NATIONAL  LIBRARY  OF  MEDICINE
             Washington
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U. S. Department of Health, Education, and Welfare
             Public Health Service
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A   SET   OF
ANATOMICAL   TABLES,

                    WITH

    EXPLANATIONS,

       and an ABRIDGMENT of the

PRACTICE  of  MIDWIFERY,

             WITH A VIEW TO ILLUSTRATE

 a  TREATISE on that SUBJECT,  and

      COLLECTION  of  CASES.



 by  WILLIAM  SMELLIE,   m.  d,



                TO WHICH ARE ADDED,
    NOTES  and   ILLUSTRATIONS,
 Adapted to the prefent Improved Method of Practice.

  by A. HAMILTON, m. d. f.r.s. Edinburgh,
    and Profeflbr of Midwifery in the Univerfity of Edinburgh.
     FIRST  WO RCE ST*E R  EDITION,

 With an entire New Set*?f Plates, carefully..OoRRECT£D and Revised.






   printed at  WORCESTER, Massachusetts,
         by   ISAIAH  THOMAS.
Sold at his Bookftore in Worcester ; by faid Thomas, and Andrews,
 I'auft's Statue, Newbury Street, Boston; and by faid Thomas, and
 Carlisle, in Waipoli, Ncwr-imp^ire.
                  MDCC.\C11I. 
 
Ill
PREFACE.
         ■^jlS, in a long courfe of teaching  and
praclice in Midwifery, I hope I may without van-
ity fay, that I have done fomething towards re-
ducing  that Art into a morefimple and mechan-
ical method than has hitherto been done ; I have
attempted to explain the fame in my Treat ife on
the Theory and Praclice of Midwifery and Col-
lection of Cafes ;  and finding that  mofl of the
reprefentations hitherto given of the parts fub-
fcrvient to Uterine Gefration and Parturition
were in many refpecls deficient, I have been in-
duced to undertake the following Tables, with a
view to fupply in fome meafure  the  dcfec~ls of
others,  and at the fame time to HI aft rate what I
have taught and written  on the fubjeth  How
far I have obtained thoje ends, it belongs to  oth-
ers to judge. If hall only beg leave  to ohferve  here
by way of Preface, that the great eft part of the
figures  were  taken frcm fubjctls prepared on
purpofe, lofJjow every  thing that might conduce
to the improvement of the young Praclithncr :
Avoiding, however,  the extreme  Minutiae, aud
what elfe feemed foreign to the prefent defign  ;
thefituation of parts, and their rcjpeclive dimcti-
Jions, being more particularly attended to, than a
minute anatomical inveftigation of theirJl rutin re.
   As thefe Tables may pojjibly fall into the hand?
of fome who kxive not  fecn  my former work,  I
                                       have 
IV
 have added an abridgment of the Practice ; which,
 though Jar from being complete, may ferae to il-
 luflratc frccral things which othcrwife by a bare
 reprefentation would be hardly intelligible.
   References are made to Vol. 1,11, and III.  By
 Vol. I, 7" mean that which Ifitjlpublifhed in the
 year 1752, and contains a view of the  Theory
 ir;d Plattice of Midwifery ;  Vol. II, and III,
 contain the  Collcflion of Cafes mentioned above.
 My firflplan for thefe Tables confined them to
 the number of twenty two, which Mr.  Rymf-
 dyke ha  I finifhed above  two  years  ago ; but I
foonfiw  that  a farther illujiration, and confe-
 quenlly an addition to that number', was necef-
fary.  In eleven of 'thefe', Dr. Camper, former-
 ly ProfefTorof Medicines Francqucr/'/z Frief-
 land, now Profeflbr of Anatomy and Botany at
 Amiterdam, greatly affifiedme, viz. Table XH,
 XVI,  XVII, XVIII,  XIX, XXIV, XXVI,
 XXVII, XXVIII, XXXIV, and XXXVI.
 The refl were drawn by Mr. Rymfdyke ; except
 the thirty feventh and thirty ninth, which were
 done by another hand.  The whole of the draw-
 ings arc  faithfully engraved: In  which, how-
 ever, delicacy  and elegance have not been fo much
 conf'ulted, as to have them done in a flrong and
 diJlinB manner ; with  this view  chiefly, that
from the  cheapnefs of the work it may be render-
 ed of'm'jre general ufe. 
 
. /Kt/r  i
 
EXPLANATIONS
             OF  A S E T OF


ANATOMICAL  TABLES,

          With an ABRIDGMENT or the

PRACTICE of  MIDWIFERY;



         FIRST  TABLE
         REPRESENTS, in  a front view, the
bones of a well formed Pelvis.

  A.  The five Vertebra of the loins,
  B.  The Os Sacrum.
  C.  The Os Coccygis.
  D.  D. The Offa Ilium.
  E.  E. The Offa Ifchhlm.
  F.  The Offa Pubis.
  G.  The Foramina Magnus.
  H.  H. The Ace tabula.

  1.1.1.1. 1.1.  The brim of the Pelvis, or that
circumference of its cavity, which is defcribed at
the fides; Uy the  inferior parts  of the Offa Ilium,
                A                      and 
6         ANATOMICAL  TABLES,
and at the back and fore parts,  by the  fupcrior
parts of the Offi Pubis and S.icrum.
   In this table, befidcs the general ftrudure and
figure of the fevcral bones, the dimenfions of the
brim of the Pelvis, and the diflance bciwcen the
under parts of the Offa Ifchiiim,  are particularly
to be attended to, from which it will appear that
the cavity of the brim is  commonly wider from
fide to fide, than from the back to the fore part,
but that the fides below are in the contrary pro-
portion.   The  reader,  however, ought not from
this  to conclude, that  every Pelvis is fimilar in
figure and dimenfions, fince even well formed
ones differ in fome  degree from each other.   In
general, the brim of the  Pelvis measures about five
inches and a quarter from fide  to fide, and four
inches and a quarter from the back to  the  fore
part ; there being likewife the fame diflance be-
tween the inferior parts of the Offa Ifchiiim. All
thefe meafures,  however,  muft be underftood as
taken from the fkeleton, for  in  the fubjed, the
cavity of  the Pelvis  is confiderably diminifhed
he  its teeuments and contents.   Correfpondent
alio to this diminution, the  ufual dimenfions of
the head of the full  grown  Foetus are but three
inches and  a  half  from  ear to  ear,  and four
inches and a  quarter frcm  the fore  to  the
hind  head.
  Vide Tab. XVI, XVII, XVIII.   Alfo, Vol. I.
Chap. 1.  Sett. 1, 2, 3. where the form and di-
menfions of the Pelvis,  as well as of the head of
the  Fcetos, und the manner in which the fame is
                                 protruded 
 
J/„',\\
 
        with EXPLANATIONS, &c.       7
protruded in labour through the bafon, are fully
treated of. Confult likewife Vol. II. Coll. i. No.
1,2. where cafes are given of  complaints of the
Pelvis arifing from difficult labours,



        SECOND   TABLE
Gives a lateral and internal view of the Pelvis,
     the fame being divided longitudinally.

   A. The three lower Vertebra of the loins.
   B.  The Osfacrum.
   C.  The Os Coccygis.
   D. The left Os Ilium,
   E.  The left Os Ifchiiim.
   F.  The Os Pubis of the fame fide.
   G. The acute procefs of  the Os Ifchiiim.
   H. The Foramen Magnum.
   1.1.1. The brim of the Pelvis.

   This plate fhows the diflance  from the fuperi-
our part of  the Os Sacrum  to the Offa  Pubis, as
well as from the  laft  mentioned bones  to  the
Coccyx, which in each amounts  to about  four
inches and  a  quarter.  The depth likewife is
mown of the pofterior, lateral, and anterior parts
of the Pelvis, not in the line of  the body, but in
that of the Pelvisirom its brim downward, which
                   A 2                  * 
8        ANATOMICAL TABLES,
is generally three times deeper on the poflcrior
than anterior part, and twice the depth of the lafl
at the fides.
  From this view  appears alfo the angle which
is formed  by the lafl Vertebra of  the loins and
the  fuperior part of the Os Sacrum,  as likewife
the  concavity or hollow fpacein the poflcrior in-
ternal part of the Pelvis, arifing from the curva-
ture of the lafl  mentioned  bone and  Coccyx ; fi-
nally, the diflance  from which to  the poflerior
parts of the Offa Jf/uum is  here expreffed.
   Vide Tab. XVI, XVII, XVIII, XIX, Alfo, Vol.
I, and II,  as referred to in  the former table.

        —^-»>»»3> tggfjBBtt <<**« h*—-

         THIRD  TABLE
  Exhibits a front view of a diflorted Pelvis.

  A. The five Vertebra of the loins.
  B. The Os Sacrum.
  C. The Os Coccygis.
  D. D.  The Offa Ilium.
  E. E. The Offa Ifchiiim.
  F. The Offa Pubis.
  G.  G. The  Foramina Xlavr.a.
  H.  H. The Acetabida.

  From  this plate may appear the great danger
incident to both mother and child when the Pel- 
X
L
r//^'IH
 
 
        with EXPLANATIONS, &c.       9
t/zsis diflorted in this manner ; it being only two
inches and an half at the brim from the poflerior
to the anterior part, and the fame diflance  be-
tween the inferior parts of each Os Ifchium.  Vide
Tab.  XXVII, where the Pelvis is  one quarter of
an inch narrower at the brim than this, but fuffi-
ciently  wide beloW.  Various are the  forms of
diflorted bafons,  but  the lafl mentioned is the
mofl common.  It is a great happinefs, however,
in pra&ice, that they are  feldom fo  narrow,
though there are inflances where they have been
much more fo.   The danger in  all fuch cafes
mufl  increafe or diminifh, according to the de-
gree of diflortion of  the Pelvis, and iize of the
child's  head.
   Vide Vol. I. Book 1. Chap. I.  Se£l. 4, 5.  And
Vol. II. Coll.  1. No. 3, 4, 5.  Alfo, Coll.  21,
27, and 29.



        FOURTH   TABLE.
Shows the external female parts of generation.

 A. The lower part of the Abdomen.
 B. B. The Labia Pudendi feparated.
 C. The Clitoris and Praputium.
 D. D.  The Nympha.
 E. The Foffa Magna, or Os Externum.
                 A3              F. The 
 io      ANATOMICAL  TABLES,
   F. The Meatus Urinarius.
   G. The Franum Labiorvm.
   H. The  Perinaum.
   I. The Anus.
   K. The part that covers the extremity of the
 Coccyx.
   L. L. The parts that cover the tuberofitu s o(
 the Offa Ifchium.

   As it is  of great confequence  to  every pra&i-.
 tioner in  midwifery, to know exadly the filia-
 tion of the parts concerned in parturition, and
 which have  not been  accurately  defcribed by
 former Anatomifls, with a view to this particular
 branch, I have given this  draught  from  one of
 the preferved fubjeds which I keep by me, in or-
 der to demon Urate thefe  parts  in  the ordinary
 courfe of my ledures.   From a view then of the
 fituation of  the  parts,  it  appears  that  the Os
 Externum is not placed in  the middle of the
 inferior part of the  Pelvis, but at the anterior
 and inferior part of   the  Pubts,  and  that the
 Labia cover likewife  the anteriour part of thefe
 bones.
   Secondly, It may be obferved, that as the Fra-
 num Labiorum, which is  nearly  adjoining  to the
inferior part of the Offa Pubis, is only about an
inch from the Anus, between which and the Coccyx
there is about three inches diflance, it  follows,
that the Anus is  nearer to  the  firft mentioned
bones than to the latter.
                                    Thirdly, 
       with EXPLANATIONS, Sec.       ^
   Thirdly,  The  view of this  and the following
table will furnifh proper hints,  with refped  to
the method of  touching or examining the  Os
Uteri, without hurting or inflaming the parts, as
it appears that the  Os  Externum is  placed for-
wards towards the Pubts, and the  Os Uteri back-
wards towards the Retlum  and Coccyx.  By this
wife mechanifm  of  nature  many inconveniences
are often prevented, which  mufl  happen if  thefe
parts were oppofite  to each other, and fituated in
the middle of the inferior part of the Pelvis, par-
ticularly a  Prolapfus of the Vagina  and Uterus,
either in the unimpregnated ftate, or in any of
the firft four months of pregnancy ; as alfo too
fudden deliveries in any of the laft  months.
  Fourthly, From a  view of the  fituation  of the
parts, it will appear, that in labour, when the  Os
Uteri is fufficiently opened to allow a paffage for
the head of the . Fatus, the  fame  is protruded to
the lower part of the Vagina, by which the  exter-
nal parts are pufhed out in form of a large tu-
mor, as in Table XV.
  Lajlly, It may be obferved, that when it is nec-
effary to dilate  the  Os  Externum, the principal
force ought to be applied downwards  and to-
wards  the Rettum,  to prevent the Urethra and
neck of the bladder  from being hurt or inflamed.
  Vide Vol. I. Book I. Chap. 2. Sed. 1. Vol. II.
Coll. 2.
A  4                 FIFTH 
12
ANATOMICAL  TABLES,
FIFTH   TABLE.
Figure I. Gives a  front view of  the  Uterus in
  S::u fufpended in the  Vagina;  the antcrioi
  parts of the OJfa Ifchium  with  the  Offa Pubn,
  Pudenda, Perinerum, and  Anus, being remove^
  in order to fhew the internal parts.

  A.  The laft Vertebra of the loin.:.
  B. B.  The Offa Ilium.
  C. C.  The Acelabula.
  D.  D. The inferior and pofterior  parts  of
the  Offa Ifchium.   Vide  Tab. XXIX, where  the
Offa Pubis  and  the  anterior parts of  the Offa
Ifchium are reprefented by dotted lines.
  E. The part covering the extremity of the Coccyx.
  F. The inferior part of the Rectum.
  G.  G. The Vagina cut open  longitudinally,
and ft retched on each fide of the  Collum Uteri, to
mew in what manner the Uterus  is fufpended in
the  fame.
  H. H. Part of  the Vefica Urinaria ft retched
on each fide of the Vagina  and inferior part of
the Fundus Uteri.
  I. The Collum Uteri.
  K. The  Fundus Uteri.
  L. L. The Tuba Fallopiana and Fimbria.
  M.  M. The Ovaria.
                                     N. N. 
7J/
 
 
        with EXPLANATIONS, &c.     13
  N. N. The Ligamenta Lata and Rotunda.
  O. O. The fuperior part of the Rectum.

