12. Extreme rigidity of the os uteri is a cause of tedious and very painful labors. It sometimes happens that the os is dilatable, but the pains are not sufficiently expulsive. Perhaps at the same time the os is found far back towards the promontory of the sacrum, and the head appears not to be driven directly into the os so as to aid in its dilatation, but rather presses against the anterior wall of the cervix. In such a case the end of the finger can be hooked into the anterior lip of the os uteri so as to aid in the dilatation, and also to help correct the displacement of the os. In other cases we may help dilate the os by a firm and gentle sweep of the finger around the advancing part of the child’s head within the os. But we cannot always do this, because we may be afraid of rupturing the membranes prematurely. If the membranes have been already ruptured, we may act more boldly, but we must never make any great efforts to dilate it artificially lest we excite inflammation. In many cases it is best to give ¼ gr. of morphine, and inform the suffering woman that she cannot possibly get through her labor in a short time, but if you can give her an hours’ rest, the os, which is rigid, will be more relaxed and pains more effectual. 13. In first labors there is sometimes unusual rigidity of the soft parts, which are external. Where the perineum is rigid it may require several hours continuance of the pains before it is sufficiently stretched to allow the head of the child to pass. But the difficulty can hardly be relieved by our interposition. We should generally wait the due time, as we must also if the os coccygis is anchylosed with the sacrum. 14. The head of the child may be comparatively large when the pelvis is of the ordinary form and size. This may be a cause of delay though it may perhaps cause nothing more than prolonged, tedious labor. In such cases you have time to send for a doctor, even if he lives at a distance. After the woman has been a long time in labor he will think it best to apply the forceps. You will be importuned in cases of slow and tedious labor to administer ergot, but any one who knows the action of the drug would never give it in any of the following cases: 1. Where the os is not well dilated. 2. When any mechanical obstacle exists to the passage of the child, or when there is a tendency to convulsions, and _you_ should never give ergot except for hemorrhage; and when you have much reason to fear it, you may in such cases give one or two twenty drop doses of the fluid extract very near the termination of labor. Quinine may be given as an oxytocic with safety. Morphine is liable to render the pains weak for a time, but it often increases their efficiency. I will now enumerate your duties when you act as accoucheur.