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uterine cavity, so that, the whole of its contents being ejected, it may return again to the non-gravid state, when it will measure from two and a half to three inches in length, about an inch and a half in width, and half an inch or three-quarters of an inch in thickness; the organ being, before the commencement of the contractions, about twelve inches long by seven or eight inches in transverse diameter.

As the os uteri is closed during pregnancy, it follows that the expulsion of the contents of the organ cannot take place until the orifice becomes sufficiently opened to permit the child to pass out; and that there is also required a sufficient dilatation of the vagina, and of the vulva; in all which parts a greater or less degree of resistance or obstacle is found; which, taken in connection with the resistance afforded by the bony structures and the perineum, are generally the causes of a delay of several hours in the birth of the child, even where it presents itself most favorably to the openings through which it is destined to effect its exit.

In a vast majority of cases, the powers of the womb alone are insufficient to effect the delivery of the child, and its birth must be aided by the forces of the abdominal muscles, and the diaphragm, which are not only capable of making a direct expulsive effort, but, by presenting a point d'appui for the contracting womb, can assist it more efficiently to exert its own peculiar powers. The abdominal muscles and the diaphragm, acting alone, can push the point of the womb down low into the excavation, and hold or fix it there, while the fundus and body of the organ are propelling the ovum against the obstacles that stand in the way of its escape. Hence, although the essential element of labor consists in the uterine contractions, there are collateral dynamic elements of the process that greatly avail in its completion, and that ought always to be well understood, in order that they may be either called into action, or restrained, as the obstetrician may please to direct. Perhaps the best idea of the dilating pains of labor is, that the presenting part of the child is pressed against the circle of the os uteri, which, by the contraction of the body and fundus, is drawn upwards over it, so as to strip the womb up over its head, its body and its legs, until the whole is expelled from the cavity of the uterus.

Cause of Labor.-The cause of labor, or, I should rather say, the cause of the onset of labor, is not well understood, although it is quite probable that it is to be found only in the inability of the neck of the womb, in any given case, to bear further distension. In the beginning of pregnancy, the ovum inhabits and distends only the

corpus and fundus of the womb. As the child increases in size, it requires a larger nidus than these parts can afford, so that the upper end of the cervix now becomes distended. Gradually, the whole of the neck is taken in to form the oviform nidus for the full-grown ovum. The os uteri still remains unexpanded; when the ovum has become too large to exist within the completely developed uterus, even the circle of the os uteri can no longer resist the distending pressure. It begins to yield; it opens a little, and, at length, its antagonism to the expulsive powers growing feebler and feebler, it is fully dilated. The whole cervix is now become a wide cylinder, through which the child is thrust by the contractions, which tend to approximate the fundus to the os uteri. This is labor. Labor begins from a necessity of the uterine constitution, and not from any ascertained degree of development of the child, which, whether large or small, is most likely to be born two hundred and eighty days after the last catamenial period of the mother; but may not be born until three hundred, or even more days have elapsed. The size of the child is not found to bear a proportion to the excess of the duration of the pregnancy. It does, in fact, frequently occur, that the womb begins its contractile effort long before the expiration of the two hundred and eighty days; or, on the other hand, it fails to commence its retraction for several days after the two hundred and eighty have elapsed; but, whenever it does begin, it is because it will admit of no further or longer-continued distension; or because the cervix and os will no longer prevent the ovum from escaping, which it always tends to do when they cannot prevent it.

This is the theory by which Baudelocque endeavors to account for it, and which I have above explained. It seems clear that there is a contest or antagonization betwixt the fibres of the cervix and those of the fundus and body of the womb going on throughout every stage of the pregnancy; that, in the early months of pregnancy, the fibres of the body and fundus yield to, while those of the cervix resist the distending force, until about the seventh month, at which time they also begin to yield, and continue to yield until the end of the ninth month. These fibres of the cervix are the seats of a retentive, while those of the fundus and body are the seats of a contentive and expulsive faculty or power. At the ninth month they are balanced, or antagonize each other exactly. At length, the development of the ovum going on, those of the fundus become the more powerful, and those of the cervix and os uteri are loosened, and finally so completely opened as to allow the ovum to escape. The same force which converted the cylindrical into the conoidal cervix continues to operate

until it has converted the conoidal neck into the wide cylinder whose diameter is at least 3.8 inches. When this change is once effected, the foetus comes forth into the vagina and then into life. This explanation is, perhaps, as good as any that could be offered; it is perhaps not unworthy of remark, that, in the development of the gravid uterus and its contents, we behold a wonderful adaptation of parts to the purposes they are destined to fulfil; since the growth of the child would, if continued indefinitely, make its delivery impossible, and therefore the Author of nature has, by a simple law, provided against such a fatal contingency; the womb, by that law, refusing to yield any further than is sufficient to allow the child to acquire a certain degree of magnitude and vigor, essential for its respiratory life, but not too considerable to prevent its birth from taking place; and this perhaps is, after all, a sufficient solution of the problem.

