MIDWIFERY. 



Of Plrturi * Order Second. 



t 



"* ~Y~**' The necessity for mutilating er destroying the child, 

 can only arise from a mechanical cause, and almost 

 uniformly from great contraction of the pelvis. \\ hen 

 this is occasioned by tumours, these may frequently b 

 extirpated ; but when it proceeds from an alteration in 

 the figure of the bones, the perforator ought to be em- 

 ployed as soon as it is ascertained that a living child 

 cannot past, and afterwards, if necessary, the crotchet is 

 to be applied. Where great deformity is known to ex- 

 ist sufficiently early, the practice of inducing prema- 

 ture labour ought in preference to be adopted. A liv- 

 ing child, at the full time, cannot pass, if the conjugate 

 diameter of the pelvis be only three inches. 



CHAP. VII. 

 Of Impracticable Labour. 



Of imprae- Some hare rashly asserted, that in every case deli. 

 very might be accomplished by breaking down the 



child, but it is more sober minded to place very little 

 iriknc* on this opinion. There can only be two mode* 

 of effecting the delivery of a child, the first through the 

 pelvis, the second, by making an incision into the ute- 

 rus, in those case* where the first mode is impractica- 

 ble. This, which is known under the name of the Ce- 

 sarean operation, it one of much simplicity, and very 

 easily performed, but one of the utmost danger, not to 

 the child, but to the mother. This danger arises from 

 two source*, exhaustion produced by irritation or inju- 

 . i the exposure of the abdominal cavity ; 

 i :_* -- ..: w hich is the most firi|nt 



Of compli- 

 cated !- 





of the two. There is at present only one instance where 

 the mother has survived in Britain, 



ful 



but many 

 the Continent, in come* 



have occurred on 



of the operation being there performed earlier, 

 er more favourable circumstance*. In the la* 

 which is published, Dr. Locker, at Zurich, sa- 

 ved both mother and child. In Britain, the delivery 

 of the woman would have been performed with the 

 crotchet, as the life of the child is never put in competi- 

 tion with that of the mother, which is so greatly ha- 

 zarded by the 



CHAP. VIII. 

 Of Complicattd Labour. 



Order First. 



When labour is complicated with uterine hemor- 

 , no time ought to be lost in delivering the 

 if the discharge be considerable. This is to be 

 effected, either by turning or bv using the foreceps, 

 according to the stage. No reliance can be placed 

 in any serious case on the practice of rupturing the 



Order Second. 



n hemorrhage takes place from the vessels of the 

 stomach or bowels, but particularly of the lungs, it is 

 evident that a prolongation of labour cannot tiul to be 

 Delivery ought to be accelerated, and in. 

 dom be trusted to the natural efforts. '1 he 

 and other ordinary means of cure must also be 

 1 to. 



Order Third. 



If the paroxysm be repeated or severe, we must de- 

 liver and employ cordials. It is also indispensiblc that 

 the abdomen be properly compressed after the expul- 

 sion of the child. 



Order Fourth. 



The most frequent kind of puerperal convulsions i 

 the epileptic, if we retain the nosological definition of 

 Cullen, who includes under epilepsia the eclamp 

 acute clonk spasm of Sauvages, one s-jiecics of which if 

 the eclanifiiia fiarlurieiiliuui. They are generally pre- 

 ceded by headach and other symptoms of determina- 

 tion to the head, and are usually very severe and fre- 

 quently repeated. Indeed, in many cases, they recur 

 with the regularity of labour pain-. Sometimes thcrv 

 i* only one paroxysm, and the jwtient, without any in- 

 terference whatever, goes on safely, but this result can 

 never be depended on, and it is to be feared that th* 

 more probable termination would be fatal apoplexy, or 

 a destruction of the vital principle during the sever* 

 convulsions which are excited. Two causes contri- 

 inatcrially to the production of this disease ; the 

 first is an undue determination of blood to the head, ei- 

 ther by predisposition or by a peculiar state of the ner- 

 vous system, excited by the condition of the uterus. 

 The second is a costive and loaded state of the bowels, 

 which operates powerfully on the brain. From this 

 view it is easy to see, not only in what the prophylaxis, 

 but also the treatment should consist The lancet is to 

 be powerfully and freely employed, the bowels are to 

 be opened by a smart clyster, and if these means, parti- 

 cularly the former, earned as far as prudence dictates, 

 do not put a stop to the disease, delivery must be arti- 

 ficially accomplished. 



Order Fifth. 



Rupture of the uterus, during labour, may undoubt- 

 edly take place suddenly and unexpectedly, but in most 

 instances it is owing to mismanagement, particularly- to 

 delaying too long the use of the forceps, or allow'ing 

 the child to remain in an unfavourable position without 

 rectifying it, or to violent and injudicious attempts to 

 turn tlic child when the uterus is acting strongly. The 

 child usually escapes through the laceration into the ca- 

 vity of the belly, the labour pains cease, great restless- 

 neat and sickness, vomiting, with rapid diminution of 

 strength succeed, and generally within a few hours the 

 sufferer is carried off. Peritoneal inflammation often 

 comes on most rapidly, but it is possible tor death to be 

 caused by mere exhaustion and sinking from abdomi- 

 nal irritation. 



The best practice, generally speaking, is to introduce 

 the hand through tiie laceration, and bring away the 

 child by the natural passage. 



Order Sixth. 



The danger arising from suppression of urine is too 

 obvious to require any reasoning to enforce the neces- 

 sity of attention to this point in every case of tedious la- 

 bour. When the catheter cannot be introduced, or re- 

 lief obtained by cautiously raising up the head of the 

 child, this .n calls for the cautious applica- 



tion of the forceps, at a period earlier perhaps than we 

 would otherwise be led from the state of the pains and 

 other circumstances to recommend. 



