[I think I have gotten at least ques tionable results by exhibiting small doses of thyroid extract from the sixth month of pregnancy. In these cases the child showed marked torpidity in its move ments in ntero, and was somewhat below the usual size and weight as compared to the children the mothers had had at previous aceouchements. S. maRx.] Much can be done by the so-called Trochowonick dietetics from the sixth month of pregnancy: forbidding sweets, pastries, fats; ordering regular exercise, and limiting the diet to meats, green vegetables, acids, and stewed non-sweet (lied fruits.
tinder prophylaxis we must call at tention to pelvimetry. We never meas ure a patient's pelvis for the sole purpose of fixing the time in advance for the termination of labor, unless the pelvic distortion be so extreme as to warrant immediate interference, or justifies an abdominal section at term. We always estimate the size of the pelvis as com pared to the size of the head; and when the time comes when by supra pubic pressure we find the head fits snugly or fails to engage. be this at the seventh, eighth, or ninth month,—pro viding the patient does not insist on a Cresarean section at term,—we proceed at once and induce labor. We never tell a patient that because of a pelvic con traction she must have labor induced at the sixth month. We perform the supra pubic manipulation once in two weeks during the last three months of preg nancy, and an attempt is made to get the head engaged into the pelvis. When this fails, labor is induced.
Curative Treatment. — The curative treatment may be divided into: (1) med ical; (2) postural; and (3) surgical, the latter affecting both mother and foetus.
The MEDICAL TREATMENT of dystocia resolves itself into the treatment of pro longed first stage. There are a number of valuable drugs that can be earnestly recommended in the abnormal dilatation of the first stage. It is, of course, of the greatest importance to ascertain the cause, if possible, of the condi tion. This once removed, the labor will in all probability be rapidly terminated. Evacuation of the bladder and colon, the careful and thorough examination of the presenting part to discover, if pos sible, a malposition, even to the extent of introducing the full hand in utero, will materially assist the treatment. We have in the sedative drugs—viburnum prunifolium; opium and its derivatives, as morphine and codeine—very valuable agents in a certain class of cases.
When the pains are weak, irregular, nagging and exhausting, they assume the character of the so-called "false" pains and may last several days; while there is no appreciable effect on the cer vix, the patient is gradually, but surely, being worn out. Here the administra tion of viburnum, 1-drachm doses every hour, or codeine is indicated. Morphine
is objectionable since the and its inhibitory action on all the emunctories arc very disagreeable feat ures. More valuable than any other drug is chloral in 10-grain doses, admin istered hourly till the patient experi ences relief.
In quinine we have a most wonderful agent in connection with the parturient uterus. Indications for its use are very pronounced in cases in which the pains are regular, though weak. Such pains have no influence on the progress of labors. They simply represent weak physiological uterine contractions. They can be wonderfully stimulated by qui nine in full doses, 20 grains by the mouth or 40 grains per rectum. Qui nine does not act like ergot, which ought never to be used before or during par turition. Ergot causes permanent spas tic uterine action, no alternate contrac tion and relaxation, while quinine influ ences the uterine pains by intensifying them and causing regular firm contrac tions and complete relaxations. Of course, its administration is limited to the first stage of labor, dystocia in the second stage being always amenable to manual or instrumental interference. j Strychnine acts similarly to quinine, but is not nearly as efficacious.
A third set of drugs which can be called sedative and antispasmodic are gelsemium in the form of the tincture, chloral, chloroform, and ether, and, lo cally, hot water. In cases of labor, occurring especially in young neurotic, weakly women, the following classical picture is often presented: The pains are hard and trying from the beginning; while regular enough, they partake more of the character of a local spasm. The woman cannot control herself and throws herself about restlessly. She calls for assistance and is soon exhausted. Lo cally there is revealed an os admitting one or two fingers, even after many hours of suffering. The head is closely pressed against the lower zone. The rim of the os is hot, painful, and tender and its edges feel extremely tense and sharp. Such a finding warrants the ad ministration of one or other of the above drugs. Chloral in 15-grain doses every fifteen minutes, four times, or the ad ministration of chloroform from drop doses during a pain to anxsthesia of the obstetrical degree, with or without con tinuous local irrigation of sterile and very hot water, work wonderfully. They cause the spasm to disappear, the os to rapidly dilate, and place the patient in a condition in which at least the pain is bearable. Ether is not of as great value as chloroform, since experience has shown that it does not relax spasm as readily as the latter. Adjuvant meas ures to be thought of are mustard paste to the small of the back and firm press ure against this part by hand or pillow.