The condition referred to in the preceding paragraph sometimes occurs in consequence of failure of the uterus to contract properly after the child has been born, or in consequence of an unusually firm attachment of the placenta to the internal walls of the uterus. As previously remarked, the after-birth is generally expelled from five to thirty minutes after the child is bora. When the uterine contractions suddenly cease after the child is born, so that the placenta is not expelled, the remedies suggested for inactivity of the womb should be applied, one of the most effective of which is the hot-water douche. In case these are not effective, it becomes necessary for the physician to pass two or more fingers into the womb and by gradually working them under the placenta loosen it and bring it away. This is a frequent cause of hemorrhage after childbirth, the treatment for which has already been given.