INFLUENCE OF PARTURITION ON MOTHER AND INFANT.
is impossible that an act so important as parturition should not react on the economy of the mother and of the infant; hence it should not surprise us to observe the supervention, in the one as well as the other, of functional modifications which we must rapidly pass in review. All the systems, the entire economy of the mother, are more or less enced by parturition, but only a few of these are more especially involve& Innervat We observe a series of derangements which vary according to the indi vidual. While most women anticipate the end of pregnancy and the be ginning of labor with joy, some are anxious, become subject to melancholy and grief, which give place to actual alarm when the first uterine contrac tions set in. Later, when the labor is fairly under way, this dread disappears in a large majority, and changes in some to apathy, a profound resigna tion; in others, to irritation, or excitement, which is manifested in words and actions. Thus we find among women a number of varieties, which most frequently depend both on their courage and their nervous sus ceptibility, but also, it should be added, on the greater or lesser intensity of their pains.
It is indeed incontestable that certain women suffer more than others, and this alone suffices to explain how labor, so well borne by some, gives rise in others to an agitation, a nervous excitement, which may in certain cases be increased to delirium. It is readily understood that primiparity plays a prominent part from this point of view. In general, however, viewed from the nervous phenomena, labor may be divided .into two periods which correspond to those of parturition. During the first per iod, that of dilatation, impatience, agitation, and excitement predominate. Owing to their incapacity to ascertain for themselves the progress of the labor, the women become enervated, agitated, despondent; they ex press their pains by lamentations rather than by screams or tears—a re bellion as it were, which makes them bewail every pain, and manifest their impatience in a more or less expressive way. Now it is pains in
the kidneys, now cramps, now shivering. Nothing is more variable than these nervous phenomena in women, but the most prominent is the feeling of fatigue, which among many finds expression in phrases which are re pasted almost periodically, especially in primipara3, such as: " What time is it?" " Put me to sleep." As soon as the stage of dilatation is passed, the scene generally changes, and as the expulsive efforts become manifest, it is not unusual for women to bear the uterine contractions much better, although they are much more painful. The woman now feels the progress of the labor; and al though she cannot absolutely convince herself of its onward march, she is conscious of it, and it is not rare to see women, until then very excited, take fresh courage, and aid the uterine impulses by their individual ef forts. Not until the last pains occur, when the head is about to be de livered, do we see this excessive agitation recur, and then mainly in cases where the head takes a certain time in passing the vulva. Whenever this disengagement is prolonged, we observe that the patients again become irritable, unmanageable, and manifest by screams, sometimes truly sav age in their nature, both their suffering and their impatience. In regard to the circulation, we have pointed out the modifications of the pulse during the contraction. But it is a noteworthy fact, that in general the circulation is not accelerated as much as might be supposed. Indeed, the pulse remains usually calm, and even at the height of the greatest efforts of the parturient, it beats generally from 70 to 80; only when the labor is excessively prolonged, in other words when it ceases to be physio logical, do we observe an elevation of the pulse, which indicates the path ological suffering of the patient.
Calorification.