Figure II. Gives a view of the internal parts as
  feen from the right  Groin, the  Pelvis being di-
  vided longitudinally.

  A.  The loweft Vertebra of the  loins.
  B. C. The  Os  Sacrum and Coccyx, with the
Integuments.
  D.  The left Os Ilium.
  E.  The inferior part of the left Os Ifchium.,
  F.  The Os Pubis of the fame fide.
  G.  The  Foramen Magnum.
  H. The Acetabulum.
  1.1.1. The inferiour part of  the  Retlum and
 Anus.                       .
   K. The Os Externum and Ji^iW; the Os  Uteri
 lying loofely in the fame.     ^
   L. The  Vefica Urinaria.
   M.  N. The Collum and  Fundus Uteri, with a
 view of the cavity of both.  The attachment of
 the Vagina round the outfide of the lips of the
 mouth of the Womb is here likewife fhown, as alfo
 the fituation of the Uterus, as it  is preffed down-
 wards and backwards by the Inteflines and Urina-
 ry  Bladder, into the concave, and inferiour part
 of the Os Sacrum.
    O.  The Ligamenta Lata and  Rotunda of the
 left fide.
    P. P. The Fallopian tube, with the Fimbria.
    Q.  The Ovarium of the  fame  fide.
                                     R.  R. 
14       ANATOMICAL TABLES,
  R. R.  The  fuperior part of the Reflum, and
inferior part of tl^e Colon.

Figure III. Gives a front view of the Uterus in
  the beginning of the firft month of pregnancy ;
  the anterior part being removed, that the Em-
  bryo might appear  through  the Amnois,  the
  Chorion being diffeclcd off.

  A. The Fundus Uteri.
  B. The Collum Uteri, with a view of the rugous
canal that leads to the cavity of the Fundus.
  C. The Os Uteri.
  Vu\c Vol.  I. Book I. Chap. 2. Sed.  2, 3. Vol,
II. Coll. 3.

          —~^^?&<&%jl<t&&«**----

         SIXTH  TABLE.
Ficure I. In the fame view and fedion of  the
  parts as in the firft figure of the former table,
  (hows the Uterus as it appears in the fecond or
  third month of pregnancy, its  anterior part
  being here likewife removed.

  F. The Anus.
  G. The Vagina with its Plica.
  H. H. The poflerior and inferior part of  the
                                    Urinary 
 
 
        with EXPLANATIONS, &c.      15
 Urinary Bladder extended on each fide, the anteri-
 or and fuperior part being removed.
   I.  I. The mouth and neck of the Womb, as
 raifed up when examining the fame by the touch,
 with one of the fingers in the Vagina.
   K. K. The Uterus as ftretched in the fecond or
 third  month, containing the Embryo  with  the
 Placenta adhering to the  Fundus.

   It appears from this and the former table,  that
 at this time nothing can  be known, with refped
 to pregnancy, from the touch in  the  Vagina, as
 the refiftance of the Uterus  is fo  inconfiderable
 that it cannot prevent its being raifed up before
 the  finger ;  and even were it kept down,  the
 length of the neck would prevent  the ftretching
 being perceptible.  The  Uterus likewife  not  be-
 ing  ftretched above the Pelvis, little change is
 made as to the figure of the Abdomen, further than
 that the Intfflines are raifed a little higher 1 whence
 poflibly the old obfervation of the Abdomen being
 a little flatter at this period than ufual  from  the
 Inleflines being prefled more to each fide.  Wom-
en at this  period  mifcarry oftener than  at any
other :  It is a great happinefs, however, in prac-
tice, that although they are frequently much
weakened by large difcharges, yet they rarely fink
under the fame, but are fooner or  later relieved
by labour coming on, which gradually ftretches
the neck and mouth of  the  Womb, by the Mem-
branes being forced  down with the  waters, and if
the Placenta is feparated from  the internal furfacc
                                         of 
 lb"       ANATOMICAL  TABLES,
 of  the  Uterut, all  its contents are difchai^id.
 But if the Placenta  Mill  adheres, the Mrmbranes
 break, the waters and Foetus are expelled, and the
 flooding diminifhes from the  Uterus contracting
 clofe  to the Secundines, which alfo are ttlually dil-
 charged fooner or later.
   From the ftrudure finally of the parts, as rep-
 resented in this and the former tabic,  it may ap-
 pear that it is much fafer to rcftrain the flooding,
 and fupport the patient, waiting with patience the
 efforts of nartire, than to endeavour to ftretch the
 Os Uteri, and deliver either with the hand or in-
 flruments, which might endanger a laceration and
 inflammation of the parts.
   VideiZ. in Table XXXVII.   Alfo, Vol. I. Book
 II.  Chap. 2. Sed. 2, 3, 4. Vol. II. Coll. 12. No, 2.

 Figure II.  Reprefents the Uterus  in the fourth
  or fifth month of pregnancy, in  the fame view
  and fedion of the parts with the former figure,
  excepting that in this the anterior part of the
  Collum Uteri is not removed.

  In (he natural fituation, the mouth and lips of
 the Womb are covered with the  Vagina, and thefe
parts  are contiguous to each other, but  here the
 Vagina G. is a little ftretched from the neck and
lips of the former, in order to {how the parts more
diftinr.tly.  I. The neck of the Womb, which ap-
pears  in this  figure thicker,  fhorter, and  fofter
than in the former.  K. The  inferiour part  of
the Fuhdui Uteri,  the ftretching  of which can
                                  fomctimes 
        with EXPLANATIONS, &c.     17
fometimcs be felt through the Vagina, by pufhing
up  a finger  on the anterior or lateral part of
the  fame.
  The Uterus now is fo largely ftretched as to
fill  all the upper part of the  Pelvis, and begins
alfo to increafe fo much as to reft on  the brim,
and to be fupported by the fame, the Fundus at
the fame time being raifed confiderably above the
Pubes.   From the  Abdomen being  now more
ftretched, the woman is more fenfible of her grow-
ing bigger, and the Uterus alfo, from the counter-
preflure of the contents and  parietes of the Ab-
domen, is kept down, and the Os Uteri  prevented
from rifing  before the finger  as formerly.  In
lean women, the ftretching of the Uterus can fome-
times be perceived in the Vagina at this period as
well as above the Pubes : But nothing certain
can be difcovered from the  refiftance  or feel of
 the mouth of the  Womb or Lips, which are com-
monly the fame in the firft months of pregnancy
 as  before it.
    The fize or bulk of the Foztus is finally here to
be  obferved, with  the Placenta adhering to the
 poflcrior part of the Uterus.
    Vide the references  to Vol.  I, and  II, in the
 former table.
SEVENTH 
18       ANATOMICAL  1 ABLFS,

     SEVEN T  II   TABLE
Reprcfents the Abdomen of a woman  opened in
    the fixth or feventh month of prrgnancy.

   A. A. A. A. The paiietesof the Abdomen open-
ed, and turned back to fhow
   B. The Ulerus.
   C. C. C.  The Inteflines raifed upwards.
   D. The Labia Pudendi, which are fometimesaf-
feded in pregnancy with 0edematous fwellings,oc-
cafioned  by the preflure of the  Uterus upon the
returning veins, and  Lymphatics.   If the Labia
are fo tumefied as to obftrud the patient's walk-
ing, the complaint is removed by punduring the
parts affected.   By which means the ferous fluid
is difcharged for the prefent, but  commonly re-
curs ; and  the fame operation muft be repeated
feveral times,  perhaps, before delivery,  after
which, however, the tumefadion entirely fub-
fides.  Here it may be obferved,  that this com-
plaint can feldom or never obftrud  delivery, as
the Labia are fituated at the anterior part  of the
Offa Pubis,  and can rarely affed the ftretching of
the  Franum,  Perinaum,  Vagina,  and  Rectum.
From this figure it appears that  the ftretching of
the Uit'.rus can eafily be felt at this period in lean
fubjerts.  through the  parietes of  the  Abdomen ;
efpecialiv if the Inteflines  do not  lie before it.
In general, indeed, as  the Uterus ftretches, it rifes
                                    higher, 
 
'    ^//  V
IU
 
        with EXPLANATIONS, Sec.      19
higher, by which means the Inteflines are likewife
raifed higher, and are alfo preffed to each  fide.
Hence the nearer the woman is to her full time,
the ftretching is the more eafily felt.
   N. B.  Oedematous fwellings, fymptomatick of
pregnancy, affeding the labia, have in  few, if
any inftances, been obferved to interrupt the prog-
ress of labour ; therefore the difcharge of  the fe-
rous fluid by pundure is feldom  requifite ; and
repeated punElure in advanced  geftation might be
attended with difagreeable confequences.
   Vide Vol. I. Bookl. Chap. 3. Sed. 3. Book III,
Chap. 1. Sed.  2. and Vol. II. Coll. 12, 13.



        EIGHTH   TABLE.
In the fame view and fedion of the parts  as  in
  Table VI. is reprefented the Uterus of the form-
  er table, in order to fhew its contents,  and the
  internal parts as  they appear in the fixth  or
  feventh month of pregnancy.

  A. The Uterus  ftretched up to  the Umbilical
region.
  B. B. The fuperior part of the  Offa Ilium.
  C. C. The Acetabula.
  D. D. The remaining pofterior  parts of  the
Offa Ifchium.
  E. The Anus.
                                    F. The 
ANATOMICAL  TABLES,
  F. The Vagina.
  G. The bladder of Urine.
  H. The neck of the Womb fhorter than in T.iblr
VI, and  raifed higher  by the  ftretching  of  the
Utdus above the brim of.the Pelvis.
  I. The veffels of the  Uterus larger  than  in  thr
unimpregnated ftate.
  K. K. The Placenta  adhering to  the inferior
and pofterior part of the Uterus.
  L. L. The Membranes that furround  the Fa-tia,
the head of which is here reprefented, as well a<
of thofe in Table VI, fituated downwards at  the
inferiour part  of the Uterus, and which I am  apt
to believe is the ufual fituation of the Foetus, when
at reft,  and furrounded with a great quantity of
waters,  as the  head is heavier than any other part.
With refped to the fituation of the body  of  the
Foetus, though the fore  parts are often turned  to-
wards the fides and pofterior parts of the  Uterus,
they are here as well as in the foregoing tabl«
reprefen'ed at the anterior  part or forwards, in
order to fhow them in  a more  diflind and  pic-
turefque manner.
   Vide Vol. I. Book I. Chap: 3. Sed. 3, 4. Vol.
II. Coll. 13. No.  1.

   From this table may appear the  difficulty of!
 ftretching the Os Uteri in flooding cafes,  even at
 this period, from the length and thicknefs of the
neck of the Womb, especially in a firft pregnancy :
 Much the fame method, however, is to be follow-
 ed here as was direded in table VI, until labour
                                      comes  t 
A* 
'  S^r/,  IX
 
with EXPLANATIONS, &c.      21
comes on to dilate the Os Uteri.  If the flooding
is  then  confiderable,  the  Membranes  fhould be
broken,  that the Uterus may contrad, and thereby
lelfon the difcharge.   The  labour likewife, if it
is  neceffary, may be affifted by  dilating  the Os
Uteri in time  of the  pains  ;  which  alfo,  if
wanting, may be  provoked by the  fame method
when the patient is in danger.   If this danger is
imminent, and  the woman feems ready to expire,
the Uterus,  as appears from this  table, is at this
time fufficiently ftretched to  receive the opera-
tor's hand to extrad the Fatus,  if the Os  Inter-
num can be fafely dilated.
   Laftly, It may be obferved that women are in .
greater danger at this  period, and afterwards, than
in the former months.
   Vide Vol. I. Book III. Chap. 4. Sed. 3. No. i,
2, 3. Vol. III.  Coll.  33. No.  2.  See alfo in the
Edinburgh  Phyfical  and Literary  Obfervations,
Art. XVII, the difledion of a woman with child,
by Dr.  Donald  Munro, phyfician at London.
 .  See, Diredions for the management in cafes of
flooding, Dr. Hamilton's Outlines of Midwifery,
page 401.


       NINTH   TABLE,
In the fame view and fedion  of the  parts with
  the former, reprefents the Uterus in the eighth
  or ninth month of pregnancy.
               B                    A. The 
 22       ANATOMICAL  TABLES,
   A. The U:nv.x as ftretched to near its full ex-
 tent, with the waters,  and containing the Foetus
 entangled in the  Funis, the head prefenting at the
 upper part of the Pelvis.
   B. B. The fuperior part of the Offa Ilium.
   C. C. The Acetabula.
   D. D. The remaining pofterior  parts of the Of-
fa Ifchium.
   E. The Coccyx.
   F. The inferior part of the Rectum.
   G. G. G. The Vagina ftretched on each fide.
   H. The Os  Uteri,  the lips of which  appear
 larger and fofter than in the foregoing table, the
 neck of the Womb being likewife ftretched to its
 full extent, or entirely obliterated.
   LI. Part of the Vejica  Urinaria.
   K. K.- The Placenta at the  fuperior and  pof-
 terior part of the Uterus.
   L. L. The Membranes.
   M. The Funis Umbilicalis.

   This and  the  foregoing table  (how  in what
 manner the  Uterus  ftretches,  and how  its  neck
 grows  fhorter,  in the  different periods of preg-
 nancy  ; as alfo the magnitude of the  Foetus, in
 order more fully  tp explain Vol. I. Book I. Chap.
 3. Sed. 4, 5. Alfo Book  III. Chap. 1. Sed.  1, 2.
 Likewife Vol. II. Coll. 13. No. 1.
   Notwithftanding it has been handed  down  as
 an invariable truth, from the earlieft accounts of
 the art, to the prefent times, that when the  head
 of the  Foetus prefcnted, the face was turned to the
                                   poflcrior 
/ 
- /'/«/. X
 
        with EXPLANATIONS,  &c.     23
pofterior part of the Pelvis,  yet from Mr. Ould's
obfervation, as well as from  fome late diffedions
of the gravid Uterus, and what I myfelf have ob-
ferved in pradife,  I am led  to  believe that the
head prefents for the moft part as  is here delin-
eated, with one ear to the Pubes, and the other to
the Os Sacrum ; though fometimes this may vary,
according to the form of the head, as well as that
of the Pelvis.
  Confult Dr. Hunter's elegant platet of the grav-
id Uterus.


