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the diflenfion oC {he utertlS by the im¡>rcgn:\ted ovurn .
Obnrultions anel prcgn.l:'l:)' are bOlh accol1lpanied by a
firetching rull ners in the ; but in the 1. 0 only,
ma}' be perceived {he areGIa, or brtJ wn ringo founa thl.!
nippl es. frcm whi ch, in lhe Ja(l Olooth" . a thi n fcrurn di·
fhIs ; bUl this c¡rele is nal always fa difccrnible "'5 in the
tid'! p'regnancy, ancl e'¡l ~o then is uncenain as wcll as lbe
olhers .
About the flfth or (ixth mon lh, the circtlrnfu ibcd tu·
mour or Uretchinn of the uterus is rclt above the os
pubis; aod , by thi; circumrcription ami conriflent e, ea(ily
dillingu:/bed from lhe afeites, or el Topfy of the abJomen:
it is airo rounder and firmer than thort: rwellings (hat
2lCCOmplny obctruétions, which procced [rom a s ena ..1
fu llners or the vdfds belonging 10 the ligamen.. aDd
neighbouring ,,¡rcera.
On the \Vhole, th: difliettlty or diflinguiflling betwcen
obfiruétions and pregnancy in the fir(l months, is fo gre.t,
thu we ought tO be e3Ulious in giving our opinion ; and
D~r prefcribe ruch remedie, as m3y endanger lhe ffUlt
oC lhe \Vomb: but rathcr endeavour (O palliate lhe eom
plaints, UD1il time d¡[cover the n:lture of the c",fe ;
aDd . j udee ? n the eharitablc fide, \VheDMe or ,e–
putatiOD ís at Clake.
In the 6rth or fi"th month or uterine eeOation, by the
touch in lhe vagina, we perceive the neck of lhe womb
confiderably fllOneoed, anC:! the (lretehing or the lower
part of lhe uteFUS is then feofi bJy feh betwe:o the mouth
or the wOlllb and the pubes, and OD eaeh of the neck .
See PI..e CX!. fig . 3.
In the feveDth Illonth, the head or the ehi ld ' is fre–
qoently relt reOing . gainO the 10\Ver pan of the uterus,
bet\veen lhe pubes aod os internum; and being pulhed
upwards towards the fundus, finks down again by its
own gr...ity, AH thefe diaenoHic. are more plaiD Ind
certaio, lhe neuer the palient approaches to the time of
delifery.
Sometimes, the heael is Dot felt till the eiglnh or
nioth month i and in fome few cafes, nOl tilJ after the
membranes are IJroke, ",hen it is foreed down by the
contraétion of the uterus, and firoog labour.pai ns. This
circumHaoce may be o\Ying to (he head's rdling above
the ba{jn, efpecially in a narrow pelvis ; or to the difien.
/ion or its bcJly with air arter death, by \Vhieh thercetus
being rendered fpeeifieally lighter than the furrounding
waten, the body Aoal!· up to the fundu s, if there is a
brge quantity of fluid in"the membranes i oor is the bo–
dy always rdt wheD the ehild lie. aerors the ute, us.
H o'W t.áij1inguiJb thef'a/ft LA DouRf'rom thetrue, tlná
th. m ' MI to be uftd on that occ'1fion ,
Ir "he os utcri remaios ciare fhut, it may be takcn for
gra.oted that the woman is not yel io tabour, OOtwith.
fiandiDg the pains fhe may fuffú : with regard to which,
an accurate inquiiy is to be made ; and if her complaints
pro~eed [rom ao ayer llretchin¡: fulloefs of the uterus or
.ell'els belonging to ihe neighbouring pa"" blooding in
tbe arm or ancle,. to the quantity of fix or eight ounce"
ought 10 be prereribed, and repeated oeeafi onaJly . Ir the
paios are occa(joned by a loofencfs or diarrh<J!a, it muO:
be im01ediatcly rc(l rained with opiates_ Chol ie pains are
F R y ,
Jinineuin,ed rrorn thore of labour, by being c1,it Ay con–
lineJ te lhe b:lly, widlOu t going off .wd returning by dif–
tin{t. ¡nlel VJb: lh~y ar: for lhe !non part pi oduced by
fx pfs t~o ).,ng n:t.,i n..:d in eh.: colon, or by fueh ingerta as
oal:J!io:1 ... r:\rCr~lqlon or e xp~nfion of air 10 the ¡nteHines ;
by which thc:y Jrt vi olclI tly Urctclted and vell iC:;<jced .
