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.

    184/1188 (page 160)
    neum. The passage of the knuckles occasions the principal pain. and danger; which are greater if the woman have not borne children before. The transition may, however, be facilitated by using the fingers as dilators ; and the operation should proceed with mingled firmness and gentleness. When the knuckles have cleared the os externum, and the whole hand is in the cavity of the vagina, it becomes necessary, in the next place, to enter the uterine cavity ; for which purpose, again give to the fingers the conoidal form, and slowly enter the uterine cavity,—passing the mouth of the womb ; which is always in a great measure dilated, before the operation can be properly begun. If the membranes have been broken, and the liquor amnii dis charged, the hand readily enters the cavity of the ovum; but ope- rating early, it will sometimes be found that the membranes are not yet ruptured; and in order to enter them laceration becomes necessary. Whatever is worth doing at all, is worth doing well. Let this part of the operation, though simple, be carefully executed. The most favourable opportunity for breaking open the cyst, is when the membranes become tense, under the action of the uterus. Be careful to put the hand into the cavity of the ovum; as the interposition of the hand between the womb and the external surface of the mem- branes might give rise to flooding, by detaching the placenta; and throughout the whole of this part of the operation, bear in mind the awful specimens of vaginal and uterine laceration which continually occur. | Suppose, now, that all these measures have been carefully exe- cuted ;—that the cyst has been opened, and the hand has been insinuated; that the os uteri has sustained neither contusion nor laceration ;—the hand being passed thus far above the brim of the pelvis, and lying in the uterus, the operator may promptly, tenderly press forward towards the fundus, so as to bring the brawn of the arm into the vaginal cavity ;—preventing, by this plug, the escape of the waters; if they are not already discharged. In this way the hand lies, perhaps, in the midst of the waters; or if the womb be lax and capacious, the hand may be moved about with facility, though the waters have been discharged. Knowing the position of the feet, advance (during the absence of pain) directly to this part of the uterus, usually the fundus ;—slowly or rapidly, as the parts may bear ; taking care not to lacerate the womb or vagina; and remembering that, at this moment, a thrust of the hand is contusion,—laceration, ——destruction,—death! The third stage of the operation completed in this manner, and the hand approximating to the feet, the arm in general lies in a line stretching from the umbilicus to the coccyx ;— , the bend of the elbow approaching the key of the pubic arch; the hand lodging in the top of the uterus; and the brawn of the arm taking its place in the cervix uteri and vagina. At this part of the operation pause for a little ;—repose, and reflect! Preparation being thus made, the fourth stage of the operation commences with the seizure of the feet ;—care being taken to ascer- tain clearly that they are the feet, and not the hands; and further,