      TENTH    TABLE
Gives a front view of Twins in Utero,  in the be-
  ginning  of labour, the anterior parts  being
  removed, as in the preceding tables.

  A. The Uterus, as ftretched with the Membranes
and waters.
  B. B. The fuperior parts of the Offa Ilium.
  C. C. The Acetabula.
  D. D. The Offa Ifchium.
  E. The Coccyx.
  F. The lower part of the ReBum.
  G. G. The Vagina.
  H. The  Os Internum ftretched open about a
finger's  breadth  with  the Membranes and waters
in time  of labour pains.
                 Ba               I.I. The 
 24       ANATOMICAL TABLES,
   I. I. The inferior part of the Uterus ftretched
 with  the waters which  arc below the head of
 the  child that prefents.
   K.K. The two Placentas adhering to the pof-
 terior part of the Uterus,  the two  Friufes  lving
 before them, one with  its head in a proper pofi-
 tion,  at the inferior part of the V ems, and the
 other  fituated preternaturally, with the head to
 the  Fundus  : The  bodies  of each  are here  en-
 tangled in their proper Funis, which frequently
 happens in the natural  as well as preternatural
 pofitions.
   L. L. L. The  Membranes  belonging to each
 Placenta.
   This reprefentation of twins, according  to  the
 order  obferved  in my  Treatife of  Midwifery,
 ought to have been placed among the  laft tables ;
 but as that was of no confequcnce, I have  placed
 it here in order to fhow the Os Uteri grown much
 thinner than in the former figure, a little  open,
 and  ftretched by the waters and Membranes which
 are pufhed down before the head of  one  of the
 Fatufts in time of a labour pain.  With refped
 to the pofition of twins, it is often different in  dif-
 ferent  cafes  ; but was thus, in a  late dilution of
 a gravid Uterus by Dr.  Mackenzie.
   Vide Vol. I. Book III.  Chap.  i. Sed. 4.  and
 Chap. 5. Sect. 1. and Vol. II. Coll. 14. and Vol
 III.  Coll. 37.
   For the improved management in cafes of plu-
rality of children, fee Dr. Hamilton's Outline, of
 Midwifery, page 412.
                               ELEVENTH 
 
7)/rr/rX\
 
with EXPLANATIONS, &c.      sj
ELEVENTH. T-ABLE   lo
Exhibits another front view of the gravid Uterus
  in the beginning of labour ;  the anterior parts
  being removed, as in the former table ; but in
  this the Membranes,  not being broken, form a
  large bag containing the waters and Foetus.

  A. The fubftance of the Uterus.
  B. B. C. C. D. D. The bones of the Pelvis.
  E. The Coccyx.
  F. The inferior part of the ReBum.
  G. G. G. G. The  Vagina.
  H. H. The mouth of the womb largely ftretched
in time of a pain, with I.  the Membranes and wa-
ters.   This circumftance makes it ufually certain
that labour is begun, whereas from the degree of
dilatation reprefented in the former table, there is
little to be afcertained, unlefs the pains  are reg-
ular and ftrong, the Os Uteri being often  found
more open feveral days, and even  weeks,  before
labour commences.                        """*
   K. The Chorion.
   L.  The fame diffeded off at  the inferior part
 of  the Uterus,  in  order to  fhow the head of the
 Foetus through- the Amnois.   N. B. This hint is
 taken from one of Dr. Albinos's tables of  the grav-
 id Uterus,
                  B 3               M. The 
l€       ANATOMICAL  TABLES,
   M. The Placenta, the external convex  furface,
of which, divided into a number of Lobes, is here
reprefented, its concave internal parts being cov-
ered by the Chorion.

   The Placenta has been found adhering to  all
the different parts of the internal  furface of  the
Uterus, and lometimes even over the infideof  the
Os Uteri ;  this laft manner of adhefion, however,
always  occafions floodings  as foon  as the tame
begins to dilate.
   Tables VI,  VIII, IX, X,  fhow the internal fur-
face of the Placenta towards  the Fxtus, with  the
veflels compofing its fubftance  proceeding  from
the Funis which is inferted, in different Placentas,
into all the different parts of the fame, as well as
in the middle.
  The thirtieth and thirty third tables fhew  the
infertion of the Funis into the Abdomen of the Fottus.
  With refped to the expulfion of the Placenta,
when the Membranes break,  the Uterus contradu
as the waters are evacuated until it comes in con-
tad with the body of the Fatus  : The fame being
delivered,  the Uterus  grows  much thicker, and
contrads clofely to  the Placenta and  Membranes,
by  which  means they are  gradually feparated.
and forced into the  Vagina.   This  fhcws  that  we
ought to follow the method which nature  teaches,
waiting with patience, and allowing it to feparite
in a flow manner, which is much  fafer pradice,
efpecially when the patient is weak ; as the dif-
charge is neither fo great or fudden as when  the
                                    Placenta 
f 
y///, ;;n
 
        with EXPLANATIONS, &c.      27
Placenta is  hurried  down  in the too common
method.  But then  we *muft not run into the
other extreme, but affift, when nature is nbt fuf-
ficient to expel the fame.
  Vide Vol. I. Book  III. Chap. 1. Sed. 4.  Chap.
2. Sed.  2. 5. Vol.  II. Coll. 14. 23.  Alfo Dr.
Hamilton's Outlines  of Midwifery, p. 211. et feq.
TWELFTH   TABLE
Shows, in a lateral view and longitudinal divifion
  of the parts, the gravid Uterus, when labour  is
  fomewhat advanced.

  A. The loweft Vertebra of the back.
  B. The Scrobiculus Cordis, the diflance  from
which to the laft mentioned Vertebra is here fhown
by dotted lines ; as alfo part of the region below
the Diaphragm.
  C. C. The ufual  thicknefs  and figure of the
Uterus when extended with the waters at the lat-
ter end of pregnancy.
  D. The fame contraded and grown thicker af-
ter the waters are evacuated.
  E. E. The figure of the Uterus when pendulous.
In this cafe, if the Membranes break when the pa-
tient is in an ered pofition, the head of the Foetus
runs a rifk of Aiding over and above the Offa Pu-
                 tt 4                    bis, 
•8       ANATOMICAL  TABLES,
bis, whence the fhoulders will be pufhed into the
Pelvis.
   Y.'r. The figure of  the Uterus when  ftretched
higher than  ufual, which  generally  occafions
vomitings and difficulty of  breathing.   Confult
on  this iubjed Mr. Levret  fur le  mechanifme
de dirferentes groffeffes.
  (.. The Os Pubis of the left fide.
  H. H.  The Os Inurnum.
  I. The Vagina.
  K. The left Xympha.
  L. The Labium  Pudendi of the fame fide.
  M.  The remaining portion of the bladder.
  N.  The AnuS.
  O. P. The left hip and thigh.

  In this period  of labour, the Os   Uteri  being
more and more ftretched by the Membranes pufh-
ing down, and beginning to extend the  Vagina, a
great quantity of  waters is forced down at the
fame  time,  and,  if the Membranes break, is  dif-
charged ; whence the  Uterus contrads itfelf near-
er to the body of  the Foetus, which is  here repre-
fented in a natural pofition, with  the Vertex reft-
ing at the fuperior part of the Offa Pubis, and the
forehead towards  the right Os Ilium.   As foon as
the Uterus is in contad with the body of  the Fatus,
the head of the fame is forced backward towards
the Os Sacrum from the line of the Abdomen B. G.
into that of the Pelvis, viz. from  the uppermoft
F. to near the end of the Coccyx, and  is gradually
pufhed lower, as in the following Table.
                                         If 
 
/£/Y
Mil
 
        with EXPLANATIONS, &c.      29
  If the Membranes  do not break immediately
upon their being pufhed  into the Vagina, they
fhould be allowed to protrude ftill further in or-
der to dilate the Os Externum.
  Vide Vol. I. Book I. Chap. 2. Sed. 2. Chap. 3.
Sed 3. Book III. Chap. 1. Sed. 1, 2. 4. Chap. 2.
Sed. 3. Chap. 3. Sed. 4. No. 5. Vol. II.  Coll.
10. No. 4. Cafe 3,  4.; Coll. 14.  Vol. III.  Coll.
34. No. 2. Cafe 4.



     T H.I R T EENTH  TABLE,
In (he fame view and fedipn of the  parts as in
  Table VI, fhows  the  natural pofitjpn of the
  head of the  Fxtus when funk down  into the
  middle  of the Pelvis  after the Os Internum  is
  fully opened, a large quantity of the waters
  being protruded with the Membranes through
  the Os Externum, but prevented from being all
  difcharged, by the head's filling up the Vagina.

  A. The  Uterus a little contraded,  and thicker,
from fome of the waters being funk down before
the child,  or difcharged.
  B. B.  The fuperior parts of the Offa Ilium.
  C. The inferior part of the Rectum.
  D. D. The Vagina largely  ftretched  with the
head of the Fatus.
                                  E. E. The 
 g*       ANATOMICAL  TABLES,
   E. E. The Os Internum fully opened.
   F. A portion of the Placenta.
   Cr. G. The Membranes.
   H. H. The Ligamenta Lata.
   1.1.  The Ligamenta Rotunda.   Both thefe  laft
ftretched upwards with the Uterus.

   The Vertex of the Foetus being now down at
the inferior part of the right  Os Ifchiiim, and  the
wide part of the head at the  narrow and inferior
part of the Pelvis, the forehead by the force of
the pains is gradually moved backwards,  and as
it advances lower, the Vertex and 0caput turn out
below  the Pubes,  as  in  the next Table.   Hence
may be learnt of what confequence it is to know,
that it is wider from  fide to fide at the brim of
the Pelvis, than from the back to the forepart, and
that it is M^der from the fore to the hind head of
the child, than from ear to ear.
   Vide  Vol. I. Book I. Chap. 1. Sed. 3. 5. Alfo
Book III.  Chap. 3. Sed. 3,  4. No. 3. Vol.  II,
Coll. 14.




     FOURTEENTH  TABLE,
  In a fimilar view and fedion of the parts with
Table XII, fhows the forehead of the Foetus turn-
ed [in its progreffion downwards, from  its pofi,
                                       tion 
9
^ /rfrfrXR1
11/
 
 
        with EXPLANATIONS, &c.      3*
tion in the former Table] backwards  to the Os
Sacrum, and the Occiput below the Pubes, by which
means the narrow part of the head is to the  nar-
row part of the Pelvis, that is, between the infe-
rior parts of the Offa Ifchium.   Hence it may be
obferved, that though the diflance between the
inferior parts of the  laft mentioned bones is much
the fame, as between the Coccyx and Pubes, yet as
the cavity of the Pelvis is much fhallower at the
anterior than lateral  part,  the Occiput of the Foetus,
when  come down to the  inferior part of either
Os Ifchium, turns out below the Pubes  ; this an-
fwers the fame end as if the Pelvis itfelf had been
wider  from the pofterior part than from  fide to
fide ;  the head likewife  enlarging the cavity by
forcing back the Coccyx, and pufhing out the ex-
ternal parts in form  of a large tumor,  as is more
fully defcribed in the following Table.
   Vide Vol. I, II,  as referred to in the  preceding
Table.

   A. The Uterus con traded  clofely to the Foetus
after the waters are  evacuated.
   B. C. D. The Vertebra of the loins,  Os Sacrum
and Coccyx.
   E. The Anus.
   F. The left hip.
   G. The Perinaum.
   H. The  Os  Externum beginning to dilate.
   I. The Os Pubis of the  left fide.
   K. The remaining portion of the bladder.
   L. The pofterior part of the Os Uteri.
                                      N.B. 
32       ANATOMICAL  TABLES,
  A. B. Although for the mod part, at or before
this period, the waters are evacuated, yet it often
happens, that more or lefs will be  retained, and
not  all difcharged, until after the delivery of
the child ; occafioned from the prefenting part
of the Foetus coming into clofe contad with the
lower or under part of  the Uterus,  Vagina, or Os
Externum, immediately,  or foon after the Mem-
branes break.



    FIFTEENTH   TABLE
Is intended principally to fhow in what manner
  the Perinaum and external parts are ftretched
  by the head of the Foetus,  in a firft pregnancy,
  towards the end of labour.

  A. The Abdomen.
  B. The Labia Pudendi.
  C. The Clitoris, and its Praputium.
  D. The hairy fcalp of the Fatus fwelled at the
Vertex, in a laborious cafe, and protruded to the
Os Externum.
  E. F. The Perinaum  and Anus pufhed out  by
the head of the Foetus in form of a large Tumor.
  G. G. The parts that cover  the Tuberofitits of
the Offa Ifchium.
  H. The part that covers the Os Coccygis.
                                       The 
'  S/t/f'r'XSr.
\
 
^
■»?  ?*"« 
        with EXPLANATIONS, Sec.      33
  The Perinaum in this figure is ftretched two inch-
es, or nearly double its length in the natural ftate ;
but when the Os Externum is fo much dilated by
the head of the Foetus as to allow the  delivery of
the fame, the Perinceum is  generally ftretched to
the length of three, and fometimes four inches.
  The Anus is likewife lengthened  an inch, the
parts alfo between it and the Coccyx being  much
diftended.   All this ought to caution the young
praditioner never to  precipitate the delivery at
this time, but to wait, and allow the parts to dilate
in a flow  manner, as  from  the violence of the
labour pains, the fudden delivery of  the head of
the Foetus might endanger the laceration of the
parts.   The palm of the operator's  hand  ought
therefore to be preffed againft  the Perinaum, that
the head may be prevented from paffing until the
Os  Externum is fufficiently dilated, to allow its
delivery without tearing the Franum, and  parts
betwixt that and the Anus, which are at this time
very thin.
   Vide Vol. I. Book III. Chap. 2. Sed. 2. Chap.
4. Sed. 4.  No. 1. and Book IV. Chap. 1. Sed. 1.
Alfo, Vol. II. Coll. 14. 24. Vol. III.  Coll. 40.
Alfo, diredions for the management  of natural
labour in Dr. Hamilton's Outlines of Midwifery,
page 207, and feq.  and the Judicious Obferva-
tions and  diredions  of Charles White, Efq;
F. R. S. Manchefter, third edition of  his Treatife
on the Management  of Pregnant and Lying in
Women, Chap. 5. page 82 to  113.
                              SIXTEENTH 
ANATOMICAL  TABLES,
SIXTEENTH  TABLE,
And  the three following, fhow in what manner
   the head of the Fu-tus is helped along with the
   forceps, as artificial hands, when it is  neceffary
   to a Hi 11 with the fame  for the  fafety of cither
   mother or child.   In  this Table the h ad is
   reprcfented as forced down  into the Pelvis by
   the labour pains, from its former pofition in
   Tabic  XII.

