260 CAUSES OF LABOR. 



atre, had pretty smart pains, and the neck of the uterus dilated regu- 

 larly and promptly as long as there were only a few pupils present. 

 When they had all assembled, she continued to complain in the same 

 manner, but the labor did not advance at all; the whole day and 

 night passed in this manner; in the morning all the witnesses went 

 away to get some sleep; the dilatation began again; about noon it 

 was quite advanced; the pupils returned, and the phenomena were 

 immediately suspended; at nine o'clock in the evening she was left 

 alone, and as I was going out, I said it would be well to assemble 

 again between eleven and twelve o'clock at night. A k\v minutes 

 afterwards, the pains were accompanied with a sensible dilatation, 

 and the efforts directed with so much force, that the child passed the 

 inferior strait at ten minutes before eleven, just as two of the students 

 entered the room. Before she left the ward this woman confessed 

 that her object was to get rid of the students, and to disembarrass her- 

 self as soon as they were gone. But these are exceptions which do 

 not hinder us from establishing it as a general rule, that the will has 

 scarcely any influence on the progress of labor, except that exerted 

 by means of the abdominal muscles and diaphragm. 



§. 11. Determiniii^ or Occasional Causes. 



660. When it is remembered how much time was required to 

 acquire correct notions concerning the efficient causes, no surprise 

 ought to be felt at the vagueness of opinions at the present day in 

 regard to the determining causes of labor. The ideas first enter- 

 tained varied in accordance with the predominant medical hypothe- 

 ses of each particular period ; and then according to the notions 

 entertained by accoucheurs upon the efficient causes : sometimes 

 they were referred to the fcetus, and sometimes to the womb or other 

 parts of the mother. They may be divided into natural determining 

 causes, and accidental determining causes. The former necessarily 

 have their origin in the ovum, or in the economy of the woman; 

 they exist therefore in every case, and belong to labor properly so 

 called. The latter are derived from without, are foreign to the or- 

 ganism, depend upon a disease of the ovum or womb, or upon some 

 particular predisposition, &c.; they are, strictly speaking, the causes 

 of abortion: I shall, therefore, not treat further of them in this place. 



661. Believing that the fostus itself opened a passage for its 

 escape, certain authors imagined that the waters of the amnios be- 

 come so acrid and irritating, as at last to produce a painful excita- 

 tion of the skin; that the bladder and rectum, fatigued by the pre- 

 sence of the urine and meconium, caused the child to feel a neces- 

 sity of passing off those matters; that the too elevated temperature 



