PARTURITION. 
cation or convulfions, and by the introduction of the 
finger into the mouth, by which alfo the tongue may 
be pulled back, and the confequences avoided. This, 
however, is a very rare accident: it has been abfurdl'y 
called “ {wallowing the point of the tongue.” See Un¬ 
derwood on the Difeafes of Children, vol. ii. 
The natural paffuges, efpecially the anus, vagina, and 
urethra, are fometimes imperforate, preventing altoge¬ 
ther, or in great part, the ufual excretions. In fome 
cafes, a collection of mucus alone proves the obltacle; 
but, in others, membranous fubftances clofe up the paf- 
fages ; in which laft inftances, an operation will be re- 
quifite to open the parts, which mult be performed by a 
fkilful furgeon. In refpeCt to the vagina, Dr. Underwood 
obferves that he never found the external parts totally 
imperforate, there being always a fmall opening at the 
meatus urinarius: but the aperture to the vagina itfelf 
fometimes requires td be opened, either by the point of 
a lancet, or by the fingers only, which is generally eafily 
effefted, there being always a raphe, or line, where the 
natural opening fhould be. The anus is fometimes clofed 
only by a thin membrane, fo that the day after birth the 
meconium may be diftinCtly felt, and in a manner feen 
fhining through it. A flight punChire with a lancet, and 
pafling a bougie or the point of a finger into the bowel 
for two or three days afterwards, is fufficient to remove 
this impediment. But more commonly the imperforate 
anus is a melancholy cafe, allowing of no effectual reme¬ 
dy, as the gut often terminates in a cul-de-fac fo high 
as not to be reached. The imperforate penis is not quite 
fo common a cafe ; but is not unfrequently fufpeCted, 
when the aperture of the paflage is merely flopped up by 
a little mucus. Under fuch circumftances, wafhing the 
part with warm milk and water, or at molt a little af- 
fiftance with a fmall probe, or any fuch blunt-pointed 
inftrument, will be fufficient to open the paflage. When 
the urethra is perfectly open nearly to the extremity, as 
often happens, it is neceflary only to make a fmall aper¬ 
ture with a lancet, ora fine trocar, and to keep the part 
open by the occafional introduction of a flender bougie. 
The meconium is that black vifcid matter, which every 
infant difcharges from the inteftines for the firfl two or 
three days after birth ; and many complaints have been 
afcribed to the undue retention of it, and confequently 
a great variety of purgative medicines have been recom¬ 
mended to be given, almofl as foon as the child is born, 
with a view to expel it. But experience has taught, that 
the natural evacuant of this matter is the firfl: milk of 
the mother, which is flightly laxative in its properties: 
the infant, therefore, fhould be put to the breaft as foon 
after birth as the fituation of the mother will allow. 
The abfurd practice of compelling the child to devour a 
quantity of fugar and butter immediately on its enter¬ 
ing the world, fhould be flriCtly forbidden. Yet fome- 
thing is neceflary to carry off the contents of the bowels, 
when the milk will not effeClit; and nothing anfwers 
better than about half a drachm of caftor-oil, which may 
be repeated once or twice if found neceflary; or, if pre¬ 
ference be given to a formula, the following, although 
rather unchemical, combination may be prefcribed. 
“R. Olei ricini. dr. iij. Svrupi rofae dr. 3 . Mifce pro 
miltura aperiente, cujus, cochleare minimum, quarta 
quaque hora, donee alvus bene foluta fuerit, detur.” 
