MIDWIFERY. 
There is no difficulty if we once get our 
hand up through the os uteri, that being 
dilated sufficiently, without the membranes 
being broken. But suppose another labour, 
where the membranes are broken without 
the os uteri being dilated. We have here 
much more to do, and less chance for doing 
it well than we had in the other example ; 
we must go on, and have to turn the child 
too, under the increased difficulty of the 
contraction of the uterus, which will not, 
indeed, be violent, but quite enough to 
render the turning difficult. But if we be 
able to manage the most easy case, and the 
most difficult, we shall be equal to all the 
subordinate or intermediate degrees of dif- 
ficulty that may be met with in turning. 
To give an example of the greastest de- 
gree of difficulty, suppose a case where the 
waters have been lost twenty-four hours, 
two days, or even three. What we have to 
do in overcoming the contraction of the 
uterus, is not altogether a matter of diffi- 
culty as to skill, so much as it is as to time 
and management. With a view to lessen 
the difficulty, opium has been given ; but 
great caution is required in its exhibition ; 
since a woman has been known to die from 
the use of opiates ; she has been drained to 
death by uterine liEemorrhages. 
The last circumstance necessary to no- 
tice with regard to preternatural labour is, 
that all the other parts being brought down, 
the head sometimes cannot be got through 
well. We may here use a moderate force, 
by pulling with the body, remembering that 
our object in using force is to save the life 
of the child. Besides, why should we use a 
force too great when we may always deli- 
ver with the forceps. Though where vio- 
lence is unavoidable, it is best to open the 
head. 
To employ that force which, without vio- 
lence, may assist in bringing away the head, 
a good method is to make a sort of loop, by 
bringing a handkerchief loosely round the 
neck; when letting the ends down upon 
the breast, we tie them rather low on the 
breast, so that there may be plenty .of room 
to place our hand within it to pull by, and 
if we succeed we must mind, that in bring- 
ing down the head, we depress the sides of 
the head so as to bring it into the hollow of 
the sacrum. If it will not come by any 
means, we must then open it: when we 
have extracted the brain we should intro- 
duce the blunt hook, .md it is used witli the 
most effect when seconded by the pulling of 
the body. 
In some instances it happens that the 
head is entirely separated from the body, 
when various means have been recommend- 
ed for bringing it away. The only sure 
method, however, is to open it ; and when 
we have dilated it by expanding the per- 
forator, we should introduce the crotchet 
before we withdraw the perforator, in order 
to have the head always secure from slip- 
ping, as it otherwise would do. The diffi- 
culty is, that whenever we touch it we have 
a smooth slippery surface, which we cannot 
keep unless we have an instrument within 
the hole we have made. It will roll over 
the upper aperture of the pelvis. We must 
recollect always to keep one hand in the 
vagina, while any operation is going on, for 
the extraction of any body which may be 
within the uterus, and in order to guard the 
instruments. 
DISORDERS SDBSEOTENT TO DELIVERY, 
Most of the diseases consequent upon 
pregnancy arise after delivery, and not dur- 
ing labour. We shall first observe, that 
Quietude and a horizontal position should 
be strictly enjoined, as a matter of the 
greatest moment. And for this reason it is 
obvious, that as the patient should not be 
moved early, she ought never to be deli- 
vered in her clothes. This, however, is a 
plan often proposed by the lower orders of 
people to save inconvenience and expense ; 
but it should never be assented to by the 
practitioner, as it is a very dangerous expe- 
riment to raise the patient to an erect pos- 
ture, at a time when she cap only remain per- 
fectly safe in an horizontal position. There 
are many instances of the fatal effects of 
neglecting such a precaution. 
A woman after delivery should remain 
perfectly at rest for at least two hours, and 
then should by no means be raised upright, 
but be very gently lifted just enough to al- 
low the drawing away of the clothes, which, 
if they give trouble, must be cut away with 
scissars, to prevent the risk of exhausting 
the patient by over exertion. 
Fainting, Fainting after delivery fre- 
quently happens, and may arise from many 
causes, most of which are of little conse- 
quence : it is always an unpleasant occur- 
rence, and sometimes dangerous. It may 
be merely the effect of fatigue; a woman 
is just able to bring the child into the 
world, and after making perhaps the last 
exertion she is capable of, sinks into a faint. 
Frequently she will fall into an hysterical 
paroxysm, which will easily be perceived 
