Dr. Lowthers Lectures on ye Theory & practice of midwifery – Lecture 1st By midwifery we understand a Branch of Medicine with treats on Pregnancy. A pregnant woman must conceive, must go a certain time before she is deliver’d. To understand conception, Uterine Gestation & Delivery, you must have a good knowledge of. Genitals, male & female, to know wh. We render coition abortive, in ye. Male [crossed out] what operations will take away his procreative power & gen [illegible] well understand ye formation of ye. Genitals to form any opinion of yt. Defect. By theory is meant to certain principles ys. is certainly necessary to be acquainted with. The knowledge of ye Pelvis is certainly necessary, tis a Cavity seated below ye last lumbar Vertebra. It’s a hole made up of different Bones & can’t be understood without being acquainted with ye. Several parts yt. Compose it with each Projection, with each notch & each hole Some say, ye its made up of three Bones, ye two of Innominata & Sacrum to wh some add the Bones of ye Pelvis Os Coccygis; others say that & Bones constructed ye Pelvis, In ye acetabulum are 3 Bones on each Side, the Ilium, Ischium & Pubis & ye Sacrum wch. is ye 7th & Coccyg. wch is ye 8th. We shd pay attention to ye difft parts of ye pelvis, ye Base of ye Sacrum measures from ye lower Edge of ye Symphysis pubis, about 5 inches. We shd be well acquainted wth. ye difft. parts and their Names. ye Women call ye. Sacrum. Rumps ye Coccys. They call ye huckle bone, ye Illium, they call ye Haunch, the Ischium ye. Hip & ye Pubis ye sheer Bone. Consider ye. Division as they constitute ye hole. Tis necessary know ye. Peculiarity of ye fetal Pelvis, wh ll give way in ye. same manner as ye. Head to ye Pelvis of ye Mother. The male & female differ greatly. Another division of ye pelvis yt is of ye greatest consequence, viz: yt those Pelvises wch are called standard, 800 out of 1000 will come very near what is called so; some divide it into ye. true & false. The properties of ye Standard Pelvis with respect to [crossed out] Midwifery, not anatomically consider'd are as follows. There are 3 parts more necessary to be acquainted with ye. others, viz. ye Brim, the Outlet & ye Cavity, between both some call it the Inlet wch. is bounded by ye Sacrum at ye Sides by ye Illium and before by ye pubis. It’s brim has been like and to many Standard Pelvis things, Monsr. Levret says, it resembles ye hearts painted on cards, but is best considered as an oval. The Dimensions of ye Standard Pelvis from ye Symph Pubis to ye. Sacrum measures 5 inches; [crossed out] Diagonally a little a little longer; The longest axes is from side to side- Dr. Smellie says that ye widest part of ye head passes thro' of widest part of ye pelvis, but this is not true. it enters diagonally, & most pass so or across ye. Head generally enters obliquely, one Ear to one side or other of ye pubis, from Pubis to Sacrum ye shortest & from side to side the longest axis. The Obliged line ye. best way for passing ye head, it generally does pass so, One Ear a little one side or other of ye Pubis, the Ear never comes out exactly under ye Symphysis Pubis. The head must always pass in Circular Line. ye Ear comes out obliquely, therefore, if ye. Ear is situated at ye. Symphysis & does not take ye turn, you most assist, if you can wth. ye fingers, if not, by Instrts. You shd. draw out by ye. long axis of ye Pelvis, when you have got ye fingers in ye. Child's Mouth, but never bring ye. Chd out of ye. Pelvis wth. its face toward ye poach of ye Mother but on one side or other & bring it always obliquely.- Bringing away ye Child Lect 2nd The Outlet of ye Pelvis limited before by ye Bones and behind by ye Sacro-Sciatic Ligamts. You shd consider wt. parts can give way: The Os Coccygis from its Structure is enabled to yield ye. longest diagonal of ye. Outlet from ye. Symph. Pubis to ye. Coccys. – The Chd. generally passes in ye. longest Axis, ye. Occicputt always rises under ye. Symph Pubis, for ye. Head is a round oval ye. Sacro-[illegible] Ligamts. are elastic for they yield. The cavity of ye Pelvis is from ye. Brim to ye. Outlet. The different parts are not alike in depth, ye front is ye shallowest, ye Posterior, ye Deepest, the lateral parts not so deep as behind, yet deeper than ye. Front parts. The Front is near 2 inches deep ye. sides 4, & ye Back 6 inches. – When you [crossed out] Examined for ye. Child, convey ye fingers up in front, as this ye. shallowest part, & you’ll have ye. length of finger for it wn. ye Chd rests on ye. Brim of ye pelvis convey ye. Finger in front & you’ll feel it, yn. mark your finger, & if you find 2 inches depth, you may be sure ye. Head is on ye. Brim. When ye. Hd is in ye Pelvis, carry ye. finger along ye. lower part of ye Symph. Pubis. parallel with. ye brim, if you feel ye. head on ye. finger it is two inches in ye. pelvis. The had does not pass in a Examining for ye Child strait Line, if it did, it pass thro. ye Anus. The posterior part of ye. Pelvis curv'd ye. Hd. of ye. Child is obliged to pass in a curv'd Line, therefore wn. we bring it out by force we shd imitate Nature as much as Possible by drawing in a curv'd Line & begin to draw wn. ye. Occiput rises undr. ye Symph. Pubis the Crotchets must be used in ye same Manner. When you have got ye. Feet. incline ye. Back to ye. Belly of ye. Mother & ye. passage is much easier.