254 OF LABOR. 



SECTION 1. 

 Of the Causes of Labor. 



645. It is common to divide the causes of labor into proximate 

 and remote, or also into occasional or determining, and efficient or 

 immediate. 



§. I. Efficient Causes. 



646. The efficient causes are those which effect, or properly speak- 

 ing, constitute {font) labor; the)r have greatly occupied the atten- 

 tion of physiologists and accoucheurs in all ages; they have by turns 

 been attributed to the foetus, the womb, the abdominal muscles, the 

 diaphragm, and sometimes to all these parts together. Hippocrates 

 and most of the ancients thought that at the end of gestation the 

 foetus tears the membranes, extends itself like a spring, and pushes 

 with its feet and breech against the fundus of the uterus, while with 

 its head it presses upon the cervix so as to dilate it, pass through it, 

 and then escape from the genital organs. This opinion, which still 

 prevails amongst the vulgar, was founded upon what takes place in 

 birds, where the little chick, for example, breaks the surrounding 

 shell with its beak, when it reaches the period of hatching; upon 

 the circumstance that children that die while in the womb are born 

 with more difficulty than those who are strong and vigorous; and 

 lastly, on the fact that children have been frequently known to 

 escape spontaneously from the womb after the death of the mother. 



647. Nevertheless, it has never been generally admitted that the 

 foetus is the sole agent, the sole efficient cause of delivery; indeed, 

 the wisest authors believed that it played an important part in this 

 grand function; but that it could not come forth without calling 

 other powers to its aid. In this respect the opinion of the moderns 

 is entirely opposed to that of the ancients. During the process of 

 its birth the foetus does not exert in any way an active power; the 

 analogy which it was attempted to trace between child-birth and the 

 hatching of a chick cannot withstand the very weakest objection: in 

 most cases the death of the child does not affect its expulsion at all; 

 besides, the slowness of the labor in such a case is explained by 

 the fact that the foetus when dead is flaccid, and cannot present to 

 the womb the same firm resistance as if it were alive; that if putre- 

 faction have commenced, the irritability and contractility of the 

 womb often receive a mischievous influence therefrom, and to a 

 greater or less extent lose their natural vivacity; finally, that the 



