1000000031

HC>

crarppcct. nor the vagin:\ in d"nger ofb:ing tore

froOl

o,t1e

w"mb; fo r in this caCe, the

\'aginl

wi111t!ogthen con –

f:d

!r.bl

y upwares.

"Vhile you are thus em?lo)'cd, I...n

~{!i(hnt

prefs with

bOlh hands on

t~e WO~\1l0JS

!.le!!}'

whiJ~

you

pun~

with

one

h:lOd,

prc:ts

wit h

lhe

otbn,

ord! r

keep

down

lhe

urerus, elle it IV:II rife

h i.:~

U?,

a"d roll abou', I:k, •

Jarge boll, bdolV the

l.,,,

parielCs of ,he aU¿or.len.. fó .s

to hlnder you feom eJTeétin¡; ,he ncce{f"y dilatation.

WheQ

yo~

h;¡,vc

O\'crcome Ihi,

conua{tion. anrl ¡ntro–

'¿ueed your

h.nd

into , he (undus, fep>ra« and ,bring the

placenta :llong, . as above dircéted:

:mj

OloulJ lhe

uterus

be eontraaeel iD the' m:delle like an

h~ur

glars, • eircum–

'Íllnce ,b.. ;ome,imcs, thougb rarelr bappeos, the fame

mOlhod muO be pra.9 ifed .

In every cafe, and e(peci.•Uy }vben ,he pl.e<nla ha,h

becn

doli\'~red

with dillieulty, introduce r our ycur hand

aflt!t

its extratlion,

arder to cxamin(

any part of lhe

urerus be pulled down and inverted.; and if ,ha, be the

cafe,

it up añd reduce

w ithoUl

Jofs of time, then

<:lear i, of

~he

eoagula,ed blood; whieh olherwife m.y

occat!on

vio~nt

after-painl.

For

the.

moO:

part, in

tCD, 6ftcen, or twenty minute!,

more or lef., the placen,a

\Viii

come aIVay of i&lf; and

though fome portion of it, or of the membranes, be left

in tlle ute,

tiS,

provid-.!d no g ea! fiooding enfue!, it is eom·

monly difeharged in a day or two, wi,hout any de'riment

tO the woman: but at .ny rate, if pon; 1<, all the fe–

<:undines ought 'o be extr.aed aC once, and before you

Jeave your

patient,

order

avoid reflcélioDS.

O. LABORIOUS LABOURS.

How

LABORIOUS LADOURS

Dr6

occllji'Jntd.

ALL

lhcfecaf.. in whieh Ihe head prefents, and eannol

be delivercd in ,he natoral way, ate accounted more or

lefs laborious, aeeording tOe ,be difFerent eircumflanee.

fróm whieb tbe diffieulty arifes: and thefe eommonly are,

nrO, Crea< weakneCs, proeeeding from lof, of appeti,e

'añd b:Íd<ligdlion; frequent vomi,ings , diarrhreas, or dy–

fenteries , Iloodings, or

an~

other diftafe that may exhaufl

the paticnt; as aJfo the (.Jtigue fhe may have uDdergone

by unll<ilful trealmenl in the begioning ofiabour.

Seeondly, From exceJlive grief aod anxiety of mind,

oecafioDed by the unf..fonable news of fudd cD misfortune

iD time o( Jabour; whieb orten affea her fo, as tO carry

off .be pain., andenda.ger her finking under the thoek.

Thiroly, From the rigidity of the os uteri, vagina,

and

ex.terAal parts, which commonly happens to ""omen

tbe 6rfl birth, efpeeially lo thofe who are abou' ,he

age of forly: thounh i, may be .Ifo owing 'o large cal–

lofities, proJuced from laceration or ulceratíon of the

parts; or tO glands aDd fehirrous tumours ,hat block up

,he vagina.

Fourthly, When the under.part o( the uterus is con·

traaed before the OlOulders, or the body entangled in the

Ilavel

firing .

Fifthly, From ti.. IVrong prefentation of Ihe ehild's

head

thu is" when lhe forehcad is towarch (he groin or

middle of the os pubis; when the f, ce p,deo" ",ilh

tb~

chin to the os puhis, ifc.:hium, cr

f..

cru:n ; when the

erO"IIO

of the helt.l rctts

,Ib~ve~{be

os p:.óis, nnd the forehcJd or

Cace is prdfcrl ínto lhe

h~1I0\9

of the fúeru:oj and

t.1aJy,

""hen one uf

fho:

C¡¡rs prclc:nrs.

