The death of the infant also seems sometimes to check uterine contraction, though probably not from the mere circumstance of its being dead, but because the womb suffers from the same morbid cause which produced its death.
Any strong moral impression may also produce the same state of things. Thus in some females the womb will instantly cease its contractions, and the labor be arrested, from fright, or from strong repugnance to somebody, or something, in the room. Instances have been known of women being so alarmed on first seeing the accoucheur, or so displeased because he was not the one they wished, that the uterine efforts immediately ceased, and could not be again brought on for a long time. The presence of some person who is a subject of dislike may also have a very prejudicial effect, and if this is known they should be immediately removed. Dr. Merriman tells us of a female who was seized with a fit, from which she died, simply from seeing a strange doctor enter the room.
Whatever may be the cause which paralyzes the action of the womb we should endeavor, if possible, to discover and remove it. If however it be beyond our reach, the patient's strength must be supported as much as possible, and the simplest means of exciting the contractions tried first; if these fail the more powerful ones must be tried, always preferring the safest. Finally, if all fail, the hand must be introduced into the womb, the child turned, and brought away by the feet; or the forceps must be used if absolutely necessary.
RIGIDITY OF THE MOUTH OF THE WOMB, VAGINA AND VULVA.
Sometimes the mouth of the womb or other soft parts, will not give way, but remain obstinately rigid, so as to render the continued expulsive efforts of the womb of no avail. If this state continues too long the parts become swollen, hot, and dry, and extremely painful, so that the slightest touch causes acute suffering. The abdomen also becomes exquisitely tender, fever sets in, with cold sweats, the head begins to wander, the features express great anxiety and suffering, and the voice alters so that it can scarcely be recognized. These symptoms will sometimes be established, and become rapidly worse in a remarkably short time, so that the patient will appear to pass suddenly from a condition of comparative ease and safety to one of extreme peril and suffering. The child also suffers in an equal degree, the continued pressure upon its head having a most injurious effect. The bones overlap to a great distance, the scalp is engorged with fluid, and all its blood-vessels are ready to burst; the brain is severely compressed; the circulation in it is suspended, and apoplexy frequently ensues. Even when one of these protracted cases eventually terminates without immediate mischief, there is much subsequent evil to be feared. The bruised parts frequently slough away, so that fistulas are formed, and the whole remain so permanently weak that they can never afterwards retain their places.
The most usual resort in these cases of obstinate rigidity is blood-letting. This frequently induces relaxation immediately, and also checks the tendency to inflammation and fever. In many cases however, if not in all, it may be dispensed with, and should always be so if possible. Very frequently it produces as much evil as good, by alarming the patient, and by creating a debility which cannot afterwards be removed. Simple warm fomentations will often make the rigid parts give way; and so will lubricating them with soothing ointment, or better still anointing them with the Extract of Belladonna. This frequently acts like a charm, and opens the rigid os tincæ in a few minutes. Injections of thin starch and laudanum are also excellent, and may be advantageously administered before applying the Belladonna. The Galvanic Battery may also be employed, it having induced relaxation in many cases, when all other means failed; as will be seen by the cases quoted in "Practical Facts."
If the labor really does progress though slowly, it is generally best to have patience and let it take its course. If however the patient is likely to sink before it is completed, or if it is at a stand still, and cannot be accelerated, artificial delivery may be necessary. It is seldom however that all of the above mentioned means fail.
OBLIQUITIES OF THE WOMB.
Sometimes the womb is so much inclined in a particular direction that its mouth does not present to the middle of the passage. Thus it may lean over so much to the right side that the mouth may open against the left wall of the Pelvis; or it may lean to the left side, or to the front. In all these cases the expulsion of the child may be totally prevented, because it is forced against the walls of the passage instead of down its axis.
Obliquity is sometimes righted spontaneously, but more frequently it requires the interference of art. The mode of rendering assistance is to support the womb on the side to which it falls, particularly during the pains, so that its mouth may be directed towards the middle of the passage.