PARTURITION. 
devifed prove infufficient; and the patient dies, fome- 
times as early as the third or fourth, day ; at others, not 
until the fixth, eighth, tenth, or twelfth, day. Puerperal 
fever is by no means to beconfidered as folely theconfe- 
quence of tedious and difficult parturition ; it full as of¬ 
ten makes its attack after natural, eafy, and expeditious, 
labours ; on which account it was thought proper to de¬ 
lineate the hiftory and treatment of it here, rather than 
under the following head. 
Puerperal fever occurring in lying-in hofpitals, or 
where a great number of fick or wounded perfons are 
confined, at fome times, that is, under certain difpofi- 
tions and temperatures of the atmofphere, becomes in¬ 
fectious, almoft every perfon delivered in the ward where 
the fever rages partaking of it in a greater or lefs degree. 
At fuch times, a larger proportion than ufual of thofe 
who are delivered in their own houfes are fubjefted to it. 
When it has made its way into a lying-in ward, the 
women fhould be removed, and feparated, where it can 
be fafely done, and no more perfons admitted until the 
ward has been well ventilated and purified. It isrecom- 
mended, that the floors be fcoured, the walls and ceiling 
fcraped and lime-wafhed ; that the beds be taken down, 
and the bed-clothes, and the whole room, expofed to 
the vapour of burning fulphur, or fumigated with the 
vapour of the marine or nitiric acid. 
We are told by Strabo, that the men in the northern 
part of Spain, after the delivery of their wives, went to 
bed, and fuffered themfelves to be nurfed by them. This 
cuftom ftill exifts in fome of the provinces of France bor¬ 
dering on Spain, where it is called making a couvade. 
The fame thing is related by Diodorus Siculus of the 
Corficans, and by Apollonius Rhodius of the Tibarenes, 
a people inhabiting the coaft of the Pontus Euxinus, in 
Afia Minor. Marco Polo, fpeakingof a province which 
in the French tranflation is called Arcladam or Ardan- 
datn, fays that the women left their bed as foon after de¬ 
livery as poffible, and that the men then took their place, 
where they remained for forty days, and nurfed the new¬ 
born child. This cuftom is laid to be ufual alfo among 
the Japanefe. 
When the Carib women in Guiana are delivered, the 
men bind up their heads and place themfelves in bed, as 
iffeized with the pains of labour: they are then vifited 
by their neighbours, who confole them by all the means 
ufual among thefe people. This cuftom muft always be 
ftriftly obferved ; for, even when engaged in war, as foon 
as they hear of the delivery of their wives they muft re¬ 
turn home. We are told by Labat, that the father of the 
child, on this occafion, muft obferve a ftri 61 fall for thirty 
or forty days ; but he adds, that this ceremony is prac- 
tifed only in regard to the firft-born, otherwife, fays he, 
the poor hufbands, who have five or fix wives, would be 
obliged to keep more falls than the Capuchins. This ac¬ 
count is confirmed by Fermin in his defcription of Su¬ 
rinam, but he fays nothing of the ftrift falling which 
muft be obferved by the father of the child. Pifo, a Dutch 
phyfician, fays, that the women among the Brazilian fa- 
vages, when they find the pains of labour approaching, 
go out into the woods to cut with a fhell the umbilical 
cord of the child, which they boil and eat; and that the 
hufbands, in the mean time, go to bed, and ufe the belt 
food they can procure, under a pretence of repairing their 
loft ftrength. We are told the fame thing by captain 
Woods Rogers, who fays that the Brazilian women, at 
the time of their delivery, go out alone into the woods, 
and when delivered walh the child ; while the men place 
themfelves in bed for twenty-four hours, where they are 
attended in the fame manner as if really fufl’ering from 
the pains of labour. 
Such pains, we may fuppofe, are in that country not 
very fevere, or they could not thus be made a joke of, or 
endured by proxy. We may therefore conclude that 
fuch labours come very legitimately under the prefent 
head of Natural Parturition. But we mean to include 
alfo certain fpecies which are ufually configned to the 
675 
next grand divifion. We mean thofe protrafted labours 
which vary from the ftriftly natural chiefly in the time 
they take for their accomplifhment, but without requi¬ 
ring the ufe of inftruments; and of plural births, when 
they alfo are completed in the natural way. 
