23. POST PARTEM HEMORRHAGE is liable to occur; when it does, obtain a physician as soon as you can, but some things must be done immediately. 1. Some one must grasp and compress the womb continually. 2. Remove the pillows and raise the foot of the bed so that the patient’s body lies higher than her head. 3. If you have it, give a small teaspoonful of extract of ergot, or twenty drops spirits turpentine or (F. 96.) 4. Examine to know if possible, the source of the hemorrhage; if it comes from the vagina or perineum where there is laceration, it is not very dangerous. Inject hot water of the temperature of 115° into the uterus, and apply a dry cotton cloth, heated as hot as possible, to the abdomen externally. 5. Before using the injections remove all clots from the vagina. 6. Quinine and stimulants may be exhibited if there is sinking, and ice may be applied to the abdomen and to the internal surface of the uterus, if the bleeding continues. I will here direct another thing which is very effectual, and which might be used at first in preference to anything else. 7. After removing the clots take a handkerchief or piece of muslin, saturated with vinegar, in your hand, pass it entirely into the uterus, and let it remain there 15 or 20 minutes, and your hand also. Your hand will compress the open blood vessels, and keep a clot in the mouth of them, and the vinegar will act as the best astringent that can be used. In one case of violent flooding I simply _held my hand still_ in the uterus for five minutes, and the flow ceased. After the hemorrhage subsides you must be careful not to raise the patient’s head above the level suddenly; her life may be put in jeopardy by suddenly raising her so that she sits up. AFTER PAINS are very seldom severe in primapara cases, and they are less likely to be severe if the proper manipulations have compelled the womb to close completely, expelling all clots, &c. But sometimes there is a peculiar irritability or neuralgic condition of the womb which gives rise to excruciating pains. Ordinarily you may use Tully’s powder. (F. 123, 93, 95, 107.) RETENTION OF URINE in some cases necessitates repeated visits of the physician, and he will appreciate a nurse who can introduce the catheter. If the patient cannot at first void the urine, perhaps the application of a hot wet sponge over the pubis may enable her to do so. But it may be necessary to introduce a catheter two or three times a day until she regains her power over her bladder, or until the swelling of the urethra subsides.