1000000031

Lrol:e ; 3n:! ir he fiod. lhe head fo large, or the pelvis fo

n~rrt)w,

lhat

\Vil.l

be. dilJi.:uh

C.tve

the

chilj;

pro.

vld~d th~

''toman

VJgoroulI

and has

(trrno pains

may \\'ilh h"l< dimeu")" briog io the erown ;f the

h~ad,

lhen wlthdraw his haod ; and

lhe paíns

returD

and con.

tinue, the eh:ld ha, a sood ehanee to be delivered .Iive.

Evtn after lhe membrancs are brokc,

ihe pre(cntinIJ

('I:\rt

hl,h

13Ckcd up lhe os

internum,

as la deraía fom:

fonion

lhe wattrs (a circumelance

eafily

known in pufh–

Ing up the part that prefenu,) he m.y lun up his h'Dd

fpeeaily

keep lhen! from bemg difchor&ed , and all io

the fame manoer: but if the child is not larse, nor the

pelvis narrow.

""crc

pity,

whilc his hand is in the

Uleru" to denn from turning the "hild and briogiog

by the (eet; bec:uf. , in lha( cafe, he mI)" bo prelty cer o

~a:o

of r.>vinS it.

B.nd.

" after the head is broughl inlo

tlle right punlioD, fhould Ihe pd Ds go off entirely, (and

this frequently happens,) or a Booding come one, in con .

fequenee of the force whi ob halh been exerted, he will

6Dd gre.. d:fli culty in lurning after the waters haTe beeo

difchargcd; (or, it is huder tO

turo

wheD the vertex

preCenlS, Ihao

any other pofition;

whe'TC'as,

the caCe

of. large bead Or oarrow pelvis, wheo Ihe' head i, forced

dowo by the Jabour-pains , .nd ",iJl not fartbe, advaoce,

th. ebild ""Y be fa..d by tbe forceps

nay, thou¡:h the

pain, do not aél fa as to force it down, to be delive,ed

cithh by ,he forcep or in the natural w'y, the

h.ad

m.y

be opeoed aod dtralled with tbe erotehet, which is Ihe

Ian refouree.

But tbis neceffily feldom oeeun, beeaufe Ihe caf.. io

",bieh we are mort eommool y ealled, are afler ,be mem–

branes have beco lons broke, ,be watees difeharged, aod

lbe Uleros nronSly conlralled arouod tbe bodyof the ehild,

which it eon6nes, as it were,

mould: fo that

Deit to impoffible to briog the head into the o.tural

pontioo ; for lhi, eaooot be e!felled ",ilhou, firlt pufhiDg

the pa't that prefents, for whieh purpofe great {orce

required; and as one hand_only caD be

in~roduced,

whcn the opcrator endeavours to bring in lhe head, the

pulbing force is abated, to allow the pulling for.. tO aa

and Ihe pans tha< hindered lhe bead from p,efenting are

agoio forced down: bcGdes, the he. d i. fa brge and

Oippery, that he can

obt.in

firro hold. He migh l,

indced , by introducing a finger iOlo the mouth, I.y bold

of the uoder jaw, and bring in tbe face, poo.ided the

/houlder prefen.. ; bul, innead of ameDeling, this would

make the clfe worfe, onlefs Ihe ehild be ""y fmall: ye',

grintins' tbe head eould be brought into the natural pon–

lion, tbe force oecdrdrily exened for this

pur~ofe

would

prodoce a fiooding, "hieh commonly weakeo. the patient,

and euries off the p,\ins; and after aH, he mufi tUrD

with lefs .dvantage: and if that cannot be performed

when the head is brough! io , he mon have recourfe 'o the

lan aod mo!! difagreeable melhod

whereas when any o·

'her part prefen.. , we caD alway. tuen the child, aod de–

liver it by Ihe feel.

Thi. we caDnOI pro,!,ife .rter the

head is brou.ght in; aod ooce the

op~rator's

hand is

the uterus, he ought oot tO run Cllch

nOu .

The child is often in danger, and fomelimeslon, wheo

the brecch prefenes, and

10\V ,down in

tb~

pdvis,

pr~ .

. ided tbe thighs are fa Itrongly pre{!'ed agamlt the fumo

OL.