Jaundice, or, as the nurfes term it, yellow gum, is 
among the difeafes which take place within a few days 
after birth. It is preceded by drowflnefs, and difincli- 
nation to fuck, and is foon difeovered by the univerfal 
yellownefs of the fkin. Sometimes the whites of the eyes 
appear yellow for a day or two before the other fymp- 
toms appear: the tinge of the fkin is feldom deep, and 
the difeafe is more readily removeable than the jaundice 
of adults ; but cafes are occaflonally met with, where 
the colouc of the fkin is of a dark yellow, the infant 
moans conftantly, and convulfions follow, which at laft 
deftroy life. In regard to the treatment of this difeafe, 
715 
if the child feem to fuffer no uneafinefs, although its 
fkin be quite yellow, and if the bowels be open, it will be 
unneceflary to adminifter any medicines. But, if he be 
unable to fuck, and have a difpofition to conftant fleep, 
aCtive meafures fhould be adopted. Thefe coniift prin¬ 
cipally in evacuating the vifcid matter, which probably 
clogs up the biliary duCls. An emetic of ipecacuan, and 
brifk laxatives, as of rhubarb, or frequent dofes of a fo- 
lution of manna, will then be found neceflary, and their 
effeCts may be much promoted by the warm bath. When 
violent colic pains or convulfions accompany the yellow 
gum, there is reafon to fear that the liver is difeafed, and 
little can be expeCted from any remedy. See the article 
Infant, vol. xi. p. 28, 9. 
Of the INSTRUMENTS used in DIFFICULT PAR¬ 
TURITION. 
To determine on the nCceffity for inftrumental inter¬ 
ference, is one of the niceft points in the practice of mid¬ 
wifery ; for, whilft the unneceflary employment of in- 
ftruments cannot be too ftrongly reprobated, ftill no con¬ 
duct ought to be more deprecated than that timid and 
cruel mifmanagement, which permits an interefting fe¬ 
male to ftruggle under fruitlefs efforts, till fhe finks ex- 
haufted from fuch exertions, or is not delivered, until ir¬ 
reparable mifehief is done to the foft parts; in confe- 
quence of which, fhe may linger out a wretched exiftence 
for a few weeks or months j the victim of criminal pro- 
craftination. 
To affift in forming an opinion on this momentous 
queftion, fome fuch circumftances as the following may 
be noticed. 
Should labour from any caufe have proceeded until 
parturient aCtion becomes fo feeble as to be inadequate 
to expel the uterine contents, or fhould the pains have 
altogether ceafed, then artificial aid is often juftifiable. 
The ceffation or diminution of pain referred to, is the 
confequence of original debility, or of an exhaufted con¬ 
dition of the uterus from long-continued and fruitlefs 
contractile exertions ; and mull be diftinguiflied from 
that occafional and temporary fufpenfion of uterine efforts, 
which is not affociated with any other unfavourable 
fymptom, and which may often be removed by repofe, 
nourifhment, and abdominal and lumbar friction. Under 
thefe circumftances, time may be given, provided there 
be a little fteady progrefs, the prefenting part be loofe in 
the pelvis ; the vagina cool, and clothed with fecretion ; 
the mind tranquil5 the powers of the fyftem not ex¬ 
haufted ; and the reCtum and bladder capable of empty¬ 
ing themfelves. 
But, on the other hand, fhould the pains have been 
for many hours ftrong and expulfive; fhould the pre¬ 
fenting part be firmly wedged in the pelvis, interrupting 
the functions of the bladder and reCtum ; furely common 
fenfe dictates that timely affiftance fhould be given to pre¬ 
vent exhauftion or Houghing. Whenever then this llate 
of things exifts, with fever, reftleffnefs, head-ache, vo¬ 
miting, (the os uteri being fully dilated,) mental in¬ 
quietude, abdominal tendernefs, with heat, and drynefs 
and pain about the vagina and os uteri—unlefs delivery 
be effected, low muttering delirium, feeble rapid and in¬ 
termitting pulfe, with cold clammy perfpiration, will 
foon terminate the heart-rending feene. 
Previous to deferibing each particular inftrument, 
fome general obfervations, which are equally applicable 
to the ufe of each of them, may be ufefully made. 
The bladder and reCtum fhould, if poffible, always be 
emptied : the former by the introduction of the catheter, 
and the latter by the exhibition of an enema. Inftru- 
ments fhould never be introduced whilft the os uteri re¬ 
mains firm and undilated, or irreparable mifehief may en- 
fue. 
The affiftance given by inftruments fhould always be 
afforded during a pain, that the uterus may be merely af- 
fifted in its exertions, and that it may be gradually emp¬ 
tied. 
