MIDWIFERY* 
■will have a firm elastic feel; the cuticle 
and hair will not come away on the linger : 
besides which, there will generally be a pul- 
sation at the fontanelle. But the navel- 
string being 'pressed may cause death ; it 
may arise, and does often arise, without any 
cause that we are able to trace. We know 
that a child may die in utero from affections 
of the mind in the woman. The death of 
the child may be known by shivering fits 
preceded by a sense of coldness in the ab- 
domen. While the child is alive, it assists 
in supporting its own heat ; but when dead, 
it necessarily must oBtain a degree of heat 
by robbing the mother of part of the heat 
in the parts around, which explains the 
sense of coldness that is felt. The breasts, 
while the child is alive, increase and conti- 
nue firm and well supported; but when the 
child dies, they immediately become flac- 
cid and empty. So that a woman, fre- 
quently used to miscarriage, will foretel its 
approach by this alone. While the child is 
alive, it gives the sensation of a living 
weight, a weight which is capable of adapt- 
ing itself to the different positions of the 
mother ; but when death deprives it of this 
power, the woman feels it flap from side to 
side, according to the way in which she 
moves. She becomes sensible of weight to 
a much greater degree than before. Be- 
sides all which, there will be the cessation 
of motion in the ftetus, which is always per- 
ceived by the mother some months before 
delivery. These are so many signs of the 
child’s death, which may be observed be- 
fore labour comes on. 
There are others which accompany la- 
bour: first, as the child is dead, the mem- 
branes will be dead also ; and for that rea- 
son will break earlier than they otherwise 
would. It has been said, that the liquhr 
amnii being turbid, points out the child be- 
ing dead ; but this circumstance sometimes 
arises while the child is alive and well. The 
strongest sign is one by which we may tell 
it before even we see the woman ; it is by 
the waters being corrupted. The smell of 
putrefaction will sometimes decide the opi- 
nion of an experienced practitioner the in- 
stant he enters the door; also in examina- 
tion, from the meconium coming away on 
the hand, in consequence of the sphincter 
muscle being putrid and relaxed. The su- 
tures of the head vacillate like bones in a 
bag. Wlien we examine, the hair and cu- 
ticle will come away upon the finger. 
When all, or even the greater part, of 
these signs are united, there can be no pos- 
sible doubt that the child is no longer 
alive. 
In what cases the Child’s Head should be 
opened. These cases are syncope, convuV 
sions, haemorrhage, on the part of the mo- 
ther; hydrocephalus internus on the part 
of the child. Tin's last disease may be as- 
certained by examination, the sutures and 
fontanelles being at a greater distance than 
they should be, and tire whole cranium very 
imperfectly ossified ; but the most unequi- 
vocal evidence is the head’s not entering the 
pelvis; by which we know that the head is 
too big for the pelvis, or that the pelvis is 
not large enough to receive tlie head into 
it, which is the same thing in effect. 
When all the stages of labour are gone 
through, and the head is not advanced, we 
are led to examine and find out what the 
state of the child is. When we have ascer- 
tained the existence of a deformity of pel- 
vis, we may generally tell the space left for 
the child’s passage, by passing the finger 
from before backward ; that is, from the va- 
gina; the space under the arch of the 
pubes, backwards and rather upwards, to- 
wards the projecting front of tlie sacrum, 
where the first lumbar vertebra rests on it. 
Now in a well formed pelvis this cannot be 
done ; it is not possible to reach the sacrum 
in this way ; but in a deformed pelvis we 
may ascertain the space pretty accurately: 
when the distance between the projecting 
part of the sacrum and the symphysis pubis 
is upwards of two inches, the delivery is 
very simple ; it would be well if it were 
less so, as then it would not be so fre- 
quently adopted as at present. Many a 
practitioner has sacrificed a child’s life at 
the shrine of his own ignorance. It is much 
easier to apply the perforator and open the 
head of the child, than it is to apply the for- 
ceps ; in the latter some considerable skill 
is required, in the former none. 
In what manner the Head is to be opened. 
The necessity for this operation being mani- 
fest, we must proceed as follows. First emp- 
ty the bladder, then throw up an injection, 
that the rectum also may be also cleared ; 
next, introduce the hand into the vagina 
up to the os uteri, upon which we are 
to pass the perforator, guarding the point 
with the utmost care, while passing it, by 
means of the other hand purposely intro- 
duced before the instrament. The points 
of this instrument are guarded by stops, by 
which when we push the points through the 
child’s head, we avoid the danger of tlieir 
passing too far, and by coming through the 
H h it 
