MIDWIFERY. 
gan, one after the other. All the caution 
that need be given, is to take care not to 
injure the woman in doing what we are 
about, neither in separating the parts, nor 
in bringing them away. 
On facilitating Labour by turning the 
Child. It will sometimes happen that in 
spite of a slight deformity of the pelvis, we 
have a chance of saving the lives of both the 
mother and the child. And there are two 
modes of attempting to do this ; the first is 
by turning the child, which will also apply 
to other cases, as well as deformity of the 
pelvis ; the second, by bringing on prema- 
ture labour. Turning is not the best of the 
two resources ; but many women will sub- 
mit to this, who will not submit to the pro- 
posal of bringing on premature labour. 
After turning a child, we may pull it 
through by the feet, while we never should 
have been able to have delivered it without, 
for the uterus would not have been able to 
push it through, in the common way of pre- 
senting with the head to the os uteri ; and 
if we prove able to save the child’s life it is a 
grand point. If after we have brought the 
feet down, the head will not pass, even then 
we are only where we were at first, and 
can open it. 
On bringing on Premature Labour. The 
operation that is certainly the best method 
of managing delivery in deformities which 
admit of it, is premature labour, which is 
founded upon these positions ; that during 
pregnancy, the head of the child is increas- 
ing in size, to, the time of delivery; so that 
if we take them in their gradual increase of 
■size, it is pretty plain that one in the early 
months of pregnacy would pass with ease 
through a pelvis that would not receive it 
at a later period ; and in this way, by con- 
sidering the case in all its parts, comparing 
the diameter of the pelvis with the size of 
the head at diiferent periods of the preg- 
nancy, we shall be able to calculate the 
time when we may bring on premature 
labour, fixing either the seventh month, 
seventh and half, or eighth month, but never 
later ; for if we do, the head will be too 
much ossified to submit to the pressure it 
must sustain, with that ease which is neces- 
sary to the delivery being perfectly safe. It 
may, indeed, be brought away as early as 
five or six months, but the child then can- 
not be expected to live ; and if it be pro- 
duced later than eight months and a half the 
labour will be as difficult as that at nine 
months. 
The first step towards bringing on prem a- 
ture labour, is to carry up a male catheter 
through the vagina to the os uteri, and to 
introduce it witli care, in such a manner as 
that the point of the catheter shall be in 
contact with the sides of the uterus, using a 
gentle pressure only. When the extremity 
of the catheter is against the membranes, 
but clear of the child, the instrument is to 
be thrust forward so as to break the mem- 
branes ; and in this the catheter is prefer- 
able to a rod of silver, since as soon as the 
catheter enters we know the object for 
which we introduce it is gained ; for while 
the instrument is still in our hand, we shall 
feel the waters passing off more or less ; 
while if a solid rod be employed it may be 
necessary to introduce it a second time. In 
puncturing or breaking the membranes, it is 
also preferable to get, the instrument some 
way up the side of the uterus, instead of 
breaking them immediately upon the os 
uteri, because in the latter way, the child is 
most frequently born dead ; which depends 
on the different effect with regard to the 
flowing off of the waters, produced by the 
mode of puncturing or breaking the mem- 
branes. 
The breaking the membranes at the side, 
only allows a partial escape of the waters, 
quite sufficient to produce a disposition to 
contract in the uterus, without permitting 
any injurious effect to arise from pressure ; 
while on the other hand, when they are 
broken in the front, the whole of the waters 
flow away, the uterus contracts very strongly 
round the child, and the circulation gene- 
rally suffers, and is either partially or com- 
pletely interrupted. Delivery, by bringing 
on the action of the uterus prematurely, is 
for many reasons very estimable : a month 
or two before delivery naturally produced, 
the head is not only smaller, but more com- 
pressible; there is a less proportion of bone; 
so that if we take two heads of the same ab- 
solute size, one being of eight months forma- 
tion, and the other seven, still that at seven 
would have the advantage in passing through 
a narrow pelvis. It is difficult for any one 
to determine the time which should apply 
to different pelves ; but where the dis- 
tance between the pubes and sacrum is 
under three, yet all but three inches, eight 
months may be allowed ; where the dis- 
tance is two and three quarters, seven 
months, and so on. Yet when a child is 
born at seven months it will rarely suck, 
and requires the utmost attention to be 
reared. By these means, then, we may be 
able to save two lives ; by the Caesarean 