- When you deliver ye Placenta, get 2 fingers on ye String/ ye Funis/ in ye Center of ye Pelvis & it’ll come away easily. The distorted Pelvis or a small one tho not distorted, if there’s a large Chd. it gives great trouble; The large Pelvis retains ye. Figure, & increases ye. Dimensions, the Crooked or distorted retains not ye. Figure & ye dimensions fall short. What can occasion such Distortion,- fractures or dislocation of ye Thigh bones will do it, but ye. general Cause is Rickets, they bring on a softness of ye. Solids parts of ye. Body, it may be distorted from Sacrum not being also, to bear ye weight of ye. Spine &c In such a Case ye Pelvis below suffers mixed. Rickety Children sit a great Distorted Pelvis from Rickets 12 yrs. of ye Placenta method of Delivering a great deal, and occasion ye. Tuberosity of ye Ischium to come too hear & to destroy ye figure of ye. Pelvis. A Woman from a Mollitios Ossium may from being well formed becomes distorted; I know it pass a strait Line from ye. Lower Edge of ye. Symph. Pubis to ye. Basis of ye Sacrum. & it measures about 4 ¾ inches, when ever you find it so, ye Pelvis is well formd. When ever you find ye. Base, it's good sign, tho' there may be a small Distortion even then. at any time wn. you carry ye. fingers up on ye Symph. Pubis fobserve it's surface [crossed out] if they are not pinched, its a bold Arch & vice versa. From one tuberosity of ye. Ischium to ye. other, measures 4 Inches, if ye. Coccys. turns up like a Hook, it is a Distortion, ye. Rectum wn. Fill’d with foces, has been mistaken for ye Base of ye Sacrum; When ye Pelvis is distorted above it is enlarge’d below & vice versa, tho' not always. A Woman may be distorted in ye. Spine, & yet not in ye pelvis, but if a woman waddles much & has curv'd Legs, it is very likely yt. her Pelvis is distorted. A Woman yt. has had ye. Rickets in her Childhood, has very probably a distortion, & where there’s a great falling in of ye spine- it is very probable & most likely to be distorted in ye. Pelvis- Lect. 3d A Pelvis may be too large; ye in convenience of a large one may be guarded against. A woman thinks she has a motion to stool, ye. Membrane break and ye. Chd. comes away, ye. Woman having had but few pains.- It has been known [illegible] a Woman has expell it on ye floor. Woman about 40 wth. rigid parts meets with but little resistance in ye. Pelvis, but, only ye. Orifice of ye Womb, & is often pushed upon with ye head of ye Child, to remedy it, keep ye Head back. If the Head cover'd, endeavor to released it as much as possible, but you’ll generally have a Prolapsus Uteri. A Laceration of ye Perineum will happen unless ye is kept up till ye Perineum yields more kindly. A Woman yt. has had no stool for a considerable time &c geniality of Foces is in ye rectum, ye pain sometimes is so strong as to push ye. rectum, Foces & all down together, this is call’d Providentia Ani. The difference between ye. Male & female Pelvis differ considerably, ye Male is more massy & not being intended for ye. same use as ye. female yt. Cavity is therefore less, considerably shallower yn. ye. Male. The Bone of ye Illium in ye Female [illegible] Opaque, in ye. Male pellucid, they are thin in Male Pelvis A Procidont Ani. A large Pelvis Women yt. have worked hard. The Illium in Woman is standing more out. The Arch in ye Male is a good distinction, ye. Base of ye Sacrum is sd. to be broader in females yn. in Males, ye. most striking mark is at ye. Pubis; The Arch of ye. Pelvis in ye. female is a bold Arch, but in ye. Male an acute Angle. It’s a vulgar Error ye. There is a strait Line from ye. Center of ye Breast & Abdomen into ye pelvis, ye Strait Line will not pass in to ye Pelvis, but a Strait Line will not pass thro ye. Abdomen into ye Rectum. In passing ye forceps, keep ye. handles as far back as ye. Perineum 'll permit, ye Blades are to be pass’d towards ye Navel. It is necessary we shd. be acquainted wth. ye Brim of ye. Pelvis, In all situations in ye. Erect position ye line is oblique & ye. Pelvis inclines forwards; If ye. Body inclines forwds, ye. Brim is pendicular. The Finger in examining must pass in an horizontal Line in ye position of ye. half sitting or half lying; the Brim is horizontal in ye. Recent Pelvis. The Brim in ye. Skeleton is mark’d out by ye. Sacrum & ye. sharp ridges of ye. Illia. some make ye. Psoas muscle ye. Brim in ye. recount, shows ye. Illianus. The longest Axis in ye. recent Subject is oblique, we must [ede??] something in ye. Measurement- about 3 1/2 inches is ye. Measure. A thin Ligamt. fills up ye. whole of ye holes & in ye pelvis, is on each side cover’d by muscles Longest Axis of Recd. Pela/ To use ye Forceps called ye. Obturator External: The Internal allow some part to bulge out, ye. other parts are filld by ye [l?gamts]. call’d ye. Sacro- Sciatic wch. are attach’d to ye [?berostity] of ye. Ischium they ye Illiarus Externus the are also very large nerves, Blood vessels &ca & a great quantity of fat. The square opening is fill’d vess by sphincter Muscle &c. The Os Coccygis A yield the joints of ye. Pelvis call’d ye. symphysis give was but very little, unless by Disease, by a preternatural softness [cross out] such a case will make ym. give way, in time of Labour. Women can walk after Labour, but cou’d not if ye. Bones [crossed out] were separated. Lect. 4th The child'll pass either by ye. Head, Feet or Breech The most difficult posses are ye Hips, Shoulders & Head. The most difficult of all is ye Head. The Head of ye Fetus differs from yt. of an Adult, in two respects, 1st. ye. head has a greater number of Bones 2ndly they are joined in a different manner; the Fotus has 12, ye. Adult but 6 - 2 frontal - 2 Bregma 4 Occipit & 2 Temporal. The Head is so contrived as to give way in a certain degree to ye parts of ye Mother the edges of ye Bones in ye fotus are much thinner Bones of ye Passage of ye Child & capable of lapping over each other very considerably the Head ’ll adapt itself to ye. parts of Mother, where ye. Sacrum has projected considerably, ye Head has been marked wth ye shape of a horse shoe. Where ye. Head is not much enlarged & ye. bones crackle by ye. Touch of ye finger, its passage’ll be very easy Where 'tis much ossified, ye. Birth is sometimes very difficult. Often in such a case there’s a necessity of destroying ye. child, yet ye Head never ought to be open'd because tis large, but wait for ye power of Nature. The figure of ye. Head is Oval there is in every Oval a short & a long Axis, in every position must must make a short & a long Axis, by [crossed out] presentation is meant, ye part wch. is opposite ye Center of ye Pelvis & is ye presenting part Where ye face is opposite to ye. front of ye pelvis, it is not a face but a Vertex Case. Where ye face is opposite to back side or front, when ye. Center of ye Face presents by depressing ye. Chin, will make ye passage easier, In coming out, ye. Chin