70 OBSTETRrcS. 



moved, and she should be allowed to change her position. In some 

 cases it may be right to administer an opiate, so as to recruit her by 

 sleep, and in all cases a stimulating enema will be found of service, 

 especially if the bowels are loaded and the delay depend on this 

 cause. But the most effectual remedy in these cases, is the ergot of 

 rye, a remedy which seems to possess a power of certain, direct, and 

 speedy action on the uterus, causing it to contract almost unremit- 

 tingly till its contents are expelled. Besides the power of strength- 

 ening feeble pains, Dr. Ramsbotham has shown that it is capable of 

 originating uterine action. 



It may be given either in substance, infusion, or tincture, in the 

 dose of from fifteen to twenty grains of the powder, till a drachm is 

 taken; half a fluid-drachm to one fluid-drachm of the tincture; or, 

 the same quantity of powder as above directed, mixed in hot milk 

 or coffee. 



It is, however, to be given with caution, as results fatal both to 

 mother and child have followed its injudicious administration. 



The indications for giving it are, according to Dr. Churchill, 1st, 

 feeble and inefficient pains without especial cause ; 2d, if the os 

 uteri be soft and dilatable; 3d, if there be no other obstacle (o a 

 natural delivery; 4th, if the head or breech present, and are suffi- 

 ciently advanced ; 5th, if there be no threatening head symptoms, 

 nor excessive general irritability. 



But, on the other hand, it should not be given, 1st, if the os uteri 

 be hard and rigid ; 2d, if the presentation be beyond reach ; 3d, 

 if theie be a mal -presentation ; 4th, if the pelvis be deformed; 5th, 

 if there be any serious obstacle to delivery in the soft parts ; and, 

 6th, if there be head symptoms, or much general irritation. 



Toughness of the membranes, even after the os uteri is dilated, is 

 sometimes a cause of tedious labour ; but, when once ascertained, it 

 admits of an easy remedy ; if the pains are active, and the os uteri 

 dilated, they may be ruptured without ceremony. The practitioner 

 should cut a notch in his finger nail, and saw through the mem- 

 branes, at the most dependent part, during a pain. 



Sometimes they protrude unbroken, down to the os externum, and 

 in some few cases, the child has been expelled with the bag of mem- 

 branes and placenta en ?nasse ; under such circumstances it would 

 certainly be drowned in its own liq. amnii if assistance were not at 

 hand to rupture them, and enable the child to breathe. 



Rigidity of the soft parts is a very common cause of delay in 

 women who have borne children late in life, or who are of a plethoric 

 condition, with a well-developed muscular system. In such, the 

 head makes little or no progress, although the pains be strong and 

 frequent. If this condition of things lasts long, the patient will fall 

 into a state of exhaustion, or constitutional irritation ; or inflamma- 



