400 DYSTOCIA. 



rarely, for it is impossible to discover them until the head has 

 passed the inferior strait; except in certain cases of breach presen- 

 tation, in which the cord may be felt tightly stretched, either betwixt 

 the thighs, around one of the limbs, or merely up along the abdo- 

 men, we can suspect the existence of these turns only upon conjec- 

 tures that are too uncertain and vague to deserve the least confidence. 

 If, however, it should be ascertained that the cord is too short, it 

 ought to be immediately cut, provided there should be any danger 

 to the child, and the labor still far from its termination; care should 

 be then taken to deliver the woman as early as possible, either by 

 the hand or with the forceps. When it" is not discovered until the 

 escape of the head, it is in general easily to be remedied: if the 

 turn be a very loose one, and the cord very long, the birth of the child 

 is most generally not at all obstructed by it, and nothing need be done; 

 in the contrary case, we must either disengage or cut the loop, so 

 that the respiration may not be long in becoming established.* 



§. V. AmeMrisiiaal ©ystocia. 



912. An aneurism within the splanchnic cavities, or even in one 

 of the great external arteries, is always a serious disease; but it is yet 

 rendered still more dangerous by the efforts of labor. The con- 

 tractions of the muscles and the repulsion of the blood consequent 

 thereto might readily occasion the rupture of a sanguine tumor, if 

 haste were not made in emptying the womb. In such cases, there- 

 fore, the patient should be advised to assist her pains as little as pos- 

 sible, and as soon as the orifice is sufficiently dilated or dilatable, 

 the child should be extracted either with the hand or the forceps. 



§. VI. Bystocia fi'osit Asthma, Myclrothorax, 

 Gibliosity, ©ropsy, &c. 



913. All diseases that render the respiration difficult, may make 

 it necessary for us not to trust the labor to the mere resources 

 of the organism. It is well known that asthmatic persons are soon 

 threatened with suffocation when under any state of violent exer- 

 tion; and that the same holds good of those who are laboring under 

 some effusion in the chest, or in whom the free expansion of the 

 chest is restrained by a deviation of the spine, &c. All wise prac- 

 titioners therefore have recommended that in these circumstances 



* Dr. Smith, who relates a case of inversion of the womb, produced by the 

 shortness of the cord, recommends, witli reason, that we should draw down a 

 portion of that which is connected with the placenta, and then slip the noose 

 over the shoulders, and not over the head of the child. 



