1000000031

'Vh.n, before Ihe membrnne. are brokc, the ehild i, fe) t

thruugh thrm. prckndng

\l.'loog.

and

the faml.! time

.he

p ...

ins pufh them Jown

fo a5 lO

,l.ut

the os ¡n(ernum

more or

Icr~

\V h~n

lhe wom,,", al any time in lhe (our

hfi

months.

is feized with a violent l100ding

(hit

c:l1lnot

be rel1 rained,

and unlors fpcedily ddivaed mufl lofe her life ; if I.bour·

pOlios cannOl

be brou; ht

firer ching

lhe pares,

deJi–

verymu!l be (oreed ;

bU l,

fhe is in labour, OInd

lhe

mem·

br1ncs h;¡ve beln pufhed down \Virh lhe

Winers,

(hey may

be broke;

WIHCh

means, lhe ftooding is frequendy di·

mini(hed, and Ihe ehild ddivered by Ihe I.bour.p.ins.

In theCt three diffcrent caf:$,

wc can prevent the

flroo!;: contraéhon of lhe uterus

keeping up [he

Willen,

we e. n .ICo for Ihe mol! ro" lurn Ihe ehild witb gre.t

cafe, eV(:" in lhe \'t!ry \Vorfi

poli,ions.

In lhe lirlt'cafc,

let

lhe operator Oowly introduce his

h~nd

into lhe vagina, and his fingers b(( ween thas pan

of lhe child wh ich is purhed down, and the os ¡nteroum:

fo doing he perceives fome of

,he

walers coming

long, he mull run up his h. nd

q uiek

pollible inlo

tbe .uterus,

benvi~l

the inCide of (he memcranes and the

ehild', boJy; Ihe lower parl of his arm will lhen fi ll up

lhe os externum like

plug, fo that no more of ,he wa·

teu can país; le' him turn the child with its head .and

lboulderJ up

Ibe fundus, Ihe broceb down

the low·

er pan of the uterus, and (he fore parts tow.¡rds the

mother's baek ; lel the hand be pun,ed no f. "her up

.haD Ihe middle oflhe ehild's body, bce.uCe, if il is ad·

.anced

high as the fund us,

muO: be withdrawn lúw–

tr,

before the child caD be

tu roed

;

aud by theCe meaDS

.be walers will be d iCcharged, and Ihe uterus of eoofe–

c:uc1t:e contna

to render (he lurning more dlfficult .

the Cecond cafe, when the membnoes are not brake,

Ind

\Ve

are cerrain that the child daes Dal prefent fair ; if

the os interoum is nOl fllfficiently dilated, and the wom1.n

in no daoger, we may let the bbour go

00,

untiJ (he

pares are more nretched ; lubricatiog aod extending tbe

externum. by degrees, during every paio. Then

iD·

troducing one hanll iOIO tbe vagina, \Ve inCinu:lte it in

fbuened form, within the osi nterllum, and purh up be·

twten

tbe membranes and the oterus, as faras the middle

of .he womb : I:.,.ing thus obtained admi/lioD, we break

Ihe ",embrancs by graCJ'Íng and Cqueezing them wilh

OUT

fingen , Oide our baod wHhio theOl, Wllhout moviog

the arm lo\ver down, (hen

turo

and deliver

formerly

direfled ; bUI if, in any of .heCe eaCeo, you 6nd Ibe bead

large or the pelvis narrow, l>ring down ,he head into

.he . ..

ur~1

polilion, and allifi as direfl<d ia liDgeriag

or I.borious cafes .

the wom.n (io Ihe Ihird eafe) i• • ttaeked wilh a

• iolenl ftooding, oeealioned by a Ceparation of all or any

part of the placenn from the merus, during the lan four

months of pregnancy, and evtry method

has

io vOlin beco

tried to lecren aud reRrain tbe dircharge, the operator

ought

pronounce the tafe dangcrous, and prudently

declare to Ihe: rebtioos of the patient, that unl([s (he is

fpeedily

deli.er

<d, bOlh (he ard Ihe child mufl pcrin.,

obfening at (he fame: time, that by immcdiare dcJivcry

Ihey may bOlh be Ca,.d: lel hin> .Ifo defire Ihe ,1liflaDce

IDd ..I,ice of (ome perCon <",iMal ia Ibe proftllioD, for

VOL,

1\1.