Protracted Labour may arife from various caufes; 
as, from weaknefs of the mother; from the l'mall fize of 
the pelvis, or the large fize of the child ; from the mem¬ 
branes breaking too early, and the waters beingdifcharged 
fuddenly, before the os uteri is properly dilated; which 
laft accident is fometimes occafioned by the unlkilfulnefs 
of the midwife. Thefe are cafes which Mr. Hogben calls 
“Difficult (but natural) Labour;” and Dr. Merriman 
Dyjloeia diutina, or lingering labour, i. e. “Labour in 
which the head prefents, as in Eutocia; which termi¬ 
nates without danger to the mother; which is efl'efted, 
principally, by the natural pains; but which occupies 
a fpace of time exceeding twenty-four hours.” Dr. 
Ereen does not denominate the labour tedious, till thirty 
hours have elapfed from its commencement: fome of 
Dr. Merriman’s cafes under this head extend from 60 to 
80 hours. 
1. Feeble or irregular uterine adliou will p rot raft labour. 
Any circumftance debilitating the conftitution, or the 
uterus only, will produce this condition of parts. Par¬ 
turition protrafted from this caufe ufually occupies a 
long time; during which, it is of the grenteft moment 
to fupport the powers of the fyftem, and luifoand the 
ftrength, by mild unirritating nutritious diet, and by 
kind and fympathizing conduft : no voluntary exertions, 
or forcible draining, ftiould be permitted : the room 
ought to be cool and well ventilated ; every encourage¬ 
ment to repofe fhould be given; and uterine aftion muft 
be increafed, by fteadily-employed friftion of the abdo¬ 
men and loins, with moderate prefffure on the uterine re¬ 
gion. A pint of tepid water, or gruel, with a handful of 
fait, as an enema, will fometimes increafe the uterine 
energies. Opium is a very efficient remedy for this 
caufe of protrafted labour. It ftiould be given, not in 
fuch a quantity as to paralize the uterine energy, but in 
a dofe of about twenty minims of the tinfture, or a grain 
of the gum, to procure fleep, and fufpend irregular or 
inert contraftions of the uterus, fo that, on their recur¬ 
rence, they ufually aft with redoubled energy. 
2. Plethora, as indicated by the calibre of the veffels,* 
or by the force or frequency of the circulation, will 
fometimes produce this feeble and partial aftion of the- 
uterus. The detraftion of a few ounces of blood will 
accelerate the progrefs of labour retarded by this caufe. 
3. An exceffive quantity of liquor amnii, by over-difter.d- 
ing the uterus, will enfeeble or paralyze its contraftile- 
power. Should this caufe be very obvious, the mem¬ 
branes may be punftured by a probe or quill, or 
fcratched with the finger-nail; but the neceftity for this 
very rarely occurs, and can fcarcely ever be necefiary 
until the membranes, diftended with fluid, have fully 
performed their office of dilating the os uteri and paffages 
to the os externum. 
4. Prematurely difeharging the liquor amnii cannot be 
too feduoufly avoided; for among the moft wearifome 
and trying cafes of protrafted labour, both to the ac~ 
coucher and patient, thofe which follow this occurrence 
muft be clafled; confequently a praftitioner fltould not 
raflily interfere in thefe cafes, or he may expeft his te¬ 
merity to be attended with augmented fuft'erings to his 
patient, inafmuch as the os uteri and vagina muft be 
flowly dilated by fome hard and irregular part of the 
child, inftead of the foft wedge formed by the membranes 
filled with their fecretion. When this circumftance oc¬ 
curs, from fome accidental caufe in the earlieft ilage of 
labour, the procefs is always protrafted, and the woman 
mull f’ubmit to an inceflant dribbling of the liquor amnii, 
without obtaining any relief from manual interference. 
Children under thefe circumftances are not unfrequently 
expelled dead. 
5. Rigidity of the os and cervix uteri gives rife to a very 
4 protrafted 
