LABOUR. 53 



the congested vessels, they diminish the vascularity and heat of the 

 part, and render it more capable of dilatation. 



The irritability of the bladder and rectum are among the most 

 prominent signs of commencing labour, and are dependent upon the 

 contiguity between the dilating os uteri and these organs, all de- 

 riving a portion of their nervous influence from the same source. 

 The disposition to urinate exists even when the bladder is empty, 

 and the tenesmic irritability of the rectum is equally independent of 

 the presence of faecal matter. 



Nausea and Vomitings at the commencement of labour, are looked 

 upon as favourable signs, being indicative of a general relaxation, 

 which favours the dilatation of the os uteri. It must not, however, 

 be confounded with that which sometimes supervenes in lingering 

 labours, which is rather prognostic of great exhaustion, and to be 

 dreaded accordingly. In ordinary cases, vomiting in the early 

 stages requires no treatment, being generally relieved as soon as 

 dilatation takes place. When, however, it is very violent, it may 

 often be checked by an effervescing draught, with a few drops of 

 laudanum. The rigors, which often occur early in labour, are like- 

 wise accompaniments of the dilating os uteri, and although often 

 severe, are not dependent on diminished temperature of the female, 

 or irregular arterial action ; they require little other treatment than 

 an extra covering, and diluent drinks. 



STAGES OF LABOUR. 



Some obstetricians divide a labour into three, others into four, five, 

 or six stages, all ending with the expulsion of the placenta. The 

 first division is the one generally adopted, and the three stages are 

 thus enumerated. The first terminates with the dilatation of the os 

 uteri ; the second with the delivery of the child ; and the third with 

 the expulsion of the placenta. 



First stage. — This is generally the longest and most distressing, 

 both to practitioner and patient. The pain, although not so great as 

 in the second stage, is of a more distressing character, and more 

 difficult to bear. The patient is more irritable, uneasy, and alarmed 

 as to the result. The character of the cry, as before mentioned, as 

 well as the gestures, are peculiar to this stage, as well as diagnostic 

 of it. Nausea and vomiting also occur during this stage, and, it is 

 thought, assist in efTecting it. 



By placing the hand upon the abdomen during a pain, the uterus 

 can be felt to contract and harden itself, and at the same time tilt 

 forwards so as to bring its axis into accordance with that of the 

 superior strait. As the pain goes ofl?*, the uterus becomes soft again, 

 without, however, returning to its former state of relaxation. 



The approach of a pain may oflen be foretold by the practitioner 

 before its access, by auscultation. " The moment a pain begins, 

 and before the patient is herself aware of it, we hear a short rushing 



5* 



