PARTURITION. 
allowed to engage in the bufinefs who have not been pre- 
vioufly inftrutted by Tome public teacher, and who do 
not obtain from - him certificates of their qualifications. 
The confequence of thefe arrangements has been, that 
every part of the art has been inveftigated with the great- 
eft care ; and fuch has been the zeal of the profeftors, 
or perfons engaged in the practice, that the works on the 
fubjeft of midwifery, which have been publifhed within 
lefs than a century, are fufficiently numerous to form of 
themfelves no inconfiderable library. Thus this art, 
which was fo late in being cultivated, has already attained 
a degree of perfection, that puts it on an equality, at leaft, 
with any other branch of medicine. 
Of this great mafs of publications, many of them ex¬ 
cellent, it may be fufficient to mention, among foreign 
productions, Puzos’s TraitCjdes Accouchemens, Baude- 
locque’s Art des Accouches, Crant De Re Inftrumenta- 
ria, and the Opufcula of Roederer, and of Plenk, which 
embrace the whole circle of the art. Among our own 
writers, White on the Management of Pregnant and 
Lying-in Women, and Rigby on Uterine Hemorrhage, 
have each in their way given directions that are calcu¬ 
lated to abide the teft of time. Obfervations on Human 
and Comparitive Parturition, publillied in 1794, may be 
added, as containing a number of curious and ul'eful 
faCts not generally known or attended to. The late Dr. 
William Hunter’s fplendid Plates of the human Gravid 
Uterus, and not more fplendid than cOrredt, place before 
our eyes the fcetus at different periods of its exiftence, 
(how the pofture in which it lies in the uterus, and the 
manner in which it is connedted with that vifcus. Dr. 
Denman’s Introduction to the Practice of Midwifery, has 
already pafied through feveral editions; and for compre- 
henfivenefs and exaCtnefs, it holds the fame rank now 
that Smellie’s Treatafe did at the time when it was pub- 
lilhed. From thefe, and from the following more recent 
w'orks, the~prefent article is compiled : 1. The London 
Pradtice of Midwifery, 1811. 2. Conqueft’s Outlines of 
Midwifery, 1820. 3. Dr. Merriman’s Synopfis of the 
various Kinds of difficult Parturition, 1821. Befides 
which, we have been indebted to various articles in the 
London Medical and Phyfical Journal, at prefent edited 
by Dr. Hutchinfon ; and to the private communications 
of a refpeCtable profeflor in full London pradlice. 
Many particulars which might be expedted to be ex¬ 
plained in a Treatife on Parturition, will be found anti¬ 
cipated under the articles Abortion, and Anatomy, 
vol. i. Conception, vol. v. and Gestation, vol. viii. 
Having thus cleared the way for the inftrudtion of the 
pupil in real pradlice, we proceed to the grand Hippo¬ 
cratic divifions of Natural Parturition, and Preternatural 
Parturition, with their refpedtive varieties, or lub-divi- 
fions. 
I. Of NATURAL PARTURITION. 
Human parturition, where every thing is natural, is 
perhaps one of the mod beautiful and interefting opera¬ 
tions in nature ; for what can be more beautiful than a 
procefs accompliftied by the combined adtion of a num¬ 
ber of powers admirably well adapted to the intended 
purpofe ? and what can be more interefting than the con¬ 
tinuation of our fpecies which depends on the operation ? 
The fcetus, at the full period, weighs from between fix 
and feven to between ten and eleven pounds, and mea- 
fures from eighteen to twenty-two inches. It is placed 
within the ovum in fuch a manner as to occupy the leaft 
poffibie fpace. This pofition has been' beautifully de- 
lcribed by Harvey : “ Infans in utero ut plurimum repe- 
ritur, addudlis ad abdomen genibus, flexis retrofum 
cruribus, pedibus decuffatis, manibufque ad caput fub- 
latis, quarum alteram circa tempora vel auriculas, alte¬ 
ram ad genam detinet, ubi maculae albae, tanquam con- 
fricationis veitigia, in cute cernuntur: fpina in orbem 
fledtitur, caput ad genua incurvato collo propendet. 