   A. A. B. C. The Vertebra of the loins, Os $a~
cram and Coccyx.
   D. The Os Pubis of the left fide.
   E. The remaining part of the bladder.
   F. F. The Inteflinum Reftum.
   G. G. G.  The Uterus.
   H. The Mons Veneris.
   I. The Clitoris with  the left Nympha,
   X. The Corpus Cavernofum  Clitoridis.
   V. The Meatus Urinarius.
   K. The left Labium  Pudtndi.
   L. The Anus.
   N. The Perinaum.
   Q. P. The left hip and thigh.
   R. The fkin and mufcular part of the loins.
                                      The 
//^m.

 
 
       with EXPLANATIONS, &c.       35
  The patient in this cafe may be, as in this Ta-
ble, on her fide, with her breech a little over the
fide or foot of the bed, her knees  being likewife
pulled up to her belly, and  a pillow placed be-
tween  them, care being taken at the fame time
that the parts are by a proper covering  defended
from the external air.   If the hairy fcalp of the
Foetus is fo fwelled  that the fituation of the head
cannot be diftinguifhed by the Sutures  as in Ta-
ble XXI, or if  by  introducing  a finger between
the head of  the child and the  Pubes,  or Groin,
the ear or back  part  of the  neck cannot be felt,
the Os Externum muft be gradually dilated in the
time  of  the pains with the operator's  fingers
(previoufly  lubricated with  hog's  lard) until the
whole hand can be  introduced into the  Vagina,
 and flipped up  in a flattifh form between the
pofterior part  of the  Pelvis and  child's  head.
 This laft is  then to be raifed  up as  high as is
 poffible, to  allow room for  the fingers to reach
 the ear and  pofterior part  of the neck.  When
 the pofition of the  head is known, the operator
 muft withdraw his hand, and wait to  fee if  the
 ftretching of the parts will  renew or increafe  the
 labour pains,  and allow more fpace for the ad-
 vancement  of the head in  the Pelvis.  If this,
 however, proves of no effed, the fingers are again
 to be introduced as before, and one of the blades of
 the forceps (lubricated with lard) is then to be  ap-
 plied along the infide of the hand or fingers, and
 left ear of the  child, as reprefented in the table.
 But if the Pelvis  is diflorted,  and projeds for-
                                        ward 
36       ANATOMICAL TABLES,
ward at the fuperior part of the Os Sacrum,  and
the forehead therein? e cannot be  moved a little
backwards, in order to  turn the car from that
part of the Pelvis which prevents the end of the
forceps to pal's the lame ; in that r.ile, I fay, the
blade muft  be  introduced along  the  pofterior
part of  the ear at  the fide of the diflorted bone.
The hand that was introduced is then to be with-
drawn, and the handle of the introduced blade
held with it as far back as the Perinaum will al-
low, whilft the  fingers of the other hand are in-
troduced to the  Os U.'cri, at the  Pubes or  right
Groin, and the other blade placed cxadly oppo-
fite to the former.  This done, the handles being
taken hold of and joined together, the head is to
be pulled lower and lower, every pain, until the
Vertex, as in this table,  is brought down to the
inferior part  of  the left Ifchium, or below the
fame.  The wide part of the head being now ad-
vanced to the narrow part of the Pelvis betwixt
the TubemJif.ies of the Offa Ifchium, is to be turn-
ed from the left Ifchium  out below the Pubes, and
the forehead backwards  to the  concave part of
the Os  Sacrum and Coccyx, as  in Table XVII,
and afterwards  the head brought along and de-
livered,  as  in  Table XVIII, and XIX.   But
if it  is  found  that  the delivery will require
a confiderable  degree of force from the head's
being large, or  the Pelvis  narrow, the handles
of  the forceps  are to  be tied  together with a
fillet,  as  rcprefented in  this Table, to prevent
their  pofition  being  changed, whilft the wom-
                                         an 
 
*/4*xvii.
 
       with EXPLANATIONS, &c.       37
an is  turned on her back  as  in Table XXIV,
which is then more convenient for delivering the
head than when lying on the fide.
   N.  B. When the head is  wedged in the Pelvis,
and the bafis not yet protruded below the brim,
the forceps can neither be employed with advan-
tage nor fafety ; and to attempt the mechanical
turns recommended here would be difficult and
hazardous.
   This Table fhows that the handles of the for-
ceps ought to he held  as far back as the Os Ex-
ternum will allow, that the blades may be in  an
imaginary line between that and the middle fpace
between the Umbilicus  and  the Scrobiculus Cordis.
When the forceps are applied along the ears and
 fides of the head, they  are nearer to one another,
 have a better hold, and mark lefs than when over
 the Occipital and Frontal bones.
   Vide Vol. I. Book. III. Chap. 3. from Sed. 1.
 to 6. and Vol. II. Coll. 25, 26, 27, and  29.
^G^***?**'"—-"
SEVENTEENTH  TABLE,
In the fame view with the former, reprefents, ta
  outlines, the  head of  the Fatus brought lower
  with the forceps, and turned from the pofition
  in the former Table, in imitation of the natur-
  al progreffion by the labour pains, which may
     r            g               likewife 
38       ANATOMICAL .TABLES,
  likewife be fuppofed to have made this  turn,
  before it was necclfary  to affift  with the for-
  ceps, this  neo flRty at laft arifing from many
  of the caufes mentioned in Vol. I.

  In this view the pofition of  the forceps, along
the ears and  narrow part of  the head, is more
particularly expreffed.  It appears alio that when
the Vertex is  turned from the left Os  Ifchium,
where it was clofely confined,  it is difengaged by
coming out below  the Pubes,  and  the forehead
that was preffed againft  the middle of the right
Os Ifchium is turned into the concavity of the Os
Sacrum and Coccyx.  By this  means-the narrow
part of the head is now between the Offa Ifchium,
or narrow part of the Pelvis,  and as the Occiput
comes  out below the Pubes, the head paffes ftill
eafier along.  When the head is advanced fo low
in the Pelvis, if the pofition cannot be diftinguifh-
ed by the futures, it may  for the  mod part be
known by feeling for  the back part of the neck
of the  Foetus,  with  St finger introduced betwixt
the Occiput and  Pubes, or towards one of the
Groins.   If the head is fqueezed  into a longifh
form, as in Table XXI, and has  been detained
many hours in this  pofition, the pains not being
fuificicnt to complete the delivery ;  the affiftance
of the forceps muft be t*aken to lave   the child,
though the woman  may be in no danger.
  The  affiftance of the forceps muft be taken to fave
the  child, though the woman be in no danger.   This
may require a little explanation.   The exad di-
                                  menfions 
        with EXPLANATIONS,  &c.     39
menfions of a child's head cannot eafily be ascer-
tained  before  delivery ;  nor can  it be  known
how long a labour may be  protraded, without any
material injury to the mother.   The changes the
head of the Foetus fuffers both in  its figure and
diminution of  bulk,  by  compreffion,  render it
capable of paffing in fome cafes where we would
little exped it.   On the contrary, when the head
is but little advanced, and wedged in the Pelvis,
the forceps are  applied under obvious difadvan-
tages;  fince  it is well known  to  praditioners,
that women fuffer the natural bruifes with more
fafety  than thofe occafioned by the beft con-
ftruded  modern inftruments,  in  the hands  of
the moil  fkilful praditioners.   The forceps,
therefore, in  general, fhould not be ufed, efpeci-
ally in the early part of a man's pradice, except
only  on  the moft  urgent occajions.  And if the
head is detained at  the brim of the Pelvis, as in
the former Table, the cafe is unfavourable for the
forceps.
   See this important precaution further enforced,
page 37,  line 4.
   This Table  alfo  fhows that the  handles of the
forceps are ftill to be kept back to the Permceum,
 and when in this pofition are  in a line with the
 upper part of the Sacrum, and if held more back-
 wards, when the head is a little higher, would be
 in a line  with the Scrobiculus Cordis.  If the for-
 ceps are applied when the head is in this pofi-
 tion,  they are  more  eafily  introduced when the
 patient is in a  fupine pofition, as in Table XXIV.
                     C  2             Neither 
4o      ANATOMICAL TABLES,
Neither is it ncceffary to tie the handles, which
is only done  to  prevent  their alteration when
turning the woman from her fide to her back.
   As I have had feveral cafes where a  longer
fort of forceps that are curved upwards arc of
great ufe to help along the head, when the body
is delivered firft, as  in Table XXXV, the fame
are reprefented here by dotted lines.  They may
be ufed in laborious cafes  as  well  as the others,
but are not managed with the fame  eafe.
   Mod of the parts of this Table being marked
with the fame letters as the former, the defcrip-
tions there given will  anfwe-r  in this, except the
following.
   L. M. The Anus.
   M. N. The  Perinaum.
   O. The common  Integuments of the Abdomen.
   R. The fhort forceps.
   S. The long curved forceps,  the firft  of thefe
is eleven inches long,  and the laft  twelve inches
and a half, which I have after feveral alteration!
found fufficient, but this need not confine others
who may choofe to alter them from this ftandard.
   Vide Table XXXVII.
EIGHTEENTH 
 
' J faff XV
III
\ *h
 
with EXPLANATIONS, Sec.
EIGHTEENTH  TABLE,
In the fame View and Sedion of the parts, fhows
  the head of the Foetus in the fame pofition, but
  brought lower down  with the forceps than in
  the former Table; for in  this the Os Externum
  is more open, the  Occiput comes lower down
  from below the  Pubes, and the forehead pafl
  the Coccyx, by which both the Anus and Peri-
  naum are  ftretched  out in form  of a  large
  tumor, as  in Table XV.

  When the head is fo far  advanced, the opera-
tor ought to extrad with great caution, left the
parts fhould  be  torn.   If the. labour pains are
fufficient, the forehead  may be  kept  down, and
helped along in a flow manner by pr^fling againft
it with the fingers  on  the  external  parts below
the Coccyx : At the  fame time  the forceps being
taken off, the head  may be allowed to ftretch the
Os Externum more  and  more in a gradual man-
ner, from the force of  the labour pains, as well
as affiftance of the fingers.  But if the former are
weak and infufficieut, the affiftance of the forceps
muft be continued.  Vide the defcription of the
parts in Table XVI.  S. T.  in this reprefent the
left fide of the Os Uteri.  The dotted  lines dem-
pnftrate the fituation of the bones of the Pelvis
                  C  3                    or, 
42       ANATOMICAL  TABLES,
on the right fide, and may ferve as an example
for all the lateral views of the fame.

  a. b. c. h. The outlines of the Os Ilium.
  D. e. f.  The fame of the Pubis and Ifchium.
  i.  i. k. The Acetabulum.   And
  m. n. The Foramen Magnum.

  Vide Vol. I. Book  III.  Chap. 5.  Sed. 3. Vol.
II. Coll. 25.



  NINETEENTH  TABLE,
  In the fame view  and Sedion of the Pelvis, is
intended by out lines to fhow, that as the extern-
al parts  are ftretched,  and the Os  Externum is
dilated, the Qcciput of the Fatus rifes  up with a
femicircular turn from out below the  Pubes, the
under part of which bones are as an  axis, or ful-
crum, on which the back part of the neck turns,
whilft at the fame time the forehead and face in
their turn upwards,  diftend largely the parts be-
tween the Coccyx,  and Os Externum.  This is the
method obferved by nature  in ftretching  thefe
parts  in labour, and as' nature is always to be
imitated, the fame method ought to be followed,
when it is neceffary to help along the  head with
the forceps.
                                       Vide 
.Jy»
«fr~SEC.
 
, //'//■
XV.
 
        with EXPLANATIONS, &c.      43
  Vide the three former Tables for the defcrip-
tions and references.



   TWENTIETH  TABLE,
In the fame Sedion of the parts, but with a view
  of the right  fide,  fhows the head of the Foetus
  in the contrary pofition to the three lafl fig-
  ures, the Vertex being here in the concavity of
  the Sacrum, and  the forehead  turned to  the
  Pubes.

   A. B. The Vertebra of the loins, Os Sacrum and
Coccyx.
   C. The Os Pubis of the right fide.
   D. The Anus.
   E. The  Os  Externum not yet begun to ftretch.
   F. The Xympha.
   G. The Labium Pudendi of the right fide.
   H. The  hip and  thigh.
   I. I.  The Uterus contradcd, the waters being
 all difcharged.
   When the head is fmall,  and the Pelvis large,
 the Parietal bones  and the forehead will, in this
 cafe, as they are forced downwards by the labour
 pains,  gradually dilate the  Os  Externum,  and
 ftretch the parts between that  and  the Coccyx in
 form of a large tumor, as in Table XV, until the
                     C 4               face 
44       ANATOMICAL  TABLES,
face comes down below the Pub(s, when the head
will be fafclv  delivered.   But  if  the  fame be
large, and the Pelvis narrow, the difficulty will be
greater, and the child in danger ; as in the fol-
lowing Table.
  Hid; Vol. L  Book  III.  Chap. 3. Sed. 4.  No.
3. Vol.  II. Coll. 16.  No. 2.