1"hi:; complrunt mult be removed by opeoing gIyficrs , ta
em pty th~ gms of their noxious coO(('nts: aod chis en'
en nioo b('ing p<!rfornH~d , Opi<lCéS mély bli! adminiflered t"
a(rui1ge the pains ~ cither tu be ,injeéhd by the anus, la
ken by the moulh, or applied eXlcro.dly in form of e
pithem orembroc:nion.
Sometimes , the os ¡nteroum may be a little dilated,
and y" it may be ¿ i/lieu!t tO judee whether or not thd
palient b~ in !abour ; the cafe, however, may be areer;
tained. aftcr fome auendance, by thert:: con(jucrat ions : il
lhe \Voman ¡s nOI arrived at her fuH time; if no roft or
glary mucus 11ath becn difeharged from the vagina; ii
lile paios are limiled lO the reg:oo of the belly, wi thol1t
extending to the baek and inCIde or the thigh.; ir they
are flighl, and continue without iotermiíIion or jaereare;
n;¡y, ifthcy ha\'e long iotervals, and r('cur without force:
fl3fficicnt te purh down lhe waters and mtmbraoes. or
child's head, [O opcn the os internuOl j i[ this part be
rel, thick aDd rigid, iD(lead orbeing fort, tbiD, and yielJ–
ing; we may f:tfely .proDounce . that Jabour is not yet bl!·
gun; aod thofe i11arms are to be reQ10ved as we have di·
reéled in the eafe of ralfe or eholic poin.. Ber,des, ir
the pulfe be quiek and (lrong, and the patient attaekeu
by flitehes in the fides, baek, or head, bloodine will b.
likewife n<cell'ary. See CX!, fig , 4,
T he diuiJion'¡ LABOU RS,
A NATURAL labour is when the heau prerents, and
the \Voman is delivered by her pains and the af!iflanee
eommonly giYeD: but, fllOUld the eafe be fo tediou, .nd
lingcring, that we are obliged 10 ufe extraordioary for ce.
in llretching the parts, eKtraéting \Vi th the forcepts, or
(tO fave the mother's lire) in opening th. head and deli ·
nring with the erotehel, it is.diltinguifhed by the appella.
tio,n of laborioru : and the pret(rntlIUrn! compreher:ds aH
thofe cares in whieh the ehild is brought by the fcet, or
the body dclivered before the head. Ntither do 'fe
.,ind how the ehild prefen.., fo much as the wa}"in whieh
ie is delifered : for ther~ are caft:s in whicb the hei\d
profents, and for feveral hours we exp«'! the ehild will
be de1iv~ed in the natural way ; but if the. woman has
QOt Ilrength enough to force dOWD Ibe ehild's head into
the pelns, or in floodings, we are .t longth obliged to
turo aDd bring it by the .ree!, becaufe it is fo high that
the roreep' eannot be applied; and if the ehild is not
large, nor the pel vis narrow, it were pi(y to ddlroy the
hopes ofthe parents, by opening the n(U1I and extraéling
with the crotchet. In this cafe, therefore, ahhough the
child prefents in a natural way. \Ve are obliged tO turn
and deliver it in the fa me manocr as if the fhotllde r, brean.
or back, had prefented : and gencrally, this opcration is
more difficult than in either of 1hofe cafes, becal1fe, if the
waters are aJl dlfd13rgcd, and :teuterus clafe contraéled
round the fectos, it is more difficl1l t to raife the head 10
Ihe fttndus. V{heD the breeeh prcfents, we are frequen t-
Iy