SiA:thly.

Fro.11

the.extra()rdin~ry

offifi:i\tion

oflhe

chiJd's

head, uy whl'c!, óe cones of tbe

Ibll

are hindered fro ..

yiddi~g,;'\s

Ihey

ar~

forC':d Into the p.:h

and for:n a

hy.

dtocephalos or dropfy,.

dde:llling

the

h~\d

to fu:n a d:.

gree,

thJt

calmut pa:',3

along until tue

water is

d¡r.

ch"rgod.

Seventhly, F rom a too fmaU or diOorted pelvis, ",hicll

orten

OCCUIs.i n

vel-y JiuJe women, or

fu ch

as'have been

~ic.

keny

iD their ehildhood. · See P la,e

CXIL

fig 6.

¡.

In all

thef.: C¡,reS,

except wh'en

lhe

pelvis is too n.Hrow

.nel :he hCld

' 00

large, provided ,1" h..d lie, al ,he up,

per' part

the brim, or (though preA;'d imo the poi

vi,)

can be ealily pulhed back into Ihe

ut~rus,

th. bd! me.

thod is, to tum the ehild .nd deliver by Ihe fee,; bUI, if

the head is prell'ed into the middle ór JOlVer part of Ihe

pelvis, and ,the u'erus flrongly

eontraa.eI

round

t~e child~

delivery ough, to be performed wi,h the foreeps ; .nd in

alJ the (eveo cares,

lhc wornan"is in dangec, and

yOIl

can neither

tUf O,

nor deli\'er

with the

forcepsJ the

hl!3J

mua be Qpenod aod delivered \Vi,h erolche". Labariou,

ca[cs,

from

fome

the

abo

recited

eaurt:s. bappt!i\

much

of"ener than

lhofe

\l/e call pretematural ; but,

tho[e:

which procced from a narrow pelvis, or a

Jarge

head, are

of the worO eonfequence. Thefe eafes demand gr••,er

judgmenl in the operator Ihan ,hofe in which the ehild's

Ioead do.. DO' prefenl; beeaufe in ,hefe l.(! \I'e knolV,

thal t'he befl aod fafeO method is .lo deliver by ,he fee' ;

whereas

laborious births ,

\Ve

muH

lna'turely confider

Ihe caufe <har relard. the held from coming along, toge–

,her with ,h. neccll'ry a{!inanee required; IVe !Dufl de–

termine ""hen we oU2ht- to wait patiently fúr (he efForti

of na,ure, and wheo i, is .bfolutely necelfary 'o come 'o

her aid.

IVe altemp' 'o (uceour ,her too foon, , aod ure

muek force in the operadon, fo

that

lhe ehild and mo·.

thec,

one of the

t\Vo,

3re

JoO:,

we wiU be apt to re·

proaeh ourfdves for h..ing aacd premalu rely; UpOD tbe

fuppoution, ,ha, if \Ve had waÍted al\lIle longer, the pain.

might have, by degr«s, ddivered the ehild ; or at leafl.

forced the he.d fo low, as Ihat we might have extnaed

it with more r,fe,y, by Ihe a{!iilance of the (orce?,. 00

the other hand. when we

leave

it.to

nature,

perhaps

the flrong pre{fure upon the head aDd buin, the ehild i.

deaa when ddivered, and ',he IVomanJo exhaDad wi,h

tc:dious

labour,

that her

is ;n

immincm daQger:

this eafe, we '

bl.me

ourfelves far del.ying our h elp fo

long, reJetling ,hat had lVe delivered ,he pa,ieot fooner,

,,'ithout paying fuel¡ ferupulons regard

the Jire of rhe

child.

the woman might have recovered without

having

run fu eh a dangerous rill<.

DO\l!nlefs i, is aur duty

fave bo,h mother and child, if po!lible; but, if ,hal i.

impraéticable,

pay

our

chie f regard

the pareat ; :lDd

in .U dubloos ca« s,

aa cau,iouOy aod eireumfpemy,

tO the befl of uur j udgment and lI<ill.

If Ihe head is aovaneed in,o the pelvis, and ¡he uteru,

flrongly eonlr.tled round the <hild, crea, force is required

to f ufh it baek. iOlO th. WODlb,

bee.uf.

,he elfort mull be

fu:tieient