TEDIOUS LABOUR. 69 



be no contraindication. Dr. Dewees once took away as much as 

 two quarts. The blood should be drawn rapidly and from a large 

 orifice ; if the patient becomes faint, so much the better. The 

 bloodletting may be assisted by an opiate enema, by the administra- 

 tion of tartar emetic in nauseating doses, or by the application of 

 belladonna ointment to the cervix. The warm bath has been 

 recommended by some practitioners and disapproved of by others. 

 Moral influences have, at times, a good efl?ect ; changing the dress, or 

 the bed, changing the position, &c., are often of service. Some 

 practitioners recommend mucilaginous injections to be thrown into 

 the vagina. 



There is another condition of the os uteri which is often a cause 

 of delay, where the anterior lip is caught between the head and 

 symphysis pubis and its .retraction prevented. This may result 

 either from an obliquity of the uterus, or more probably from an 

 unequal dilatation of the anterior and posterior lips, the latter dilating 

 most rapidly. 



The remedy is simple and easily applied. During the interval 

 between the pains, when the os uteri is soft and dilatable, the prac- 

 titioner should gently push back the anterior lip over the crown of 

 the head and hold it there during the succeeding pains, — a proceed- 

 ing which, if nicely accomplished, will soon be followed by the 

 expulsive pains of the second stage. 



Premattire rupture of the membranes. — This may occur either 

 through their own weakness, or from violence, either accidental, or 

 from the officious meddling of the accoucheur. The result is, that 

 the OS uteri instead of being dilated by the bag of membranes, which 

 is soft and wedge-like, comes at once in contact with the child's 

 head, which is not by any means so good a dilator. The only 

 remedy is patience. An examination should be made early in order 

 to correct the presentation without loss of time, should it be abnormal. 



Excessive quantity of liquor amnii is sometimes enumerated as 

 a cause of tedious labour ; and this is apt to be in excess when the 

 patient is feeble and the child small a"nd ill-nourished. The treat- 

 ment for this is rupture of the membranes ; but it should not be 

 practised without due caution, or it may produce tedious labour from 

 the cause mentioned in the preceding paragraph. 



In the second stage^ the labour is often rendered tedious by the 

 feeble and irregular action of the uterus ; when this exists, the interval 

 between the pains is long, and the pains themselves are feeble and 

 short, and have little or no effect on the child. This state of things 

 is not uncommon in delicate women, or, in the reverse ; or it may 

 be produced by mental depression, a deranged state of the digestive 

 organs, or, it may arise from hereditary transmission. 



In the treatment of these cases, it is above all things necessary to 

 keep up the patient's spirits ; all causes of irritation should be re- 