in front, ye Forehead behind, you shd. gradually work it from ye. Groin to ye front of ye. Pubis, where ye. Chin is very low. The jaw case is ye. easier, but wh. ye Chin is high, more Difficult. The best Presentation is where ye long Axis Presenting part of ye Chd. Bones of ye Hd can be made as short as possible; When you can find ye. little Fontanel coming off, by depressing, [cross out] ye. Occiput, you make ye. long Axis ye short one and make ye. Head come out easier by ye. Chin being push'd to nearer ye Breast; if Fingers will not do, you must use ye Single blade of the Forceps to do it. Where ye. Ear presents you shou’d turn in all Cases depress ye Chin near ye breast. The worst position is where ye. Longst. Axis presents wch. is from ye. Chin to ye. Vertex one consolation is, yt. it can’t be alter’d for ye Worse, The best way is to draw ye. Chin as near ye. Perindumn as possible. Where ye. Forehead presents by drawing by it, you make ye. face to come forwds., wch. alters the Situation for ye. best. Rules to know ye Position of ye. Chd. in ye Pelvis you must have, where ye. Head is low, either ye. face, ears or one or other of ye. Fontanels If ye. Vertex comes down, you’ll be able to feel either ye. Ears or fontanels, first feel for one part that you can be certain of, if you can feel an Ear, you may make out ye. Position very distinctly. It is very useful to know one part of ye ear from another by a fontanel is meant a deficiency of Ossification, in ye Direction of Sutures. You shd. never be positive of ye Position but corroborate ye. Opinion by ye. 2nd examination Where ye. Pelvis is most fill'd, There is ye. Occiput where it is least fill’d up ye Face ye Ears is either at ye Symph Pubis or a quarter from it, to find it carry yr. finger to ye. Symph. Pubis, where ye. Ear is. The finger passes with more Ease than at ye. Occiput.- Lect 5’ On ye. Genitals & their Diseases- We give it with a view to illustrate Midwifery Externals are such as may be view’d without dissection. An itching on these parts is a very common Complaint, in many it depend on perpetual Eruptions ye. Cure is & formed by preparation of Lead, ung. ye. All I Bleeding & opening ye. Body, adding where the patient is very bad, the Warm bath & give an Opiate all night to procurers & Ascarides have been found in the parts, which have occasioned the itching ye [cross out] When you use an Instrument take care you dont take hold of the hair which will give exquisite pain when the bladder comes down there will form a Hernia in ye Labia Distinguishable from other Tumors, by pressing on it, if it is from the bladder’s falling down, the Woman will have an inclination to make water, a Tumor like an Aneurism depends on an odema or a Rupture of some blood Vessel, pressure sometimes takes it off, an Odema comes on Gradually with very little Gentials & their Diseases and Eruptions pain, when you examine, you’ll find that it. Pitts if there’s Inflammation, bleed & keep the body lax, with the use of Fomentations & Necessary pressure will be of great service, Scarification, shd. be avoided, a Tumor of blood is known by coming on Suddenly with pain & generally happens in or after labour, if one side only is affected it is a good distinction, is in generally Cured by Incision or leaving it alone it will burst. Haller says he has known the Labia So long as to take in the Anus, the Clitoris has been found Ossified in some Subjects.- In a Woman that's in labour you shd. take care not to let her retain her water too long, but the Catheter, but don’t incline [cross out] it to much towards the Perineum,- When ye Head of the Child bulges against the Hymen it is best to cut, Women who never did Menstruate & yet have Violent pains, every month & strong bearing down, it is best to examine whether whether ye passage is clear if obstructed by the Hymen, an Incision through that will remove the complaint Menstruation Lecture 6th In case the perineum is lacerated, you shd. take off the Inflammation & have the lips to heal separately on distinctly, the common breadth of the [cross out] Vagina in Adults, is 4 or 5 fingers, the Uterus in a Woman when she menstruates is heavier, [cross out] the Uterus quite gravid is so high up as not to be touch’d, the breadth of the Vagina differs, in some women one finger passing up gives great pain, in others one hand may pass very easy, some have it so narrow as to be oblidg’d to have it open’d by art, The Vagina is liable to many accidents from Inflammation, loss of substance, gangrene &c Involuntary Discharge of Urine happens in predisposed habits that have a Tendency to Inflammation, from shancres, & its connection, with ye Rectum it can’t be hurt without that Rectum suffering, loss of substance in the Rectum occasions a discharge of feces through the Vagina.- the fluor Alb: will now & then Destroy the whole internal Ruga, it has slufs off many times, where it is in the Direction of the bladder, the consequence is much [illegible] Fluor Albus to be dreaded, if 'tis very far in. An Inversion of ye. Vagina is to be remedied in ye. same manner as ye Prolapsus Uteri. The Os Tinco wn. diseas’d is rugged, notch’d or half eaten away by Cancer. Women have taken Medicines to make ym. miscarry, but some have taken enough to poison themselves and yet, have not answered the desir’d Effect. The Contents of ye Uterus with Matter whence comes this Matter? partly from ye. Male & partly from ye Female. The Semen of ye Male is said to form ye. Bones, Muscles &c & ye. same from ye Mother. When both meet in ye Women, is join’d all together & a Fermentation both on in ye. womb of ye Mother; As to twins & monsters, if there’s Semen enough, there is twins, and if more yn. enough for one, yn tis said to be a Monster &c. The Semen of ye. Male must go beyond ye. Womb, for if ye Ovaries in Women were taken out, ye Procreative Faculty wd. be destroy’d. The Bunch of small Eggs in a hen is call Vitularium The Chd is lodged in ye. Mother & only wants ye Seed of ye Male to enter it. This is ye. Opinion of Many.