The principles and practice of obstetric medicine / Carefully revised & corr., with ... additions and notes by Alexander Cooper Lee and Nathaniel Rogers.

  • Blundell, Dr., 1790-1878.
Date:
[1840]
Catalogue details

Licence: Public Domain Mark

Credit: The principles and practice of obstetric medicine / Carefully revised & corr., with ... additions and notes by Alexander Cooper Lee and Nathaniel Rogers. Source: Wellcome Collection.

    169/1188 (page 145)
    A ‘Mis-management are so like each other, that their nearest acquaint- | { ~~ A ance cannot always distinguish the one from the other ! In bringing away the head of the child, the operator has, some- times, to contend with difficulties at the brim ;—arising, most fre- quently, from want of room between the front and the back. .To the consideration of these I will next proceed. Eight or ten crural presentations, with deficiency of room at the brim, have fallen under my notice ;—the want of space being ascer- tained, in these instances,—not by nicely measuring the pelvis,—but by the detention of the head at the superior aperture ;—notwith- standing that the position was favourable, and a full abstractive force was employed. When the feet present, and the head is lying in the brim, the body being thrown out of the way into a commodious po- sition, a dexterous operator might, I have no doubt, apply the long forceps (or even the lever) to the head of the foetus, and draw down with great effect. Steel, however, like the nerves of a rude accou- cheur, is apathetic, and has no sympathies.* ‘The steel of the in- strument-maker is sometimes as fatal as the steel of the armoury ;— and Laundy+ and Perkins { may perhaps vie with each other. In difficulties of this kind, instruments are not, in general, needed ; and therefore, I conceive, they ought not to be employed. The delivery, in many cases, may be effected in the following manner. Availing himself to the utmost of his knowledge of the forms of the head and the pelvis respectively, agreeably to the principles so often stated, the operator places the head at the brim, with the face and occiput in the sides of the pelvis, and the chin upon the chest ;— taking care to draw in the axis of the brim; that is, in a line ex- tending from the navel to the coccyx. To secure the command of the head, when practicable, place two fingers on the chin ;—the rest of the hand bearing on the shoulders and chest in front; while, the other hand resting on the shoulders and chest behind, pass a finger as high as may be on either side the occiput, obtaining that bearing on the child which is required. The child thus secured, request an assistant to take his place at the bed- side, near the loins of the patient; and (with the interposition of a cloth) grasping the body of the foetus, to draw as you direct. These preliminaries observed, when a pain occurs draw down in co-opera- tion ;—perhaps swaying the body a little from front to back (careful of the perineum, however) ; till, the head brought to its bearing, you say to your coadjutor,—“ Stop !—Lie on the pull !—Let us suffer the head, under moderate compression, to mould itself.— Let us wait for another pain!” Look at the countenance ;—count the pulse ;—reflect! After pausing in this manner for one or two minutes, draw as before (during a pain, if there be any) ;--advancing the head a little further, and again pausing, with the same caution as before ;—thus allowing the head to become further moulded and compressed. Proceeding in this manner,—pulling at one moment, * From ovy, with; and racye, to suffer. t A surgical instrument-maker in St, Thomas’s Street, Southwark. { The inventor of the steam-gun. L