1000000031

1\1

fDíppin~

tbrough the

jun~ur~.

ShoulJ this

attcmpt·réi!,

he:

ruul1:

dimini(h the bulk in the

bd l

Ol<tnncr

CilQ

think

or, and briog

lhe

body uf lhe fi rH, in

d¡!T~renl piec~sJ

pulling or cutling

liJen)

af"uncJ:.:r.

as he

extr¡~c1s

",ilh

t be help of ,l,e cre,chet.

No ccnain ru ks can be Jaidclown in theCc cí\fes, ,\hic h

Idom happen

and lhcreforc a grc:at

dcal

muH be

1t:ft

the judgment anJ fagacity of lhe opcrator, who mu!l re·

gulstc"his

condu~ ·accord ing

to ¡he circul11f1ances of [he

caCe, and according to

lh..:

d.re{

tioos givcn

lar

delivcrinJ,

wheo

the

p::Jvis is narrow aod

lhe

chiJd rtn

extraord:ua –

ry large.

Oflh,

C JES ARIAN

OPER.IT

lO S.

WHEN a wom.n cannot be delivered by any of the

m ethods hitherto defcribcd and rccommellded in hboriou5

aDd

prcteroatural

Jabours, on

acccuoJ

of the

narrownefs

difiortion

the

pelvis, ioto which it

fOmet tffiCS

iDlpoffibl e to intr.oduce the: hand; or from large C'xcre–

""'ces and glandular flVellings, ,hat fill up the v.gin.,

and c¡nnot

emoved; or froro Jí\rr,e

ci~? t.rices

and

heuons

lbat pan, and

lhe os

ut~ri,

which

cannOI be

{~paratc:d

; in [ueh emergeneies, if (hc

woman is

(hone,

and of

good haoit of body, rhe C.,f.. i,D

op~r.rion

cenaioly ad'V¡ feable, and ought to

p':rformcd ;, becaufe

the mother and child have no other chanee:

[aved,

nnd it is óettcr

have reeourCe to

:10

operadoo which

luth Cometimes Cuceeeded, ,hao Jeave them both to ioc:vj.

rabIe dealh. N evenhelefs, if the wcman is weak,

fX –

haufied Wilh fruitlefs labour, violent floodings, or any

o–

tber evacuation, whieh renders h:r

rccovc.ry

dt,ubtfuJ,

c–

ven if (he were ddivered

the

natur:d

way:

tbefe. cir–

cumfl:anees il w()uld be rafhneCs and prefu¡;nptioD tO at·

' empr an operarion of this kind, which eugh,

be.delay–

ed until the

womaa expires, and then immediately per–

{ormed. with a view

rave. the.child.

The operarion harh been

p~rformed

bo,h io ,his and

tbe JaJl century. and fometirne.s

w~h

fueh (ucce(9, ( that

lbe mother has recovered,

and

(he child Curvived.

1 'he

prevíous Heps

to be

taken, are

to (hengthen

lhe

patient,

weak,

with nouriflling brQths and cordials; to evacuate

(be indurated f::eccs with repeated gJytlcrs; and,

the

bladJer is diflended with urin:, tOdraw

off wit h a ca–

the'er. Tbefe precaUlioos bcing "ken, .Ote mul! be laid

her baek, on a couch or becl, her fi de on whieh the

;Dcifion is to be made being raif. d up hy pillo\Vs plaeed

below the oppofite fide: the oper3lion

may

be performed

either fide , though ,he lef, is eOOlOlonly preferred to

the right; becauCe, in lhis

Jan , lhe

liver exte.nds Jowu.

Tite appa rarus confin. of a billory, probe.feilfars, large

needles thrt:aded, fpungeS', warm wate r, pledgets, a Jarge

teor or doflil, cOOlprelfes, and a band'geJ'or the belly.