- Abortion On Conception Lecture 7- of the signs of Pregnancy Every woman that has conceiv’d, undergoes a considerable alteration of the body, all such Phenomena leads us to conclude the Womans with child, an other method is by the feel, & by the Womans Relations, the Signs in general are very Difficult to explain, the marks are those which is taken from the Monthly Discharge from some Irregularity of it, or being less in quantity than usual, some delicate Women have a greater increase of them than usual, sickness, Nausea & Vomiting in ye morning, loathing of ye food, Loss of Appetite, falling away of the body. a peculiar look of the Face changed in point of temper, A Sprightly good Natur’d Women, chang’d quite surly & morose, Nothing can please ym. Many wish to have uncommon things for food. Strange longings &c- Another effect is a falling away of the face, the Belly flattens, the breast becomes more prominent, the Areola round the Nipples becomes more dusky, & a Liquor discharges from them, & sometimes in great pain, The belly enlarges, Another Sign is that of quickening, the Signs in general are Signs of Pregnancy very Intricate, frequent frights & Dreams when asleep -Women sometimes think they have Quickened when the feel wind pressing from one Intestine to Another, when they have Quickened you may perceive that Cloaths to move or if you place a Hand on the Belly you may feel it,- Then ask the Woman the following Questions- do you make much water or as much as Usual, if more than usual or more frequent she is not Dropsical, It is a Sign of pregnancy if the belly Swells before the Legs, - If the legs began first to swell she is Dropsical.- What time the Belly began to swell -If it was the first time of being out of order- On the Progress of the Gravid Uterus It is called Embryo, when it is to small, as to appr. much like brute species, - the Doctr. has them from the size of a Barley corn, to the full growth. in ye Womb. A child at 3 months is said to be 64 times the weight, that it was at first- & so on to ye 6th month twice 64 times its weight &c – About ye Twentieth day the Embryo may be seen but not before which is then about the Size of a barley corn,- the Fetus hangs in the womb by the Umbilical chord, with the head a little Downwards, Women have Sometimes pains in the Arms, Palms of the Hands & Soles of the feet, this is not to be Depended on except in Old Women that has had many children & is allways attended with Spasms, [& Vomiting] the vomiting commonly goes off in 3 months, the Sickness is owing to the Childs not being able to make use of all the blood that is Stopt in the Menses- The Belly in Pregnancy does not begin to swell till the 3d. month, the Vomitg. goes off at a certain period at a certain period in pregnancy if it grows worse & worse it arises from a Suppression of the Menses,- The Manner of Women Recovering Depends 1d. on the Menstrual Discharge only reckon 1 month from being Irregular, Some take the Reckoning from the first motion of the Child, most Women Quicken about the 4th month or a little later of The Management During the Pregnant State Inpoint of food let them order for themselves, except it is very Improper- Inpoint of motion let them, take yr Air, & moderate exercise, In women who are apt to Miscarry. At the 3d. month shd. be confined to their Room from the 2d. to the 4th month, Coition ought to be refrain'd from during that time as it prevents miscarriage, they must refrain from Riding a Horse back or going into a boat, tight lacing must be avoided, as it prevents Reckoning of Wom the growth of the child, high heel'd shoes is often the Occasion of Miscarriages. the Passions of the mind must be regulated, Costiveness must be avoided, rather more than one Stool the day shd. be procur'd, if the patient be well bleeding may be avoided, but when proper ought to be had recourse to- Lingering labours is the worst of all labours for young practitioners, Lingering labours take up from one to 4 days, no Medicine, or Remedies will take effect, all these circumstances which prevent the Childs passage is call’d resistance, the contraction of the Uterus &c expells the Child, & are called the moving powers, resistance gets the better of labour Whatever [cross out] Increases the moving powers Quickens labour- To have a good labour you must procure as much rest as possible to ye. Patient by opiates, In lingering labours you must nourish ye. patient with Liquors Diet &c that may be thought most proper, Sometimes a Hemorrhage from the Nose will ensue to a Considerable degree, but never does Mischief, in frights &c- opiates shd. be given, where the parts are Rigid, Glysters, Bleeding &c should be employ’d & Drinking any thin Diluting liquors- Spirituous Liquors must be avoided as Lingering Labour well as well as Opiates, the Position of the Woman must be alter’d, they may sit over the Steams of warm Water, Borax & Ol: Cinnam: have been recommended where the Womb is Lanquid, Ol: Cinnam: shd. be made use of & is of great service, the parts may be well greased for in Case anything [cross out] shd. be torn you will be under Blame, Let them take their own ways in any Innocent remedies, Women about 40, there Labours are Generally rigid, when they have us'd to hard work- In these kind of labours it is Necessary that the Air & heat of the Room shd. be regulated. they shd. not drink any thing strong, the Heat of what she drinks in Summer shd. be scarce warm, let her have as much air as possible to gaurd against & flooding, Convulsions &c,- All such Patients shd. loose blood more than once keeping the body open &c Glysters every Day, Observe when the pain remits, & give an Opiate, allways order Some Medicines in this case to gain time order Some warm Water to be put in a Close stool & let the patients sit over it, do any thing to keep the mind Employ’d, Convulsions often attend, in that case, it is allways best to call in Assistance it begins with a Violent pain in the head, dimness of the Sight in this case fatid Glysters must be given, The first position of the [cross out] Preternatural labour is by tho far you shd. never attempt to deliver till the Waters are broke, & the mouth of the a Womb large enough to admit ye. hand, then when the feet are in Sight draw them down gradually 'till you have the Funis in View. Then you must gradually turn the Childs face to the Sacrum & extract it pretty Quickly, not waiting for pains, for if you wait more than 10 minutes after the Funis is in sight it will be compress’d [cross out] Cause a Strangulation & be the Death of the child, when you are got near the Arm Pitts, you must Endeavour to bring them down, then Secure the Mouth & Extract.