If flooding happens during the first six months, bleed according to the state of the pulse, keep the patient still in bed; and though she is faint, cold, or low, give no warm cordials, for they increase the discharge in proportion as they raise the spirits. If a vomiting attends, the neutral mixture, and such light food as passes soon into the circulation, such as broths, salep, milk, etc. may be given in very small quantities, lest vomiting should be excited; but let the supplies be frequent. Relieve costiveness by clysters that are barely laxative. If anxiety and wakefulness are distressing, let opiates be repeated, at due distances, in small doses. The bark joined with opiates, and sometimes with nitre, is very-effectual. The pulv. stypt. Ph. Ed. above named, is also not to be omitted; and cloths dipped in cold water may be applied to the region of the uterus.

If this disaster happens in the seventh or eighth month, the danger is far greater than in the former months; for the diameter of the vessels is enlarged, and the neck of the uterus is rigid; so that if the flooding is violent, the woman may be lost before the best helps can be of any use. In this case, as in the former months, it is the best not to attempt delivery till a laxity of the parts is come on; for were we to attempt it in their rigid state, we should increase the flooding, tire ourselves, and exhaust the woman, and this without being able to deliver her.

The most dangerous time is the last month of pregnancy, for then the diameters of the vessels are at their greatest dimensions. If in this case the blood runs off in a full stream, introduce the hand, break the membranes, and, taking the advantage of the waters, turn the child, and bring it footling. If at this period a flooding happens, or in the time of labour, and the patient loses not a great quantity in a short space of time, she may bear it, and in the course of labour-pains it will stop, and the labour go on well. If the woman is plethoric, and not much weakened by the discharge, if the child presents fair, break the membranes to restrain it, and allow time for the labour to come on afterwards.

If, during labour, a flooding is caused by a laceration of the placenta in delivering the first of twins, immediately introduce the hand, turn the remaining child, and bring it away by the feet; then the uterus will contract, and the diameters of the vessels will be lessened: but if the flooding precedes the delivery of a twin, and then abates, let the other remain a little, and recruit the woman with caudle or jelly; for in twin cases the belly is vastly distended, and the vessels are very much dilated and full, and a sudden emptying of them may cause a syncope, or even death.

The placenta is not only sometimes loose, but also is sometimes fixed over the os tincae, in which case delivery must be effected with all convenient speed. To deliver with safety when thus circumstanced, introduce one finger into the os tincae; then two, and gradually the rest, until the whole hand is introduced; dilate the parts by degrees; then, if the membranes first offer, break them, and get the feet of the child, by which bring it away, and deliver the rest at discretion. But if the placenta presents at the os uteri; 1st, you will know by the touch; for, on introducing the finger, neither the membrane nor the naked head is perceived; on the contrary, thick and soft flesh is felt,-distinguish-ed from that of a child by being softer, and also without form. 2dly, This case is always joined with a flux of blood, to the danger of both the mother and the child; therefore the birth must be hastened without waiting for pains; a linger must be introduced into the os tincae, and the placenta removed until the membranes can be reached; which done, tear them to come at the feet of the child: if you cannot push the placenta from the os tincae, force your finger through its middle, and make way by dilating your fingers for the membranes to descend; this done, break them, and, by the running off of the waters, the uterus will contract, and gradually lessen the flooding: if, on the waters being discharged, the head presents, endeavour to remove the placenta, so as to give way to the head, then the pains may bring forth the child; but if it is in a preternatural posture, bring it away by the feet.

If the flooding happens from a blow, and there is a great discharge in a little time, delivery must be hastened as speedily as possible; and if the haemorrhage abates not on the child being brought away, the placenta must be hastened too. Remember, that during delivery an assistant should gently press the belly of the woman, and continue the pressure a little while after the placenta is delivered; the woman must be supported by frequent small quantities of caudle.

The floodings which happen after delivery are sometimes very dangerous; this kind is generally owing to the womb being suddenly emptied, and so not having time to contract the diameters of the vessels, they remain open, and the blood by its own specific gravity pours out. The chief intention here is to contract the uterus: to which end the properest means is the application of cloths dipt in vinegar, or vinegar and water: these should be laid on the back and region of the womb. Also stupes impregnated with a mixture of cold water and vinegar, or cold water alone, and passed up the vagina to the os tincae, have been recommended. A hand may be placed on the belly, to press the uterus towards the pubes. But the greatest specific in this case is an opiate: it should be given in large doses; for if the woman can be once composed, if it be but for a few minutes, the flooding will almost certainly cease; and when it once ceases, it rarely returns.

To deliver a woman without pains, or to force labour, the subsequent directions should be pursued her on her back, with her heels upon the bed, having assistants to keep her steady. The operator may be in any position that he finds most convenient; in the course of one labour he will generally find occasion to sit, stand, and kneel; the elbow of the introduced arm should be supported by the knee, to give additional strength, and to prevent the arm from being-wearied. The hand of the operator being well smeared with hog's lard, or unsalted butter, he must gradually dilate the external parts by introducing the fingers one after another, moving them in a rotary manner; then begin to dilate the os internum, proceeding gently and gradually, resting at intervals both for his own and the man's ease: when the hand has passed into the uterus, he must break the membranes, but permit not the waters to run off before he has found the feet, and the child is properly turned; the feet secured, proceed as in delivering by the feet. When the child is delivered, if the placenta adheres, but the flooding is not so violent as to render the bringing it away immediately necessary, opiates arc the most likely means of promoting the separation and exclusion of it, by relaxing the parts concerned, and removing the stricture which always accompanies the pain: give the tinct. opii gutt. xxx. vel opii gr. ij.

Though many later authors have written well on abortion, and some moderns have added many improvements, yet Hippocrates deserves to be read on this subject.

See Dr. Leake's Medical Instructions, edit. 6. and also his Practical Observations. Denman's Aphorisms on Uterine Haemorrhages. Smith's Letters to Married Women. On the Management of Children, etc. by William Moss, Surgeon. On Uterine Haemorrhages, by M. Leroux, Surgeon. London Med. Journal, i. 59.