,9,

Ihe Calisfaflion of her Cri.oos, . nd Ihe Cupport o( hi. o\Vn

re puI;uion. 'VIIC:rc there are no laboar-pains, aod

lile

mOlHh of Ihe womb is not dilated,

is fometimes very

d,fficuh to ddíver, more e:fpecially if the os 1o,eroum

¡,

nOI • linle lax, bUI

f.el

. rigid.

If the os, uleri is fo much cootralted, that the linger

cannOI be lntroduccd, fome authors

have

recornmended

• drlator, by which il mal' be gndu,tlly opcned

admit a 6nger or two . D oubdefs, fome cafes may hap.

pen, in whil:h lhis may be necclfdry.

in ilretching

Ihe

os internuru, labour pains are brough l on, let the opera·

tOr Oowly proceed and encourage Iheill: when

[he

momh.

of Ihe womb i, opened , if ¡he head prefcnts and Ihe

paios are firong, by bn:aking the me'1lbranes the flooding:

will be diminin,ed : bu., if (he floods

fu eb a degr«

be in danger or her lire, aod (he di!atation docs

nOl

bring on labuur, at lean nOl eDough (or the occafion,

(he

mul! be inimedia:ely delivcred in ;he following maoner:

bu. in Ihe 6rCl place lel her friends be apprized of Ihe

danger, and the operator beware of promifing to (ave

ei·

ther mother or child.

The

operator having performcd his duty

mzking the

fri ends acquainted with the lituation of the caCe, mull

gently opeo lhe os externum, by introducing his 6ngers

gr.dually, lurDing Ihem half round and pu(hing up 'vard ;

theo forming them. with the lbumb,

iD10

the figure of

wedge or 'Cone, continue

dilate Oowly and by inter–

vals, until his hand is admitted ioto the vagina: having

thus far gained his poiot. let him ioCinuate. in lhe [ame

{]ow (autious manner, 6rO one. then

IWO

fingen, into

(he os inleroum, which may be dilated fo

to admi't

tbe

other twO and the thumb in lhe fame conicaJ formo which

will gradually

m.ke

way for Oiding the hand aloog be–

tween the outGde of the membuoes and ¡oude of the

u·

terus; then he

mufl

manage as dire(ted

the fecood

caCe:

If,

"'pon nidiog up

nis

haod UpOD Ihe outGde of

Ihe membranes, he Ceels Ibe placeala adhering

tpac

fide of Ihe womb, he mufi eilher ",i.hdraw Ibal haod,

and introduce Ihe o.her

Ihe oppolile fi de, or break

through ,he membranes al the lower edge of the placenu

The greatell daoger in Ihis c:¡fe frequently proceed.

from Ihe Cudden emplying of Ihe ulerus and belly: fo r

when Jabou r comes on of itfe1f, or is brougln

regular manner, aod Ihe membranes are broke, the

Bood–

ing is gradually dimini(hed, and fira the chilJ, then Ihe

placenta, is delivered

the paios; fo lhat the prdfure

or refiflaoce is not

2111

al once

removed from the belJy and

Uterus of tbe woman, which have time

cootraél

degree,; eonCequently, IhoCe (aioliog·6.... and eonvlIl–

Cioos are: prevented which often proceed from a fudden

removal of Ihat comprcffion

~under

which the circuladon

was performed.

The younger Ihe woman is u it h child, the greater is

the difficuhy

openiog the os ¡nteroum

:and more fo

Ihe firfl ehild,

eCp~ally

if Ibe i.

p.fl

Ihe age of Ihir\y-

6ve.

'Ve (hould Dever refuCe

deliver iD tbe(e dangerous

cafes, even ahhough the patienl fccms expiring: for,

imOlediately arecr ddigery. the

Ut~rus

contn8s; the

moulhs of tI:e ve!rel. are (hUI up,

Ih.. the

B~oJiDg

ce¡,[cs; and fue may recot'tr, if Che li'Vu 6fe: or Gx hours

3 N

.Clcr