Tali membrorum fitu qualem in fomno per quietem quae- 
G71 
rimus. Harvey Exercit. de Partu. This pofition may be 
viewed in the two laft figures of the engraving to the ar¬ 
ticle Conception, vol. v. p. 12. See alfo Anatomy, 
vol. i. p. 620-624, and Plate VI. fig. 2. alfo, Anatomy 
of the Gravid Uterus, Plate V. p.652. 
Natural labour fuppofes four things rFirft, that the ver¬ 
tex prefents. Secondly, that there is fufficient room in 
the pelvis to admit of the ready defcent of the head of 
the child in that direction which permits the occiput to 
emerge under the arch of the pubis. Thirdly, that there 
is parturient energy adequate to the expulfion of the con¬ 
tents of the uterus without manual interference, and 
without danger either to the mother or child. Fourthly, 
that the procefs of parturition is completed within a 
moderate time. 
The fufferings of a woman during labour having been 
compared to the fatigues of a perfon on a journey, the 
phenomena of labour have been divided into ftages, each 
ftage being marked by fome diftinguithing circumftances, 
either in the nature of the pains, the dilatation of the 
parts, or the degree of defcent of the head ; and various 
have been the divifions arbitrarily adopted by different 
authors. Thus, Dr. Denman divides labour into three 
ftages only. “ The firft includes the dilatation of the os 
uteri; the rupture of the membranes; the difcharge of 
the waters. The fecond, the defcent of the child ; the 
dilatation of the external parts 5 the expulfion of the 
child. The third, the reparation of the placenta ; the 
expulfion or extraction of the placenta,” Aphorifms, 
p. 3.—The London Practice of Midwifery makes four 
ftages. “ The firft ftage is that when the head of the 
child enters the pelvis, palling down as far as it can move 
without changing its pofition. The fecond inclndes the 
period of the child’s head paffing through the os uteri 
into the vagina. The third, the change which has taken 
place in the vagina and os externum. The fourth, the 
delivery of the body of the child, and the expulfion of 
the placenta.”—Dr. Bard, of New York, makes four 
ftages. “ The firft is occupied in opening and dilating 
the internal orifice of the womb ; the fecond, in the pal- 
fage of the child’s head through the bones ; the third, in 
dilating the external orifice, and the delivery of the child ; 
and the laft, in the delivery of the placenta, or after¬ 
birth.” Compendium of Midwifery, p. 105 - -Mr. Hog- 
ben divides labour into five ftages. “ The firft lafts from 
the commencement of labour till the child’s head enters 
the brim of the pelvis. The fecond is the time in which 
the face partes into the lower pelvis, the face turning into 
the cavity of the facrurn. The third, the further ad¬ 
vance of the head without the os externum. The fourth, 
the expulfion of the body and lower extremities of the 
child. The fifth, the difcharge of the placenta and mem¬ 
branes.” Obftetric Studies, p. 33. This work is illuf- 
tTated with very curious Anatomical Tables, on an en¬ 
tirely new plan.—Dr. Merriman prefers a divifion into 
four ftages; and his third includes the third and fourth 
of Mr. Hogben. 
First Stage. —For fome days previous to the accef- 
fion of thofe phenomena which characterize the exiftence 
of labour, there are often prefent certain premonitory 
fymptoms, which, by women who have borne children, 
are viewed as precurfors of that hour they fo much dread. 
Subfidence of the uterus and abdomen is not an unufnal 
monitor of the approach of fuffiering. It may be view'ed 
in a favourable light, inafmuch as it indicates room in 
the pelvis. Glairy mucous fecretion from the os uteri 
and vagina, popularly termed a Jhow, fometimes occurs 
for days before the more aCtive lymptoms of labour. It 
is often ftreaked with blood, and tends to lubricate the 
parts concerned in parturition. Irritability of the blad¬ 
der and reCtum, demanding their frequent relief, is ano¬ 
ther occafional precurfor of labour. 
In confequence of the refiftance which the uterus meets 
with during its contraCtile efforts, pain follows every 
fuch contraction 5 but the pain attendant on parturition 
4 differs 
