet a

violence ; and even where the symptoms are third mode, the least desirable, but t’!:

pressing, you are still scarcely justifiable in most effectual, by which the placenta mayabstracting manually, provided the operation be be removed, (and to this you may haveattended 3vith the risk of laceration; for when recourse in the last resort,) I mean the in-a patient must be exposed to dangers, in the, troduction of the hand into the uterine ca-general, perhaps, she had better be exposed vity, hn operation, against the unnecessary

to the dangers which arise naturally from performance of which you have already beenher situation, than to those which may so frequently cautioned. In performing the

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operation, you will not, probably, meet may sometimes be ascribed ; and this causewith much difficulty, because, as half an is an irregular contraction of the womb, tohour or an hour before, the lead and body the consideration of which we will next pro-d the child have been transmitted along ceed. After the expulsion of the fmtus,the vagina, your hand, of course, unless it be when the birth of the placenta takes placeunusually bulky, if duly lubricated, will pass in the usual manner, the summit or fundus

up with facility. The hand then being in the of the uterus is first contracted, then theuterine cavity, you may grasp the placenta body, then the neck, the mouth contractingand draw it downwards, proceeding with ultimately; there being in genera a ten-the usual obstetric mixture, resolution and dency to contractions of the upper part oftenderness, careful that you leave no por- the uterus, before the under portions becometion of after-birth behind. Here, then, constricted. Now the womb contractingare the three practices to be adopted for the in this manner, in ordinary cases, the pla-removal of tho placenta ; in difficulties of centa and uterus mutually separate ; forthis kind, the introduction of the hand, the when the womb contracts, being muscu.external compression of the uterus, and the lar, the placenta wanting that muscularity,commission of the expulsion to the unaided cannot contract itself in a correspondingeffurts of the womb. Provided you find that manner, and the surface of the uterus mov-the parts are very lax, and that the hand may ing, of consequence, on the placentar surface,be carried into the uterus with perfect a mutual dissolution of adhesion ensues.

safety, I would excuse your having early The placenta then being detached in thisrecourse even to manual operation ; but if manner, and the uterine contractions pro-in making this essay, or if on making an ceeding, the detached mass is pushed lowerexamination, and considering all circum- and lower towards the vagina; and if thestances previously, you expect there will be uterus be very vigorous and active, it maythe least difficulty to the introduction of the even be urged beyond the external parts,hand, or the smallest probability of lacera- or a considerable way into the vagina, be-tion, then, by all means, first confide the birth coming, in most cases, partially pushed intoof the placenta to the other two modes of the vagina, so that it may be easily seizedtreatment, and satisfy yourselves of their in- and taken away. But when the irregularefficiency before you have recourse to this contractions now under consideration occur,nndesirable operation. in some cases we find the uterus contiacted

BBhen examinations have been frequent, around the placenta, as if anxious to retainor deliveries have been laborious, or instru- it, so that you can neither abstract the after-ments have been administered, and some- birth, nor insinuate your hand into the cavitytunes independently of the action of these of the womb, (observe the preparation whichcauses, the cotter parts occasionally become I now circulate,) and, in other cases, in theirunusually inflamed and exeoriated, and the occurrence more common, the placenta isgenitals swelled and irritable, are totally im-. retained by circular contraction of the uterus,patient of the touch. In these cases, then, seated more frequently at the mouth of thein which there is excoriation, swelling, and womb, and more rarely in the centre, inso-irritability, embarrassment may arise in the much, that the cavity of the womb becomesabstraction of the placenta, in general, how- divided into two chambers, the superior,ever, to be subdued with facility. The parts and one below. This constitutes what, frombeing in this condition, provided the patient an analogy of form, has been denominatedpossess a moderate share of strength, you the hour-glass contraction; not, however, ofought, I think, to take away 12 or 16 ounces so frequent occurrence as many imagine, forof blood, giving afterwards a somewhat copi- unless an accoucheur be tolerably skilful, heous dose of opium, and 50 or 60 drops, for may think there is this clepsydral contrac-example, drops, 1 mean, not minims, may be tion of the uterus, when in reality the con-gtvenat once in cases of this kind. This done, traction is oral, the upper part of the vagina.procuring a full supply of warm water, you long and dilated, being, in examination,may very thoroughly foment the parts ; and mistaken for the lower part of the cavity ofafter a thorough fomentation, large oses of the womb.op.um, and the extraction of blood from the These irregular contractions are not ofarm, you will most probably find the irrita- difficult detection. In a preceding lecture,bility so much allayed, that the necessary when we were speaking of the delivery ofDmnu!U operations may be performed, so the placenta in ordinary cases, it was, you.that seizing the chord with the one hand, may remember, observed, that you ought toand the substance of the placenta with the carry your fingers along the umbilical chord,c.t:.er. with resolution and gentleness, you until you reach the mouth of the uterus.i-meit and lead it forth from the uterine After which, when you find any portion ofcavity. the placenta lying forth at the mouth of the