In. N°, 79.

237

aod belly, as to nop th. cireulation in the ropo : as aifo–

wh~n

the eh.ild is detaioed by the hcan, after th< body

dehvereJ.:.

botl~

e.\fes, the ?Jnger mu!l

obvia~cd

an expeJtttous ddtve,y; .nd If Ihe body is 'entangled in

the n...el,nring, it

mt~n

be diftngaged a, well 's poUible,

efpectally wheo the funls h'ppens to be betw«n lhe thighs.

The legs and breeeh of the ehild being broughl down,

ood the body properly turoed wilh Ihe rore pUlS to Ihe

mother's back, let lhe accou cheur cndcavour to bring it

al'log; bUl, if it js cb.ined- by Ihe fize of the

~elll',

die.

tended

with

air or water, (a care

thu

frequcntly hJppens

IVheo the child has been d,ead ro, (everal

d.ys

,J leuh:

belly be o?en,d, by forcing into it tbe poiots or his foilTaes'

or, he may

teu

opeo

witb

Ihe

fharp crotchet.

The bodyof the ehild being delívered, the arms "rought

down , and every method hitherto diroaed unfuecefsfully

ufed for the eXlrallion of tbe head, whieh is d:taincd by

beiog naturally too large, over offified, or dropncal. or

(rom

the

narrowoers

and dHlortioD of.

lhe pelvis

Ib-:

belly was nOI opened, and Ihe ehild is fvund to be ali'e

by Ihe Olotion of tbe hean , or pulfation of t-he aneries

lhe fuois, the fo,rceps ought to be tried ;

bUI,

Jinds

it impratl'icable to

dcliver

the

hcad, fo as

f...

'l!

tue life of the child, he mull, a-:cor'ding to Come. force

the poin.. of Ihe feiITar. Ihrough the 10\ller pan of the

oceipita'l bone,

through

rhe

foramen

m3gnum;

tbeD.

dilate the blade., fa as to enlarse the opeoiog. and in.

troduee a -blunt or fh"p 11ook.

Thi, operation rarelr

fuece.ed

, IVhen the head is over,offified; but may anfwer

the purpofe when Ihe boDe. are for, aod yielding; or iQ

the ca(e of an hydroeephalu,: beeaufe, in the

tirlt,

die

apenure

may

Cometimes be eolarged,

and

the

other

the water will be evacuated fo as to diminilh the bulk of

Ihe head, whieb wil!, of eonfequeoce; come llonl: with

more caCe.

If, nOlwithnanding thefe eodeavoues, the head eaortot

be extraéted, let the opérator introduce hit hand along

the head, .od his 6ngees Ihrough lhe os uteri

then md.

up ooe of the curved erotcbeu along the ear, betwil" his

hand and the child', head, upoo the upper part of whieh

it mul! be Sud: this b.ing done.

1<1

him withdraw bis

hand, lake hold of tbe ionrument with one hand, turniog

the curve of it over the forehead, aod with the other grafp

th.. neck and fhouldees, Iheo pull along. The erotcbet

being thu. 6xed

tbe upper pan, where the baDes are

thiD and yieldiug, make. a larse opeoing, thtough whielo

the eonteolS of the rkull are emptied, the head eoll.pnog

with more certainty extraéled, and the ¡narument hath

a firm hold to Ihe Jan,

Ibe forebead, os petrofum, aoll

baGo of lhe rkull.

T he e::<.cellency of

Mtfmlrd's

contrivance'¡s more con·

fpicuous her. tAan when tbe head prefen.. ; bec.ufe the

curvature of the crotchet allows (he poior to be 6xcd

01\

the

upp~r

part

the rkull, whieh i, tO be tare apeo;

and in pulling. the contenu t\re

c"l~ua~ed,

and the.hea.d

i. le{!'ened: by thef<

me.ns

, the pnnClpal obnruélloo

removell. See Plale

eXIlI.

fig. 8 .

a, Reprefeou a pair of cu"ed erotcheu loc<ed tOselher

in lhe fame maoner os Ihe forceps. The doucd

lines along Ihe ionde of uoe of the blades "pre(ent a

Ihettb contrived tO guord lbe point lill it is intro-

_ 3 O

duccd