390 DYSTOCIA. 



sixty-fiive times in nearly forty-thousand pregnant women; the progno- 

 sis is in general unfavorable, for by the admission of that lady, in 

 spite of the most rational and careful treatment, one third of the cases 

 proved fatal. It is more frequent in the last three months and during 

 labor than at other periods, and is less dangerous when it occurs after 

 delivery, or previously to the sixth or seventh month of gestation. 

 Not so serious, cseteris paribus, when occurring during labor, as be- 

 fore it, it is less so in proportion as the labor is more advanced at the 

 moment of the first attack.* As the emptying of the uterus is often 

 the only means of putting an end to the convulsions, it is evident 

 that the danger arising from them will be in a direct ratio to the 

 difficulty of effecting that object; if the neck of the womb and the 

 head of the foetus are disposed in such a way as to make it an easy 

 matter to extract the child, the disease may be considered as less 

 alarming than if the orifice is still hard and undilated. Those cases 

 that attack women who are hysterical, epileptic or endowed with 

 great nervous susceptibility, or whose form exposes them more par- 

 ticularly to these two affections; those in whom the paroxysms are 

 short, or separated by well marked intervals of calm, and of restora- 

 tion of all the functions, are always less to be dreaded than such as 

 possess no analogy with an anterior nervous state of the woman, 

 which supervene in women who are sanguine, plethoric, or whose 

 organs are all surcharged with serosity ; which are accompanied 

 with apoplectic phenomena, as coma, stertor, or complete insensibi- 

 lity during the intervals of the paroxysms; and also of such as are 

 only the symptoms of organic disease of longer or shorter stand- 

 ing, seated in the brain, the lungs, the heart, or any other important 

 organ, aud which had been greatly aggravated by pregnancy. 



894. The child runs scarcely less risk than the mother; in the 

 first place, it often dies in the midst of the extraordinary motions 

 that mark each paroxysm; and then, wherever abortion takes place, 

 its life cannot be preserved; the same thing often takes place when 

 premature delivery cannot be avoided; and even in forced delivery 



* I am of opinion that convulsions are more to be feared in labor where the 

 pains are violent, but ineffectual, than in those where the pains are feeble and 

 of short duration. The violent efforts of the abdominal muscles in consent with 

 the energetic contractions of the womb, and the strain upon the respiratory or- 

 gans in the bearing-down, cannot but press tlic uterine globe very strongly 

 against the aorta, and the great arterial trunks in the belly; hence, an increased 

 determination of blood to the head. Hence the swollen and flame colored coun- 

 tenance, the extraordinary activity of the innervation; and lastly, the convulsive 

 attack. Hence too, an additional motive for emptying the womb as soon as 

 practicable, in order to obviate one of the causes which, having produced, will, 

 if unchecked, continue to aggravate the cerebral causes of the convulsion. — 31. 



