1000000031

arter tho oporJtion, and C3n be f'P?orted by rrequ01t

dr:.ughts ofbroth,

jelly,

caudll!,

W~il!{

c;Hdial, and

ano ,

dyne medicines, which mJ.int.lin the circulation. and

gra..

d u,lly 611 th: em?ty ,'offel , .

Ir.

in tilUe of Ilooding, Ole is f<ized with I.bour. pain"

ir, by

every no'" élnd (hen

n retchin~

\Vith you rfingers

the os internum, .

yllu

bring

1.,!)our,

which either

lhe

ml!mbran~s

or head of [he

chi lcl

pdhcd

d,,\Vn, and

Oreos

the os imcrcum, the

m~rn~rancs

ought

broke; fo

lh,o\(

fmne of

Ihe walc:r!

b..:ing

dirch .lr~ed,

the

uterus m¡y contraél: and fquecze

J OWll

rhe (retus. This

may

be::

done faoner in

thore

\Volll.:n

who llave haJ ehit·

dren {ormcrly . If, ootwilhnandi:lci this

expedient o

[he,

1J00dtog IIdl cootinu'es, and the ehild is nut like tO b;,

{oon delivered.

!nun be turned irnmediatel >' ; or,

the

head ¡s in

the pelvis, delivered wilh tne fo rceps : boto

n!:ither of theCe twO methods will!Cuccecd.

account of

the

narrowners or lhe pelyis.

thc bignefs

Ihe head , this

lan ",un be opened aDd delivered with the . rotehet. In

al1 tlltr. eafes, let ¡he parts be dilat<d Oowly aod by in·

tervalS,

arder

prevenl h.cera.tion. See PI:\te

CXI.

lig.

4. 5. 6.

T h! /hird c/aji

o/PUTERN ATURAL L A' OU RS.

hl~e

alreadY-Obferved, thal the principal diffieul·

tie!

turning

childr.en

and bringing lhem by the feet,

proeeeded from the eootraélion of the utúus and bad

ppGtion of the fcetus. If the ebild lie, in a round form,

whether the fore· parts are towards the os internum, or

\lp

to the fuodus uteri,

cao, for the mofl put, move

it with the

h.nd

, fo a, to turn the

he.cI

and Ihoulders to

the upp: r

pan.

and lhe breech and legs downwards ; but

if the c"ild lie,

leogthw.ys

, lhe

wo.mb

beiog eontraéled

:\rouod ¡t, like· a long lh:ath, the tolO( is more difficult ;

erpecially, if the head and Ihouldas of lhe ehild are

dowo at the Jowdl: pan of the Ulerus, with lbe breecb

and feel turned up to the fundus.

The hand of the opentor beiog introdueed ioto the u–

teros, if he 6nd, the breeeh below the head and Ihoul–

den, lec him fearch for lhe Jegs,

:lOd

bring

them

down: but

if the breeé'h be higher than the upper p.rts of the child,

ar equal \Vilh them, he muO try to

t u

the head and

Ihoolder! to the fundus, aod the breech downw:lrds, uy

puChing up the 6,n. and pulling dowo the I.n; then pro–

cced with. deli very as

befare di reéled. T his

~ommonly

exccuted wltb eafe

provided

fome

pot rt

lhe waters

Oill

Tc'natn in the uterqs :. but, if the wom:m has becn long

in I¡bour. and the \\'arers

dircbar~t'd,

the contr:;¡étion of

lhe

wo;nb

is fo

Hrong.

th:u lhe

cbild cannot

turned

\\" ithoul

the

exenion of great force

frequently

repeated.

this cafe, lhe

ea.r~dt:

mechad bOlh for

the

patient 2nd

operator, is to puCh up the hand gradually 00 that (,dtno

which lbe le&, and thighs

are

turocd; and

even arter he

h~s

reached lhem,

they arc oot very

high up,

Jet

h¡m

aUV1nce his haod

far a, the

fUDdu~

utui; he

will

tbus

T~mOT~

the greatc:Oobfi3cle, by en1arging Ihecat<ity of the

,"omb, fo

more ..(,Iy to feel and bring do· ...n the legs:

then he ruay puCh up and pull down, as we have pre·

fcribed abo.. : but, ir the bead and Ihoulders nill eontinue

hinder the breeeh and body from eo:ning . Iong. aod

tite. fcet eanOOl be brought fo 10IV, al the outfid. of the

'l.

