MIDWIFERY. 
ficnlly of the labour at first will depend on sion being much more violent than any fit 
itself without any reference to the child, of epilepsy. The paroxysm is so violent, 
But after one child is horn, we can easily indeed, that a woman, who, when in health 
was by no means strong, has shaken the 
lay our hand upon the abdomen, and deter- 
mine the point ; not forgetting that where 
theie are more than one child, the placenta 
must never be brought down till the last 
child is delivered ; for if we use any force 
so as to detach a part of the placenta I'rom 
the utei iis we produce a flooding. If the ab- 
domen be examined before delivery, we 
shall feel the tumor reaching high up to the 
scrobiculus cordis ; if after delivery, we 
shall perceive a rounded tumor lying on one 
side above the pelvis like a foot-ball. It we 
examine the abdomen in a twin case, after 
one child is delivered, we shall not be 
able to say, fi om the diminished size of the 
tumor, that one child has come away. 
When we have ascertained that a second 
child remains in the ulerns, we should wait 
quietly, and without communicating the 
fact to the patient herself lest we alarm 
her, till by a recurrence of the pains we find 
the part that presents ; and if it be an arm 
or shoulder, we should tuck up the sleeve 
of our shirt, and pass up the hand greased 
into the uterus, without any preparation on 
the part of the woman ; it is here better 
avoided, and the child may be turned at 
once. The one child has already passed, 
therefore the contractions of the uterus and 
vagina will be a smaller impediment here, 
than in any other case. Before we thus 
act, however, it will be better to leave the 
patient to recruit herself awhile. If the 
practitioner be a young man, it is best to 
wait about four hours, before he does any 
thing towards the delivering the second 
child ; an experienced person probably need 
not wait so long. If we wait four hours, no 
barm can happen fr om hastening the deli- 
very ; we have w aited so long as to justify 
ourselves in the eyes of all the world. 
A tw in case is not quite so safe as a single 
birth; for the woirran will sometimes die with- 
out our being able to give the least reason 
for it. As there have been some fatal in- 
stances, vve should be upon our guard not to 
say there is no danger iir sitch a case ; we 
may say they are commonly not cases of 
danger, but should not, when asked, affirm 
that they are perfectly safe. 
Convulsions. Cases of puerperal convtrl- 
sion bear a strong analogy to epileptic fits : 
so much so, that it is nearly impossible to 
distinguish them at first sight, excepting 
from the different degree of violence at- 
tending each : the fit of puerperal convul- 
whole rooiir with her exertions. 
Puerperal convulsions may occasionally 
arise at any time between the sixth month 
and the completion of labour ; they seldom 
or never happen before the sixth month. 
They may arise as the first symptom of la- 
bour, in the course of labour, or after the 
labour is in other respects finished. Puer- 
peral convulsions have these characters be- 
longing to them ; they always occur in 
paroxysms, and those paroxysms occur pe- 
riodically like labour pains ; so that there 
is a considerable space, perhaps two hours, 
between the two first attacks ; after this, 
they become more frequent. They not 
only occur with the labour pains, but in the 
intervals ; and whether there liave been 
labour pains or not, before they come on 
we shall always find the os uteri dilated, 
and it is sure to become dilated from the 
continuance of these convulsions; and at 
length, if the woman be not relieved and 
the convulsions continue without killing 
her, the child is actually expelled, without 
any labour pain at all: On opening such 
cases after death, where the convulsions 
have been violent, the child has been found 
partly expelled from the contraction of the 
uterus; which power is capable of ex- 
pelling it even after death. In one case in 
which it happened, the whole child was ex- 
pelled except the head. 
It is a disease depending on the uterus, 
and brought on by the labour pains ; or if 
arising before them, is of itself capable of 
expelling the child, if the w'oman survive 
long enough. It occurs in all presentations : 
sometimes with the first child, and some- 
times with those born afterwards. It re- 
sembles hysteria, as well as epilepsy ; but is 
more violent than either. No force can 
restrain a woman when in these convul- 
sions, be the same woman naturally ever so 
weak. The distortion of the countenance 
again is beyond any thing that can be con- 
ceived : in regard to deformity, surpassing 
any thing the imagination of the most ex- 
travagant painter ever furnished ; nothing 
bears any resemblance to the progress of 
this disease ; the rapidity with which the 
eyes open and shut, the sudden twirlings of 
the mouth, are altogetlier frightful, dreadful, 
and inconceivable. 
These convulsions are by no means exter- 
nal only ; respiration is first affected with 
