severe after-pains; but where this has been delayed until the second or third day, the first application of the child to the breast is sure to induce a sharp attack; the truth of the old adage, that "the child brings after-pains," is thus verified. After-pains must be looked upon as an important agent in preventing those attacks of inflammation and fever which arise from the retention of putrid coagula and lochia: they ought not therefore to be checked, unless their severity is such as really demands it: hence the custom of giving an opiate after _every_ labour cannot be too strongly reprobated, for by this means those uterine contractions are suspended, by which nature would have rid herself of the offending cause: nor do we consider ourselves justified in giving an opiate where after-pains are severe, until by change of posture, &c. we are satisfied that no accumulation exists in the passages. "Wherefore," says Burton, "we must not be too forward in giving strong opiates and other internal medicines, which may take them off while this grumous blood is lodged within these sinuses. I doubt not but those patients who die from the eighth to the fourteenth day, whose uterus has been inflamed with the symptoms above-mentioned, have been injured by the too free use of opiates." (_Essay towards a complete new System of Midwifery_, by J. Burton, M. D. p. 342.) We do not deny that a mild sedative is frequently of great benefit after labour: it calms the irritability of the system and procures sleep: these effects will be much better obtained by a little extract of hyoscyamus, lettuce, or hop. Where an opiate is really necessary, twenty minims of Liq. Opii Sed. in any aromatic water will be as good a form as any.[76] CHAPTER III. MECHANISM OF PARTURITION. _Cranial presentations--first and second positions.--Face presentations--first and second positions.--Nates presentations._ If we were asked to point out the basis on which the principles of practical midwifery should be founded, we would answer, on an accurate knowledge of the manner in which the child presents, and passes through the pelvis and soft parts during labour. In confirmation of this remark, we may observe, that almost every great improvement in midwifery practice which has taken place during the last century, has resulted from farther investigation into this difficult field of inquiry, and from the gradual addition of new facts to our knowledge respecting this interesting process.