MIDWIFERY. 



245 



Mate. 



Of the ger both to the mother and child. These have been 

 Prejrnant divided into two classes ; those arising from the im- 

 plantation of the placenta over the os uteri, and those 

 m which the placenta is attached higher up. This di- 

 vision is highly proper in one respect, but is neither 

 safe nor useful if it is to give rise to a rule of practice 

 peculiar to each kind. The only safe rule is a general 

 one, that no pitient, in flooding, can be with impunity 

 allowed to remain undelivered, after the state of the 

 s uteri will permit of delivery: 



The first attack ol hemorrhage is in general sudden 

 and severe, but it soon u suspended, or at least mo- 

 derated. It often takes place during the night, and is 

 usually unattended with pain. The effects -produced 

 by the first attack will depend on the strength and ha- 

 bit of the patient, and the severity of the hemorrhage. 

 By a recurrence of the discharge, the strength however 

 in every instance i* greatly reduced, the patient be- 



State. 



comes pale, and the pulse feeble. At the same time, Of the 

 slight but inefficient pains are excited. The os uteri J 

 becomes soft and dilatable, perhaps partially dilated, 

 and hopes are entertained that labour shall come on and 

 safely relieve the patient. Such hopes are never enter- 

 tained by any man who understands the nature of the 

 case, for although one or two patients may thus escape 

 out of many hundreds, the rest die undelivered. 



The plain and obvious practice to be followed is, to 

 restrain the discharge by stuffing the vagina until the 

 os uteri becomes dilatable, and then deliver the patient 

 by turning the child. We thus do not interfere so early 

 as to produce injurious irritation by harshly opening 

 the os uteri, nor do we, on the other hand, permit the 

 strength to be sunk to a hazardous degree. The con- 

 comitant treatment must proceed on general prin- 

 ciples. 



PART II. OF PARTURITION". 



CHAP. I. 



Of the Clainjicallon of Labourt. 



Of Farturl- Labour may be defined to be the expulsive efforts 

 "o"- made by the uterui lor the birth of the cnild, after it 

 onbeciu- **** "l u ' re<1 . * uch " degree of maturity as to give it a 

 fitaiion of chance ol living independently of its uterine appen- 

 Uboun. dages. 



Labours may be divided into seven classes. 

 CLASS I. Natural labour ; which may be defined to 

 be labour taking place at the end of the ninth month 

 of pregnancy ; tlie child pre*enting the central portion 

 e sagittal suture, and the forehead being directed 

 t first toward the tacro-iliac symphysis ; a due pro- 

 portion existing between the size of the head and the 

 capacity of the pelvis ; the pains being regular and ef- 

 fective ; the process not continuing beyond 24 hours, 

 seldom above 1 2, and very often not for six ; no mor- 

 bid affection supervening capable of preventing deli- 

 very, or endangering the life of the woman. 

 '1 In- comprehends only one order. 

 CLASS II. Premature labour ; or labour taking place 

 considerably before the completion of the usual period 

 of utero-gctation, but yet not m early as necessarily to 

 prevent the child from surviving. 

 This comprehends only one order. 

 CLASS III. Preternatural labour*; or those in which 

 the presentation or position of the child, it different 

 from that which occurs in natural labour, or in which 

 the uterus contains a plurality of children, or monsters. 

 This comprehends seven orders. 

 Order 1. Prmriitatiun of the breech. 

 Order '2.. Presentation of the inferior extremities. 

 Order S. I'ri -cnution of the superior extremities. 

 Order 4. Presentation of the back, belly, or side* of 

 the child. 



ler 5 Mai-position of the head, 

 Order b. Presentation of the funis. 

 Order 7- Plurality of children, or monsters, 

 i \ IV. Tedious labour, or labour protracted be- 

 yond the usual duration , the delay not caused by thr 

 i of thr child, and the process capable of 

 1 safely, without the use of extracting in- 



Tbi* comprehends two orders. 



1. W nrre the delay proceeds from some ira- 

 i or irregularity of muscular action. 



Order 2. Where it is dependant principally on some OfPartnri- 

 mechanical impediment, . ''""^ 



CLASS V. Laborious or instrumental labour ; labour """Y" 1 

 which cannot be completed without the use of extract- 

 ing instruments, or altering the proportion betwixt the 

 size of the child and the capacity of die pelvis. 



This comprehends two orders. 



( >nler 1. The case admitting the use of such instru- 

 ments as do not necessarily destroy the child 



Order 2. The obstacle to delivery being so great, as 

 to require that the life of the child should be sacrificed 

 for the safety of the mother. 



CLASS VI. Impracticable labour; labour in which 

 the child, even when reduced in size, cannot pus 

 through the pelvis. 



This comprehends only one order. 



CLASS VII. Complicated labour; labour attended 

 with some dangerous or troublesome accident or dis- 

 ease, connected in particular instances with the process 

 of parturition. 



This comprehends six orders. 



Order 1. Labour complicated with uterine hemor- 

 rhage. 



Order 2. Labour complicated with hemorrhage from 

 other organs. 



Order 3. Labour complicsted with syncope. 

 r 4. Labour complicated with convulsions. 



Order 5. Labour complicated with rupture of the 

 uterus. 



( >nlcr 6. Labour complicated with suppression of 

 urine, or rupture of the bladder. 



CHAP. II. 

 Of Natural Labour. 



The intention ot Ubour is to expel the child and se- Of natural 

 rundines. For this purpose, the first thing to be done 'bour. 

 by the process, is to dilate, to a sufficient degree, the os 

 uteri, so that the child may pass through it. The next 

 point to be gained ii the rxpiil-mn of the child it-*- 1 1', 

 Mid list of all the foetal appendage* are to be thrown 

 off*. The process may therefore be divided into three 

 stages. The first stage is generally the most tedious. 

 It is attended nith frequent but usually short pains, 

 which are described a* being sharp, and sometimes so 

 severe a* to be called cutting nr grinding. Tlie\ c. in- 

 monly begin in the back, and extend toward the pubis 



