CAUSES OF LABOR. 257 



the OS uteri? Who does not know, that when passed up to search 

 for coagula, the placenta, or the foetus itself, the hand is soon 

 forcibly expelled, together with the foreign body it was designed to 

 remove? 



652. Strictly speaking, the contractions of the uterus might suf- 

 fice for the expulsion of the child; in several cases of complete 

 procidentia of the womb, such as those reported by Peu, Jalouzet and 

 Madame Lachapelle, the pregnancy has been found to go to the 

 full term, and the labor to terminate spontaneously; many women 

 have been unconsciously delivered during an attack of lethargy, of 

 asphyxia, or in a deep sleep, into which they had fallen in conse- 

 quence of criminal attempts. Women weakened by protracted dis- 

 ease, a hemorrhage, or exhausted by suffering unconnected with 

 childbirth; those who are affected with ascites, inflammation in the 

 chest, delirium, or madness; those whose abdominal muscles, thin 

 and pale, have lost almost all their contractility; such as are pusilla- 

 nimous, timid, excessively irritable, or of a very marked lymphatic 

 constitution; and lastly, all such as from debility, disease, want of 

 courage, excess of sensibility, or want of power do not bear down 

 at all, and who, on the contrary, employ all the resources of their 

 volition to arrest the least effort of their muscular system, are deli- 

 vered notwithstanding. The womb alone in such cases bears the 

 whole burthen of parturition. 



653. Accessory efficient cause. Nevertheless, the womb in most 

 cases requires to be sustained by the action of the diaphragm and 

 abdominal muscles. The concurrence of this action is so evident 

 in most women that no observer has thought of denying its exist- 

 ence, and that it is sufficient to announce it as a simple proposition; 

 but its importance has not been understood in the same way by 

 all authors. According to Haller, the womb contracts only for 

 the purpose of preventing the child from being pressed together 

 into a confused mass, to force it to present one extremity of its 

 occipito-coccygeal diameter to the straits; by their contractions, 

 the abdominal muscles support the womb in front and on its sides, 

 so as to prevent it from deviating, or from abandoning the direction 

 of the axis of the pelvis, or bending in any direction, and make it 

 in some respects resemble a straight canal, continuous with the 

 pelvis. The descent of the diaphragm then bears wholly upon the 

 fundus of the uterus; the cervix, being unsupported, yields to the 

 effort; and the foetus, being forced from above downwards, passes 

 through the genital organs as an inert and solid trunk, passing out of 

 a long canal with inflexible parietes. 



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