500 OBSTETRIC OPERATIONS. 



BOOK HI. 



OBSTETRIC OPERATIONS. 



In the various malpresentations and malpositions, as well as for the 

 other causes of dystokia already enumerated, the indications for adjust- 

 ment and extraction were alluded to and described at sufficient length, 

 and the means to be adopted for carrying them out were likewise men- 

 tioned. It was shown that, in many cases, it is sufficient to correct the 

 abnormal presentation or position, and rectify the deviation of limbs, 

 neck, or head, to effect delivery in the ordinary manner by means of the 

 hand alone. For, as has been well said, the practised hand is the best 

 and most perfect of all instruments, and it can effect in obstetrical 

 operations what no instrument is competent to achieve. Therefore it is 

 that an operator with a long and powerful arm, and a small hand, with 

 strong fingers, possesses many advantages as an obstetrist, and is in a 

 better position to afford relief than one with a short arm and large hand 

 — especially in the correction of those deviations which are so frequent, 

 and oftentimes so baffling. 



Extraction by the hand alone ma}^ be effected in many cases of diffi- 

 cult parturition, when these rectifications have been made ; though even 

 then it is essential that the os uteri be fully dilated, the vagina and vulva 

 dilatable, and sufficiently prepared to allow the young creature to pass 

 through ; it is likewise necessary that such a relationship in proportions, 

 between the volume of the foetus and the capacity of the pelvis, should 

 exist, that extraction can be accomplished without much difficulty. 

 Finally, it is particularly desirable that the uterus retain its contractile 

 power, and that its regular contractions second the efforts of the 

 operator. 



In only too many cases of dystokia, however, one or more of these 

 conditions are absent, and the unaided hand — no matter whether it be 

 ever so well endowed and practised — fails to effect delivery : so that, in 

 order to overcome the difficulties, recourse must be had to various surgi- 

 cal instruments and appliances, and there must be practised, either on the 

 mother or fcetus, more or less complicated and serious operations, which 

 demand strength, expertness, and an accurate knowledge of anatomy and 

 physiology and ev^en of mechanics, in addition to a thorough acquaint- 

 ance with surgical pathology. Some of the obstetrical operations have 

 already received attention from us ; l^ut it is necessary to study them as 

 a whole, in order to master their special features, and particularly the 

 manner in which they are performed ; as upon the exactness of our knowl- 

 edge with regard to them, will generally depend their successful results. 



These operations have for their object either to supplement the forces 

 of nature, which are insufficient to secure the birth of the young crea- 

 ture ; to diminish the size of the latter when it is either too large, too 

 deformed, or too deviated or distorted, to pass through the maternal pas- 

 sages ; to enlarge the latter, or to extract the foetus by an artificial pas- 

 sage, when these last do not admit of extraction. This leads to a con- 

 sideration (i) of the Mechanical means of extraction of the foetus ; (2) 

 Etnbryotomy^ or extraction by mutilation of the foetus ; (3) Vaginal hyster- 

 otomy ; (4) Gastro-hysterotomy or the Ccrsarean Section ; (5) Symphysiot- 