Subsidence of the Womb.-The term of utero-gestation and the commencement of labor may be supposed, as has before been said, to be fixed, and rendered necessary in part, by the great distension of the abdominal muscles and the intolerable pressure upon and displacement of the parts contained within the abdomen. I know not what influence upon the production or first excitement of labor contractions may be exercised by the altered state of the abdominal muscles themselves; but it is, perhaps, not too much to infer that they do at length exert some considerable share of influence, by their constant or tonic contractile operation, in aiding the fundus and body to overcome the retentive effort of the os uteri, any yielding or relaxation of which tends to invite or provoke the contractile effort of the fundus. We see, at least, that in the last days of pregnancy the womb settles down with its apex in the excavation, and the woman seems much smaller than she was before this sinking downwards of the uterine globe was perceived. Now, it may be asked what can cause this settling or sinking downwards of the womb, if it be not the action of the abdominal muscles and diaphragm, which have pushed it downwards. Labor pains are caused by the contractions of the womb, and are first situated in the neck of the organ; but it happens that when the womb is much sunken, it in one case feels very hard and firm, as if its fibres were in a state of contraction or condensation; whereas in another case it is soft and flaccid, notwithstanding it may be very much de pressed into the excavation; no sign of actual labor being present in either example. The sinking downwards of the womb takes place, in some persons, several days before the first pains are felt. In such instances, the womb must be regarded as wholly passive in the

matter; it is forced down by the muscles, and not by any intrinsic action or any power of its own.

This is called the subsidence of the womb before labor comes on, and it is a sign of the approach of that crisis, which monthly nurses and experienced women are acquainted with-and which it is proper that the Student should also be able to appreciate.

Discharges from the Genitalia.-As labor approaches, the secretions of the vagina and os uteri become augmented. They grow more viscid, and are often of a pink or even red color. In some cases there is a clear show of blood. The labia externa seem to be swollen or succulent with the increased circulation in their capillaries, and the mucous lining of the vulva retains its moistness notwithstanding the augmented vascular activity. They do not become harder, but, on the contrary, softer and more ductile: which prepares them well to yield to the distending force by which they are soon to open a way for the transit of the child.

Labor Pains. The contractions of the womb take place at intervals which are longer at the beginning, and shorter as the labor advances. They last from fifteen to thirty or forty seconds, and, on many occasions, even longer. The intervals, at first, are from twelve to thirty minutes; but as the irritation becomes more intense, the pains are repeated every five, three, and two minutes, and even every minute; increasing in violence and duration until the organ is freed from its load.

As to the duration and number of the pains, I said a little while ago that the average duration of a labor has been stated to be four hours. If this computation is a correct one, then it may be said that in the first hour the woman shall have a pain every twelve minutes, which would give five pains for the first hour. If she should, in the second hour, have a pain every six minutes, she would have ten pains in the second hour; pains in every five minutes of the third hour would amount to twelve pains; and if she should be affected with them every three minutes during the fourth and last hour, she would suffer the pains twenty times in that period. So that twenty, twelve, ten, and five pains would make up the sum of forty-seven pains for the labor. The whole duration of the whole of the labor pains, supposing each one to last only forty seconds, would, under this computation, be about fifteen minutes; so that, in a labor of four hours, the woman would be thirty minutes under labor-throes, and three hours and a half without them. It is to be understood, however, that much pain

and distress may be sometimes experienced notwithstanding the womb is not actually contracting, or during the intervals; though, generally speaking, the woman is comfortable except when under the power of the pains.

This calculation refers, therefore, only to the state a woman is in when under the influence of a labor pain, and not to the other causes of distress, from pressure, distension, and the distension of the textures in the pelvis.

There is a very singular passage in Saccombe's Elémens de la Science des Accouchemens, p. 202. I was much tempted to translate the whole story as he relates it, not only as a case excellently calculated to give instruction to the young, but quite as much so to show forth the impudence and audacity of that singular and talented author. The case in question is the history of a labor which he had charge of, and which he observed, from beginning to end, without in the least interfering with the operations of nature. He was alone in the chamber with the young woman. "En cet état des choses, je me suis mis en embus. cade, l'œil au guet, et bien resolu d'abandonner entièrement la patiente à la nature, comme si elle eut été seule au sein d'un bois. La, le compas dans l'oeil, la montre d'une main et le crayon de l'autre, voici le spectacle vraiment ravissant dont je fus temoins." M. Saccombe goes on to say that, from ten o'clock exactly, to eleven A. M., the woman in labor had seven pains, which became greater and greater in succession, and followed each other in the order here expressed.

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From eleven to twelve o'clock she had twelve pains, increasing pro

gressively and recurring as follows:

From the 7th to the 8th pain

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