67 6 
PARTURITION. 
protraCled labour. With this condition of parts, if the 
finger be carried within the os uteri it feels fmooth and 
unyielding; and, whenever this fenfation is communicated 
to the finger on examination, confiderable time will 
eiapfe before the mouth of the womb dilates ; and, if 
aihltance be not given, after fuffering through days and 
nights, the os uteri will remain clofe, and thick, and 
hard. . / 
The management of thefe cafes requires confiderable 
difcretion 5 and, although time will ufually terminate 
them, yet the dilatation may be materially accelerated by 
the abftraCfion of blood in quantity to be regulated by 
the powers of the woman. This being done, the bowels 
fhould be freely opened by an aperient exhibited by the 
mouth, and by a large emollient clylter. After thefe 
meafures have been adopted, a few ounces of tepid water 
or gruel, with from one to two drachms of tinClure of 
opium, (honk! be thrown into the reClurn ; or the os 
uteri may have gently rubbed into it, about half a 
drachm of the extraCl of belladonna. By thefe means, 
relaxation is often fpeedily fecured. In addition, the 
patient’s mind may be amufed by fitting over fleam ; by 
having large emolient enemas frequently exhibited ; and 
by fomentations to the uterine region. 
6 . Mdpojition of the uterus is very embarrafling to thofe 
who have not met with the occurrence. If the os uteri 
be thrown backwards againfl the promontory of the fa- 
crum, the labour is generally protraCled. It principally 
happens to women with capacious pelves, and is not 
eafiiy deteCled on the firft examination. Time will rec¬ 
tify this difplacement, and the woman who is the fubjeCl 
of it fhould pafs through parturition lying on her back. 
If the os uteri be forced forwards againfl: the fymphyfis 
pubis, or tilted over it with the fundus backwards, the 
cafe will probably prove to be retroverfion of the uterus, 
continuing to the full period of geflation. This is a 
particularly trying cafe, in which nothing but time and 
patience can efteCl any thing. 
7. Small fize of the pelvis, or large fize of the feet us .— 
The treatment arifing from either of thefe caufes mufl 
be nearly the fame. Much muff neceffarily be trufled to 
time. If care be taken to avoid all caufes of fever and 
inflammation, and to prevent the patient from exhauft- 
ing her flrength by unavailing {trainings, the labour 
may be differed to proceed for very many hours without 
danger; and at length the head of the feetus may' be 
fqueezed through the pelvis, very much elongated and 
compreffed : yet the child may be born living, and the 
mother may have a favourable recovery. 
The molt frequent obttacle to labour is an enlarge¬ 
ment of the head from hydrocephalus; but it has been 
eftimated, that even this does not occur oftener than 
once in nine hundred labours. Sometimes, in fuch 
cafes, the head is fufliciently compreflible to be expelled 
undiminifbed by the pains. An hydrocephalic foetus 
has palled entire, the circumference of whofe head was 
feyenteen inches; another palled alive, and lived nearly 
an hour, whofe head meafured in circumference twenty- 
two inches ; both the above labours were long and pain¬ 
ful. 
But, when the child is really tnonfrous, from the re¬ 
dundancy of fome large parts, as from two heads or two 
bodies, it is fufliciently obvious that, if the mother be 
at the full term of geflation, the obllacles to delivery 
will often be infurmountable by the natural powers. 
Fortunately, however, in by far the greatefl number of 
cafes of monflers of that kind, the aCtion of the uterus 
is excited before the ordinary period. But we fhall here 
introduce a recent cafe, where a child with two heads 
was born at the full time, and of the full fize, by the 
procefs of natural but protracted labour. The account 
is from Mr. Jackfon, a member of the London Royal 
College of Surgeons, refiding at Bolton le Moors, in 
Lancafhire. 
Mary Honeyford, the mother of the child to be de- 
feribed, is about twenty years of age, of a fanguineous 
temperament, florid complexion, and rather below the 
middle flature; fite has enjoyed nearly uninterrupted 
good health from infancy. In the forenoon of the 10th 
of Auguft, 1820, I was defired to vifit her, and take with 
me the midwifery-inflruments. I learnt from the mef- 
fenger, that (lie had been in labour upwards of two 
days, and that midwives had been with her mofl of the 
time. For the lad eighteen hours, one of them had 
been conftantly afiifting her, but was unable to accom- 
plifli her delivery : the pains were very weak, 'and her 
flrength nearly exhaufted. When I arrived at the houfe, 
I was informed by the midwife that the waters had been 
drained off twenty or twenty-four hours; the head had 
been in the fituation it now occupied for ten or twelve 
hours; and, to ufe her own expreffion, the head had 
defeended flowly to the birth, and then it had ftuck on 
the fpare bone. The patient's pulfe was 135, and weak. 
The parturient paroxyfms occurred every three minutes, 
but were inefficient. Anxiety was depicted in her 
countenance, and a general reftleflnefs pervaded her; as 
is frequently, if not always, witnefled in tedious painful 
labours. 
On examination per vaginam, I found the os frontis 
prefenting, the integuments of which were tumefied, 
from the time it had remained in the pelvis, and the at¬ 
tempts the midwife had made to afiift her. The face was 
towards the pubis, or rather towards the right groin, 
and the foft parts of the mother quite relaxed : thus, 
reafoning from my experience in fimilar prefentations, I 
believed there could be no apparent obftacle to a fpeedy 
and favourable termination. I ordered her a little wine 
and water, and calmed her mind, by flattering her with 
a fpeedy releafe from her fuffering and anxious fituation. 
As the parturient energies were nearly exhaufted, I was 
perfuaded it was not fafe to truft any longer to nature, 
and that artificial aid was neceflary to aflill the natural 
efforts to promote her delivery: I therefore afiifted her 
in the following manner. I introduced two fingers 
under the os pubis of the mother, where I could reach 
the mouth of the child, by which I could command con¬ 
fiderable force, and aflill the expulfive efforts of the 
uterus: thus, by extracting at each pain, in lefs than 
half an hour the face emerged from under the pubis, and 
and the head was nearly half protruded through the os 
externum. Finding that fomething impeded the com¬ 
plete expulfion of the head, though I ufed confiderable 
extracting force, I pafied two fingers by the head of the 
child to afeertain the obftruCtion, and where it exifted, 
when they came in contaCt with a firm tumor, defend¬ 
ing into the cavity of the pelvis, clofely joined in con- 
taCl with the neck of the firft head. On examining it as 
particularly as the confined flate of the parts would per¬ 
mit, I was convinced it was the head of a child, from 
the hair on the fcalp and the feel of a future. I imagi¬ 
ned it a cafe of twins, in which the head of the l'e- 
cond child, by Tome partial contraction of the uterus, 
had been forced dowm, or fomehow got entangled before 
the flioulderof the firft. 
The woman continued to have regular, though very 
inefficient, pains, at each of which I ufed fuch extracting 
force as I thought was compatible with the fafety of the 
mother and child : I eafiiy afeertained it was living, by 
the pulfation of the temporal arteries. After fome time 
I found I was gaining a little ground, and that the 
heads retained their relative fituation ; that is, as one 
was further protruded, the other defeended lower to¬ 
wards the os externum. Having more fpace for examin¬ 
ing the prefenting part of the fecond head, I fatisfied 
myfelf, from the futures and pofterior fontanel, that it 
was the occiput. I thus continued extracting and 
guarding the perineum for about an hour, when the fe¬ 
cond head was protruded; immediately after which fol¬ 
lowed a fharp expulfive pain, when the body of a living 
male child with two heads was brought to view. 
The 