- The breech Case is when the Legs & thigs are along the belly of the child & the breech presents, in Such cases you must Turn, let your Patient go to bed early, as the pains are strong when up- but let her hold the bed post & bear down, there is often a Discharge of the Colon or Meconium by the pressure upon the belly, when the [cross out] Belly is to ye. Back of ye Mother A Difficulty from ye. Curve of ye. Sacrum & Coccygis first search for ye. Groin, to do yt. set out from part you know; if you know ye. Back is forward wch. may be known by ye. Vertebra & ye. Belly to ye. Back of ye. Mother, observe ye. Directions of ye. Arms & Breech Case Genitals, make a strait Line across & push boldly to ye Groin. If you can get 2 fingers 'on it, will be best.- You shd. never pretend to turn unless you are clear ye. Women is in great Danger for 9 times out of Ten, it’s ye. Occasion of ye. Child’s Death, if it must be done, you must take your time, if possible, before you are come away or wn. ye. Os Tinca is large enough to receive ye. hand ye. Waters may be broke & take hold of ye Legs with ye. left Hand, if convenient, yn. with ye. Assistance of ye. other hand on ye. Abdomen you may assist ye. left hd.; It’ll be best to introduce ye Hand in ye. Interval of ye pain, yn. very slowly and gently lay hold of ym. & turn ye. Feet towards ye. Belly of ye. Child & bring ym. to ye Os Tinca. If ye. spasms are very strong, give 25 or 30 drops of R. Thebain or if plethoric Bleed. If you cant lay of both Feet, you must be contented with one & draw round with great care, this is to be done wn. shouldr. or Arm presents. wn. you introduce ym. Hand, never let it rest on ye. Body of ye. Mother. Where rest is necessary if ye. Spasm is very great, take if off, by an Opiate you must give a tolerable Dose, & wait 'till it has taken Effect, then you’ll carry your hand up easier If ye. Chd. is putrid, be careful not not use too much force, or you’ll pull ye. Foot off. Where ye Navel String presents, it sometimes falls down before ye. Head, if it falls down before any other part except ye. Head, it is necessary to turn.- A young Practitioner had better not turn, but let ye. Child perish, for 9 times out of 10 it perishes. In this Case there is dangers of turning bursting of ye. Uterus, lacerating ye Vagina Inflammation &c. In general it is better not to turn. If there’s no pulsation in ye Funis there can be no Reason for turning. Suppose ye. Chd. has Life & ye Head is in ye Pelvis, leave it alone & turn it not. If ye waters have been long evacuated, & a strong Contraction, never Thinks of turning. Dr. Lowthers relates a Case. where a Women draw’d ye Chd. in a strait not in a Curved Line, ye Hd. or ye Chin hitch’d on ye. Sciatic Ligamt. [upon] from wch. she tried a long time to remove it, not knowing wt. was that Obstructing Cause. The Bystanders that proposed to send for Dr. Dame, wch, was greatly against ye. Midwife's Will, on hearing him at ye Door She pull’d so hard as to separate ye hd. from ye. Body. When ye. Dr. came he put ye finger in to ye. Mouth & extracted it wh. great Ease After such bad Cases, ye Child is apparently dead & phaps put away for Dead, & yet in half an hour, they have revived. You cannot be too careful of ye chd. in all Cases.- Of Twins- Two or three Child.n at a Birth is common, somet. 4 or 5. How to Manage. Where there’s more yn. one ye. 2nd will be either natural, Laborious, or preternatural. Sometimes Twin Cases have been dangers. from ye Womb being exceedingly stretched, but they seldom go their full time. Where there is a 2nd. Chd. wait ½ or ¾ of an hour to see wt. natur'll do, wn There is no pains after waiting so long, you may bring ye. Chd. away. Turning is more easy in twin Cases yn. in Others. We ought never to draw the Placenta away after ye. Birth of ye 1st Chd. as they are generally attached to each other. It’ll bring on a flooding unless it is expelld. down so far as to require only falling away tis detach’d from ye. other. [cross out] The Dm. has & [illegible] of Monsters. I has crown log Chd. another wh no head, another no Leg not Thighs, an other where they grow together and many others. Extractn. of Twins The Operation for ye. Cesarian Section is generally fatal. it ought never to be performed, if ye Hand or any Instrumt. can be introduced.- Miscarriages- A Woman may be delivered at full time, some before their time & some few go beyond their time. Those yt. happen from ye 7 & to ye 8 month may live sometime, those before ye 7th. cannot on account of ye Texture & one term’d Miscarriages A woman may Miscarry at any time of ye. many great Violence will bring it on. It generally happens about ye 3d. Month & more miscarry at this time then any other time. With regard to Danger, the Woman seldom perish in ye. Early Months from ye. loss of Blood. The Chd. can’t be saved in ye Early Months, in ye. latter it may. A woman who miscarries in ye 3d. Month; The first Symptoms is a discharge ye of Blood. Woman has other Signs about her & miscarriages sometimes will happen without any Discharge of Blood; Where she has a shivering, a pain in ye Back, bearing down, a frequency of making Water & a Discharge of Blood Miscarriages there is great reason to think she’ll miscarry Women have a Discharge of Blood & yet will not miscarry. Questions to be aske’d, are, whether ye. Discharge comes on at ye. usual period, yh whether she has been frighted, whether she has pain or bearing down &c & if they answer, no – you may have Reason to believe they have not miscarried, but if the discharge comes on irregular & all the symptoms the reverse there you may think there is a miscarriage- to prevent a Miscarriage, rest & a dark room without any Noise is absolutely nesassary.