ELECTRICITY AS AN OXYTOCIC.
In passing to the second division of our subject, which, broadly speak ing, concerns the utility of electricity as an agent for re-enforcing or awakening uterine contractions, we are justified in taking for granted the acceptance of the statement that electricity is able to cause contractions of the uterus, either indirectly through the effect of the current on the nerve centres which innervate the organ, or else directly through stimu lation of its muscular substance. On this point there seems to be no scope for difference of opinion. The question to be settled, tersely stated, is this, Has electricity any advantages over the routine methods at our disposal in those conditions in which stimulation is called for ? If it has not then it is scarcely worth the obstetrician's while to burden himself with an additional instrument; if it has, then, in view•of the fact that in certain emergencies even the most reliable means may fail, any number of additional ones should be welcomed.
It would be a thankless task to burden these pages with a record of the diverse opinions which have been expressed in regard to the utility of electricity as a means of stimulating the uterus to contraction or of restoring tone to it when its energies are flagging. We will consider the subject rather from its clinical than its theoretical side, in connection with the two conditions in which electricity may a priori claim to be indicated, and particularly in comparison Nr•ith those measures which are matters of accepted routine.
The two conditions in which we are called on to re-enforce or awaken uterine contractions. are: Uterine inertia, the induction of premature labor.
Uterine lnertia.—This condition, broadly speaking, may be present during either of the three stages of labor, or may follow at a variable in terval on the completion of the third stage. We will briefly consider the cause of the inertia during these separate periods, and thus endeavor to deduce the indication, if it exist, for resort to electricity.
During the first stage of labor, under the usual normal conditions, that is to say, given a parturient canal of sufficient size, a fcetus present ing favorably, and the absence of pathological alterations in the soft parts, a prime cause of ineffective uterine contractions is exhaustion of the parturient. What is needed here then is rest for the uterus rather than stimulation. In this stage, therefore, resort to electricity will as rarely be called for as, in the opinion of leading obstetricians, are other oxytocics, such as massage and ergot. In this stage, while the labor is otherwise progressing normally, time and patience will be of greater ad vantage to both the mother and the child than resort to any uterine stimulant. In the second stage of labor the conditions are somewhat different. Dilatation of the cervix once completed, it may be considered of positive advantage to end the labor as soon as possible without resort to means. which are meddlesome or fraught with danger to either the
mother or the child. Here then stimulation of the uterus and of the abdominal muscles, while of direct assistance to the parturient, is not at all open to the charge of interfering with the natural forces, but on the contrary, may be looked upon as a desideratum. At this juncture then we may properly consider the value of electricity in comparison with other means of assisting the mother. Resort to ergot is common enough still during the second stage, notwithstanding the fact that prominent obstetri. clans reject the drug prior to the completion of the third stage of labor. Unquestionably ergot will re-enforce the contractions, and will not always by any means be attended by those tetanic contractions which imperil the life of the child, or, after its birth, may interfere with the due completion of the third stage of labor. In view, however, of these possible conse quences, it seems wiser to reject ergot in the second stage. Massage and compression of the uterus are further means, and, in general, effective ones, of re-enforcing the contractions during the stage of expulsion. The method by mnietage and compression, however, is tedious, and the com pression, if persisted in, becomes annoying to the patient. Electricity, on the other hand, is not open to the objections which attend the use of ergot. None of those who have used it, as far as we have been able to discover, have found that the agent tetanizes the uterus, and so far from the patient complaining of the applications, she will often crave them, for exceptionally it seems as though they took the edge off the pains. This latter point is one on which Baird' lays considerable stress, although we have personally not noted this sedative effect, nor does it seem to have especially impressed other observers. This gentleman states that " when ever the pains are of sufficient severity to cause considerable distress, I make them a pretext for the use of the faradic current, at the same time promising the patient some relief from her sufferings, but without ex plaining to her or her friends all the benefit which I expect her to derive from its use. In making the application to relieve pain, I pay no regard to the stage of the labor. Too much care cannot be exercised here in making the application to the abdomen not to use too small an elec trode," else, the current being localized, painful contractions of the ab dominal muscles are at once produced. " At first a current barely strong enough to be perceptible to the patient is generally sufficient, and it can be gradually increased if necessary. I then keep the circuit closed until sedation is obtained." It seems likely, then, that in addition to re-enforcing the expulsory pains through resort to electricity, we may spare the patient suffering, an advantage which no other oxytocic means at our disposal possesses.