   TWENTY  FIRST   T A B L £
Shows the head of the Fatus in the fame pofition
   as in the former Table, but being much larger,
   it is by ftrong labour pains fqucezed  into a
   longifh form with a tumor on the  Vertex, from
   the long compreffion of the head in the Prlvt •<.
   If the child cannot be delivered with the labour
   pains,  or  turned and brought footling*, the
   forceps are to be applied on  the  head  as de-
   fcribed in,  this figure, and brought along a$  it
   prefents ; but if that cannot be done without
   running the  riftjue  of tearing the Perinaum,
   and even the Vagina and Rcftum of the woman,
   the forehead muft be turned backwards  to the
   Sacrum.   To  do  this more effectually,  the
                                    operator
   *Tur*ing, wben the head it fo far advanced in the Pe/.n,  and of a
more than ufual  fiae,  u a drttd/ul pra&icc,  and  (houJd never be
an-. !!• •.-ltd. 
>
k.//ss/*'XX\.
 
 
        with EXPLANATIONS, &c.      45
  operator muft grafp  firmly with  both hands
  the handles of the forceps, and  at the fame
  time pufhing  upwards,  raife the head as high
  as poffible, in order to turn the  forehead to
  one fide, by which it is brought into the nat-
  ural  pofition ;  this  done,  the head may be
  brought down  and  delivered as in  Table
  XVI. &c.

  Vide Vol.1. Book III. Chap. 3. Sed. 4. No. 2.
 and Vol. II. Coll.  28. Alfo the former Table for
 the defcription of the parts, except
  K. The tumor on  the Vertex. The fame com-
 preffion and elongation  of the head, as  well  as
 the tumor on the Vertex, may be fuppofed to hap-
 pen in a greater or lefs degree in the XVI, XVII,
 XVIII,  XIX Tables, as well as in this, where the
 difficulty proceeds from the head being large,  or
 the Pelvis narrow.   Vide Tables XXVII, and
 XXVIII.
  L. The forceps.   Sometimes the forehead may
 be moved to the natural pofition by the affiftance
 of the  fingers,  or only one blade of the forceps.
  N. B. Though  the ufe of a fingle blade of
 the  forceps, or the fimple lever, is ftill retained
 in pradice, and  in a few particular cafes maybe
 employed in preference to the double lever,  the
 application is more difficult, more flight and pro-
feffional judgment are neceffary in the manage-
ment, and the two bladed forceps can  be em-
ployed  with  more fafety  and equal  fuccefs,  in
general, by  young praditioners.   The  forceps
                                      may 
46       ANATOMICAL  TABLES.
may either be the ftraight kind, or fuch as arc
curved to one fide,  when  it is  neceffary to ufe
one or both blades.
  M. The  Vefica Urinaria  much diftended with a
large quantity of Urine, from the longpreilureof
the  head againft the Urethra, which  fhows that
the  Urine ought to be drawn o(F with  a Catheter,
in fuch extraordinary cafes, before  you apply the
forceps, or in preternatural cafes, where the child
is brought footling.
  N. The under part of the Uterus.
  O. O.  The Os Uteri.

         —»-»>»>»*»<^g&X«tt«««~—--

  T W E N T Y  SECOND  TABLE
   ■
Shows, in a front view of the parts,  the forehead
  of the Foetus prefenting at the brim of the Pel-
  vis, the face being turned to one fide, the Fov-
  tanelle to the other, and  the feet and breech
  ftretched towards the  Fundus Uteri.

  A. A. The fuperior part of the Offa Ilium.
  B. The Anus.
  C. The Perinaum.
  D. The Os Externum ;  the  thicknefs of the
pofterior part before it is ftretched with the head
of the child.
                               E. E.E. The 
VrXXIt
 
'j%/<\
XXIU
-r-^£ii
 
       with EXPLANATIONS, &c.      47
  E. E. E. The Vagina.
  F. The Os Uteri not yet fully dilated.
  G. G. G. The Uterus.
  H. The Membrana Adipofa.

  If the face is not forced down,  the head will
fometimes come along in this manner ; in which
cafe the Vertex will be flattened, and the forehead
raifed  in a conical form ; and when the head
comes down to the lower part of  the Pelvis,  the
face or Occiput will be turned from the fide, and
pome out below the Pubes.   But if the  head is
large, and cannot  be delivered by the pains, or
if the wrong pofition cannot be altered, the chilcr
muft  be delivered  with the forceps.   If they
fhould fail, recourfe muft be had to Embryulcia.
  Vide Vol. I. Book III.  Chap. 2. Sed. 3. Chap.
3. Sed.4. No. 3. Vol. II. Coll. 16. No. 4. Coll. 28,



   TWENTY  THIRD   TABLE
Shows, in a lateral view, the face of the child
  prefenting,  and forced  down  into  the  lower
  part of the Pelvis, the chin being below  the
  Pubes,  and the Vertex in the concavity of the
  Os Sacrum ;  the waters likewife being  all dif-
  charged, the Uterus appears clofely  joined  to 
 48       ANATOMICAL  TABLES,
   the body of the child, round the neck of which
   is one .ciicumvolution of the Fun:$.

   A.B.  The  I'crtcbra of the loins, Os  Sacrum,
 and (\'ccyx.
   C. The Os Pubis of the left fide.
   D. The inferior part of the RcHutn.
   L. Tiie P( rinaum.
   F. The left Labium Pudendi.
   G. G. G.  The Uterus.

   When the Pelvis is large,  the  head,  if fmall,
 will come along, in this pofition, and the child be
faved :  For, as the head advances lower, the face
 and forehead will  ftretch  the  parts between  the
 Franum  Labiorum and Coccyx in form  of a large
 tumor.   As the Os Externum likewife is  dilated,
 the  face  will  be forced through it ; the under
 part of the chip will rife upwards over  the  an-
 terior part of the  Pubes ; and the forehead,  Vtr-
 tcx, and  Occiput, turn up from the  parts  below.
 If the head, however, is large, it will be detained
 cither when higher or  in this pofition.   In  this
 cafe, if the pofition cannot be altered  to the  nat-
 ural, the child ought to be turned, and delivered
 footling.
   See X. R. at the end of explanation of Table
 XXV. page 51.
   If the  Pelvis, however, is narrow, and the   wa-
 ters  not  all gone, the Vertex fhould, if poffible,
 be  brought to prefent ; but  if the Uterus is fo
                                     clofil y 
 
> J /frfe XXIV.
 
       with EXPLANATIONS, Sec.       49
clofely contraded that this cannot be effeded, on
account of the ftrong prelfure  of  the  fame,  and
flipperinefs of the child's head, in this cafe the
method direded in the following »table is to be
taken.



 TWENTY  FOURTH  TABLE
Reprefents, in the literal view,  the head of the
   Foetus in the fame  pofition as in the former
   Table ; but the delivery is fuppofed to be re-
   tarded from  the  largenefs of the head, or a
   narrow Pelvis.

   In this cafe,  if the head cannot be raifed, and
pufhed up into the  Uterus, it ought to  be  deliv-
ered with the forceps, in order to fave the child.
This pofition of the chin to the  Pubes  is one of
the fafeft cafes where  the  face  prefents, and  is
rnoft eafilv delivered with the forceps ; the man-
ner of introducing of which over the ears is fhown
in this Table.  The patient muft lie on her back,
with her breech a little over the bed, her legs and
thighs being fupported by an affiftant  fitting on
each fide.  After'the parts have been flowly di-
lated with the hand of the operator,  and the for-
ceps introduced,  and properly  fixed along the
ears of the child, the head is to be brought  down
                                         by 
50       ANATOMICAL  TABLES,
by degrees, that the parts below the Os Externum
may be gradually  ftretched : The chin then is
to be raifed up over the Pubes, whilll the  fore-
head,  FontamLc, and Occiput, are brought out
flowlv  from the Perinaum and Fundament to pre-
vent the fame  from  being hurt  or lacerated.
But  if the Foetus cannot be cxtraded  with the
forceps, the delivery muft be left to the labour
pains, as long as the patient is in no danger  ; but
if the danger is apparent, the head muft be de-
livered  with the curved crotchets.  Vide Table
XXXIX.
  When the face prefents, arid the chin  is to the
fide  of the Pelvis, the patient muft lie on  her fide;
and  after the forceps are fixed along the ears, the
chin is to be brought down to the lower part of
the Os  Ifchium,  and then turned out below the
Pubes,  and delivered in  a flow manner as above.
  Vide Vol. II. Coll. 16. No. 6. As  alfo Tables
XVI, XVII, XVIII, andXIX,forthedefcription
of the  parts.




   TWENTY   FIFTH   TABLE
Shows, in a  lateral  view of the right fide, the
  face of the Fatus prefenting, as in Table XXIII,
  but in the contrary pofition ; that is,  with the
                                       chin 
/r/fcxxv:
 
 
         with  EXPLANATIONS,  Sec.      51
   chin to the Os Sacrum, and the Bregma to ths
   Pubes, the waters evacuated,  and the Uterus
   contraded.

   A. The Os Externum not yet begun to ftretch.
   B. The Anus.   VJe Table XX, for the further
 defcription of the parts.

   In fuch cafes, as well as in  thofe of the laft
 mentioned Table, if the child is fmall,  the  head
 will be pufhed loWer with  the labour pains,  and
 gradually ftretch  the lower  part of the Vagina
 and the external parts ; by which means the Os
 Externum will be more  and more dilated, until
 the Vertex comes out below the Pubes, and  rifes
 up on the outfide ; in which cafe the delivery is
 then the fame as in natural labours.  But if the
 head is large, it will pafs along  with great  dif-
 ficulty  ; whence the brain,  and veffels of the
 neck, will be fo much compreffed and obftruded,
 as to deftroy the  child.  To prevent which, if
 called in time, before the head is far advanced in
 the  Pelvis,  the child ought to  be  turned,  and
 brought footling.  If the head, however, is  low
 down, and cannot be turned, the  delivery is then
 to be periormed with the forceps,  either by bring-
 ing along the head as it prefents,  or  as in the fol-
 lowing Table.   See  the references  in  the  pre-
 ceding  Table.
   X. B. Alarming floodings only excepted,  it is
 bad pradice  to turn the child when the  head pre-
fents ;  and in  cafes of relative difproportion be-
                                      tween 
52       ANATOMICAL  TABLES,
twecn it and the Pelvis, wc can never propofe to
lave the child by turning.
  See note, Table XXI, page 45.



   T W EN TV   SIX T II  T A B L E
 Reprcfents, by outlines, in a lateral view  of the
   left fide of the fubject. the Foetus in the fame
   fituation as in the former Table.

   The head here is fqucezed into a very oblong
 form ; and though forced  down fo as fully  to
 dilate the, Os Externum, yet the Vertex and Occiput
 cannot be brought fo  far down, as to turn out
 from below the Pubes, as in the foregoing Tat)le,
 without tearing the Perinaum and  Anus, as well
 as the Vagina and Rectum.
   The beft method in this cafe,  after  either the
 fhort or long  curved  forceps have been applied
 along the ears, as reprefented in  the Table, is  to
 pufh the head as high up in the  Pelvis as is pof-
 fible ; after which the chin is to be turn d  from
 the Os Sacrum  to  either  Os  Ifchium,  and after-
wards brought down to the  inferior part of the
 laft mentioned bone.   This  done, the operator
muft pull  the forceps with one hand, whilft two
fingers of the other are fixed on  the lower part
of the chin or under jaw, to keep the face  in the
                                     middle 
 
 
        with EXPLANATIONS, Sec.      53
middle, and prevent the chin from being detain-
ed at the Os Ifchiiim,  a$ it comes  along,  and in
this manner move the chin round  with  the  for-
ceps, and the above fingersj until brought  under
the Pubes,  which done,  the head will be eafily
extraded, as in Table XXIV.
  If, before affiftance has been called, the head
is fo fqueezed down into  the Pelvis, that it is  im-
poffible to move the chin from the Sacrum to ei-
ther Os Ifchium, fo as to deliver with the Forceps
for the fafety of the child, the  operator muft
wait with patience, as long as the  woman is  not
in danger, or there is no  certainty of the death
of the Foetus :  but  if  the patient runs the leaft
rifle, the head muft be delivered with the crotchet.
  In general, with refped to the pofture of the
woman in the application of the forceps, when
the ears are to the fides of the Pelvis, the forceps,
as was obferved in Table  XXIV,  are molt eafily
introduced when the patient lies upon her back,
with her breech over the fide of the bed ;  but
When the ear is  to the Pubes or Groin,  they are
better applied when the patient lies on  her fide,
as was obferved in the  cafes  where the Vertex
prefented.
   Vide Table XXIV,  for the description of the
parts, and the references.  Alfo Table XXXIX,
for the manner of ufing the crotchet.   See  alfo
general rules for ufing  the forceps  in Dr. Hamil-
ton's Outlines of Midwifery, page 269,  and  feq.
and Dr. Denman's Aphorifms on  laborious  and
preternatural prefentation.
                 D              TWENTY 
ANATOMICAL TABLES,
TWENTY  SEVENTH   TABLE
 Gives a lateral internal view of a diflorted Pelvis,
   divided longitudinally, with  the head of a Fa-
   tus of the feventh  month  parting  the fame.
   Vide the explanation of Table III.

   A. B. C. The Os Sacrum and Coccyx.
   D. The Os Pubis of the left fide.
   E. The Tubtrofityoi the Os Ifchium, of the fame
 fide.
   The head of the Fatus here,  though fmall,  is
 with difficulty fqueezed down into the  Pelvis, and
changed from a round to an oblong form  before
it  can pafs,  there  being  only the  fpace of two
inches and one quarter between the projcdion of
 the fuperior part of the Sacrum and the Offa Pubis.
 If the head is  foon delivered, the child may be
born alive : But if it  continues in this manner
 many hours, it is in danger of  being loft, on ac-
 count of the long preffure on the brain.  To pre-
 vent which, if the labour pains  are not fufficient-
1 v  ftrong, the head may be helped along with the
forceps, as  direded in Table XVI.
   Dr. Ofburn has endeavoured to prove, " that
the fastal head, at full maturity, cannot bear com-
preffion to a volume much fmaller  than three
inches, from one parietal bone to the other, con-
fiftcntly with  fafety  to   the child's  life."  He
                                   therefore 
e?/rXXVE.
'./ 
lhr/< XXV
111
 
        with EXPLANATIONS, &c.      55
therefore concludes : " Through a Pelvis which
has its cavity fo contraded, that the bones ap-
proach nearer to each other than three inches,  it
is  utterly impoffible for a  living child, at full
maturity, by any means to pafs."
   See Dr. Ofburn's  Effay on Laborious Parturi-
tion, page 28. et feq.
   This figure may ferve as an example  of the
extreme degree of diftortion of the Pelvis, between
which and the well formed one  are many inter-
mediate degrees, according to which the difficulty
of delivery muft increafe or diminifh, as well as
from the difproportion of the Pelvis and head of
the Foetus ; all which cafes  require the greateft
caution, both as to the management  and fafety
of the mother and child.
   Vide Vol. I. Book III. Chap.  2. Sed. 3. No. 5.
Chap. 3. Sed. 4* N0.3. Vol* II. Coll. 21. No. 1.
and Coll. 29.
TWENTY  EIGHTH  TABLE
Gives a fide view of a diflorted Pelvis, as in the"
  former Table, with the head of a full  grown
  Foetus fqueezed into the brim, the Parietal bones
  decuffating each other,, and compreffed into a
  conical form.
                D *              A. B. C. 
 56       ANATOMICAL  TAIiLES,
   A. B. C. The Os Sacram and Couyx.
   D. The Os Pubis of the left fide.
   L. The Tuberofity of the Os Ifchium.
   F. The Proceffus Acutus.
   G. The Foramen Magnum.

