1000000031

"',

• J -

tah

fufli¿ient hold, l<t il be opened il,,,vly, fo as 'o aro

Jow his hands

PUfllCd

up with

e dro!;

,·,hen he ha,

inúnu:ucd a finger or t\Vo·in each groin. Jet him place his

thumbs on

lhe

(l1;gI1l',

[hey

tlrC

lowarCs the o(j:\ pubis,

fo as to ob"io a l:rm holel. theo

Imll

al ~og

from fide to

liue, aod. if the b"ek of the

r1lild :,

the os pubis, cor.·

tillue to

afli~l

this

m:.:nner, l1ntil

lhe

body

and head

are

dc1ivered: ll¡e Jegs being commonly

are.t~h<u

up aloog

lhe belly aod bre. a, ,.bto the child is e"tr.(ted as far .,

the Choulders,

(he

come

out

ch!mrcln:s,

or are eafily

brought dowlI; but, if the beJly of ,he child is turneJ

pnc: fide, or to lhe os pubis, in lh3t e.1fe , w!)cn lhe breech

i. delivered, he ought to turo the bdly dowo tO the f.,–

crum, aod the back

tbe os pubis ; and

chat

~he

fael!

may be alfo turoed to ,he baek of the ",other, le, him re ·

member lhe quarter extraordinary, which muO. be again

reverf1'd, aod theo he may pull .Iong .od

dcli.er.

the body caooot be turned uOlil the thigh. and legs

are brought down,

tither

on account

'Of

lh'e bulk. or be·

c:au(w,he hold on {he breech 1S nOI

(uflideDl,

Jet him con–

t.inue

pull along , until the ha!lls <'ppcar on the ou tfide

cf the os

externum; (hen feize one of the knees with hi3

finger aod thumb, .aod e" traa ,h.t le&; aod

~et

,he oth"

be br·ought down io the fame mílnner.

he 3ttcm?ts tO

pull out lhe Jegs. before the h¡¡ms arrive at this place,

the thighs are always in daoger of beiog bent or brokc;_

Wheo ,he legs are deli\'ered, let him

WI'.p

a eJo,h rouod

the

breech.of

the child,

as the

bo~y

\Vos

pulled dowo

almoa as far as the brean·, before the legs could ue brough,

out,.

mufl be pplhed up again to the nílvel, or above

iti

becaufe, \IIithout this precaulion, (he A.loulders would be

fo much eDc.ged io the pelvis. th.t it would be imprac–

ticable to make the maticns formerly direfled , (o as

turn the (ace to the back of the mo\hcr: whereas, when

the body is purhed up, thofe turo. can be effd led wi,h

grea!« -eare, becaufe the belly being io the pelvis, it

yields e. Ger to the form of the bafio. 'Vhe" the face

i. turoed properly down, let him proceed

deliver, as

aboye direéled .

the breech is detaioed aboye the pelvi., either by

lts uncommOD magnitude, or the narrowoe(s of the bario;

one of the Dates ¡s purh ed jo, while [he other rens

above the os pubis, (acram, or

either tide

¡..

che wo–

man-is Jow aod weak, the paios Jingering aDd infufficient

to force the ehild along; or if rhe is io danger from a vio–

leDt fl oodiog: io aoy of thefe cafe. , let him (duriog

e·

very paio) gradltally opeo firft the os externu"" anc! ,hen

the os interoum, with his f¡ngers and htmd_ Hav iog thus

gained admiflioo, Jet him pUOl up the breech to the fore

or back part, or

ODe

fide of the uterus, that his hand

OilOd al m may have room to fl ide along the rore-pans or

beJly of the child, fo as tO fed the thighs, that will di–

.ea bim to the legs, which -mulT be brought dowo wi,h

his

fingH5,

while, at the (ame time, he pulhes up (he

hams with his thumb, that io cafe thc kgs lie a raight

up, they may be extraaed with more e,re by the noa ioo

of lhe knce, and run lhe lefs rilk of bring bent, broke,

or o.erilrained: for , if they aro [oldeu dowoward, th, y

are the more eafily brought out.

