During the third stage of labor it is questionable if electricity prop erly finds a place. When the uterus is given time, as it should be, to rest and recover tone after its efforts, under normal conditions judicious expression is all that is needed to complete the stage, and so long as there are no indications, the chief of which is hemorrhage, for active spurring of the organ, it is a sound rule to leave it alone, that the pla centa may have the opportunity to separate normally. In the event of inertia and hemorrhage during this third stage, the faradic current will very likely evoke contractions, but the preferable indication then is to proceed to the manual removal of the afterbirth, a step which of itself will often cause uterine contratkions. If it should not, the placenta hav ing been removed, we are in the presence of inertia after the completion of the third stage, that is to say, postpartum hemorrhage is either a fact or is imminent, and in this complication electricity must take high rank as an adjuvant in treatment. It cannot, however, be depended upon alone to the exclusion of other recognized methods, for the fact must be emphasized that, although occasionally the uterus responds. instantane ously, as it were, to the faradic stimulus, in other instances the action is too slow to meet the emergency, and in others still it may fail altogether. Often again, where the uterus contracts under the influence of faradism, it relaxes at once when the circuit is broken. The agent, hence, is one not to be depended on in this emergency, except in conjunction with other well-known means.
To summarize then the facts in regard to the value of electricity dur ing labor, as they present themselves to us from a careful study of the contributions to the subject: The agent may be considered a valuable aid to the parturient during the second stage, in that by means of it we are able to assist the expulsory forces, and there is reason further to believe that a certain amount of sedation is exerted; during the first and the third stages of labor there are means at our disposal for assisting the parturient which better fulfill the indications, that is to say, rest during the first stage, expression during the second stage; after completion of the third stage, in the presence of more or less inertia, electricity may be looked upon as a decided adjuvant to the routine methods at our disposal, but it cannot be depended upon alone to avert an impending or to check an existing hemorrhage.
It is but just to state that in reaching these conclusions we have en deavored to draw a happy mean between those observers who are enthu siastic in regard to the value of electricity in labor and those who can see no good in it. The diversity of opinion is very striking among practical obstetricians. Thus, to refer only to the views advanced of later
years, Playfair, in discussing Kilner's paper on the induced current dur ing parturition,' said that he had tested the current and it had proved a failure, possibly because he lacked the special skill, and that if special skill were needed, it could not be generally used. He had found its effects in diminishing pain slight, and not to be compared with other means at our disposal. He considered it useless as an oxytocic. On the other hand, Murray, of New York, has treated over fifty cases of uterine inertia by means of the faradic current and with uniformly good results; Tripier and Apostoli are strong advocates of faradization; Robert Barnes states' that by means of electricity the uterus can be made to contract, when it resists the influence of what may be called " the diastaltic reme dies," although he cannot rely on the agent in that its effects are not always permanent, an objection which is applicable with peculiar force to its utility in case of post-partum hemorrhage; Lusk says that " prob ably the faradic current is a most efficient agent in securing contrac tions of the but then it is rarely on hand when needed; finally Baird, who has used electricity in obstetrics to a greater extent than any one in this country, claims that the agent " stands unrivalled as an oxy tocic." In his hands it has subserved the following purposes: I. To modify the pains of labor; 2. To favor a more rapid dilatation of the os; 3. To promote more vigorous uterine contractions; 4. To add tone and strength to all the muscles engaged, and increase their power of doing work; 5. To abridge the time occupied by the labor; 6. To prevent shock, exhaustion, and postpartum hemorrhage; 7. To insure contrac tions of the uterus in cases of instrumental delivery; 8. To arrest hemor rhage and accelerate labor in cases of placenta prrevia; 9. To prevent an undue expenditure of nervous force, in all cases of debility from what ever cause, thus leaving the patient in a condition to secure a speedy and favorable convalescence.' In regard to the variety of electricity which may prove of service in the condition which we have referred to, there can be question simply of faradism, since, as we have stated, this is the only variety which the ob stetrician can be expected to have with him in the immediate emergen cies of labor. Fortunately, this is the very current which is most likely to fulfill the indication, and if it should fail, there is no ground for think ing that galvanism would answer. The methods of application we have already spoken of, decidedly the most convenient being to give the patient one electrode, hold the other in one hand, and complete the circuit by means of the other, grasping or massaging the uterus through the ab domen.