   This Table fhows the impoffibility in fuch a
 cafe to fave the child, unlcis by the Cafarian op-
 eration ; which, however, ought never to be per-
 formed, excepting when it is impradicable to de-
 liver at all by any other method.  Even in  this
 cafe, after the upper part of the  head is dimin-
 ifhed in bulk, and the  bones are cxtraded, the
 greateft force muft be applied in order to cxtrad
 the bones of the face and  bafis  of the fkull, as
 well as the body of the Fatus.
   Vide Vol. I. Book III. Chap.  3. Sed. 7. Chap.
 5. Sed. 3. and Vol. III. Coll. 31. 39.
   X. B. In  oppofition  to  the  opinion of  Dr.
 Smeliie, and fentiments  of former authors,  Dr.
 Ofborn has proved, from  the cafe of Elizabeth
 Sherwood, that  " a child at full maturity  may
 be  extraded by the crotchet  through  a  Pelvis
 whofe aperture does not exceed  one inch and  a
 half from Pubes to Sacrum, with tolerable facility
 to the operator, and pcrfed fafety to the  mother;
dimenfions much lefs than what have  been  fup-
pofed to require the Cafarian operation,  even in
the lateft and beft books."  Effay on Laborious
 Parturition, page 64.—251, &c.
                                TWENTY 
 
W/'-xx\x
 
with EXPLANATIONS,  Sec.      ST
TWENTY  NINTH   TABLE
 Reprefents, in a front view of the Pelvis, as in
   Table XXII, the breech of the Foetus  prefent-
   ing, and dilating the Os Internum,  the Mem-
   branes being too foon broke.   The  fore parts
   of the child are to the pofterior part of the
   Uterus ; and the Funis with a  knot upon it,
   furrounds the neck, arm, and body.

   Some time after this and the following Tables
 were engraved, Dr. Kelly fhowed me a  fubjed he
 had opened,  where the breech prefented itfelf,
 and lay much in the fame pofition with its body
 as in the ninth Table, fuppofing the  breech in
 that figure turned down  to the Pelvis,  and the
 head up to the Fundus Uteri.
   I  have fometimes felt, in  thefe cafes  |[when
 labour was  begun, and  before the breech  was
 advanced into the Pelvis] one hip at the Sacrum,
 the other refting  above  the  Os  Pubis, and the
 private parts to one fide : But before they could ad-
 vance lower, the Xates were turned  to the  fides
 and wide part  of the brim of the  Pelvis, with the
 private parts to the Sacrum, as in this  Table ;
 though fometimes to the Pubes, as in the follow-
ing Table.  As foon as the breech advances to the
 lower part of the bafin, the hips again return to
 tlicir former pofition, viz.  one hip turned out
                D 3                  below. 
58       ANATOMICAL TABLES,
below the Os Pubis, and the  other at  the back
parts of the Os Externum.
  X. B.  In this cafe the child, if not very large,
or the Pelvis narrow, may be often delivered alive
by the labour pains ; but if long detained at the
inferior part of the Pelvis, the long preffure of the
Funis may obftrud the circulation.  In  mofl
cafes where the breech prefents, the tiled of the
labour pains ought to be waited for, until at lea ft
they have fully dilated the  Os Internum and Vag-
ina, if the fame have not been  ftretched  before
with the waters  and Membranes.  In the mean
time, whilft the breech advances, the Os Externum
may be dilated gently during  every pain,  to al-
low room for introducing a finger or two of each
hand to the outfide of each groin  of the Foetus,
in order to afjift the delivery when the Xates
are advanced  to  the lower part of the  Vy/na.
But if the Fatus is larger than ufual, or the Pelvis
naiTOW, and after a  long time and many repeated
pains the breech is not forced down into the Pel-
vis, the patient's ftrength at the fame time failing,
the operator muft in a gradual manner open the
parts, and,  having introduced a hand into the Vag-
ina, raife or pufh up the breech of the Fxtus, and
bring down the legs and thighs.   If the Uterus is
fo flrongly contra£ted that  the legs cannot begot
down, the largeft end of the blunt  hook is to  be
introduced, as direded  in  Table XXXVII.  As
foon as the breech or legs are brought down, the
body and head are to be delivered as defcribed in
                                        the 
 
 
        with EXPLANATIONS, Sec.      5$
the next Table, only there is no neceflity here to
alter the pofition of the child's body.
   Vide Vol. I. Booklll. Chap. 4. Sed 1,  2. Vol.
III. Coll.  32.
   The defcription of the parts  in  this, and the
following  Table, is the fame as in Table XXII,
only the dotted lines in this defcribe the place of
the Offa Pubis, and anterior  parts of  the  Offa If-
chiiim which are removed,  and may ferve in this
refped as an example for all the other front views,
where, without disfiguring the Table, they could
not be fo well put in.
   X. B. The ufe of the blunt  hook, in  breech
cafes, is a  hazardous expedient ; and manual af-
fiftance of every kind fhould be avoided, the moft
urgent cafes only excepted.
  See Dr.  Hamilton's Outlines of Midwifery, page
370, et feq.

        —3»^>»»>>»>»e3gSJj>^<-<c«rfe *■' "

   THIRTIETH   TABLE
  Shows,  in the fame view,  and with the fame
references as the former, the breech of the Fatus
prefenting ; with this difference,  however, that
the fore parts of the child are to the fore part of
the Uterus. In this cafe,  when the breech com-
ing double, as it prefents, is  brought down to the
hams, the legs muft be extraded, a  cloth wrap-
                 D 4                  ped 
60       ANATOMICAL  TABLES,
ped round them, and the fore parts of the child
turned to the back parts  of the woman.  If a
paiu fhould in the mean  time force  down  the
body of the child, it ought to be pufhed up a«.;ain
in turning, as it turns eafier when the belly is in
the Pelvis, than  when the breall and fhoulders
are engaged  ; and as fometimes the face and fore-
head are rather towards one of the groins,  a quar-
ter turn more brings thefe parts to the fide of the
 Pelvis, and  a little backwards, after  which  the
body is to be brought down.  If the child is  not
large, the arms need not be  brought down, and
the head may be  delivered by preffing  back  the
fhoulders and body of the child to the Perinaum,
and whilft the chin and face are  within the Vag-
ina,  to bring the Occiput out from below the Pubes,
according to Daventer's method.   Or  the opera-
tor may introduce a finger or two into the mouth,
or on each fide of the nofc, and, fupporting  the
body on the fame  arm,  fix two fingers of the
other hand over the  fhoulders, on each  fide
 of the  child's  neck,  and in this  manner raife
the body over the Pubes, and bring the face  and
 forehead out with a  femicircular turn upwards,
 from the under  part of the Os Externum.  All
 this may be eafily done when the woman lies on
 her  fide ; but if the child is large, and the Pelvis
 narrow, it is better  to  turn  the  patient on her
 back, as defcribed in  Table XXIV; and after the
 legs and body are extraded as far as  the fhoul-
 ders, the arms are to becautioufly brought down,
 and the head delivered.  If the woman has ftrong
                                      pains, 
         with EXPLANATIONS, Sec.      0i
 pains, and when by the felt pulfation of the vef-
 fels of the Funis Umbilicalis, or the ftruggling mo-
 tions of the Foetus, it is certain that the child is
 ftill alive, wait with patience for the affiftance of
 the labour : But if that and the hand are infuf-
 ficient, and the pulfation of the Funis turns weak-
 er, and if  the child cannot be brought double,
 the breech muft be pufhed up ;  and if  the re-
 finance of the Uterus is fo great as  to prevent the
 extradion of the legs, the patient ought to be
 turned on her knees and elbows.   When the legs
 are thus brought down,  the woman, if needful,
 is to be again turned to her back,  to allow more
 freedom to deliver the body and head, as  before
 defcribed.  If the head, after feveral trials, can-
 not be delivered, without endangering the child,
 from overftraining the neck, the long curved for-
 ceps ought to be applied,  as in Table XXXV.
 If thefe fail, and the patient  is not in danger,
 fome time may be allowed for the effed of the
 labour pains; which likewife proving infufficient,
 the crotchet muft be ufed as  in Table XXXIX,
 and when it is certain that  the child is  dead, or
 that there is no poffibility  of faving it.
   X. B.  Under proper management, if there  is
 no confiderable  relative difproportion between
 the head and the Pelvis,  the hand of the operator
 will  be fufficient to relieve the head, when re-
 tained after the delivery of the body, in breech,
and other preternatural  prefentations.  See  Dr.
Hamilton's Outlines of Midwifery, p. 366 to 368.
                                 THIRTY 
62       ANATOMICAL TABLES,

    THIRTY  FIRST  TABLE
Reprefents, in a front view of the  Pelvis, the Foe-
  tus compreffed by the contradion of the Uterus
  into a round form, the fore parts of the former
  being towards the  inferior part of  the latter,
  and one foot and  hand fallen down into the
  Vagina.  In this figure the anterior part of the
  Pilvis  is  removed by a longitudinal fedion
  through the middle of the Foramen Magnum.

  A. A. The fuperior parts of the Offa Ilium.
  B. B. The Uterus.
  C. The mouth of the Womb ftretched, and ap-
pearing in
  O. O. O. O. The Vagina.
  D. The inferior and  pofterior part of the  Ot
Externum.
  E. E. E. E. The  remaining part of the Offa Pu-
bis and Ifchium.
  F. F. F. F. The  Membrana Adipofa.

  This and  the three  following  Tables, rcpre-
fenting four different preternatural pofitions of
the Foetus in utero,  may ferve as examples for the
manner of delivery in thefe as well as in all oth-
er preternatural cafes.
   In all preternatural cafes, the Foetus may be
eafily turned and delivered by the feet, if known
                          sts      s before    ,1 
       with EXPLANATIONS, &c.      63
before the Membranes are broke,  and the waters
difcharged ; or if the Pelvis  is narrow,  and the
patient  is ftrong,  the head, if  large,  may be
brought down fo as to prefent in the natural way :
But if all the waters are difcharged, and the Ute-
rus is flrongly con traded to the body of the Foe-
tus, this laft method can feldom  take place, on
account of the ftrong preffure of  the Uterus, and
flipperinefs of the child's head.
   In the prefent cafe, the woman may either be
laid on her back or fide,  as  defcribed in Tables
XVI, and XXIV ; and the operator, having flow-
ly dilated the Os Externum with his fingers, muft
introduce the fame into  the Vagina, and pufh up
into the Uterus the parts of the  Foetus that pre-
fent ; or if there is fpace for it, his hand may
pafs in order to dilate the Os Internum if not fuf-
ficiently ftretched  previoufly by the Membranes
and waters.   This done, he muft advance his
hand into the Uterus, to know the pofition of the
Foetus ;  and, as the breech is rather lower than
the head, fearch for the other leg,  and bring down
both feet without the Os Externum.  A cloth muft
then be wrapped round them ; and, having grafp-
ed them with one hand,  he  is to introduce the
other into the Uterus, in order to raife the head
of the Foetus, whilft the legs and thighs are pulled
down by the hand that holds the feet.   When
the head is  raifed, and does not fall down a?ain,
the hand of the operator may be withdrawn from
the Uterus, and the delivery completed as dired-
ed in  the  two former  Tables.  By the aitlefs
                                    method 
64       ANATOMICAL  TABLES,
method of taking hold and pulling one  or  both
feet, the breech may come down  and the  head
rife to the Fundus ; but if  this fhould not  hap-
pen, there will b • great  danger of overftraining
the  Foetus,  which  is  prevented by  the  former
method.  If the Membranes are broken before the
Os Uteri is largely opened, and the hand of the
operator cannot be introduced, which  fometimes
happens in a firft pregnancy, the parts of the Fa-
tus fhould be  allowed to protrude ftill  further,
by which means the rigidity of the Os Internum
will  in time be leffened.
  Vide Vol. I. and  III. on  preternatural labours.
  See alio diredions for the  management of pre-
ternatural labours in Dr. Hamilton's Outlines of
Midwifery, page 357, et feq. and  Dr. Dcnman's
Aphorifms  refpeding  the Diftindion  and Man-
agement of preternatural prefentation.

         .  «=. t»»x»»<(C@flOP<< >w» -   ■

  THIRTY SECOND  TABLE
Reprcfents, in the fame view with the former, the
  Fxtus in the contrary pofition; the breech and
  fore parts being towards the Fundus  Uteri, the
  left arm in the Vagina, and fore arm without
  the Os Ex'rmum,  the  fhoulder  being likewife
  forced into the Os Uteri.
                                      The 
y/u
XXXH.
 
 
       with EXPLANATIONS, &c.      65
  The operator in this cafe muft introduce his
fingers between the back part of the  Vagina and
the arm of the Fatus, in order to raife the fhoul-
der and make room for paffing his hand  into the
Uterus to  diftinguifh the pofition.   This being
known, he ought to pufh up the fhoulder to that
part of the Uterus, where  the head is lodged, in
order to raife the fame to the Fundus.   If the
body of the  Foetus does  not move round, and
thereby lie in  a  more convenient pofition for
bringing down the legs, the hand of the operator
ought to be pufhed  up ftill higher to fearch for,
and take hold of the feet, which are to be brought
down as far  as  is poffible.   If this  fhould  not
change the pofition, the fhoulder is to be pufhed
up, and the legs pulled down alternately, until
they are brought down into  the Vagina, or with-
out the Os Externum, after which the delivery
may be completed as in the former cafe.
  If the feet cannot be brought down lower than
into the Vagina, a noofe may be introduced over
both ankles, by which the legs are brought lower
by pulling the noofe with  one hand, whilft the
other,  previoufly introduced   into  the  Uterus,
pufhes up the fhoulders and head. By this dou-
ble  force the pofition of the Foetus is to be altered,
and the delivery effeded.   In  thefe cafes, as the
fhoulder is raifed to the Fundus, the arm com-
monly returns into the Uterus ;  but if the arm is
fo fwelled as  to prevent the introdudion of the
operator's  hand, and cannot be folded up or re-
turned into the  Uterus, it muft be taken off at the
                                   fhoulder, 
66        ANATOMICAL  TABLES.
fhoulder, or elbow, in  order to deliver and fave
the woman*.   If both arms come down, when
the breaft pel* uts, the methods above defcribed
are to be ufed.
   Vide the explanations and references of  the
foregoing Table to illuftrate this and the follow-
ing.