- fell. the pulse to know if bleeding be proper, if there is a great loss of blood, with a full & tense Pulse Blee’d, & on the contrary refrain from it.- after Bleeding give the bark & acid of Vitriol on Tinct Rosar, & opium may be given where there is Costiveness remove it, Where ye Discharge is very great in ye early months of pregnancy you must not be freighted as the Women Seldom seldom dies at this time, Employ the Women that stand by tending, for Vinegar Water &c- by opening the Window to give free air- ask if she is thirsty, & give a large draug of cool water which will be of great service, grate Some Nutmeg on a piece of bread, dip it in Vinegar & let the Woman Smell to it. Cold water shd. be apply’d to the back & Abdomen, examine at ye time & you’ll generally find the Orifice diluted & the Ovum bearing on it, get your fingers upon it & Endeavour to bring it away if it Shd. Have a Tendency to break, leave it to Nature, Sometimes the Waters break & the Child is expell’d, yet the Bag remains, you are not to be Alarm’d as it will Come away in 3 or 4 days, tho Sometimes it is 6 weeks first- In Hysteria Fitts, theres not much danger, which may be known by their being Sensible at Intervals, but not So in Convulsions which are Very Dangerous & Generally fatal.- Solid glysters with opiates may be given. the Warm Bath is advisable. which will Sometimes, take off the irritation, Where the pulse is hard give. Nitri but if weak the Mineral Acids, Some have made use of Saturnine Medicines- Management after Labour- Immediately after labour take care care to keep her as dry as possible, a cloth to the pudenda & 3 or 4 along the thighs & one to ye. Abdomen, make a Gentle pressure on ye Abdomen to prevent Fainting, by means of a Napkin or place a pillow & confine in by the Cloaths or with a persons hand, Allways examine the Placenta before ye nurse, see that it is whole, or if any of the Skin remains- Tell the participation order to make her easy You will lend Something to bring it away, when the Woman is weakly & subject to floodings, you shd. avoid hasty moving, let her Remain for an hour, her drink shd. not be taken hot, but about Milk warm- with regard to their diet, Caudle may be taken but shd. not be too Spicy, nor much wine in it, Water with a Toast in it may be given to Drink, & Where she is very thirsty is ye Best, she may allso take Beef Tea &c- If the Woman has a desire for food the first day, let her have it, allways order Some Medicines, Spum: Coti, Conf: Card &c the Doctor Says is the Best mixture, from one to 2 drachums every 6 hours- There is more reason to give the child Medicines ye the mother, Children are Very Irritable & their bodys cannot be too Soon open’d by the prelv Rhei Aloes & Syrup is the Common Medicines, Milk is the best but for the Child, it ought to be applied to ye. breast as Soon as it is born & the Milk will purge the Child, if it does not Suck, Water Gruel made thin is the food most proper.- The Diseases Woman are subject after labour is After pains, Griping pains, which go off gradually & have no fever attend. Then- Women that are apt to flood have after pains,- those that have had Several Children are subject to Severe after pains. They have seldom any with the first child ye Reason of ye after pains is Large cloos of Blood, which cannot be Discharged but by the Efforts of the mother, Immediately after the Delivery of the Child & Placenta the belly from being very small becomes very large, from wind rushing into, or from one Intestine into another, & is the Cause of pain, where you have use’d any Instrument it brings on a Small Inflammation but the pains are seldom mortal, be carefull to Distinguish where there is any Fever or [any] quickness of the Pulse, but what is brought on by the the thoughts of Labour- The Dr. advises ye Caudle to be very weak or not to be given- he advises the child to be put to the breast very early it will purge the Child & care the Mother of her pains- Where the Discharge of blood is So great as to affect her pulse & her Extremities are Coldish, it is called flooding in ye care the Dr. Says he has seen a Wash hand Bason full discharged, when the pulse has been Weakned & the flooding still persists, he advises the Introduction of the hand to cause the Uterus to Contract- which oft times may be reliev’d by applying Cold externally. After pains are never mortal, but if they Die & if they die it is from Some other causes in these pains give moderate Doses of Opium from 5 to 7 grains & when the Wind to [illegible] from one Intestine to another give a Glyster, But Sometimes they have an Inordinate Contraction of the Uterus, this he accounts for from Some of the Fibres of the Womb being over straind.- In this case give the Castor Bolus gn/c. Sal: Succin gm iij this the Dr. Says is attendd. with Success- Upon first applying the Child to the breast the Patient has often a pain in the Belly,- The discharge after the Placenta is Separated is allways bloody Women may lose too much, but if the pulse is affect by the loss 'twill do no Injury or if the strenght is not Impair’d 'tis of no Consequence- you may check in by applying Vinegar to the Temples, palms of the hand giving air &c- If these do not Succeed- apply a cloth dipp’d in Vinegar or Cold water to the Abdomen, If it is [cross out] Very profuse to the back & Pudenda Sometimes Several of the cloths will not stop it, in that case introduce your hand into the Uterus, grasp it & by irritation bring on a Contraction of the Womb- After all this if you cannot do any Service rather do Something than Seem Careless- With regard to the Application of Cold it never is of bad Consequence Consider the health. A strength of our patients, if she is well don’t think about the discharge, where her strength impair’d. Check it, give the Cortex wth. Elix. Vitial: Acid:- the Discharge gradually changes its colour, if the Lochia be stop’d or check’d, & uses no more than one or 2 cloaths a day & only 2 or 3 days after labour, consider her pulse & strength & if both are well you have no occasion to be uneasy- but allways something.