;'f

the weather is cold, lhe patient

muH

be kept warm,

aod 00 part of the belly uncovered , exeept thnt on whieh

the inei(ion is to be made: if lhe o peralor be- a young

¡,raéli',ioner, ,he place may be markcd by drawing a line

along tke middle (pace betwecn the navel alld the. os

iliu "l, about (ix or fevcn inches in )ength, (}anting for–

",ards toward. , he Idt gtoin, .ud bcgi'Joing as high as

,he

nave!.

lI,~cording

tO !his

dir<~icn,

let hiOl hold the O<in of

the ahdomen tenrc bet ween die fi riGer 2nd thu mb o( one

han.d.

a~d,.

wich the bifto,

in .the oth:r,

rui!J:~

a 10ngi.

tudlr..,l

In~¡{iuíl

lhlOUgh

the

CU,I: , tO t he

membrar.:1

adi.

pofa, which, with lhe

r.lufdcs~

mua be

n O'A

ddreét~j

and

(cp~rated,

un:il he r<a ches

th~

peritonzlJ lO, which

f=1u rt he

diV'id~d

very cautiouOy, for fea r

of woundiog

the

ime!Hnes Ihat freq uently n3n up at the fides, efpecially if

the mcmbra.nes are. broke, lhe waters difchOl,ged, and

the

uterus cont ra ...

'lt:d.

' -!1:

pcriton;::eum beiog

laid

bare,

may either be

pinr beJ up by the ¡ingcrs, or llowly dilf,éled \Vitb ,he

LiHory, until

ope.njn~

is made fuAlcieot ta admit the

fore.ti_oger, which mua be in!roduccd as a direélor foc

the biHory oc feifr" rs io makiog

dTeétuaJ dilatation.

Ir the-iotdlioes pUOl OUt, Jet them be

preF.ed

dowowards.

<ti

Ihat the uterps may come

contj.lét with the! opeo.

il\g.

Ihe womb is

fiill

diflenued with the waters, and

at (ome di(LlOee from_ the child, the operator may

Rlítke

upon

a longitudinal incífion at once; but if it is

COR·

" ..éled c10fe round ,he body ohlte frelus, he mufl pioeh

IIp,

aod dilate io {he fame cautious manDer praétifed

upon tbe peritonzum, taking CaTe to avoid \\'ounding {he

Fallopian tllbes, Jigameots, and bladder : theD iotrodu·

ing his haod, he Ol.1y uke out the child and fe cundincl.

Ir (he woman

fl rong, the merus immediately cODtraéh.

that the opeoing, which at firfr extt:nded to about

fix

or feveo ¡oches,

re.duced

two, or leC, ; and in

cODfcqucnce of Ihis cootnélion, the vefrels being Quuok

up, a great

cffufion

of blood is prevented.

The co.glllatc<l blood being removed, and what is

mil

/luid fpuDged up, the ioeifion in tbe

a~domen

mufl be

llitched with the interrupted (mure, aDd fufficient room

left btl weeo ,he lan nireh and me 10IVer end of ,he open·

ing, for ,be difcharge of the moi flu re and exrravaf..ed

!luid. Tlle wouod may be drelfed with dry pledgi,s or

doffils dipped in fome liquid balfam 'warmed, covered

with compre!fes moifieoed with wioe, and

bandage

keep on ,h e drcflings andfuflaio Ihe belly. Sorne authon

obC~rve,

lhat

the

cu tis aDd rnl1(cles ooly (hould be take.n

up in the futnre, len bad fymptoms /hould arife from

fi :tching the peri tonreu rn .

'The woman mu(f be kcpt in bed, as quiet as poffible,

nnd every thing ad nliniCl:ercd

promote the Jochia, per·

fj)iration,

and

(leep :

"hich

will prevent

rever and

o–

,her dangerous fym'p,om. . U fi,e bar\¡ Ion a gre>! quan–

tiiy of blood from the wouDds

lhe \!terus and abdo·

men, fa as !obe iDd IOgerfrom inaDitioo, broths,

caud le~,

and wine, ought to be given.!o (maJl quanlities, and

rr~·

qu~ntly

repeated; and the Peruviao bark adminine.red

powder, dccoétioD, ol"cxtraét, may be of

gre.at

fcrvice. in

,bis eafe.

Ihe managenunl

tUJomen / rom

'n!

lime of ,luir

ádjvery lo Ihe

t1Jd

Ihe-mDnln, rwiln

Ih~/~v~rt11

dif

enlo lo'Which Ih,) are

lu~jd}

during Ihul periodo

Of Ihe

EXTERHM. ApPL ICATIOH .

womnn bcing deliycred of (he. child and placenta,

I'!t a foft line.o cloth. war01ed, be applied to the exter–

nal pans; and if /he complains

D1uch

of a fmarting fore–

nef., fOOle pomatllOl may be frread upon it. Tbe lioen

Iba,