There is yet a third and an important womb, this part should be secured, and, incause, to which the retention of the placenta, this manner, with the chord in. one hand,

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and the body of the placenta in the other, is a rough measure, and not perhaps alto-you may withdraw the entire mass from the gether without its danger ; for the bleedinguterus, the uterine contractions effectually might be followed by flooding frLm the

assisting. Now, if it so happen, in these uterus, and the patient, if of feeble consti-difficulties, that the uterus is firmly em- tution, might sink. The tobacco injection. Ibracing the whole of the placenta, examining have little doubt, would relax the uterus,

externally above the symphysis pubis, this even in the most difficult cases, so as to

contraction may, perhaps, be detected pretty admit the introduction of the hand; but :!-:easily ; feeling for the uterus above the sym- tobacco injection is attended with consider-physis pubis, grasping it a.s you ought able danger; and I have already laid :’.

always to do, and finding it very round and down as a principle, that the retention ofhard, while yet no part of the placenta the placenta is not attended with that degreestretches down into the vagina, you will of danger which may justify you in resortinghave a pretty clear proof, that it is in this to the more perilous measures. It has too

way that the placenta is retained. While, been advised in these cases, that we shouldin cases where a circular contraction, whe- try the effect of cold emetics, and oti,e:ther oral or central, is the retaining cause, remedies insignificant, and unimportant, andthe contracted aperture may be felt on pass- sometimes a nauseating or emetic dose, sul.ing up the fingers. phate of zinc oripecacuanha, for example, mayWhen a retention of the placenta occurs have the effect of expelling the placenta: or

in consequence of these irregular contrac- the sudden application of cold over the uterus,i.ions, by a little manual skill and labour, or the lower part of the abdomen, mav relaxyou may sometimes abstract the placenta the spasms. For myself, however, in all

easily enough : carry one or two fingers of cases which I have hitherto met, I baw.the left hand up to the os uteri, and insert found that the uterus has relaxed suffi-those fingers into the aperture ; then the ciently under very simple mode of tieat.fingers being deposited there, act with ment. From the arm 1 have abstractedthem, as now demonstrated, in the manner sixteen or twenty ounces of blood, a lossof a dilator ; tenderly, resolutely, perse- which most patients can bear very wEll;veringly, and again I say tenderly, expand- then, immediately afterwards, I have ad-ing the uterine mouth as it may bear, and ministered a copious dose of opium, sixtythus room may be obtained to bring the or seventy drops of the tincture, or a cor-

placenta away. responding quantity ctf the solid, or ofIn some few cases, on carrying the hand Batley’s excellent anodyne. This done, I

to the entrance of the uterus, you may find have waited half an hour till the irritabilitylying in it a portion of the placenta. Now, of the parts has been quieted, and then Iin these cases, if the constriction of the have proceeded to dilate the os uteri, anduterus be firm, it may not be safe to draw abstract the placenta as before explained,down by this portion, lest laceration and always bearing in mind the two grand prin-detachment should ensue ; yet, should it so ciples of management here: I mean, first,happen, that the mouth and neck of the that the placenta is never to be abstracteduterus are lax, then, without further trouble, with violence; and, secondly, that if with-the placenta may be abstracted, the viscus out violence it may be got away, its re-

being gently worked through the opening, moval is desirable, as during its retentionin the mode here demonstrated, with the the woman is never altogether secure.handkerchief. After abstraction examine I here show you a beautiful specimenthe secundinès, and ascertain that the whole of a retained placenta, produced by a gene-mass has been abstracted entire. ral contraction of the uterus. In some

But it is not always that you meet with women, there seems to be a strong pre-these cases of easy management, for some- disposition to this inregular contraction of thetimes the mouth and body of the uterus are womb after delivery ; and this being thecontracted with more than ordinary firm- case, it comes to be a question of some im.ness ; or, if you dilate, the part contracts portance, whether we may have recourse toagain more firmly than before ; and, if you any effectual preventive. Of the preven-again dilate it, again it contracts ; and if at- tives proposed, one of the most promisingtempting to overbear resistance, you use a is that which used, 1 think, to be recom-greater force, you lacerate. DEATH. When, mended by Dr. Hamilton of Edinburgh, andin this way, the contractions are very strong, this consists in committing the birth of theand the womb is very irritable, before body to the natural efforts, the womb beingyou attempt to abstract the placenta, suffered to expel it slowly after the birth ofyou ought to have recourse to relaxents. the head. If the head being expelled, weBleeding to faintness might sometimes hastily draw the body from the vagina, he-effectually resolve the uterine contraction, fore the womb is contracted, the uterus, sud-and some few cases might perhaps justify denly emptied, becomes more obnoxious to

it. It must be admitted, however, that this irregular contractions afterwards; but where

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6e body, arms, and legs, are pushed away ’,by the regular and healthy actions of the

uterus, a more regular and healthy con-n.cuo!t may be afterwards expected.