    TIIIRTY  THIRD  TABLE
Exhibits, in the fame view likewife of the Pelvis
  with the former,  a third pofition of the Fatus
  when compreffed  into  the round form,  the
  belly, viz.  or Umbilical region, prefenting at
  the  Os Internum,  and the  Funis fallen down
  into the Vagina,  and appearing at the Os Ex-
  ternum.

  The delivery in  this cafe is to be effeded as in
the former Table, by pufhing up  the breaft, and
bringing  down the  legs.   When  the  belly pre-
fents, it is eafier coming at the  legs,  than when
the breaft prefents, becaufe in the former cafe the
head is nearer to the Fundus Uteri, and the legs and
                                        thighs
  * The protruding arm of the child doe* not impede the introduction of
the operator*! hand in turning ; and the horrid expedient of amputati**
irommended her.-, and by foimtr practitioner!, if feldom ■■  effary, evcav
in cafe* of confiderable narrownefi of the Pelvis from diftortion.
  See Dr. Hamilton's Outlines of M.dwifcry, page 392, et feo. 
^
s//>xxxm

 
///£/'■ XXX
xxxw
 
        with EXPLANATIONS, Sec.      67
thighs  lower.   If  the belly or breaft is forced
down into the lower part of the Pelvis, the child
will be in danger from the  bending of the Ver-
tebra, and the preffure of  the fpinal marrow, fo
great force is alfo required to raife thefe parts up
into the Uterus, in  order to come at the feet, that
it will fometimes be neceffary to turn  the wom-
an to her knees and elbows, to diminifh the  re-
fiftance of the  Abdominal mufcies.   When  the
Funis comes  down without the Os Externum, if
there is a pulfation felt, it muft immediately be
replaced, and kept warm in the  Vagina,  to pre-
ferve the circulation, and prevent a  ftagnation,
from its being expofed to  cold air.   If the Funis
comes down when the head  prefents, the  child is
in danger, if not fpeedily delivered with the pains,
or brought footling.
   X. B. For an ingenious  method  of reducing
the prolapfed cord, See London Medical Journal,
Vol. VII. 1786, page 38.
  See the two former Tables for the explanations
and references.



  THIRTY   FOURTH  TABLE
Shows, in a lateral view of the Pelvis, one of the
  moft  difficult  preternatural cafes.  The left
  fhoulder, breaft, and neck of the  Foetus  pre-
                                    fenting, 
68       ANATOMICAL TABLES,
  fenting, the head refleded  over  the  Pubes to
  the right fhoulder and back, and the feet and
  breech ftretched up  to the Fundus,  the  Uterus
  contraded at the fame time, in form ol a long
  ftVath round the body of the Fatus.

  A. B. C. The Os Sacrum and Coccyx.
  D. The Os Pubis of  the left fide.
  E. Part of the  Urinary bladder.
  F. The Rectum.
  H. I. K. The private parts.
  M. The Anus.
  M. N. The Perinaum.
  V. The Meatus Urinarius.
  O. The Os Uteri not yet opened, and fituated
backwards towards the Rettum and Coccyx.
  R. S. The fame reprefented in dotted lines, as
opened when the labour is begun.
  T. U. The fame more fully dilated, but nearer
to the poflcrior than anterior  part of the Pelvis.
  W. P. The fame not fully ftretched at the fore
part, though intirely obliterated at the back part,
the Uierus and Vagina being there only fometimes
one continued furface.

   Hence it appears why the anterior part of thd
Os Uteri is frequently protruded before the head
of the  Fatus at the Pubes, which, if it retards de-
livery, is removed by  Aiding  it up with a finger
Or two between the head and laft mentioned parti
The pradice recommended here is attended with
confiderable hazard ; and in a favourable pre-
                                   fentation 
 
TTTTT
(
'////> XW
1\ 
        with EXPLANATIONS, Sec.      £9
fentation of the Fatus the dilatation may be fafely
trailed to nature.  Vide Tables IX, X, XI,XII,XIII.
  The manner of delivery, in the pofition of the
Fatus, as reprefented in this Table, is to endeav-
our with the hand to force up  the part prefent-
ing, in order to raife the head to the  Fundus.  If
this is impoffible from the  ftrong contradion of
the  Uterus, the operator muft pufh up his hand
in a flow and cautious manner along the breaft
and belly of the child, in  order  to come at the
legs and feet, which are to be taken hold of, and
brought down as far as the pofition of the Fatus
will admit of.  The body is then to be  moved
round by pufhing up the lower parts, and pull-*
ing  down the upper, until  the feet  are brought
without the Os Externum, and the delivery com-
pleted, as in Table XXXI. But if the feet cannot
be <*ot down, fo as to be taken hold of without
the  Os Externum, a noofe muft be fixed over the
ankles, as in  Table XXXII.
  Vide Vol. I, and III, as direded in Table XXXI.


    THIRTY  FIFTH  TABLE
Shows, in a lateral view of the Pelvis, the method
  of affifting the delivery of the head of the Fatus
  with the long curved forceps, in preternatural
  cafes, when  it cannot be done with the hands,
  as defcribed  in Tables XXIX, and XXX.
  A. The three loweft Vertebra of the loins, with
the Os  Sacrum and Coccyx.
                   £                 B The 
7^       ANATOMICAL  TABLES,
  H. The Os Pubis of the left fide.
  C. id. The Perinaum and Ams preffed back-
wards with the forceps.
  D. The Inteflines.
  E. E. The Parietes of the Abdomen.
  V. F. F. The Uterus.
  C The pofterior part of the  Os Uteri.
  H. The Reel urn.
  I. The Vagina.
  After the body  and arms  of  the child arc de-
livered, and the different methods ufed to bring
down the head with the hands,  a< directed in the
«bove Table, and  more fully defcribed in Vol. I,
and III, the following  method is to be tried in
order to fave the child, which muft otherwifc be
loft by overftraining the neck andfpinal marrow.
The woman being in  the lupine pofition, as in
Table  XXIV, one of the afliflants ought to  hold
the body and arms of the child up towards the
Abdooun of the woman, to give  more room to the
operator, who having introduced one hand up to
the c hild's  face,  and moved it from  the fide a
little backwards, for the eafier  application of the
forceps along the  fides  of the head, mull  then
turn his hand to one of the ears, and introduce
one of the  blades with the other hand between
the fame and the head,  with  the  cured fide to-
wards  the Pubes,  as in this  Table.  This done,
tlit; hand is to be  brought down to hold the han-
dle of the  blade  of the forceps,  until the other
hand is introduced to the other fide of the head,
by which means the fame is preffed againft the
                                     blade 
        with EXPLANATIONS, <&c.      7i
blade that is up,  and which  is thus prevented
from flipping, whilft  the other hand introduces
the fecond  blade  on  the  oppofite  fide.   The
blades being thus introduced, care muft be taken,
that  in  joining them  no  part of the Vagina is
locked in. After the forceps are firmly fixed along
the fides of the head> the face and forehead muft
be turned again to the  fide of the brim of the
Pelvis,  by  which  means the wide part  of the
head is to the wide part of the  brim.  This done,
the head is to be brought lower, and the force grad-
ually increafed, according to the refifiance from the
largenefs of the head, or narrownefs of the Pelvis.
The forehead, when brought low enough down, is
then to be turned into the concavity of the Os Sa-
crum and Coccyx, the handles of the forceps raifed
upwards, and the fame caution ufed in bringing the
head through the Os Externum, as defcribed in Ta-
ble XIX, and XXX. By this method the head will
be delivered, the child frequently faved, and the ufe
of the crotchet prevented, except in thofe baforis
that are' fo narrow, that it is impoffible to deliver
without diminifhing the bulk of the head.
   Vide Table XXXIX.  Alfo,  Vol. I. Book III.
Chap. 4. Sed. 5. Vol. III. Coll. 34, 35.
   X. B.  In preternatural labours, if the head can-
not be relieved by the hands of the operator, the
child can feldom be faved by mechanical expedients.
In difficult cafes the long cflrved forceps may, how-
ever,  be attempted to be applied.  Thofe of Dr.
Leak, in thofe circumftances, are preferable to any
others. See note after explanation of Table XXX.
                E 2               THIRTY 
72
ANATOMICAL  TABLES,
THIRTY   SIXTH   TABLE
Reprefchts, in a lateral view of the Pefoh, the
  method of extrading, with the affiftance of a
  curved crotchet, the head of the  Fatus,  when
  left in the  Uterus,  after the body is delivered
  and feparated from it, either by its being too
  large, or the  Pelvis too narrow.
  A. B. C. The Os Sacrum and Coccyx.
  D. The Os Pubis of the left fide.
  E. E. The Uterus.
  F. The locking part of the crotchet.
  g. h. i. The point of  the crotchet on the  infide
of the Cranium.
  If this cafe happens from the forehead's being
towards the Pubes, or the child long dead, and fo
mortified  that both the  body and under jaw are
feparated unexpededly, the long forceps that are
curved upwards will be fufficient  to cxtrad the
head ;  but  if the fame  is large, and the  Pelvis
narrow, and the delivery cannot be effeded by
the above method, then the head muft be  open-
ed, that its bulk may diminifh, as it is extraded.
The patient being placed either on her back, or
fide, as in the explanation of Table  XVI,  and
XXIV, the left hand of the operator is to  be in-
troduced into die Uierus, and the forehead  of the
Fatus turned to the  right fide of the brim  of the
Pelvis,  and  a little  backwards, the chin being
                               downwards; 
rfvfrXJKVI.
 
 
        with EXPLANATIONS, Sec.      73
downwards ;  after which  the  palm of the hand
and  fingers  are  to be advanced as high as  the
Fontanelle, and the head grafped with the thumb
and little finger  on each fide, as firm as  is poffi-
ble, whilft an affiftant pieffes on each fide of the
Abdomen with both hands, to keep the Uterus firm
in the middle and lower part of the fame.  This
done, the operator having with his right hand in-
troduced and applied the crotchet to the head
(the point being turned towards the forehead, and
the convex part towards the Sacrum) he  muft go
up along the infide of the left hand as high as
the Fontanelle, and there, or near it, fix the point
of the crotchet,  keeping ftill the left hand in the
former pofition,  until with the other he pierces
the Cranium with the point of the inftrument, and
tears a  large opening in it from K to I ; after
this, keeping, the crotchet fteady,  he may fflide
down his left hand in a  cautious manner,  left
the former pofition fhould be altered,  and the
head will fink lower down by the afliftant's preff-
ing on the  Abdomen.   The two fore fingers of
the left hand are  then to  he introduced into the
mouth, and  the thumb below the under jaw. the
hand being above  the blade of  the  crotchet.
When this firm hold is taken,, the operator may
begin and pull flowly with  both hands, and as
the brain difcharges through the perforation, the
head  will  diminifh, and  come  along.   If  this
method fhould  fail from  the  flippcrinefs of the
head, or its being fo much offified that a fuffi-
cient opening cannot  be made, the Vertex muft
                    E 3                 be 
74       ANATOMICAL  TABLES,
be turned down to  the  brim of the Pelvis, the
Fontanelle backwards, and each blade of the long
forceps introduced  along the fides of the head,
with the curved fide towards  the Pubes.   Aftct
they arc joined  and locked, the handles  are  to
be tied  together with a fillet, to keep them firm
on the head, an affiftant is to keep the handles
backwards until the Cranium is  largely  opened
with the long fciffars fhown in Table XXXIX.
This done, the  head is to be extraded in  a flow
manner, firft turning the forehead to the  fide  of
the brim, and as the brain evacuates, and the
head comes lower down, again turning the fore
head into the concavity of the Sacrum, and com-
pleting the delivery, as in Table XVI.
  This Table may alfo ferve for an example,  to
fhow the method  of fixing the crotchet on the
head, when although the body  is not feparated
from it, yet  it cannot be delivered with the ope-
rator's  hands, or the long forceps,  as in  Table
XXIX, and XXXV.
  Vide Vol.1. Book III. Chap. 3. Sed. 7.  Chap.
4. Sed. 5. Alfo, Vol. III. Coll. 31, 36.
  X. B. It is the fafeft pradice, where the refift-
ance is confiderable from relative difproportion,
to diminifh the  volume of the child's head pre-
vious to the extradion with the hook.
THIRTY 
 
y^rfrXXXXW.
923930�9 
with EXPLANATIONS,  Sec.     75
THIRTY SEVENTH   TABLE
And the two following, reprefent fever,al kinds of
  inftruments ufefiil in laborious anddifficultcafes.
  A. The ftraight fhort forceps, in the exad pro-
portion as to the width  between  the blades, and
length from the points to the locking part : The
firft being two and the fecond fix inches, which
with five inches and a  half (the  length of  the
handles) makes in all eleven inches and a half.
The length of the  handles may be altered at
pleafure.  I find, however,  in pradice, that this,
flandard is the moft convenient and  with lefs
difficulty introduced, than  when longer, having
alfo  fufficient force  to  deliver  in  moft cafes,
where their affiftance is neceffary. ./The handles
and  loweft part of the blades may as here he
covered with any durable leather^ but the blades
ought to be wrapped round with fomething of a
thinner kind, which may be eafily renewed when
there is the leaft fufpicion of veneral infedion in
a former cafe  ;  by being thus covered,  the for-
ceps have a better hold,  and mark lefs the head
of the child.   For their eafier introdudion,  the
blades ought likewife to begreafed with hog's lard.
  B. Reprefents the  pofterior part  of a fingle
blade, in order to fhow  the width and  length of
the open part of the fame, and the form and pro-
portions of the whole.  The handles, however, as,
here reprefented, are rather too large.
                  E 4                  Vide 
 ;9       ANATOMICAL TABLES,
    V:de Table XXI, for the figure and proportions
 of the long iorceps,  that are curved upwards,
 and covered in the fame manner as  the former.
   The loir> n> were at firft contrived to fave the
 Fain.*, and prevent, as much as  polbble, the ufe
 of fharp inftruments ; but even  to this falutary
 method recou'rfe ought not to be had but in cafes
 where the degree of force rcquifite to cxtrad will
 r.Ot endanger, by its confequences, the life of the
 mother.  For, by the imprudent ufe of the for-
 ceps, much more h irm may be done than good.
   See the explanation of  Table XVI,  alfo  the
 Preface to Vol.  II, with the  cafes in the collec-
 tion on that fubjed.
   C. The blunt hook, which is ufed for three
 pur poles.
   Firjl, To affift the extradioh of the head after
 the Cranium is  opened with the feiffars,  by  in-
 troducing the fmall end along the ear on the out-
 fide of the head to  above the  under iaw,  where
 the point is to be fixed ; the other extremity of the
 hook being held  with one hand, whilft two fin-
 gers of  the  other are  to be introduced  into  the
 forefaid opening, by which holds the head is to
 be gradually ex traded.
   Secondly, The fmall  end is  ufeful in abortions
 in any of the firft four or five months, to hook
 down  the Secundines,  when lying loofe in  the
 Uterus, when the  patient  is much weakened by
 floodings from the too long retention of the fame,
 the pains  alfo being unable to expel  them, and
when they cannot be extraded with the fingers.
                                        But 
 
