411 



bability, the foetus refuses to admit the blood sent to it by the umbilical 

 vein. The placenta becomes affected with congestion; the stagnation of 

 the fluids extends, gradually, to the uterus, and to the neighbouring 

 parts. Stimulated by their presence, these organs are called into ac- 

 tion, the woman feels wandering, irregular pains, similar to cholic 

 pains, which become more acute, are attended with a feeling of con- 

 striction, and act from above downwards, that is, from the fundus to 

 the cervix of the uterus. This contractile cavity, assisted by the dia- 

 phragm and abdominal muscles, then acts with redoubled effort to expel 

 its contents. The pains become more acute and frequent ; the face red, 

 the pulse full and frequent, the whole body seems to partake in the affec- 

 tion of the uterus, and is agitated with convulsive motions. The mem- 

 branes, filled with the waters, force themselves like a wedge, through the 

 mouth of the uterus, whose edges are much weakened ; the throes of la- 

 bour increase in strength and number, the membranes rupture, the liquor 

 amnii escapes, the head of the child follows, and it soon clears the mouth 

 of the uterus with most excruciating pains. 



These pains are particularly severe, when the sacrum not being suffi- 

 ciently concave, the nerves of the sacral plexus are violently compressed 

 by the head of the foetus; this part of the body, almost always, presents 

 first; it passes through the upper outlet of the pelvis, in an oblique di- 

 rection, the occiput being turned forward, and corresponding to one 

 of the acetabula, while the face is directed backward towards one of 

 the sacro-iliac junctions. It passes thus along the greatest diameter of the 

 pelvis, but in descending lower down in the pelvis, it describes a portion 

 of a circle, and passes through the lower outlet of the pelvis, at its 

 greatest diameter, which is from the fore to the back part. The head 

 descends through the vagina, appears outwardly, soon disengages it- 

 self, and is followed by the shoulders and the rest of the body. Thus 

 it is, that Nature, after having produced fecundation by an act attend- 

 ed with pleasure, expels the product of conception in the midst of 

 pain. 



CCXVII. The passages, along which the foetus is carried out of the 

 body, would be too confined, in their ordinary state, to allow expulsion 

 to take place without laceration, if, as I am going to explain, Nature 

 had not disposed every thing to facilitate labour. In fact Nature has 

 not only formed the foetal skull of several flexible pieces, separated by 

 membranous unossified spaces, so as to allow the bones to move one 

 another, and the whole head to be reduced in size in passing through 

 the female pelvis; but she has, besides, united the bones of the pel- 

 vis, in such a manner, that their articulations become evidently relax- 

 ed towards the end of pregnancy. During the progress of pregnancy, 

 the fluids of the mother flow, in every direction, towards the pelvis 

 and the parts which it contains ; the ligamento-cartilaginous articula- 

 tions of the pubis, of the sacrum and coccyx, soaked in fluids, unite, 

 with less firmness, the bones between which they are placed. Hence, 

 being softened and swollen, they do not force them assunder, like a 

 wedge, by increasing their diameters, but facilitate the separation of 

 the bones, by the passage of the head through the pelvis. Ic is on 

 the relaxation of the articulations of the pelvis, that the indication for 

 the operation of dividing the symphysis pubis rests ; an operation said 

 to have been performed successfully by Sigault and by Professor Alphonse 

 Leroy. 



