ASTHMA, HERNIA. 401 



the efforts of the woman should be controlled, and that she should 

 be artificially delivered as soon as the stale of the parts admits of 

 the child's feet being brought down sufely. 



914. The same precept has been given where the labor is com- 

 plicated by the presence of some large tumor in the abdomen, or 

 Avith a dropsy in that cavity; and that, because here, as in the, pre- 

 ceding cases, the efforts of the womb might give rise to a fear of 

 asphyxia, or at least might be followed by a dangerous collapse. 



915. However, I ought to remark that many dropsical women go 

 through their labors almost as easily as those who are in the enjoy- 

 ment of perfect health. I saw at the hospital de Perfectionnement, 

 in 1824, a woman laboring under ascites who had been tapped 

 thirty-six times, and who was, notwithstanding, delivered very natu- 

 rally after a labor of a few hours duration. Another one came 

 to the same establishment in 1826, who had been dropsical for four 

 years, and whose labor lasted only two hours, although her abdo- 

 men was enormously large, and although from ten to fifteen litres 

 of fluid had been several times drawn off from the belly by tapping. 



Nevertheless, as the abdominal muscles are generally very much 

 weakened, and separated, in ascites, by a thick stratum of fluid, their 

 mediate action can be possessed of but little energy in the expulsive 

 part of labor. 



§. VH. Merraial ©ystocia. 



916. When the hernia, of whatever species it may be, is reducible, 

 it should be returned to its proper situation before the pains become 

 very strong, and then during each contraction its escape is to be 

 prevented by holding the tluimb, a compress, or the hand, upon the 

 opening through which it passes outwards. This manoeuvre is to 

 be attended to by the accoucheur, or at least by an assistant fit 

 to be trusted, and not by the woman herself. When it is an old 

 and irreducible one, we must be content to support it exactly, 

 so as to prevent it from becoming strangulated, or receiving an ad- 

 dition of new portions of viscera to those already contained within 

 the tumor. Beyond this, the labor requires no particular assis- 

 tance, and we should confine ourselves merely to moderate the dis- 

 position of the woman to improve her pains by bearing down; never- 

 theless, should the violence of the efforts be such that nothing could 

 prevent the descent, or if there should be strangulation and tlie 

 labor far advanced, the child should be extracted with all suitable 

 precautions as soon as the dilatation of the os uteri admits of it. 



§. vni. Dystocia from Syncope. 



35* 



