body turned near a quarter or a sixth of a circle, to bring it under the arch of the pubis, beneath which it extends itself again after recovering from its first flexion, so as to allow the crown of the head, the forehead, the face, and last of all the chin, to roll out, in succession, from the floor of the vagina and edge of the perineum. These three mutations are the most important in the mechanism of labor: first, the flexion; second, the rotation; and third, the extension of the head. The regular succession of these several states is necessary to an easy natural labor: and the principal business of the medical attendant, in such labors, is to see to it that they occur in due order and time.

I am reminded here of the necessity there is to warn the Student to pause for a moment, and consider what is really the presenting part in a first or vertex-left position. He should reflect that the fontanel, which is directed towards the left acetabulum, is a good ways off from the ostium vagina towards the left-and that, in fact, the part that he Touches in his Examination is the right parietal bone, whose parietal protuberance meets the point of the finger introduced for the exploration or diagnosis. To reach the vertex, therefore, he must carry the palp of the finger upwards and outwards, and backwards towards the left acetabular region, where it will come in contact with the triangular or occipital fontanel. In second positions or vertexright positions, it is the left parietal boss that presents, and so on as to the rest of the positions. The vertex, therefore, is not, strictly speaking, the presenting point in vertex labors until the rotation has become complete.

As to any person's being able to explain the mechanism of the pelvis, or its operation in parturition, without the aid of the subject, either recent or dried, I hold it to be an impossibility. Let the Student, therefore, who wishes to comprehend this matter, which involves probably the most important information that he will have occasion for in obstetric practice-let him take a dried pelvis and a foetal cranium, each well and naturally proportioned to the other-let him plunge the cranium into the excavation, holding it in the first position, but without flexion; he will find that it cannot descend very far, on account of the rapid approach of the inclined planes of the ischia below. But if he now turns the vertex somewhat downwards, or brings the chin upwards, it will descend a little farther. As he presses it downwards, the inclined plane of the left ischium tends to repel and deflect it towards the pubic arch, in which direction no great bony resistance is offered. If it glance upon the obturator membrane, and indent it, the resiliency of that tissue is sufficient to repel it still more, and still more to deflect it towards the front; in fact, it easily takes a pivot or rota

tory movement, which is greatly enhanced or promoted by the structure of the back and lateral parts of the pelvic excavation, which are so inclined as to likewise repel and deflect the forehead backwards, and cause it to fall into the hollow of the sacrum. Let this experiment be tried both with the dip or flexion, and without it, and it will be seen that in the first case the rotation is almost spontaneous, and in the last very difficult, if not impossible, without powerful extrinsic aid. The rotation being completed, the vertex is found jutting forth under the arch of the pubis; it emerges more and more completely until the occiput, or the upper part of the nucha becomes pressed against the crown of the arch, when the further progress of this part ceases-it becomes a fixed point, or it is an axis, on which the head, as before said, turns or rolls out from the orifice of the vagina, at the close of which evolution the extension of the head is complete.

After the head is born, the face turns again to the side of the pelvis, towards which it was directed at the beginning of labor, or before the rotation began; and that is called its act of restitution. If the vertex when within the pelvis was left, it seeks the left when driven outside of the excavation.

While the head is undergoing these mutations, the shoulders of the child are entering the basin. In the first position, the vertex is to the left acetabulum, and the right shoulder to the right acetabulum, while the left one is to the left sacro-iliac junction. As the shoulders descend, the right one rotates towards the arch of the pubis, and the other falls backwards into the hollow of the sacrum; the thorax is now plunged deep into the excavation, where its farther progress is arrested by the floor of the pelvis. A renewal of the uterine effort forces the left shoulder to glide off from the apex of the sacrum and coccyx, and displace the perineum, which it thrusts backwards, out of its way, until the shoulder is born. The edge of the perineum is now retired so far backwards as to allow the right shoulder to disengage itself from above, and then from beneath the crown of the pubic arch; and the body of the child is immediately afterwards expelled with great violence, occasioned by the irresistible tenesmus the woman experiences in this stage, and which compels her to bear down with her whole energy. Sometimes the shoulder nearest the pubis is first expelled; generally the other is the first to be born.

A repose of eight or ten minutes follows the birth of the child, and next, a slight pain, or a voluntary bearing down, expels the placenta and membranes, as before said.

The almost supernatural exertions and struggles of the woman, as well as the painful sensations she experiences, and the novel impres

sions made upon her nervous system by the successive stages and Occurrences of parturition, have brought about a violent excitement of the nervous and circulatory systems of the economy; the former of which is resolved by cries of joy, by tears, and by the delightful sense of security, of triumph, and finished toil, and by that gushing tenderness which a mother feels for her new-born helpless progeny. The excitement rapidly abates, under the more or less abundant effusion of blood, and the abstraction of the stimulus of exertion, pain, and dis may. The flood of perspiration gradually subsides, and a short sleep, the best restorative, soon permits the patient to feel "comfortable,” a phrase peculiarly adapted to the case of a puerperal woman. A review of the whole of the phenomena, both physiological and psychological, that are evolved during the progress of a case of labor, presents perhaps the most perfect example of the condition called hysteria that can be anywhere observed. I shall not devote these pages to a comparison of them with those of an hysterical paroxysm, but merely refer the reader to his clinical observation, whether past or future, for a confirmation of this view of the case. Indeed, the whole matter of a labor is ipso facto, a matter depending merely on the status or modality of the womb, and its influences and sympathies. It therefore is a pure specimen of the local action and constitutional influences displayed by the child-bearing organs, or what Wigand calls the whole generationsphere.