///,/
xsxvm.

 
        wtth EXPLANATIONS, Sec.      77
But if the Placenta ftill adheres, it is dangerous
to ufe this or any other inftrument to extrad the
fame, as it ought to he left until it feparates nat-
urally.  If a fmall part of the Secundines is pro-
truded  through the  Os Uteri, and pulled away
from what  ftill adheres in the Uterus, the mouth
of the Womb contrads, and that irritation is there-
by removed which would have continued the pains,
and have feparated and  difcharged  the whole.
  Thirdly, The large hook at the other end is  ufe-
ful to affift the extradion of the body, when the
breech  prefents,  but fhould be  ufed with great
caution,  to  avoid the diflocation  or fradure of
the thigh.
  X. B. The fmall extremity of the hook can nev-
er be employed without danger to  the mother in
the former cafe ; nor the large hook without haz-
ard of deftroyrng the child, or occafioning violent
injury  to the mother in the latter.
  Vide Table XXIX. Alfo, Vol. I. BookIL Chap.
3. Book. III. Chap. 3.  Sed. 7.  and  Chap. 4.
Sed. 2. Vol. II. Coll.  12. Vol. III. Coll. 31, 32.


  THIRTY  EIGHTH   TABLE.
  A, Reprefents the whalebone fillet, which may
fometimes be ufeful in laborious cafes, when  the
operator is not provided with the forceps in fud-
den and unexpeded exigencies.
                                     When 
78       ANATOMICAL  TABLES,
  When the Vertex of the Fatus prefents, and the
head is forced  down  into the lower part of the
Pelvis, the woman weak,  and the  pains not  fuf-
ficient to deliver it, the double of the fillet  is to
be introduced  along the fore part  of the Parietal
bones to the face, and if polhble above the under
jaw ;  which done, the whale J>one may be cither
left in or pulled down out of the  fhcath, and ev-
ery weak pain affiftcd by pulling gently at the
fillet.  If the head can be railed to the upper part
of the Pelvis,  the fill' r  will be more eafily got
over the chin,  which is  a fafcr and better hold
than on the face.  If the face or forehead  pre-
fents. the fillet is to be introduced over the Oa ifml.
   Vide Vol. I. Book  III.  Chap. 3. Sed. 2. Vol.
II. Coll. 24.
  In fuch cafes, likewife, the whale bone may be fup-
pliedby a twigof any tough wood, mountedwitha
limbergarteror fillet lowed in form of a long fhcath.
   X. B. Fillets, of whatever conftrudion,  being
difficult of application,  trifling in their  powers,
liable to cut or  gall  the child's  head, though  a
fecure hold fhould  be  obtained,  and in  other
refpeds inferior to the forceps, are now with juf-
tice rejeded from pradice.
   B. B. Gives two views of a new kind of peffary
for the  Prolapfus Uteri,  being  taken  from  the
French and Dutch kind.  After the Uterus is re-
duced, the large end of  the peffary is to be in-
 troduced into the Vagina, and the Os Uteri retain-
 ed in the concave part, where there are three holes
 to prevent the flagnation of any moiflure.  The
                                       fmall 
       with EXPLANATIONS, Sec.       79
fmall end without the Os Externum has two tapes
drawn  through the two holes, which are  tied to
four other tapes, that hang down from a belt that
furrounds the woman's body, and by this means
keep up the peffary.  This fort may be taken out
by the  patient  when fhe goes to bed, and intro-
duced again in the morning ; but as this fome-
times rubs the  Os  Externum, fo as to make its ufe
uneafy, the round kind marked C  are of more
general ufe.  They are made of wood, ivory, or
cork (the laft covered with cloth and dipt in wax :)
the peffary is to be lubricated with pomatum, the
edge forced through the paffage into the Vagina,
and a finger introduced into the hole in the mid-!
die lays it acrofs within the Os Externum:  They
ought to be larger or fmaller,  according to the
widenefs or narrownefs of the paffage, to prevent
their being forced out  by any  extraordinary
ftraining,  Vide Vol. L Book IV. Chap.  1. Sed.
7. Vol. III. Coll. 24.
   See  a  defcription of a globe peffary, recom-
 mended by Dr. Denman, London Medical Jour-
 nal, Vol. VII, for 1786,  page 56.
   D.  D. Gives  two views of a female catheter, to
 fhow its degree of curvature and different parts,.
 Thofe for common ufe may be made much fhort-
 er for conveniency of carrying  in the  pocket;
 but fometimes when the head or body of the child
 preffes on  the bladder above the Pubes, it requires
 one of this length ; and in fome  extraordinary
 cafes I have been obliged to ufe a male  catheter.
   Vide Vol. I. Book II. Chap. 1. Sed.  1, 2. Vol.
 II. Coll. 10.  No. 2.               THIRTY 
80       ANATOMICAL TABLES,

   THIRTY   NINTH   TABLE.
   a Reprefents a pair of curved crotchets locked
together in the fame manner as the forceps.  It
is  verv rare that the ufe of both is neceffary, ex-
cepting when  the face prefents with the chin
turned to the Sacrum,  and when it is  impolfiblc
to move the head to bring the  child tootling, or
deliver with  the forceps.   In that cafe, if one
crotchet is not fufficient, the other is'to be intro-
duced, and when joined together will ad both as
crotch'ets, 411 noening the Cranium, and as the head
advances, will likewife ad as forceps in moving
and turning the head more conveniently for the
delivery of the fame.   They may alfo be ufeful
to aflift when the head is left in the Uterus,  and
one blade is not fufficient.  There is feldom oc-
cafion, however, for the fhaq:>  crotchet, when the
head prefents, the blunt hook in Table XXVII,
being commonly fufficient, or  even the forceps to
extrad the fame, after  it is opened with the fcii-
fars.  Great  care ought to be taken when tho
fharp crotchet is introduced,  to keep the point
towards the F./ius, efpecially in  cafes where the
fingers cannot be got up to guide the fame. The
dotted lines along the infide of one of the blades,
reprefent a fheath that is contrived to guard the
point until it is introduced  high enough ; the
ligature at the handles marked with the two dot-
ted lines is then to  be untied, the  fheath  with-
                                     drawn, 
v/rv/rXXXK
I
eee-ei. 

X
{ 
        with  EXPLANATIONS, &c.      81
drawn, and the point, being uncovered, is  fixed
as direded in Table XXXVI.
   The point guarded, with this fheath, may alfo
be ufed inftead of the blunt hook.
   b Gives a view of the back part of one of the
crotchets, which is twelve inches long.
   c Gives a front view  of the point,  to fhow its
length and breadth,  which ought to be  rather
longer and narrower than here reprefented.
   X. B. In the lefs improved  ftate  of the art,
when  mechanical  exertions were  chiefly  trailed
to accomplifh  delivery, in  cafes of narrownefs
from diftortion of the bones,  two blades of the
crotchet were  recommended by  Dr. Smellie.
That pradice is now rejeded ; for both blades
can never be employed  at once with  advantage,
and feldom with  fafety.
   See Dr.  Hamilton's  Outlines  of  Midwifery,
page 285 to 302  ; alfo Appendix, 420 ; and Dr.
Olburne's  Effay on Laborious Parturition.
   d Reprefents the fciffars proper for perforating
the Cranium in very narrow and diflorted Pelvifes.
They  ought to be made very ftrong, and nine
inches at leaft in length, with ftops  or refts in
the middle of the blades, by which a large  dila-
tation is more eafily made.
   The above inftruments ought only to be ufed
in the moft extraordinary cafes, where it  is not
poflible to fave the woman without their affiftance.
   Vide Vol. I.  Book III. Chap. 3. Sed. 5. Chap.
5. No. 1. Vol. III. Coll. 31, 35.
                           ADDITIONAL 
8s       ANATOMICAL  1 AfcLES,

     ADDITIONAL  TABLE.

                Number  XL.

By the late Dr. ThomAs Younc, with improvements by Dr.
   Hamilton, both Protefforsof Midwifery at Edinburgh.

  Among the few improvements which have been
made in the obftetrical apparatus fince  the  days
of Dr. Smellie, the moft important are the alter-
ations in the forceps, by which the inconveniences
formerly attending the ufe of that inftrument are
obviated, and the operation is rendered more fafe
and ealy.                                    *
   In contriving thefe alterations,  the intentions
were, 1. That the large curves fhould correfpond
as nearly as poffible with that of the Pelvis. 2. That
their points fhould be thrown forwards and made
round, to prevent their hitching, or even preffing
uncafily againft  any part of the Pelvis ; and
likewife  to  maintain their hold  of  the head,
whilft it is to be brought forwards  in that curv-
ed  line  of  diredion which nature  obferves.
3. That an inverted curve fhould be made towards
the joints, whereby the Perinaum  may be faved
from injury, the extrading force rightly condud-
ed, ;.r.d  the handles at the fame time  kept  from
preffing uncafily on the inferior and anterior parts
of the Pubes.  4. That their fubftance fhould be
reduc. d as much as poffible, fo that they are not
made lexible, or fo thin at the edges  as  to hurt
the part.  5. That their clams be made  to  prefs
                                    equally 
//////^XL
v.V
/<,.,/>.
C 
 
       with EXPLANATIONS, Sec.       83
equally on the child's head, and fpread gradually
from the joint,  fo as not to dilate the Os Vagina
too fuddenly.  6. That the clams  be  of a due
breadth, with the outer furface a little convex,
and extremely fmooth, that they  may  not prefs
uneafily or hurt the woman.   7. That their length
be fuch as can  be  applied  fafely and  commo-
dioufly within the Pelvis, and at the fame time fuit
the different fizes of the head as much as poffible.
  The inftrument, executed  according  to thefe
intentions, is called the Short Curved Forceps.  It
confiils of two blades, or parts ; each of  which
is diftinguifhed into the handle A, the joint B C,
and the clams D E.   See fig.  1. which reprefents
one of the blades before it is bent  into its perfed
ftate 1  a a a are three holes for  admitting fcrews
to fix the  wooden handle.—Fig. 2. fhows the in-
ftrument finifhed and  locked,  in  which ftate it
meafures about  11 inches ;  and, when  properly
made, weighs about 11 ounces troy.  The clams
muft be covered  with  the beft Morocco leather,
fhaved thin, moiftened with water, and fewed on
with waxed filk.
  X. B. Several inconveniences, both in the intro-
dudion and confequences, having been  found to
attend the ufe of the forceps with  the clams cov-
ered, praditioners at  prefent very generally pre-
fer thofe of polifhed fleel.
  Fig. 3. A catheter, with a fmall curve towards
the point,  which is better adapted  to the female
Urethra than the ftraight.  It may be perforated
with 8, 12, or 16 holes in rows, as here reprefent-
                                        ed, 
 84       ANATOMICAL  TABLES,
 ed,  and  terminated  b\  a flight, vciy  fmnoth,
 rounded, or oblong knob.   The length fhould be
 nearly fix inches, ami the diameter not trifling.
   EijV 4. The perforators of Dr.  Dcnman,  now
 employed by  many praditioners, in preference
 to thofe of Dr. Smellie, -with the angular refts ren-
 dered ftneother and mere rounded.  If the long fcif-
 fars of Dr. Smellie  fhould be ftill retained  in
 pradice, the fharp edges  ought to be removed ;
 they fhould have, like thofe of Dr. Dcnman, a
 degree of curve towards the points, and  In-  pro-
 vided with blunt knobs,  inftead  of the  angular
 refts, which expofe  the patient  to the  hazard  of
 having the parts wounded or lacerated.
   See  Dr.  Hamilton's Outlines  of Midwifery,
 page 290.
   Ar. B.  With a view to fave the child when the
 mother is in danger, but  the  head too high for
 the cemmon Jhort forceps, and  alfo to obviate an
 inconvenience complained of  by many  pradi-
 tioners, of their  locking  within the Vagina, the
 long forceps of Mr.  Leveret of  Paris,  Dodors
 Smellie and Leak of London, and of  Mr. Pugh
 of Chelmsford in  Effcx,  have been invented.
 The lightnefs and neatnefsof conftrudionof Dr.
 Leak's, with juftice, entitle them to the preference.
   Y\%.  5.  The blunt hook, as prefently ufed, with
a fwell in the middle,  by which  a  more fecm
hold can  be taken,  and the extradion  accom-
plifhed with more fafety and  fuccefs,  than  with
the ftraight hook.
F   I  X  I  S. 
 
 
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