DURATION OF LABOR.
Some writers include in their figures all the pre cursory phenomena, others leave them altogether out of consideration. But above all, two facts can be demonstrated: 1st. While some women have a rapid delivery, others give birth to their children with extreme slowness, and this independent of any complications.. 2. Primiparte al most invariably bear much more slowly than multiparty. This latter fact is so marked that, reckoning parturition as beginning with the first pains, and counting the number of hours necessary to effect expulsion, we can say that in primiparre the mean is from twelve to fifteen hours; in mul tiparte, from six to eight hours. The same stages of labor are not of the same length in these two classes, and this is self evident, since the peri neum and vaginal orifice offer a much greater resistance in the former than in the latter, and considerably prolong the second stage in primi parx. The same is true of the first stage. There is hardly an accoucheur who has not experienced that truly exasperating slowness with which the dilatation of the cervix proceeds in certain primiparre, while ordinarily it takes place more regularly and sometimes quite rapidly in multiparty. Even this dilatation does not proceed in a strictly progressive manner, for in primipara3 it takes nearly twice as long for the cervix to dilate to the diameter of a silver dollar, as it does from that width to complete dilatation; and in multiparty it is not unusual to see the cervix, after having dilated to the size of a silver dollar, give passage with one or two pains to the head and trunk of the foetus, the delivery terminating in a quarter of an hour, or an hour at most.
Cazeaux ascribes some importance to heredity, and Depaul to race and climate. According to him, the Flemish, Alsatians, and Germans have a slower delivery than the French. Burns had also maintained that Americans, Persians, and Africans have a more rapid delivery than Euro peans. Country women have a shorter labor than city women. But it is impossible to lay down a positive rule in this respect, and the accoucheur must never presume to predict the end of her delivery to his patient. Not even the rupture of the membranes can serve as a certain guiding point in this respect, for we have seen above, that, according to Churchill, among 814 women the termination of labor after the rupture varied from one to one hundred and fifty hours. Still, in in a general way it may be
admitted that, in primiparie and under normal conditions, the termina tion of labor is accomplished within four or five hours, and in multiparte within an hour after rupture of the membranes. But this termination may vary from different causes—size of the ketus, presentation, position, uterine contractions, etc.
Much difference of opinion also prevails regarding the influence of age: some consider that advanced age of a woman at her first delivery is a cause of tardy labor; others look upon this circumstance as of no significance. Still, it is an incontestable fact that very young subjects have generally a much more rapid delivery than others. We ourselves had opportunities of seeing a certain number of very young women delivered rapidly. One of these women was little more than a child. There were: All these women had not only natural, but rapid deliveries.
The view that labor is protracted iu old primiparte was disputed by Mme. Lachapelle and Cazeanx, but has been again advanced in 1872 by Cohnstein and Ahlfeld.
Coccio occupies a slightly different standpoint, since his studies were confined to the innocuousness of labor in old primiparte, and not to the duration of labor; but he admits implicitly that labor is protracted, for he says with Pajot: " These difficulties in parturition are not due, as the older authors maintained, to ankylosis of the coccyx, but to the stage of dilata tion which is prolonged, and to the resistance of the soft parts; there is, if I may be allowed to use the expression, a sort of general cornification." While admitting all this in a general way, we believe that ankylosis of the coccyx sometimes plays a prominent part. We recently had a very good example of this. The case was that of a primipara aged thirty-six years, in whom we were permitted to demonstrate this ankylosis of the coccyx directly, the head being unable to pass it. We were obliged to apply the forceps, and for nearly six weeks the woman suffered a fixed pain at the level of the coccygeal region, which was undoubtedly due to the injury inflicted on the sacro-coccygeal articulation by the head at the time of its disengagement.