The lochia, for such is the denomination of the bloody discharge that follows, flow in such abundance as to require five or ten napkins to imbibe the blood effused during the first twenty-four hours; after which they decrease in quantity, and grow pale, until, by the tenth or fifteenth day, many women have none but a whitish discharge, which also ceases between the twentieth and thirtieth day.

On the day after delivery, the globe of the uterus appears to be larger than it was immediately after the discharge of the placenta. It can generally be felt, in the hypogastrium, during from six to ten days; after which it retreats into the recesses of the pelvis, diminishing daily in size, until, by the end of the month, it is nearly as small as before it was gravid.

Such is the history of Labor, in general terms, which, though it may perhaps afford a pretty good coup d'œil of the phenomena by which it is characterized, is not sufficiently in detail for the purposes of this work; on which account I shall proceed to treat of other particulars in the ensuing pages.

In general, as soon as the signs of respiratory life are fully established in the child, the cord is to be severed by the attendant, who

divides the navel-string after having secured it with one or with two ligatures, and puts an end, by this severance, to all foetal connection with the mother.

As to the child, it comes, in a good labor, healthy and vigorous into the world. The loud sounds of its vagitus, its cries, pervade the apartment, and carry consolation and even transport to the bosom of the fatigued, exhausted, and terrified parent. "Ah, mi corazon! Mi carrissimo, querido corazon !" said a Spanish lady, from the midst of her pangs, as soon as the head of her offspring became free, and before the shoulders were born-for she heard its vagitus uterinus-and her heart "leaped up" with passionate expressions of love, to greet it even before it was completely ushered into the world. As a physician, who has passed a life among those who were in pain, in peril, and in fear of imminent death, I must have been witness to many scenes of human emotion-but of all the expressions of love, made manifest and identi fied in voice and in speech, that I have ever witnessed, the most intense, the most rapturous and sacred, have been the thoughts that breathed and words that burned as they vehemently issued from the lips of a young mother, whose body had just escaped from the fell suf ferings of those who, in sorrow, travail in child-birth, according to the primal woe pronounced against the sex.

The child being born, it remains that the secundines, consisting of the placenta and membranes, shall be expelled from the uterine cavity. The same kind of power that was used to force the child into the world is required for the delivery of the after-birth.

I believe that the after-birth comes off in about ten minutes. There are many labors in which the placenta is chased out of the womb into the vagina by the same pain that pushes the child forth. But, in general, this is not the case, the placenta being only loosened and detached, in whole or in part, and left lying crushed up into a sort of ball by the contraction of the womb upon it.

After a repose of some ten minutes, it may be, and it is an indifferent matter, twenty minutes, the contractile power of the uterus is again in activity. This excites the tenesmus, as before, and the woman, bearing down, coincidently with the uterine contraction, pushes forth the after-birth, generally accompanied with coagula, and a quantity of fluid blood. The pregnancy is thus brought to its close.

Lochia. After the expulsion of the entire product of the concep tion, the patulous orifices of vessels, left exposed by the separation of the placenta, freely discharge several ounces of blood. This discharge is called lochia. As the cavity of the womb is hot obliterated by the

conclusion of the labor, it must happen that the blood effused within its capacity shall coagulate, and that the patient shall discharge from time to time a utero-morphous-clot, as large as an egg, or as large, sometimes, as a man's fist. As the organ grows smaller and smaller, these coagula become smaller and smaller-the flow assuming more and more the appearance of the menstrua. In the course of a fortnight in some, of a month in others, the last traces of uterine excretion dependent on the late pregnancy have disappeared, and the woman is restored to the Jewish estate of cleanness.

The lawgiver of that ancient race pronounced that a woman could not be clean until the fortieth day. But our Christian women generally deem a month sufficient for the whole process of the uterine purgation.

As to the lochia, let the Student learn that, when the milk begins to be abundantly secreted, which is on the third day, or about seventytwo hours after the close of the labor, the mammary molimen serves to check the determination to the womb; and consequently to lessen the amount of the lochia-which, however, becomes again abundant on the fifth day. Can it be that the opened orifices of the uterine vessels, from which the lochia are discharged, shall return to their normal, non-gravid condition, without the intervention of a state fit to be called phlebitis? Such is the proposition of an able French writer. If those vessels cannot recover their ordinary state without passing through a stage of inflammation worthy to be called phlebitis, however slight that may be, it is certain that we ought to feel no surprise when we find such inflammation to become violent, dangerous, or even fatal, by developing all the phenomena of pyogenic fever, and consequent pyæmia.

Having now given a plain account of what happens in an ordinary labor, I shall in the next chapter proceed to give directions for the Conduct of a Labor. I cannot, in doing so, avoid some iteration, nor shall I apologize further for so doing, since, without repetitions, I cannot possibly maintain the even tenor of the story, for, though Obstetrics is a Science, it is made up of a vast number of unconnected items.