- keeping the body open is allways necessary- the stoppage is Sometimes attended with Ill [crossed out] effects. fever & Violent pain in ye Region of the Uterus, generally a Total stoppage of the discharge, If called in at the beginning you must bleed & keep the body open by Glysters, fomentg. the belly is of great service- If the pain & fever increases most likely it will prove fatal- The Milk fever is about the 3d. day the Patient has Shivering with fever & pain in the breast but no discharge, a spoonfull or two Terminate the Complaints, a poultice of bread & milk is serviceable & will Encourage, the Discharge, a Glyster will take off the Complaints the Sooner the Child is put to the breast the better, In Some it Terminates in Inflammation of the Mesentery- & pain of the groin, in others by Violent purging- where the Child don’t suck, it may be prevented by not forcing the milk too suddenly -The Evening of the 3d. day the Woman may get to have her bed made.- The Miliary Fever- Nothing relieves this so Much as keeping the body open, if great Soreness is Complain’d order a poultice, If they mention that the Perineum is torn, Don’t Seem concern’d about it, you must poultice it & not to think of uniting it by Sutures- let the poultice lay on 'till the Inflammation has gone off & let the Lips unite of themselves_ Lecture Disorders of Children in ye month- Those Disorders belong either to Physic or Surgery- Those of surgery happens in the Birth Some before others after- Where there has been a Tedious Labour it makes a particular form of the childs head, a great protrussion of ye Scalp &c- you had better let it alone unless Instruments have been used, Where the child is born with the face downwards it has a very Ugly appearance but will Soon recover of itself- when the forceps have been used order Something to prevent swelling & poultice is the easiest application, keeping the Body open &c- Where you have made use of the blunt hook pulling by the Groin, poultice till the Slough comes off- where you turn the child be carefull of breaking the extremities, which [happe?] by taking hold of them improperly- If a fracture of the Arm keeping together is all that’s necessary, in the thigh bone it is more difficult- because of the child having 2 or 3 Stools every day & the frequency of making Water- After you have laid a Woman, always examine the child, because the Nurse will go to sleep & lay the fault to you if she happens to break an arm &c- The Thigh bone is to be treated in the common manner- a Parylisser of the arm, happens often by pulling, & hangs as if it did not belong to the body two or 3 weeks generally cures it, [cross out] The Internal Hydrocephalus is Generally mortal, it has been cured by Opodeldoch, Sp. Minderer: &c- the Doctr advices Soap less, which has cured in about three weeks or a month, In the Hair Lip, if not thro the palate, desire it to be kept 'till the child becomes of an age fit to undergo the operation- The Situation of the Child in the Uterus- the Ancients tho't the Child laid in the Womb with the feet downwards, 'Till the latter months, but this not true, for in Miscarriages the head comes first, the Child lies in the Womb with the feet to the Chin up on ye belly of the child & the legs upon ye thighs, to find the feels your hand shd. be upon the belly of the belly of the Child- To know if a Woman is Pregnant, call’d Phenomina A change is brot on in the Menses, it stops, & Sometimes a large Discharge, with Sickness & loss of apetite, falling away of the flesh, flattening of ye abdomen- change upon the breast & Quickening of the Child- Largeness of the Belly the Doct says we are not to take these signs single, the Doc. has been call’d to Women that have tho't they were with child, but was not the neck of the Womb presents & has been tho’t to be the Childs Arm- the nurse shd. Place her hand upon the belly-& feel the motion, the swelling of the belly may come from the Wombs being schirrous or Dropsical, a schirrous Womb may [cross out] Remain for several years, if you think it Dropsical ask her if she makes much water or if frequently, if they do 'tis not a Dropsy- A sign of pregnancy is frightfull dreams, women may have a fluid from the breast & not be pregnant- on the first motion of the child they faint away & feel as if they would Die, but Soon recover, they feel Something like Birds fluttering the motion may come everyday for Some Days- Questions to be ask’d, when her belly began to swell- if she answers as Soon as the Menses stop, you may have reason to think yt she is not with Child, for the Belly is not enlarg’d 'till the 3d or 4th month.- if the sickness continues 'till the 5th or 6th months & gets worse you may have reason to think they’re not with Child, if it goes off about the 3d. or 4th you may suppose she is not with child.- Women will ask you how to they ought to recon, Women generally go 9 [cross out] callender months- or 40 weeks Some Quicken as the 3d. Some at the 4th. & others at the 5th. but the usual time is the 4 month -Diseases of the Child- Inflammation of the Eye Lids, continue from 1 to 8 Weeks, foment them with Elder flowers & poppy heads & the Ung. Saturn: Bleeding with Leeches, In the Thrush they are Sleepy you find them first on the Tongue, accompanied with fevers, Borax & Honey, 1 Scruple to an ounce- Fits are often fatal, in these Cases, Purge & Vomit & Bleed wth. Leeches, give mixt toh’d & Mosch & ye use hot bath &c- Diseases after Labour After pains are never Mortal, they have no fear. Clotte’d Blood is ye. Occasion of After pains. Opium in small Doses is ye. best remedy or Castor Bolus wth. Sal Succein gn. ij [?el] iij- The Placenta is sometimes found degenerated in Hydatids.- The Navel string is made up of 1 Vein & 2 Arteries sometimes there's only one Artery The string is longer yn. in other [cross out] Animals The length in general is bout 2 Feet sometimes 3 or 4 feet- you will sometimes loose a Chd. by ye Bleeding at ye. navel, take wt. care you will by ye. Strings getting loose & ye Child bleeds to Death of here are three Membranes belonging to ye Child, ye External. wch. Dr. Hunter says is a part of ye. womb The Fluid wch. is found in ye. Membranes will never coagulate this not known from when it comes when there are Twins & one of ym is flatten’d it is owing [illegible] to ye Liquor Amnios escaping [cross out] [cross out] there by one C[cross out] pressure ye other. If ye Liquor Amnios escapes in ye. 3, 4, 5 or 6 months ye. Chd. can’t live, but a Water may Come away & not be Liq. Amnios.