THE INDUCTION OF PREMATURE LABOR.
first limited to cases of hemorrhage, later extended to pelvic con traction, and later still to all obstacles which might render labor at term difficult, dangerous, or impossible, for both mother and child, the induction of premature labor may be defined as an operation performed in the interests of the mother or of the child, and aiming at awakening uterine contractions, so as to cause the expulsion of the infant before the natural term of pregnancy, although at a time when this infant is able to live outside of the uterus, that is to say, is viable. Premature labor, then, is included between the seventh month of pregnancy and term.
Although Justin Siegmundin in 1690, Puzos in 1707, and Bohn in 1717, advised rupture of the membranes in case of hemorrhage due to placenta prwvia, and so induced premature labor, it was not for some years after wards that this procedure, in case of deformity of the pelvis too great for the passage of the foetal head at term, was admitted into obstetric prac tice, and it was in 1756, Denman tells us, that the most distinguished phy sicians of London gave the method their unanimous sanction, in view of the fact that many women with pelvic contraction had been delivered prematurely and spontaneously of viable children who had lived. It is to England, therefore, that the origin of this operation belongs.
Practised for the first time, some say by a midwife, Mary Dunally, others by Macaulay, or Kelly, the induction of premature labor became the rule in practice, through the efforts of Barlow, Denman, Merriman, Marshall, Clark, Ramsbotham, Burns, and others. From England, the operation passed to Germany, where Mai first advised it in 1799, and he was followed by Woidmann; but it was not till 1804 that Wenzel first per formed it. Krauss practised it in 1813, but only on the appearance of the monograph of Reisinger, in 1818, was the operation finally adopted. The greatest partisans of the operation were Osiander, Joerg, Stein the younger, Kluge, Ritgen. In Holland. J. Themmen, Salomon, Vrolik, \Vellenbergh performed it. In Italy, Lorati, Billi, Ferrario, reported
successes. In France, although proposed, in 1804, by Roussel de Vau zesmes, it was still rejected by the Academy of Medicine in 1827, owing to the influence of Baudelocque; it was not till 1831 that Stoltz resorted to it, and so successfully, that he was followed in 1832, 1834, by P. Dubois, and from this time on, thanks to the efforts of Dezeimeris, Lacour, Fer niot, and Lazare Se(% it was performed and written about constantly, until to-day it is the practice of all French accoucheurs.
While the operation was becoming generalized, its indications were widening, and to-day they are almost infinite. The indi6ations, however, are subordinated to a certain number of conditions, which Naegele and Grenser state as follows: 1. Exact diagnosis of the shape of the pelvis 2. Certainty of fcetal life.
3. Determination as far as possible of the date of gestation.
4. Absence of serious disease which might be aggravated by the opera tion.
The most frequent indication for the induction of premature labor, the one for which it was originally performed, is contraction of the pelvis. Authorities, however, are not in accord in regard to the limits of this contraction, that is to say, as to where the line is to be drawn which justi fies resort to the procedure.
Spiegelberg, in 1870, from the study of the results of the operation in case of deformity of the pelvis, constructed the table on the following page, which sets forth the practice of different authorities.
Comparing now these results with those obtained in case of the spon taneous induction of premature labor in case of pelvic deformity, and with labor, under the same condition, terminated by forceps and version, he places the upper limit of justifiability of the operation at 3.12 inches. Whenever the maximum contraction does not reach this figure in the true conjugate, he rejects premature labor, except where from previous labors large children are to be expected with large heads, etc.