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teaching her to hold her breath and bear down during the actual contractions. In this way it is believed that much valuable time may be saved, not only in shortening the patient's suffering and husbanding her strength, but also by diminishing the time that the physician will be kept from his practice.
The original chair has done good work and is still in daily use, but
a new chair has been devised which gives a number of different positions not obtainable in the original, as for example, in cases of pendulous abdomen where the forces are so apt to be expended in the wrong direction. The latest model (Fig. 2) allows the patient to sit so that the long axis of the uterus may be directed into the pelvis brim no matter how pendulous the abdomen may be.
The following statistics are based on 179 consecutive cases, admittedly a small number but sufficient nevertheless to form some idea of what a well regulated posture can do to assist in the shortening of confinement cases. In these 179 cases, there were 166 primiparae with 168 babies (4 twins) and two still births, and 13 multiparae with 13 babies. From the standpoint of the anatomical conditions to be dealt with, the following table is of interest.
A further analysis of these cases shows the following salient features:
Reference to the last part of this table and the notes appended thereto, will show that in three cases, abnormalities of fetal position (1 R.O.P., 1 L.O.T. not rotated, 1 prolapsed cord) prevented progress, while in 3 cases, abnormalities in the mother necessitated interference (1 eclampsia, 1 prominent spines, 1 slow dilatation). Of the remaining 13 excluding 3 where the progress was not recorded, there were 10 cases where uterine inertia prevented delivery. Therefore, in less than one per cent (0.7) of the 133 cases, there was no progress notwithstanding the use of the chair.
A brief table detailing the period in which the mothers were kept in the chair is of interest.
This table and the explanatory note shows that in more than 10 per cent of the cases, labor lasted only one hour or less after the patient was put in the chair. In one case apparently 15 minutes sufficed, though here the cervix was four fingers dilated at the time, while in three cases where the cervix was only two or three fingers dilated, from 30 to 45 minutes only was required.
In the second group of cases, the primiparae with abnormal pelves, the following table shows the important points.
Medium High Version. Breech ex- Cesarean. Total. taneous. forceps. forceps. forceps.
It will thus be seen that in eleven cases where conditions anatomically might have necessitated operative interference, spontaneous delivery occurred; in other words, in 33 per cent. of the cases the obstetrical chair apparently obviated the necessity of any other artificial aid. Of these eleven cases eight were in the first stage of labor and three in the second stage. In two cases the patient was kept in the chair for 5 and 6 hours respectively, while in another, one hour sufficed to effect delivery, in five cases, two hours and in three cases, three hours were necessary for spontaneous delivery. The average duration of the entire labor in these cases was 22 hours, while the average time in the chair was 3 hours.
Of the seven multiparae with normal pelves, all were delivered
spontaneously, the average time in the chair being 24 hours. Of these, six were in the first and one in the second stage of labor when put in the chair. In one case, one hour sufficed; in one, two hours, while in three cases, three hours, and in two cases, four hours were necessary to effect the delivery.
Of the six multiparae with abnormal pelves, the following table shows the important features:
In only one case of those spontaneously delivered was the patient in the chair for more than two hours.
A brief table of this series of cases with reference to the occurrence of abnormal positions and deliveries is of decided interest.
From this last table it will be seen that in 50 per cent. of eighteen cases of R.O.P. positions, in one case of L.O.P. of a total of four, and in one case of transverse, spontaneous delivery occurred. As originally stated, the number of cases on which these statistics are based is small, yet one cannot but be struck by the distinct advantage the use of the chair offers in delivery, especially in those cases where for some abnormality in the mother or fetus, operative interference is indicated.
So useful has this chair been in my private cases in the private pavilion of the hospital, that I am at present working on a small compact chair which shall retain all the salient features of the one now in use, and yet be so constructed that it can be easily carried from one house to another and so simple in construction that all parts of it can be ren