Grenser justly observes, we must see if the retardation of the labor is really due to the inefficient contractions of the uterus, and if so, we must ascertain the cause of the anomaly. The uterus may be simply reposing, and in endeavoring to awaken the contractions, we may exaggerate them. The main indication is to control the forces of the uterus at the outset, so that they may be sufficient for each stage of the labor. Do not impose any arbitrary position upon the patient, but allow her to assume the one that is most agreeable to her. Some women have stronger pains when lying upon the back, others when standing. Give her a little light nourishment (tea, bouillon), and encourage her kindly, but do not fix any time for the termination of the Avoid frequent examinations, as they are both useless and wearisome; note the condition of the bladder and rectum, and empty them if necessary. If the woman is weak, give light stimulants. If she is wearied by ineffectual pains, it is a good plan to give her fifteen or twenty drops of laudanum, or a • drachm of chloral, by the rectum. Warm vaginaldouches and baths will sometimes give great relief. Above all, wail ; do not be in a hurry to interfere, but gain time by soothing the patient. If the pains continue, but are feeble and irregular, the membranes may be ruptured, but only under the following conditions: 1. The os must be dilated to some extent, and the cervix must not be rigid. 2. Both the position and presentation must be favorable. 3. The pelvis must be well-proportioned. 4. There must be no complications, such as prolapse of the cord, or of a limb. If accomplished with care, and with due regard to these conditions, the operation is often very useful. Do not act too hastily; rash interference is, in the great majority of cases, more dangerous than expectant treat ment.
For feeble pains during the second stage of labor, a number of reme dies have been suggested; they may be described as mechanical and dynam ical. Among the former is posture; the woman may be caused to stand and walk about, but this often increases her fatigue and effects nothing. The Germans have recommended the use of Bratin's colpeurynter, and the introduction of a bougie into the uterine cavity; the latter method is often useful, but it is sometimes inconvenient to leave a foreign body in the cavity for several hours. Kristeller has suggested uterine expression, a manipulation which consists in grasping the uterus with both hands, in such a way that the ulnar border of each hand is turned toward the pelvis, while the palm encircles the fuming on each side, and exerting firm pres sure downwards, at the same time squeezing the organ between the hands. The pressure is maintained from five to eight seconds, then the operator rests for half a minute (sometimes two or three minutes), when the same manwuvre is repeated, and this is done from ten to twenty or forty times.
If the patient is very sensitive it may be necessary to administer chloro form. Suchard mentions the following indications for expression: 1.
Arrest of labor from uterine inertia, when the os is not sufficiently dilated to allow the introduction of the forceps. 2. Spasmodic contractions of the os. 3. Arrest of the head, in breech presentations, after the trunk has been expelled, whether this arrest is due to contraction of the cervix or to resistance on the part of the perineum.
We believe that these propositions are exactly opposes to all the prin ciples of rational practice. If the uterine contractions are arrested at a period when the os is not sufficiently dilated to permit the introduction of forceps, it is better to wait if the indications are not urgent, or to dilate rapidly and apply forceps if they are. Kristeller's method seems to op pose rather than to favor dilatation when the cervix is the seat of spas modic contraction, because by exciting the uterus to fresh action we only increase the irritability of the circular muscular fibres. Finally, the for ceps applied in practised hands are preferable to expression as a means of overcoming the resistance of the perineum. The hot vaginal douche, re peated two or three times and continued for about ten minutes, is a use ful agent.
Among the dynamical means may be mentioned cinnamon, borax, ergot, especially the latter. The latter possesses advantages, but its use is dan gerous for the mother, in that it produces tetanic contraction of the uterus, and for the foetus, since it causes profound disturbance of the placental circulation. Ergot should be absolutely rejected during labor. not only in the first stage, but in the second and during the third, its use. being confined to the period after the expulsion of the placenta. This is the dictum of Pajot, who affirms that ergot should not be admin istered until the uterus is entirely emptied of its contents, including the fcetus, placenta, and blood-clots. Cannabis Indica,,pulsatilla, uva ursi, and pilocarpine, have been recommended. Electricity was first proposed by Herder in 1803; was first employed by Henninger and Jacoby, and its use was revived by Saint Germain in 1869. The latter experimented with galvanism, employing the Ruhmkorff apparatus. Ho decided that the galvanic current caused a notable increase in the number and strength of the uterine contractions, that the os dilated steadily and rapidly under its influence, and that neither the mother nor the child suffered harm, while the placenta was invariably expelled spontaneously and immediately after the birth of the child. Apostoli stated to the Academy of Medicine, in 1881, that ho was accustomed to use the faradic current as soon as the child was delivered, introducing one pole into the uterine cavity. He claimed that involution was hastened in this way, while no bad results fol lowed. It is precisely in the conditions described by Apostoli as favor able for the employment of electricity, that we regard its use as unjusti fiable. The woman should be kept absolutely quiet during the five or six days following delivery; such interference as he describes is not only use less, but dangerous.