It rarely happens that the placenta is re-tained in the uterus, in consequence of in-

flammatory adhesions of that h.ind, whichhas been denominated the scirrhous; forthough you may frequently hear of cases socalled, yet I am persuaded, from my ownobservations, as well as from the expe-rience of my valued predecessor, Dr. Haigh-ton; that the genuine scirrhous adhesion isb no means very common in its occurrence.Sometimes, however, the womb inflames ;and, in consequence of this inflammation,the placenta may become attached to itssurface; and if this have been going on inthe earlier or middle part of gestation, theadhesions may be extensive and strong.11-ith indnration of the placenta, these ad-hesions may be accompanied, in conse-

quence, I suppose, of an interstitious depo.sition of 13 mpli in the pores of the placentarstiticture; and this induration, I appre-hend it is. and not a genuine schirrosity,which has given rise to the epithet bywhich the disease is designated ; for al..

though the parts are hardened and alteredin their structure, I am not aware that thereis that peculiar change of organisation,which the morbid anatomist understands bythis disease.

LECTURES ON CHEMISTRY,

BY

PROFESSOR BRANDE.

Delivered at the Royal Institution of GreatBritain.

LECTURE XLII.

On Gold ; the combinutions nf Platinum withPalladium, Rhodium, Osmium, and Iridium ;a/!d Sdica.

It yold be heated in chlorine, in a state ofniiiiiite division, a deep yellow-colouredcompound is produced, which, when actedupon by water, is a muriate of gold ; and byadding a solution of potash to this muriate,and heating the mixture, you obtain a pre-cipitate, which is oaide of gold. The oxideshould be washed in a weak solution ofpotash, and then with water, and dried at atemperature not exceeding 1000; if you ex-ceed this, a portion of the oxide is reduced.The nitric acid scarcely acts upon the

K’’a), although it readily dissolves theoxide; and the only true solvents of gold,are the nitro-muriatic acid and chlorine. Two

parts of muriatic acid, and one of nitric, dis-solve gold readily ; and by evaporation,prismatic crystals of muriate of gold may beobtained. When liquid ammonia is addedto a solution of muriate of gold, diluted withabout three times its weight of water, a

brown precipitate is formed, which, ifcare-fully dried at a temperature of ?12°, is a

very fulminating powder. It explodes byfriction with hard bodies, and by an electri-cal shock; and if detonated upon a piece ofplatinum leaf, the platinum is torn by theexplosion. If a piece of tin foil be im-mersed in a dilute solution of muriate ofgold, a purple powder is thrown down,which is much used for enamel painting,and for tinging glass of a fine red colour, acompound generally known as the purple 0/’Cassius; and it appears to be composed ofthree parts of oxide of tin, and one of oxideof gold, in a very low state ofoxidisement.The celherial solution nf’gnld, or aurum pntu-

bile, as it was called, is made by mixing sul-plitiric aether with a solution of the muriateof gold. It was, at one time, proposed togive it as a medicine; and true it is that

gold is very useful in medicine, but onlywhen given by the patient to the physician,the physician giving other metals to the pa-tient. It is used for gilding other metals,but not without injury to the edge of cuttinginstruments ; and a curious circumstance

attending it is, that if kept long, the metal isdeposited in the crystalline state.The alloys of gold are of considerable

importance; with zinc, tin, lead, nickel,cobalt, and bismuth, it forms alloys, all ofwhich are so brittle as to be useless ; and itis curious to inquire how such small quan-tities of tin or lead should render the goldbrittle, and that to such a degree, that it iseven dangerous to have lead or tin in the

neighbourhood of the furnace in which thegold is melted. On the other hand, goldmay be alloyed with silver, and the com-pound will be harder than either metal it-self. With copper it forms a hard alloy,which is generally employed for coinage,and many other purposes. Eleven parts ofgold, that is, standard gold, the specific

gravity of which is 19, when mixed withone part of copper, produce an alloy, the

specific gravity of which is about 17 ; ofthis alloy, twenty pounds troy are coined into934 sovereigns, or fifteen pounds into700 sovereigns. One pound was formedinto 44 guineas, but now it is coined into46 sovereigns. Arsenic and antimony com-bine with gold, and render it brittle.The other morning I described to you the

mode of assaying silver, in order to deter-mine the quantity of copper which it maycontain. Now gold is assayed in the sameway ; but, in.consequence of the strong at-

traction which it has for copper, it is gene-