50 OBSTETRICS. 



really force it lower. The accident may also happen from falls, 

 shocks, lifting weights, and, according to Churchill, in the early days 

 of menstruation, when the uterus is increased in weight by the afflux 

 of blood. The growth of tumours in the neighbourhood of the fun- 

 dus is also a cause. 



The sy7nptoms are, violent bearing-down pains, sense of fulness 

 and distention about the loins and hollow of the sacrum, dragging 

 and tension in the groins, and inability to pass faeces or urine. A 

 per vaginam examination reveals the os tincae thrust up behind the 

 symphysis pubis, and the vagina seems to be obstructed by a hard 

 body, which is the fundus turned down into the hollow of the sacrum. 



The treatment consists in emptying the bladder and rectum, and 

 pressing up the fundus by two fingers in the rectum, assisting them, 

 if necessary, by a finger of the other hand in the vagina, by which 

 the OS uteri can be hooked down. Venesection is sometimes necessary 

 to relax the system. Sometimes merely emptying the bladder and 

 rectum are sufficient, the uterus recovering itself through the muscu- 

 larity of the round ligaments. Sometimes it is necessary to rupture 

 the ovum, and let the uterus condense itself. At others, tapping the 

 uterus is required. The after-treatment is, rest in a horizontal pos- 

 ture, and the avoidance of the distention of the bladder and rectum. 



General treatment of the female before labour, — A woman should 

 be prepared for the perils of childbirth by a course of preliminary 

 treatment, commencing a few weeks before her term. This should 

 consist of an occasional venesection, if she is plethoric or has headache, 

 and the use of a gentle aperient that may serve to secure the regular 

 evacuation of her bowels. The diet should be light and unstimulat- 

 jng, and the female should, as far as possible, take regular exercise 

 either in riding or walking till the end of gestation. 



LABOUR. 



By this term is understood, that process by which the contents oj 

 tJie gravid womb are expelled. It should commence, as we have 

 already seen, at or about the two hundredth and eightieth day from the 

 last appearance of the menses, or about one hundred and forty after 

 quickening. The principal agent in affecting this process is the 

 uterus itself, assisted, however, by the action of the diaphragm and 

 abdominal muscles. 



The cause of labour is not well. understood: it has been variously 

 attributed to the inability of the uterus to sustain farther distension, 

 to the struggles of the foetus in its endeavours to breathe, and to the 

 absence of adequate nourishment. Whatever be the cause, certain 

 it is, that the foetus contributes nothing to expediting the process, 

 being entirely passive throughout, and the volition of the mother is but 

 little concerned, farther than the assistance afforded by the voluntary 

 contraction of the abdominal muscles and diaphragm, the action of 

 the uterus being entirely involuntary. This action consists in the 