If·the breech be flrongly preOcd in'o the upper part of

the pelvis, Jet him alfo puO, it upw;¡ró aod tO ooe lide,

<li.u

hio hand andoarmo nny h'\'e rree

d'alTa~e

; for the

hlgher [he brccc!l

ra:rc.i om of h s

Wdy,

\~ iU

be at

more frccdom

~o eXl ra ~t

lhe

lC'9.!'!_

both

Ic:g3

cannot

bl!

ca1ily uro:.¡ght down, he may

frlrdy

ucii\-cr

w1th

un! , of

whlch tdking

hold

",ieh a

lineo

c10th wrappfll rQunú

it,

let him

nide

up his olher hétnd

¡mo [he: vagin:l, and a finger or tw!' into lhe outride of

[he groio \vhich is b::ot :

there me...os, th e hip wiIl

come down lhe eafier, and lhe leg, which is aln:ady ex'–

traéled, \Vdl not be c'-t:r·nraincd by rullaining lhe whole

force of Full ing th e body along.

lhe leg' Jie to\\'ard. ,he lef, fide of the 1I'0mao, who

i, luid

0 0

ha back, , he right haod mul! bo introuu:ed

into lhe u[elus;

thl!Y líe to- hu right fide, che Jeft

hand \ViII bette. <,nf\Ver {he purpofe; and

they are

10.

wards her back or belly, either hana may be indifF.rent–

Iy "red.

lo all cafes where the breech prefeo", ,he f. fell

rrac–

tice is always to

pUnl

u}' ;¡nd u,irg down Ihe Jegs, pro.:.

vided {he os merí

is (uffi(

iently ddated,

aorl

the walers

nal wbolly

di Ccha rg~d _

If the waters are eV3cuated, the

merus flrongly contralled around

th~

child, lhe breech

Jow, fo as that it canDot be returned, or (o fmaH

come eatily along. \Ve ol:ght lhen tO deliver it accordiog.

Iy ; but, if fo Jarge as nei,her

be puO,ed up or brought

alGog wi t/l ,he affifla"e< of ,he fingers, let the operator

introduce lhe curvcd handle of [he blllnt- crotchet ioto

one of the groins, his fingers ioto the other, and pull

very

c.tutiouny,

in order tO pre

"c.nt

a fraéture

diflo–

..,ioo of the thigh bone, which might olherwife happen

from lhe ure of [his infirumenl, the blunt

POiOI

of which

mun be fuflicieotly

part

, he 1:,oiu.

fiJlet may .Ifo be

ufed for the faOle purpofe.

In the foregoing cafes ,he womao was fuppofed to be

Jaid

her baek, he< Jegs fupported, aod breeeh

the

bed·fide; thi, being gencrally ,he b¿ll pofi,ioo for deli–

yeriog the body and bead: iodecd . wheo the child i.

fm.II

, rhe !'>ay Jie on her fide , aod ,he fome o,ethods be

ufeu in delivering, provided Ihe operator nill remembe"

tmt in this pOGtiOD the iliulll .and iCchium of ooe fide

are down, and the

othe:r~

up_ Betides, when the

breeeh

puOled up, in <?rder to briog dówn the legs,

they

lie

forewards

towards {he fQre part of the uterus, and the

belJ y is pendulous, he can reach

tht.Ol

Wilh

the greaterl

eaCe! when (he líes on one [¡de, or, iI the reriHance il

VCJy

great, turo her lO her knees and elbows; but, wheo

the legs are delivered, if the ehild is

lar~e,

or lhe pelvi.

narrow,

(he

C\ught to be tu rncd upon her back, bec3ufe

the body aod he.d can be better aod fafer delivered by

pulling up ' Dd down; and io ,hat poljure (he is alfo kept

more firm, aod her thighs Icfs in [he opC'riuor's way, (hao

whcorhelies upooherfide.

s..

Plate

CXIl

fig.

l .

and

2 •

Thefocolld

<111ft

PR ETE RN .'TURAL L A.OURS.

' VHEN

the mc::mbranes :lre broke. but the (ace, Ihoul.

der\, or fome other pan of che chilJ. bcing pufhed iDto

the pelvis, locks up the os i",<roum. (o as that a fm.1!

qU'2n tity of the waters hath been dirch:lrged. the uteru!

kt:pt (rom con:raéling llronJ!ly lound the chdd, which

is therefore more cafily turned thao it poffibly cao

whCB

ther are

"JI

gone ,

W hen