CHAPTER VI.
SIXTH SPECIES OF DYSTOCIA.
Faulty Labour from a faulty Condition of the expelling Powers.
I. Where the uterine activity is at fault—functionally or mechanically—from debility—derangement of the digestive organs—mental affections—the age and temperament of the patient—plethora—rheumatism of the uterus—inflammation of the uterus—stricture of the uterus.—Treatment. II. Where the action of the abdominal and other muscles is at fault.—Faulty state of the expelling powers after the birth of the child.—Hæmorrhage.—Treatment.
Although this species includes that condition of the expelling powers, where their action is excessive, we shall defer this portion of the subject until we treat of precipitate labour, with which it is essentially connected.
The agency by which the child is expelled during labour is of two kinds: 1st, involuntary action of the uterus, assisted, secondly, by the partly voluntary and partly involuntary action of the abdominal muscles.
On the approach of labour, the uterus, which hitherto had been merely performing the office of a receptacle and a means of conveying nourishment to the fœtus, now assumes a totally different character; from being in a nearly passive state, it assumes an entirely opposite condition, viz. of high irritability and powerful action. We might almost suppose that its connexion with the nervous system was become more close and intimate; for it is now sensible to the influence of impressions which had before produced no effect upon it. Thus, we see, that affections of the mind, even but of moderate intensity, and to which it was, before labour, nearly, if not quite, insensible, are now capable either of rousing its efforts to the utmost violence, or of arresting them in the midst of full activity; and, on the other hand, we see that where its action has been deranged or interrupted, it gives rise to serious affections of the nervous system, or even convulsions.
With all this, it now displays peculiarities of function, which strikingly distinguish it from all other organs of the body; in some cases it appears to annihilate or to absorb, by its all-pervading influence, the functional energies of other organs; and, in spite of its increased nervous power and susceptibility to various impressions, it seems to possess the faculty of continuing its efforts uninfluenced by general disease, unimpaired by exhaustion, and, for a time, almost independent of the life itself of the mother. In convulsions and paralysis, in general fever and inflammation of vital organs, its powers appear to be undiminished: on the contrary, where the patient, from whatever cause, is rendered incapable of assisting its efforts by the abdominal muscles, the uterus will take upon itself the whole task of expelling the child, which will be born apparently without a single effort upon the part of the mother.