- When ye. Woman is costive. Dr. Lowther recommends 3i ol. Ricins 6 [illegible] hora done Albus solata facrit.- The Womb begins to enlarge about ye. 3d. Month, as high as ye. Navel at ye. 7th Month & as high as ye. Scrobical. Cordis, On ye. Dropsy If ye Legs swell, you shd. apply a Roller or a strait Stocking, but it sometimes brings on a shortness of Breath & you are forced to loosen it- you shd. take care to keep ye. Body open. You shd. never scarify wn. it depends on Pregnancy, for it’ll go after Labour sometimes a Black Spot appears on ye Belly & she thinks 'tis going to mortify; you shd. ask her if ye. Child has moved very strong- Bleeding is usefull if ye Woman can bear it & give an opiate to still ye. Child &c._ Frequency of making Water is very disagreeable, but can’t be relieved, Tell her it is a good sign of a good Labour In This Case ye. head ye. Head of ye. Chd. is generally down advise ye Woman to raise her Belly with her Hands to get ye. Head off from ye Pubis. A pain in ye Groin proceed from a stroking of ye Ligamt, rub Oil or any other thing.- The Jaundice is a Disease arising sometimes from a diseas’d Liver & sometimes from ye. Womb rising 10 high as ye Liver &c. you'll be able to Cure this when ye. Labour is over. but wn. it proceeds from a diseas’d Liver, ye Cure is form’d wth. Difficulty. Soap wth. Rhubarb may be given with safety during Pregnancy Where there is two Childn. you may judge from ye. Size of ye first Ruptures Many have lost their lives through Ruptures some are reducible others not, they are sometimes cured by Pregnancy. Those yt. are not reducible are very dangerous; you shd. keep. ye. Body open if ye Pain is very violent, Let an assistant put his hand to ye Part, wch. will give great Ease sometimes When there’s no labour, ye Orifice of Uterus is not dilated but contracted, yn tis a fit of ye Gall Stone, put her into ye. Warm Bath if there’s great Pain or Danger In The Stone in ye. Kidney or Urethra, ye. warm bath is proper, but not without there is danger of ye Women’s Life, for it is not proper for pregnant Women- In a Cancer, ye Cannot poultice or Honey Oil & flow. will give Ease   21 Blank Leaves Not Scanned Liquor. Anodyn. Hoffmani Mineralis secund Pharm Wistenbury- Ye ol. Vitriol. ab omni Phlegmake liberati & Sph. Vini [illegible] & vi. Ol Vitriol instillation successive spur. Vini- Degeratar dein per Dies alijust & [illegible] institutar destillatio igne Arena e Cucurbits satis alta- When ye. mixture in ye. Tetort (after drawing of a great part of ye. Spirit) begins to grow black, ye. greatest case is necessary in ye. Management of ye. Fire, otherwise this black froth will arise suddenly into ye. Receiver & spoil ye. Whole, the Receiver shd. therefore be changed & the fire be very gentle, & wth. a Sulphureous Liquor, a small proportion of Athenal Oil will come over, this must be carefully separated from ye. Sulphur Phlegma & dissolved in ye Liquor wch. came over first, wch. will then be so [illegible] Liq Anodyn Mineral H.B. The same Caution must be taken in making ather For fine Injections no Colour will do but Vermillion- A heart & Penis make a neat dry Preparation.- A large Prepartion while it is drying, shd. be daily washed with Ol. Terel to kill ye Vermin, shd. be open to ye Air, hid from ye. Sun & kept free from smoke & Dust- When a preparation is quick dry then use ye. shining Varnish wch. completes yn Trouble, & if ye. Injection has run successfully & ye. Dissection good twill amply compensate ye Cost.- Inject ad Gonorrhea. non Verulent ꝶ Litharg. Aur pulu ℥i aict. Pistill. ℥v here Corros. Sublimate. ʒss In. Stent [si??il] per horay & y ꝶ liquor supra proseript ʒij vel ℥ss Org Puro ℥iv & bis die [inji?iatur]- Ather ꝶ of Vitriol Concentr/Mensura/Hiij Spt Vini Tect/Mensura/Hvi- The Liver, Kidneys & such preparations as are to be on acerated shoud be injected with with ye. Course without any Suet.- Spr. of Saller by Sort Dilated with water is ye. best Medicine for comoding preparations- The best way to inject a Fetus is by ye Umbilicus.- A chd. may be injected by ye Carotid, Iliac or Brachial Arteries, but ye. best way is by ye aorta as Arcendens from ye. left Ventricle.- When ye. Arteries of ye Iris appears fill’d thro' ye. Cornea, ye Injection has run well, & pushing further wou’d burst some of ye Vessels.- Before Injecting any part, let it lay 3 or 4 Days to soak in water, to get out what blood you can. Before you inject a Chd. put it in hot Water for some time & as soon as injected immediately into Cold, to hinder ye colour from separating, & preventing ye. Child from becoming putrid, by cooling by [cross out] Degrees- Hard brown Spt. Varnish ꝶ Gum Junip [illegible] Shell Lac toss spt. Vini 6 Cong. iij [illegible] Shining Varnish ꝶ Resin flav. Colophon a & [?iy] Spt. Vini 6 Cony. ij [illegible] Hard White Spt. Varnish ꝶ Gum: Junip. & [illegible] Sp. Vini 6 Cong iij [illegible]- The Colours for Injections are Vermillion Verdigrease, like White & king’s yellow Remarks To know wn. ye. Injection is of a dire Consistence, while it boils, a few Drops less fall into cold Water, will soon inform you- Experience can only teach you when tis too brittle, so as easily to break, or wn, too soft so as to sweat thro ye. Vessels, if it is too soft, ye. addition of a little Resin is necessary, if too hard, Turpentine Varnish will soften it.- Injections- Dr. Nichols’s Coarse Injection ꝶ Res. flav.- Dij Cera flav. Hi Turpentine Varnish. gs.- Fine- Hard whole & brown Spirt Varnish a & O Turpentine Varnish & Vermillion a a g.s.- Monroe’s Coarse ꝶ Cera flav. ℥zvj Sev. Ovill. depur. ℥iy m Fine ꝶ Ol Terebinth. & Vermillion Hunter’s coarse ꝶ Res. Flav. ℥viij Cer Flav ℥4 lev. bvil depart ℥iy M Fine ꝶ Turpent. Varnish ℥4 Ol Terel ℥iss Vermillion g.s. Turpent Varnish ꝶ Ol. Tereb ℔i Resin. flav. ℥4 M