cxtcr~uOl.

while they are

y.!t

in the vagina he nuy

.??I

ooof. upon one or both; for unlefs

ti"

ch,ld is

fm;¡lIlhat he

C.lO

tum

rou.ld

grafping lhe body when

lhe heaci .tnd fh:lu!d: rs are pufheJ

uj>. anJ

he endc:avoLJis

bc-ing down the

oth~r

pan,

tl1.:y \Vdl

ag~in

rcturn co th:

fa me

plAce, alld

rctard

dclivery: whcreilS , ir

gAios 1

firm

hold of che feet,

ei[h~r

witho,Jt the os excernum , orin the

vanin~.

J\1C:ln3

of che noole

(j:<ed

uroo che anclcs, he

can

with the other h!nd pulh

th" he.d and Choulder, aod be

ablc

thu moloner

bring

clown

che

bre~ch.

muH

con–

!inue this mechod

puOlín:;: up and

p." lIi0t:

down, ur.til

the he Id ancl Chould.!r are

rttired to [he

funous uteri . for

Choul.! he leave off too foon, .nd withdraw his hand: al.

though the ehild

exua(ll!rl

far as the breech,

the

he.d i, fometimes fo pr<Oi:d down and eng.¡:cd with the

body

the p¡lf.tge, chat it canOOl be brou:;hc farcher

down without ,bcing tare along

with

Ihe crotehee ; ror che

breech .nd part of the Iiody may hloek up the pa{f'ge in

ruch a mOlnner, as that the ha:1d canobt be inu oduced

raire the head,

Thore caCcs are COnlOlQ:lly the eafien

which the fore–

paru prefcnt. and

rhe

c:hild Jiu in

round or oval form,

acrofs th e Ulerus, or diagnnillly; \IIhen

the

he.ld

orbrcc:ch

above and over lhe os puhis, wilh lh e

lcg~.

arms.

and

navc:l:firiog, or on:. or

;tll

{h~m,

al the upper or lowcr

pan of the

Y4gina,

or on Ihe outfide of the os ex;;e.rnum.

Thofe are more diffieull iD whieh, though tbe ehild lie.

the fame round

eontraétcd forOl, the back, Choul–

ders. belly, ar brean, are over the o, ioteroum

beeau[c

we ea.onot move the

child

round, fo as to place lhe head

ta the fuodus, the legs are brought dowo wirh'much more

diffieu!ty thao in the otber cale: but if the Choulder ,

brean , oeck, ear, face, or erown of the heaJ preCents,

and

the legs and breech are

to lbe fundu! uleri, lhe cafe

i. llill more difficult; beca"re, in the other two. the u–

tenu is 'cODtraéted in a round form, fo thac ,he wroAg

pofition of tbe child is more elGly altered than in this,

when the \Tomb is contralted

lone

Chape, and fO,me–

times requires

van

force to firetch it, [o as that the

~ead

m.y be raifed to tite fu.dus, and the legs aod breech

brought down,

The crown of the he.d i, the worn part that eao p"–

{ent, becaufe

thal caCe the fc:et

a~nd

breech are high-er,

anel the uterus of a longer form lhan in

aoy

otner. The

prt:(tou,ion of rhe face ¡s, néxc

litis, atteoJed wilh the

groatdl diffieu!ty: pur when the neek, Choulder,

b.ek

, or

Brean prefeot, the head is rurned upwards, aod keeps the

lo\\'er part of the womu dineoded : fo that, upoo nreteh–

ioS the upper part, the ebild's hcaJ is more eaGly raired

to the fundus .

"¡hen the fore-parts of the child prefent, if the feet,

h~nds,

and navel Oring are nOI del.lincd al>of'c the

p–

teri, fome or alJ of them de(ccnd into the

vilGina.

ap·

pear

the oueGde of lhe

externum . If one or more

of thcm come down,

aod

lhe chiJd al Ihe fame time lie,

round form acror, lhe Ulcrus. let tite accou:hcur

in–

troduce his hand betwcen them and lhe facrJm \\lhen

is:paCl the os intcrnuOl, Jt:t it ren

I¡ttle. whiic he fed,

wilh hi.

r.o~crs

the po(¡tioo of the flrtus: j f lhe head

and {ho"lúe" lie

hi~her

than the bree: h, he mun take

hold of the

le~,

and briog tbem down withcut(¡de the os

iotcrnum: