Lectures
ON THE
Practice of Midwifery
by
Dr. Haighton.
1803
&
1804.



1
Introduction.
Persons unaquainted with the sbject of Midwifery
may form very limited Ideas respecting it, supposing
it only to the actual delivery of the woman but it not 
only consists in this, but in the explanation and treatment
of a number of Disease connected with Pregnancy
and after actual Delivery.
Pregnancy has a begining, which is called conception,
a duration which is called Gestation and a 
termination which is called Labour or delivery, and 
after delivery then is a time which is called the Recovery
at which time Women is subject to many Diseases peculiar 
this this state, and as a Supplementary branch
may be added, such infantile Diseases as occur 
within the Month.
Conception supposes a previous knowledge of 
the Fruition, and Aconemy of the Organs of Generation
which consists in the parts mainly, Anatomical,
Physiological, and Pathological.
The Anatomical part comprehends a knowledge
of the Pelvis, as giving attachment to the Genitals



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as containing the Womb and its appendages as 
being the part thro' which the child must pass to 
come into the World, the situation and structure
of the organs of Generation, both external and internal,
including the Mons Veneris, Labia Pudendi frenum
Perineum, Pudendum, Fossa Navicularis, Clitoris,
Plexus retiformis, Nymphae, Orifice of the Urethra,
hymen, Caruncula Myrtiformis, Vagina, Uterus and
its appendages.- 
The Physiological part, consists in the explanation
of the natural and healthy actions of the above
mentioned Organs, or their uses as far as it is known.
The Pathological part, in the description of the 
Various diseases, to which the Generative Organs
are incident, and the most effectual method of administering
relief.-
Many practice very successfully without any
knowledge of the Alteration which is produced by conception,
but it is expected that all who practice this 
branch should have a knowledge of it. In some cases
when conception has taken place considerable alteration



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alteration is produced in others not any of consequence.
The external parts of Generation in the female are 
subject to several Diseases which will during the 
course be treated of End then is great variation with 
respect to Labour, each cavity will be fully treated of
rotation, but from have only a view of giving an 
Idea of the mode in which they will be treated of 
and shall begin with a description of the Pelvis as 
a knowledge of this necessary to form a proper Idea
of the other parts.
The Pelvis is formed of that assemblage of 
Bones at the lower part of the Abdomen, below the 
fifth or last Vertebrae of the Loins.
It is an easy matter to distinguish between
the Male and female Pelvis, the female being much
more capacious, and of a different shape, being formed
to alow the passage of the Child, where as the Male is 
only for the [illegible] of containing certain parts, and 
giving attachment to the Muscles &c.
The Pelvis in fœtal state is composed of a 
greater number of Bones than in the adult, and 
which is of considerable advantage in delivery as 



4
in the breech presentation, the Bones will on that account
give way more, and more easily pass.
The Bones which form the Pelvis will not be particularly
considered as that more properly belongs to 
an anatomical Description, but will be considered
together as forming the Pelvis.
In the adult the Pelvis is composed of three
Bones namely the 2 Os. Innomenata, and the Os. Sacrum
to which may be added the Os Coccigis which makes 
them 4 in number. The number of Bones in the fœtal
state is eight, each of the Os. Innomenata being divided
into 3 Bones namely the Illium or haunch Bones
the Ischium or sitting Bone, and the Pubis or shorse
Bone, the [illegible] of the Os. Sacrum is the Rump
Bone and the Os. Coccigis is called Huckle Bone, a 
knowledge of this becomes necessary to understand
what the Women Midwifes mean by the Names they
commonly use.
The formation of the different parts into 4 Bones
does not take place to after the Age of Puberty.
There are three parts of the Pelvis more particularly
interesting, namely the Brim, Cavity and 



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outlet, the shape of the Brim [Cavity] is rather of an Oval
form, but in some measure resembling a heart.
The line in the fore part which joins the two 
Ossa Pubis is called the Symphisis Pubis. 
It is sometimes the case that the upper
Part of the Brim of the Pelvis, instead of being 
round and smooth forms a sharpe ridge, and 
which from the womb pressing on this ridge gives
a sense of cutting in this case a Bandage with 
compress round the Abdomen and placing the 
patient in a more upright posture, a rather 
reclining Backwards, to take off the bearing
upon the part will be of Service.
The size the Pelvis varies in different People
but from one particular size being more often found
that is called the standard Pelvis, and which is of 
the following dimensions a line drawn from 
the upper edge of the Symphisis Pubis is 4 In. long
a line across the Brim of the Pelvis from side 
to side, is 5 In. long and a line in an oblique
Direction, from the Sacro Iliac Symphisis is 5 1/8 In.
a knowledge of the Dimensions, is necessary in practice,



6
practice, for the purpose of adjusting the long Axis of the 
head to that of the Pelvis.
In general the head of the child enters the 
Pelvis without any assistance, and of course then
cant be any thing done with respect to the way 
in which it enters, but in case the child is turned
and brought away by the feet, the way in which the 
head enters entirely rests with the practitioner,
in this case the long Axis of each must be Kept in 
view at the brim, and changed as it passes to bring
them to correspond at the lower part or outlet.
In the case of turning no delay is admissable
when the Body of the child is partly passed, for if the 
head is confined long the child must inevitably Die
on account of its supplies from the mother being cut
off and respiration being at the same time prevented.
Shall now conside the Dimensions of outlet
the lower edge an outlet, a line drawn from the 
lower edge of the Symphisis Pubis to the extremity
of the Os. Coccigis is 4 In long, but by this bone giving way
during Labour this line becomes an inch longer in 



7
way making the line 5 In. long. a line drawn
across from one tuberosity of the Ischium to the 
other is 4 In. long. thus long axis of the Brim and outlet
are in opposite directions, so that it becomes
necessary for the head of the child the to turn in its
passage thro the Pelvis, and which is very much
assisted by the oblique direction of the Os. Innomenata
it is necessary to attend to this in making use of 
instruments. The form of the outlet is rendered
more complete by the Sacro Sciatic Ligaments, extending
from the Spinous proofs and tuberosity of the 
Ischium, to the False transverse processes of the Sacrum.
In considering the Cavity there are two things
to be attended to, namly the Depth and Axis, the 
Depth of the Pelvis at the fore part is about 1 1/2 In. and 
at the sides twice the Depth of the front, and three
times the Depth at the Back part, but the matter
of the greatest important is the Axis this must 
be either in direct or curved line, but is certainly
that of a curve, a knowledge of this circumstance
is necessary in the application of instruments, as 
in case the head of the child wont enter the brim of 



8
the Pelvis, in this case if there is disproportion it 
may be necessary to make use of the long forceps or 
the perforoter & Crotchet.
There are frequently deviations from the Standard
Pelvis, and which may be either in shape or 
size when the lines drawn across in different directions
are longer it is called a large Pelvis, and where
they are shorter, a small one, and when the shape deviates 
from the well formed Pelvis it is called a deformed
or distorted Pelvis. To render a Pelvis deformed there
must be some cause, and which cause either consists 
in Ricketts, or Mollities Ossium. Bone is composed
of a quantity of Earthy Matter and Animal Gluten
the cause of Ricketts consists in a deficiency of 
Earthy Matter and which causes a yielding of the 
Bones. In some cases there is a destruction of 
Symmetry, the deformity not being equal in both 
sides, a knowledge of this circumstance, wits of 
great ability in some cases, as advantage may in 
some instances be taken of this circumstance, of
inclining the child to the part where there is most 
Room. Some have supposed the Pelvis may be 



9
partially distorted, that is, the brim may be narrower
without the outlet being effected and the Reverse, but in most
if not all cases when the Brim is narrower, the outlet 
is enlarged tho' in some cases they are both contracted.
The Pelvis may be narrower from before 
backwards, or the reverse that is to say from side
to side, tho' the former is most common in some 
cases the fore part of the Pelvis appear to be pressed inwards
by the weight of the Body. The Spine in some
cases projects forwards into the Pelvis and in
this way occasions a want of Room.
A knowledge of the form of the Pelvis will
in many cases be of consequence in respect to 
forming an Opinion in what way the Progress
of the Labour is likly to proceed, as in case of the 
Brim of the Pelvis being narrower, the head of the 
Child will frequently rest a considerable time before 
it enters, as it cant do this till the Bones
of the head have given way, and which requires some 
time to be effected after which the progress of the Labour
will be quick, as there is no more obstacle to its proceeding.
In this case the lever or long Forceps may 
be of service, as by their use the head may be brought



10
quarter or half an inch down and which in many
cases is all that is wanting.
If the Pelvis is narrower below, the case will
be reversed and the Labour will proceed at first 
rapidly and when the head comes to the lower part
of the Pelvis, the will be considerable delay, from 
this it will appear evident what caution is necessary
in giving an opinion of the trim Labour is likely
to terminate, except you exactly ascertained the form
of the Pelvis &c.
In some cases Instruments will be 
of Service in assisting the expulsion of the Child, but
in many cases when the deformity is considerable
it will be impossible to bring the child away without
opening the head. In some instances the
Os. Coccigi will project very much forward, and
the projections of the Tuberosities of Ischii will frequently
at the same time be forced in which 
renders the passage of the child extremly difficult.
Must now take a practical view of the 
Business, as the means necessary to Know the 
Degree of deformity, or whether there is deformity in



11
not, there are two ways of judging one of which is 
probable and the other certain.
The Probable way is by judging from the presence
of a Ricketty state of the Body, or from a deformity
of other parts as the curvation of the Spine Os.
as it is probable a Woman with a curved Spine
will have a deformed Pelvis, but this is not always
the case, as this curvation may be owing to accident,
or posture, or from other causes, as particular employments,
but when this is the case other parts of 
the Body are seldom deformed, if then is no general
Disease, but if it is from a degree of softness
or weakness of the Bones the projection of the Sacrum
will frequently be forced forwards and diminish
the diameter of the Pelvis.
The diameter of the Pelvis may in some 
cases be diminished by Exastosis, and other Bony
Projections.
The certain way of ascertaining the demensions 
of the Pelvis is by measurement, and for 
this purpose, different ways have been proposed, our
way is by different instruments, but which dont 



12
appear deserving of notice, and no instrument is 
necessary for this purpose the fingers answering
best, the method of doing this is by passing your finger 
to the centre of the Base of the Sacrum, and then
mark what part come opposite the Symphisis
Pubis, you then measure the length from that 
part to the end of the finger, deducting 3/4 In. for the 
oblique line, and it then gives the proper length of 
the direct line as for instance if these oblique line
is 4 3/4 In. deducting 3/4 In. leaves 4 In. the length of the 
line in the standard Pelvis. Another way of measuring
is by opening the two fore finger, and thus ascertaining
the length of the line, but this requires practice
to determine it with accuracy.
The way to ascertain whether the fore part
of the Pelvis has the proper degree of curve, is by
passing 2, 3 or 4 finger up the fore part and by the 
ascertaining the degree of Curve, thus if you can lay
3 or 4 finger flat you may be certain then is the proper
degree of curve, but if you cant bring more 
than two or three fingers to touch without laying
them over each other the must the be a more acute





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angle than in the well formed Pelvis.
To determine whether the outlet is well formed
you may place your finger in the Angle formed by 
the two projections of the Ischium, in the natural and
well formed Pelvis they form an Angle of about 60 Dg.
which is somthing less than a right angle, any deviation
from this constitutes a degree of deformity.
You may ascertain wether the Os. Coccigis is 
properly formed by feeling it.
In proportion to the degree of deformity or diminution
of the size of the Pelvis, is the difficulty in extracting
the head.- If the deformity or diminution
is in a small degree, tho' the head wont pass, yet
this may be effected by the assistance of the Lever or 
Forceps, but if this is greater then the perfortor and 
Crotchet become necessary, and when it is in a very
great degree the child cant possibly be extracted
by any means thro' the natural passage in their 
case the Cesarian Operation becomes necessary.
Actual measurement is not of so much consequence
as at first sight appear to be the case 
as it frequently will depend upon disproportion of 



14
of the head to the Pelvis, thus a Pelvis may be of the 
natural size, and yet the child wont pass on account
of the head being particularly large, or the state of 
Ossification more advanced or soft parts rigid.
From what is already mentioned it would
at first sight appear as tho' a large Pelvis would
be advantageous, but this is not the case, as there 
is danger from this circumstance, for as there
is not that degree of resistance to the quick expulsion
of the child as in the standard Pelvis, the soft
parts are liable to be lacerated, on account of there
not being sufficient time for their proper dilatation,
and from the quick expulsion of the child the 
womb has not time to contract in a proper degree 
and this way hemorrhage is produced. Or invert the womb.
Labour pains are not always to be distinguished
from the sensation of a want to evacute to contents
of the Rectum, a mistake of this sort may 
possibly be attended with very serious consequences
as the child may be expelled in this way without 
the Patient being aware of it, a mistake of this 
kind of very great importance should it happen
to an unmarried woman, as it may appear as 
tho' the child was killed and afterwards thrown 



15
away, for the purpose of concealing the affair.
A Medical Man in Yorkshire gave his opinion,
in a case of this sort, that a Woman may 
in all cases distinguish between the pains of 
Labour, and the inclination to go to stool, but he
afterwards had reason to alter his opinion, and 
was on that account under considerable uneasiness.
In all cases when you are called upon
to give your opinion, in a Business of this sort
you will do well to call in the aid of several colateral
circumstances, or whether she has made 
any preparations &c. and upon all occasions if 
either be favorable, this sudden expulsion of the 
child can only take place when the soft parts are 
relaxed and disposed for labour, but in case of rigidity,
and the womb acts violently, when there is a large
Pelvis, there is danger of a Prolapsus Uteri, or 
of a laceration of the Perineum, or of a retroversion
of the Womb.
In this case to prevent these effects, you 
must press upon the mouth of the Womb, during 
pain to prevent its being forced down before the 



16
external parts are sufficiently dilated, and it will
be of service to endeavour to open the mouth of the 
Womb, by degrees, by the introduction of 2 or 3 finger
gradually dilating the parts, the same treatment
is necessary in its passage thro' the external parts,
gradually opposing the passage of the child 'till the 
parts are sufficiently dilated.
Retroversion of the Womb is not peculiar to
a large Pelvis, tho' there is in this case danger of 
its taking place for a greater length of time, and if 
there is much relaxation may take place at as 
great a distance of time from the Labour as the 
fourth Month.
Shall now make a few remarks between the 
formation of the male & female Pelvis. The Male 
Pelvis is only formed for the insertion of Muscles
and to contain certain parts &c. whereas the 
female is not only to answer there purposes but to
alow the passage of the child. The male pelvis is 
more mossy, and projections in different parts
longer, for the purpose of giving greater strength
and slowing the muscles to act with greater advantage, 
tho' it is not so capacious as the female



17
the female Pelvis has not so much Bony substance
as the male tho' it is more capacious, its depth is not 
so great as the male.- The difference in suspect to
desasions is taken notice of by Artists, and their 
rule is that the male exceeds the female as much 
in breadth across the Shoulder, as the female does 
the male across the Hips.- The difference in respect
to the size of the Pelvis is chiefly in the degree of curve
in the Ossa Innomenata the male being less curved, but 
the Sacrum in the female is rather Broader,and also curved.
But there is the greatest difference in the Angle
which the two Ischii make in front, as that in
the male is much more acute, the projection of 
the tuberosity of the Ischium below the Acetabulum
is longer, and which slows a greater power for the 
action of the Muscles, the Acetabulae are smaller.
The female Pelvis is much shallower than 
the Male, which is an advantage with respect to 
the passage of the child.
The next consideration is the bearing of the 
Pelvis with respect to the Body, and this is necessary
to be know for the purpose of adjusting one by the 



18
other, so as to bring the brim of the Pelvis Vertical, horizontical,
oblique &c.- A straight line will not pass
thro' the Axis of each, but lines which pass thro'
the Axis of each would intersect each other so as to form 
an Angle making a right angle. When the Body is erect the plain of the
Brim of the Pelvis is downwards and forward in 
some cases placing the plain of the Brim of the Pelvis
in a Horizontal direction is advantageous, for different
purposes, as to slow the Womb to gravitate, this
is done by placing the Woman in a posture half sitting
and half lying, which is at an Angle of about 45 Dg.
in some cases it is advantageous to fix the patient
so as to bring the lower edge of the Pelvis upwards
in a horizontal direction, as in reducing a retroversion 
of the Womb, or Prolapsus Uteri, you may
effect this by placing the Patient on the Knees and 
elbows.- In making examination the best position
of the Pelvis is obtained by laying the patient on the 
side.
We must now consider the child with relation
to the Pelvis. A standard child or a one of the 
common size can only pass thro' a standard Pelvis
in these directions, that of the Head which is most 
common, that of the Breech, and that of the lower extremities, 



19
extremities, the head being the largest part, requires more 
particular consideration, as in case of the head presenting 
if it passes all the rest of the Body will follow, and 
it will pass with more or less ease according to the 
part which presents, and likewise the situation.-
From this it will appear evident that [illegible]
notions respecting presentation and situation are 
necessary, for this purpose it will be necessary to compare
the standard head with the Standard Pelvis.-
A standard head is one which corresponds with the 
generality of heads in shape size and mobility.
The Presentation is that part which is in the 
center of the Pelvis, and the presentation may be the 
same tho' the situation may vary, as it may be 
to any part of the Pelvis, then the Vertex may present,
and the face may be to any part of the Pelvis,
the same rules are applicable to the Breech presentation,
as in case the Anus is in the center, the 
Back of the child may be to any part of the urethra.
These two terms presentation and situation, are 
vary frequently confounded.-
The presentations of the head are divided
into 4 namely the Face, Vertex, Ear and Forehead,
and as before said the Head will pass with 




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more or less case according to the part which presents.
The Vertex presentation will pass with more 
or less case according to the degree of depression of the 
occiput, thus in case of a Vertex presentations and 
it wont pass, depressing the occiput, by means of 
the Liver, or by any means will frequently be
of great service in facilitating the Passage of the 
head. Thus the best possible presentation is when 
the Vertex presents, with the occiput depressed.
The Vertex presentation will pass with greater 
ease, than the face, and this with greater ease
than the forehead, the Ear presentation passes
with the greatest difficulty. In general the 
forehead presentation terminates in the face 
case.-
When the head enters the Brim of the Pelvis it 
does not exactly come down sideways, but rather in 
an Oblique direction, as that is the long Axis, [illegible] Pelvis but as
it descends it gradually changes its position
to that with the face to the Sacrum, and their way
the long axis of each is opposed at the outlet.
In some instances there is a deviation from 
this as the long axis of the head may be opposed to the 
short one of the Pelvis, or the face will come forwards 



21
to the Pubis instead of Sacrum, this by some is called
the face presentation, but is not as the Vertex presents
only the situation is wrong. This is not so favourable
a position, as the other, the parts not agreeing in the 
form of parts so well, and there is more danger of a 
laceration of the Perineum.
When the head is low down there are four things
necessary, to render this the best possible position,
the Vertex must present, the occiput be depressed
the occiput must be to the Pubis, and the Sagittal Suture
must be in a direct line from before backwards
in the middle of the Pelvis.-
The Face presentation is when the Nose is 
in the center of the Pelvis.- When the head of the child
is at the Brim of the Pelvis, the best situation is
when the chin of the child is to either side as in this 
case the long Axis of the head and Pelvis correspond,
and as it descends the chin is gradually thrown
forwards, but in some cases the situation is different
the face being placed so that the long Axis of each
dont correspond, in this case help may be necessary
and a Knowledge of these circumstances will be necessary
in giving the assistance.- The long Axis is of each 




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generally correspond, and as it descends the chin in 
thrown forwards, and the occiput emerges. The
chin is sometimes placed to the back part of the
Pelvis tho' situation is very rare, if this situation
is not altered in a very little time it will be a very
difficult matter to save the Life of the child.-
They way that the forehead presentation is changed
to the face is by the action of the Uterus on the Body of 
the child it pushes the Body down and the chin 
for as the chin forwards.- 
The Ear presentation is when that part is 
in the center of the Pelvis, and in this case the Vertex
may be situated to any part of the Pelvis, in some 
of these cases assistance becomes necessary, tho' not in 
general, this assistance may be given by means of 
the Lever, acting on that part of the head so as to bring
the Vertex down, and by that means bring it to a 
Vertex Presentation.- In using instruments,
great care is necessary in their application either at 
the fore or back part of the Pelvis on account of injuring
the Urethra or Rectum.-
Shall now take a more particular View of the 
Fœtal head.- The Figure of the head is Oval, or Ovi-form




23
Ovi-form, the long Axis of which varies according to the 
part which presents, from this it will appear
instant the necessity of taking dimensions from 
different parts in measuring the different Axises
of the head.- There are two expressions which tho'
different are essentially the same, that is raising
the Chin and depressing the occiput.
A Line drawn from the Vertex to the Chin is 
5 1/6 In. Long, one drawn from the upper part of the 
Occiput to the forehead is 4 1/2 In Long, whereas a line 
from the lower part of the occiput to the upper part 
of the forehead is only 4 1/8 In. long this therefore is the 
shortest Line of the long axis, the short axis is from 
the protuberance of one Parietal Bone to the other and 
which measures 3 1/2 In. this is the different dimensions
of the standard head. But the case with which 
the head will pass does not depend altogether upon
size but in a great degree likewise upon mobility
of the different parts.-
The Fœtal head consists of a greater number 
of Bones than the Adult, the adult head consists 
of 6 Bones, and the Fœtal of 12. The Bones of 
the adult are the Frontal, the Occipital, two Parietal



24
Parietal and two Temporal, with the Sphenoid and Ethmoid 
Bones, but these two last are common to both
head and face.- In the fœtus the Frontal Bone is 
divided into two, the occipital into four, each
Temporal is composed of two parts the Squamous
and Petrous portion, which with the two Parietal Bones
make the number 12.- Thus different Bones are 
joined together by Sutures but which vary in the 
Fœtus very much from those of the adult, for in the
fœtal state they are moveable, whereas in the adult
the Sutures are immovable. The mobility arising
from this formatition of the head is of very great ability
in presentation, as it slows the head to accomodate
itself more to the passage, by the edge of one Bone in 
some cases being forced over the other.-
The Sutures are first the Coronal, which extends
over the fore and upper part of the head and joins the 
Os. Frontis to the two parietal Bones, second the
Sagittal, this extends along the upper part of the head
from before backwards, it begins from the Coronal
Suture, and extends as far back as the upper edge
of the occipital Bone, it joins the two Parietal Bones
together, third the Lambdoidal Suture, this joins the



25
occiptial to the two parietal Bones, and besides this 
then is in the Fœtal state a Suture which joins the 
two portions of the Os. Frontis together, and one to
form a junction between the Squamous and Petrous
Portions of the Temporal Bones, Besides these there is 
another called Squamous or Temporal, which joins the Temporal to the 
Parietal Bones. On the fore and upper part of the head, when the 
Sagittal Suture arises from the Coronal, then a defect
of Bone in the fœtal head, which is called the greater
Fontanel to distinguish it from another similar
defect, at the part when tho Sagittal Suture terminates
in the Lambdoidal, which is called the less or 
fontanel, this besides being smaller is of a different
Shape from the others it being Triangular, where as 
the other is quadrangular, each angle projecting
into a portion of Suture, thus one into each of the portion
of the Coronal, into the Sagittal, and into the 
Frontal.- The lesser fontanel has only their angles
one into each portion of the Lambdoidal, and into the
Sagittal Suture.- By means of these Fontanels and  
the Sagittal Suture, the Situation of the head may be 
ascertained.- Besides this, there is another advantage
arising from these Sutures, as they will slow of the head 



26
being more compressed by a greater degree of mobility,
for in many instances where different parts of 
head are in a more advanced state of Ossification, it 
has been necessary to open the head, and when it has not 
been of an increased size, but only from this want of 
mobility.-
In some cases the Sutures are seperated in a much
greater degree than natural, and the head is considerably
increased in size, tho opening may be to the 
extent of one, two, or three fingers breadth when this 
is the case it is from a collection of Water in the head,
and you must judge from the size whether it is necessary
to open it or not for the purpose of extraction.-
The head may easily distinguished from other
parts of the Body by the larger Bony surface, and by 
the degree of convexity. The Shoulder Blade presents
a large surface of Bone, but you may easily
distinguish the head from this by passing your finger
round. In some cases the head will feel much 
more soft than common, this more particularly if 
examined during pain, this from a larger collection 
of Scalp.- The head may be easily distinguished from 
the back by feeling the Spinous processes of the Vertebra
it may be distinguished from the Breech, by the quantity 



27
of soft Parts, and by the Anus and Organs of Generations.
Besides presentation it is necessary to know the situation,
as tho' the Vertex presents the face may be to any 
part of the Mother.- This is done by feeling for the great
and little fontanel, and by passing you finger along the 
Sagittal Suture, and by comparing the form of the
fore and back part of the head.-
In a case of Hydrocephalus where the Sutures
were very much open it was mistaken by a Medical
Gentleman for a Back presentation, but this might 
be easily distinguished by the want of Spinous processes.
If when you feel the head you can feel the greater
Fontanel, and along the course of the Sagittal Suture you 
feel the Lesser Fontanel, you may then be certain it 
is a Vertex Presentation.-
A face presentation is easily distinguished by
its different parts as the Nose, Eyes &c.-
The forehead presentation is a mixed one, being 
in part the face, and in part the Vertex presentation,
on examination, you will find the greater fontanel
with part of the Sagittal Suture are one part, and 
on the other part you will find part of the face.-
The Ear presentation cant be easily mistaken.-



28
Besides presentation, the situation is necessary
to be known, as for instance in the Vertex presentation
the face may be to any part. In the Vertex presentation
you may know the situation, by feeling for 
the Sagittal Suture, and the Fontanels, if the head is 
low down in the Pelvis, but you cant at all times determine
this way, when this is the case you must 
feel for the ear by passing your finger up, and if you 
can feel this you determine which way the face 
is, by the projecting part of the Ears, as this is always
towards the back part of the head.- There are several 
other circumstances which may assist in the forming
the judgement, and which should be all taken into 
consideration as the whole of different parts of the 
head &c.- It is much the best in all cases when 
you examine to be carefull in giving an opinion
in respect to the Progress of the Labour as there are 
many circumstances which may render it more 
difficult, than you may at first imagine.
The Bones of the Pelvis are connected together
by Ligaments. Ligaments are that substance which 



29
connects the different Bones of the Body together, and 
and is divided into two kinds, namely Elastic and 
inelastic, the elastic Ligaments in some parts of 
the Body act the same as Muscles, as they in some 
degree antagonize the muscles, for instance the 
Ligament which extends along the Spine, in some 
Animals. The Ligaments of the Pelvis an inelastic
as they are made for the purpose of joining the Bones
so firmly together, for the purpose of sustaining the 
weight of the upper part of the Body, and likewise
any additional weight which the Body may at 
any time sustain.-
The different Ligaments which connect the 
Bones of the Pelvis together are first the Ligament
which connects the the last Lumbar Vertabrae and 
the Illium, second and third the Sacro Illiac
Ligament, both external and internal, fourth, the 
Sacro Ischiatic Ligament, external & internal fifth the Sacro Coccigeal 
Ligament, which is for the purpose of slowing
a degree of mobility in the Os. Coccigis, sixth the 
Ligamentum Foramen role, which serves for 
the insertion of Muscles, and thro' a vacancy



30
which is left in the Foramen Ovale by this 
Ligament, the Obturator Nerves and Artery & Vein
pass.- Seventh, the Ligament which connects
the Symphisis Pubis, this is formed by a cartilaginous
covering over each Bony Surface,
and with a portion of intervening Ligamentous
substance, but the chief strenth of this connection
depends upon the strong Ligamentous Fibre
which surround, the junction of the two Bones.
The Symphisis Pubis is sometimes the seat 
of disease, being subject to a collection of gelatinous
substance, or of Matter, and which is a matter of very
great importance, as the Ligaments which form the 
junction of the two portions of Bone, are in a great 
measure destroyed.- When matter is formed, a 
great deal cant be done except evacuating 
it, and keeping a depending opening, and this way
arousing Granulation to shoot up and fill up 
the cavity, but the time when you may be of the 
most service is before the formation of the Matter during
the inflamatory stage, when the application of



5
31
Leeches, Blisters &c. may possibly subdue this inflamation,
and prevent the future bad consequences.-
But if from symptoms you have reason
to suppose there is matter formed you should make 
an opening into the part to evacuate the Matter, and 
upon making this opening you should not find any 
matter, you then have done no injury as the operation,
has not done any injury to parts of any 
importance, and the opening will again heal.-
The Symptoms of this disease are a fixed and 
acute pain in the part, and which is very much
increased on the patients attempting to move or
walk.-
This disease has by some been supposed
to arise from some injury received during Labour
but this does not appear to be the case, but seems
to be owing to the same Scrophulous Habit, as that 
in which Disease of the other joints arise in, and 
begins from the same kind of inflamation.-
When there is a formation of Matter, and you
have evacuated it by an opening, if you keep open
this opening, granulation will spring up and 



32
a cure will sometimes be effected, but the Disease
is in a more advanced stage, and Symptoms of 
irritation, and hectic have come on, then the termination
of this Disease is different, as these Symptoms
go on increasing, and Death is the consequence.
Some practioners have supposed the Ligaments
of the Pelvis gave way in laborious parturition, but
there is no reason to suppose they do, except from 
very violent injury or disease, and when ever this
does take place, the patient is a great length of 
time before she perfectly recovers.-
The cure may be assisted by means of the cold
bath, and the local application of cold to the part, and 
by means of Bark and Corrborants internally, and 
by means of a proper bandage to support the part.
The Os. Coccigis has in some instances become
anchylosed and has rendered it necessary from this
circumstance to open the childs head.
The Uterus in the unimpregnated state is contained
in Cavity of the Pelvis, and is small, but when
impregnated becomes considerably larger, and rises
higher up, before it is placed the Bladder, and behind



33
it the Rectum, and there are likewise other parts
as Blood vessels, absorbents &c. which contribute to
diminish the size of the cavity of the Pelvis, and to 
lessen the size of the opening thro which the head must 
pass.-
From the pressure of the Uterus (when impregnated)
upon the Bladder, a retention of Urine or frequent indication
to make water called micturition is produced, this 
opposite effect from the same cause arises from the 
different parts of the Bladder upon which the pressure
is made.- If the pressure is applied to the part below
the entrance of the Ureters, a suppression of Urine
is the consequence, if this is above this part more 
upon that part towards the frenem of the Bladder, it 
then diminishes the size of the cavity, and that way 
induces the frequent indication to make Water.
When this part presses on the Rectum, tenesmus
constipation, or hemorrhoids are produced, for if it 
produces a degree of irritation, tenesmus is the consequence
or this pressure may cause constipation
by preventing the proper passage of the contents of 
the Rectum. This Pressure by obstructing the motion
of the Blood by the Veins, will cause the Hemorrhoids
this from the Blood in the Anterior not being obstructed 



34
in the same degree. A Woman under these circumstances,
cant expect a cure of those disease till
the cause which produces them is removed, and 
which cant take place 'till after delivery, tho' the 
symptoms may be moderated by means of the application
of a few Leeches to the part, or by other means
and internally by the exhibition of gentle Laxatives.
Some patients are very much alarmed by these
circumstances, and it may right to quit their 
apprehension by explaining the Business to them.
There are other parts besides these which may 
suffer considerably by this pressure, and produce a 
variety of Symptoms, such as swelling of the lower
Extremeties &c. this swelling is frequently called by 
the name of breeding with a Dropsy, but this Disease
is of quite a different notion from that of Dropsy, as 
in Dropsy there are a great variety of Symptoms,
which are not present in this Disease, as in it there 
are Symptoms of a broken down constitution, difficulty
of breathing, scarcity of Urine &c. whereas
Women during Pregnancy in generally labour under none of their Symptoms,
having only what arises from the distention of



35
parts.- From what has been before said, it will
appear evident that pressure sooner effects the
circulation in the Veins that in the Arteries and this 
pressure causing an obstruction of the free return
of the Blood by the Veins, the Arteries act more forciably
to overcome this resistance, a greater quantity
of fluid is thrown out by the seriferous Arteries,
this increased evacuation might possibly be of no consequence
if this pressure was not acting on the Absorbents, 
which should take up and return this fluid.
It is seldom necessary to evacuate this Water
by means of openings made into the part, as proper
pressure by means of Bandage or a Laced Stocking
will in general be sufficient, tho' if not, then is so
larger, for a few small punctures made into
the part, and which may afford relief.- It is necessary to 
attend to the state of the Bowels, and to keep
then sufficiently open.
There are three large Nerves, which are subject
to pressure by this cause, the first is the Anterior
Crural Nerve, but which is not much
subject to this pressure, the next is the Obturator
Nerve, which passes thro' the opening left in the foramen



36
foramen Ovale, and which will cause cramps, and 
spasms in different parts of the lower Limbs, but that 
which is the most subject to this pressure is the 
great Sciatic Nerve, which sends off various branches
to different parts about hind parts.-
The head of the Child in its passage thro the 
Pelvis, frequently presses upon the Obturator and Sciatic
Nerve, and will in many cases cause convulsive,
or spasmodic actions of the Muscles of the lower
limbs, one or both according to circumstances.-
The same Symptoms may be produced by 
the application of instruments, more particularly
when improperly used.- The Lymphatics from 
this pressure, sometimes become very much enlarged.
Somtimes encysted Tumors are formed in these
parts or Tumors of different Kinds, and be the 
cause of considerable difficulty during the time 
of Labour.- In some cases the Kidneas are 
situated very low down and become enlarged, and 
be a mean of difficulty.- Another Disease which 
may take place in these parts, as an enlargement
of the Ovariæ, which may be for different cause
one of which is a collection of Water in the Cavity
constituting the ovarian Dropsy.- [illegible] by [illegible]



37
Organs of Generation.
External and internal.-
The external Organs of Generation comprehend
the Mons Veneris, Labia Pudenda, Frœnum, Clitoris.
Fossa Navicularis, Nympha, Hymen, and Carunculœ
Myrtiformes, to which may be added the Orificium
Urethra.
The Labia are subject to various diseases, as 
inflamation, pruritus, cohesion from malformation
or excoriation, Ulceration, Tumors &c.-
Inflamation if it arises from common causes
is to be treated by the usual mode of treating inflamation
in any other part, but if it is attended with 
darting, shooting pains &c. it is probably an indication
of some internal disease.
Pruritus, is a peculiar and distressing itching 
of the parts, and is often in so great a degree as to 
render the patient almost miserable. The treatment
of this Disease must be various, according
to the cause, when it arises from Herpetic eruption
on the parts, preparations of Lead externally



38
and internally Neutral Salts &c. Some times this disease
is caused by Ascarides which infect the Rectum and 
which may have got to these parts and cause this 
disease, in this case a Glyster composed of a Mixture
with Aloes, or the Extract. Colocynth. Comp. may be of 
Service, and assisted by the exhibition of purges by the 
mouth, such as Calomel Aloes &c.- When this Disease
is Sympathetic of irritation in the Bladder or Urethra,
the use of Mucilagenous and Anodyne injection
may be of Service, and internally Uva Ursi, Bark,
Opium &c. may be given with advantage. A good
injection for this purpose is one composed of Oil
and Tinctum of Opium in the proportion 8 oz. of 
Oil, and 72 oz of R. & Opii. thus recommend an injection
of Aq. Coleis and Oil.- Thus peculiar sensation is 
in some instances only present during pregnancy
and frequently comes on at the time the menses
disappear, and is in many instances very difficult
to cure more particularly if there is no very
evident cause, if it is connected with Plethora, the 
taking away Blood may be of Service, joined with
the exhibition of Cathartics.- Cold applications will



6
39
generally afford more relief than warm ones.
There is no remedy which appear to have any
specific power over the Disease.- The application
of Blister may in some instances afford relief and 
the Ung 1/2 Alb. Camphor (Dr. Bateari) was of service
when many other things had failed, likewise an 
Infusion of Nicotianæ may be of Service, or the injection
of cold Water, into the internal parts.- An Ointment
composed of Ung 1/2 Simplex and Pulv. Gotta
Abp: succeeded after many other things had failed
in the proportion if 3 iss of Pulv. Gotta. to 3j Ung 1/11
Sin Alox.-
Ulceration when seated on the parts of generation
should not hastily be considered Veneral, those
frequently arise after delivery.- This frequently
arises from excoriation of the parts, and which instead
of healing, degenerate into Ulcers, forming sloughs &c.
and in many instances have been mistaken for 
Venereal, and treated as such, but which treatment
instead of being of Service, has agravated the Symptoms
considering.- This Disease frequently arises
from some injury received during Labour.-



40
Somtimes there will be small Ulcerations about 
the Genitals of Children, and which have a very much the 
Chancrous appearance, this is somtimes the case
at about the Age of Puberty.- The exhibition of 
Opium, Bark &c. will frequently of Service or a lot
will tend to alay irritability, in giving the 
Bark to children it may be necessary to take off
the nauseous taste of the Bark by joining it with
other things as Rad. Glyeyrrkis. &c.- and given a 
little R a|1 Opii according to the age of the Patient and 
degree of irritability. Externally a wash composed
of Ag Calcis and Calomel will answer a good purpose,
by the means the [illegible] of the Ulcer will
be stopped, and yellow surface will be changed to
a healthy granulating one.- If by this method
a Venereal Ulcer should be healed, secondary Symptoms
will after a time come on, and you may proceed,
upon the plan of treatment with certainty.
Sometimes the Labia adhere together at 
the time of birth and may require an operation,
but there certain consideration, necessary before 
the operation should be performed, or with respect



41
respect to state which the internal parts are likly
to be found in &c. When this the consequence of the 
parts adhereing after birth, from excoriation &c. there
can be no doubt respecting the propriety of the Operation.-
When this cohesion is partial, the parts may
by mechanical means dilated sufficiently. When these
are seperated by an Operation, it will acquire particular
attention, to prevent the parts again adhering.
The Labia are subject to tumefaction from 
various causes, as from a collection of Water from extravasated
Blood, or from hernia. or of Matter.
Hernia may be distinguished from the other 
kinds of Tumor, by the common means, as the size
of the Tumor varying on the posture being changed, and 
by its receding when in a recumbent posture.
The cure of hernia in these parts may be [illegible] procured
by the common means, by proper bandages
except it proceeds thro the foramen Ovale, in which 
case, a bandage cant be applied to act on the part 
with any kind of propriety. The part from which 
the rupture proceeds, may be distinguished by 
attending to the [illegible] where it disappears on its receding,
as whether it goes over the edge of the Brim



42
of the Pelvis or not.-
The Labia are somtimes distended with Water
and to that degree so as to impede the free motion
of the parts, and causing abrasion.- This disease
very seldom requires any punctures being made, for 
the purpose of evacuating the Water, tho' there is no danger
from this being done, but it in general will give
way to pressure made upon the part, by means of the 
T bandage, at the same time acting upon the Bowels
so as to keep the Body tolerably open.- Should the 
parts be in this state, and the time of Labour coming 
on it will be a matter of no consequence, as when this 
is the case, the parts are generally in a relaxed state
These parts are somtimes swelled from extravasated
Blood, this somtimes takes place after delivery,
and may arise at any time from the parts being 
bruised by accident, the sooner this Blood is evacuated
the better, or if not, it will very soon coagulate, and then 
it will be impossible to remove it. This is done best
by making a few small punctures into the part,
by which means the greatest portion of blood will
be evacuated, and the absorbents will generally take 
up the rest.- Leeches very seldom afford any relief
in this case as the Blood lays too deep for the action



43
If the patient wont submit to the removal of the
Blood by the punctures with early stage, it very soon
becomes coagulated, after a time a Throbing sensation
comes on, attended with increase of heat, and an Abcess
will follow.- If this extravasation is in a small
quantity, it may possibly be taken up by the Absorbents
the action of which may be assisted by Astringents, or 
by the application of Red Wine Lays &c.- If you precede
an Abcess is likely to form, you must then assist the 
process by the application of Poultices &c.- An Abcess
will somtimes form after you have evacuated the 
Blood by punctures, but it will then be proportionally
smaller.
Clitoris is that part which projects at the upper
part of Labia, and is in some instance considerably enlarged,
and has been mistaken for a Penis, but may easily
be distinguished from that, by its not having an 
Urethra, and it has likewise no corpus spongiosum.
In children the Clitoris generally projects more
than in adults, and has when this is the case been
taken for the parts of an Hemophrodite.
In a case of the Penis adhering to the Scrotum
a Gentleman mistook this for a Hemophrodite, as 
the Scrotum projected on each side so as to give the 



44
appearance of Labia.- The Plexus Retiformis is
composed of the Veins which return the Blood from 
the Clitoris, and which in part surrounds the Vagina
and by their distention in coitu, assist in diminishing
the diameter of Vagina, as they are placed just
over the Sphincter of the Vagina.- The Clitoris is in 
some instances very irritable, the least motion or touch
giving pain, a good application in this case, is a Mixture 
of Ol. Oliva and Tinct. Opii.-
Nympha, so called from the supposition
that they directed the stream of Urine.- Their figures
very much resembles a Myrtle leaf.- The Nympha
are somtimes very much enlarged, and require
an Operation being performed for their removal, this is 
not very common in this Country, tho' is somtimes
the case, but in the Warmer Climate, this Disease
is very common, it is called Nymphatomia, and is 
easily performed by putting a piece of past board
on one side and cutting upon it.- The Nympha
somtimes adhere, and it becomes necessary to make 
an incission for the purpose of seperating them, and 
considerable care is necessary after the operation
to prevent them from again adhering.-



45
Urethra, a correct knowledge of this, and more particularly
of the orifice, is of the greatest importance
in practice, from the frequent necessity then is of 
introducing the Catheter and which should be done 
without exposing the Parts, for this purpose it is necessary
to have some common Rules as a direction.
For this purpose there are three different directions,
one of which is, to find the lower edge of the Symphisis
Pubis, and the orifice of the Urethra, is situated
just below that part.- Another rule is, to find
the Orifice of the Vagina, and as the Urethra is 
situated just above that part, by raising your finger
a little, you will feel the orifices which you may 
distinguish, by its circular form;- A third rule for
finding it, is to feel for the Clitoris, and the Orifice of 
the Urethra is situated just an inch below this part,
just in the middle between the Nympha.-
One objection to finding this by the orifice of the 
Vagina, is from there being several Lacuna in this part,
and which may be mistaken, for this part, and likwise
Ruga, the Lacuna are generally so small as not to 
admit the end of the Catheter, tho' somtimes they are
sufficiently enlarged to do that.- You may know when 



46
the instrument is in the Urethra by its passing forwards,
whereas if in a Lacuna it wont pass more than 
the eight part of an inch, on account of this circumstance
the way of finding the Urethra by the Clitoris is best, as 
the part between the Clitoris and Urethra is perfectly smooth.
The Female Urethra is much shorter than the 
Male, being in general about 2 In. long.-
The course of the Urethra is in the direction of a 
Curve, and in passing the Catheter this must be attended
to, for if passed in a straight direction this is danger
of its being forced thro' the sides of the Urethra into
the Vagina, as been the case, and is a matter of very
great consequence, from the Urine irritating the 
parts &c.-
The Urethra in the female in a great measure
resembles the Male in structure, its internal
membrane being the same, and like it having several
Lacuna, it is much larger in diameter than
the male, and from this circumstance females are 
not near so liable to Stone as males.- In females
there is no prostate gland.- The prostate Gland in 
the male is about the size of a Nutt, and is a secreting
gland, the exact use of which is not known.-
The situation and direction of the Urethra may be varied



7
47
varied from different causes as prolapsus Uteri &c.
in the cases the Catheter must not be introduced in 
the common direction, but according to the present
direction of the Urethra.-
From the situation of the Urethra it will appear 
evident that the Urethra is liable to injury, in difficult
Labours, and by the use of instruments, if applied
so as to act on the fore part of the Pelvis.-
Retention of Urine.-
The Symptoms of retention of Urine, are pain
and tension in the Region of the Bladder accompanied 
with Symptoms of irritation, and 
great distention, somtimes there is a Stillicidium
an involuntary drifting away of the Urine, and 
which Symptom has often deceived the Practitioner
as from this be supposing this case an incontinence 
of Urine, but the true nature of the case
may be easily known by attending to the other 
Symptoms.- -
The consequence of this Disease if not relieved
by proper means, is bursting of the Bladder
and the Urine escaping into the cavity of the abdomen,
causing a high Degree of inflamation of 
the Peritoneum and Death.- There is more danger



48
danger from the bursting of the Bladder on the back 
than the forepart for when it gives way on the 
back part, the urine escape into the cavity of 
the Abdomen, whereas when the rupture is on the 
fore part, and where the Bladder is not covered by 
the Peritoneum, the Urine may possibly escape 
without getting into the cavity of the Abdomen.
It is in this part that the Bladder should
be punctured if done at all above the Pubes.-
The causes of suppression of Urine are either
from Pressure inflamation or Spasm.-
Suppression of Urine from pressure may be 
either from the enlarged state of the Womb, or from 
inversion or Prolapsus Vagina &c. or from Tumor
found in the parts
The treatment of this Disease will be different
according to the cause producing it. If it 
arises from pressure, introducing the finger or 
laying in a posture, so as to take of the pressure from 
these parts will effect the evacuation of the Urine
there in case of Pregnancy Woman will frequently
be able to discharge the Urine by putting themselves
in a reclining posture, and introducing the finger
press up the Womb, so as to take off the Pressure upon



49
the Urethra.- When inflamation is the cause of 
suppression of Urine, the treatment must be divided
to the removal of that inflamation, this by means 
of Bleeding, purging, the warm bath &c.-
If this disease arises from spasm, opium
will afford the greatest relief, given bitten by the 
mouth or in the form of Glyster, in the proportion
of 50 or 60 Drops.- The Warm bath may in this case
be of Service.
In all these cases the distention of the Bladder
must be relieved by means of the Catheter, and for this 
purpose you should be provided with different sized
Catheters taking care before their introduction, that 
the orifices at the end are open.- The next consideration
is the best position for you to stand in with 
respect to the patient, as it wont be pleasant for you
to stand with your face towards that of the Patient,
but what is much better and more convenient is 
to stand on the right side of the patient, and introduce
the instrument with the right hand, in this 
way your back will be towards the face of the Patient.
You should make use of two small Basons for 
the purpose of receiving the Urine.- Somtimes there 



50
will be a sudden stoppage of the flow Urine, in
consequence of the instrument being pressed against
the side of the Bladder, or from the pressure being applied
to the middle of the Bladder, forming it into two 
seperate Cavities. Whenever the Urine suddenly
stops recurring, more particularly if there is a sense
of fullness remaining you may be certain the Urine
is not all evacuated.
A suppression of Urine somtimes takes place
from a dropsical state of the Body, when this is 
the case, considerable attention should be paid, as 
mistakes under these circumstances have very frequently
been made, and the Bladder has been punctured
by mistake with the Trocar, when the tumefaction
from the Distended state of the Bladder has been mistaken
for Dropsy.- A greater mistake than this 
has been made, by the Trocar being Avoid into the 
thro' the Bladder, into the Uterus, when in an impregnated
state, and thro' the Uterus into the head of the 
child, and occasioning the Death of the Patient.-
It is right upon all occasions, to draw off the 
Urine before the operation of tapping is performed, for 
the Bladder is much distended it may be injured by



51
the Trocar.- A Lady had an enlargement of the 
Abdomen, and which came on rather suddenly, that 
is to say in a few Days, and during which time she 
had made very little Water, she was attended by two Physicians,
one of which proposed tapping but the other was
of Opinion it was not necessary, and after a little farther
consultation, they agreed to call in Dr. Orure, to examine
the state of the Bladder, and on his introducing the Catheter,
he drew off a Gallon of Urine, and the Tumefaction
was entirely removed.-
The Bladder does not swell exactly in the same 
way during pregnancy as at other times, in this case
the swelling is more sideways, from the Pressure of the
Womb on its middle, and this may possibly give an 
Idea of its being a collection of Water in the Cavity of the 
Abdomen, but you may easily distinguish between the 
two by the absense of fluctuation more to the back part.
Incontinence of Urine, may arise either from
loss of tone in the parts or from loss of Substance,
the loss of power of retaining the Urine, frequently
arises from a pressure upon the parts during delivery
and will in a general way, gradually recover in
the course of a few Days.- If this Disease arises from 



52
loss of substance, the Disease will be permanent, as then 
is generally a communication with the Vagina.-
This last circumstance generally arises from
some injury received during Labour, more particularly
if instruments have been used.- A Lady who had
a few Days before been delivered by the Forceps, had Symptom
of inflamation and suppression of Urine came
on, after a little time, a drilling away of the Urine came 
on, and a substance was discharged from the parts, and 
which was a portion of the Urethra and Vagina, which 
had sloughed off.-
When a patient applies to you for this Disease
it is necessary to know whether you can afford any
relief or not, you may know this by passing a Catheter
into the Urethra, and your finger into the 
Vagina, if there is a communication between the two,
you will feel the Catheter in contact with the finger,
and in this case very little relief can be expected.
But if it proceeds from loss of tone, time, with
the assistance of the cold bath, Chalybeates &c. and 
Cantharides externally and internally may possibly
effect a cure.-
1



53
Caruncula Myrtiformes, so called from their
supposed resemblance to Myrtle Berries, the number of 
them is various, somtimes being two, at other 4 or 5 in number,
these parts are not always to be found, as they depend
upon a certain circumstance, being formed by the 
ruptured portions of the hymen.- These parts sometimes
become painfull and inflamed, and require
the application of cooling remedies.- They somtimes
become considerably enlarged, and may require removal.-
They somtimes become Ulcerated, and give
rise to a supposition of their being Venereal, but you
must always be very carefull in forming an Opinion.
Hymen, is situated and the lower part of the 
opening between the Labia, its situation in children
is very evident, but is very often found wanting in 
adults, and which may depend entirely upon accident.
It is the part from which the caruncula Myrtiforms
are formed, and is a membranous projection
of no regular determined stroke, and in general
forms a somwhat circular irregular constricting
membrane.-
Somtimes there are a number of small
openings in this Membrane, forming what is called
the Cribrated Hymen, it has been long a Question



54
whether the cribrated Hymen was an Obstacle to impregnation,
but from the following case it does not appear
to be the case.-
A Lady who was married to a Medical, laboured
under this obstruction, after a time an enlargment
of the Abdomen took place, but from the above circumstance
it was supposed this could not be pregnancy,
she was treated as a Dropsical patient, but the enlargment
went on gradually increasing, she was
ordered to Bath, when she remained some time, but
without any effect being produced on the swelling,
on her return home, she was attacked with pain
but which she would not alow to be labour pains, a 
Practitioner in the neighbourhood, was sent for, and 
on his arrival found the head of the child low down
in the Pubis pressing against the external parts, and 
on a crucial incision being made, the child passed.
The Hymen are somtimes found imperforated,
and which the coeval with the birth of the patient is 
very often not found out 'till the Age of Puberty, as 
then will be all the usual Symptoms of Menstruation
but no external appearance.- This fluid when collected
behind the membrane in considerable quantity



55
has been mistaken for the Water in the fetal membranes.-
When this collection has been evacuated by 
an incision, it is generally found of a cream colour
and to be in a fluid state, tho' it may have been
collected in these parts for a great Length of time, in
this respect differing from Blood.- Her Menstrual
Discharge is composed of the serous parts of the Blood &
the Red particles, but with no portion of the coagulable
Lymph.- The fluid before it is exposed to the external
Air, is perfectly free from acrimony, but when
exposed by an incision it becomes considerably so, this
renders it necessary after the operation to wash out 
the parts by means of a Syringe and warm Water.-
The operation consists in making a longitudinal
incision into the parts, and afterwards a short transverse
on, which should be sufficiently large to alow 
of contraction.- In performing this operation, you
should not only have the evacuation of the fluid in
view, but likwise future sexual purposes.- When
the fluid is evacuated you should apply Dossils of
Lint to prevent the parts again adhering.- 



56
Internal Organs of Generation.
These comprehend a part of the Clitoris with 
its erector Muscles, the Vagina with its Sphincter,
the Plexus Retiformis, and the Uterus with its appendges.-
The Clitoris and plexus retiformis have been
already mentioned, and it now remains to mention
the Vagina, and the Uterus with its appendages.-
Vagina, this is the canal leading to the Uterus
from the external parts, and is situated between
the Bladder and Urethra on the forepart and the 
Rectum behind, and connected to them by cellular
membrane, its figure is not cylindrical,
but Oval is the most capaceous, in the middle, its 
course is moderatly curved, making an obtuse Angle
with the Uterus, the structure of this part is 
of a peculiar Kind, and these enter into its composition
Arteries, Veins, Absorbents and Nerves, and its internal
surface, consists of a plicated membrane, disposed
in different directions, called Ruga, these Ruga
are for the purpose of alowing of dilation, and may
possibly be formed to answer some other sexual purpose.



57
purpose.- The length of the canal varies, but in
general is about 5 or 6 In. tho' it has been found
much shorter.- The Figure of the canal should
be attended to in the use of Pessaries.-
The canal of the Vagina is somtimes divided
by a septum, and in some instances, has been 
found double, forming two Vagina, each having 
seperate hymen and and an Uterus.-
The diseases of this part are inflamation
and its effects, such as cohesion, suppuration,
contraction from cicatrices, mortification and 
sloughing away of a portion of its substance &c.
The treatment of inflamation will be different
according to the Kind and case, and likwise
the stage of the inflamation, as whether it is 
Phlegmonous, or irrisipelatous.- When inflamation
of this part arises from injury during 
Labour it is generally of the Phlegmonous Kind.
Irrisipelatous inflamation is more disposed
to attack the surfaces of Parts, and Phlegmonous
the Reverse.- The pain in irrisipelatous inflamation
is of the hot burning kind, and in Phlegmonous
of the throbing kind.- In irrisipelatous there
is always a considerable degree of irritibility, and 
Debility, and which must be attended to in the constitutional




58
constitutional treatment, as local applications, moderately
astringent injections will answer the best purpose.-
In Plegmonous inflamation the Symptoms
are more of the Tonic kind and which must be 
attended to in the treatment both constitutional
and local, as local, injection of the cooling sedative
kind answer the best purpose.-
If cicatrices have formed, they will prevent
the parts from yielding, and may require either
mechanical or instrumental Dilation.-
When there is cohesion, the cavity may be very
much obstructed, and render it necessary to seperate
these by means of the knife, but much dexterity is
required, and the parts should be kept assunder
by means, of a piece of Sponge or Lint.- This disease
is owing to want of proper alteration, when
inflamed.-
When there is a sloughing of a portion of 
these parts, it may form a communication between
the Vagina and rectum, or with the Urethra
and alow the Feces and Urine to pass thro' the 
Vagina, and which are very distressing circumstances.-



59
Uterus.
The Uterus is to be considered in two states, namly
that of vacuity, and in the impregnated state.
The shape of the Uterus when in the unimpregnated
state, is Pyriform and flattened, and has by some been
compared to a wine flask inverted, and from which 
resemblance different names have been given to different
parts, as the Body, Fundus, Neck, and Mouth.
The surface of the Uterus is flatter on the fore than the 
back part.- The Uterus is in general 3 In. long, one
half of which goes to the neck, and the other to the Body
this Division into Body and neck does not appear
evident on the external surface, but when Laid [illegible]
appears very evident on the internal part, as there
evidently appear a contraction of the cavity in the 
middle, and there is a difference in the membrane
which lines the cavity, that of the Body is smooth
whereas, that which lines the neck is not.-
The Substance of the Womb is Muscular, the fibers
of which rear in different directions, and Arteries, Veins,
Absorbents and Nerves, enter the composition being 
connected together by dense cellular membrane.-
The cavity of the Uterus is divided into two parts 



60
one of which is larger and triangular, the other conical
with the narrow end approaching the Angle of the other
this last is the neck, and the other the Body.-
The situation of the Uterus is nearly in the middle
of the Pelvis, between the Bladder and Rectum, and is 
as high, as the top part of the Uterus would touch a
line drawn across the Pelvis, from the upper edge of 
the Symphisis Pubis, to the top of the Sacrum.-
The Uterus in young subjects is situated higher, for 
in them, a line drawn in this direction would pass thro'
the middle of the Body of the Uterus.-
The situation of the Uterus may be varied from
different causes, as procidentia Uterii &c. Retroversion.
The Uterus may be retroverted if in the unimpregnated
state, and without being perceived, but if it becomes
impregnated, it than becomes a matter of very great
consequence.- Instance have been related of the 
Uterus being contained in the cavity of a hernia, but 
this is very rare, Sennutus relates one in the wife
of a Cooker, who whilst at Work, perceived somthing
suddenly give way, and an enlargment was perceived
in the Groin, after a time she became pregnant
and, and it Here appeared that this swelling in the Groin
contained the Uterus, it went on enlarging the usual way 



61
and at the proper period particular Symptoms came
on, an opening was made into the Tumor, and the Child
extracted, but the result of the case is not related.-
The Retroversion of the Uterus will be considered
when on the Pathology of Pregnancy.
Procidentia Uteri and Prolapsus, are the same 
kind of Disease, only meaning different degrees, thus
the smaller degrees of the Disease are called prolapsus,
as in case it projects so much as to be even
with the external parts.- When there is a Prolapsus
or Procidentia Uteri, you may distinguish it from the 
tumors found in these Parts, as Polypi &c.- by the 
Rugeous character of the Vagina, and by its having 
a hole in the center corresponding with the mouth of 
the Womb, and if it is at the proper time of Life, it will
be the hole thro' which the menstrual discharge will loss.
In some cases the Uterus is forced down behind the 
Vagina, pushing this forwards, in this case there is 
no opening, but you may know the nature of the affection
by the Roya.-
Women who have born children are more subject 
to their Disease, more particularly than who have
a large Pelvis, then should be particularly attended
to during Labour.- Women of a relaxed habit of Body 



62
are particularly liable to this complaint.-
Women who are subject to this Disease in a small 
degree frequently have a difficulty in making Water,
and which may be relieved by passing up the finger
and pressing against the Parts.-
Women labouring under this complaint are subject 
to the fluor albus.-
Procidentia Uteri has been mistaken for other
disease, or Polypus or inversion of the Womb, this last
disease as a turning of the Womb inside out, and is
often brought on by pulling at the placenta for the 
purpose of bringing it away, before the womb has began
to contract, and this way bringing the fundus of the 
womb down.-
You may distinguish between Polypus and Procidentia
Uteri, by the Orifice or Cavity in the middle of the 
Tumor in procidentia, and by the Periodical return
of the menses which will be found to flow thro' this 
opening, and by the Rugae.- Somtimes you cant perceive
the opening, but in this case the Rugae, will be 
a mark of Distinction.-
The Prolopsus Vagina will frequently reduce
itself on the patient being put in a recumbent posture
but on again returning to the event, it will again
appear, sometimes it wont recede even tho' a slight
force should be applied, in this case much Dexterity is 



9
63
required with reduction, and in doing this you must 
the pressure backwards towards the Perineum.-
If the part has been down for any length of time 
it will often be very difficult to reduce, and in this case
some have advised the application of warm fomentation,
but which is very wrong, the treatment in this 
case should be exactly the same as in strangulated 
Hernia, and cold application should be made use of as
they diminish the size of the Vessels, whereas as warm
fomentation &c. increase their size.-
Somtimes a sloughing of the part comes on, now in
this case some have recomended waiting 'till the parts
had seperated, but this should not be done, for it should always
be immediatly returned, and not alowed to remain
'till the seperation of the slough.-
When a Prolapsus Vagina has been reduced, proper
means should be resorted to, to prevent its return
and this is done by means of Pessaries.- For this purpose
different kinds have been used, some are in the form of a 
globe, and others of a flat circular form, then last are 
the best, and are commonly made of Box Wood, and 
with a small hole in the middle, which should not be too
large, the size of the opening must be of that size to admit 
of the end of your finger.- This opening answers two
purposes, one of which is to alow the menstrual Discharge
to pass, the other is for the introduction of the finger, for the 



64
purpose of introducing the Pessary in the Vagina, this hole
should not be made too large or it will admit of a portion
of the Parts above to escape thro' it, and cause Strangulation.-
The form of the Pessary is generally circular, tho'
they are somtimes made of an Oval form, and possibly
with advantage, the edge should not be too narrow, and 
should be rounded off, for the purpose of making it more 
easy.- It should be oiled at the time of introduction.
With respect to the size of the Pessary, that will be serious,
but it should be sufficiently large to stick in the 
Vagina, when introduced, but to begin with one small
enough and gradually increase the size 'till you find it 
sufficiently large.- This form of Pessary is of service
only when the Perinœum is whole, for in case this is 
injured, they wont be of any use, another sort has been 
invented for this purpose, and which is composed of 
a ring Pessary, with a stem to it, and with a moveable
Ball & Socket at the other end end, this slows of 
the movements of the Body without its affecting the part
within the Vagina.- For the purpose of confining this in
the Place, takes on fixed to the part without the Body.
A Piece of Sponge cut in a proper shape is under
some circumstances the best Pessary, as it will alow of 
being medicated, but they require frequent removal 



65
for the purpose of cleaning them.- They should have a
Piece of Tape fastened round them.-
The mode of introducing the common Pessary
is to introduce it sideways 'till you get it within the 
Vagina, and then with your finger in the opening, put
it in the right position.- In introducing it, you should 
not press directly upwards, but press towards the
back part of the Perineum.- It will somtimes cause
excoriation and soreness of the parts on its first introduction,
to remedy this you must advise the use of the 
Saturnine wash.--
The mouth of the Womb is called the Os. Uteri
likewise the Os. Tinca from its resemblance to a 
Finches mouth, and by other Names.- A precise knowledge
of this is necessary to form a judgment either 
with respect to Disease or Pregnancy.- The size of this 
Part varies very much in the healthy state, and under different
circumstances.- In some cases you will find 
a very small protuberance, in others a flat surface,
the size of the opening likwise varies very much, in those 
who have not had children it is very small, about the 
size of the Bulbous end of a Probe, but in those who
have had children it is considerably larger.-
The shape of the opening too, varies very much.



66
The feel of the part likwise varies very much, being 
in general smooth, but sometimes has a particular
roughness and yet be in a healthy states.-
Cancer Uteri.
No age is perfectly exempt from this Disease tho
it most commonly attacks Women, at the middle and
more advanced periods of Life.- Its commencement is 
somtimes insidious begining with a Discharge like 
the fluor Albus, and attended with irregular Menstruation,
in old Women it resembles returning Menstrual 
Discharge, but which occurs at irregular periods.-
Some have supposed that People who not borne Children
are most subject to this Disease, but others are of a 
Different Opinion.- The Symptom which denote the 
presence of this Disease, are darting shooting pains, attended
with an Ichorous Discharge, this from its somtimes being
tinged with Blood, has been mistaken for the Menstrual
Discharge returning to often, and when it has not been
much discoloured, has been mistaken for the fluor Albus,
but it may be easily Distinguished from this by the 
Degree of Arcimony &c. If you make examination, you 



67
will find a rough scabrous surface, and occasion
considerable pain, and probably a slight hemorrhage.
The Disease in this way goes on 'till the neck of the 
[Bladder] Uterus is destroyed, and then it attacks the Body of the 
womb, destroying the greatest part of this and likwise a 
portion of the Bladder and Rectum, the Urine and Feces
will pass thro' the Vagina, occasioning considerable degree
of excoriation, and great irritation and Symptomatic Fever
coming on, Death closes the Scene.- This Disease more
commonly begins at the Os. Uteri, and shreding as before
mentioned to the different parts.-
The treatment of this Disease is confined entirely to 
Palliatives.- The warm bath has been frequently and 
and with some advantage in procuring case, but from
the degree of weakness it produces, is not a remedy very
advisable, the application of fomentations to the part may
be had recourse to.- Cicuta is of service in procuring
case and is found somtimes successfull when Opium
fails.- Opium likwise must be had recourse to.-
Dr. Johnson relates a case which terminated successfully
and in his case, and in which he made use of 
are Electuary composed chiefly of Aethiops mineral, but 
the remedy he placed the most dependance whose, was 



68
a fomentation or wash composed of a Decoction of the 
common Herbs, with a large portion Goose's Fat, melted
in it, which he applied warm to the part, but it appear
very doubtfull whether this was a case of Cancer, and more 
particularlly so, as there are no more cases on record when
it again succeeded.- In some cases an injection of 
a Solution of Sacch. Saturn will be of Service, this joined
with opium in the following way. Rx Sacch Satum. Pulv.
Opii a| 3ss Aq: Hord. Hss, this injected, and the parts
washed with it may afford temporary relief. But towards
the latter stage of the Disease, full Doses of Opium
internally are all that will afford relief.-
Schirrous.- A Schirrous state of the Uterus 
is often mistaken for cancer, and when it becomes
Ulcerated, in some measure resembles it in some of its 
Symptoms, as in both there is violent pain, but the 
pain is of a different kind, so in schirrous the pain is 
of the dull heavy kind, with a sense of bearing down
whereas in cancer the pain is of the sharp lacinating
kind.- In schirrous, the mouth of the Womb
is somtimes dilated, and you may feel the internal 
part of the neck which is rough and Scabrous.-
The size of the Tumor gradually increase somtimes



69
so much so, as to impede the regular action of the Rectum
and Bladder.-
In the incipient state of the Disease, the use of 
Calomel in small Doses, and occasionally giving gentler
Laxatives has in some instances been of Service.-
When Schirrous is in the more advanced stage, there
is always considerable pain, and when the parts are 
in an Ulcerated state, there is frequently some irregularity
of discharges.- The size of the womb is considerably
increased, and which may frequently be felt on
examination by the Rectum, and by its size impeding the 
action of that part.-
When it is in the Ulcerated state, little can be done
except as palliative, Chalybeates have been recommended
on R. o Ferri Ammon. but their action as well as any 
other seems to be upon the Stomach and secondary Symptoms.-
The application of warm fomentations or the 
warm bath may afford Temporary relief.-
The Symptom will somtimes subside for a time 
but generally return again, if this is during the use 
of any remedy, it gives the Idea of having performed
a Cure.



70
Polypus Uteri.
Polypi are situated in different parts of these Organs
as in its Cavity Neck and Mouth, and they are somtimes
attached to the Vagina.- Polypi are somtimes attached
by a small neck, at others by a Broad surface are the 
surface is in some cases sought like a Caulifower,
but is in general smooth.-
Polypi have their origin from different parts 
and great advantage arises from a perfect knowledge
& their Origin in the treatment.-
When the origin is from the internal part of the 
womb, they possibly may not be perceived for a length
of time and from the increasing in size till they fill
the Cavity, often appear as tho' suddenly produced from 
their being by some sudden exertion forced thro' the Mouth
of the Womb, in this case you may distinguish its origin
by passing your finger up as far as you can, and 
feeling entirely round the Tumor, you will feel somthing
corresponding with the Os. Uteri, and be able to pass your
finger entirely round, in this case you may be certain
its origin is from the internal part or Cavity.-
When on your attempting to pass your finger round
the Tumor, you meet with some destruction, you may then



10
71
be certain, its origin is not from the Cavity, but from the 
Neck, or part when you feell the resistance.-
The Veins of a Polypus are situated on its surface
and are somtimes large at others small, and upon these
depend the hemorrhage. It has been supposed that 
the Hemorrhage is more violent, when they are attached
to the Body of the Womb, that when to the Neck.-
When their Origin is from the Cavity of the Body of 
the Womb, and this by a narrow neck, they somtimes
fall off spontaneously, this appears to owing to the mouth
of the Womb, pressing upon the Neck of the Tumor, and 
this way acting as a Ligature.-
There is somtimes a Disposition in the Uterus to
form Coaguli, and which come away spontaneously
and have been mistaken for Polypi.-
It is necessary to distinguish this Disease from
others which occur in these parts, and in some measure
bear a resemblance, as Prolapsus Vagina, Procidentia
Uteri, or Inversion &c. this may be easily done
if the tumor is situated low down, in prolapsus Vagina
the Rugeous Character will sufficiently distinguish
the Nature of the case, and in Procidentia Uteri, you
may know the part which forms the Tumour, by the 
hole you will feel in the center of the Tumor, and by 
by other circumstances, as by its receding when in



72
a recumbent posture. This Disease is more likely 
to be confounded with an inversion of the Womb, but
you may ascertain the Nature of the complaint by 
inquiring into the History of the complaint, as in the 
way it first made its appearance. If it is inversion
of the Womb, there will be frequent discharges of Blood
from the Tumor, and at the menstrual periods this evacuation
will be found to exude from its surface, and 
if you press the Tumor, you will find it to have a greater 
Degree of sensibility.-
Polypus is frequently connected with a Schirrous
state of the Uterus, and under these circumstances their removal 
can produce very little good effect and they may 
likwise be combined with a cancerous affection.-
In some cases where a Polypus is formed in the 
internal parts of the womb, more particular if at the 
Fundus it may by its weight, bring down the womb 
and cause inversion, and if the neck of the Womb
is short, the nature of the case may not be known
and a Ligature may be applied for the removal of the 
Polypus, and which instead of being applied upon the 
Diseasd part is put upon the inverted Uterus, this happened
to John Hunter, who in a case of this kind applied
the Ligature upon a portion of the Womb, and which 



73
brought on great Symptoms of high irritation, and in the 
end Death, he was at a loss to account for the Symptoms
but upon examination after Death he found the cause.
From this case he laid down the following practical 
Rule, never to tye a Polypus without you can feel
the mouth of the Womb. But this is not at all times to 
be felt, and it seems doubtfull if you can distinguish
the part where one terminates and the other begins, if the 
Ligature should be applied to that part, as there is a possibility 
that a portion of the Uterus may project into 
the Tumor, and can should always be taken Not to include
any portion of the Uterus in the Tumor.-
Mr. J. Hunter's Rule is certainly a very good one
but should be joined with the following in case you
cant feel the mouth of the Womb, which is to press
upon the Tumor gradually proceeding upwards, 'till you
find the pressure gives pain, and apply the Ligature
just below this, in the insensible part.-
When they appear of the cancerous kind, they are
not of a proper description for the application of the Ligature.-
Somtimes their growth is very rapid, and 
it is possible, if they are removed by Ligature they will
be very soon reproduced, but tho' their removal in this 
way is not entirely successfull, yet it is right to do it



74
if merely on account of temporary relief.- When the 
size of the Tumor is small and attached by a slender Barr
there is the greatest probability of the operation being 
successful.-
For the purpose of applying the Ligature upon
Polypi different instruments, have been invented, one 
of which is composed of two long tubes, which are fastened
together, and the ligature which is a piece of fine wire
is passed thro' both these tubes, leaving a portion out
at one end forming a bow or loop, this is passed over
the Tumor, and drawn tight so as to stop the circulation 
thro' the part, but John Hunter invented a 
better instrument, and which is composed of a Piece
of Iron, rather acorded and in the end is a small hole,
this is fixed in a handle, and in which is fixed a 
small cross Barr.- This instrument may be used in 
two ways, one of which is by passing a Ligature, single,
thro' the opening in the end, this by Means of the instrument
is passed round the Tumor, and then the other end 
of the Ligature is passed thro' the loop, and in this way
you may draw it as tight as you please, fixing the 
Threads round the cross Barr at the Handle.-
The other way of using the instrument is by passing the 
Ligature, double, thro' the hole in the instrument, forming 



75
forming a loop, this is passed over the Tumor, and fastened as
before.- When you apply the Ligature, you should take 
notice whether you give much pain, a little is always
the consequence, if there is much, the Ligature is applied
to high and should be altered.- The Ligature will
require straightening & Tightening daily on account of the Shrinking
of the Tumor.- The Polypus somtimes requires
supporting as from its weight giving considerable uneasiness,
and in some cases a considerable degree of
Putrefaction takes place, and it may on this account
and on account of its producing a considerable degree
of irritability, be necessary to remove it by the Knife before
its entire seperation by the Ligature.-
There will frequently be considerable Degree of irritability 
come and a particular uneasiness at the 
Stomach, and which will require proper Medical 
assistance.
For the purpose of obviating the putrescent
effects in some measure cloths moistened in Vinegar 
and Water may be applied to the external parts
and a Lotion of Aq. Hord. with R a| Myrrh may be 
applied more particularly to the parts.-



76
Fluor Albus.
This is a discharge which takes place in Women, and 
which continues for a length of time if not cured by the use 
of the Medicine or from some cause. It is a secretion from 
the internal surface of the Vagina, and the mucous follicles
about the mouth of the Womb, and the Cervex Uteri.
The discharge is generally of whitish colour, but not 
always being somtimes of green, or yellow colour, and has 
somtimes a Purulent appearance.-
Women labouring under this discharge are generally
more or less affected in their health, tho' there are some few 
exceptions to this Rule, as there are some Women, who are 
in the best health when labouring under this discharge, more 
so than when it is not the case.
This discharge may accompany a Plethoric state 
of the Body, or the reverse, and this will cause variation in 
the mode of treatment.- When this discharge is present, the 
Patient generally complains of pain and Weakness in 
the Loins, with a general appearance of debility, such as 
listlessness &c. tho' as before observed there is somtimes a 
Plethoric state of the Body.- Some Women have a Discharge
during Pregnancy, of a thick white Mucus, then proceeds
from the Mucous follicles about the mouth of the Womb.
This discharge should be distinguished, from discharges
from these parts arising from other causes, as from, 



77
cancer, Gonorrhea &c. it may be easily distinguished 
from that arising from Cancer by the Absence of Pain &c.
but is not so easily distinguished from the Discharge of 
Gonorrhea, more particularly in the more advanced
stage of this Disease, tho' it possibly may in the beginning
as there is always more or less inflamation in the beginning
of a Gonorrhea, which is never the case in this Disease,
other circumstances must be taken into consideration
as the moral Character of the Patient &c.-
The Aura of this disease will be different according 
to circumstances, as whether than is a Plethoric state or the 
reverse, if there is Plethora, Bleeding, Purging &c. will be 
indicated, but if there is a state of Debility, the Tonics, and 
astringents as Bark, Preparations of Iron, Astringents
of the mineral kind, the cold Bath, Balsams, such as Bals.
Capioi &c. may be of Service, tho' this last does not appear 
so likely to relieve as some other things.- Preparations
of Lead internally have been recommended, but this use
is rather more precarious than some other remedies.-
Along with these internal remedies, injections of different 
kinds may be used, as an Infusion of Green Tea,
Rose leaves &c. with the addition of Alum or other things of 
the astringent kind, these should be injected into the part
by means of a Proper Syringe, Along with these modes
of treatment, attention should be paid to Diet.-



11
78
Tympanites Uteri.
This is a collection of Air in the cavity of the Uterus 
and which escapes frequently by different movements
of the Body.- Every case of discharge of Air from these
parts is not to be considered, as a Disease of this kind, as 
discharge of Air may take place from Various causes
from the death & Putrefaction of the Child in Uterus &c.
but this disease arises with out any such cause, and 
appears to be owing to the Vessels of the part having a 
disposition to form Air. The occurance of this Disease
is very rare, and the Cure extremely difficult.-
The Cure should be attempted by means of Tonic 
and Nervous Medicines, and by a strengthening Regimen,
and it possibly might be of Service to inject, by 
means of a proper apparatus, gently astringent Medicines
into the Cavity of the Uterus.
Menstrual Discharge.
This discharge is that periodical discharge which 
takes place in Women at a certain period of Life, and 
generally occurs at stated periods, which are generally
at the distance of a Month, from which circumstance
it takes the Name of Menses or Menstrual Discharge.
This discharge is not Blood which proceeded from 



79
the rupture of Vessels is was formerly supposed, but is a 
regular secretion from the extremities of the Arties, by
a proper organization for that purpose.- It is composed 
of the Serum and Red particles of the Blood without 
the coagulable Lymph. This discharge in its natural
state wont coagulate, and whenever it will, it is a morbid
state of the discharge as there must then be the presence
of Coagulable Lymph, this constitutes the Disease called Menorrhagia.-
The Age at which this evacuation first makes 
its appearance is about the fifteenth Year in this Country,
but there are many varieties in this respect, as it is 
in many cases much earlier, and in thus much later
than this.- There is variety in this respect in different
countries, in the warmer Climates, the time of their appearance
is much earlier, and in the colder Climates much
later.- Tho' the period of the appearance is these various
yet, if there is no constitutional affection is consequence
of this, it cant be called a Morbid state.-
When the Menses are about to make their appearance
there will be always more or less constitutional affection,
great variety of Symptoms being present, frequently a 
state very much resembling Pthisis Pulmonalis, when 
there are symptoms of this kind present, a considerable
short discrimination is often necessary to distinguish 
the Nature of the case, and it is impossible in some instance



80
instances to say what the nature of the case is, 'till by the use 
of some remedies, it becomes more clear, as the remedies for 
these Disease are quite of a Different kind, are requiring
Tonics &c. which would to injury in the other Disease.
It is frequently the case that a considerable degree
of Langour, and diminution of strength takes place at 
the time of the menses being about to appear, and by some
it is the practice to order the to use an extra Degree
of exercise, this plan is very injurious, so the System
should be invigorated by proper remedies, as Chalybeates
and what are usually called emmenagogues &c. and the 
the usual vivacity and inclination for exercise will return,
whereas if you order exercise to be used, when the 
strength is so much diminished you are in danger
of producing some bad consequence.-
Chlorosis is in many instance only a Symptom
of a dificiency in the proper secretion of Blood, and when 
this is the case the first indication is to assist that
process by proper nourishing treatment, both in the medical
Depeartnent and in respect to Diet, when this is 
the case emmenagogues are improper 'till the constition
has been strengthened, then their use will be of Service.
Electricity is only proper when there is a proper secretion
going on.-
The discharge is seldom regular in respect to its 




81
recurence, for some little time after its first appearance.-
Before the appearance of the discharge in the 
regular way, there will generally be some particular
Symptoms come on for a few Days, as a sense of dullness
and heaviness, pain in the back and Loins, Vertigo &c.
and there usually is a whitish discharge for a few Days
or for a Day or two, before the appearance of the Red discharge.
The Length of time which the discharge continues is very 
various, but in general is about 3 Days.- The Quantity too
is subject to great variety in some instance only just 
tipping the Linea, in others the quantity is considerable
accounting to several Ounces, and at the same 
time does not produce any bad effect on the constitution
it is not quantity discharged which constitutes
a morbid state, but it when this quantity produce
some ill effect on the constitution, the same Rule
is applicable with respect to duration.-
There is obstruction of another kind occasionally
taking place, when the Body is in other respects in 
a healthy state, this disease may arise from different
circumstances as from the application of cold
&c. in their case quite a different mode of treatment
is proper, from that pursued when the Body
is in a debilitated state, in this case Bleeding in 
small quantities, Electricity, Aloctic Purges, this Service



82
Service pieces &c. will be of Service.- If by the use of then
means the affection is not releived, other Symptoms
will come on, as an effusion within the Cellular
membrane, producing a swelling of the lower Extremeties,
and a Dropsical state.-
All obstructions of this discharge are not to be 
considered as morbid is there is always a disappear
of this evacuation during pregnancy, and in general
this is the case, tho' not always during the secretion
of milk. There will frequently be a Discharge
of Blood at different times during pregnancy, but this 
is quite of a different Nature from the Menstrual Discharge
as this is a discharge of Blood, and probably comes
on in consequence of partial seperations of the Placenta,
as from its being situated over the mouth of 
the Womb &c.-
The menses at a certain Period of Life cease
to flow, the Age at which this takes place as various, in
general about 65, the it will take place both before and 
after this period at considerable distance of time it is generally
the case, that those Women who had the menses
first appear at an early period, will likwise have their 
cessation early and the reverse of at a late Period before
their first appearance. This change is considered by 
them as a matter of very great consequence and with 




83
very good reason, for these are frequently symptoms of very
great consequence come on at this time.- When the discharge
has ceased to appear for two or three periods, there will frequently
be a Plethoric state of the System more particularly if no 
attention has been paid to the Diet, and there will then take 
place a Discharge, and this may be repeated at intervals,
this discharge is not of the same nature as the menstrual
but is a discharge of Blood, containing coagulable Lymph and 
from this circumstance produces more debilitating effects
and if repeated may cause such a Degree of weakness as 
to be the cause of other Diseases as Dropsy &c.
In Women who have born several children, there 
will frequently be a cessation for a month or two, and then 
a sudden and perhaps profuse discharge of Blood take place
and if this in any part comes away in a coagulated form
gives them the Idea of having miscarried, this is a case of 
Menorrhogia, and should be treated as such, these discharges
will recur at intervals. It has been usual in all cases 
to give tonic and astringent Medicines under these circumstances,
but which in many instances in a wrong practice
as a treatment similar to what is pursued in case of 
Hemoptoe, will in general be more proper as at the time 
when from certain symptoms the discharge is likly to take 
place if the Pulse is is generally case, are rather full and
have the jerking feel, the loss of a small quantity of Blood 



84
from the Arm, as from 4 to 8 oz. according to circumstances
will be of service, and at the same time giving gentle apperients
as small Doses of Neutral Salts &c. and in the intervals
giving gentle Tonics and astringents, the common
tonics and astringents may not be so proper in this case
as some others, a good one for this purpose, is Infusion of 
Roses, with a small portion of Glaubur Salts, the basis of both
their being the same thus does not any decomposition take place
each has its basis the Sulphuric Acid.-
It possibly may answer a very good purpose at the time 
the menses are about to disappear, to take away as small
quantity of Blood for a few times once in two months, and this 
perhaps with a little attention to the Bowels & Diet might prevent
any of the consequence ensuing.-
When the disease has continued for a length of time
this plan wont be proper, but recourse must be had to 
Tonics as the Bark, Chalybeates mineral Acids &c. and 
a nourishing diet, as the System has been very much reduced
and must be recruited.-
At this time there will frequently be an affection
of the intestinal Canal, that is a disposition to flatulency
producing a sense of fullness and a swelling of the Abdomen,
and which by Women has been mistaken for Pregnancy
tho' it may be easily distinguished from this state, this
state may be remedied by the use of aperients Medicines
joined with Aromatics and those of the Nervous kind as 
Pill. Gall. Comp. &c.



85
Appendages of the Uterus 
The appendages of the Uterus are four in Number namely,
The Fallopian Tubes, Ovaries, Round Ligaments, and Broad
Ligaments.
The fallopia Tubes go off from the upper part of 
the Uterus sideways terminating in a fimbriated extremity
they are in general about 5 In. long, but are subject to rarity
as they may be very much lengthened from certain causes,
and from an enlargement of the Ovariæ &c.
The diameter of the tube is smallest where it joins the 
Uterus, and becomes considerably enlarged at the other extremity.-
This tube is subject to variety in several respects
its course being in general straight tho' somtimes in a Spiral
direction.-
The Fallopian Tube is subject to a varity of affection
and is somtimes found imperious or obliterated, they are
likwise subject to a collection of Matter in their cavity, and 
to a Dropsical state, the quantity of Water is seldom large
not being more than an ounce in general, this Disease is seldom
of any consequence in respect to its effects on the constitution,
nor are their any Symptoms whereby its presence
may be known.- If both the tubes are in this state, it 
must certainly be a cause of sterility as the passage of the 
Ovum is entirely prevented.- Matter when formed in 



12
86
Ovaria has escaped by these Tubes into the Uterus and 
this way found an outlet.-
The structure of the fallopian Tubes must 
be in part muscular tho' muscular fibres cant 
be discovered, yet there can be no Doubt of this from the 
actions they perform.
The office of the fallopian Tubes will be more 
particularly explained, when treating of impregnation,
yet this is evident that they are for the purpose of carrying
the Ovum from the Ovaria to the Uterus.-
Another office, which is that of carrying the [illegible]
fluid of the male to the ovaria has been
ascribed to them, but this does not appear to be the 
case as will be here often explained.-
Ovariae.
The figure of the Ovaries is very much like that 
of the testes, the surface is irregular, they are vesicular
internally, more obviously so between the Age
of Puberty and the middle period, these vesicles are 
unequal in size, and indefinite in number.-
When one of these vesicles has received the Stimulus
of impregnation, it gradually begins to enlarge
and after a time bursts, the Ovum escapes, and is embraced 
by the fimbriated extremity of the fallopian
tube and carried to the Uterus.- The Ovaria have 



87
in some instances been found wanting.-
The Ovaria are subject to different diseases, to 
inflamation, and suppuration, the matter from which 
may be discharged in different ways, one of which 
is by the fallopian Tube into the Uterus, and may 
give an Idea of its having been formed in that part.
They are likwise subject to an enlargement of 
the Schirrous kind, and which may keep gradually
increasing in size for several years, in many cases 
without having any material effect on the constitution,
tho' somtimes it is the reverse.- This enlargement
has in some instances been mistaken for 
Pregnancy, but may be distinguished by the Tumour
begining on one side.- Nothing can be done in 
this disease except in the Palliative way, so by giving
Opium, Aperients &c.-
These parts are likwise somtimes found
in a state of ossification, and have somtimes been
found to contain, the different parts of a fetus as 
Hair, Bones &c. and in some instances it appear
difficult to account for the formation.
When parts of the fœtus have been contained in
the Ovaria, this constitutes an [cross out] extra Uterine
case, in this case the usual Symptoms of impregnation
go on for a length of time, there cease but the 
enlargement continues, after a length of time an Abcess



88
forms and the different parts are evacuated.-
The Ovaria are subject to a collection of Water
in their cavity constituting a Dropsical state, the qantity
of water which be contained is various, has in some 
instances been found to be to the quantity of 10, 12 or 
even 15 Gallons.- Women about the middle age are 
most subject to this disease, but no Age is entirely
except.- The disease in the first place begins 
in one of the Vesicles, somtimes in two or three, these dont 
at first communicate with each other tho' they afterwards
so, this is a fortunate circumstance in drawing
of the water by tapping.- The substance which is contained
in the Ovaria, is somtimes partly fluid and 
in part solid, and which will render relief by tapping 
up, from this it will appear evident the necessity of 
giving a guarded [illegible] in this Disease.- If the solid
part is situated anteriorly, the common trocar will
not evacuate the Water, in this case it is probable
on a greater length might be of Service.-
The begining of this disease is seldom noticed
tho' there will be somthing perceived to move on the 
side affected on the Body being put into different
positions, this affection seldom produces so much
derangement of the System, as cases of common Dropsy.
Her water collected in the Ovaria varies very much
in some instances being perfectly thus and Lymped 




89
in others viscid and glutinous, when the fluid is 
in this state the constitution is generally giving way 
Different modes of cure have been recomended,
on of which was to extirpate them in the early stage
but this would be attended with many difficulties,
as from the difficulty of distinguishing them before they 
were considerably enlarged, and when this is the case the 
opening required for their removal would be so large
as to render the operation extremely dangerous, and many
other besides these. It has been proposed to cure
them by causing inflamation in the cavity in the 
same way in in the cure of Hydrocele, but there are 
no facts in support of this.-
The treatment of this disease is only palliative
which is by tapping, the use of Medicine has never
been of any service, tho' these have been instances of 
a cure taking place by accidents, which have burst
the Cyst.-
When both Ovaria are affected with this Disease
impregnation cant take place, tho' this may 
if only one is diseased, and when this is the case 
very unpleasant effects are the consequence, more 
particularly during Labour, and this may be more 
so if the Tumour is small than if it is larger,
from its descending more into to cavity of the Pelvis
and obstructing the passage of the head.- They way
to distinguish a Tumor of this sort from the head of 




90
the child is by its being compressible, and yeilding
which is not the case with the head of the child.
When this is the case, a question arises whether
it would be best to open the head of the child or to draw
of the the water from the Tumor by the tapping, there have not 
been a sufficient number of cases on record to say 
which of these is the most eligable, as no general Rule
should be laid down from solitary cases tho' when the 
whole should prefer the latter.-
Round Ligaments, an attached to the 
upper part of the Uterus, and often passing towards the 
lower, go thro' the abdominal Ring like the Spermatic 
chord in the Male, and are the distributed
about the Mons Veneris &c. The structure of these
Ligaments is muscular and Vascular, and their 
use appears to be for the purpose of supporting the 
Womb, and keeping it steady.- During pregnancy
there is somtimes a painfull uneasiness about 
the Abdominal Ring and Mons Veneris, from these 
Ligaments being put on the stretch, and which 
may require the use of Anodynes &c. for the purpose
of worsening relief
Broad Ligaments, consist of a doubling
of the Peritoneum, enveloping the other appendages of the 
Uterus with its vessels, and attached to the sides of the 
Pelvis, dividing it into two Cavities. These Ligaments




91
are formed by the Peritoneum being reflected over
the Fundus, and posterior part of the Bladder, over 
a small portion of the anterior part of the Uterus, over 
the fundus and posterior part, and then over the Rectum
leaving a portion of the back part of the last uncovered.-
From this it appears that the Neck of 
the Bladder and a small portion of the posterior part of 
this, near the neck, and part of the anterior portion is 
not covered by the Peritoneum, and there is likwise
part of the anterior portion of the Uterus with the Neck
and Vagina, which are not covered by it, nor is 
the lower and posterior part of the Rectum.-
From a knowledge of these circumstances
some practical hints may be derived, as for instance
that of tapping the Bladder (in case of suppression
of Urine) from the Vagina, by means of a curved
Trocar, when a Catheter cant be introdced
[illegible] [illegible] supposed the Tapping might be done
with advantages in Ascites from the [illegible] but
the Intestine would be a great [illegible] of [illegible]
the Broad Ligaments are attached



92
Gravid Uterus.
The Gravid Uterus comprehends a series of changes
induced on the Uterus and its appendages, also the Ovum
contained within it, consisting of the Fœtus, Navel
String, and Placenta, the Water called Liquor Amnii,
with the different membranes, as the decidua,
chorion, Amnios &c.
We shall first describe the Ovum and afterwards
the Uterus &c. The Ovum being the produce
of conception, this merits a previous consideration.
Conception, there is great variety in the mode 
which impregnation takes place in different Animals,
in some there is the power of impregnation in
themselves, having both sexes contained within themselves
in others, the organs of both sexes are perfect, but then
require sexual intercourse, and a double or reciprocal 
impregnation follows.-
The things necessary to impregnation in the male
are Testes, secreting semen, in the Female ovaries
in a healthy state, with a determination of Blood
to the whole Uterine System. The Oestrum or disposition
to impregnation and the coitus are the occasional
causes.- It is not necessary that both Testicles shoud
be perfect, as one testicle and one Ovarium in a healthy 



13
93 
state are sufficient for this purpose, and tho' there
is a necessity for a determination of Blood to the parts
yet impregnation may take place, when there has 
been no menstrual Evacuation provided there is 
this determination to the Uterus &c.-
Different opinions have been formed with 
one put to the part the fecunditating fluid of the Male
is conveyed to produce impregnation, as whether it
is only conveyed to the Vagina, or Mouth of the Womb
in to the Body of the Uterus, or whether it is conveyed by
the fallopian tubes to the Ovaria, but from the result
of several experiments it appears, that sympathy or 
consent of parts, and which opinion receives additional
strength, by the Breasts sympathizing with the action
of the Uterus.- The Stimulus of impregnation is probably
first given to the Uterus, the Ovaria then harmonize,
afterwards the fallopian tubes &c.-
The alteration which takes place in impregnation
is, after the Stimulus of impregnation is given
one of the Vesicles of De Graaf, this swelling and projects,
before the rest, after a time this bursts and the
Ovum escapes, which is imbraced by the fimbriated
extremity of Fallopian Tube, and by this is conveyed
to the Uterus, there is then a particular membranous
attachment formed to prevent the Ovum from escaping
this membrane is called Tunica Decidua, there 



94
likwise a secretion of thick mucus which pluggs
up the mouth of the Womb, and thus becomes a farther
security.- The substance of the Vesicles does not take 
on the form of a Ovum immediately on its entering the 
cavity of the Uterus, but the membrane before mentioned
is first formed, and the different parts of the Fœtus are
not immediately formed, but take place in some little
time from this.- The parts for it formed are the Organs
of Sense, as the Brain, the head is first formed then
the Skin, is seen projected, and soon after this the Eyes are
seen and afterwards the extremeties.- The heart is too,
very early formed.-
Super fetation may take place if there is a 
second coition, before the Ostrum is gone off, an instance
of this occured, in a Married Woman of Jamaica,
who had twins, one of which was white and the 
other Black, she endeavoured to account for it by an
affection of the Mind from fright in the same way as 
Navi Materni are supposed to arise.-
From circumstances it is probable, that the
fecunditating fluid of the male, has nothing to do
with the formation of the Fetus, except by giving a proper
stimulus.-
After impregnation and the contents of the Vesicles
of De Graaf is evacuated the Cavity then becomes
filled by a Yellow Matter and which is called Corpus 




95
Lutei, and this is the course of some time gradually
disappear, probably may do this in the course of about
12 months.- There Corpus Lutei always correspond
with the number of Fœtuses, except in some instances
when there are the Rudiments of two Fœtuses in
one of the Vesicles and which is very rare.-
It has by some been supposed that this was 
not the case, from a greater number of these Bodies
being found than fœtuses, but there must then have 
been a corresponding number of impregnation, and 
most probably miscarriages
The Navel String is that chord which 
passes from the middle of the Abdomen of the Child to 
the placenta, the place when it is attached to the Placenta
is not always in the center, being frequently
to one side or very near the Edge.-
The Length of the chord varies very much, being in
some instances no more than 6 In. long, and has been
found as long as 57 In.- Both these extremes have
their disadvantages, for when very short, there is danger
either of inverting the womb, or breaking the chord
on the expulsion of the child, or there may be in consequence
of this a partial seperation of the Placenta,
and by its being done before the Vessels have any 



96
ways contracted may cause a proper hemorrhage,
from this circumstance, care should always
be taken not to move the child far from the 
mother, when expelled, or rather to bend it towards
the mother as it is passing the external parts.-
When the chord is of more than common length
it may possibly get down before the head of the Child
and being this way compressed the circulation will
be stopped, and as the Lungs are not in this case
in action, the Death of the child very soon takes
place, or the chord may be passed round the Neck
of the child.- Somtimes there is a Knot formed upon
the chord, this probably is done during Labour, by 
the Chord, passing over the Child.-
In some cases the chord may be felt, by the 
Pulsatory feel, before the Bagg of Waters is broke, in this
case you should avoid, breaking these as long as possible
and endeavour to alter its situation, or it possibly
by some motion of the child may be spontaneously
changed.-
The umbilical chord is composed of two
Arteries, and one Vein, connected together by a [cross out]
Cellular substance & covered by a Membrane substance, which contains a mucous
substance, but it has neither absorbents nor Nerves
entering its composition at least so far as at present



97
present is known.- The umbilical Vein in the adult
is so far obliterated is to destroy its cavity, and forms
that part called the Ligamentum Rotundua of the 
Liver.- These Vessels not only convey Blood but
likwise nourishment to the fœtus.-
The Vessels of which the chord is composed pass 
in different direction, somtimes the Arteries pass
in a spiral direction round the Vein, and in other
cases the reverse, in some instances they pass in
paralel lines with each other, and they somtimes
form a Coil.- The different directions which the
Vessels take may possibly be for the purpose of retarding
the Velocity of the Blood, and possibly for some other
Parlous.- From their being no Nerves in the composition
of the Chord, it appears improbable that 
the mind of the mother should have any power
in the formation of what are called Nevi Materni
and other circumstances, that have been attributed to 
the influence of the mind, as the case of the Jamaican
Lady before mentioned.-
The Placenta is that part which forms the 
medium of connection between the Mother and 
Fœtuses, and correspond with the Fœtuses in respect
to number, thus if there are one, two, or three fœtuses
there are the same number of Placenta, except in
case of one of the Vesicles of De Graaf containing the 



98
Rudiments of two Fœtuses, in this case there will
be only one placenta and on Bag of Waters.-
When there are two or more placenta, the Vessels
of each have in general no communication, tho'
in some instances they have, and it is from this 
circumstance, that the necessity of tying the chord or 
each side the part you divide it, for if the Vessels
of the two placenta communicate, and this was not 
done, it is most likly the Death of that Fœtus in
Utero would take place, from the discharge of Blood
owing to this communication, it is on this account
and not on account of the Quantity being injurious
to the Mother, the necessity arises.-
The thickness of the Placenta varies, in general
about an inch thick in the middle, and gradually
becomes thinner towards the Edge, and its forgive is 
in general round & flat.- Its attachment is to different
parts in different cases, in general it is to the 
upper part or fundus, and which is the best place
for the attachment, in some instances it is placed
over the mouth of the Womb, and which constitute
one of the most dangerous cases in Midwifery.
The Placenta has an external and internal
surface, the external is that which is in contact
with the Uterus, on which there are several fissures



99
dividing into lobes, which probably are for the purpose
of slowing it to accomodate itself.--
The Arteries are spread chiefly on the internal
surface the Veins on the external, before the Arteries
in the substance of the Placenta, they communicate with 
each other.-
The Placenta consists of two parts, the Maternal
and Fœtal the maternal part is cellular, the other
which is the Fœtal is Vascular, there are no communication 
between the two parts by continuation
of Canal.- There are two distinct circulation going 
on in the Placenta, one between the Mother and 
Placenta, the Blood passing by the Arteries into the 
Cells of the Placenta and returning to the mother
by the Veins, the other between the Fœtus and placenta,
the Blood passing by the Arteries into the Vascular 
or Fœtal part of the Placenta, and returning
by the Veins.- The communication between the 
Maternal and fœtal part of the Placenta, is probably
by Lymphatic Vessels, and which may probably 
arise in a similar way to the Lacteals, from
the cellular part of the Placenta.- The way in which 
the Fœtus is nourished is not as some have supposed
by the mouth or Skin, but by the chord, which 
is not from its receiving red Blood, but coagulable 



100
Lymph, which it converts into Red Blood by its own 
sanguifying powers, the same as the chick is Ovo.-
The more this is examined the more it appears
to be like the process of Vegitation, that the Fœtus is 
nourished.- From several circumstances it 
appears that the placenta her forms a similar office
in the fœtus, upon the Blood, to what the Lungs do 
in the adult, except in the power of evolving heat
which is not necessary in the Fœtus, rendering it 
fit for circulation, and this is evident in case
the chord is compressed so as to stop the circulation,
before the child can breath. Death is the consequence,
and which cant be from the supply of 
nourishment being cut off.-
The circulation of Blood in the Fœtus is different 
from that of the adult, as there is a communication
between the right and left Auricle, called
the Foramen Ovale, and thro' which a great portion
of the Blood passes, a small portion only going 
thro' the Lungs for their nourishment.
Membranes, are the bag in which the fœtus,
Navel string, and Waters are contained, the number
of these bags in general correspond with the number
of Fœtuses, the use of this is obvious, for in case there 



14
101
were two or more Fœtuses, if one of the Bags gives
way the other Fœtus or Fœtuses is not effected.-
The number of the membranes vary in the 
early and later periods of Pregnancy, in the early
Period there are 4 Membranes, namly Tunica
Decidua Uteri, Tunica Decidua reflex, Chorion,
and Amnios, in the later periods then are only
three, namly, the Tunica Decidua Uteri, commonly
called, the Spongy Chorion, the true Chorion, and 
the Amnion.- In the early stages of impregnation
these membranes appear more like a portion of 
coagulable Lymph, than distinct membranes.
After some little time the Tunica Decidua
reflexa disappears, in consequence of a discontinuation
of Growth, and not by condensation, as John
Hunter, and some others have supposed.-
The Spongy Chorion is formed by coagulable
Lymph thrown out by the Uterus, which afterwards
becomes organized the same as under other circumstances, 
at the time of the Ovum descending from the 
Fallopian Tube, this Lymph is thrown out for the
purpose, of its being imbedded in it, there is then a 
process of this spread over it, which forms the Tunica
Decidua reflexa, and which as before observed after a 
little time disappears, the use of this last membrane



102
appears to form an attachment before than is done
by means of Vessels.- John Hunter was of opinion
the Spongy Chorion was formed of the internal membrane
of the Uterus.- The Spongy chorion is very Vascular,
which Vessels are derived from the Uterus, it is of 
greater thickness than the other membranes, and has 
a Granulous Surface, with numerous Foraminula,
which probably act the same as Lacteals,
in the nurishment of the Fœtus.- In some cases 
this membrane is expelled, when this is the case
you may be certain of Abortion following, when it is 
expelled in this way, is has very much the resemblance
of a Piece of Brussels Lace.-
The spongy Chorion is that which conserve
contact with the Uterus, next to which is the true
Chorion, the structure of this is more firm and 
compact the that last mentioned, and is probably
Vascular.-
The next or inner most membrane is the 
Amnion, this is thinner than the other two, but of 
a much firmer texture.-
The Placenta is situated between the Spongy
Chorion, and the true Chorion, and the maternal
part of which is formed by a portion of the Spongy
Chorion, but the Fetal or Vascular part of the Placenta



103
is formed by the ramification of the Umbilical
Vessels, this substance may be said to convey Nutriment
to the Fœtus in a similar way to what 
the Lacteals and Absorbents do in the adult.
The use of the membranes is for the purpose of 
containing the water and defending the child, and 
for some other purpose which will be mentioned
when speaking of the Waters.-
Water called likwise Liquor Amnii from 
its being contained in the Amnion, is divided into 
true and false, the false is a collection between
two of the membranes, and which is somtimes evacuated,
giving the Idea of the membranes having 
been ruptured, somtimes a quantity of Urine is 
suddenly evacuated from the Bladder, by some 
motion of the Child, and which is mistaken for the 
escape of the Waters.- The Properties of this fluid
very much resemble that which is effused into different
cavities of the Body.-
The quantity of Water is subject to considerable
variation, is somtimes in as small a quantity
as from half an Ounce to an Ounce, and in other
instances a pint, or even two or three pints have been
found, but in general from half a pint to a pint 
is the quantity.- With respect to the relative proportion



104
proportion to the Fœtus, this likwise varies, in the early
periods the Water very much exceeds the Fœtus in 
Bulk, and the reverse in the late periods, not but
that the Water keeps increasing in quantity, tho'
not in the same degree as the Fœtus. They very
near agree in quantity at the third month.-
The Water appears appears to be a secretion
from the Amnion.- When the Water are by any 
means evacuated at an early period. Abortion
must follow.- In case of actual Labour, when 
the Waters are evacuated, the time at which Labour
shall actually take place from this is uncertain
or in case the Water, has by any means been Discharged.
The Uses of the Waters, are to defend the child, and 
together with the membranes, to dilate the passages
in the early stages of Labour, and lastly to facilitate
the Passage of the child by lubricating the Parts.
The reason why larger in proportion early in the 
fœtus being soft so as to be liable to give way
to any slight [illegible]. It will be pressed [illegible]
at the 3 or 4th month



105
Changes on the Uterus by Impregnation.
The alteration produced by impregnation upon the 
Uterus, are considerable and in may respects, as in 
Shape, size, Weight, and in the size of the Cavity.-
Those alterations have considerable effect upon the 
ajacent parts, as by pressure upon the Bladder, a
frequent discharge of its Urine or a suppression
takes place, according to the part acted upon, thus if 
the upper part of the Bladder is pressed, the size of the 
cavity is diminished, and this causes frequent evacuation,
and if the lower part about the Neck is pressed
upon, a suppression is the consequence.- In these cases 
change of posture may be of service, and in case of suppression,
pressing up the Womb by means of the finger, will
releive the Bladder or it may be necessary to introduce
the Catheter.-
The enlargement of the Uterus is confined to the 
Body of the Womb till the end of the 5th month, after which
time the Cervix Uteri begins to strech, and is obliterated
at the end of the Ninth month.- Some practitioners
have supposed the neck of the Womb to have began to shorten
before this Period, but it is not the case, as it is of 
the full length, that of 1 1/2 In. till the end end of the 5th month



106
The shortening of the neck of the Womb does not take 
place in a regular gradual manner, but proceeds
faster at some periods than others, at the 6th month it 
is a little shorter, at the 7th month it has lost two thirds
of its length, being then only 1/2 In. long, at the 8th month
it is still shorter, and at the 9th month is entirely obliterated.-
Great advantage arises from this Order
of the Womb enlargment, for if the neck of the Womb was
obliterated at an earlier period, any sudden action of 
the parts might force of the mouth prematurely, and 
which is prevented, by this state of the parts.
During this enlargement of the Uterus it somtimes
spontaneously bursts, and the child escapes into 
the cavity of the Abdomen, the symptoms by which you
may ascertain this having taken place, an sense
of something suddenly giving way, attended with considerable
pains different from that of Labour, and you may 
distinguish the different parts of the Child thro' the Parietes
of the Abdomen.- This is more often the consequence
of bad practice in turning the child, from too great
a degree of force being used.- When this has taken 
place, it is certain to end in death or nearly so.
The practice recommended under these circumstances 
is to pass the hand thro' the opening and to 
find the feet, and endeavour to extract this way.



107
The part that gives way from violence during Labour
may be either the Uterus or Vagina.- From this it 
will appear the great necessity there is for case in 
case of a necessity for turning.-
The chief alteration produced upon the Os. Uteri
a Mouth of the Womb, from impregnation, consists in 
a more developed condition of the Mucuos follicles
occasioning a considerable discharge from these parts
in many instances, and which which has by some 
Women been mistaken for fluor Albus, and an account
of the quantity have been alarmed, but it is not a 
Matter of any consequence as it does not produce
any weakness, and upon the whole may be said
to indicate a more favorable Labour, from the 
parts being generally in a more relaxed state, than 
when there is no discharge.- There is always a discharge
of mucus preceding Labour, but which is in that 
case tinged with Blood, this is by them called the 
Shew.- The figure of the Os. Uteri likwise varies
gradually becoming less prominent, and Broader.
The ascent of the Womb when impregnated
is in a ratio corresponding with the Period of 
Pregnancy, at the third month, it is just above the 



108
Brim of the Pelvis, at the 5th Month it is half way
between the Umbilicus, and brim of the Pelvis, at the 
6th Month it is nearly at the Umbilicus, and at 
the 7th Month a little above it, at the 8th Month, it 
is half way between the Umbilicus, and Ensiform
Cartilage, and at the 9th Month is as high as this 
Cartilage.-
This enlargment and ascent of the Womb, produces
considerable effect upon the different parts
contained in the Abdomen, as upon the Bladder, Rectum,
Stomach &c.- The Nausea and Vomiting
which takes place at the early periods of Pregnancy,
cant be owing to pressure upon the Stomach
but must arise from irritability, or Sympathy.-
The Figure of the Womb in general is between
the Oval and Pysiform, tho' it is subject to variation
from several causes, as from the number
and position of the Fœtuses, quantity of Water &c.
The Position of the Womb is generally in the 
center of the Abdomen.-
The Arteries of the Uterus are 4 in number,
two of which arise from the Spermatic Arteries
and two from the Hypogastric, these are distributed



15
109
distributed upon the Uterus in a Serpentine direction
the Veins which return the Blood from the Uterus
in general accompany the Arteries, but instead
of taking a spiral direction, go nearly in a straight
course, they go from the Uterus to the Vena Cava
on the right side, and on the left side to the Emulgent
Veins. There have been different Opinions
respecting the Serpentine direction of the Arteries, 
some supposing it to be for the purpose of slowing the 
Uterus to enlarge, but as they are in the same spiral
direction when the Uterus is at the full size,
this cant be the reason, it must be for the Purpose
of retarding the motion of the Blood in these 
parts.- There are likwise Nerves and Absorbents
in the Structure of the Uterus both of which become enlarged
in the impregnated state, the Absorbents have 
at times very important actions to perform
as it is by their action the Uterus is reduced to its 
proper size after delivery.- The womb does not only
enlarge in circumference but in substance, during 
pregnancy, and different opinions have been
formed, respecting the thickness of the Womb at the 
time of Labour, whether it is thicker or thinner than
in the unimpregnated state, both these circumstances
may be right in different cases, in general the 



110
thickness is about 3/8 In.- The Womb at the time of 
Labour is supposed to contain 51 Cubic Inches and 
in the unimpregnated state 4 1/2 Cubic Inches, which
is nearly 11 times the Bulk. all this is to be taken
up by the Absorbents.- The size of the Womb should
be remembered after the expulsion of the child on 
account of its weight occasioning some inconvenience,
and rendering a horizontal position necessary.
Different opinions have been formed respecting
the substance of the Womb, some supposing it to 
be muscular, and others not, but there is not the least
doubt of its being Muscular from the actions which
the Womb performs, these muscular fibres are distributed
in different directions.- It is by the contraction 
of these muscular fibres, that the child is expelled and 
by a farther contraction, the expulsion of the Placenta
is effected, in many cases entirely without assistance.
This contractile state of the Womb is of very great
consequence in the prevention of hemorrhage, diminishing 
the size of the Vessels, for if no diminution of their 
capaciousness was to take place there must be much more 
hemorrhage after delivery, and from this circumstance
practical hints may be taken in flooding to assist 
the wombs contraction by any means as pressure upon
the Abdomen &c. or if the Placenta is not yet expelled 




111
and is the cause, extracting it, and which will slow the Uterus
to contract, and in this way stop the hemorrhage.-
Pregnancy.
Pregnancy has been already treated of Physiologically
but we must now take a different view of the subject
and in the first place speak of the signs by which
it is known.-
Signs of Pregnancy, these are numerous, but 
any one of them alone is fallacious, therefore in forming 
an Opinion, several of these should be taken
into consideration, the usual symptoms which 
take place in pregnancy are Amenorrhea
sickness and vomiting, frightful Dreams, loss of 
appetite, emaciation, peevishness, enlarged Breasts,
dark and enlarged Areola, quickening, enlargememt
of the Abdomen &c. shall now consider each of these
Symptoms seperatly.-
Amenorrhea, this is frequently a symptom
of Disease as well as pregnancy, as it may arise
from accident, such as taking cold at the time
or just before, the menstrual period, but this should 
be taken into consideration. At a certain time
of Life there is always a cessation of this discharge and 



112
which takes place at an earlier period in some 
Women than others, in general those who begin to 
menstruate at an early Period, have a cessation at
an early Period likwise; in a general way this takes
place at about the 45th Year.- Women never have the
natural menstrual Discharge during Pregnancy,
tho' there will in some Women be a discharge of Blood
at times, and which may be in some cases at regular
Periods, when this is the case it is accidental
and is frequently owing to portions of the placenta
being detached, probably in consequence of its being 
situated over the Mouth of the Womb.-
Sickness and Vomiting is likwise a very 
doubtfull sign, as this frequently arises from many
other causes, from the readiness with which the Stomach
Sympathizes with other parts, that which occurs
during Pregnancy is more particularly in the 
morning
Frightful Dreams this is amongst the 
most doubtful of the signs but in some particular
patients, is rather a certain symptom.-
Loss of Appetite this is a sign upon which 
no dependance can be placed if alone, as it arises from 
so many different causes.-

4th Month
Stethoscope= Inf Pulsation- Placental
Breast Softens

113
Emaciation and Peevishness, these are likwise
subject to very great uncertainty and deserve very
little Notice in general.-
Enlargment of the Breasts, this when attended
with the secretion of milk, is a probable Symptom;
but various instances have occurred, which prove
its fallibility
Areola, when this is enlarged and of a Dark
colour, is thought by some to be the best single Sign
but requires experience, to form a judgement from
this correctly.- The seat of this is in the Rota Mucosa 
surrounding the Nipple, and in the unimpregnated
state, resembles in colour, new plained Mahogany,
but becomes of a Darker colour in the impregnated
state.- In the unimpregnated state, it 
is in general about 1 1/2 In across, but in the impregnated
state becomes considerably larger.- After delivery
the Areola will in general regain its natural colour
and size in the course of some little time, except impregnation
takes place again very soon, in which case
it will become still larger and Darker.
Quickening, this is likwise a very fallacious 
sign, and both Patient and Practitioner may be
Deceived, pressing on each side of the Abdomen with the 



114
hands, may occasion uneasiness to the child, and that
way its movements be felt
Enlargement of the Abdomen, this is likwise
fallacious as it may be owing to various morbid causes
as well as from pregnancy, this it may assist in 
forming the opinion if combined with some other 
of the usual Symptoms, where this is connected with 
suppression of the Menses, and begins 3 or 4 Months
after the time of supposed impregnation, begining at
the lower part of the Abdomen, and gradually extending
upwards, more particularly if this has been
preceded by a degree of flatness of the Abdomen the 
first month or two, in this case, it becomes rather a 
strong Symptom, tho' there is no one on which so 
much dependance can be placed as upon the Attention
of the Areola.
Besides these there are several other Anomalous 
Symptoms somtimes attend pregnancy, but 
which appear to have very little apparent connexion
with it.-
Enlargement of the Abdomen may be combined
with Dropsy or with a Diseased state of One of the 
Ovaria. When the swelling is entirely owing to either
of these it may be distinguished by the undulation in 
one, and by the enlargment begining on one side in the other. 



115
Reckoning.
This is commonly divided into long and short reckong
the short is callendar Months, and the other Lunar Months,
the duration of Pregnancy is in general about 40 weeks
and which makes about 9 Callender, and exactly 10 Lunar
Months.- There are different times from which this 
reckoning is dated, either from suppression of the Menses,
Quickening, and coitus.-
That from which you can form an Opinion
of the Stage of pregnancy, with the greatest accuracy
is from the suppression of the Menses, but this in many
instances, cant be done on account of the Woman not 
having been regular in this respect, or not having 
the Discharge at all, as for instance in the case of a 
Wet Nurse, who will frequently have no menstrual Discharge
and yet become pregnant.- To form a judgment
with any degree of accuracy from this it is necessary
she should have been regular in the discharge.-
Different Opinions have been formed respecting
the period, at which impregnation takes place previous
to the stoppage of the menses, but in a general way
it may be said to be the second Week, or in some instances
may be the third, but no precise time can be 
mentioned




116
Some Women reckon from the time of quickening
that is the first time they have perceived the child
to move, and this has been said by some to be at the 
third, and by others the fifth month, but from observation
which was made upon 100 cases, 80 of them were
found to be at the fourth month, and this therefore appears
to be the Average time, being found to occur 8 
out of 10 times.-
Reckoning from the time of Coitus can only
be depended upon, under particular circumstances.
Management during Pregnancy.
Pregnant Women are liable to be in commoded
by causes, which to others, in a different state would
be harmless, hence attention to the Rules of living
are expedient, these Rules are comprehended in the 
non-naturals, namely Diet, Air, Rest, Exercise, Pathemata,
and Evacuations.-
With respect to diet, this must be regulated 
according to circumstances, but in general 
that which is found to agree best with the Stomach
is the best.- It is very seldom necessary
to recommend a change of Air, except under 



16
117
very particular circumstances, and with respect
to rest that.- Exercise in moderation is often
very serviceable, except under particular circumstances,
as in case of slight floodings, Pains &c.
or in case there has been repeated miscarriges
at some certain Period, under which circumstances
rest must be enjoined, with respect to proper
exercise, that must depend very much upon former
habits, tho' none very violent should be alowed
such as riding on horseback, dancing &c.-
It is frequently of consequence to attend to the 
Dress, as the mode of tight lacing formerly practiced,
must be very injurious, preventing the Uterus
from enlarging in the proper place, and causing
the mouth of the Uterus to be dilated prematurely.
The make of the Shoes should be attended 
to as the high heeled must be very injurious
attending the center of Gravity, and throwing the 
Womb forwards upon the forepart of the Pelvis
in making an alteration in this respect, it should
be done gradually, for if they have been worn for 
any length of time, the muscles will be attend in
their length, and on this account it should be gradual.-
The Passions of the mind have very 



118
great influence upon the Body and therefore
all violent emotion should to avoided as much 
as possible, and care should be taken against any 
thing causing alarm.-
Evacuations are of different kinds, on Practioners
have been of different Opinions respecting 
some of these, it is frequently necessary to act gently
upon the Bowels during pregnancy, as costiveness
is very common, this is best done by any gentle
Purgative in a Pillular form, or may be given
in any form most agreeable to the Patient.-
With respect to the exhibition of Emetics, there
is a general prejudice against them, but which
appears to be without much foundation, as Women
frequently Vomit spontaneously, even with considerable
straining and with impunity, from this 
it appears, that in cases when their use is required,
they may be safely given provided they are
not of too violent a Nature, tho' in account of the 
Prejudice, it will be best to be guarded in their use
and to avoid giving them when the Purpose can 
be answered by any other means, and when absolutly 
necessary, may in some instances be right to give 



119
them without in forming the patients that they 
are Emetics.
Bleeding during pregnancy has been very
much recommended by some, and as much condemned 
by others, it is certainly serviceable in some 
cases, as in case of Plethora, local or general inflamation,
or in case of a rigidity of fibre, it may
be a means of rendering the subsequent Labour
more easy. But you will in many instances
be under the necessity of doing it, on account of Prejudice,
and it may be right to do it from this except
there is some particular circumstance to forbid
its use, as in case of debility, or a disposition to 
a Dropsical state.-
Pathology of Pregnancy.
Diseases occurring at this time, are either arising
out of the Pregnant condition, or accidentally connected
with it, and are distinguished into those 
which occur in the early or latter stages.-
Particular attention should be paid to the mitigation
of their immediate causes, as this will
assist very much in forming a prognosis, and 
in the mode of treatment.-
Most these Diseases may be refered to one 



120
of the following general causes, namly, Plethora,
irritability of constitution, and Mechanical Pressure
this is to be understood to apply to Diseases arising
from the Pregnant State.-
When the Diseases arose from a Plethoric state
that state is known by the usual Symptoms of 
Plethora, and may be relieved by Blood letting, Purging
&c. or by attention to Diet, or Perhaps by both.-
When they arise from irritability of constitution,
the treatment must be varied according to circumstances,
so likwise must it, when in consequence
of Mechanical pressure
Particular Diseases of Pregnancy.
in the early Months.-
Nausea and Vomiting, these may arise from disease
as well as pregnancy, and it should therefore be
distinguished from which of these causes it may arises.
When they arise from a Disordered state of the Prima
Viæ, removing this by means of Aperients &c. will
be the means of cure, in this case you will be unwilling
to give an Emetic on account of the Prejudice
there is against it, but if you cant effectually remove
the complaint without, you may give it with
safety.- When there is much relaxation of the Stomach 



121
a good Emetic in this case will be Zinc. Vitriol. in
the Dose of from zss to zi, this in some measure bracing
the Stomach.-
When these are Sympathetic of Plethora, attending
this by bleeding, Purging &c. is indicated.-
When sickness is a Symptom of internal inflamation,
it may be distinguished by the usual Symptoms
denoting that state, and must be treated in a Secondary
way, regard being chiefly had to the primary complaint
by Bloodletting, purging &c. and by a strict Antiphlogistic
Plan, exactly the same as when unconnected
with Pregnancy.-
When symptomatic of mere Uterine irritation,
or Pregnancy, it will in different instances give 
way to different remedies, as Opiates, Saline Medicines
in the state of effervescence, Stomachic bitters &c. in 
this case, the quantity or bulk of the Medicine is often
very necessary to be attended to, as it will often be rejected
from from the Stomach on account of its quantity
then in giving Opium, a grain of solid Opium will
frequently be of service, when given in the form of a 
Draught it will be rejected.- In giving Saline
Draughts great attention is necessary, in respect
to quantity, and in being properly regulated in respect
to the proper quantity of each, a powder composed of 



122
Common Tart. and Sal. Soda, in proportion of two 
parts of the former, and one part of the Latter, this 
mixed in a small quantity of Water at the time of 
exhibition.- It is often necessary to give the food
in very small quantities, and which should be of the 
most nutritious kind.- In some cases it is necessary
to keep the Stomach perfectly empty for twelve
or twenty four hours, and occasionly giving a little 
solid Opium.- Nourishing Glysters may be 
thrown up the Rectum, and a little of their parts may 
be absorbed, and conveyed into the circulation. 
Warm Plastiers, or Rubifacients to the Scrobiculo
Cordis may afford relief, but in some instances
there will be a complete cessation at the time of 
quickening.- Somtimes it is owing to some particular
smell or effluvia, which was inoffensive 
at another time, in this case the cure is obvious
Pain in the Head and Breast, there are often
Symptoms of Plethora, and relieved by Bloodletting &c.
tho' in some instances, may arise from Sympathy,
in which case the treatment will vary according
to circumstances
Inability to Walk, attended with a sense of 
bearing down, a yellowish Discharge, and painfull 



123
Discharge of Urine, somtimes amounting to 
suppression.- This disease is to be distinguished
from gonorrhea, and may be done by attending to 
the Symptoms, in Gonorrhea, there is pain in making
water, but of a different kind than in this Disease, and the 
the discharge is different, the difficulty in making 
water is relieved by varying the posture, or by pressing
the neck of the Uterus up with the Finger, in some 
cases it may be necessary to introduce the Catheter
The cure of this disease is generally spontaneous,
as the Womb becomes enlarged, taking of 
the Pressure upon these parts, the Disease arising
from pressure
Retroversion of the Uterus, this consists
in the fundus of the Womb being thrown backwards
and which by its situation between the Bladder
and Rectum causes different affections of these 
Parts.- This disease can only be ascertained
by actual examination, for if the Uterus is retroverted,
the fundus is thrown back upon the Rectum
and the mouth of the is thrown forwards towards
the Pubis, and on examination if there is retroversion,
you will find the Os. Uteri in that situation
instead of its natural place, for whenever this is in 
the natural situation, there can be no retroversion.



124
Retroversion of the womb is not confined to the 
impregnated state, as the Womb may be enlarged
from Disease and become in consequence retroverted,
and it may be retroverted in the natural
state, but not be known 'till the Uterus becomes enlarged
either from Pregnancy or other causes, bring on the usual
Symptoms.-
The Symptoms of this Disease usually come on 
about the third month of Pregnancy, as at this time
the Uterus becomes of the size so as to cause these Symptoms,
they consist of Pain, Difficulty of voiding Urine,
constipation of the Bowels, Tenesmus &c.-
The Period of the Symptoms coming on may be 
a little varied, tho' they are always confined to the 
early months, as it cant take place after the Womb
is of a certain size.-
The most common cause of Retroversion of
the Uterus, is a Distended state of the Bladder, and this 
acts by pressing upon the fundus of the Womb so
as to force it downwards and backwards, and at 
the same time by its arising higher up in the Pelvis
it draws up the mouth of the Uterus in consequence
of the connection of these parts, in this way it acts 
in two ways, that is at the time it is forcing the 
fundus down, it is pulling the mouth of the Uterus
up.- Other causes have been mentioned, as a  



17
125
Blow upon the lower part of the Abdomen, but the
Bladder must be in a distended state.- An enlarged
state of the Ovaria, either from a collection of water
within them, or from other causes, may occasion this 
Disease.- Distention of the Bladder may in
some cases be an effect as well as a cause of this 
Disease.- From these circumstances it appears
evident how particularly carefull Women in the 
early stage of Pregnancy, should be to avoid a distended
state of the Bladder.- When the Bladder becomes
very much distended in this complaint there 
is great danger of its being ruptured, and on this 
account it should be frequently emptied by the 
use of the Catheter or by other means, and when this 
cant be done, it will be necessary to puncture the 
Bladder by means of a small Trocar, above the 
Pubis. In some instances when a common female 
Catheter cant be introduced, one of a smaller
size or a different form may, as that which is for a 
Boy.- The Danger in Retroversion is according 
to the state of the Bladder, and Degree of irritation.
The treatment in this case, consists in obviating
the distentention of the Bladder by the introduction
of the Catheter 3 or 4 times a Day, and this in 
some cases is sufficient alone, tho' not always
the length of time this should be tried depends upon



126
the Degree of irritability &c.- Before you attempt
the reduction of the Uterus, the Bladder and Rectum
should be emptied, and the patient should then be 
placed on the Knees and Elbows, and then introduce
a finger or two up the Rectum, and press
the fundus of the Womb upwards, at the same time
with the finger of the other hand up the Vagina
endeavour to bring the mouth of the Womb down,
in case the fingers are too short it may necessary
to have recourse to an instrument, which 
may be made by a piece of cured Cane or Whale bone
which should not be too weak, and at the end a 
Piece of sponge covered over with soft Leather, this 
should not be too small, and should be well secured
upon the end of the Stick, in using this the finger should
be passed up the Rectum along with it, and the force
with which which it is and should be regulated with 
some degree of ninty. The end may in some instances
slip up the Rectum by the projection of the fundus
but this will in a great measure depend upon 
the mode of using the instrument.- The more 
difficulty there is in the reduction the greater
softly there is against a natural.-
It was proposed by Dr Hunter to puncture Her
Uterus, but this must be attended with very great 



127
Danger and has no facts to support it.-
Mr. Cruikshanks thought the Division of the 
Symphisis Pubis might be of some advantage,
this certainly diserves some attention, but has not any
facts to support it, in this case the Patient would not 
be placed on the Knees and Elbows, in attempting the 
Reduction.-
Diseases of the latter Months.
Sickness and Vomiting, may occur now as well 
as in the early stages of Pregnancy, or may continue
from the early stage.- They may arise from Plethora
or from a foul state of the Stomach from irritability
or pressure of the womb upon the Stomach.
If from Plethora, the loss of Blood or gentle Laxative
Medicines &c. may be of Service, and when 
the Stomach being in a disoredend state, an Emetic
will be serviceable, if nothing particular contraindicates,
and afterwards proper Stomachic Medicines.
When irritability or pressure is the cause, these
exhibition of Opium Saline Medicines in the State
of efferverscence &c. must be resorted to, and food
must be given in very small quantities, and frequently
repeated, and should be of the most Nutritive
quality.- In case all these remedies fail in producing



128
producing any mitigation of the Symptoms, and the 
patient appears to be sinking under the complaint,
and not likly to support it 'till delivery takes place
naturally, it may be right under such circumstances
to bring on Labour prematurely, by puncturing
the Bag of Waters so as to alow of their Discharge
and Labour will then come on the course of some 
time, perhaps may be a Day or even two
Jaundice, when this is merely a consequence
of Pregnancy, there is little Danger and the treatment
may be confined to the Palliative, where 
there is much pain in the Epigastrium, the use
of Opium Aperients &c. may be necessary.- The way
Pregnancy causes Jaundice is by pressure, which 
tho' not directly yet may be indirectly upon the 
Billiary Duct.-
Jaundice during pregnancy may somtimes
depend on a Schirrous state of the Liver, or Diseases
of the Billiary Ducts; such cases are more complicated,
and the mode of treatment must depend upon
the Particular part effected.-
Costiveness may depend either on torpor of 
the Intestines or upon Mechanical pressure, and 
may become very inconvenient, and therefore should 



129
be obviated by means of Purgative Medicines, and 
by the use of Glysters. In some cases the Feces become
very much indurated, rendering it necessary
to break them down by means of a large Bougie, and 
them to inject a Glyster for the Purpose of bringing
them away.-
Hemorrhoids are in two states namly
Bleeding and Blind Piles, and a third Kind particularly
noticed by the German Practitioners,
which is called Hemorrhoidal Cholic, the Symptoms
of this complaint are Cholicky pains in the Intestines
and which may be traced along the Colon, Caecum
and Rectum, and which are relieved by a Discharge
of Blood, these pains are not cured by the common
thing in the use for pains in these parts.
As Mechanical Pressure is intimatly connected
with the Production of Piles, they will often continue
'till delivery takes place, but it will be advisable
to Palliate the Symptoms, by means of Leeches applied
to the parts, or by Saturnine ointments or washes,
a good ointment for this Purpose is one composed
of Simple ointment, with a portion of fine powdered
Galls and Opium. Patients are frequently alarmed
for fear the Piles should produce Fistula in End
but this is seldom or never the case.
There are some other complaints remain to be 



130
mentioned, but which are not of very great consequence,
as the swelling of the lower extremeties, this 
may be relieved by means of a Laced Stocking.-
Some Women have considerable uneasiness
from the violent movements of the child, in this 
case you may moderate the Symptoms by means
of Opium.-
There will in some instances Black Spots
appear upon different parts of the Abdomen, and 
which may alarm the Patient, but are of no consequence,
and will disappear after delivery, they are 
probably owing to the rupture of some of the small 
vessels, in consequence of the Distention.-
Diseases accidentally connected with Pregnancy.
Lues Venera, when this Disease is in the 
form of Gonorrhea, the treatment is so gentle
as not to require particularly to be mentioned in 
this place, but when in the form of Chancre, it then
becomes a matter of much more consequence, for 
tho' they are only primary sores, yet from their slowing
absorption of Matter, constitutional Symptoms
may be produced, as Ulcerated throat, Eruptions &c.



131
Chancres are often cured without Mercury by 
the parts being destroyed with a Caustic, but the constitutional
or secondary Symptom require the 
use of a considerable quantity.-
When Salivation is produced during Pregnancy,
some have apprehended dangerous effects, but this 
is not necessarily the case, as the only thing of consequence
is its disposing to premature Labour.
Different opinions have been formed respecting
the mode of conduct proper under these circumstances
some have given Mercury in the alterative way so
as to produce a temporary cure of Symptoms, and 
this way gaining time 'till delivery has been effected,
but this must depend upon the Stage of Pregnancy
and upon the urgency of Symptoms, for if the Symptoms
are such as wont admit of Delay, you must
then proceed to the Cure, conducting the course with 
more caution, tho' with even so much, Abortion
will frequently take place.-
Dropsy, by this is meant Ascites, not Ovarian 
Dropsy, this Disease when connected with Pregnancy
comprehends some subjects for enquiry, namely,
whether Delivery is possible, whether the Patient will
live after Delivery, wether the Child will be Dropsical
whether tapping in proper, and whether a Cure will 



132 
succeed. With respect to the first of these, that is, the 
possibility of Delivery, experience proves this to be the case,
and without any extra Difficulty, for tho' the expelling
Powers are less, yet those of resistance are proportionally
diminished, but with regard to the second subject,
that of her living after Delivery, this is extremely doubtfull
on many accounts, one of which is the degree of 
Debility then present, and which will be very much
increased by the discharge which necessarily attends delivery,
and which is somtimes greater than others.
The third question is the child being necessarily
affected with the same Disease as the Mother, this [cross out]
is not the case, but it is impossible to say whether
the child will be Dropsical, for it may or may not 
be the case, as children are frequently born Dropsical
of sound and healthy Parents and the reverse, but a 
Dropsical state of the Mother entails no such state
in the Child.-
The Fourth circumstance; is the propriety of 
tapping under these circumstance, this is always
proper, whenever, the Disease is in that state to require
it, but should be done with caution on account
of the Danger of the Trocar being forced into the Uterus,
but this danger is entirely done away, by inabling



18
133
an incision with a Lancett, carefully thro' the integuments
in the course of the Linea Alba, the hole
into the Cavity of the Abdomen being about the size 
of the Canula of a Trocar, a Probe should be introduced,
into this opening, and upon this Probe or 
Canula slided into the opening.-
The last of these questions, is whether a Cure
will succeed Delivery, this has in many instances
taken place, and the way this is generally affected
is by the fluid escaping thro' the Fallopian Tubes
into the Uterus, and in this way been evacuated, the 
extremeties of these tubes are loose and floating in 
the abdomen, and tho' in the natural state it may
not be possible for any fluid to escape by this way
yet a certain action may take place in them
which may be the means of evacuating the fluid.
Hernia, are frequently very much effected 
by Pregnancy, and the purpose of considering this subject
more effectually, it will be necessary to divide
them into two states namely, Reducible and Irreducible.-
When the Hernia are Reducible, the Phenomena
are subject to variations, depending on the seat of 
the Rupture, as being either Femoral, Inguinal, Ventral, 



134
or Umbilical.- Reducible Hernia are generally
cured, that is temporally, by Pregnancy, except in particular
situations, as at the Umbilicus &c. which it
somtimes increases, and in some Women Pregnancy
always produces Hernia, when they are not subject to
it at other times.- It is very seldom proper to use 
a Truss for the Ruptures during Pregnancy on account
of the Pressure necessary to keep the parts reduced.-
Irreducible Hernia are dangerous in the extreme
as the ascent of the Uterus, may bring on Strangulation.
Whenever amongst other Symptoms, a patient informs
you of having a Hernia, and which she has 
not been able to reduce for some time, you should lay 
particular stress on the necessity of keeping the Bowels
compleatly open, and this should be done even if the 
Hernia is reducible.-
Women out of Delicacy will frequently avoid mentioning 
their being subject to Hernia, therefore in all
cases of violent pain in the Bowels, more particularly
if confined to any particular part, and this 
does not give way to the common modes treatment in
a moderate space of time, you should make particular 
enquiry and examination, to ascertain whether
there is any thing of this kind.
When Pregnancy is somewhat advanced, perhaps  



135
about the fifth month and Symptoms of Strangulation
come on, the treatment then becomes very complicated
and the event uncertain. It has been proposed, (when
the common methods of proceeding have failed) to bring 
on premature delivery, and by this to take off the exciting 
cause, but the mouth of the Womb is in general so rigidly
closed, that this could not be done without using a greater
Degree of violence than would be consistent with 
safety.- When the parts are in a relaxed state, and 
easily dilatable, this is a favorable circumstance and 
you may then proceed to dilate the parts in a slow 
and gradual manner and this way bring on Labour,
taking care not to use any violence.-
When the os. Uteri is in a rigid state, introducing an 
instrument and puncturing the membranes to evacuate the Waters, has been proposed,
for the purpose of bringing on Labour as this will follow
sooner or later, but this must depend upon the state of 
the Hernia, for if in the advanced stage there wont be 
sufficient time to wait for this, nor even to wait for 
bringing on Labour in the other way [cross out] when the parts
are dilatable, if it is in a still more advanced stage.-
When this is the case the operation becomes absolutely
necessary, but which is attended with considerable
difficulty, an account of the adhesions, and other circumstances.-
The operation should be performed in 
the usual way, and when the hernial Sac is laid bare
this should either be divided or not according to circumstances,



136
circumstances if it does not adhere, and you have reason to 
suppose the Contents are in a state proper to be returned
you may then do so without opening it, but if there is 
considerable adhesion, or you have any doubts about 
the state of the contents you should then lay open the 
Sac, for the purpose of examining them
Stone, when speaking of Stone as connected with 
Pregnancy, not only Urinary, but likewise Biliary
Calculi are comprehended.-
Gall Stones when in the Biliary passages, produce
Symptoms which should be distinguished from Labour
Pains, the Pain arising from the presence of a Gall
Stone in the Biliary Ducts, is about the Scrobicula Cordis,
is attended with considerable sickness and vomiting, and 
now not slow of that compeat intermission, which takes 
place in Labour pains, then will likwise after some 
little time be an affection of the Urine and Skin, and 
in the course of some length of time the pain will cease
from the Passage of the Stone into the intestines, a quantity
of Bile will be evacuated by stool, and the whole
of the Symptoms will disappear, at least 'till another
of these calculi obstruct the Passage.-
For the Purpose of moderating the Symptoms, Opium
should occasionally be given, and gentle aperients, and 
Bladders of warm warm Water should be applied to the 



137
part, or fomentations &c.- It would be very advantageous
to prevent a fit of the Gall Stone, at this time
and which may be attempted by ordering a greater
Degree of Exercise, and at the same time giving Aloctics
combined with Saponaceous Medicines, or by the exhibition
of Lixis Sapon. in the Dose of 30 or 40 Drops, three
times a Day and which may be gradually increased to 
a teaspooonfull, it should be given largely diluted, a convenient
vehicle, is a quantity of Mutton Broth, as this very
much sheaths the acrimony of the medicine, but the effects
of these remedies are very doubtfull.-
Urinary Calculi may either be seated in the 
Kidney, Ureters or Bladder, which may be distinguished
by attending to the Different Symptoms, when the Stone
is in the Kidney, the will be considerable pain in that
part of the back opposite the Kidneys, and which pain
will extend down the Thigh along the course of the Nerves
and as the Stone passes along the Ureter, the seat of the 
pain in the Back will be changed, and often a time all 
the Symptoms will cease from the Passage of the Stone
into the Bladder, when other Symptoms will come on,
the Urine will likwise be tinged with Blood at times.
By attention to these circumstances, and by the continuation
of pain, this may be easily Distinguished from
Labour pains.- The treatment will be different according



138
according to circumstance, as whether there is inflamation 
and fever or not, it will be right under all circumstances
to keep the Bowels sufficiently open, a good medicine
for the purpose is Castor oil, this may be made 
into a Mixture by the addition of a little Kali &c. and
along with this, opium should be given joined with Ipecacuhana, 
or Antimonials, and Bleeding if necessary should be 
had recourse to.-
When calculi a situated in the Bladder being formed
there or have passed from the Kidneys, different Symptoms
take place, as sudden suppression of Urine, discharge of 
a quantity Mucus &c. in the Urine, and occasional pain,
but as these Symptoms may arise from some other 
affection of the Bladder it may be right to try the use of 
some remedy in the first place, as by giving Uva Ursi
in the quantity of from 3ss to 3i two or three times a Day,
for some time [time].- If the Symptoms dont 
give way to these [illegible] of treatment, you should
then make examination, and in case you ascertain
the existance of a Stone different opinions have been
entertained respecting the propriety of performing the 
operation for its removal, but if this cant be effected
by any other in cases it may be done.- You may
somtimes ascertain the size of the stone by passing your
finger up the Vagina, and getting the Stone upon it, if
it is small it may possibly be got away without an 



139
incision being made, by dilating the Urethra, by a 
series of Bougies, or by the introduction of an intestine 
(with the end tyed up) into the Urethra, upon a long probe
or Bougie, and then forcing a quantity of Warm Water
into the Intestine to dilate it, and likwise the Urethra
this last method has been found successfull.-
If the Parts cant be sufficiently dilated in this 
way, recourse must be had to a cutting instrument,
but in using this it must be remembered, that there 
is some danger of wounding the Crura Clitoris, this 
renders the operation less perfect, this does not add to 
the danger of it.- The incision should be made in 
an oblique direction, the edge of the Gorgett being 
inclined obliquly downwards, and in this way the 
danger of wounding the Crura is lessened.-
If the existence of a Stone in the Bladder is 
not known till labour comes on, a good deal of management 
is necessary to prevent mischievous
consequeces, and for this purpose different ways 
of proceeding have been recommended, Dr. Smellie
advised the raising up of the Stone, and this is a very
eligable mode of practice of it can be done, if on
examination in the early stage of Labour the Stone
is found below the head of the Child, if this has not 
descended much, the Stone may be raised above the 
Brim of the Pelvis, and this way prevent serious consequences,



140
consequences, for this purpose a Male Catheter or a Sound 
may be introduced into the Urethra, and two finger
(one on each side the Instrument,) up the Vagina, and 
in this way acting upon the Stone, and raising up, and 
when you have done this you should keep it raised
for some time, 'till pains come on, and force the 
head of the Child lower down, and preventing the descent
of the Stone.- To effect this some time may possibly 
be required, and the woman should be placed in the 
most favorable situation.-
Some have recommended the introduction of a pair
of Forceps up the Urethra, and extracting the Stone by 
that means, but there a great objections to this mode
if much force is used, on account of the injury which 
must be done to the Parts.-
Another mode of proceeding has been recommended,
and which is much more eligable, that is, the making 
an incision from the Vagina, into [cross out] lower part
of the Bladder, opposite its superior Curve, as the Stone
generally lays there.- The way of doing this, is by carrying 
a finger up the Vagina opposite to that part, and 
introducing a curved Bistory upon it, and in this way
making an opening into the Bladder.- The Bistory
should be covered by means of somthing passed round
it, except towards the end.-
It has been advised in a case of this sort to open 



19
141
the childs head when the other methods fail, this 
may somtimes be necessary, but there is one thing 
to be taken into consideration, which is the Death
of the Child.
Examination.
By this is meant manual examination, and 
which should always be conducted with the greatest
Delicacy and gentleness, so as to give as little pain
as possible.- The reasons for examining are comprehended
under five particular views, namely.
1st. To ascertain the existence of Pregnancy. 2d. To
determine its period. 3d. To know if Labour is present.
4th. To know the precise kind of Labour, 5th.
To investigate the true nature of a Disease.
Some Dexterity is required in making examination,
and in case you find it necessary to examine
by the Rectum likwise, it is much better to mention
it, to prevent then forming a bad opinion of your
judgment, supposing you make a mistake.- When
ever you find it necessary to examine, it will be 
adviserable to have another female in the Room
more particularly if the Person is a Stranger.-
Shall now proceed the different views separatly.



142
1st. To know if a Woman is Pregnant. There is very
little to be gained from examination on this account
before the third month, on account of the enlargement
not being sufficient to alow of a determination being
formed, and this may be still increased if there is 
a Degree of corpulency, or from a distended state of 
the Bladder, but this last circumstance may be removed.-
From these circumstances it is always
much better to decline examining, except particularly 
requested, and then it is best to mention the 
uncertainty.- The best position for the Purpose of 
making examination is half sitting and half lying as
this places the Pelvis on a horizontal situation, and 
before you attempt to examine the Bladder should
be emptied.- The way to examine is to pass two 
or three fingers of one hand up the Vagina, to feel for 
the neck of the Womb &c. and with the other press
upon the Abdomen, doing this alternatly, and you 
may somtimes be able to ascertain the size and 
state of the Womb, the larger the Uterus is, the more easily
will Pregnancy be ascertained.
2d. To ascertain the Period of Pregnancy.- This is 
done either by observing the degree of the Wombs ascent
in the Abdomen; or by the shortening of its Neck.-
Shall first mention the circumstance of the Wombs



143
ascent at the third month the fundus of the Womb is 
just above the Brim of the Pelvis, at the 5th,, Month, half
way between this and the Umbilicus. 6th,, Month, a little
higher, 7th,, Month, even with or a little above the Umbilicus,
8th,, Month, halfway between the Umbilicus and Scrobiculs 
Cordis 9th,, Month, at the Scrobiculs Cordis.-
With respect to the shortening of the neck of the 
Womb, that remains of its full length 'till the end of the 5th,, Month
namely 1 1/2 In. after which time it begins to shorten,
at the 5th,, Month 1 1/2 In. 6th,, Month a little shorter 7th,,
Month 1/2 In. 8th,, Month, somthing less 9th,, Month, entirely
gone, the way to form this measurement is 
by passing the finger up the Vagina and pressing against
the Body of the womb, and forming your measurement
by the finger.- But in forming a judgement
it is best to compare both these methods, along
with other circumstances
3d,, To determine the existence of Labour.
Before this can be done it is necessary that Labour.-
should be defined.- Labour consists in the evacuation
of the fetus and Involucra, from the Uterus,
and is divided into natural, laborious, and preternatural
Labour.- Natural Labour, is when the 
head of the Child presents, and the Labour is terminated
without instrumental assistance.-



144
[illegible]. see after
Laborious Labour, is when the Head likwise
presents, but from circumstances, as a greater degree
of resistance from any cause, the aid of Instruments
is necessary.-
Preternatural Labour, consists in the Presentation
of any other part but the head, as the Arm,
Breech &c.-
The Symptoms of Labour, are pain, dilatation
of the Os. Uteri protrusion of the Membranes & Water,
tension or relaxation of the membranes, during the 
Presence or absence of Pain, and you may form some
opinion of the Stage of Labour, and of the kind, and length,
of time it is likely to be before its termination, from
there, and from the advancement and recession of 
the child during the presence or absence of Pain.-
Pain alone is not to be depended upon as a Symptom
of the existence of Labour, as this may arise from 
many other causes, as Cholic &c. nor even if with combined
with some dilatation of the Os Uteri, as this may 
be in a relaxed state, from some cause, but if along
with these you can feel the protrusion in some measure
of the Bag of Waters, it then becomes a certain sign.
4th,, To know the kind of Labour, this should always
be ascertained as soon as the Progress of the Labour
will permit, more particularly if the Waters have been
evacuated, as if there is a necessity for turning or any 



145
thing else to be done, this is the most favorable opportunity
for doing this.- I making examination to
ascertain the kind of Labour, the three different kinds
must be kept in View.-
Natural Labour, supposes proper Presentation
of the Head, sufficient Room in the Pelvis, and 
sufficient Pains.-
Laborious Labour supposes either want of Room
or want of Pains.-
Preternatural, when any other part except the 
Head presents.-
When the head of the child presents the Labour
may still not be Natural, and the aid of instruments
will become necessary, but you should wait some time
to see what nature will do (if there is nothing contraindicates)
for you cant always determine whether there
is want of Room or not, tho' this may be done after
some time, for tho' the Pelvis may be sufficiently large
and the head not larger than common, yet if the Bones
of the head are more ossified than usual, this may
prevent its passing, and the Reverse of this may be 
the case.- With respect to the sufficiency of pain
you cant form a correct judgement from the quantity
of Vociferation, but from the effect it has on the 
muscular actions of the Different parts, in general the 
most is done, when the patient holds in her Breath
and bears down, as the breath the Lungs contain, assists 



146
the action of the Muscles in forcing down.-
5th,, To distinguish the Disease in Question, various
Diseases require examination which have been before
mentioned, such, Cancer Uteri, Polypus, Retroversio Uteri &c.
Natural Labour.
Natural Labour is divided into quick or lingering
Labour according to the time necessary for its
completion, as in some cases the Labour is over in 
the course of two or three hours, in other cases much
longer, as for instance 2 or 3 Days or more, when ever the 
duration of Labour is protracted more than 12 hours
it then becomes lingering. There is another Distinction,
made by Women, that is into Sick, Wet or Dry
Labour, according as Sickness occurs, or the parts are 
in a moist or Dry state from the quantity of Mucus
secreted.-
Labour is likwise divided into three Different stages,
the first stage is the dilating process, and every thing
that takes place 'till rupturing of the Membranes.
The 2d,, stage is from the evacuation of the Waters 'till
the Birth of the Child is compleated.-
The 3d,, Stage includes every thing which occurs after
this as the expulsion of the Placenta &c.
[illegible] bound



147
Preparatory Considerations.
A young Practitioner should adopt the Customs
of the Country in which he resides, the position in
which a Woman is delivered varies, in some places
she sits on the lap of another Woman, in other a 
stool or Chair of a particular form is used, but 
these modes are very objectionable, for this throws
the Pelvis on a horizontal position, and if the parts
are in a relaxed state, and the Pelvis large, the Child
may be expelled so suddenly as to produce considerable
injury by either breaking the Umbilicus, suddenly
detaching the Placenta, bringing on hemorrhages
or by inverting the Womb, which will be very easily
done when in this state.- Her Position in general
use in this Country is the left side, and is by far the
best, the Patient may be either above or under the Bed
cloaths, tho' in general under them is preferable.-
Guarding the Bed is another circumstance
necessary to be known, this is by means of a Skin of 
Leather or any thing that wont alow the wet to penetrate 
to the Bed, and over this a Blanket &c.-
All postures are not the same tho' the Patient is
on the left side, for the purpose of rendering the Posture
the most convenient, the Patient should lay on the left



148
side, with the Knees bended, and brought towards
the Abdomen, and with the breech to the side or bottom
of the Bed, facing the Practitioner.-
It is adviseable more particularly if you any
Distance, to take somthing for the Purpose of making
a Purging Glyster, and a little R a Opii, for in many
instances, when the Pains are weak, and instead of forwarding
the Labour, only teaze and weaken the Patient
25 or 30 Drops of Tinct. Opii will be of great use, by
putting of the Pains entirely for some time alowing
the Patient to get some sleep and by that means being
refreshed, the Pains will after a time return with 
more vigour, and compleat the Labour.-
With respect to the Propriety of taking Instruments,
that must depend upon circumstances, as 
the Distance &c. and upon the command the Practitioner 
has over himself, as whether his having them
with him will cause to use them unnecessarily,
these things taken into the account, it may under certain
restrictions be adviseable to take some simple
Instrument as the Lever.-
Incidents connected with the first stage of 
Labour.- Pain is one of the first signs, this originates
in the Back and Loins, in the begining the Pain is confined,
but becomes more diffused as Labour advances,



20
149
Sometimes the pain begins in the fore instead of the back part,
and if this recurs at intervals in the same way as the 
other, it may be equally a sign of Labour, but if this pain
is continued, or has only very slight intermissions it
probably is owing either to Cholic, or to inflamation
if there are at the same other symptoms joined with this 
as a degree of fever, quickness of Pulse &c.-
The Pain in the begining is very slight, and in 
the begining continues perhaps 1/4 or 1/6 a Minute, recuring
at intervals of 15 or 20 Minutes, but as the Labour advances
the Pain becomes more violent, and continues longer
recuring at shorter intervals, so as towards the last
to be nearly continued pain and exertion.-
The cause of this Pain is the contraction of the 
Womb upon the Fœtus, for the purpose of effecting its
expulsion.-
Show. This is another sign of Labour, this is 
a discharge of Mucus secreted by the Mucuos Fallicles
about the mouth of the Womb, and when this becomes
a sign of Labour is tinged with Blood, this discharge
will somtimes take place a Day or Perhaps more, before
the commencement of Labour.- The red tinge 
is probably owing to some small vessels being ruptured,
in consequence of the mouth of the Womb becoming
a little Dilated.- Somtimes Labour comes on without
any discharge of this sort taking place.-



150
The Use of this Discharge is for the purpose of lubricating
the parts and rendering the dilating process more 
easy, and facilitating the Passage of the Child.-
Women will frequently this Discharge of Mucus
(untinged with Blood) for a considerable time previous
to Delivery, and in very considerable quantities, and 
will frequently be very much alarmed on account
of the supposition that it will weaken them and be 
a cause of difficult Labour, but this is not found
to be the case, and the Labour in some instances
appear to have been easier on this account, from 
there being a greater Degree of Relaxation. It is seldom
necessary to do any thing on this account, except
they appear anxious for somthing to be done,
in this case you make a Tonic Mixture of some 
kind as Decoct. Cort. &c.-- In some cases they 
may suppose themselves injured, and will make 
inquiries respecting this, you must be very cautious
of giving an Opinion, and before you do have some 
other circumstances than discharge alone.-
Show is not a sign of actual Labour, only of 
its approach, Pain is the first Symptom of actual
Labour.-
Rigor.- Labour is frequently ushered in 
by a Rigor, and frequently as a Symptom of Strong
Pain is a favourable circumstance, but this is likewise



156
likewise a Symptom of Fever, or internal Inflamation, it then becomes
an unfavorable symptom.- It becomes
necessary to distinguish the cause which gives rise to 
this Rigor, and which may be done by attending to
circumstances.- That from Labour may be distinguished
from Rigor as a Symptom of Fever, or Inflamation,
in having not hot stage, going directly from 
this to a state of Perspiration, and in the being no whiteness
of the Tongue &c.-
Vomiting. This is frequently Symptomatic
of strong Pains, but somtimes of internal inflamation.-
Vomiting as a Symptom a Labour may be 
distinguished, from the same symptom as connected
with fever or inflamation, by the Absence of Fever, state
of the Tongue &c.- If a Symptom of Labour and it is 
very violent, and frequent, it may reduce the Strength
of the Patient very much, and therefore should be moderated,
by the exhibition of R [illegible] Opii. Aq. Menth. or by 
the use of Saline Draughts in the state of effervescence.
Micturition and Ischury. These may both
occur during Labour, and arise from the Pressure of 
the Womb upon different parts of the Bladder, on this account,
(if micturition) you should never stay long in the
Room at a time.- If there is suppression, it may sometimes
be necessary to draw off the Urine with the Catheter
tho' pressing up the Womb with the finger will frequently
be sufficient.- 



157
Tenesmus. This often occurs and more particularly
in the latter stage of Labour from the Pressure of
the Childs head upon the Rectum.- In some cases, when
there is considerable relaxation of Parts, and the Labour
is considerably advanced, it will not be safe to alow
the Patient to make use of the close Stool, as the Child
might by the action at that time be expelled, but if any
thing passes away as the Patient lays it must be removed
by means of Cloths, &c.-
Observations &c.
On certain proprieties of conduct concerning
Labours.-
Always go as soon as sent for, as this may
somtimes be necessary and will always give more 
satisfaction, and be carefull to avoid any conduct
that may occasion alarm, is this tends to check and 
somtimes to divert the Labour Pains.-
If the Labour be in the early stage, do not stay
in the Room too long at once.-
Never be anxious about making examination
if the Labour is not much advanced, for you cant determine
much by it in this stage, and the Nurse or Attendants
will either ask, or set a Chair by the side of 
the Bed, with some Pomatum &c. which be to the same 
Purpose. The proper time for examination is 
when Labour is somewhat advanced, and the parts 



158
are become Dilated or when the bag of Waters has been
broken if this has not been done before.-
It is not necessary to repeat the examination
very often, and in doing the Presentation, and Progress of 
the Labour should be kept in View.
The Patient need not constantly be confined to the 
left side or to the Bed during the whole of the Labour
but either occasionally walk or sit in a Chair, in the 
begining Labour, tho' this cant be alowed in the 
later stages.-
First Stage of Labour. This begins with pain
in the Loins, which in the begining is confined, and 
continues only for a short length of time, and recurring
at long intervals, but after some time this becomes
more diffused, continues longer, and recurs at 
shorter intervals, and along with this a bearing down
of the Uterus, the external Parts become relaxed, and 
the mouth of the Womb a little dilated, after a little time this becomes
more dilated, and the membranes protrude, or you may
feel the fetus, [in] making examination, which should always
be done during during Pain, as not only give less
Pain, but feel every thing much more distinctly.-
There is frequently more time required to gain
a Dilatation to the size of half a Crown that to effect
the remaining Dilatation.
The dilating process gradually goes on and the 



159
Bag of Waters becomes considerably more protruded
and if these after a time are not ruptured, it will
be necessary to do this by means of the Finger Nail,
or pressure with the finger upon the Bag, if there is much Water,
for if this was to go on and the Child was to be expelled 
with the membranes whole, it would be literaly
drowned in its own waters, the same as in any other
fluid, as the supplies from the Mother are cut off.-
The proper time for rupturing the Membranes
is when the Mouth of the Womb is considerably dilated,
so as to alow the head of the Child to act as a 
Wedge, for the farther dilatation. There is great
disadvantage in evacuating the Waters too soon, for 
the Head is not able to effect the Dilatation, so well
in the begining as with their assistance, therefore
you should never rupture the membranes too
early.- If there is a considerable quantity of Waters
it will be better to collect them upon a Cloth &c.-
When the Waters are evacuated if you have
not before examined, or if you have any Doubts
about the case, this is the proper time for examination,
and to ascertain the situation &c. for if
there is a necessity for any thing to be Done, this 
is the most favorable time for doing this, such
as turning &c. for if the Womb is alowed to contract
more force will be required, and of course more pain
and Danger to the Patient



160
Second Stage of Labour.- This comprehends
all that takes place from the Rupture of the Membranes
'till the birth of the Child is compleated.-
The begining of this Stage is the proper time for 
ascertaining the situation and presentation, if this
has not been done before. If the Pains are Strong
and the parts relaxed the Labour now proceeds very
quickly.- When there is great relaxation of the external
parts, and this not the first Child, it will not 
be safe to alow the Woman to sit up or Walk about 
as the Child might be suddenly forced away and if she 
walking, fall in the Floor, and be a cause of considerable
Danger.-- In quick natural Labour, the 
head is very much forced down by a few pains, after
the escape of the Waters, and when the head has been
small or the Pelvis large, the same pain that has 
ruptured the membranes, has expelled the Child.-
The time when assistance becomes necessary
is when the head becomes forced against the Perineum
as there is some danger of its becoming lacerated, and 
which laceration may extend to the Rectum, this 
is a Matter of very great consequence, as there is generally
a high degree of irritation comes on, and the parts
wont again unite, and the power of retaining the fœces
is the consequence.- This is often occasioned by 
the improper use of Instruments. They way to prevent
the laceration of the Perineum is to press against 
it by means of the Hand or a Cloth, or by pressing against 



161
the head of the Child so as to regulate its passage, this 
must be done no more than is actually necessary
on account of retarding the Labour.-
The way in which the head passes the external
parts is with the Occiput to the Pubes of the Mother.-
When the head has passed the external parts, you
should examine to know if the Chord be round the 
neck of the Child, and if it is, it must be put over the 
Occiput, or the opening dilated, and slided over the 
Body of the Child as it passes.-
When the head has passed you must apply
one hand on each side, for the purpose of making
a little extension, and direct to Patient to hold in her
Breath and force down, you must extend gradually
pull down, giving the Body the proper turn, that is with 
the Shoulders to the Sacrum and Pubes, the long Ax is 
opposed.- When the shoulder have passed, you must 
make extension by them.
You must not remove the child from the parts of 
the Mother, for if the Navel string is short, you run the 
risque of breaking it, or detaching the Placent, or of inverting 
the Womb, all of which are of very great consequence 
as the Child passes, you should bend the Child
towards the Mother.-
You should not immediatly tye the Chord, but feel
for the Pulsation, tho' it is not necessary to wait till that 
ceases before you apply the Ligature.- If from the Pulsation



21
162
Pulsation you have reason suppose the Child alive, you
must not tye the Chord 'till the  Child breaths, and 
after waiting a little time it does not, the Body may
be rubed with gentle stimulants, or it may be necessary
to throw air into the Lungs, by stopping the Nose, and 
blowing into the mouth, at the same time pressing upon
the Thyroid & Crycoid Cartilages, so as to prevent the 
air escaping into the Stomach, for that would be doing
injury, and you must endeavour to immitate respiration
by pressing the air out again continuing this 
for some time.- Another way of inflating the Lungs is 
by means of a small curved pipe of a proper construction
introduced into the Epiglottis, they way of doing this 
is by passing your finger down into the Œsophagus 
'till you feel the Glottis, you must then pass down the 
Tube by the direction of the finger into the Epiglottis
and by that means throw in Air. This last mode
preferable.- Whilst these attempts are going on the 
Body should be kept warm.- If tho' the Pulsation
in the Chord was strong at first, this gradually becomes 
weaker, and after a time ceases, this is an indication
of Death.
The Ligature is generally made about 2 or 3 Inches
from the abdomen tho' 1 In. would be quite sufficient tho'
it would be inconvenient to make very near to the Abdomen
as a small portion of Intestine might be protruded at 



163
the Part, or if the Ligature was to come off there would be
difficulty in fixing on another.- A second Ligature
must be made nearer the mother, and the part between
the two divided by means of a Knife or pair of Scissors.
The necessity of making this second Ligature occurs
very seldom, but it is right always to do it, it occurs only 
when there is another child and the Vessels of each
Placenta communicate, in this case the second Child
would bleed to Death if this Ligature was neglected, tho'
then would be no danger to the Mother
Third stage of Labour. This consists
in the expulsion or extraction of the Placenta.-
The Placenta is not to be extracted immediatly
after the expulsion of the Child, for as the womb
is not yet contracted the Vessels of the Uterus remain
of their full size, and a considerable Hemorrhage.
would be the consequence. The interval may be 
employed with advantage in attending to the Child
and if there is much faintness in the mother, as 
there frequently will be, a small quantity of 
some Cordial may be given, but you must be particularly 
carefull that too much is not given, or 
it may do considerable mischief.-
Before you attempt to extract the Placenta
always be certain there are no more fœtuses, and 



164
which you may do by laying your hand upon the 
Abdomen, and making gentle pressure, if there is no 
more, you will feel the parieties of the Abdomen fluid
and Uterus in the center, contracted into a hard round
substance, but if there is another Child, there will
still remain a general enlargement of the Abdomen.-
Somtimes the Uterus is not disposed to 
contract, and this may give rise to a supposition of their
being another Child, but by making pressure upon
the Abdomen to assist the contraction, will very 
soon determine the Case.-
With respect to the time which you should
wait before extracting the Placenta, this must 
depend very much upon circumstances, if there 
are no unpleasant Symptoms you may wait 
longer, but if flooding &c. comes you must extract
more speedily, as a general Rule from 15 to 20 Minutes
may be the proper time.-
Nature will very frequently expect the Placenta
without any assistance, but if this becomes
necessary, this is given by taking hold of the Chord
with a Cloth in one Hand, and pass the two fore
fingers of the other hand up the Chord to the Placenta
then separate them taking hold of the Placenta between
them, making extension both by Chord 
and by means of the Fingers, endeavour to extract it 



165
which if there are no adhasions you will be able
to effect.- When the Placenta is extracted, or is 
expelled, you should apply a Cloth to the parts, squeezed 
out of warm Water, and another under the Thigh, as 
it may be adviseable to let the Patient remain a
little time before she is moved.-
When the Uterus shews no disposition to contract
and expel the Placenta, if there is no flooding
you may endeavour to excite this contraction, by
rubing the Abdomen with some kind of Liniment
tho' it is the friction which renders the service.
Practitioners have varied very much in 
this opinions respecting the Extraction of the Placenta,
some advising in all cases to extract immediatly 
whether there is flooding or not, others recommend
leaving it entirely to Nature.- Both these 
extremes a wrong and Dangerous, a middle course
of proceeding is best.-
The speedy extraction may bring on profuse
Hemorrhage, by detaching the Placenta
whilst the Vessels are yet large and uncontracted,
when this is the case assisting the contraction of the 
Uterus by pressure upon the Abdomen or by other
means will answer a good purpose.- The speedy
extraction may likewise cause inversion of the Uterus
more particularly if the Placenta is attached to the 

The inversion of the Womb is somtimes partial
which may be known by passing the fingers up
the vagina.- This may be mistaken for a Polypus
are you are not carefull in making the Distinction.
The reduction must be attempted by pressing upon
the middle of the Tumor.- 

166
Fundus, and the attempt to extract has been made
by the Chord.- Flooding chiefly occurs when the 
Placenta is partially detached.-
When the Uterus is inverted the reduction should
be immediatly effected, for any time is alowed to 
elapse before this is attempted, the Uterus will have 
began to contract, and render the reduction either 
extremely difficult or else impossible.-
To prevent inversion of the Uterus, you should
wait 'till the Uterus is in some degree contracted,
except in case of flooding, in which case, before you
attempt to pull the Placenta [cross out] away you should compleatly
detach it, by passing up your hand and grasping
it, so as to effect a separation before you pull down.
The way to attempt the reduction is by pressing
upon the fundus of the Uterus so as to dent it in 
gradually proceeding in this way 'till you have
compleatly returned the Parts, not only within the 
Vagina, but compleatly into this natural situation,
which may be known by the way the hand 
passes up, and by feeling with the other Hand upon
the abdomen.- If the reduction cant be effected
it then becomes a Matter of very great consequence.
Death will somtimes take place very shortly 



167
from the shock given to the System, and if this does 
not then take place, it will do so generally after a 
length of time perhaps a may a Year or two.-
The Part which forms the external Surface 
of the Tumor is the internal part of the Uterus, than 
part from which the Menses flow, this flow not
only takes place at the usual Periods, but with greater
violence, and often recurs at shorter intervals,
and in the intermediate times a Discharge of a Serous
kind generally occurs, this produces a great degree
off irritation, and Debility, and generally ends in Death.
When the Uterus is inverted with the Placenta
attached, it becomes a question whether it will best
to separate it or not before reduction, this last appears
to be most eligable.-
Leaving the expulsion of the Placenta entirely
to Nature, is attended with Danger, as many
Die in consequence of it from its producing a 
high degree of irritation &c. and which my perhaps
by moderated by the use of R a Opii &c and the Discharge
corrected by Antisceptic washes or injections.
Somtimes the Uterus will contract so forcibly
if the Placenta has been left for a length of time, as 
to prevent the introduction of the hand, without 



168
doing more injury by the Violence used, that will
arise from leaving the Placenta, in which case
it must be left, and the Symptoms moderated by 
proper treatment.-
The Navel String is somtimes broken off in 
this case you must pass your hand up into the 
Uterus, and separate the Placenta & bring it away.-
Impediments to the Extraction of the Placenta
somtimes arise from Schirrous adhesion at 
others from irregular contraction of the Uterus.-
Schirrous adhesion does not so often take
place as has been generally supposed, when it has 
done, there must have been some Previous pain 
in the Part, and Chronic inflamation, in consequence 
of which a quantity of Coagulable Lymph is thrown 
out, which forms an adhesion betwext the Maternal
part of the Placenta and the Uterus.
In this case the Child will be expelled and every
thing will appear to be going on well, the Uterus
will contract and form the round Tumor in the 
Abdomen, after waiting a proper time, on attempting
to bring the Placenta away this cant do [illegible] and 
upon introducing the hand, the Placenta will be
found to adhere, if this adhesion is small, a little
force will effect the separation, but if the portion 
Sevri Cartilaginous?



169
which adheres is large it will be very Difficult if 
not impossible to effect the separation. Probably a 
Pair of Forceps might answer a good Purpose in 
assisting the separation, in using them you give no 
pain if only the Placenta is taken hold of.- You
must either by means of these or other means separate as 
much of the Placenta as possible, comparing the different
Portion when extracted.-
If any portion of the Placenta is unaviodably
left, (but none should if possible to extract it) Symptoms
of Fever and very high irritation will come on, and 
the use of various medicines and Remedies will be 
required to alay these as by Opium, Saline Draught
in a state of effervescence, internally, and likwise
antiseptic injections, as an injection of Ag. Hord.
℥vj Vis. Rubr. ℥ij.
When the Difficulty arises from irregular
contraction of the Womb, this may be from untimely
contraction of the Os. Uteri or a preternatural 
contraction at any one part of its Body.
The mode of treatment in both these Cases is 
nearly the same, but is different according on these
is or is not flooding, if there is no flooding you may
wait a little time and possibly the contraction may 



22
170
go off, or a Dose of Tinct. Opii may be given, and 
which in some cases will take off the Spasm.-
In some cases the Spasm only recurs at 
intervals, in this case on passing up your fingers
the part may contract upon them, but by proceeding
gradually you will overcome this, and be 
able to extract the Placenta.-
But when there is flooding, the case is different,
as there is then considerable Danger, this 
flooding somtimes brought on by puling at the 
Chord or perhaps by breaking it off, this could not 
have happened if both Hands had been used, as the 
cause of the Difficulty would than have been discovered.-
In case of flooding you must proceed
more rapidly, yet not so as to use any violence
you must introduce the hand gradually passing
it into the contraction, and by degrees Dilate the 
part 'till you have passed your Hand, and can
take hold of the Placenta, you must then endeavour 
to extract it, if you have only in the first
instance got hold of a small portion you should
endeavour to take hold of a larger, or it may be 
torn off, and which will frequently be the case
removing it by Degrees 'till you have extracted
the Whole, comparing the Different portions and proceed



171
proceed 'till the whole is extracted.- I will not be 
necessary to take the hand out, every time you have
detached a portion, but to slide that part downwards.-
Lingering Labour. This is when the Child
is a greater length of time than common, in expulsion, 
it is not called lingering if over in the course of the 
Day.- The cause of lingering Labour either deficiency
in the expelling Powers, or increased resistance,
or both.-
Defect of Pain, may depend upon Debility,
Plethora, Passions of the Mind, Over distention
of the Uterus, or any thing that may check the general
Exertions of Nature.
Debility requires the use of means that 
can give strength and afterwards to stimulate
the parts to act, such as Cordials of Different Kinds
as Ag. Menth. &c. and occasionally a little wine,
and this in most cases will be sufficient, tho' in
some cases a stimulus will be necessary, such as 
walking about, or by the introduction of the finger
or the Lever, not for the purpose of Delivery, but of 
exciting the Uterus to action.- In some cases when
than is only weak, with giving any assistance towards
the Progress of the Labour, only teazing the Patient and 



172
keeping her awake, a Dose of Ra Opii will afford considerable
Service.- Some have supposed that Debility 
could not be a cause of Lingering Labour, as 
Women have been Delivered when labouring under
Phthisis, and with the greatest Ease, but in this 
case the powers of Resistance are likwise diminished.-
Plethora.- This may be a cause of Lingering
Labour.- You may easily Distinguish this State 
the Countenance and other usual Symptoms, this 
Plethora should be removed by Bloodletting &c. and 
then the Pains will frequently come on sufficiently
if not you may Stimulate the parts to action as 
above.- If you apply this Stimulus before you
have made the evacuations, you run the risque
of some Vessel being ruptured, and this happen
in any part of the Body as the Lungs &c.-
Passions of the Mind. These always divert
the Pain, therefore all causes of Mental Agitation
should be avoided. If any thing of this sort has 
taken place, it may sometimes be necessary to 
take away a little Blood, or to exhibit some Tinct:
Opii.-
Over Distention of the Uterus. This acts 



173
in the same way as an over distention of the Bladder,
if this is from a larger quantity of Water than common,
rupturing the membranes more early than
common will be of Service, this may be slow when
the Os. Uteri is not more Dilated than 1/2 Crown, but
before this is done the case should be will ascertained
for if you evacuate the Waters and they were not 
the cause you do injury.-
Impediments to the general Exertion of Nature.
there may be from different causes, as inflamation
of the Lungs V.S. preventing the action of these parts
in assisting Labour.- Cholicky pains, along
with those of Labour may be another cause in
this case a Purging Carminative Glyster may 
be injected, or Purgatives joined with Carminative
may be given, these will be of Service by procuring
a Discharge of Filatus.- If Opium is given
before the remedies above have been tried it will
do injury, and will be of Service if given after.
Increased Resistance.
Toughness of the membranes may be another 
cause, acting upon the Principle of increased resistance,
when the Mouth of the Womb is sufficiently
Dilated.- Rigidity of Passages, Disproportion
of Parts, and Unfavorable Situation of the Head,
are likwise causes of increased Resistance.-




174
Toughness of the Membranes. This cant impede
the progess of Labour in the early Stage, only
when Labour is somwhat advanced, and the Os. Uteri
considerably dilated, in this case you should Rupture
them, for if this is not done the Whole Ovum
may be expelled together, but this would require
very great Exertion and the Child must be still
born for it becomes drowned in its own Waters in 
consequence of the communication with the
mother being cut off. There is danger too on this
account to the Mother, for the Womb being Distended
for a length of time after the Placenta has been
Detached, a considerable Hemorrhage may be 
the consequence.-
Rigidity of the Passages. This is more frequently
the cause of lingering Labour than any other
and may easily be ascertained.- In a case of this 
sort it will be much better to mention the Delay
that is likely to take place. Under these circumstances,
the objects to be kept in View, are to effect
a relaxation of Parts, to gain time, to guard against
accidents, and to encourage the Patient.
When there is rigidity the loose of some Blooding
possibly be of Service, keeping the Patient still and 



175
and cool, and not alowing much company to 
be in the Room, and keeping the Patient upon a low 
Diet not alowing any thing of Strength to be given.
Whatever will produce relaxation will be of Service
tho' very little can be done by Medicine, it may be right
to give somthing Simple to satisfy the Patients Mind.
Antimonials in nauseating Doses have been recommended,
tho' the continued nausea must be 
very unpleasant. If the Pains are weak and 
only teaze the Patient, a Dose of Ra Opii may be 
of Service by procuring Sleep and that way gaining
time and Strength, and a Glyster may be occasionally
given with advantage.- The Patient may
likwise have warm Fomentations applied to the 
Part, or sit over the Night Chair with some Warm
water in it, these are not of much real Use, tho they
may shew the appearance of Doing somthing.-
A considerable time will elapse before there 
is much Dilatation of the Os. Uteri, perhaps a Day
or more before it has gained the Size of 1/2 Crown.
and the Labour may be 2, 3 or even 4 Days before it 
is terminated.-
If Women of a Rigid Fibre, Blood should be taken
away two or three times during Pregnancy and 
she should live upon rather a low Diet if nothing 
Particular contraindicates.- 



176
During this dilating process, there will sometimes, 
Symptoms come on which are attended
with Danger, as Convulsions, and which is generally
indicated some time before they actually take place
by particular Symptoms, as Pain in the head
Loss of Sight, a Morbid Sensibility of the Eye &c. this 
Pain in the Head is very much different from 
the common Headach, being a violent darting, Shooting
Pain.- When these Symptoms take place
it may be right to inform the Friends of the Patient
what is likely to follow, and there is Plethora
the loss of Blood may be a means of preventing 
this may be taken from a Branch of the Temporal
Artery or Jugular Vein, if there appears a Determination
to the Head.-
Disproportion. This is understood to be 
only slight, and only requires time to alow the Bones
of the head to accommodate themselves to the Passages
this should be ascertained when you examine and 
this should be done not only in one or two points
but entirely round
Unfavorable Situation. This may likewise
be a cause of lingering Labour, as any situation
different from the Natural one is more unfavorable,
and some of these more than others.-

[words crossed out] with its Pearson
23 and [Rem???])

23
177
There are some other Causes which are supposed
to be a cause of lingering Labour, but 
which are somwhat Doubtful, as the Premature
bursting of the Membranes, this may in some 
measure be a cause by reason of their assisting
in the Dilation of the Os. Uteri in the begining
before the head cant to advantage, and the violent
Action of the Parts may force the Womb, down
out of its Place, and if it does not do this, the injury
done may dispose to procidentia Uteri.-
The Cord being round the Neck of the Child has
been supposed by some to be a cause of lingering
Labour, but this cant possibly be the case.-
The Shoulder of the Child hitching upon the 
Pubis, is another cause supposed by some to be
a cause of this kind of Labour, this cant retard the 
Passage of the head, tho' when the Head has passed
the external parts, it may be a cause of preventing
the Body from being expelled, you may remedy
this by pressing with the Finger upon the Neck
of the Child so as to depress the Shoulder, and then
give it the proper turn, and when you can take 
hold of the Shoulder you should pull by them, being
always carefull of applying pressure in the Axilla
on account of the Axillary Plexus of Nerves.



178
Whenever you are called to a Labour which is 
lingering you should always make inquiry, what
this arises from, and whatever that may be, you
must take measures accordingly.-
Laborious Labour. This is when Nature
is not able to expel the Child, tho' the Head presents.
These cause of this is either disproportion between
the Pelvis & Head, Defect of Pain, or a greater
degree of Ossification of the Bones of the Head.-
Disproportion may either be on the Side of the 
head or Pelvis, as the Pelvis being deformed, or the 
head enlarged from any cause as Hydrocephalus
or the extra Ossification preventing the Bones yielding
as they commonly do.- There may in some 
instances be disproportion both on the side of the head
and Pelvis.-
Disproportion varies in its Degrees, the lesser
of which may be relieved by the more gentle means
the greater by more severe treatment.
Nature in all these cases should be alowed
to exert herself to see what can be done without
assistance.-
The milder kinds of Laborious Labour are 



179
manageable by the use of the Lever or Forceps
which do no injury either to the Mother or Child
if properly used,- The more severe kinds require
the Perforator and Crotchet to remove the 
disproportion.- For the milder kinds of Laborious
Labour, [crossed out] Fillet has been recomended
but from the difficulty with which it was applied
the use of it is laid aside.-
An Instrument resembling the Lever was 
invented by a Mr,, Chamberlin, but which had 
very little curve, and on that account would be
applied with very little advantage.- After a time
the Lever, which is more curved was invented, and which
is now very much used and with advantage in the 
milder kinds of Laborious Labour:- The Lever now
in use, is considerably more curved than what was 
formerly used.- The Lever acts with advantage and without
injury if properly used but may do considerable
mischief if applied improperly.-
The Forceps were afterwards invented and which 
act with advantage when the Lever frequently
wont succeed.- The French make use of longer
Forceps than is the Practice in this Country
an apply them under different circumstances
that is when the Head rests [cross out] at the Brim of the 
Pelvis.- The Lever may be be of Service when the 



180
Head rests upon the Brim of the Pelvis, and is out of 
the reach of the common Short Forceps, tho' the long
curved Forceps have been applied with advantage
when the head rested at the Brim in consequence
of some disproportion, and in a case or two when it 
would have been necessary to open the head, only
for the use of these.
The Forceps in common use in this Country are
considerably Shorter, and are only applied when the Head
is low down in the Pelvis.
Dr,, Luke invented Forceps with three Blades
but two are used much more readily and with
greater advantage, as they will alow as much
force to be used as either of Service or consistent
with Utility.- Those Forceps are the best which
will alow the protuberance of the Parietal Bones
to go it into the opening in the Blades, and at 
the same time are bevilled off so as to lay close
to the Head, for the part which gives the Resistance
is that protuberance, and the Forceps cover this
they add to the Back of the Childs Head.-
The intention for using the Forceps are to 
bring the Child away alive, without injury to the 
Mother.
Consideration regarding the Use of the 
Forceps. There comprehend the Propriety of using  



181
them, the Rules to be attended to in all cases, and 
Rules applicable in Particular Cases.-
Various reasons have been assinged for the 
use of this Instrument, but these are not all of 
equal weight.- One very good reason when a 
Woman has been in Labour for a considerable
length of time the head low down in the Pelvis, the
Pains have been Strong but are now going off the 
Patient much exhausted, and Floodings or Convulsions
attending, but the Forceps may be applied
with propriety and advantage in cases much
less urgent.-
Another reason for the use of the Forceps has
been assigned, which is when the Navel String comes
down before the head if the Child, there is no danger
Danger from this circumstance to the Mother
tho' very great to the Child, you may endeavour
to put this to one side when it wont be pressed
upon by the head, but if this cant be done the the 
Forceps may possibly be of Service by bringing the 
Head more quickly this the external parts.-
The Bladder and Rectum should always 
be emptied before the Forceps are introduced.
The Patient may lay on the left side in any 
position of the head with respect to the Pelvis,



182
but with the Breech opposed to the Practitioner, and 
very near the edge of the Bed, it will somtimes be
necessary to support the Feet by means of a 
Chair.-
The Forceps should always be used Warm.
The Os. Uteri fully Dilated.-
The Head descended low down.-
The instrument introduced during pain
as both Blades have the same construction
it is immaterial which is introduced first.
The direction of the Blades must be determined
by the Ears of the Child, as the Forceps should
be applied on each side of the Head.- There is 
one exception to this when the head of the Child is 
just entering the Brim of the Pelvis, and this is 
narrower from the Pubis to Sacrum, and the face
of the Child is to either side, the Long Forceps are 
required here and they may be applied to the 
Face and Occiput, this case may somtimes
be relieved by the Forceps tho it will frequently be
necessary to open the Head
If you warm the Forceps and are carefull in 
using them you may somtimes do this without
the Knowledge of the Patient or by Standers, more particularly
if introduced during pain, which should  
a



183
always do, not that you can introduce them with
more ease, but you will give less sensible pain.
You cant often introduce the Forceps unknown
tho' the Lever frequently may.
If you attempt to introduce the Blades before the 
mouth of the Womb is compleatly Dilated, you run
some risque of doing injury by forcing the end of the 
instrument against that portion of the Vagina, which
is joined to the Uterus.- From this cause the Rule
of keeping the point of the instrument close to the 
Head arises.-
When you are about to introduce the Blades
it is immaterial which of them is introduced first
as they are both formed alike, tho' it is best to introduce
that with the left hand first (if you introduce
them sideways) and the right hand Blade over this,
and when you introduce them above and below, it
is best to introduce the lower Blade first.-
When are about to introduce the instrument
you must prepare the way by the introduction of 
the Fingers to separate the Labia &c.- then take one 
of the Blades loosely between the Thumb & fingers, and
introduce the Point under the Fingers, carrying it
gently or with the Point close to the head, 'till you have 
passed it sufficiently high up.- If you meet with 



184
any resistance, you must not use force to overcome
this but gently alter the Direction &c.- When you 
have introduced the first Blade, you must fix this
by means of the third and fourth finger and the Thumb
of our hand, whilst with the first and second you
prepare the way for the other, which you must introduce
in the same gradual manner, always taking
particular care respecting the Locking of the Blades.
If you find you have not got good hold it is not 
necessary to withdraw the Blades, but to move them
gently and by that means fix than properly.-
When you have fixed the forceps properly you
should not immediately begin to draw down, but wait
'till pains come on, and then make extension, having
off when the pains ceases &c.
You must not make the extension in a direct
Line, with in a line to correspond with the Axis of 
the Pelvis, gently moving the instrument from side 
to side as you extend.- Considerable care is necessary
when the head approaches the external parts,
if the Perineum does not Dilate sufficiently, you
must attempt to do this forcibly, but by keeping up
a regular degree of extension, and inclining the 
Handles of the Forceps to the Abdomen.-
Some care is necessary in taking the Forceps



24
185
off more particularly if you have used them without
the Patients knowledge
Application of these Rules, to particular
Cases. No Part except the head is proper for the 
application of the Forceps, tho' they have been applied
to the Breech and might act with considerable force
but the points will press upon the Abdomen, and 
may do considerable injury, in this case the Blunt
Hook acts with much more advantage and safely
but this will be mentioned hereafter.-
The Forceps can only be applied to head in
to two presentations, the Vertex and Face.-
When the Vortex presents, the Face may have
different situation with regard to the Pelvis, the
French have formed six cases from this, but these
may be divided into two namely, the Ears to the 
sides of the Pelvis or opposed to the Pubis and Sacrum. 
When the Ears are to the Sides of the Pelvis with
the face in the Hollow of the Sacrum, the Woman being
laid on the left side with the parts as near the edge  
of the Bed as possible, you must then introduce the 
Blades as directed first [cross out] below than [cross out] above, as by this
means you secure the Locking much more easy.
In some cases you are not able to bring the parts 



186
sufficiently near the edge of the Bed to alow of the introduction
of the Second Blade, you may then pass it sideways
over the face of the Child, for a little way, and 
then turning the Handle downwards, you bring the 
Blade opposite the other, and by carrying it a little 
forwards easily bring them to a Lock.- You must 
then proceed according to the general Rules
When Ears are situated to the Sides of the Pelvis
with the Face to the Pubis. This is attended with 
much more difficulty on account of the parts
not being so well adapted to each other in Shape
In this case if the presentation is ascertained
early before it has entered the Brim of the Pelvis in
any degree, Dr,, Smellie, recommends passing up
the hand to find the feet, and bringing the Child
away by that means.- This may be advisable if the 
case is early ascertained.- When the head has passed 
only a little way within the Pelvis, Dr S. recommends
passing up a long pair of Forceps, and fixing
them on the Head, to raise it up by Degrees 'till he 
can give it the turn with the Face to either side, and 
afterwards when the Head has descended somwhat
lower to turn it with the face to the Sacrum.
In some cases this practice may be adviseable.



187
adviseable.- Objections have been made to this if the
Uterus acts with much force, on account of the 
Vertebra of the Neck being injured, or the Uterus ruptured,
but these depend very much upon the way in 
which the attempt is made.-
In this case the Forceps must be applied on
each side the same as in the last, but the utmost
care will be necessary to prevent a laceration of the 
Perineum, the extension must be made gradually
and the occiput depressed as much as possible to make 
the Axis of the head as Short as Possible.- In speaking
in this way of the application of the Forceps the head
is understood to be low down in the Pelvis. so as tummy
is out of the Question
It will often be a question whether it may not
be better to open the Head of the Child than to use the 
degree of force which would be necessary for the Extraction
of the Head, as the Child will be still born, and a
considerable Degree of injury must be done to the soft
Parts.- When the head is considerably descended, it 
will somtimes be very difficult to ascertain the presentation
and Situation on account of the accumulation
of Scalp, obscuring the Fontanels &c.-
When the Ears are to the Pubis and Sacrum.
The head is considered as low down for they are 
always in this situation, at the time of entering the 



189
Pelvis.- The situation should be clearly ascertained
to form a judgment which way you should give
the Head the Turn, for if you make a mistake
and instead of turning the Face into the hollow
of the Sacrum, should bring it towards the Pubes
you render the case extremely difficult instead
of an easy one.- In some cases when you cant
feel either Sutures or Fontanels from the accumulation
of Scalp, you may determine the situation by
this circumstance, as the accumulation is always
greatest at the Occiput.- The Blades of the Forceps
must be applied towards the Pubis and Sacrum, the 
Blade towards the Pubis first.- When the Blades are 
properly fixed upon the Head, you must gradually
turn the Face into the Hollow of the Sacrum.
The Face Presentation. This is when the 
face presents with the Nose in the Center. In 
this case the Chin may be to any part of the 
Pelvis.- The head wont pass so easily as in 
the Vertex presentation, tho' it will in many
instance pass without any assistance, the Forceps
are sometimes necessary.- To gain a perfect
knowledge of the mode applying them with the 
greatest advantage, it will be necessary to understand
the way in which the head passes without 



190
assistance.- The most simple case is when
the Chin is opposed to the Pubis, as in this the
head passes with the greatest ease. In this case
the Chin is forced forwards and downwards by
the Spine acting upon it, and as it passes takes
exactly the same turn as the Vertex presentation
the Chin gradually emerging under the Pubis.
When the Forceps become necessary you must 
have the above circumstances in view, exactly the 
same as when the Vertex Presents.- The Blades
must Lock over the Mouth of the Child, but you
will not find the so well adapted to the Shape of 
the head as in the other presentation.- When you have
got good hold by the Forceps, you must draw down 
depressing the Chin so as to alow it to pass out under
the Pubis, and then elevate the Handles of the 
Instrument so as to bring them towards the Abdomen
of the Mother 'till you have effected the Passage
of the head, and then proceed as in a Vertex Case.
When the Chin is situated to either side, the 
object is to incline the Chin to the Pubis, and 
proceed as before.- If the head is high up, it may
be necessary to bring it down rather lower, before 
you attempt to give the turn.-

 

191
The Chin is somtimes situated towards the 
Sacrum, here the extraction of the Child alive is
scarcely possible unless the Head be very small.
Fortunately these cases rarely occur.-
On the Use of the Lever.
The management of the Lever supposes a Knowledge 
of the general Rules for using the Forceps,
also the necessity for using it should be well ascertained.-
The cases which render the use of the 
Lever proper, are when nature has done a good
deal but wants some assistance to compleat
the Business.- This instrument is improperly
called a Lever, as this might lead to a wrong mode
of application, it is not to act on the Principles of a 
Lever, but when applied to the head, and its action opposed
by means of 2 fingers, it acts similar to the 
Forceps tho with less advantage.-
It has been recommended to make use of 
the Lever when the head is at the Brim of the Pelvis
but this can seldom be done with advantage, and 
may often do much injury by bringing a Vertex Presentation
to that of an Ear &c.-



192
This instrument can only be applied with advantage 
to two parts of the head, namely the Occiput,
or by passing it along the Side of the Face fix the Fenestra 
of the Blade upon the Chin.-
It is necessary to ascertain the exact Situation
before you apply it, for in case of a Vertex Presentation,
of it was wanted to bring Down the Occiput
and the Instrument by mistake is fixed upon the 
Chin, the case will be changed to a face Presentation.-
When the Head is about to make the Turn
it is better to leave this to Nature, as the Face may 
possibly be turned Forwards, and then you do injury.
The same general Rules are to be observed
as in the introduction of the Forceps.-
You may know when the instrument is fixed
upon the Chin by comparing the Part of the Head
you can feel, with the Blade of the Instrument.
When the instrument is applied you may apply
two or three fingers of the other hand upon the head
of the Child to oppose it, and act in the same way
as with the Forceps, gradually puling down, and at 
the same time makeing use of lateral Motion.
You should be carefull in applying it to the fore
part of the Pelvis in account of the Urethra.-



193
Perforator & Crotchet.
In cases when neither the Lever nor Forceps
can effect the Extraction of the Head, either in consequence
of the Narrowness of the Pelvis, largeness
of the Head, or any other cause, the disagreeable
alternative of opening the head by means of the 
Perforator and Crotchet must be resorted too.-
As the child must in this way be destroyed
the necessity of doing this must be well ascertained,
and if there is the least possibility of bringing 
the Child away (alive) without this, and without
very much endangering the Life of the Woman, this
should be done, this is in case the Child is alive
but if it is already Dead, you may frequently
save the Woman very much by lessening the head
sooner that you would do provided it was alive.
You may often form some Idea of the Business
provided she has had former Labour, and 
thsen have been difficult, tho' this will not amount
to any thing like certainty, for tho' it may
have been necessary to open the head of the Child in
2 or 3 former Labours, yet there may have been 



25
194
some alternation in the Pelvis, or the head of this
child may be small, so that it may pass.
This circumstance may assist the judgment 
and proceed without so much Hesitation.-
If this necessity has only happened once, you
cant reply upon it so much.-
It is much safer to trust to the measurement
of the Pelvis together with accurate observation
respecting the head, and in making 
this measurement and examination you should
do it compleatly in all parts.-
The Necessity of opening the Head may depend
on different causes, but which are resolveable
chiefly into one, namely, Defect of Room.
This may be either from the Pelvis being smaller
or the head larger or more Ossified, so as to prevent
its yielding.-
But it is sometimes admissable to open
the Head where the Disproportion is slight,
this is in case the Child is Dead, but in doing 
this there should not be the least Doubt respecting
the Death of the Child, and the different Signs
of which should be well examined, these any great
Mobility of the Bones of the Cranium, Separation
of the Cuticle, Emphysema, want of Pulsation 





195
in the Cord, Putrid Discharge, want of Motion
in the Child, Discharge of the Meconium &c.-
All these Symptoms are fallacious, tho'
some of much more consequence than others.-
Great mobility of the Bones, this is a vague
term, but by it is meant, a very high Degree
so that the Bones may be formed into any 
Shape, and feels as tho' the Substance of the brain was
destroyed.-
Separation of the Cuticle, this has taken place
without the Child being Dead, tho' is one of the best
single signs.-
Emphysema, this arises from many other
causes, but may assist in forming an Opinion.-
Want of Pulsation in the Cord. If this can
be felt (as Cord), it is a very good sign, for the Child cant
live long after this ceases to beat, tho' it may for 
a Short time.-
Putrid Discharge.- This may arise from 
many other causes.-
Want of Motion in the Child. This is the 
most ambiguous sign of any, for the Child is
frequently not felt for a great length of time
before Delivery and yet may be born alive.-



196
Discharge of the Meconium.- If the breech does not 
present this is one of the Strongest Signs of the Death
of the Child, but somtimes when the Breech presents
this will be forced away tho' the Child is alive, by the
pressure of the Thighs and Knees upon the Abdomen.-
Others Symptoms have been mentioned but 
which are of very little consequence, as want of Pulsation
at the Fontanel, but this can be very seldom
be felt.- Movement of the Child from side to side
this of no consequence.-
But in forming the opinion several of these 
Symptoms should be combined, as they are all liable
to fail singly, and if you cant compleatly make 
up your mind respecting its Death, you must
then proceed on the Supposition that is alive.
Different instruments have been invented
for the purpose of opening and extracting the Head,
but those now in use, are the Perforator, Crotchet,
and Blunt Hook, and in some cases a pair of 
large Forceps with long Teeth.-
When you are about to use these Instruments
the Woman should lay on the left Side, with the 
Breech very near the Edge of the Bed, and you should
be seated opposite the Breech to give as much command



197
command as possible, for the Business will often be attended
with very great Fatigue.-
You must first introduce the left Hand
to find the Sagittal Suture or Fontanel, and then
pass up the Perforator up the Groove made by
the hand, to the Cranium, and then with a motion
the same as when using a boreing instrument,
pass it into the Scull, and before you attempt
to open the Handles, be certain the Point is in 
Cranium, not slided on one Side, you must then
take hold of the Handles, and open them, and then
change the position and open them again, and 
afterwards move them round when open to break 
down the Substance of the Brain, you may then
introduce a Spoon for the purpose of scooping
out part of the Brain.- After this has been done
some have recommended to wait and see if 
nature wont finish the Business, but this should
never be done, but should immediately proceed to 
extract the Child.- If the disproportion was not 
very great very little assistance will effect the 
extraction, but if the Disproportion was very 
considerable, then will be often a great deal of Difficulty.-
When slight, the Blunt hook passed up 



198
so as to fix upon some part of the Cranium, will
affect the extraction, by drawing gently down, and
is best done during pains.- If the Blunt Hook
is not sufficient, you must then have recourse
to the Crotchet, by passing it up and fixing the 
Point on some part within the Cranium, you 
must pull down, but always have your fingers
opposite the Point of the Instrument to prevent 
its injuring the Mother in case it should Slip off
or the Bone give way.- Somtimes different portion
of Bone will give way, and become detached, you 
must be very carefull in effecting the removal 
of these to prevent their injuring the Parts, by
bring them down with some Care, or by Doubling
them between the Thumb and fingers before you attempt
to bring them away.-
The Instrument may somtimes be fixed
with advantage on the ouside of the Cranium
when the rest of the Bones are very much Detached.
If the Pelvis is very narrow it may sometimes
be necessary to bring the Basis of the Cranium
down sideways.-
The large Forceps may be employed with advantage,
by taking hold of the sides of the Scull after the 
Summit has been detached.- After the Child has
been brough away it will be better either to cover the head



199
with a Cloth or unite the parts by means of a Suture,
to render its appearance less disagreeable.-
After opening the Head, some practitioners have
recommended passing up the hand to find the feet
and bring them down, but this should not be done,
for the portions of Bone may injure the internal
Surface of the Uterus very much.-
If the head is enlarged from a collection of 
Water called Hydrocephalus, simply puncturing the 
Head may be sufficient.-
In all cases of this kind it will be much
better to call in another Practitioner, before you attempt
to open the Head.-
If the Resistance is at the Brim of the Pelvis
the long Curved Forceps may possibly bring the 
head down when it otherwise would have required
being opened, they may be used with advantage if
the Disproportion is small, but if it is considerable
the Child will die from the necessary force being
applied therefore it will be better to open the head
as this does less injury to the Mother.-
The Patient living abstemiously during Pregnancy
will somtimes be attended with good effect  



200
It has been proposed and in some instances
practiced with success, to save the Life of the Child
by bringing on premature Birth, in case of Distortion
of the Pelvis.- The Period at which this must 
be done must in some measure depend on the 
degree of Distortion, but cant be done to answer the 
intended purpose, before a certain Period.- Most
of the Children die, that are are born at or before the 
7th,, Month whether accidentally expelled or this excited
by act, therefore seldom should be proposed at that 
period, but will be much more likly to succeed if 
deferred till Pregnancy has continued 7 1/2 or
8 Months, but you cant do this with Propriety
except you know the exact Period of Pregnancy,
and to do this the Woman must be very accurate
in her Reckonings, and this may be done with 
the greatest certainty from the cessation of the 
Menstrual Discharge, if she has been regular
previous to that time.- Quickening is much
more uncertain, but that has been spoken of before.
The mode of bringing on premature Labour
is by evacuating the Waters, this is done by means
of the Stilet or a Catheter, you should pass your
finger up as a guide, and then pass this 2 to let up
the neck of the Womb, which is not yet compleatly 



201
obliterated, and Puncture the Bag of Water, not 
using any force afterwards to bring on Labour, but
this after some time (perhaps 2 or 3 days) will come
on.- You will know when you have punctured
the Bag of Water by its drilling away
Preternatural Labour.
In Preternatural Labour the Head comes away
the last part. These may be divided into two 
Classes, as requiring turning or not.-
The first Class will comprehend the Presentation
of the Feet, Knees or Breech, as the Child can 
pass thro' the Pelvis in that Direction.-
The second, comprehends the presentations of any
other Parts as the Arm Back &c. these requiring
turning before they can pass.-
The Presentation of the Feet being the most Simple,
shall first speak of that.-
In this case the Mouth of the Womb must 
be sufficiently dilated, or you will meet with considerable
Difficulty in compleating the Extraction
therefore never pull down 'till the Os. Uteri & external Parts is compleatly



20
202
compleatly dilated, for if this is not the case, when 
the Breech or Shoulders are at that Part they will
occasion considerable delay, and if it is the Shoulders
or head, the Death of the Child will be the consequence
as it cant Breath, and the communication with 
the mother is cut off.-
The Belly of the Child should be to the Sacrum
to alow it to pass with the greatest case, and if by the 
situation of the Toes you find this not to be the case
you should turn it in this direction in pulling down
by doing this as soon as you have got hold of the 
Thighs, not deferring it longer or you will find much
more difficulty in doing it.-
When the Parts are sufficiently dilated, you
must then take hold of the feet by means of a 
Cloth, and pull down gently, moving the Child from
side to side as you extend, when the Child is come
low down as for instance the Breech near the 
external Parts, you must not then wait for pain
but go on extending; and direct the Woman to hold 
in her Breath and force down, for if you wait
in this stage the Child will be lost from the Pressure
made upon the Navel string.- When you 
have brought the Child so low that the Shoulders



203
are approaching the external parts, you must
then bring the Arms down, one after the other, this 
must be done by passing up your finger and pressing 
upon the Arm at the elbow joint for the purpose
of giving the hand a sweeping direction over the 
face of the Child, when you have got one Arm
down, you must proceed the same with the other
and when both arms are extracted, you must
not then pull down, but pass the forefinger of 
one Hand into the Mouth, and take the Occiput
between two fingers of the other Hand, you have
them compleat command of the head, which
you must give 1/4 of a turn to make the Head
correspond with the long line formed by Cavity
between the Sacrum and Illium, but the Head
wont pass out in this direction, you must therefore
turn it back again, with the Face to the 
Hallow of the Sacrum, then by depressing the 
Chin you are able to bring the Head out without
much difficulty.-
There will be more difficulty attending this 
case if it is the first Child, more particularly
if the Woman is advanced in Years, in this case
you should wait 'till the Parts are more fully 
Dilated



204
Breech Presentation. This is when the presenting
Part is the Breech with the Anus in the Center.-
This should be distinguished from a Hip presentation
which wont pass, but which may be changed
into a Breech case.-
In this presentation the back of the Child
may be situated towards any part of the Woman
tho' the most favorable is when the Back of the 
Child is towards the Belly of the Mother.-
The situation may be know by feeling the 
Notes, and the opening between this; and the Scrotum
which somtimes becomes very much Distended 
by the pressure made upon the Abdomen, forcing
fluid down into the Tunica Vaginalis Testis 
When the Back of the Child is opposed to the 
Belly of the Mother, [and] and Both Child and Pelvis
are standard, if the Pains are sufficiently 
strong, Nature will frequently terminate the 
case without assistance, but when there is either
disproportion or deficiency of Pain, assistance
becomes necessary, and if the Child is near the 
outlet a finger may be introduced into the 
Groin, and gradually pulling Down first on 
one side and then the other; but the Breech is



205
situated higher up, a Blunt Hook may be used
acting first on one side and then or the other 'till
you can act with the Fingers.- You must go on 
in this way 'till you can grasp the Breech, which
you must do as soon as possible, and then go on 
pulling down 'till the Feet drop out and then the
case must be finished as in the Foot case.-
You must not attempt to pull the Thighs
out but kept going on pulling by the Breech,'till
they fall out of themselves.-
In applying the Finger or the Blunt Hook
in the Groin you must not act upon the Thigh
but upon the Pelvis of the Child above the Groin.
When the Pelvis is too narrow to admit of the 
Breech passing, you must pass up the Hand or
find the feet, bringing them down, and endeavour
to extract the Child singly, if this cant be done
the Head must be opened.-
When the sides of the Child are to the Sacrum
and Pubis if it is necessary to make any extension
by the Finger or Blunt Hook in the Groin
you must have the Axis of the Pelvis in view, and pull down
3 times as much in the back as in the forpart 
'till you can grasp the Breech, and then you
must do it and turn the Child with the back to
the Belly of the Mother which brings it to the first case. 



206
When the Back of the Child is to the Sacrum. In 
this case you should endeavour to bring the Child into
the first situation, by taking hold of the Breech as
soon as you are Able, and give it 1/4 of a turn, and 
in the course of a little time longer, another 1/4 turn, and 
which will bring the Back to the Belly of the Mother
and make it the same as the first case.-
In this case it might be adviseable to endeavour
to turn the Child with the Face to the Sacrum
before it has descend much with in the Pelvis, by means
of a Pain of long Forceps fixed on each Hip, and often
the turn was affected to take them off and proceed as 
in the first case.-
When one Foot presents.- This is to be managed
in part like a foot and in part like a Breech
case, by gradually extending &c. 'till the foot Drops
out, and then finish as before mentioned.-
When one or both Knees present. In this 
case you must draw down by the Thighs, 'till the 
Legs drop out, and then proceed according to the 
directions laid down for the foot case.- 



207
Turning.
Turning consists in passing up the hand to find
the Feet, when any other part presents, and is divided
into turning from Necessity and turning from Choice.
When turning from Choice is mentiond it must 
not be understood to be from caprice, but that in this 
case the Child might possibly be born without turn
yet, if the Child is turned, the Danger will be less.-
When neither the Head, Breech nor lower Extremities
present, then turning is required to affect Delivery, this 
is turning from Necessity.- In cases of this sort
it was the Practice of the Ancients, to take the Child
in Pieces, for the purpose of extraction, if they could
not by any means bring down the Head.-
Hypocrates directed the Woman to be shook, under
the Idea of changing the situation of the Child.- 
Ambrose Puree was the first who recommended the 
the turning the Child in cases of this sort by passing 
up the hand to find the Feet, much in the secure way
as now directed.
Tho' the Operation of turning is an improvement
it is not altogether without Danger in itself, more 



208
Particularly if proceeded about in a rough improper 
manner.- The Danger from turing is in proportion
to the Degree of Pain, and the shape of the Uterus
and direction in which the Child lays whether in 
a round or oblong form, for the rounder the Child
lays with the more ease will the the turning be effected.
Turing is somtimes thought proper when
the Head presents, here the concomitant Symptoms
must determine the propriety, these circumstances
usually are, unfavourable Situation of 
the Head. Flooding. Convulsions. want of Pains.
want of Room in the Pelvis.- Oblique situation
of the Uterus.- Prolapse of the Navel String with 
the Head.- These will be each considered separatly.-
In all these cases the head is supposed 
not to have entered the Brim of the Pelvis in any 
Degree, for if it has you must not attempt to 
turns but give assistance in another way, by the 
use of the Lever and Forceps.- You should likewise
have the parts sufficiently dilated before you
attempt to pull down.-
Unfavourable Situation of the Head. This may 
require turning if this cant be rectified, by means
of the Hand or Lever as in case of the Ear presenting
you may sometimes alter the presentation to the 



209
Vertex Case by acting on the Head with the Lever.-
Flooding and Convulsions. The propriety of turning
will be treated of when treating of these particular Subjects.
Want of Pain. This does not require turning if 
there are no unfavorable Symptoms come on, this may
be known by the Pulse and Strength, &c. and if there are
no unfavourable Symptoms you must wait and 
Nature after some time will be able to expel the Child.
With respect to the time you must wait, this depends
very much upon circumstances.- A Patient has 
been in Labour 2 or 3 Days, and during almost the 
whole of this time, the Os. Uteri has been considerably dilated,
but very little pains, these have then come on
and the Labour has soon terminated favourably.-
But if whilst you are waiting any unfavourable
Symptoms come on, and the Patient appears to be 
Sinking, you must then proceed to turn, or in case
the Head has entered the Brim of the Pelvis, the long 
Forceps will then be preferable.-
Want of Room. This is understood to be 
in a slight degree for if disproportion is considerable, 
it will be impossible by any means
to bring the Head away without opening. When 



27
210
the Disproportion is slight, Practioners say in
their Opinions respecting the propriety of turning
at all on that account, very few recommend
it, for the object of turning in this case is to save
the Life of the Child, and it will be a very difficult
matter to bring the head away soon enough to do this 
if you turn on account of Deficiency of Room.
In this case the Lever of Long Forceps would
probably answer better, and save the Life of the 
Child when turning would fail.-
Obliquity of the Uterus. Turning is very
seldom necessary on this account, as this may
generally remedied by changing the Position of the 
Woman so as to alter the bearing of the Womb.
Prolapse of the Navel String. When the 
Navel String comes down before the head of the 
Child, there are different Opinions respecting the 
propriety of turning, some Favour it and others
not.- In cases of this sort if you dont turn 8 in
10 of the Children will be Born Dead, and if you do 
5 in 10, this is understood as a general Rule. In 
certain cases it may be right to turn but if the 
Object is to save the Child, and not on account of 



211
any benefit to the Mother you should never turn
without a probability of Success, and the following
circumstances must be taken into consideration.
Whether the Child is alive this may be known
by the Pulsation of the Chord.-
Whether or not the Head has entered the Pelvis
if the Head has entered the Pelvis turning is out of 
the Question.
Pains Strong or not. If the Pains are Strong there
is an objection to turning, as the degree of force necessary
may injure the Woman, and the Life of 
the Child wont be saved.-
Rigidity of the Passages. If these are in a rigid state
this will prevent the head being extracted time
enough to save the Life of the Child, therefore the 
parts must be in relaxed State to admit of turning,
with any probability of Success.- **
You may sometimes feel the pulsation of the 
Chord before the Membranes are ruptured in this 
case you should endeavour to keep the Bag of Waters
whole 'till the os. Uteri and parts are compleatly
dilated, for whilst Membranes are whole
the Cord is not pressed upon, and it likwise alows
the Child to be much more speedily expelled after they



212
are ruptured.- When the Chord is come down you
should endeavour to put it to some part of the Pelvis
when there is most Room, or to put it entirely
up; if this cant be affected, turning may be then
admissible under certain circumstances before mentioned.-
No Practioner is justified in turning the Child
from any motives of convenience to himself.-
There are certain circumstances which affect
turning rendering more difficult or easy, according
as one or other take place, the Child will be turned
with greater ease according as it lays in a round
form, and more difficult as it form and that of 
the Uterus becomes more oblong.- Another circumstances
to be taken into consideration is want of 
Room in the Uterus, this may depend either upon
Waters having been off a great length of time or upon
the violent action or rigidity of the Uterus.
In these cases if the turning is from Choice
it is much better to be backward in doing it unless
the are pressing Symptoms, but if the turning is 
from necessity, it is then right to do it, but at the 
same time will be adviseable to mention the Danger 
to the Friends.- If the Patient is labouring under
certain Diseases, Phthisis, Fever &c. you should be 



213
backward in attempting to turn, except from necessity.-
When it is necessary to turn, you will always
do this to the greatest advantage, immediatly after
the evacuation of the Waters, and from this you will
perceive the necessity of ascertaining the precise
presentation and Situation immediatly after the 
Waters have been evacuated.
Whenever you have reason from any circumstances
to suppose turning will be necessary, you
should never be in haste to break the Bag of Waters,
but alow the parts to be sufficiently dilated before this 
is done.- In cases you may feel a part, which 
will indicate the necessity of turning, before the Bag
of Waters is broken, in this case alow the Waters to remain
'till the parts are sufficiently dilated, and
the membranes a ruptured immediatly pass your
Hand up, and if possible plugg up the Mouth of the 
Womb so as to keep in a Portion of the Waters, this 
will facilitate the Turning.-
When the Waters are evacuated before the Os. Uteri
is sufficiently dilated, and the presenting part
is not well adapted to effect this dilation, as for 
instance in the Back Presentation; you may then
assist the dilating process by passing up your fingers



214
fingers and acting as a Speculum, but this must be 
done with the greatest gentleness
Before attempting to turn the Rectum and Bladder
should be emptied, for if the Bladder is distended
there is Danger of its being ruptured.-
The Patient in all cases may lay on the left
Side, except in some few Instances, and the Parts
should be brought as near the edge of the Bed as possible.-
In some few cases the right Side may be another
more advantageous, this depends upon the Situation
of the Child, but very little benefit can arise
from the Patient being placed in the Hands & Knees 
as some have recommended, and this is in general
a Painfull Situation.-
The Child will seldom require turning before 
the 7th,, Month, but this will depend upon circumstances,
in saying this the Child & Pelvis are supposed 
to be Standard.-
With respect to the Hand most proper to be 
used, that will depend upon the Situation of the Child,
the Back of the Hand should always be opposed to 
the Bones of the Pelvis and the Palm of the Hand to 
the Child.- In passing up the Hand no great degree
off force should be used, but it should be done in a gentle 



215
gradual manner. When you are about to turn, you
should take off your Coat, and do this in way so as to excite
as little alarm as possible to the Patient, and rub
the Back of the Hand (and not the inside) with some oil
or Pomatum, to facilitate its passage.- 
When introducing your hand, this must be done
in a Slow and gradual manner, and if you meet with 
any resistance, you must wait a little to alow the 
Parts to dilate and attempt to overcome this by any
violent degree of force suddenly applied.- There will
generally be a considerable degree of Pain, when the 
Knuckles are about to pass the external parts, and 
when they have passed, somthing less and the wrist will
become grasped, on account of then being more Room
in the Vagina.- In this Stage you should put
your hand in a proper position for finding the 
Feet, the part to which they are situated should have
been well ascertained before, as on this depends the introduction
of the Proper Hand, and in the Proper direction.- 
In passing up the Hand you must 
take care it passes in contact with the Child and 
not on the outside of the Membranes, for these will
prevent you taking hold of the Feet, and will endanger 
the bringing on a Flooding by the Separation of 



216
the Placenta, you may know when your Hand is on 
the outside of the membranes by feeling the interposition
of the membranous Substance between your Hand and 
the Child.- The Uterus should be supported by an Assistant
whilst introducing your Hand, and you should
introduce the hand gently and during the absence of 
Pain, desisting from the attempt during Pain.-
If the Uterus acts frequently and strongly, a Dose 
of R [illegible] Opii may be of Service by lessening the Pain, both
in frequency and Strength, to produce this effect it 
should be given in a full Dose, from 30 to 50 Drops or
more, alowing time for this to produce its effect, perhaps
waiting an hour or an hour & half will be sufficient.
Shd the violence of the pains prevent turning immediately after this [illegible] 
-You should likwise take care to carry the 
hand sufficiently high to find the Feet, and to avoid
mistaking a hand for a Foot, this may be done by 
feeling for the Elbow, or the heel.- Take care likewise
that both feet belong to the same Fetus, this will
be in general the case, as each Fetus is mostly contained
in a separate Bag, tho' is not always the case,
you may ascertain this by passing your hand up
to the Perineum.- If you have only got hold of 
one Foot you should not draw down 'till you have
got the other, and when you have get hold of both 



217
you should draw down in a gradual gentle manner.- 
In some cases when you have got hold of the 
Feet and are attending to bring them down, the head
will descend at the same time, in this case you cant
leave hold of the feet to elevate the Head, but you
may pass a Fillet round one or both Feet, for the 
purpose of keeping them down, and the press upon
the Head so as to elevate it, and alow the Feet to come 
Down.-
In turning, the object to be kept in view is to 
bring the Belly of the Child to the Back of the Mother.
The Difficulties are sometimes such as you cant 
get the better off, so that you wont be able to turn the 
Child and Mutilation will be necessary.-
When you have brought the Feet down, past
the external parts the case must be finished as 
the Foot case.-
Application of the Rules to particular Cases.
The general principles already mentioned being 
perfectly understood, their application to particular
cases will not be attended with much Difficulty.-
As the general principles in all cases are the same
it will not be necessary to mention every individual
variety that may occur.- 



28
218
Back Presentation.
This requires training, and may be distinguished
by feeling the Spinous Processes of the Vertebra in
the middle of the Pelvis, and the Situation may be
determined by the different distances of these at the 
lower and upper part, as this is much greater towards
the Loins & Sacrum.- This in general is not 
a very difficult case.- The Peculiarity in the mode
of turning in this case, consists in conveying the 
Hand up to the Feet by crossing the Back.- In
this case the Back of the Hand should be opposed
to the Sacrum.- The Situation of the Feet must
determine which hand is most proper.-
In the Back Presentation, some have recommeded,
pushing up the Shoulders and alowing
the Breech to come down, but as pushing up
is always attended with Danger, this should never
be done.-



219
Arm Presentation.
If the water have been evacuated for any length
of time, and the Shoulder is wedged into the Pelvis
and at the same time the Pains are Strong, it will
be extremely difficult if not impossible to turn
the Child.- An Arm Presentation seldom requires 
turning before the sixth Month, but is generally necessary
at the Seventh, and somtimes earlier, therefore
particular enquiries should be made respecting the 
Stage of Pregnancy, and if no longer than the Sixth
Month, you may then take hold of the Arm and pull
down and the Head will pass in that Direction.
This is only a general Rule, as in this case the 
Head & Pelvis are supposed to be Standard, and as
there may be deviations on either side, these of course
will affect it, there for you should not rely wholly
upon the Stage but, but take other things into the 
account, as examination &c. make of the Woman
state of the Parts &c.- But in all cases if you
have the least doubt either in respect to the Stage
of Labour or Proportion, you should pass up the Hand
and find the Feet.- Somtimes a hand comes 



290
down with the Head, this is not a true Arm Case.
In this case you must not take hold of the hand
and pull, or you bring it to an Arm presentation,
but you must endeavour to raise the Hand up, and 
keep it up 'till the Head comes down and presents
its returning, perhaps the Lever may be of use here
in bringing the Head down more Speedily.-
If the head is small or the Pelvis large they will
somtimes pass in this direction together.-
But in case the hand becomes jammed in along
with the head and it will neither pass, and your are 
not able to raise it, it will then become necessary
to open the Head.-
A true Arm case is when the Arm alone
descends and when this was the case it was formerly
recommended to push the Hand up, under the 
supposition that some other part would descend, but 
this is bad practice and should never be done, for in all
cases there is danger from pushing up, of rupturing
the Uterus, and in this there is no advantage gained, you
must not likwise pull down by the Arm, except in case
of the Elbow presenting, when you may pull down the 
forearm to make more room to pass up the Hand.
In some case of Arm Presentation, the Child has
spontaneously turned in the Uterus, the Arm going up and 



221
the Breech becoming the presenting part, this is what 
is called Spontaneous Evolution, from this circumstance
Dr,, Denman recommended waiting to see if this would not 
be the case, but from its frequently failing and when
it did succeed the Child was almost always born Dead,
he afterwards restricted this to when the Children were
known to be dead, but this should not be done in any case
except the Child is evidently upon the move, for if you
wait any time the Shoulder of the Child becomes wedged
in the Pelvis so firmly, as to render turning extremely
difficult or impossible.-
In the Arm Presentation where the Shoulder is wedged
in the Pelvis, and the Pains are Strong turning is extremely 
difficult, in this case the Pains may be moderated by
full Doses of Opium, alowing sufficient time for them
to produce their effect, perhaps waiting an hour or an
hour and half, and endeavour to pass up your hand by
gently elevating the Shoulder, and in doing this the greatest
dexterity will frequently be necessary, always using
as little force as possible, in doing this the general Rules
respecting turning must be kept in View, and the Woman
must lay on the right or left side according to the 
situation of the Child, and this must likwise determine
the hand proper to be introduced.- The situation of the Child 



222
may be known by examining the Direction of the palm
of the Hand likwise, the Thumb and Radius, and you 
are not certain from this pass your hand to the bend of 
the Elbow and Axilla.-
In cases when the Difficulty is such as to prevent
your being able turn the Child and bring it away, it then
becomes necessary to mutilate the Child, this is called 
Embryotomy, and may be done by means of the Perforating
Scissors. The mode of doing this is by passing up the 
Scissors guarded by the Hand, and separating the Arm
not at the Shoulder Joint, but by taking of the Scapula
and then making an Opening into the Thorax and Abdomen,
to evacuate their Contents, this will make sufficient
Room to alow of the introduction of the Hand, which you
should do and extract the Child by the feet.
Before you proceed to do this all possible means to 
bring the Child away should be used, consistent with the 
safety of the Mother, if the Child is alive, but in case 
the Child is known to be dead, you may then do it without
so much Hesitation.-
In some instances after the Child has been turned
there will be difficulty in the extraction of the Body
this may be from Air or Water in the Cavity of the Ab



223
this may be relieved by a puncture made into the 
Cavity of the Abdomen.- Sometimes there will be difficulty
in the Extraction of the Shoulders, rendering the 
Blunt Hook necessary, but this should be used with 
great care if the Child is alive, but if dead, so much
caution is not necessary, and if it is great the Arm may
then be separated. 
The greatest difficulty is in the extraction of the 
Head in many cases, and arises either from unfavourable 
position or disproportion, the former of 
these is owing to mismanagement, in not attending
to the Rules laid down for turning, the latter is 
inevitable.- From this it will appear evident
how necessary it is to attend to the Rules.-
If the disproportion is slight, putting the Head
in the position best adapted to the Shape of the Pelvis, will
often effect the extraction, but in case it is in the 
degree so as not to be brought away by this means
some have recommeded long Forceps, but they can 
be of no use as sufficient force may be applied by 
introducing our finger into the Mouth and the 
other hand upon the Shoulder with the Finger on the 
Occiput, this gives you a sufficient command of 
the Head likwise.- If you cant effect the Extraction



224
Extraction of the Head this way it then becomes necessary
to open the Head by means of the Perforator..
If your are able to extract the Head, and there has 
been considerable difficulty, tho' the Child may appear
Dead, yet it may be adviseable to inflate the Lungs
by means of a Proper instrument.-
When it is necessary to open the Head, this must
be done by means of the Perforator, and the part
most convenient for this purpose is the Lambdoidal
Suture, and after the Brain is broke down, you 
may then extract either by extension, or by the introduction
of the Crotchet.- Some have recommended
separating the head from the Body in this case,
but this should never be done.-
In case the Head has been separated from the Body
it has been recommended to trust the expulsion to
Nature, but this cant be done with propriety, more 
particularly if there is Disproportion.-
When a case of this sort occurs, you should make
particular enquiry, whether the Difficulty has arisen
from Malposition or Disproportion, and if from Malposition,
and there is at the same time a Spasmodic affection
relieving that Spasm by means of Opinion, may alow the 
Womb to expel the Head.- Somtimes there will be a Spasmodic
constriction of the Mouth of the Womb, so as to compleatly



225
compleatly in close the Head, it would not be adviseable to 
overcome this Spasm by force, but to give a full
Dose of Tinct. Opii. and wait 'till it produces some 
effect, and then endeavour gradually to Dilate the part.
Different Instruments have been invented for 
the extraction of the Head, but very few of them are 
worth notice, one invented by Gregwaar, to pass into
the Foramen Occipitale, might be of Service when 
there was no disproportion and might assist in 
fixing the Head for the Use of the Perforator and 
Crotchet, which are the only means that will
effect the extraction where there is disproportion,
in using them you must fix the head, either by 
somthing passed into the foramen Occipitale, or by
pressure upon the Abdomen, and the lessen the head
by the Perforator and introduce the Crotchet, for the 
purpose of extraction.- It will somtimes be necessary
to pass the Basis of the Scull sideways if the Disproportion
is great.- You will have much firmer
Hold by the Crotchet, at the Basis, than if it was the 
Summit of the Cranium.- 



29
226
Twins.
Somtimes instead of there being only one Child
there, or 2 or more, have been 3, 4, and in one case
5 Children. When the management of Labour
where there is only one Child is perfectly understood,
that when there is twins &c. cant be difficult
to comprehend, as circumstances are much the 
same.- When there are more than one Child, the
Labour is in general easier, as the Children for the 
most part are less, tho' there have been some exceptions
to this Rule where there were two Children.
If there are 3 or more, the Woman is generally
delivered before the termination of the usual Period
of Pregnancy, as the Womb wont alow of that Distention
necessary for their compleat growth.
The symptoms which indicate the existence of 
Twins during pregnancy are very equivocal, as 
the size of the Abdomen, double quickening &c. as 
this extra enlargment may be from a greater quantity
of Water &c. double quickening not of any consequence
as it may be from the same Child moving
at these different times. There are other Signs mentioned
but which are of no consequence.- 



227
During the time of Labour, and before the Birth of 
the first Child, circumstances sometimes occur which
indicate the existence of Twins, as the presentation
of two Heads, their feet, or Anus &c.-
The time most proper to ascertain whether there
are Twins &c. is often the Birth of the first Child, either
by the Pains, or by laying the Hand on the lower part
of the Abdomen, or by examination internally by the 
Vagina.- It will seldom be necessary to examine internally,
as you may in general determine this by 
laying your hand on the Abdomen, if there is another
Child it will feel full and distended, if not, the Uterus
may be felt contracted in the middle of the Abdomen
in a round hard Body, this way of examination
is preferable.- If you examine internally you
may either feel some part of the second Child, if there 
is another, or the Bag of Waters, but you may possibly
be deceived in this last respect, by a collection of 
Blood &c.-
If you feel a second Bag of Waters you should
immediatly rupture this, as the purpose of alowing 
them to remain that of Dilating the parts, is not 
wanted, and as the parts are relaxed and dilated
by the passage of the first, the second will generally
pass with very little Difficulty, on this account it may 



228
in some cases be better to conceal their being a second
Child from the Patient and bystanders, as they may 
suppose there will be the same difficulty attending the
expulsion of this as the first, this you may do, under
the pretense of assisting the expulsion of the Placenta.
Different Opinions have been formed respecting
the management of the second Child, some have advised
immediate Delivery, others to commit the 
expulsion entirely to Nature, and others have advised
are intermediate Course, which is preferable.-
After the birth of the first Child you should immediatly
ascertain the presentation of the second, for 
it is necessary to turn, this can be done at this time
with the greatest ease, and in case of a presentation
which does not require turning and pains come on
the Labour must be conducted as in other cases.
If pains go off, some have recommeded waiting
'till the again come on, but this is not good practice
for the mouth of the womb may again contract, and render
the expulsion more difficult. Dr,, Louden in
all cases, often waiting an hour, tho' the head was the 
presenting part and no unpleasant Symptoms
cause on, always turned.- If unpleasant Symptoms
come on you must attempt Delivery sooner 



229
such cases as require turning in case of 
only one Child require it equally when there
are two or more.-
When all the Children are born, you must
then proceed to the extraction of the Placenta,
as this must not be attempted before, on account
of bringing on flooding &c. and occasioning
other bad effects.- The manner of doing
this is to take hold of the different Chords, together
and proceed as in other cases, taking care
not to invert the Womb.-
Monsters.
There are Fetuses, which differ from the common
form, and do so in different ways.-
The mode of formation is very obscure, and 
the causes which divert Nature from the ordinary
course of evolution are not well understood.-
They are frequently attributed to some effect
which has been produced upon the mind, during 



230
Pregnancy, but this is not at all probable, as
many of these happen when the different parts of the 
Fetus are fully formed, if ever it does it must
be at a very early period.-
A knowledge of the different forms of Monsters
is as full in practice, as they may somtimes
occasion a little embarrassment.- A Brainless
Monster may possible be mistake for one 
whose head has been opened, a mistake of this 
sort occured to a Practitioner, who supposed the 
Head has been Opened
Monsters considered relatively to practice
may be divided into such, as have deficiency
Redundency, Mal Formation and Mal Situation.-
Those that are Deficient can occasion
no difficulty in Labour, except in case of turning
being necessary when the Extremities are
wanting, if there are the lower ones, some embarrassment
will be the consequence, and it may be 
necessary to open the Head.-
When there is redundency, it may be a cause
of Difficulty. It may in this place be right to



231
mention that in case two Children adhere by 
there Chests, that the internal parts are common
to both, this to prevent any thing being done
by way of separation.-
Our circumstance which is favourable, is 
that in [cross out] most cases of monstrosity, there is a disposition
to premature birth.-
Deviations from the common Period of Birth.
Most Labour occur at the end of Nine Callendar
Months or 40 Weeks, and many happen before 
this time, but there are different Opinions, respecting
the possibility of this time bring exceeded.-
From the observation made upon Brutes
it is probable that this may take place in the 
Human subject, but to what extent it is extremly
difficult to determine, this subjects comprehends
a Question of Law relative to the Legitimacy of 
Children, but it is impossible to draw a line of 
Distinction, if the Period is protracted beyond the 



232
45th,, or 46th,, Week, it then admits of a Doubt.-
Premature Birth.
This may take place to any period of Pregnancy,
but as some of these Children live after
Birth, and others not, they are from this Distinguished
into Vital and non Vital, this is likewise frequently
a Question of Law, and on this account
the Line is generally drawn at the 7th,, Month,
but this admits of some Latitude both ways.
Pulsation of the Chord is a sign of Life in a 
Physiological View, but wont be sufficient in 
the other view of the subject.- If the Child cries
it is a certain sign of Life, and if it could be proved
to have breathed that may be sufficient.-
Miscarriages are supposed to occur more 
frequently at some Periods than others, as the 
6th,, Week or third Month, attending to this circumstances
and more particularly if the same Person
has repeatedly miscarried at any certain Period,
may be of some consequence, as by keeping the 
Patient cool and quiet, at that time, miscarriage



233
may frequently be avoided, and at the same 
time giving gentle aperients &c.-
When a Woman has repeatedly miscarried
she will often begin to despair, and there will
be in some reason an assisting cause of this 
taking place, and should by all means be removed
if possibly and for this purpose any thing may
be done to divert this either by way of Medicine
or any other way.-
The immediate cause of Miscarriage is 
the same as that of Labour, which is the contraction
of the Uterus to expel its contents, therefore pains from
Uterine contractions should either be moderated or 
removed.-
Miscarriage may be produced, either by separation
of the Placenta; premature breaking of the 
membranes from any cause, or any thing that only
occasion the Death of the Fetus, tho' abortion does 
not always immediatly follow the Death of the Fetus
as this may take place at a length of time, before 
it is expelled even 4 Months or longer.
Miscarriage from accident will sometimes occasion
a susceptibility to future miscarriages, when 



30
234
this is the case particular care should be paid
in avoiding any of the exciting causes, keeping
the Patient cool and quite and attending to the 
different Symptoms as they may occur.-
A Miscarriage sometimes is not preceded
by any considerable Discharge of Blood, at others it 
is, this is owing to the exciting cause, if it is from 
any thing causing a contraction of the Womb, as 
the rupture of the Membranes &c. there is [cross out] no 
large discharge of Blood, in this case the Uterus proceeds
the same as in Natural Labour; first expelling
the Child then the Membranes, but when miscarriage
proceeds from the Placenta being either partially or 
wholly detached, there is then considerable Hemorrhage
and the case is then much more dangerous than
the Former, and on that account merits particular
attention.-
Miscarriage preceded by a Discharge of Blood.
These are much more dangerous than the other
kind, and this in proportion to the stage of Pregnancy,
as the more advanced, the larger the Vessels
are and consequently the greater Danger.
The cause in this case is the separation of the 



235
Placenta either partially or entirely, when this is only
partial Miscarriage does not always follow, but 
great care in this case is necessary.-
The signs are a Discharge of Blood, taking place
at unexpected Periods, which will coagulate; with 
pain, bearing down &c.-
Some judgment is somtimes necessary to
discriminate between such discharges and the 
menstruations in the early Months of Pregnancy
but this may be done by attending to circumstances,
as whether it occurs at the periods when the 
Menses [wa?] expected, or is accompanied with 
pain or not, or whether the Discharge will coagulate.-
Menstruation very seldom occurs so late 
or later than the third Month, and shews no disposition
to coagulate.- Enquiry may likwise
be made whether the Discharge proceeded from
any accidental cause.-
It is usual to divide these as they occur in 
the early or late Stage of Pregnancy, the time between
the two is generally drawn at the fourth
Month.- Those which occur in the later Periods
of Pregnancy are much more Dangerous, tho' the
others are attended with considerable Danger.-



236
Treatment of Miscarriage in the early Stage.
When there are any Symptoms which indicate 
on approaching Miscarriage, the Patient
should be kept as much as possible in a Horizontal
position, and as cool as possible, the room
should be as cold as conveniently can be, and the 
Bed Cloathing very tight, every thing heating or
Stimulating should be avoided, it is a very common
practice to give Red Wine under the Idea
of its being an Astringent, but this is very wrong
as it acts as a Cordial and of course does injury.
Then somtimes comes on faintness, this should
not be removed by Cordials &c. as it is upon the 
whole a favourable circumstance, alowing the 
formation of a Coagulum, and that way preventing
a return of Hemorrhage except the 
action of the Heart becomes very much affected, and 
the Extremities cold, it may then be necessary to give
some Cordial.-
In some cases instead of immediatly giving
Astringents it may be necessary to take away
Blood from the Arm, but this must be determined
by the State of the Pulse and other circumstances. 



237
Nitre, Mineral Acids, Opium &c. must be given
according to circumstances.- A common remedy
is an Infusion of Roses with Nitre, this does not
appear a very eligable way of giving the Medicine on
the Acid of the Roses may decompose the Nitre, tho' as
it does so only in a small Degree, it may still be 
very serviceable, an Infusion of Roses with the addition
of Natron. Vitriol. is equally well adapted for 
the purpose and is not liable to that inconvenience.
Opium is serviceable only under certain circumstances,
as in case of great irritability, when it answers
best if given in small Doses and repeated frequently or 
2 or 3 Drops every 3 or 4 hours.- If there is no hemorrhage,
at may sometimes do good given in full doses.
Digitalis would appear likely to answer a 
good purpose under certain circumstances, but is
so uncertain in its operation as not to be adviseable.
When the flooding has ceased, the Patient shd,,
be particularly carefull to prevent a return
by attending to the Bowels &c. and by avoiding any
exertion. This mode of treatment in supposed
to be necessary and proper during a state of Strength,
but when the Disease has continued somtimes a



238
different mode of treatment becomes necessary, instead
of giving Nitre &c. Astringents rather of the Tonic
kind become necessary, as the Mineral Acids, or Alum
this last in Doses of from 4 or 5 grains to 8 or 10.-
Preparations of Lead are somtimes given, or Tinct.
Saturn. g tt,, xx. ad g tt, x4, or the Cariess. Acetat. gr, 76 ad
gr. i sal gr,, ii - iii; this in general should be joined with 
small quantities of Opium to prevent its affecting
the Bowels.
Frequent returns of Hemorrhage may 
lead to considerations on the propriety of promoting
Miscarriage, it is better not to do this except
Nature appears to tend that way, except under particular
circumstances, as the Bag of Waters having
been ruptured, or the patient very much reduced
by the discharge, when you may proper examination,
tho' it will be better to avoid this in the early
Stage.- If on examination you feel the Mouth of the 
Womb soft and dilatable, or the Membranes protruding
you may then introduce your finger and act as a speculum,
gradually Dilating the parts &c. but if you
find the Os. Uteri rigid and closed, it will be much
better to leave the case to Nature only making use 



239
of the proper means before mentioned. If on examination
you find the Ovum in the Mouth of the Womb
this is the actual state of Miscarriage, and you should
do nothing for a time except you have reason to suppose
there is an internal bleeding going on, in which case
you may attempt the removal to alow the Uterus
to contract.-
Various instruments have been invented for 
the purpose of Dilating the womb but they are very 
seldom wanted, and may often do injury if used, the 
fingers are in general quite sufficient, and answer
the purpose much the best.-
Some have recommended the application of Styptics 
to the os. Uteri by means of Plugs, this is what 
the French call Tampon these are very objectionable
as they might possibly cause the os. Uteri to close but 
at the same time alow an internal hemorrhage
to go on.- They might be serviceable after the expulsion
of the Contents of the Uterus, when it was not disposed
to contract.- A Patient has considerable Thirst
in general, Cold Water may be alowed, tho' it will
be better if acidulated, as in this case a smaller
quantity will be effectual, and which is adviseable  



240
If on examination you find the Ovum wedged in 
the Mouth of the Womb, and the hemorrhage has continued 
for a length of time, it may be right to endeavour
to bring that away.- It is not in general
necessary to stay with a Patient under these circumstances,
but to see her occasionally.-
You should always carefully examine all discharges
that come away for there will frequently be
Coaguli discharged, and which may be mistaken
for an Ovum.- You should always examine to 
ascertain whether there is a Cavity or a Membranous
substance which may have been the Cavity, if this is 
the case, it is a Miscarriage, but if it is perfectly
Solid, it then is a Coagulum.-
You should likwise examine to know whether
the Placenta is expelled, if not you must not 
attempt the extraction, but leave it to Nature, and 
correct the putrid Discharge which may take 
from time to time by means of antiseptics, as 
Decoct. Hord. in R a,, Myrrh. Decoct. Cort. Inject.
Vis. Rubr. &c.- The Placenta is somtimes expelled
with pains, at others not.-



241
Miscarriages in the latter Months.
The Danger from miscarriage in the latter Months
of Pregnancy, is much greater than that of the 
early Months, on account of the Vessels of the parts
being so much larger.- The Degree of Danger is 
in proportion to the quantity of Blood discharged
and its effects upon the constitution.-
Separation of a Part or the whole of the Placenta
is the cause of this, and which be either from accidental
causes or from the Placenta being attached 
over the Mouth of the Womb, or very near to it.
You may endeavour to ascertain the cause
of this flooding and may do so with a considerable
degree of accuracy by attending to the different circumstances,
as whether it has come on in consequence
of any accidental cause, or whether it has occured without
any such thing, as when perfectly at rest, or
in Bed.- If it arises from separation taking place
owing to its attachment, it will in general come on
about the middle of the 5th,, or 6th,, Month, as the Neck
of the Womb at that time begins to stretch, and not 
much before.- It will likwise be repeated at times
without any evident cause as Neck of the Womb continues



31
242
to Dilate.- If the Discharge is either violent or 
so often repeated, as have considerable effect upon
the constitution, you should examine to ascertain
the state of the Parts, if the mouth of the Womb is any 
ways dilated so as to alow of the introduction of one 
or two fingers, you may then distinguish whether the 
placenta is situated over the mouth of the Womb or 
not, if it is the Placenta that presents, you will
feel a fleshy substance, but if not, you will feel
the Membranes protruding.-
In cases of this sort all the different means 
of stopping the Hemorrhage in the early months
must be had recourse to according to circumstances,
and if the discharge is either checked or stopped
great care should be taken to prevent a return.
If the discharges continue or are so often repeated
as to weaken the Patient very much, it then becomes
a question respecting the propriety of bringing on Delivery,
and which should not be deferred to long or the 
Woman may not have sufficient strength carry her
thro'.- Delivery may be brought on two ways
either by inviting natural Labour, or by the 
more active practice of turning, the violence
of the Hemorrhage, Disposition of Parts, and state 
of pain, will have very great influence in the 



243
determination of the mode most proper.- They 
way to invite natural Labour, is by passing up
the finger to the mouth of the Womb, introducing
one or two of them and making gentle pressure, and 
it the same time acting in a gentle manner as 
a Speculum, this way endeavouring to excite
the Womb to action.- You will somtimes feel
the Bag of Waters protrude, and when this is the 
case you should rupture them, which may be 
done with much propriety sooner than in natural
Labour when there is no hemorrhage, as you now 
want to reduce the size of the Womb, and doing 
this by evacuating the Waters has in some instances
been sufficient.- But in some cases there
is such a Degree of debility as to prevent the 
Womb from be able to expel its contents, in this 
case it becomes necessary to have recourse to 
more active means, that of passing up the hand 
and bringing down the Feet.- When the Hemorrhage
is more violent, as in case the Placenta
is attached over the mouth of the Womb, you must
not then wait for the bringing on natural Labour
but deliver as soon as possible without using violence 

After the Child is extracted, the Placenta must be 
immediately brought away, to slow the Womb to contract
speedily as possible.- 

244
pass up the hand and turn.- The center of the 
Placenta is not always immediately attached
over the Mouth of the Womb, somtimes only a small
portion, in this case the Danger is not so great, but 
when the middle of the Placenta is attached, it is 
then an extremely dangerous case, when this is 
the case you must not attempt to separate the 
Placenta from the Womb, for the Purpose of alowing
the introduction of the Hand, [illegible] that would be multiplying
the number of Bleeding Orifices; and under
the case of the Woman more dangerous but you
must pass your hand thro' the Substance of the 
Placenta to the Feet.- In these last cases the 
Child must necessarily be destroyed by the loss 
of Blood.- Manual assistance may somtimes
be necessary before the Uterus is of a sufficient size
to alow of the introduction of the Hand, as at the 3d,,
or 4th,, Month, in this case you may puncture the 
Bag of Waters by the use of the Stiletto or a Catheter, and
Labour will in general come on in the course of from
one to three or four Days.- It will be necessary to 
alay the irritability which will be produced, by
means of opiates occasionally, but there wont be 
than degree of irritability produced in the early as in 



245
latter periods of Pregnancy.-
Flooding after Delivery.- This is often the 
consequence of an inert condition of the Uterus, and
cannot in many cases be trusted to Nature with 
safety, if upon laying your hand upon the Abdomen
you dont find the Uterus contracted, you may in
many instances excite this gentle pressure upon
the Abdomen, or you may apply Clothes wetted in 
cold Water to the Abdomen.- The common mode of 
applying Clothes moistened in Vinegar and Water
to the external parts is injudicious and often does
injury by causing excoriation, and as the action
of this is not from any astringent property independant
of its coldness, cold water will answer way
purpose and that applied to the Abdomen, as near
the part affected.- It very violent cases it has 
been recommended to throw cold Water into the 
Cavity of the Uterus by means of a proper Syringe
in want of which a long Glyster pipe might answer
the purpose.- You may likwise endeavour to 
rouse the Womb to action by passing your finger
the the Os. Uteri and making pressure, or by passing
passing your hand into the Cavity and recovering it round
[cross out] 



246
[cross out]
[cross out]
[cross out]
[cross out]
[cross out]
Flooding does not always come on immediately
after Delivery, but in some cases occurs 3 or 4 Days
or even a Week or two after Delivery, if this is not owing
to some accidental cause, there is great reason to 
suppose the Uterus is in a Diseased state.-
In flooding after Delivery the usual remedies as 
in other cases must be had recourse to according 
to circumstances, as Infus. Rosa. Carcess. Acetat.
Alum in &c.- It is somtimes the case to give the 
Infusion of Roses, joined with Carcess Acetat, under
the Idea of their assisting each other, but this is not 
the case, as the render is each other less usefull by their 
combination.- A degree of faintness frequently
comes on, and which should not be obviated except
when in an alarming degree, as it is upon the whole
rather a favourable circumstance, alowing the Vessels
to form a Coagulaum &c.- If in a very alarming degree,
a small quantity of some Cordial may be 
given and repeated according to circumstances.-



247
The plugg or Tampons has been recommended
in these cases, but does not appear to be well adapted
as it may act as an Astringent to the Neck of the 
Womb causing it to contract, and alowing an internal
bleeding to go on.- The way it may be 
applied is by means of a piece of Spong, and which 
may be moistened in any astringent Liquid.-
Pain of the Head connected with Flooding.
This is the effect of [ina??ition] and usually continues
'till that state is removed, consequently any 
medicine for its Cure will be of little Service, but 
the best mode of attempting its removal is by 
giving nourishing food, and in small quantities
and frequently repeating it, according as the Stomach
will bear it.- Leeches to the Temples do have, tho'
a Blister may afford some relief.-
Excessive Restlessness. This is another consequence
of violent flooding, and is extremely Dangerous, 
some few have recovered when this has 
been only in a slight degree, tho' it is generally
a Symptom of approaching Death, it marks a very 
high Degree of Depletion.- In cases of great loss 



248
of Blood, transfusion might be of very great Service,
if not for prejudice, as the Blood should be 
Arterial, it cant be taken from the Human Subject, 
but might from a Sheep, by laying bare the
Carotid Artery, and introducing one end of a Tube
and the other into the Saphena Vein, and in 
this way a portion of Blood might be introduced.
In great loss of Blood upon other occasions
the practice might be serviceable.-
Fevers connected with Parturition.-
Any fever which is Dangerous when occuring at
other times is more particularly so now, those
attended with the least danger are intermittants,
tho' there are some few exceptions to this, as in case
there is a considerable degree of Stupefaction &c. showing 
a considerable determination to the Head, this
often proves fatal, at the 3d,, or 4th,, attack, in this
case, actives means must be employed and then
early.- The Distinct kind of small pox as 
having but little Fever, is not exceeding Dangerous,
tho' the confluent is attended with considerable 
Danger.- In all Fevers the danger is agravated
by parturition, for if the Fever is of the low Typhus 



32
249
kind, the loss of Blood would do injury, and there
is generally a considerable Discharge attending Delivery.-
If the Fever is of the inflamatory kind
the violent exertions increase the inflamatory
affection.-
Delivery is not consequently rendered more
difficult by the presence of Fever, some think it 
either rather more easy.-
When there is Delirium, the progress of the Labour
should be diligently attended to, for when there 
has been Delirium, the Child has been expelled, without
the knowledge of the Bystanders, therefore particular
attention should be paid.- After Delivery
has been effected during the presence of Delirium, this 
will frequently subside, and the patient appear
better, but in many cases this is only transient,
and the patient very soon begins to sink, and 
Death follows. Speedily
The general treatment of Fevers will be the 
same as under other circumstances.-
Convulsions. These are particularly
Dangerous during Pregnancy.- They exist under
to different forms, Acute and Chronic.- Convulsions
must be distinguished from Hysteria.- The cause 



250
Convulsions has been referred to two opposite
conditions of the Body, namely Plethora and Inanition,
but there dont appear sufficient without a
certain degree of irritation.-
When Plethora is the cause Bleeding &c. will be of 
Service, if the Plethora is general, but it somtimes is
local, consisting in a determination to some particular
part as the Head, in this case the application
of Leeches, Cupping &c. will be of Service, and this
by way of preventative, a perature is an indication
of their approach by Vertigo, &c.
If the cause is from inanition, it is then 
much more dangerous, as this is much more difficult
to remedy, it must be attempted by means
the most nourishing kinds of food given in small
quantities or as the Stomach will bare it, and frequently
repeated.-
If Convulsions arise from irritation, the 
cause of that should be removed if possible, but the 
seat of that irritation must be first attended to, if 
the seat of irritation is in the Primæ Viæ, the 
exhibition of an Emetic, and afterwards clearing the 
Bowels, by a gentle Purgative or a Glyster may be of 
Service, afterwards giving Tinct Opii. Assa Fœtid.
or different kinds of Antispasmodics may be of Service



251
or Some of them as Opinion or Assa Fœtida may be 
given in the form of Enema.- The warm bath may
occasionally be of Service, and as this takes some time
in preparing it will be always right to have this 
in readiness early.- If the seat of the irritation is 
in any other part that must be attended to, if from 
Distention of the Bladder, the Water must be drawn off.
If the Uterus is the seat of irritation, it may in
right in some cases to bring on delivery, as in 
case this is much danger apprehended to the Life 
the Mother, from former Labours &c.- If on examination,
you find the Os. Uteri relaxed, and a Disposition
to Labour, this may be improved, but should
be done by the gentlest means possible, for there is 
frequently great injury done by using to much
force.- Even if there is no Disposition to 
Labour if you have ascertained the necessity or propriety
of bringing on premature Labour, making 
gentle and persevering attempts will generally succeed,
at the same time assisting the relaxation of 
Parts by different means as warm glysters throw 
into the Rectum.- Advantage will be gained by 
the early Rupture of the membranes.- During the 
convulsions it will be right to interpose some substance
between the Teeth to prevent the Tongue being injured.



251
Convulsions during pregnancy are very
frequently fatal, the Danger is in proportion
to their frequency of recurrence and Degree of 
Violence.-
When Convulsions are so violent & frequent 
as not to alow of any lucid interval, there is great
reason to suppose a Determination to the Brain
to be present, in this case you should endeavour
to make a Derivation, by purging &c. only opening
the Jugular Vein.-
Extra Uterine Cases.
These do not terminate by the common Passages
as other kinds do, but somtimes from an Abscess being 
formed in the Abdomen from which a Putrid Fœtus or its 
Bones are discharged; eithr by Nature or Art at other times these Bones escape
by the Rectum, from this being ulcerated Through.
Extra Uterine cases are of three kinds, namely
in the Fallopian Tubes, Ovariae, and Ventral case.
The way the Ovarian is formed, is by the Stimulus
of impregnation being given to one of the Vesicles of 
De Graaf, but which does not escape from the Ovarium
but goes on evolving itself.- When the Vesicle of impregnation



253
impregnation escapes from the Ovarium, but instead of 
being embraced by the fimbriated extremity of the Fallopian
Tube escapes into the Cavity of the Abdomen, it attaches
itself to any part it comes in contact with, the Vessels
of the Maternal part of the Placenta, in osculate with
the Vessels of that part, and evolution goes on.- 
When the Fallopian tube is the seat, it arises from 
the ovum being detained in that part, and evolution
takes place as before.
Mun 4th, kind
Evolution goes on in their cases 'till about the 
usual period at which time pain and the usual
Symptoms of Labour come on, but this does not advance,
these recur at times, but after some time, they 
entirely cease, the enlargement still continuing.
When the Child is contained in the Uterus, when the 
Symptoms of Labour come on at the usual Period
of the Child on any account cant be expelled, or attached &c such
Symptoms come on as inevitably end in the Death
of the Woman, therefore whenever even the Symptoms of 
Labour come on, and then after a time subside, and 
go off entirely, it must then be an extra Uterine case.
Somtimes during Labour, the Child will escape
thro' the Uterus or Vagina into the Cavity of the Abdomen,
a case of this sort occured, and when the Child afterwards



254
afterwards remained afterwards for upwards of 40 Years,
on examination after Death the Child was found in 
an Ossified State.- If a case of this sort was to occur
it would be right to pass up the hand after the Child, and 
endeavour to bring the Child away by the Feet, tho' the 
Woman most probably would Die.-
A Woman may live with an extra Uterine Case
for Years, and it afterwards be discharged either by the
ways before mentioned, or by an Operation which consists
in cutting into the Cavity containing the Child, and 
extracting it, afterwards closing the Wound by Sutures.
The Child does not continue to increase in size
after the 9th,, Month, at which time it becomes Dead.-
In cases of this sort you should never attempt to 
extract the Child by an incision 'till Nature appears
to point that way, by the formation of an Abscess as then
the Cavity is circumscribed, and Air is not admitted
into the Cavity of the Abdomen.- This Operation has 
been called the Cesarian Operation but improperly-  



255
Cesarian Operation.
The true Cesarian Operation always supposes one 
incission made into the Uterus, and may in some cases
be necessary both in the living and Dead Subject.
When the Woman is dead, if the Operation is 
performed it should be done immediatly, or the Child
will likwise be dead.- It is useless to perform the 
Operation in this case before the 7th,, Month of Pregnancy.-
In some cases where the Woman has died
suddenly undelivered, the hand has been passed up the Vagina
and the Child extracted by the Feet, if this is done it 
should likwise be done immediatly.-
In the living subject the Chances of compleat
success are very few, and therefore it should never be 
proposed, where delivery by the Natural Passages is possible.-
Different causes have been assigned for the frequent
failures of this Operation, as the admission
of Air &c. this cant be the case, as air is not found
to produce so much injury, when admitted into any
Cavity as has formerly been supposed.- As Death
in general take place in the course of 24 hours, it as



256
to be owing either to loss of Blood or to the Shock which
is given to the System and from extravasation into the 
Cavity of the Abdomen &c. 
Different Parts have been recommended for the 
incission, as towards one side, but the Epigastric 
Artery would be divided.- The best part for the incission
is in the course of the Linea Alba.
The incission should be begun at or rather above the Navel, and 
extended downwards 6 In. the external incission may 
be rather more, but that thro' the Uterus should be 
only 6 In. in length.- It is rather unfortunate when 
the Placenta is attached to the anterior part, of the 
Uterus, if there is a considerable portion attached
it may be better to make the incission directly thro'
it, but if only a small portion, it may be adviseable
to separate it.- When the Uterus is laid bare
you may possibly find somthing which may indicate
the attachment of the Placenta when before in 
this case making the incission rather to one side 
may be adviseable.-
The Bladder should be emptied before the incission
is made.- When the incission is made the hand 
must be passed, and the Feet takes hold off.- There 
will somtimes be difficulty in extracting the Shoulders.



33
257
the Head must be placed in the most favourable Position
and Head, on this account no time should be 
alowed for the Uterus to contract.- After the 
Child is extracted, the Hand must be again introduced,
for the extraction of the Placenta.-
The external Wound should be then closed by means
of the Quilled Suture, but the Ligatures should by no 
means be passed either thro' the Uterus or Peritoneum.-
A Very slight Bandage must be used.-
After the Operation an Opiate must be given, and 
which should be repeated from time to time, joined
with other remedies to allay the irritation, and occasionally
Laxatives, Glysters, fomentations &c.-
Section of the Symphisis Pubis.
This has been proposed as a Substitute for the 
Cesarian Operation but is only an imperfect one 
and is now fallen into neglect. 
In case any advantage was gained in respect 
to Room, the soft parts were so much injured,
as to almost certainly destroy the Patient.



258
Treatment of Women after Delivery.
When the Woman is delivered, that is when the Child
and Placenta are expelled, all moisture should be 
removed by means of Cloths, and a Cloth wrung
out of Warm Water applied to the Perineum, and 
another under the Breech.- The woman should
lay some little time perhaps 1/2 an hour, but this 
must depend upon circumstances, if there is flooding
she must remain a greater length of time, before
she is put to Bed.-
It is right to examine the different portions
of Placenta, is this has come away in detached
portions, comparing the to Satisfy the Nurse and 
attendants.- It has been usual to pass a Bandage 
round the Abdomen, but this should only be 
a Simple Napkin.-
The Room &c. should be kept moderately cool
not so hot as was formerly done.-
The Diet should be Simple, nothing either in 
form of food or Drink that is Strong should be alowed
for the first few Days.-
If either from any irregularity or from other 
causes, any unpleasant Symptoms come on 
purging will generally be found preferable to 



259
Bleeding. Always determine the necessity of the Bleeding
befor you attempt to do it.- The Bowels should
always be kept moderatly open by means of some 
gentle Laxative.- Opium will occasionally be 
Serviceable to alay irritability, but will generally require
either to be joined with Aperients, or those to be 
occasionally given.-
After Pains.
These arise from the contraction of the Womb, and 
continue to take place 'till that is compleatly
affected.. After pains should distinguished from 
Pains arising from other causes, as from internal
inflamations of Different parts, namely Enteritis, Inflamation
of the Uterus, Puerperal Fever &c. and this 
may done by attending to the Different Symptoms
after Pains, recur at intervals, [cross out] the Pain arising
from inflamation is constant, and the Pulse are affected.
In Pain from costiveness the Pulse may not be affected
yet the pain is more constant.-
Women who have had several Children have the 
after pains more violent.- The usually continue about
2 or 3 Days.- The treatment is generally by Opium 



260
but which is better joined with Aperients, more particularly
if there is costiveness.-
Symptoms of flatulent Cholic sometimes
attend, in this case Carminatives and Aperients
or Carminative Glysters may be Serviceable, and 
afterwards Opium
Lochia.
This is a Discharge which takes place from the 
Uterus after Delivery, and arises from the Vessels
of the Uterus which communicated with the Maternal
part of the Placenta.-
The Qauantity and duration of this Discharge
is very variable, in general it continues about 10
or 12 Days, but you must judge whether the Discharge
is too excessive or continues too long by its affect upon 
the constitution.- If the quantity is such as to produce
some unpleasant affect upon the Constitution
you must must then endeavour to check it either by
astringents, or if it arise from any other cause as 
Cough, that cause must be attended to, and the 
treatment must be the same as in flooding after
Delivery.- In some cases flooding will come on 



261
several Days after Delivery, when this is the case there
is great reason to suppose a Diseased State of the Uterus
to be the Cause.-
Women are Somtimes alarmed if the Lochia, become
suddenly suppressed, but if this does not arise
from any particular cause, as inflamation &c. [??ed]
is not followed by unpleasant Symptoms, it is of 
no consequence, but if it is caused by or is accompanied
with Symptoms of inflamation, those must be 
attended to.- Before you proceed to take away Blood
it will be generally right to give a Purge, and that 
alone will often be sufficient.- 
Somtimes the Lochia will only be suppressed
for a short time by a Clotter of Blood stopping up the 
mouth of the Womb, the Uterus be be excited to act for the 
expulsion of this, and the Lochia will then again flow.
In some cases of Stoppage of the Lochia, a discharge
of another kind will take place, which supplies its place.
The Discharge is at first composed of Blood, but it 
gradually changes, and after sometime only tinges the
Linen of a Pale Red, and afterwards of a Greenish Colour
and it then very soon ceases altogether  



262
Inflammation of the Uterus
The Symptoms of this are pain below the Navel
taking place the second or third Day after Delivery
and which has no intermissions.- If Pressure is 
applied, it gives considerable pain, and there is a 
considerable Degree of Fever and this of the Acute kind
attended with a Suppression of the Lochia.-
It may arise either from violent Labour or 
improper management, perhaps in the use of Instruments.-
A gradual Diminution of Pain, and return
of the Lochia, are favourable Signs
The Treatment in this complaint must be of 
the active kind kind and early employed, or Death
will take place.-
Bloodletting must be had recourse to early
and occasionally repeated according to the Constitution
of the Patient, not alowing to long intervals between
each evacuation, also Leeches may be applied to 
the Abdomen, and a Blister will somtimes be adviseable,
also fomentations &c. The Bowels must be 
kept freely open, and the Patient kept upon the strict
antiphlogistic Plan.- Before you proceed to this 



263
active mode of Treatment, you must be certain of 
this being the Disease, and that it is not from irritation.-
If you have any Doubt it may be better to 
give a Purge, and take away a small Quantity of Blood,
and from this you may be enabled to form a judgment
with more certainty.-
Puerperal Fever.
This term, if literally employed, might comprehend
any fever happening in the Puerperal State,
but is is used to denote one particular form of fever
which only occurs at that time.
This Fever is attended attended with, Pain in
the Head, and intense Pain in the Abdomen, and is 
contagious.-
The Abdominal pain should be distinguished
from arising from other complaints, as Distention
of the Bladder, Cholic, After Pains, Enteritis, Inflamed 
Uterus &c.-
You may know whether the pain arise from 
distention of the Bladder by the introduction of the 
Catheter or by other circumstances, and likwise from
Cholic by attending to circumstances.- After pains  



264
intermit at times, which is not the case with pain
in Puerperal Fever, tho' it suffers slight remissions.
After pains may be accompanied by accidental 
Fever.-
In Enteritis there always considerable Difficulty
in procuring Stools which is not the case, in Puerperal
Fever, as there is often a Degree of Purging.
It is more Difficult to distinguish between this complaint
and Inflamation of the Uterus, but by attending
to all the circumstances you may generally distinguish
between the two, in the Puerperal Fever
the Lochia are not suppressed, which is the case 
in inflamation of the Uterus.- The mode of attack
in the two complaints is different.- The Pain is often
in a different part, as in Puerperal Fever the Pain
may be in any situation which is not the cas in 
Inflamation of the Uterus.-
From many facts it is proved that this Disease
is contagious, and sometimes very actively so, no 
Women except those in Puerperal State, are liable
to be affected by it.-
The attack is by a Rigor followed by a Degree
of feverish heat, and pain in the Abdomen.
The Disease is not always equally contagious
often depends upon the mode of Life, Situation &c.



34
265
In many instances when a Practitioner has 
been attending a Patient Labouring under Puerperal
Fever, and is immediatly called to a Woman in Labour,
the complaint has been communicated.-
The commencement of this Disease from the 
time of Labour is various, generally on the second
or third Day, sometimes as late as the fifth, and
has been observed much later, even a late as a Month.
The attack is by a Rigor attended with Pain
in the Abdomen, the Rigor after some time goes off 
and is succeeded by pain in the Head and feverish
Heat.- 
The Duration is very indefinite, it has terminated
fatally in 36 hours after the attack, and 
as late as the 9th,, or 10th,, Day, in generall if it continues
'till the 6th,, or 7th,, Day the Patients recover.
The Peritoneum is the seat of inflamation, and 
has been found in all the Different Stages, as that 
of adhesion, in one part in others, effusion, and Suppuration,
and the seat of the Pain will be various
according to the seat and stage of the inflamation.
Different Writers have described the Pain to be in
different situation, they may have all been right, as 



266
the situation will vary according to the situation
and stage of the inflamation.
Prognosis.- This is always unfavorable, but
not at all times equally so.- A Very quick Pulse
with much tension of the Abdomen indicate extreme
Danger.- What in other fevers would be considered
a quick Pulse is in this rather slow, as 120
in this Disease the Pulse are of often 140 or 160, or even
so quick as not to be numbered distinctly.-
In this complaint the Pulse assist more in 
forming a judgment than in most others, if the 
Pain abates it is not of much consequence except
there is an alteration of the Pulse likewise. A sudden
cessation of Pain that has before been violent, unless
attended with a favourable Pulse, should be regarded
with Distrust.- It is a favourable sign when
quickness of Pulse and degree of Pain, gradually abate.-
Delirium very seldom attends this complaint
tho' there is such great quickness of the Pulse, the 
mind being generally tranquil.
Treatment. Different and opposite modes of 
Treatment have been recommended in this som 



269
complaint, some strongly recommending Bleeding
others condemning it.- In cases where active Inflamation
exists, with a degree of strength in the constitution,
Bloodletting is proper and should be taken in
rather a large quantity and in the early Stage, but 
if there is a Degree of weakness and the complaint is
more advanced, it will then be injurious, but this 
must entirely depend on the nature and Stage of the 
Complaint and the Patients constitution.-
Dr. Gordon of Edenburgh says that in all cases
when the Patient was bled to the quantity of 20 oz.
early, they recovered, and another respectable Practitioner
says that in all cases when bleeding was 
employed the Patients Died.- It will be right to 
take away a small quantity and this will assist
in determining the Propriety of Bleeding more freely.-
Local bleedings either by Leeches or cupping
may be had recourse to with advantage, but 
as the inflamation is only a consequence not
a cause of the Fever, it must be attended to only 
secondarily.-
Vomiting is strongly recommed by the French
Practitioners, and certainly always affords relief, it 



268
always be employed early, and is best given in
repeated Doses so as to produce the full effect,
Ipecacuanha answers the Purpose best.-
Somtimes a spontaneous vomiting of a Dark
grumous Matter comes on, when this is the case
the Patients generally Die.-
Purging has been strongly recommended
and may frequently be given with advantage
the purging should be kept up by giving the 
Medicine in repeated Doses so as to procure
5 or 6 Stools Daily, a good purge a a Solution of 
Natron. Vitriol. in Aq. Mentha. A good Rule
for the exhibition of Purges may be to give so 
long as the Patient is relived and not weakened.
Somtimes a Spontaneous Diarrhea comes 
on which relieves very much, on which account
you should never be in parts to check any thing
of that sort which takes place, except it weakens
the Patient, then you may moderate or Check it.
Blisters to the Abdomen may be of Service
and should not be to small, and should be 
applied early.-
If the disease changes from the inflamatory
kind, and puts on Symptoms of Typhus, the 



269
mode of treatment must be changed, Medicines
of the Cordial Diaphoretic kind may be had recourse
to as Camphor &c. or Wine, and Bark, somtimes
rather freely, in the advanced Stages of the complaint.
Attention must likwise be paid to the 
Palliation of Urgent Symptoms, as Pain, by
Fomentations, Anodyne Liniments, Rubefacients
&c. a Liniment composed of Ol. Olivar. ℥i Camphor.
ʒij R a,, Opii ʒij M. will often relieve.- The Warm
Bath is not adviseable on account of its disturbing 
the Patient so much.-
Sickness and Vomiting may be relieved by 
Opium, or the Saline Draughts in the State of 
effervescence 
Milk Fever.
This comes on about the second or third Day 
after Delivery, with Rigors and other Febrile Symptoms,
attended with a Painfull Sensation of the 
Breasts, all which are abated by a Discharge of the 
Milk, hence the remedy is Obvious, and the Child
should be put to the Breast, as the first Discharge of 
Milk is proper and Serviceable to the Child.-  



270
If during the cold Stage any thing hot or Stimulating
is given, a considerable Degree of Fever will
be excited, and will render the exhibition of Purge
necessary.-
Many Women dont wish to give the Child the 
Breast but want this Milk repelling, this is sometimes
effected with care and safety, at other times
not. When this is wanted to be effected, you shd,,
act moderately upon the Bowels, procuring 4 or 5
Stools daily, and ordering a low Diet, and the application
of some simple Plaster to the Breast.-
It will sometimes be necessary to take small
quantities of Milk away by means of proper
Glasses &c. or the Thinner parts being absorbed, will
leave a portion inspissated, this causing irritation
will bring on a Milk Abcess.- When Inflamation
takes place a few Leeches may be applied &
the Saturnine washes.-
Somtimes inflamation will put a stop
to the Secretion of Milk.-
When by the application of Leeches, Saturnine application,
Purging &c. you cant subdue the inflamation,



271
inflamation, you must have recourse to poultices, to 
forward Suppuration, and evacuate the Matter
by means of an Opening when formed.-
This Disease very seldom terminates in Cancer.-
Soreness of the Nipples. This is relieved or 
cured by washing them with Brandy or a Weak
Solution of Alum.- wearing Leads &c-
Swelling of the lower Limbs
This is an œdamatous swelling of the lower Limbs
which comes on after Delivery, which begins at the 
Groins and extends downwards to the Feet.
The complaint may attack either one or both
sides.
The time of its commencement from delivery 
is variable, may come on in the course of a Week, or 
two, and has been as late as 6 or even 9 Weeks.-
The Limb in the beginning is œdamatous, but 
after the Disease has remained some time it looses
its softness, and becomes considerably more hard.
The cause of this Disease is inflamation and 



272
obstruction of the Lymphatic Glands about the Groin
and Poupart's Ligament, probably owing to some portions
of Blood remaining in the Uterus, which becoming
Acrid, Stimulate the absorbents, causing irritation, and 
inflamation of the Glands situated about the Groin.
The Disease has been distinguished into mild
and violent according to the Symptoms.-
The Hardness which takes place after a time
is owing to a quantity of coagulable Lymph, which 
is thrown out becoming inspissated.-
Success in the treatment of this Complaint, depends
on the early resolution of the inflamation, rendering
them pervious to the Passage of the Lymph
and afterwards to invigorate them by means of 
Tonics and Stimulants.
In the early Stage Leeches applied to the Part
and other means of reducing the inflamation
may be applied.- Purges may be frequently administered
with advantage.- Emetics likwise from 
the goods effects in other cases of a Similar Nature,
as Hernia Humoralis, may be employed with advantage, 
and should be given in full Doses.-
When the Disease is more advanced and a Degree
of Hardness has taken place, you must then have recourse
to a different mode of treatment. Ungt Hydroy.



35
273
Fort. rubbed in upon the lower extremities will be of 
service, and this may be done with great freedom
without producing any effect on the constitution, on account
of the impervious state of the Vessels.- If the
Mercury does affect the Mouth it is upon the whole a 
favourable sign, shewing that the Vessels are not entirely 
obstructed.- In this stage of the complaint, Pulv.
Ipecac. Comp. may sometimes be given with advantage.-
This Disease very seldom terminates in Suppuration
tho' it does somtimes, this should be prevented if 
possible, for if an Abcess bursts, it is extremely difficult
to Heal, and there are many abcesses generally form, and
this repeatedly for a length of time.-
Laceration of the Perineum.
This is much less disposed to Heal than an incised
Wound in the Same part, yet the attempt should
be made.- You must keep the parts in contact as 
much as possible, by passing a Roller round the 
Thighs, as neither Sutures not adhesions can be 
made use of with propriety, or advantage.
Some gentle stimulant application may be made 



274
use of to promote the growth of Granulations, as
Tinct. Myrrh. Simpl. &c.
When the laceration extends to the Rectum
the loss of power to retain the Feces is the consequence.-
In case the Head of the Child is so large as to 
render it very probable that the Perineum may 
be lacerated, it may be a Question whether making 
a slight incision would not be more adviseable
than alowing the parts to be lacerated.-
Excoriation of the Labia.
When the Labour has been Difficult, and the Head
has rested a considerable time upon the external
parts, they are frequently Excoriated, and sometimes
Ulcerate, and if the constitution is irritable will put
on a flabby unhealthy aspect, and have frequently
been mistaken for Venereal, on this account you
should always take particular care to Distinguish
between the two, for if you employ Mercury in a case 
of this kind, you will do very great injury.-
The mode of treatment must by by any means
that will alay irritation locally an constitutionally, as
fomentations of Poppy heads, Opium, Cicuta &c. or occasionally 



275
occasionally Bark and Wine, sometimes very freely.
When Simply an excoriation, a little simple Ointment,
or Saturnine wash may be employed.-
Diseases of Children.
The Diseases mentioned are to be confined to those
which prevail in early infancy.- Some of these
are Surgical cases, and others belong to the Physician.
Some of the Surgical Cases, arises from the 
Birth, others existed while in Utero, and others appear
after Birth.- 
Of the first kind are the different effects of Pressure
on the Scalp, producing Inflamation, Abcess & Gangrene,
the are to be treated according to the common Rules
of Surgery.-
When the Shape of the Head has been altered, forming
what are called a mole shot, or Horseshoe head,
it has been recommended to press on the head in 
the opposite direction, but this very wrong and shd,,
never be done.-
Others have recommended apply a cupping
Glass over the part, or a Piece of Adhesive Plaster, or 



276
or wet Leather, with a String to the Center, to alow
of extension being made, this may sometimes be 
Serviceable.-
Paralysis of the Arm somtimes takes place from
pressure made on the Axillary Plexus of Nerves, more 
particularly if the Blunt Hook has been used, the
way to avoid this is make the Pressure on the back
Part of the Arm.- What [illegible] produced? [illegible] slight Galvanic [illegible]
Fractures sometimes take place during birth
more particularly of the Humerus or Femur, in 
Breech, or Feet presentations, these must be treated
like other fractures.-
It will be adviseable to examine the Child, immediately 
after birth, or the Nurse may break any
Bone &c. and say it occurred during Labour.-
Fractures are most liable to occur when the 
Blunt Hook is used.- 



277
Diseases existing before Birth.
Swellings of the Head containing a Fluid. These
are often seated on the Parietal Bones, and contain
a Gainy fluid.- These Tumors must be Distinguished
from Hernia Cerebri.-
Some have supposed these Tumors to arise
from some injury received during birth
but this is not the case.- The Bone is not 
necessarily affected, tho' is somtimes, but appears
to be in a secondary way, from pressure.
These Tumors will in general be cured by the 
use of Astringent Embrocations, as a strong Solution
of Alum.- If the Tumor does not give
way to this, it may be adviseable to evacuate
the fluid by a Small opening, to prevent the 
affects of Pressure upon the Bone.-
Cohesion of the Genitals. If this is of the 
Labia Pudenda you should examine to ascertain
whether the internal parts are perfect, and 
the external parts only adhering, if this is the 



278
case you may divide the Parts by means of the 
Knife, afterwards dressing the Parts to prevent
them again adhereing.- If you have any doubt
you had better wait 'till the Age of Puberty, and
these Symptoms may occur which may direct
your Judgement, for if it is only the Hymen being
imperforated the Menses will be found collected
behind it.- 
Cohesion of the Eye-Lids. If these are in 
other respects well formed, this adhesion may
be divided by means or a Small Bistory, or a 
Direction, avoiding wounding the Puncta Lachrymalia
&c.
Tongue Tied. This should always be remedied
early, or the Tongue will grow in the curved
position, and prevent the Childs speaking.-
This is remedied by dividing the Frenum by
means of a proper pair of Scissors, taking care
to avoid the Sublingual Vessels, and Ducts of the 
Maxillary Glands. Women often suppose the Child 



279
is Tonge tied when it is not, and it may be better
to draw Blood to satisfy these.- The Child is not 
Tongue tied if it can elevate the tip to the Roof of
the Mouth, or put it over the lower Lip.-
Hair Lip. The proper time for curing this
is only to be considered here, namely whether before 
putting the Child to the Breast or after it is weaned.
If there is a fissure in the Palate and the Child
is not able to suck it will be adviseable to perform
it early, that is before it takes the breast at all, but
in a general way it will be better to defer it 'till the 
Child is weaned.-
Umbilical Hernia. Children are often born
with small protrusion at or near the Umbilicus,
and sometimes with larger ones if there are small
a cure may generally affected by a constant and 
regular pressure made upon the part either by 
adhesive Plaster, and sheet Lead, or by means of 
a well constructed Truss.- No Circular Bandage
can be used with advantage, as it would
tend to increase the Tumor by its pressure on 
the sides of the Abdomen.- When these Tumors are 



280
larger they generally prove fatal, as there is likewise
a Defect of the Parietes of the Abdomen.- 
Spina bifida. It receives this name
from the spine in the part when the Tumor is 
situated being split into two portions.
This Disease may be distinguished by passing 
the Finger along the Spine, if it is Spina Bifida,
you will perceive the Defect in the Bone.-
It is most commonly seated in the Loins.
The appearance is sometimes a small Tumor
at others, the Skin is flat and shrivelled, this is 
owing to the Tumor being burst During births
when this is the case Children are generally born Dead.
This Disease is somtimes combined with Hydrocephalus.-
This Disease is formed by a 
quantity of Water distending the Membranous, covering
of the Spinal Marrow.-
The sensation of the lower Limbs is generally
impaired.- The Tumor should be kept from 
bursting as long as possible, for when this takes
place Death in general soon follows, this maybe
attempted by astringents and Bandage.- 



36
281
Malformation of the Urinary Passages.
These are of different kinds. When the Pressure 
is imporated, a small portion of the end 
may be taken of by a Scalpel.- When is elongated
or constricted a small part may be taken off
or it may be slit up the same as in the 
Operation for Phymosis.
When the Glands Penis are imperforated,
different modes of treatment may be necessary
according as there is a preternatural opening
or not, but the success off any operation is very
uncertain.- If there is not any opening it will
be extremely Difficult to affect one by art, and 
if there is a preternatural one, endeavouring 
to make one in the proper part will be extremely
Difficult or impossible, for tho' an opening
might be made, yet it will almost to a certainly
close again, as as Membranous Living cant be given.
Sometimes there will be a retention of Urine
without any malformation, in this cas a bent
Probe or small Catheter will be useful, if a Male 



282
or if a female, washing the Parts with a Spong
and Warm Water, to cleanse away any sebaceous
matter, may be of use.-
Imperforate Anus. When this is the case 
the Child will not have the usual Discharges, and 
on examination, (if the imperforation is only at the 
Anus) the Meconium, may be felt fluctuating
behind the part, in this case a puncture may
be made or a small crucial incission, keeping 
the parts from again adhereing.-
If the Stricture is situated higher up, relief
is less certain, and that in proportion as the seat
is higher.- Somtimes the Anus terminates
in the Bladder or Vagina, if in the Bladder Death
may soon takes place, but if in the Vagina, the
Patient may live, but will be in a Distressing
state, and not remediable.-
Lues Venera. This Symptoms of this complaint
are in general less evident in this state than
in the adult, as there is not that regular pain



283
of Symptoms.- When these are dubious Symptoms,
which dont yield to the common modes of 
treatment, it will be right to give Mercury a
trial.
The best way of giving Mercury to Children is 
by giving a grain of Calomel every night or again
of Quicksilver rubbed down with any common Substance,
or what may perhaps be still better, giving
a little Calomel, which has been washed with Aq:
Calcis to divert it of its Acid.-
It may not in all cases be prudent to betray
suspicion.
Different opinions have been formed respecting
the way in which a Child can receive the 
Disease from the Mother, one Opinion is that 
there must be actual contact of Matter, and that 
this takes place during its passage thro' the Vagina.
John Hunter is of this Opinion, but there are 
facts which tend to prove than this is not absolutly
necessary, but that sucking the Breast of 
a Diseased Woman is sufficient.-
Swallowing the Tongue. This is owing to the 
Frenum being to short, alowing the end to be turned



284
back towards the Throat, and bringing on evident
coughing, with a sense of Suffocation.- This is 
relieved by bring the Tongue forwards by means
of the Finger or the Handle of a Teaspoon. 
Elongation of the Uvula. This often brings on 
similar Symptoms, and is owing to a relaxed State.
Anstringent washes, composed of a Solution of Alum
or a powder with a portion of Alum will be of Service.
Purulent Eye. This complaint is most common
among indigent people, and those who are 
filthy.- The first Symptom are a degree of fullness
and redness of the Eyelids, which takes place a
few Days after birth, soon after this the Eyelids adhere
together, and on separating them, a quantity
of Purulent Matter will be discharged, if the Disease
is alowed to go on, the Eyelids become tumid, and 
inverted so that they cant be closed, opacity of the 
Cornea follows, and incurable blindness.-
This is owing to a larger quantity of fluids
being determined to the Conjunctiva, from their
being in a relaxed state.-
In the begining astringents in the form of Lotion.



285
or Tinct. Opii. will be of Service, a Solution of Alum
or vitriolated Zinc. in the proportion of 4 or 5 Grains to an
Ounce will answer very well, this should be applied
as is very common to the side of the Face, but should
be dropped between the Eyelids.- When there is much
Tumefaction it may be necessary to divide some of 
the Vessels to take off the Distention.-
When there opacity of the Cornea a Solution
of Hydrary. Muriat in the proportion of gr. ss and gr. in,,
to ℥j.
Purulent Discharge from the Ears.
This somtimes arises from behind the Ears, and
at others from the Meatus Auditorius.-
When from behind the Ear, the discharge may 
be stopped by Astringent washes or Calomel Ointment.
When the Discharge proceeds from [cross out] within the
Ear, it probably originates from behind the Typanum,
and as a portion of this with probably some of the 
Bones will be destroyed, it may be of very great
consequence.- The cure may be attempted by
means of Astringent injections.-



286
Diseases of Infants requiring Medical Treatment
Much uncertainty often attends this part of Medical
Practice, from the uncertain of Diagnosis, on account
of Children not being able to express themselves except 
by the signs of Nature.-
The state of the Pulse in Children is but an uncertain
Criterion of Disease.- In Infancy the Pulse
are in the natural state, about 120 or rather more 
and this corresponding with 72 in the Adult, but to
she any remarkable degree of increase of quickness
they must be 200, or much more, and which can not 
be counted.-
The Degree of fever in Children, is much better ascertained
by the Degree of heat, Thirst and frequency
of respiration.-
Children are much more irritable than Adults
this in consequence of the Brain and Nerves, bearing
so much greater proportion to the rest of the Body
than in the Adult.-
Diseases of early infancy depend principally
upon these causes, namely irritability, Acid Acrimony
in the Primæ Viæ, and over feeding.



287
Irritability, as depending in part upon the 
cause before mentioned, cannot be compleatly removed,
but it may frequently be much moderated,
by removing any irritating cause, or by the 
action of certain remedies, as antispasmodics &c.
according to circumstances.-
Acidity in the Primæ Viæ, this existence of this 
is evident from many Symptoms, as from the smell
&c. and indicates the use of Antacids, in giving these
it may not be necessary to entirely subdue the Acidity
but only to moderate it.- As alway will coagulate
Over feeding is a very common cause of Disease
in Children and often takes place of the Child being
fed to quieten it, when it is uneasy from other causes,
in this case Nature will frequently relieve herself
by Vomiting. The Cure is obvious.-
Red Gum, this is a Disease of very little consequence,
except to distinguish it from Measles,
which the eruption somewhat resembles, only is not 
attended with the usual Symptoms, as Cough, Fever
&c. the eruption making its appearance without
any previous Symptoms.-



288
Apthæ, may be suspected, when pain is expressed
during sucking, and there is soreness of the Nipples,
it is easily determined on examination, by white Specks
on the Tongue, Fauces &c.
This Disease is distinguished into mild and 
Malignant, these are distinguished by the Colour
of the Specks. &c. if they are of a White colour and unattended
with Fever, this kind is curable by local
applications, as honey Borax &c. tho' it may be 
sometimes necessary to give a Purge, or some 
Cretaceous Medicine with R [illegible],, Opii in small
Doses.-
When the Pustules are of a Brown dusky colour,
attended with fever, irritation and a considerable
degree of Debility, besides cleansing the Mouth,
attention must be paid to the Fever.- The 
Primæ Viæ must be cleaned by Emetics or Purgatives, 
and afterwards, Bark, Wine and Opium
may be had recourse to.- The Bark may be 
rendered more pleasant by the addition of a bitter
Liquorice, to the Decoction, and it should be given Warm.



289
Convulsions may be distinguished into the Acute
and Chronic.- In the acute form of the Disease
the Child often dies on the first attack, therefore active
treatment becomes necessary.-
Children are very much disposed to Convulsions
from their excessive irritability, consequently
all irritating causes should be avoided or removed.
The irritating causes may be either seated
in the Primæ Viæ or in the constitution at 
large.- When the Stomach is the seat Vomiting
or Purging may frequently effect the removal
and it may somtimes be necessary to excite the
action of Vomiting sooner than can be done by
Medicine, that is by irritating the Fauces.-
Stools may be procured by Suppositories as
a Piece of Soap in a Conical Shape &c.-
General irritation will cause convulsions
as is the case in fever, Small Pox &c. you must
then endeavour to alay it by different means, as 
the Warm Bath, Opium, Musk, Assafœtida, or 
by Glysters of some of the Articles before mentioned 



290
in which you may in general give about 3 times
the quantity you would give by the Mouth.
Sometimes the milk disagrees with the Stomach
when this is the case it is evident what must be 
done.-
Convulsions succeeding an Acute Disease in 
the advanced State, are generally fatal.-
In the Chronic form of the Disease, several
of the remedies before mentioned may be had recourse
to, and external applications as Volatile
Liniments may be used. These frequently end in
Idiotism.-
Icterus. Children are after born with this Disease
but which in general disappear in a few Days by 
the Discharge of the Meconium.- Somtimes are 
Emetic, or a little Rhubarb may be of Service.-
Vir. Aloctic. Alkalin. has been recommended.
There is a Species of this Disease attended with
Emaciation, wrinkled face, and Shrill Voice, which
is fatal.-
Watery Gripes. This is often a consequence
of a deprivation of proper breast milk.- The 



291
remedy therefore is obvious.- The Testaceous powder
with Aromatics and Opium are sometimes
usefull.- This Disease is more easily prevented
than cured.- If these things dont do proper milk
must be had.
Erysipelas Infantilis.- When the Navel
string comes off there will somtimes be a slight
Erysipelatous Affection, but which is of no consequence
and is generally cured by the Nurse with singed Rags.
But there is another Disease of much more consequence,
and attack, either the parts about the 
Navel, or the Genitals, spreading to the Back and 
Belly and which puts on a putrid appearance,
it attacks different constitutions, and its progress
is very rapid, frequently ending in Mortification.
Bark and wine may be given internally, and 
Camphorated Spirit applied locally
Periodical Cholic. This often takes place at 
the time the Nurse menstruates. (which they sometimes
do) May be moderated by gentle opiates 



297
You will frequently be asked to recommend a 
Wet Nurse, but which should if possible be declined
and when asked respecting the health of any one you
should be extremely guarded, and only speak in general
Terms, as you cant always possitively say, whether
or not the Woman as free from Disease.-







































Lectures
ON THE
Practice of Midwifery
by
Dr. Haighton.
1803
&
1804.



1
Introduction.
Persons unaquainted with the sbject of Midwifery
may form very limited Ideas respecting it, supposing
it only to the actual delivery of the woman but it not 
only consists in this, but in the explanation and treatment
of a number of Disease connected with Pregnancy
and after actual Delivery.
Pregnancy has a begining, which is called conception,
a duration which is called Gestation and a 
termination which is called Labour or delivery, and 
after delivery then is a time which is called the Recovery
at which time Women is subject to many Diseases peculiar 
this this state, and as a Supplementary branch
may be added, such infantile Diseases as occur 
within the Month.
Conception supposes a previous knowledge of 
the Fruition, and Aconemy of the Organs of Generation
which consists in the parts mainly, Anatomical,
Physiological, and Pathological.
The Anatomical part comprehends a knowledge
of the Pelvis, as giving attachment to the Genitals



2
as containing the Womb and its appendages as 
being the part thro' which the child must pass to 
come into the World, the situation and structure
of the organs of Generation, both external and internal,
including the Mons Veneris, Labia Pudendi frenum
Perineum, Pudendum, Fossa Navicularis, Clitoris,
Plexus retiformis, Nymphae, Orifice of the Urethra,
hymen, Caruncula Myrtiformis, Vagina, Uterus and
its appendages.- 
The Physiological part, consists in the explanation
of the natural and healthy actions of the above
mentioned Organs, or their uses as far as it is known.
The Pathological part, in the description of the 
Various diseases, to which the Generative Organs
are incident, and the most effectual method of administering
relief.-
Many practice very successfully without any
knowledge of the Alteration which is produced by conception,
but it is expected that all who practice this 
branch should have a knowledge of it. In some cases
when conception has taken place considerable alteration



3
alteration is produced in others not any of consequence.
The external parts of Generation in the female are 
subject to several Diseases which will during the 
course be treated of End then is great variation with 
respect to Labour, each cavity will be fully treated of
rotation, but from have only a view of giving an 
Idea of the mode in which they will be treated of 
and shall begin with a description of the Pelvis as 
a knowledge of this necessary to form a proper Idea
of the other parts.
The Pelvis is formed of that assemblage of 
Bones at the lower part of the Abdomen, below the 
fifth or last Vertebrae of the Loins.
It is an easy matter to distinguish between
the Male and female Pelvis, the female being much
more capacious, and of a different shape, being formed
to alow the passage of the Child, where as the Male is 
only for the [illegible] of containing certain parts, and 
giving attachment to the Muscles &c.
The Pelvis in fœtal state is composed of a 
greater number of Bones than in the adult, and 
which is of considerable advantage in delivery as 



4
in the breech presentation, the Bones will on that account
give way more, and more easily pass.
The Bones which form the Pelvis will not be particularly
considered as that more properly belongs to 
an anatomical Description, but will be considered
together as forming the Pelvis.
In the adult the Pelvis is composed of three
Bones namely the 2 Os. Innomenata, and the Os. Sacrum
to which may be added the Os Coccigis which makes 
them 4 in number. The number of Bones in the fœtal
state is eight, each of the Os. Innomenata being divided
into 3 Bones namely the Illium or haunch Bones
the Ischium or sitting Bone, and the Pubis or shorse
Bone, the [illegible] of the Os. Sacrum is the Rump
Bone and the Os. Coccigis is called Huckle Bone, a 
knowledge of this becomes necessary to understand
what the Women Midwifes mean by the Names they
commonly use.
The formation of the different parts into 4 Bones
does not take place to after the Age of Puberty.
There are three parts of the Pelvis more particularly
interesting, namely the Brim, Cavity and 



5
outlet, the shape of the Brim [Cavity] is rather of an Oval
form, but in some measure resembling a heart.
The line in the fore part which joins the two 
Ossa Pubis is called the Symphisis Pubis. 
It is sometimes the case that the upper
Part of the Brim of the Pelvis, instead of being 
round and smooth forms a sharpe ridge, and 
which from the womb pressing on this ridge gives
a sense of cutting in this case a Bandage with 
compress round the Abdomen and placing the 
patient in a more upright posture, a rather 
reclining Backwards, to take off the bearing
upon the part will be of Service.
The size the Pelvis varies in different People
but from one particular size being more often found
that is called the standard Pelvis, and which is of 
the following dimensions a line drawn from 
the upper edge of the Symphisis Pubis is 4 In. long
a line across the Brim of the Pelvis from side 
to side, is 5 In. long and a line in an oblique
Direction, from the Sacro Iliac Symphisis is 5 1/8 In.
a knowledge of the Dimensions, is necessary in practice,



6
practice, for the purpose of adjusting the long Axis of the 
head to that of the Pelvis.
In general the head of the child enters the 
Pelvis without any assistance, and of course then
cant be any thing done with respect to the way 
in which it enters, but in case the child is turned
and brought away by the feet, the way in which the 
head enters entirely rests with the practitioner,
in this case the long Axis of each must be Kept in 
view at the brim, and changed as it passes to bring
them to correspond at the lower part or outlet.
In the case of turning no delay is admissable
when the Body of the child is partly passed, for if the 
head is confined long the child must inevitably Die
on account of its supplies from the mother being cut
off and respiration being at the same time prevented.
Shall now conside the Dimensions of outlet
the lower edge an outlet, a line drawn from the 
lower edge of the Symphisis Pubis to the extremity
of the Os. Coccigis is 4 In long, but by this bone giving way
during Labour this line becomes an inch longer in 



7
way making the line 5 In. long. a line drawn
across from one tuberosity of the Ischium to the 
other is 4 In. long. thus long axis of the Brim and outlet
are in opposite directions, so that it becomes
necessary for the head of the child the to turn in its
passage thro the Pelvis, and which is very much
assisted by the oblique direction of the Os. Innomenata
it is necessary to attend to this in making use of 
instruments. The form of the outlet is rendered
more complete by the Sacro Sciatic Ligaments, extending
from the Spinous proofs and tuberosity of the 
Ischium, to the False transverse processes of the Sacrum.
In considering the Cavity there are two things
to be attended to, namly the Depth and Axis, the 
Depth of the Pelvis at the fore part is about 1 1/2 In. and 
at the sides twice the Depth of the front, and three
times the Depth at the Back part, but the matter
of the greatest important is the Axis this must 
be either in direct or curved line, but is certainly
that of a curve, a knowledge of this circumstance
is necessary in the application of instruments, as 
in case the head of the child wont enter the brim of 



8
the Pelvis, in this case if there is disproportion it 
may be necessary to make use of the long forceps or 
the perforoter & Crotchet.
There are frequently deviations from the Standard
Pelvis, and which may be either in shape or 
size when the lines drawn across in different directions
are longer it is called a large Pelvis, and where
they are shorter, a small one, and when the shape deviates 
from the well formed Pelvis it is called a deformed
or distorted Pelvis. To render a Pelvis deformed there
must be some cause, and which cause either consists 
in Ricketts, or Mollities Ossium. Bone is composed
of a quantity of Earthy Matter and Animal Gluten
the cause of Ricketts consists in a deficiency of 
Earthy Matter and which causes a yielding of the 
Bones. In some cases there is a destruction of 
Symmetry, the deformity not being equal in both 
sides, a knowledge of this circumstance, wits of 
great ability in some cases, as advantage may in 
some instances be taken of this circumstance, of
inclining the child to the part where there is most 
Room. Some have supposed the Pelvis may be 



9
partially distorted, that is, the brim may be narrower
without the outlet being effected and the Reverse, but in most
if not all cases when the Brim is narrower, the outlet 
is enlarged tho' in some cases they are both contracted.
The Pelvis may be narrower from before 
backwards, or the reverse that is to say from side
to side, tho' the former is most common in some 
cases the fore part of the Pelvis appear to be pressed inwards
by the weight of the Body. The Spine in some
cases projects forwards into the Pelvis and in
this way occasions a want of Room.
A knowledge of the form of the Pelvis will
in many cases be of consequence in respect to 
forming an Opinion in what way the Progress
of the Labour is likly to proceed, as in case of the 
Brim of the Pelvis being narrower, the head of the 
Child will frequently rest a considerable time before 
it enters, as it cant do this till the Bones
of the head have given way, and which requires some 
time to be effected after which the progress of the Labour
will be quick, as there is no more obstacle to its proceeding.
In this case the lever or long Forceps may 
be of service, as by their use the head may be brought



10
quarter or half an inch down and which in many
cases is all that is wanting.
If the Pelvis is narrower below, the case will
be reversed and the Labour will proceed at first 
rapidly and when the head comes to the lower part
of the Pelvis, the will be considerable delay, from 
this it will appear evident what caution is necessary
in giving an opinion of the trim Labour is likely
to terminate, except you exactly ascertained the form
of the Pelvis &c.
In some cases Instruments will be 
of Service in assisting the expulsion of the Child, but
in many cases when the deformity is considerable
it will be impossible to bring the child away without
opening the head. In some instances the
Os. Coccigi will project very much forward, and
the projections of the Tuberosities of Ischii will frequently
at the same time be forced in which 
renders the passage of the child extremly difficult.
Must now take a practical view of the 
Business, as the means necessary to Know the 
Degree of deformity, or whether there is deformity in



11
not, there are two ways of judging one of which is 
probable and the other certain.
The Probable way is by judging from the presence
of a Ricketty state of the Body, or from a deformity
of other parts as the curvation of the Spine Os.
as it is probable a Woman with a curved Spine
will have a deformed Pelvis, but this is not always
the case, as this curvation may be owing to accident,
or posture, or from other causes, as particular employments,
but when this is the case other parts of 
the Body are seldom deformed, if then is no general
Disease, but if it is from a degree of softness
or weakness of the Bones the projection of the Sacrum
will frequently be forced forwards and diminish
the diameter of the Pelvis.
The diameter of the Pelvis may in some 
cases be diminished by Exastosis, and other Bony
Projections.
The certain way of ascertaining the demensions 
of the Pelvis is by measurement, and for 
this purpose, different ways have been proposed, our
way is by different instruments, but which dont 



12
appear deserving of notice, and no instrument is 
necessary for this purpose the fingers answering
best, the method of doing this is by passing your finger 
to the centre of the Base of the Sacrum, and then
mark what part come opposite the Symphisis
Pubis, you then measure the length from that 
part to the end of the finger, deducting 3/4 In. for the 
oblique line, and it then gives the proper length of 
the direct line as for instance if these oblique line
is 4 3/4 In. deducting 3/4 In. leaves 4 In. the length of the 
line in the standard Pelvis. Another way of measuring
is by opening the two fore finger, and thus ascertaining
the length of the line, but this requires practice
to determine it with accuracy.
The way to ascertain whether the fore part
of the Pelvis has the proper degree of curve, is by
passing 2, 3 or 4 finger up the fore part and by the 
ascertaining the degree of Curve, thus if you can lay
3 or 4 finger flat you may be certain then is the proper
degree of curve, but if you cant bring more 
than two or three fingers to touch without laying
them over each other the must the be a more acute





13
angle than in the well formed Pelvis.
To determine whether the outlet is well formed
you may place your finger in the Angle formed by 
the two projections of the Ischium, in the natural and
well formed Pelvis they form an Angle of about 60 Dg.
which is somthing less than a right angle, any deviation
from this constitutes a degree of deformity.
You may ascertain wether the Os. Coccigis is 
properly formed by feeling it.
In proportion to the degree of deformity or diminution
of the size of the Pelvis, is the difficulty in extracting
the head.- If the deformity or diminution
is in a small degree, tho' the head wont pass, yet
this may be effected by the assistance of the Lever or 
Forceps, but if this is greater then the perfortor and 
Crotchet become necessary, and when it is in a very
great degree the child cant possibly be extracted
by any means thro' the natural passage in their 
case the Cesarian Operation becomes necessary.
Actual measurement is not of so much consequence
as at first sight appear to be the case 
as it frequently will depend upon disproportion of 



14
of the head to the Pelvis, thus a Pelvis may be of the 
natural size, and yet the child wont pass on account
of the head being particularly large, or the state of 
Ossification more advanced or soft parts rigid.
From what is already mentioned it would
at first sight appear as tho' a large Pelvis would
be advantageous, but this is not the case, as there 
is danger from this circumstance, for as there
is not that degree of resistance to the quick expulsion
of the child as in the standard Pelvis, the soft
parts are liable to be lacerated, on account of there
not being sufficient time for their proper dilatation,
and from the quick expulsion of the child the 
womb has not time to contract in a proper degree 
and this way hemorrhage is produced. Or invert the womb.
Labour pains are not always to be distinguished
from the sensation of a want to evacute to contents
of the Rectum, a mistake of this sort may 
possibly be attended with very serious consequences
as the child may be expelled in this way without 
the Patient being aware of it, a mistake of this 
kind of very great importance should it happen
to an unmarried woman, as it may appear as 
tho' the child was killed and afterwards thrown 



15
away, for the purpose of concealing the affair.
A Medical Man in Yorkshire gave his opinion,
in a case of this sort, that a Woman may 
in all cases distinguish between the pains of 
Labour, and the inclination to go to stool, but he
afterwards had reason to alter his opinion, and 
was on that account under considerable uneasiness.
In all cases when you are called upon
to give your opinion, in a Business of this sort
you will do well to call in the aid of several colateral
circumstances, or whether she has made 
any preparations &c. and upon all occasions if 
either be favorable, this sudden expulsion of the 
child can only take place when the soft parts are 
relaxed and disposed for labour, but in case of rigidity,
and the womb acts violently, when there is a large
Pelvis, there is danger of a Prolapsus Uteri, or 
of a laceration of the Perineum, or of a retroversion
of the Womb.
In this case to prevent these effects, you 
must press upon the mouth of the Womb, during 
pain to prevent its being forced down before the 



16
external parts are sufficiently dilated, and it will
be of service to endeavour to open the mouth of the 
Womb, by degrees, by the introduction of 2 or 3 finger
gradually dilating the parts, the same treatment
is necessary in its passage thro' the external parts,
gradually opposing the passage of the child 'till the 
parts are sufficiently dilated.
Retroversion of the Womb is not peculiar to
a large Pelvis, tho' there is in this case danger of 
its taking place for a greater length of time, and if 
there is much relaxation may take place at as 
great a distance of time from the Labour as the 
fourth Month.
Shall now make a few remarks between the 
formation of the male & female Pelvis. The Male 
Pelvis is only formed for the insertion of Muscles
and to contain certain parts &c. whereas the 
female is not only to answer there purposes but to
alow the passage of the child. The male pelvis is 
more mossy, and projections in different parts
longer, for the purpose of giving greater strength
and slowing the muscles to act with greater advantage, 
tho' it is not so capacious as the female



17
the female Pelvis has not so much Bony substance
as the male tho' it is more capacious, its depth is not 
so great as the male.- The difference in suspect to
desasions is taken notice of by Artists, and their 
rule is that the male exceeds the female as much 
in breadth across the Shoulder, as the female does 
the male across the Hips.- The difference in respect
to the size of the Pelvis is chiefly in the degree of curve
in the Ossa Innomenata the male being less curved, but 
the Sacrum in the female is rather Broader,and also curved.
But there is the greatest difference in the Angle
which the two Ischii make in front, as that in
the male is much more acute, the projection of 
the tuberosity of the Ischium below the Acetabulum
is longer, and which slows a greater power for the 
action of the Muscles, the Acetabulae are smaller.
The female Pelvis is much shallower than 
the Male, which is an advantage with respect to 
the passage of the child.
The next consideration is the bearing of the 
Pelvis with respect to the Body, and this is necessary
to be know for the purpose of adjusting one by the 



18
other, so as to bring the brim of the Pelvis Vertical, horizontical,
oblique &c.- A straight line will not pass
thro' the Axis of each, but lines which pass thro'
the Axis of each would intersect each other so as to form 
an Angle making a right angle. When the Body is erect the plain of the
Brim of the Pelvis is downwards and forward in 
some cases placing the plain of the Brim of the Pelvis
in a Horizontal direction is advantageous, for different
purposes, as to slow the Womb to gravitate, this
is done by placing the Woman in a posture half sitting
and half lying, which is at an Angle of about 45 Dg.
in some cases it is advantageous to fix the patient
so as to bring the lower edge of the Pelvis upwards
in a horizontal direction, as in reducing a retroversion 
of the Womb, or Prolapsus Uteri, you may
effect this by placing the Patient on the Knees and 
elbows.- In making examination the best position
of the Pelvis is obtained by laying the patient on the 
side.
We must now consider the child with relation
to the Pelvis. A standard child or a one of the 
common size can only pass thro' a standard Pelvis
in these directions, that of the Head which is most 
common, that of the Breech, and that of the lower extremities, 



19
extremities, the head being the largest part, requires more 
particular consideration, as in case of the head presenting 
if it passes all the rest of the Body will follow, and 
it will pass with more or less ease according to the 
part which presents, and likewise the situation.-
From this it will appear evident that [illegible]
notions respecting presentation and situation are 
necessary, for this purpose it will be necessary to compare
the standard head with the Standard Pelvis.-
A standard head is one which corresponds with the 
generality of heads in shape size and mobility.
The Presentation is that part which is in the 
center of the Pelvis, and the presentation may be the 
same tho' the situation may vary, as it may be 
to any part of the Pelvis, then the Vertex may present,
and the face may be to any part of the Pelvis,
the same rules are applicable to the Breech presentation,
as in case the Anus is in the center, the 
Back of the child may be to any part of the urethra.
These two terms presentation and situation, are 
vary frequently confounded.-
The presentations of the head are divided
into 4 namely the Face, Vertex, Ear and Forehead,
and as before said the Head will pass with 




20
more or less case according to the part which presents.
The Vertex presentation will pass with more 
or less case according to the degree of depression of the 
occiput, thus in case of a Vertex presentations and 
it wont pass, depressing the occiput, by means of 
the Liver, or by any means will frequently be
of great service in facilitating the Passage of the 
head. Thus the best possible presentation is when 
the Vertex presents, with the occiput depressed.
The Vertex presentation will pass with greater 
ease, than the face, and this with greater ease
than the forehead, the Ear presentation passes
with the greatest difficulty. In general the 
forehead presentation terminates in the face 
case.-
When the head enters the Brim of the Pelvis it 
does not exactly come down sideways, but rather in 
an Oblique direction, as that is the long Axis, [illegible] Pelvis but as
it descends it gradually changes its position
to that with the face to the Sacrum, and their way
the long axis of each is opposed at the outlet.
In some instances there is a deviation from 
this as the long axis of the head may be opposed to the 
short one of the Pelvis, or the face will come forwards 



21
to the Pubis instead of Sacrum, this by some is called
the face presentation, but is not as the Vertex presents
only the situation is wrong. This is not so favourable
a position, as the other, the parts not agreeing in the 
form of parts so well, and there is more danger of a 
laceration of the Perineum.
When the head is low down there are four things
necessary, to render this the best possible position,
the Vertex must present, the occiput be depressed
the occiput must be to the Pubis, and the Sagittal Suture
must be in a direct line from before backwards
in the middle of the Pelvis.-
The Face presentation is when the Nose is 
in the center of the Pelvis.- When the head of the child
is at the Brim of the Pelvis, the best situation is
when the chin of the child is to either side as in this 
case the long Axis of the head and Pelvis correspond,
and as it descends the chin is gradually thrown
forwards, but in some cases the situation is different
the face being placed so that the long Axis of each
dont correspond, in this case help may be necessary
and a Knowledge of these circumstances will be necessary
in giving the assistance.- The long Axis is of each 




22
generally correspond, and as it descends the chin in 
thrown forwards, and the occiput emerges. The
chin is sometimes placed to the back part of the
Pelvis tho' situation is very rare, if this situation
is not altered in a very little time it will be a very
difficult matter to save the Life of the child.-
They way that the forehead presentation is changed
to the face is by the action of the Uterus on the Body of 
the child it pushes the Body down and the chin 
for as the chin forwards.- 
The Ear presentation is when that part is 
in the center of the Pelvis, and in this case the Vertex
may be situated to any part of the Pelvis, in some 
of these cases assistance becomes necessary, tho' not in 
general, this assistance may be given by means of 
the Lever, acting on that part of the head so as to bring
the Vertex down, and by that means bring it to a 
Vertex Presentation.- In using instruments,
great care is necessary in their application either at 
the fore or back part of the Pelvis on account of injuring
the Urethra or Rectum.-
Shall now take a more particular View of the 
Fœtal head.- The Figure of the head is Oval, or Ovi-form




23
Ovi-form, the long Axis of which varies according to the 
part which presents, from this it will appear
instant the necessity of taking dimensions from 
different parts in measuring the different Axises
of the head.- There are two expressions which tho'
different are essentially the same, that is raising
the Chin and depressing the occiput.
A Line drawn from the Vertex to the Chin is 
5 1/6 In. Long, one drawn from the upper part of the 
Occiput to the forehead is 4 1/2 In Long, whereas a line 
from the lower part of the occiput to the upper part 
of the forehead is only 4 1/8 In. long this therefore is the 
shortest Line of the long axis, the short axis is from 
the protuberance of one Parietal Bone to the other and 
which measures 3 1/2 In. this is the different dimensions
of the standard head. But the case with which 
the head will pass does not depend altogether upon
size but in a great degree likewise upon mobility
of the different parts.-
The Fœtal head consists of a greater number 
of Bones than the Adult, the adult head consists 
of 6 Bones, and the Fœtal of 12. The Bones of 
the adult are the Frontal, the Occipital, two Parietal



24
Parietal and two Temporal, with the Sphenoid and Ethmoid 
Bones, but these two last are common to both
head and face.- In the fœtus the Frontal Bone is 
divided into two, the occipital into four, each
Temporal is composed of two parts the Squamous
and Petrous portion, which with the two Parietal Bones
make the number 12.- Thus different Bones are 
joined together by Sutures but which vary in the 
Fœtus very much from those of the adult, for in the
fœtal state they are moveable, whereas in the adult
the Sutures are immovable. The mobility arising
from this formatition of the head is of very great ability
in presentation, as it slows the head to accomodate
itself more to the passage, by the edge of one Bone in 
some cases being forced over the other.-
The Sutures are first the Coronal, which extends
over the fore and upper part of the head and joins the 
Os. Frontis to the two parietal Bones, second the
Sagittal, this extends along the upper part of the head
from before backwards, it begins from the Coronal
Suture, and extends as far back as the upper edge
of the occipital Bone, it joins the two Parietal Bones
together, third the Lambdoidal Suture, this joins the



25
occiptial to the two parietal Bones, and besides this 
then is in the Fœtal state a Suture which joins the 
two portions of the Os. Frontis together, and one to
form a junction between the Squamous and Petrous
Portions of the Temporal Bones, Besides these there is 
another called Squamous or Temporal, which joins the Temporal to the 
Parietal Bones. On the fore and upper part of the head, when the 
Sagittal Suture arises from the Coronal, then a defect
of Bone in the fœtal head, which is called the greater
Fontanel to distinguish it from another similar
defect, at the part when tho Sagittal Suture terminates
in the Lambdoidal, which is called the less or 
fontanel, this besides being smaller is of a different
Shape from the others it being Triangular, where as 
the other is quadrangular, each angle projecting
into a portion of Suture, thus one into each of the portion
of the Coronal, into the Sagittal, and into the 
Frontal.- The lesser fontanel has only their angles
one into each portion of the Lambdoidal, and into the
Sagittal Suture.- By means of these Fontanels and  
the Sagittal Suture, the Situation of the head may be 
ascertained.- Besides this, there is another advantage
arising from these Sutures, as they will slow of the head 



26
being more compressed by a greater degree of mobility,
for in many instances where different parts of 
head are in a more advanced state of Ossification, it 
has been necessary to open the head, and when it has not 
been of an increased size, but only from this want of 
mobility.-
In some cases the Sutures are seperated in a much
greater degree than natural, and the head is considerably
increased in size, tho opening may be to the 
extent of one, two, or three fingers breadth when this 
is the case it is from a collection of Water in the head,
and you must judge from the size whether it is necessary
to open it or not for the purpose of extraction.-
The head may easily distinguished from other
parts of the Body by the larger Bony surface, and by 
the degree of convexity. The Shoulder Blade presents
a large surface of Bone, but you may easily
distinguish the head from this by passing your finger
round. In some cases the head will feel much 
more soft than common, this more particularly if 
examined during pain, this from a larger collection 
of Scalp.- The head may be easily distinguished from 
the back by feeling the Spinous processes of the Vertebra
it may be distinguished from the Breech, by the quantity 



27
of soft Parts, and by the Anus and Organs of Generations.
Besides presentation it is necessary to know the situation,
as tho' the Vertex presents the face may be to any 
part of the Mother.- This is done by feeling for the great
and little fontanel, and by passing you finger along the 
Sagittal Suture, and by comparing the form of the
fore and back part of the head.-
In a case of Hydrocephalus where the Sutures
were very much open it was mistaken by a Medical
Gentleman for a Back presentation, but this might 
be easily distinguished by the want of Spinous processes.
If when you feel the head you can feel the greater
Fontanel, and along the course of the Sagittal Suture you 
feel the Lesser Fontanel, you may then be certain it 
is a Vertex Presentation.-
A face presentation is easily distinguished by
its different parts as the Nose, Eyes &c.-
The forehead presentation is a mixed one, being 
in part the face, and in part the Vertex presentation,
on examination, you will find the greater fontanel
with part of the Sagittal Suture are one part, and 
on the other part you will find part of the face.-
The Ear presentation cant be easily mistaken.-



28
Besides presentation, the situation is necessary
to be known, as for instance in the Vertex presentation
the face may be to any part. In the Vertex presentation
you may know the situation, by feeling for 
the Sagittal Suture, and the Fontanels, if the head is 
low down in the Pelvis, but you cant at all times determine
this way, when this is the case you must 
feel for the ear by passing your finger up, and if you 
can feel this you determine which way the face 
is, by the projecting part of the Ears, as this is always
towards the back part of the head.- There are several 
other circumstances which may assist in the forming
the judgement, and which should be all taken into 
consideration as the whole of different parts of the 
head &c.- It is much the best in all cases when 
you examine to be carefull in giving an opinion
in respect to the Progress of the Labour as there are 
many circumstances which may render it more 
difficult, than you may at first imagine.
The Bones of the Pelvis are connected together
by Ligaments. Ligaments are that substance which 



29
connects the different Bones of the Body together, and 
and is divided into two kinds, namely Elastic and 
inelastic, the elastic Ligaments in some parts of 
the Body act the same as Muscles, as they in some 
degree antagonize the muscles, for instance the 
Ligament which extends along the Spine, in some 
Animals. The Ligaments of the Pelvis an inelastic
as they are made for the purpose of joining the Bones
so firmly together, for the purpose of sustaining the 
weight of the upper part of the Body, and likewise
any additional weight which the Body may at 
any time sustain.-
The different Ligaments which connect the 
Bones of the Pelvis together are first the Ligament
which connects the the last Lumbar Vertabrae and 
the Illium, second and third the Sacro Illiac
Ligament, both external and internal, fourth, the 
Sacro Ischiatic Ligament, external & internal fifth the Sacro Coccigeal 
Ligament, which is for the purpose of slowing
a degree of mobility in the Os. Coccigis, sixth the 
Ligamentum Foramen role, which serves for 
the insertion of Muscles, and thro' a vacancy



30
which is left in the Foramen Ovale by this 
Ligament, the Obturator Nerves and Artery & Vein
pass.- Seventh, the Ligament which connects
the Symphisis Pubis, this is formed by a cartilaginous
covering over each Bony Surface,
and with a portion of intervening Ligamentous
substance, but the chief strenth of this connection
depends upon the strong Ligamentous Fibre
which surround, the junction of the two Bones.
The Symphisis Pubis is sometimes the seat 
of disease, being subject to a collection of gelatinous
substance, or of Matter, and which is a matter of very
great importance, as the Ligaments which form the 
junction of the two portions of Bone, are in a great 
measure destroyed.- When matter is formed, a 
great deal cant be done except evacuating 
it, and keeping a depending opening, and this way
arousing Granulation to shoot up and fill up 
the cavity, but the time when you may be of the 
most service is before the formation of the Matter during
the inflamatory stage, when the application of



5
31
Leeches, Blisters &c. may possibly subdue this inflamation,
and prevent the future bad consequences.-
But if from symptoms you have reason
to suppose there is matter formed you should make 
an opening into the part to evacuate the Matter, and 
upon making this opening you should not find any 
matter, you then have done no injury as the operation,
has not done any injury to parts of any 
importance, and the opening will again heal.-
The Symptoms of this disease are a fixed and 
acute pain in the part, and which is very much
increased on the patients attempting to move or
walk.-
This disease has by some been supposed
to arise from some injury received during Labour
but this does not appear to be the case, but seems
to be owing to the same Scrophulous Habit, as that 
in which Disease of the other joints arise in, and 
begins from the same kind of inflamation.-
When there is a formation of Matter, and you
have evacuated it by an opening, if you keep open
this opening, granulation will spring up and 



32
a cure will sometimes be effected, but the Disease
is in a more advanced stage, and Symptoms of 
irritation, and hectic have come on, then the termination
of this Disease is different, as these Symptoms
go on increasing, and Death is the consequence.
Some practioners have supposed the Ligaments
of the Pelvis gave way in laborious parturition, but
there is no reason to suppose they do, except from 
very violent injury or disease, and when ever this
does take place, the patient is a great length of 
time before she perfectly recovers.-
The cure may be assisted by means of the cold
bath, and the local application of cold to the part, and 
by means of Bark and Corrborants internally, and 
by means of a proper bandage to support the part.
The Os. Coccigis has in some instances become
anchylosed and has rendered it necessary from this
circumstance to open the childs head.
The Uterus in the unimpregnated state is contained
in Cavity of the Pelvis, and is small, but when
impregnated becomes considerably larger, and rises
higher up, before it is placed the Bladder, and behind



33
it the Rectum, and there are likewise other parts
as Blood vessels, absorbents &c. which contribute to
diminish the size of the cavity of the Pelvis, and to 
lessen the size of the opening thro which the head must 
pass.-
From the pressure of the Uterus (when impregnated)
upon the Bladder, a retention of Urine or frequent indication
to make water called micturition is produced, this 
opposite effect from the same cause arises from the 
different parts of the Bladder upon which the pressure
is made.- If the pressure is applied to the part below
the entrance of the Ureters, a suppression of Urine
is the consequence, if this is above this part more 
upon that part towards the frenem of the Bladder, it 
then diminishes the size of the cavity, and that way 
induces the frequent indication to make Water.
When this part presses on the Rectum, tenesmus
constipation, or hemorrhoids are produced, for if it 
produces a degree of irritation, tenesmus is the consequence
or this pressure may cause constipation
by preventing the proper passage of the contents of 
the Rectum. This Pressure by obstructing the motion
of the Blood by the Veins, will cause the Hemorrhoids
this from the Blood in the Anterior not being obstructed 



34
in the same degree. A Woman under these circumstances,
cant expect a cure of those disease till
the cause which produces them is removed, and 
which cant take place 'till after delivery, tho' the 
symptoms may be moderated by means of the application
of a few Leeches to the part, or by other means
and internally by the exhibition of gentle Laxatives.
Some patients are very much alarmed by these
circumstances, and it may right to quit their 
apprehension by explaining the Business to them.
There are other parts besides these which may 
suffer considerably by this pressure, and produce a 
variety of Symptoms, such as swelling of the lower
Extremeties &c. this swelling is frequently called by 
the name of breeding with a Dropsy, but this Disease
is of quite a different notion from that of Dropsy, as 
in Dropsy there are a great variety of Symptoms,
which are not present in this Disease, as in it there 
are Symptoms of a broken down constitution, difficulty
of breathing, scarcity of Urine &c. whereas
Women during Pregnancy in generally labour under none of their Symptoms,
having only what arises from the distention of



35
parts.- From what has been before said, it will
appear evident that pressure sooner effects the
circulation in the Veins that in the Arteries and this 
pressure causing an obstruction of the free return
of the Blood by the Veins, the Arteries act more forciably
to overcome this resistance, a greater quantity
of fluid is thrown out by the seriferous Arteries,
this increased evacuation might possibly be of no consequence
if this pressure was not acting on the Absorbents, 
which should take up and return this fluid.
It is seldom necessary to evacuate this Water
by means of openings made into the part, as proper
pressure by means of Bandage or a Laced Stocking
will in general be sufficient, tho' if not, then is so
larger, for a few small punctures made into
the part, and which may afford relief.- It is necessary to 
attend to the state of the Bowels, and to keep
then sufficiently open.
There are three large Nerves, which are subject
to pressure by this cause, the first is the Anterior
Crural Nerve, but which is not much
subject to this pressure, the next is the Obturator
Nerve, which passes thro' the opening left in the foramen



36
foramen Ovale, and which will cause cramps, and 
spasms in different parts of the lower Limbs, but that 
which is the most subject to this pressure is the 
great Sciatic Nerve, which sends off various branches
to different parts about hind parts.-
The head of the Child in its passage thro the 
Pelvis, frequently presses upon the Obturator and Sciatic
Nerve, and will in many cases cause convulsive,
or spasmodic actions of the Muscles of the lower
limbs, one or both according to circumstances.-
The same Symptoms may be produced by 
the application of instruments, more particularly
when improperly used.- The Lymphatics from 
this pressure, sometimes become very much enlarged.
Somtimes encysted Tumors are formed in these
parts or Tumors of different Kinds, and be the 
cause of considerable difficulty during the time 
of Labour.- In some cases the Kidneas are 
situated very low down and become enlarged, and 
be a mean of difficulty.- Another Disease which 
may take place in these parts, as an enlargement
of the Ovariæ, which may be for different cause
one of which is a collection of Water in the Cavity
constituting the ovarian Dropsy.- [illegible] by [illegible]



37
Organs of Generation.
External and internal.-
The external Organs of Generation comprehend
the Mons Veneris, Labia Pudenda, Frœnum, Clitoris.
Fossa Navicularis, Nympha, Hymen, and Carunculœ
Myrtiformes, to which may be added the Orificium
Urethra.
The Labia are subject to various diseases, as 
inflamation, pruritus, cohesion from malformation
or excoriation, Ulceration, Tumors &c.-
Inflamation if it arises from common causes
is to be treated by the usual mode of treating inflamation
in any other part, but if it is attended with 
darting, shooting pains &c. it is probably an indication
of some internal disease.
Pruritus, is a peculiar and distressing itching 
of the parts, and is often in so great a degree as to 
render the patient almost miserable. The treatment
of this Disease must be various, according
to the cause, when it arises from Herpetic eruption
on the parts, preparations of Lead externally



38
and internally Neutral Salts &c. Some times this disease
is caused by Ascarides which infect the Rectum and 
which may have got to these parts and cause this 
disease, in this case a Glyster composed of a Mixture
with Aloes, or the Extract. Colocynth. Comp. may be of 
Service, and assisted by the exhibition of purges by the 
mouth, such as Calomel Aloes &c.- When this Disease
is Sympathetic of irritation in the Bladder or Urethra,
the use of Mucilagenous and Anodyne injection
may be of Service, and internally Uva Ursi, Bark,
Opium &c. may be given with advantage. A good
injection for this purpose is one composed of Oil
and Tinctum of Opium in the proportion 8 oz. of 
Oil, and 72 oz of R. & Opii. thus recommend an injection
of Aq. Coleis and Oil.- Thus peculiar sensation is 
in some instances only present during pregnancy
and frequently comes on at the time the menses
disappear, and is in many instances very difficult
to cure more particularly if there is no very
evident cause, if it is connected with Plethora, the 
taking away Blood may be of Service, joined with
the exhibition of Cathartics.- Cold applications will



6
39
generally afford more relief than warm ones.
There is no remedy which appear to have any
specific power over the Disease.- The application
of Blister may in some instances afford relief and 
the Ung 1/2 Alb. Camphor (Dr. Bateari) was of service
when many other things had failed, likewise an 
Infusion of Nicotianæ may be of Service, or the injection
of cold Water, into the internal parts.- An Ointment
composed of Ung 1/2 Simplex and Pulv. Gotta
Abp: succeeded after many other things had failed
in the proportion if 3 iss of Pulv. Gotta. to 3j Ung 1/11
Sin Alox.-
Ulceration when seated on the parts of generation
should not hastily be considered Veneral, those
frequently arise after delivery.- This frequently
arises from excoriation of the parts, and which instead
of healing, degenerate into Ulcers, forming sloughs &c.
and in many instances have been mistaken for 
Venereal, and treated as such, but which treatment
instead of being of Service, has agravated the Symptoms
considering.- This Disease frequently arises
from some injury received during Labour.-



40
Somtimes there will be small Ulcerations about 
the Genitals of Children, and which have a very much the 
Chancrous appearance, this is somtimes the case
at about the Age of Puberty.- The exhibition of 
Opium, Bark &c. will frequently of Service or a lot
will tend to alay irritability, in giving the 
Bark to children it may be necessary to take off
the nauseous taste of the Bark by joining it with
other things as Rad. Glyeyrrkis. &c.- and given a 
little R a|1 Opii according to the age of the Patient and 
degree of irritability. Externally a wash composed
of Ag Calcis and Calomel will answer a good purpose,
by the means the [illegible] of the Ulcer will
be stopped, and yellow surface will be changed to
a healthy granulating one.- If by this method
a Venereal Ulcer should be healed, secondary Symptoms
will after a time come on, and you may proceed,
upon the plan of treatment with certainty.
Sometimes the Labia adhere together at 
the time of birth and may require an operation,
but there certain consideration, necessary before 
the operation should be performed, or with respect



41
respect to state which the internal parts are likly
to be found in &c. When this the consequence of the 
parts adhereing after birth, from excoriation &c. there
can be no doubt respecting the propriety of the Operation.-
When this cohesion is partial, the parts may
by mechanical means dilated sufficiently. When these
are seperated by an Operation, it will acquire particular
attention, to prevent the parts again adhering.
The Labia are subject to tumefaction from 
various causes, as from a collection of Water from extravasated
Blood, or from hernia. or of Matter.
Hernia may be distinguished from the other 
kinds of Tumor, by the common means, as the size
of the Tumor varying on the posture being changed, and 
by its receding when in a recumbent posture.
The cure of hernia in these parts may be [illegible] procured
by the common means, by proper bandages
except it proceeds thro the foramen Ovale, in which 
case, a bandage cant be applied to act on the part 
with any kind of propriety. The part from which 
the rupture proceeds, may be distinguished by 
attending to the [illegible] where it disappears on its receding,
as whether it goes over the edge of the Brim



42
of the Pelvis or not.-
The Labia are somtimes distended with Water
and to that degree so as to impede the free motion
of the parts, and causing abrasion.- This disease
very seldom requires any punctures being made, for 
the purpose of evacuating the Water, tho' there is no danger
from this being done, but it in general will give
way to pressure made upon the part, by means of the 
T bandage, at the same time acting upon the Bowels
so as to keep the Body tolerably open.- Should the 
parts be in this state, and the time of Labour coming 
on it will be a matter of no consequence, as when this 
is the case, the parts are generally in a relaxed state
These parts are somtimes swelled from extravasated
Blood, this somtimes takes place after delivery,
and may arise at any time from the parts being 
bruised by accident, the sooner this Blood is evacuated
the better, or if not, it will very soon coagulate, and then 
it will be impossible to remove it. This is done best
by making a few small punctures into the part,
by which means the greatest portion of blood will
be evacuated, and the absorbents will generally take 
up the rest.- Leeches very seldom afford any relief
in this case as the Blood lays too deep for the action



43
If the patient wont submit to the removal of the
Blood by the punctures with early stage, it very soon
becomes coagulated, after a time a Throbing sensation
comes on, attended with increase of heat, and an Abcess
will follow.- If this extravasation is in a small
quantity, it may possibly be taken up by the Absorbents
the action of which may be assisted by Astringents, or 
by the application of Red Wine Lays &c.- If you precede
an Abcess is likely to form, you must then assist the 
process by the application of Poultices &c.- An Abcess
will somtimes form after you have evacuated the 
Blood by punctures, but it will then be proportionally
smaller.
Clitoris is that part which projects at the upper
part of Labia, and is in some instance considerably enlarged,
and has been mistaken for a Penis, but may easily
be distinguished from that, by its not having an 
Urethra, and it has likewise no corpus spongiosum.
In children the Clitoris generally projects more
than in adults, and has when this is the case been
taken for the parts of an Hemophrodite.
In a case of the Penis adhering to the Scrotum
a Gentleman mistook this for a Hemophrodite, as 
the Scrotum projected on each side so as to give the 



44
appearance of Labia.- The Plexus Retiformis is
composed of the Veins which return the Blood from 
the Clitoris, and which in part surrounds the Vagina
and by their distention in coitu, assist in diminishing
the diameter of Vagina, as they are placed just
over the Sphincter of the Vagina.- The Clitoris is in 
some instances very irritable, the least motion or touch
giving pain, a good application in this case, is a Mixture 
of Ol. Oliva and Tinct. Opii.-
Nympha, so called from the supposition
that they directed the stream of Urine.- Their figures
very much resembles a Myrtle leaf.- The Nympha
are somtimes very much enlarged, and require
an Operation being performed for their removal, this is 
not very common in this Country, tho' is somtimes
the case, but in the Warmer Climate, this Disease
is very common, it is called Nymphatomia, and is 
easily performed by putting a piece of past board
on one side and cutting upon it.- The Nympha
somtimes adhere, and it becomes necessary to make 
an incission for the purpose of seperating them, and 
considerable care is necessary after the operation
to prevent them from again adhering.-



45
Urethra, a correct knowledge of this, and more particularly
of the orifice, is of the greatest importance
in practice, from the frequent necessity then is of 
introducing the Catheter and which should be done 
without exposing the Parts, for this purpose it is necessary
to have some common Rules as a direction.
For this purpose there are three different directions,
one of which is, to find the lower edge of the Symphisis
Pubis, and the orifice of the Urethra, is situated
just below that part.- Another rule is, to find
the Orifice of the Vagina, and as the Urethra is 
situated just above that part, by raising your finger
a little, you will feel the orifices which you may 
distinguish, by its circular form;- A third rule for
finding it, is to feel for the Clitoris, and the Orifice of 
the Urethra is situated just an inch below this part,
just in the middle between the Nympha.-
One objection to finding this by the orifice of the 
Vagina, is from there being several Lacuna in this part,
and which may be mistaken, for this part, and likwise
Ruga, the Lacuna are generally so small as not to 
admit the end of the Catheter, tho' somtimes they are
sufficiently enlarged to do that.- You may know when 



46
the instrument is in the Urethra by its passing forwards,
whereas if in a Lacuna it wont pass more than 
the eight part of an inch, on account of this circumstance
the way of finding the Urethra by the Clitoris is best, as 
the part between the Clitoris and Urethra is perfectly smooth.
The Female Urethra is much shorter than the 
Male, being in general about 2 In. long.-
The course of the Urethra is in the direction of a 
Curve, and in passing the Catheter this must be attended
to, for if passed in a straight direction this is danger
of its being forced thro' the sides of the Urethra into
the Vagina, as been the case, and is a matter of very
great consequence, from the Urine irritating the 
parts &c.-
The Urethra in the female in a great measure
resembles the Male in structure, its internal
membrane being the same, and like it having several
Lacuna, it is much larger in diameter than
the male, and from this circumstance females are 
not near so liable to Stone as males.- In females
there is no prostate gland.- The prostate Gland in 
the male is about the size of a Nutt, and is a secreting
gland, the exact use of which is not known.-
The situation and direction of the Urethra may be varied



7
47
varied from different causes as prolapsus Uteri &c.
in the cases the Catheter must not be introduced in 
the common direction, but according to the present
direction of the Urethra.-
From the situation of the Urethra it will appear 
evident that the Urethra is liable to injury, in difficult
Labours, and by the use of instruments, if applied
so as to act on the fore part of the Pelvis.-
Retention of Urine.-
The Symptoms of retention of Urine, are pain
and tension in the Region of the Bladder accompanied 
with Symptoms of irritation, and 
great distention, somtimes there is a Stillicidium
an involuntary drifting away of the Urine, and 
which Symptom has often deceived the Practitioner
as from this be supposing this case an incontinence 
of Urine, but the true nature of the case
may be easily known by attending to the other 
Symptoms.- -
The consequence of this Disease if not relieved
by proper means, is bursting of the Bladder
and the Urine escaping into the cavity of the abdomen,
causing a high Degree of inflamation of 
the Peritoneum and Death.- There is more danger



48
danger from the bursting of the Bladder on the back 
than the forepart for when it gives way on the 
back part, the urine escape into the cavity of 
the Abdomen, whereas when the rupture is on the 
fore part, and where the Bladder is not covered by 
the Peritoneum, the Urine may possibly escape 
without getting into the cavity of the Abdomen.
It is in this part that the Bladder should
be punctured if done at all above the Pubes.-
The causes of suppression of Urine are either
from Pressure inflamation or Spasm.-
Suppression of Urine from pressure may be 
either from the enlarged state of the Womb, or from 
inversion or Prolapsus Vagina &c. or from Tumor
found in the parts
The treatment of this Disease will be different
according to the cause producing it. If it 
arises from pressure, introducing the finger or 
laying in a posture, so as to take of the pressure from 
these parts will effect the evacuation of the Urine
there in case of Pregnancy Woman will frequently
be able to discharge the Urine by putting themselves
in a reclining posture, and introducing the finger
press up the Womb, so as to take off the Pressure upon



49
the Urethra.- When inflamation is the cause of 
suppression of Urine, the treatment must be divided
to the removal of that inflamation, this by means 
of Bleeding, purging, the warm bath &c.-
If this disease arises from spasm, opium
will afford the greatest relief, given bitten by the 
mouth or in the form of Glyster, in the proportion
of 50 or 60 Drops.- The Warm bath may in this case
be of Service.
In all these cases the distention of the Bladder
must be relieved by means of the Catheter, and for this 
purpose you should be provided with different sized
Catheters taking care before their introduction, that 
the orifices at the end are open.- The next consideration
is the best position for you to stand in with 
respect to the patient, as it wont be pleasant for you
to stand with your face towards that of the Patient,
but what is much better and more convenient is 
to stand on the right side of the patient, and introduce
the instrument with the right hand, in this 
way your back will be towards the face of the Patient.
You should make use of two small Basons for 
the purpose of receiving the Urine.- Somtimes there 



50
will be a sudden stoppage of the flow Urine, in
consequence of the instrument being pressed against
the side of the Bladder, or from the pressure being applied
to the middle of the Bladder, forming it into two 
seperate Cavities. Whenever the Urine suddenly
stops recurring, more particularly if there is a sense
of fullness remaining you may be certain the Urine
is not all evacuated.
A suppression of Urine somtimes takes place
from a dropsical state of the Body, when this is 
the case, considerable attention should be paid, as 
mistakes under these circumstances have very frequently
been made, and the Bladder has been punctured
by mistake with the Trocar, when the tumefaction
from the Distended state of the Bladder has been mistaken
for Dropsy.- A greater mistake than this 
has been made, by the Trocar being Avoid into the 
thro' the Bladder, into the Uterus, when in an impregnated
state, and thro' the Uterus into the head of the 
child, and occasioning the Death of the Patient.-
It is right upon all occasions, to draw off the 
Urine before the operation of tapping is performed, for 
the Bladder is much distended it may be injured by



51
the Trocar.- A Lady had an enlargement of the 
Abdomen, and which came on rather suddenly, that 
is to say in a few Days, and during which time she 
had made very little Water, she was attended by two Physicians,
one of which proposed tapping but the other was
of Opinion it was not necessary, and after a little farther
consultation, they agreed to call in Dr. Orure, to examine
the state of the Bladder, and on his introducing the Catheter,
he drew off a Gallon of Urine, and the Tumefaction
was entirely removed.-
The Bladder does not swell exactly in the same 
way during pregnancy as at other times, in this case
the swelling is more sideways, from the Pressure of the
Womb on its middle, and this may possibly give an 
Idea of its being a collection of Water in the Cavity of the 
Abdomen, but you may easily distinguish between the 
two by the absense of fluctuation more to the back part.
Incontinence of Urine, may arise either from
loss of tone in the parts or from loss of Substance,
the loss of power of retaining the Urine, frequently
arises from a pressure upon the parts during delivery
and will in a general way, gradually recover in
the course of a few Days.- If this Disease arises from 



52
loss of substance, the Disease will be permanent, as then 
is generally a communication with the Vagina.-
This last circumstance generally arises from
some injury received during Labour, more particularly
if instruments have been used.- A Lady who had
a few Days before been delivered by the Forceps, had Symptom
of inflamation and suppression of Urine came
on, after a little time, a drilling away of the Urine came 
on, and a substance was discharged from the parts, and 
which was a portion of the Urethra and Vagina, which 
had sloughed off.-
When a patient applies to you for this Disease
it is necessary to know whether you can afford any
relief or not, you may know this by passing a Catheter
into the Urethra, and your finger into the 
Vagina, if there is a communication between the two,
you will feel the Catheter in contact with the finger,
and in this case very little relief can be expected.
But if it proceeds from loss of tone, time, with
the assistance of the cold bath, Chalybeates &c. and 
Cantharides externally and internally may possibly
effect a cure.-
1



53
Caruncula Myrtiformes, so called from their
supposed resemblance to Myrtle Berries, the number of 
them is various, somtimes being two, at other 4 or 5 in number,
these parts are not always to be found, as they depend
upon a certain circumstance, being formed by the 
ruptured portions of the hymen.- These parts sometimes
become painfull and inflamed, and require
the application of cooling remedies.- They somtimes
become considerably enlarged, and may require removal.-
They somtimes become Ulcerated, and give
rise to a supposition of their being Venereal, but you
must always be very carefull in forming an Opinion.
Hymen, is situated and the lower part of the 
opening between the Labia, its situation in children
is very evident, but is very often found wanting in 
adults, and which may depend entirely upon accident.
It is the part from which the caruncula Myrtiforms
are formed, and is a membranous projection
of no regular determined stroke, and in general
forms a somwhat circular irregular constricting
membrane.-
Somtimes there are a number of small
openings in this Membrane, forming what is called
the Cribrated Hymen, it has been long a Question



54
whether the cribrated Hymen was an Obstacle to impregnation,
but from the following case it does not appear
to be the case.-
A Lady who was married to a Medical, laboured
under this obstruction, after a time an enlargment
of the Abdomen took place, but from the above circumstance
it was supposed this could not be pregnancy,
she was treated as a Dropsical patient, but the enlargment
went on gradually increasing, she was
ordered to Bath, when she remained some time, but
without any effect being produced on the swelling,
on her return home, she was attacked with pain
but which she would not alow to be labour pains, a 
Practitioner in the neighbourhood, was sent for, and 
on his arrival found the head of the child low down
in the Pubis pressing against the external parts, and 
on a crucial incision being made, the child passed.
The Hymen are somtimes found imperforated,
and which the coeval with the birth of the patient is 
very often not found out 'till the Age of Puberty, as 
then will be all the usual Symptoms of Menstruation
but no external appearance.- This fluid when collected
behind the membrane in considerable quantity



55
has been mistaken for the Water in the fetal membranes.-
When this collection has been evacuated by 
an incision, it is generally found of a cream colour
and to be in a fluid state, tho' it may have been
collected in these parts for a great Length of time, in
this respect differing from Blood.- Her Menstrual
Discharge is composed of the serous parts of the Blood &
the Red particles, but with no portion of the coagulable
Lymph.- The fluid before it is exposed to the external
Air, is perfectly free from acrimony, but when
exposed by an incision it becomes considerably so, this
renders it necessary after the operation to wash out 
the parts by means of a Syringe and warm Water.-
The operation consists in making a longitudinal
incision into the parts, and afterwards a short transverse
on, which should be sufficiently large to alow 
of contraction.- In performing this operation, you
should not only have the evacuation of the fluid in
view, but likwise future sexual purposes.- When
the fluid is evacuated you should apply Dossils of
Lint to prevent the parts again adhering.- 



56
Internal Organs of Generation.
These comprehend a part of the Clitoris with 
its erector Muscles, the Vagina with its Sphincter,
the Plexus Retiformis, and the Uterus with its appendges.-
The Clitoris and plexus retiformis have been
already mentioned, and it now remains to mention
the Vagina, and the Uterus with its appendages.-
Vagina, this is the canal leading to the Uterus
from the external parts, and is situated between
the Bladder and Urethra on the forepart and the 
Rectum behind, and connected to them by cellular
membrane, its figure is not cylindrical,
but Oval is the most capaceous, in the middle, its 
course is moderatly curved, making an obtuse Angle
with the Uterus, the structure of this part is 
of a peculiar Kind, and these enter into its composition
Arteries, Veins, Absorbents and Nerves, and its internal
surface, consists of a plicated membrane, disposed
in different directions, called Ruga, these Ruga
are for the purpose of alowing of dilation, and may
possibly be formed to answer some other sexual purpose.



57
purpose.- The length of the canal varies, but in
general is about 5 or 6 In. tho' it has been found
much shorter.- The Figure of the canal should
be attended to in the use of Pessaries.-
The canal of the Vagina is somtimes divided
by a septum, and in some instances, has been 
found double, forming two Vagina, each having 
seperate hymen and and an Uterus.-
The diseases of this part are inflamation
and its effects, such as cohesion, suppuration,
contraction from cicatrices, mortification and 
sloughing away of a portion of its substance &c.
The treatment of inflamation will be different
according to the Kind and case, and likwise
the stage of the inflamation, as whether it is 
Phlegmonous, or irrisipelatous.- When inflamation
of this part arises from injury during 
Labour it is generally of the Phlegmonous Kind.
Irrisipelatous inflamation is more disposed
to attack the surfaces of Parts, and Phlegmonous
the Reverse.- The pain in irrisipelatous inflamation
is of the hot burning kind, and in Phlegmonous
of the throbing kind.- In irrisipelatous there
is always a considerable degree of irritibility, and 
Debility, and which must be attended to in the constitutional




58
constitutional treatment, as local applications, moderately
astringent injections will answer the best purpose.-
In Plegmonous inflamation the Symptoms
are more of the Tonic kind and which must be 
attended to in the treatment both constitutional
and local, as local, injection of the cooling sedative
kind answer the best purpose.-
If cicatrices have formed, they will prevent
the parts from yielding, and may require either
mechanical or instrumental Dilation.-
When there is cohesion, the cavity may be very
much obstructed, and render it necessary to seperate
these by means of the knife, but much dexterity is
required, and the parts should be kept assunder
by means, of a piece of Sponge or Lint.- This disease
is owing to want of proper alteration, when
inflamed.-
When there is a sloughing of a portion of 
these parts, it may form a communication between
the Vagina and rectum, or with the Urethra
and alow the Feces and Urine to pass thro' the 
Vagina, and which are very distressing circumstances.-



59
Uterus.
The Uterus is to be considered in two states, namly
that of vacuity, and in the impregnated state.
The shape of the Uterus when in the unimpregnated
state, is Pyriform and flattened, and has by some been
compared to a wine flask inverted, and from which 
resemblance different names have been given to different
parts, as the Body, Fundus, Neck, and Mouth.
The surface of the Uterus is flatter on the fore than the 
back part.- The Uterus is in general 3 In. long, one
half of which goes to the neck, and the other to the Body
this Division into Body and neck does not appear
evident on the external surface, but when Laid [illegible]
appears very evident on the internal part, as there
evidently appear a contraction of the cavity in the 
middle, and there is a difference in the membrane
which lines the cavity, that of the Body is smooth
whereas, that which lines the neck is not.-
The Substance of the Womb is Muscular, the fibers
of which rear in different directions, and Arteries, Veins,
Absorbents and Nerves, enter the composition being 
connected together by dense cellular membrane.-
The cavity of the Uterus is divided into two parts 



60
one of which is larger and triangular, the other conical
with the narrow end approaching the Angle of the other
this last is the neck, and the other the Body.-
The situation of the Uterus is nearly in the middle
of the Pelvis, between the Bladder and Rectum, and is 
as high, as the top part of the Uterus would touch a
line drawn across the Pelvis, from the upper edge of 
the Symphisis Pubis, to the top of the Sacrum.-
The Uterus in young subjects is situated higher, for 
in them, a line drawn in this direction would pass thro'
the middle of the Body of the Uterus.-
The situation of the Uterus may be varied from
different causes, as procidentia Uterii &c. Retroversion.
The Uterus may be retroverted if in the unimpregnated
state, and without being perceived, but if it becomes
impregnated, it than becomes a matter of very great
consequence.- Instance have been related of the 
Uterus being contained in the cavity of a hernia, but 
this is very rare, Sennutus relates one in the wife
of a Cooker, who whilst at Work, perceived somthing
suddenly give way, and an enlargment was perceived
in the Groin, after a time she became pregnant
and, and it Here appeared that this swelling in the Groin
contained the Uterus, it went on enlarging the usual way 



61
and at the proper period particular Symptoms came
on, an opening was made into the Tumor, and the Child
extracted, but the result of the case is not related.-
The Retroversion of the Uterus will be considered
when on the Pathology of Pregnancy.
Procidentia Uteri and Prolapsus, are the same 
kind of Disease, only meaning different degrees, thus
the smaller degrees of the Disease are called prolapsus,
as in case it projects so much as to be even
with the external parts.- When there is a Prolapsus
or Procidentia Uteri, you may distinguish it from the 
tumors found in these Parts, as Polypi &c.- by the 
Rugeous character of the Vagina, and by its having 
a hole in the center corresponding with the mouth of 
the Womb, and if it is at the proper time of Life, it will
be the hole thro' which the menstrual discharge will loss.
In some cases the Uterus is forced down behind the 
Vagina, pushing this forwards, in this case there is 
no opening, but you may know the nature of the affection
by the Roya.-
Women who have born children are more subject 
to their Disease, more particularly than who have
a large Pelvis, then should be particularly attended
to during Labour.- Women of a relaxed habit of Body 



62
are particularly liable to this complaint.-
Women who are subject to this Disease in a small 
degree frequently have a difficulty in making Water,
and which may be relieved by passing up the finger
and pressing against the Parts.-
Women labouring under this complaint are subject 
to the fluor albus.-
Procidentia Uteri has been mistaken for other
disease, or Polypus or inversion of the Womb, this last
disease as a turning of the Womb inside out, and is
often brought on by pulling at the placenta for the 
purpose of bringing it away, before the womb has began
to contract, and this way bringing the fundus of the 
womb down.-
You may distinguish between Polypus and Procidentia
Uteri, by the Orifice or Cavity in the middle of the 
Tumor in procidentia, and by the Periodical return
of the menses which will be found to flow thro' this 
opening, and by the Rugae.- Somtimes you cant perceive
the opening, but in this case the Rugae, will be 
a mark of Distinction.-
The Prolopsus Vagina will frequently reduce
itself on the patient being put in a recumbent posture
but on again returning to the event, it will again
appear, sometimes it wont recede even tho' a slight
force should be applied, in this case much Dexterity is 



9
63
required with reduction, and in doing this you must 
the pressure backwards towards the Perineum.-
If the part has been down for any length of time 
it will often be very difficult to reduce, and in this case
some have advised the application of warm fomentation,
but which is very wrong, the treatment in this 
case should be exactly the same as in strangulated 
Hernia, and cold application should be made use of as
they diminish the size of the Vessels, whereas as warm
fomentation &c. increase their size.-
Somtimes a sloughing of the part comes on, now in
this case some have recomended waiting 'till the parts
had seperated, but this should not be done, for it should always
be immediatly returned, and not alowed to remain
'till the seperation of the slough.-
When a Prolapsus Vagina has been reduced, proper
means should be resorted to, to prevent its return
and this is done by means of Pessaries.- For this purpose
different kinds have been used, some are in the form of a 
globe, and others of a flat circular form, then last are 
the best, and are commonly made of Box Wood, and 
with a small hole in the middle, which should not be too
large, the size of the opening must be of that size to admit 
of the end of your finger.- This opening answers two
purposes, one of which is to alow the menstrual Discharge
to pass, the other is for the introduction of the finger, for the 



64
purpose of introducing the Pessary in the Vagina, this hole
should not be made too large or it will admit of a portion
of the Parts above to escape thro' it, and cause Strangulation.-
The form of the Pessary is generally circular, tho'
they are somtimes made of an Oval form, and possibly
with advantage, the edge should not be too narrow, and 
should be rounded off, for the purpose of making it more 
easy.- It should be oiled at the time of introduction.
With respect to the size of the Pessary, that will be serious,
but it should be sufficiently large to stick in the 
Vagina, when introduced, but to begin with one small
enough and gradually increase the size 'till you find it 
sufficiently large.- This form of Pessary is of service
only when the Perinœum is whole, for in case this is 
injured, they wont be of any use, another sort has been 
invented for this purpose, and which is composed of 
a ring Pessary, with a stem to it, and with a moveable
Ball & Socket at the other end end, this slows of 
the movements of the Body without its affecting the part
within the Vagina.- For the purpose of confining this in
the Place, takes on fixed to the part without the Body.
A Piece of Sponge cut in a proper shape is under
some circumstances the best Pessary, as it will alow of 
being medicated, but they require frequent removal 



65
for the purpose of cleaning them.- They should have a
Piece of Tape fastened round them.-
The mode of introducing the common Pessary
is to introduce it sideways 'till you get it within the 
Vagina, and then with your finger in the opening, put
it in the right position.- In introducing it, you should 
not press directly upwards, but press towards the
back part of the Perineum.- It will somtimes cause
excoriation and soreness of the parts on its first introduction,
to remedy this you must advise the use of the 
Saturnine wash.--
The mouth of the Womb is called the Os. Uteri
likewise the Os. Tinca from its resemblance to a 
Finches mouth, and by other Names.- A precise knowledge
of this is necessary to form a judgment either 
with respect to Disease or Pregnancy.- The size of this 
Part varies very much in the healthy state, and under different
circumstances.- In some cases you will find 
a very small protuberance, in others a flat surface,
the size of the opening likwise varies very much, in those 
who have not had children it is very small, about the 
size of the Bulbous end of a Probe, but in those who
have had children it is considerably larger.-
The shape of the opening too, varies very much.



66
The feel of the part likwise varies very much, being 
in general smooth, but sometimes has a particular
roughness and yet be in a healthy states.-
Cancer Uteri.
No age is perfectly exempt from this Disease tho
it most commonly attacks Women, at the middle and
more advanced periods of Life.- Its commencement is 
somtimes insidious begining with a Discharge like 
the fluor Albus, and attended with irregular Menstruation,
in old Women it resembles returning Menstrual 
Discharge, but which occurs at irregular periods.-
Some have supposed that People who not borne Children
are most subject to this Disease, but others are of a 
Different Opinion.- The Symptom which denote the 
presence of this Disease, are darting shooting pains, attended
with an Ichorous Discharge, this from its somtimes being
tinged with Blood, has been mistaken for the Menstrual
Discharge returning to often, and when it has not been
much discoloured, has been mistaken for the fluor Albus,
but it may be easily Distinguished from this by the 
Degree of Arcimony &c. If you make examination, you 



67
will find a rough scabrous surface, and occasion
considerable pain, and probably a slight hemorrhage.
The Disease in this way goes on 'till the neck of the 
[Bladder] Uterus is destroyed, and then it attacks the Body of the 
womb, destroying the greatest part of this and likwise a 
portion of the Bladder and Rectum, the Urine and Feces
will pass thro' the Vagina, occasioning considerable degree
of excoriation, and great irritation and Symptomatic Fever
coming on, Death closes the Scene.- This Disease more
commonly begins at the Os. Uteri, and shreding as before
mentioned to the different parts.-
The treatment of this Disease is confined entirely to 
Palliatives.- The warm bath has been frequently and 
and with some advantage in procuring case, but from
the degree of weakness it produces, is not a remedy very
advisable, the application of fomentations to the part may
be had recourse to.- Cicuta is of service in procuring
case and is found somtimes successfull when Opium
fails.- Opium likwise must be had recourse to.-
Dr. Johnson relates a case which terminated successfully
and in his case, and in which he made use of 
are Electuary composed chiefly of Aethiops mineral, but 
the remedy he placed the most dependance whose, was 



68
a fomentation or wash composed of a Decoction of the 
common Herbs, with a large portion Goose's Fat, melted
in it, which he applied warm to the part, but it appear
very doubtfull whether this was a case of Cancer, and more 
particularlly so, as there are no more cases on record when
it again succeeded.- In some cases an injection of 
a Solution of Sacch. Saturn will be of Service, this joined
with opium in the following way. Rx Sacch Satum. Pulv.
Opii a| 3ss Aq: Hord. Hss, this injected, and the parts
washed with it may afford temporary relief. But towards
the latter stage of the Disease, full Doses of Opium
internally are all that will afford relief.-
Schirrous.- A Schirrous state of the Uterus 
is often mistaken for cancer, and when it becomes
Ulcerated, in some measure resembles it in some of its 
Symptoms, as in both there is violent pain, but the 
pain is of a different kind, so in schirrous the pain is 
of the dull heavy kind, with a sense of bearing down
whereas in cancer the pain is of the sharp lacinating
kind.- In schirrous, the mouth of the Womb
is somtimes dilated, and you may feel the internal 
part of the neck which is rough and Scabrous.-
The size of the Tumor gradually increase somtimes



69
so much so, as to impede the regular action of the Rectum
and Bladder.-
In the incipient state of the Disease, the use of 
Calomel in small Doses, and occasionally giving gentler
Laxatives has in some instances been of Service.-
When Schirrous is in the more advanced stage, there
is always considerable pain, and when the parts are 
in an Ulcerated state, there is frequently some irregularity
of discharges.- The size of the womb is considerably
increased, and which may frequently be felt on
examination by the Rectum, and by its size impeding the 
action of that part.-
When it is in the Ulcerated state, little can be done
except as palliative, Chalybeates have been recommended
on R. o Ferri Ammon. but their action as well as any 
other seems to be upon the Stomach and secondary Symptoms.-
The application of warm fomentations or the 
warm bath may afford Temporary relief.-
The Symptom will somtimes subside for a time 
but generally return again, if this is during the use 
of any remedy, it gives the Idea of having performed
a Cure.



70
Polypus Uteri.
Polypi are situated in different parts of these Organs
as in its Cavity Neck and Mouth, and they are somtimes
attached to the Vagina.- Polypi are somtimes attached
by a small neck, at others by a Broad surface are the 
surface is in some cases sought like a Caulifower,
but is in general smooth.-
Polypi have their origin from different parts 
and great advantage arises from a perfect knowledge
& their Origin in the treatment.-
When the origin is from the internal part of the 
womb, they possibly may not be perceived for a length
of time and from the increasing in size till they fill
the Cavity, often appear as tho' suddenly produced from 
their being by some sudden exertion forced thro' the Mouth
of the Womb, in this case you may distinguish its origin
by passing your finger up as far as you can, and 
feeling entirely round the Tumor, you will feel somthing
corresponding with the Os. Uteri, and be able to pass your
finger entirely round, in this case you may be certain
its origin is from the internal part or Cavity.-
When on your attempting to pass your finger round
the Tumor, you meet with some destruction, you may then



10
71
be certain, its origin is not from the Cavity, but from the 
Neck, or part when you feell the resistance.-
The Veins of a Polypus are situated on its surface
and are somtimes large at others small, and upon these
depend the hemorrhage. It has been supposed that 
the Hemorrhage is more violent, when they are attached
to the Body of the Womb, that when to the Neck.-
When their Origin is from the Cavity of the Body of 
the Womb, and this by a narrow neck, they somtimes
fall off spontaneously, this appears to owing to the mouth
of the Womb, pressing upon the Neck of the Tumor, and 
this way acting as a Ligature.-
There is somtimes a Disposition in the Uterus to
form Coaguli, and which come away spontaneously
and have been mistaken for Polypi.-
It is necessary to distinguish this Disease from
others which occur in these parts, and in some measure
bear a resemblance, as Prolapsus Vagina, Procidentia
Uteri, or Inversion &c. this may be easily done
if the tumor is situated low down, in prolapsus Vagina
the Rugeous Character will sufficiently distinguish
the Nature of the case, and in Procidentia Uteri, you
may know the part which forms the Tumour, by the 
hole you will feel in the center of the Tumor, and by 
by other circumstances, as by its receding when in



72
a recumbent posture. This Disease is more likely 
to be confounded with an inversion of the Womb, but
you may ascertain the Nature of the complaint by 
inquiring into the History of the complaint, as in the 
way it first made its appearance. If it is inversion
of the Womb, there will be frequent discharges of Blood
from the Tumor, and at the menstrual periods this evacuation
will be found to exude from its surface, and 
if you press the Tumor, you will find it to have a greater 
Degree of sensibility.-
Polypus is frequently connected with a Schirrous
state of the Uterus, and under these circumstances their removal 
can produce very little good effect and they may 
likwise be combined with a cancerous affection.-
In some cases where a Polypus is formed in the 
internal parts of the womb, more particular if at the 
Fundus it may by its weight, bring down the womb 
and cause inversion, and if the neck of the Womb
is short, the nature of the case may not be known
and a Ligature may be applied for the removal of the 
Polypus, and which instead of being applied upon the 
Diseasd part is put upon the inverted Uterus, this happened
to John Hunter, who in a case of this kind applied
the Ligature upon a portion of the Womb, and which 



73
brought on great Symptoms of high irritation, and in the 
end Death, he was at a loss to account for the Symptoms
but upon examination after Death he found the cause.
From this case he laid down the following practical 
Rule, never to tye a Polypus without you can feel
the mouth of the Womb. But this is not at all times to 
be felt, and it seems doubtfull if you can distinguish
the part where one terminates and the other begins, if the 
Ligature should be applied to that part, as there is a possibility 
that a portion of the Uterus may project into 
the Tumor, and can should always be taken Not to include
any portion of the Uterus in the Tumor.-
Mr. J. Hunter's Rule is certainly a very good one
but should be joined with the following in case you
cant feel the mouth of the Womb, which is to press
upon the Tumor gradually proceeding upwards, 'till you
find the pressure gives pain, and apply the Ligature
just below this, in the insensible part.-
When they appear of the cancerous kind, they are
not of a proper description for the application of the Ligature.-
Somtimes their growth is very rapid, and 
it is possible, if they are removed by Ligature they will
be very soon reproduced, but tho' their removal in this 
way is not entirely successfull, yet it is right to do it



74
if merely on account of temporary relief.- When the 
size of the Tumor is small and attached by a slender Barr
there is the greatest probability of the operation being 
successful.-
For the purpose of applying the Ligature upon
Polypi different instruments, have been invented, one 
of which is composed of two long tubes, which are fastened
together, and the ligature which is a piece of fine wire
is passed thro' both these tubes, leaving a portion out
at one end forming a bow or loop, this is passed over
the Tumor, and drawn tight so as to stop the circulation 
thro' the part, but John Hunter invented a 
better instrument, and which is composed of a Piece
of Iron, rather acorded and in the end is a small hole,
this is fixed in a handle, and in which is fixed a 
small cross Barr.- This instrument may be used in 
two ways, one of which is by passing a Ligature, single,
thro' the opening in the end, this by Means of the instrument
is passed round the Tumor, and then the other end 
of the Ligature is passed thro' the loop, and in this way
you may draw it as tight as you please, fixing the 
Threads round the cross Barr at the Handle.-
The other way of using the instrument is by passing the 
Ligature, double, thro' the hole in the instrument, forming 



75
forming a loop, this is passed over the Tumor, and fastened as
before.- When you apply the Ligature, you should take 
notice whether you give much pain, a little is always
the consequence, if there is much, the Ligature is applied
to high and should be altered.- The Ligature will
require straightening & Tightening daily on account of the Shrinking
of the Tumor.- The Polypus somtimes requires
supporting as from its weight giving considerable uneasiness,
and in some cases a considerable degree of
Putrefaction takes place, and it may on this account
and on account of its producing a considerable degree
of irritability, be necessary to remove it by the Knife before
its entire seperation by the Ligature.-
There will frequently be considerable Degree of irritability 
come and a particular uneasiness at the 
Stomach, and which will require proper Medical 
assistance.
For the purpose of obviating the putrescent
effects in some measure cloths moistened in Vinegar 
and Water may be applied to the external parts
and a Lotion of Aq. Hord. with R a| Myrrh may be 
applied more particularly to the parts.-



76
Fluor Albus.
This is a discharge which takes place in Women, and 
which continues for a length of time if not cured by the use 
of the Medicine or from some cause. It is a secretion from 
the internal surface of the Vagina, and the mucous follicles
about the mouth of the Womb, and the Cervex Uteri.
The discharge is generally of whitish colour, but not 
always being somtimes of green, or yellow colour, and has 
somtimes a Purulent appearance.-
Women labouring under this discharge are generally
more or less affected in their health, tho' there are some few 
exceptions to this Rule, as there are some Women, who are 
in the best health when labouring under this discharge, more 
so than when it is not the case.
This discharge may accompany a Plethoric state 
of the Body, or the reverse, and this will cause variation in 
the mode of treatment.- When this discharge is present, the 
Patient generally complains of pain and Weakness in 
the Loins, with a general appearance of debility, such as 
listlessness &c. tho' as before observed there is somtimes a 
Plethoric state of the Body.- Some Women have a Discharge
during Pregnancy, of a thick white Mucus, then proceeds
from the Mucous follicles about the mouth of the Womb.
This discharge should be distinguished, from discharges
from these parts arising from other causes, as from, 



77
cancer, Gonorrhea &c. it may be easily distinguished 
from that arising from Cancer by the Absence of Pain &c.
but is not so easily distinguished from the Discharge of 
Gonorrhea, more particularly in the more advanced
stage of this Disease, tho' it possibly may in the beginning
as there is always more or less inflamation in the beginning
of a Gonorrhea, which is never the case in this Disease,
other circumstances must be taken into consideration
as the moral Character of the Patient &c.-
The Aura of this disease will be different according 
to circumstances, as whether than is a Plethoric state or the 
reverse, if there is Plethora, Bleeding, Purging &c. will be 
indicated, but if there is a state of Debility, the Tonics, and 
astringents as Bark, Preparations of Iron, Astringents
of the mineral kind, the cold Bath, Balsams, such as Bals.
Capioi &c. may be of Service, tho' this last does not appear 
so likely to relieve as some other things.- Preparations
of Lead internally have been recommended, but this use
is rather more precarious than some other remedies.-
Along with these internal remedies, injections of different 
kinds may be used, as an Infusion of Green Tea,
Rose leaves &c. with the addition of Alum or other things of 
the astringent kind, these should be injected into the part
by means of a Proper Syringe, Along with these modes
of treatment, attention should be paid to Diet.-



11
78
Tympanites Uteri.
This is a collection of Air in the cavity of the Uterus 
and which escapes frequently by different movements
of the Body.- Every case of discharge of Air from these
parts is not to be considered, as a Disease of this kind, as 
discharge of Air may take place from Various causes
from the death & Putrefaction of the Child in Uterus &c.
but this disease arises with out any such cause, and 
appears to be owing to the Vessels of the part having a 
disposition to form Air. The occurance of this Disease
is very rare, and the Cure extremely difficult.-
The Cure should be attempted by means of Tonic 
and Nervous Medicines, and by a strengthening Regimen,
and it possibly might be of Service to inject, by 
means of a proper apparatus, gently astringent Medicines
into the Cavity of the Uterus.
Menstrual Discharge.
This discharge is that periodical discharge which 
takes place in Women at a certain period of Life, and 
generally occurs at stated periods, which are generally
at the distance of a Month, from which circumstance
it takes the Name of Menses or Menstrual Discharge.
This discharge is not Blood which proceeded from 



79
the rupture of Vessels is was formerly supposed, but is a 
regular secretion from the extremities of the Arties, by
a proper organization for that purpose.- It is composed 
of the Serum and Red particles of the Blood without 
the coagulable Lymph. This discharge in its natural
state wont coagulate, and whenever it will, it is a morbid
state of the discharge as there must then be the presence
of Coagulable Lymph, this constitutes the Disease called Menorrhagia.-
The Age at which this evacuation first makes 
its appearance is about the fifteenth Year in this Country,
but there are many varieties in this respect, as it is 
in many cases much earlier, and in thus much later
than this.- There is variety in this respect in different
countries, in the warmer Climates, the time of their appearance
is much earlier, and in the colder Climates much
later.- Tho' the period of the appearance is these various
yet, if there is no constitutional affection is consequence
of this, it cant be called a Morbid state.-
When the Menses are about to make their appearance
there will be always more or less constitutional affection,
great variety of Symptoms being present, frequently a 
state very much resembling Pthisis Pulmonalis, when 
there are symptoms of this kind present, a considerable
short discrimination is often necessary to distinguish 
the Nature of the case, and it is impossible in some instance



80
instances to say what the nature of the case is, 'till by the use 
of some remedies, it becomes more clear, as the remedies for 
these Disease are quite of a Different kind, are requiring
Tonics &c. which would to injury in the other Disease.
It is frequently the case that a considerable degree
of Langour, and diminution of strength takes place at 
the time of the menses being about to appear, and by some
it is the practice to order the to use an extra Degree
of exercise, this plan is very injurious, so the System
should be invigorated by proper remedies, as Chalybeates
and what are usually called emmenagogues &c. and the 
the usual vivacity and inclination for exercise will return,
whereas if you order exercise to be used, when the 
strength is so much diminished you are in danger
of producing some bad consequence.-
Chlorosis is in many instance only a Symptom
of a dificiency in the proper secretion of Blood, and when 
this is the case the first indication is to assist that
process by proper nourishing treatment, both in the medical
Depeartnent and in respect to Diet, when this is 
the case emmenagogues are improper 'till the constition
has been strengthened, then their use will be of Service.
Electricity is only proper when there is a proper secretion
going on.-
The discharge is seldom regular in respect to its 




81
recurence, for some little time after its first appearance.-
Before the appearance of the discharge in the 
regular way, there will generally be some particular
Symptoms come on for a few Days, as a sense of dullness
and heaviness, pain in the back and Loins, Vertigo &c.
and there usually is a whitish discharge for a few Days
or for a Day or two, before the appearance of the Red discharge.
The Length of time which the discharge continues is very 
various, but in general is about 3 Days.- The Quantity too
is subject to great variety in some instance only just 
tipping the Linea, in others the quantity is considerable
accounting to several Ounces, and at the same 
time does not produce any bad effect on the constitution
it is not quantity discharged which constitutes
a morbid state, but it when this quantity produce
some ill effect on the constitution, the same Rule
is applicable with respect to duration.-
There is obstruction of another kind occasionally
taking place, when the Body is in other respects in 
a healthy state, this disease may arise from different
circumstances as from the application of cold
&c. in their case quite a different mode of treatment
is proper, from that pursued when the Body
is in a debilitated state, in this case Bleeding in 
small quantities, Electricity, Aloctic Purges, this Service



82
Service pieces &c. will be of Service.- If by the use of then
means the affection is not releived, other Symptoms
will come on, as an effusion within the Cellular
membrane, producing a swelling of the lower Extremeties,
and a Dropsical state.-
All obstructions of this discharge are not to be 
considered as morbid is there is always a disappear
of this evacuation during pregnancy, and in general
this is the case, tho' not always during the secretion
of milk. There will frequently be a Discharge
of Blood at different times during pregnancy, but this 
is quite of a different Nature from the Menstrual Discharge
as this is a discharge of Blood, and probably comes
on in consequence of partial seperations of the Placenta,
as from its being situated over the mouth of 
the Womb &c.-
The menses at a certain Period of Life cease
to flow, the Age at which this takes place as various, in
general about 65, the it will take place both before and 
after this period at considerable distance of time it is generally
the case, that those Women who had the menses
first appear at an early period, will likwise have their 
cessation early and the reverse of at a late Period before
their first appearance. This change is considered by 
them as a matter of very great consequence and with 




83
very good reason, for these are frequently symptoms of very
great consequence come on at this time.- When the discharge
has ceased to appear for two or three periods, there will frequently
be a Plethoric state of the System more particularly if no 
attention has been paid to the Diet, and there will then take 
place a Discharge, and this may be repeated at intervals,
this discharge is not of the same nature as the menstrual
but is a discharge of Blood, containing coagulable Lymph and 
from this circumstance produces more debilitating effects
and if repeated may cause such a Degree of weakness as 
to be the cause of other Diseases as Dropsy &c.
In Women who have born several children, there 
will frequently be a cessation for a month or two, and then 
a sudden and perhaps profuse discharge of Blood take place
and if this in any part comes away in a coagulated form
gives them the Idea of having miscarried, this is a case of 
Menorrhogia, and should be treated as such, these discharges
will recur at intervals. It has been usual in all cases 
to give tonic and astringent Medicines under these circumstances,
but which in many instances in a wrong practice
as a treatment similar to what is pursued in case of 
Hemoptoe, will in general be more proper as at the time 
when from certain symptoms the discharge is likly to take 
place if the Pulse is is generally case, are rather full and
have the jerking feel, the loss of a small quantity of Blood 



84
from the Arm, as from 4 to 8 oz. according to circumstances
will be of service, and at the same time giving gentle apperients
as small Doses of Neutral Salts &c. and in the intervals
giving gentle Tonics and astringents, the common
tonics and astringents may not be so proper in this case
as some others, a good one for this purpose, is Infusion of 
Roses, with a small portion of Glaubur Salts, the basis of both
their being the same thus does not any decomposition take place
each has its basis the Sulphuric Acid.-
It possibly may answer a very good purpose at the time 
the menses are about to disappear, to take away as small
quantity of Blood for a few times once in two months, and this 
perhaps with a little attention to the Bowels & Diet might prevent
any of the consequence ensuing.-
When the disease has continued for a length of time
this plan wont be proper, but recourse must be had to 
Tonics as the Bark, Chalybeates mineral Acids &c. and 
a nourishing diet, as the System has been very much reduced
and must be recruited.-
At this time there will frequently be an affection
of the intestinal Canal, that is a disposition to flatulency
producing a sense of fullness and a swelling of the Abdomen,
and which by Women has been mistaken for Pregnancy
tho' it may be easily distinguished from this state, this
state may be remedied by the use of aperients Medicines
joined with Aromatics and those of the Nervous kind as 
Pill. Gall. Comp. &c.



85
Appendages of the Uterus 
The appendages of the Uterus are four in Number namely,
The Fallopian Tubes, Ovaries, Round Ligaments, and Broad
Ligaments.
The fallopia Tubes go off from the upper part of 
the Uterus sideways terminating in a fimbriated extremity
they are in general about 5 In. long, but are subject to rarity
as they may be very much lengthened from certain causes,
and from an enlargement of the Ovariæ &c.
The diameter of the tube is smallest where it joins the 
Uterus, and becomes considerably enlarged at the other extremity.-
This tube is subject to variety in several respects
its course being in general straight tho' somtimes in a Spiral
direction.-
The Fallopian Tube is subject to a varity of affection
and is somtimes found imperious or obliterated, they are
likwise subject to a collection of Matter in their cavity, and 
to a Dropsical state, the quantity of Water is seldom large
not being more than an ounce in general, this Disease is seldom
of any consequence in respect to its effects on the constitution,
nor are their any Symptoms whereby its presence
may be known.- If both the tubes are in this state, it 
must certainly be a cause of sterility as the passage of the 
Ovum is entirely prevented.- Matter when formed in 



12
86
Ovaria has escaped by these Tubes into the Uterus and 
this way found an outlet.-
The structure of the fallopian Tubes must 
be in part muscular tho' muscular fibres cant 
be discovered, yet there can be no Doubt of this from the 
actions they perform.
The office of the fallopian Tubes will be more 
particularly explained, when treating of impregnation,
yet this is evident that they are for the purpose of carrying
the Ovum from the Ovaria to the Uterus.-
Another office, which is that of carrying the [illegible]
fluid of the male to the ovaria has been
ascribed to them, but this does not appear to be the 
case as will be here often explained.-
Ovariae.
The figure of the Ovaries is very much like that 
of the testes, the surface is irregular, they are vesicular
internally, more obviously so between the Age
of Puberty and the middle period, these vesicles are 
unequal in size, and indefinite in number.-
When one of these vesicles has received the Stimulus
of impregnation, it gradually begins to enlarge
and after a time bursts, the Ovum escapes, and is embraced 
by the fimbriated extremity of the fallopian
tube and carried to the Uterus.- The Ovaria have 



87
in some instances been found wanting.-
The Ovaria are subject to different diseases, to 
inflamation, and suppuration, the matter from which 
may be discharged in different ways, one of which 
is by the fallopian Tube into the Uterus, and may 
give an Idea of its having been formed in that part.
They are likwise subject to an enlargement of 
the Schirrous kind, and which may keep gradually
increasing in size for several years, in many cases 
without having any material effect on the constitution,
tho' somtimes it is the reverse.- This enlargement
has in some instances been mistaken for 
Pregnancy, but may be distinguished by the Tumour
begining on one side.- Nothing can be done in 
this disease except in the Palliative way, so by giving
Opium, Aperients &c.-
These parts are likwise somtimes found
in a state of ossification, and have somtimes been
found to contain, the different parts of a fetus as 
Hair, Bones &c. and in some instances it appear
difficult to account for the formation.
When parts of the fœtus have been contained in
the Ovaria, this constitutes an [cross out] extra Uterine
case, in this case the usual Symptoms of impregnation
go on for a length of time, there cease but the 
enlargement continues, after a length of time an Abcess



88
forms and the different parts are evacuated.-
The Ovaria are subject to a collection of Water
in their cavity constituting a Dropsical state, the qantity
of water which be contained is various, has in some 
instances been found to be to the quantity of 10, 12 or 
even 15 Gallons.- Women about the middle age are 
most subject to this disease, but no Age is entirely
except.- The disease in the first place begins 
in one of the Vesicles, somtimes in two or three, these dont 
at first communicate with each other tho' they afterwards
so, this is a fortunate circumstance in drawing
of the water by tapping.- The substance which is contained
in the Ovaria, is somtimes partly fluid and 
in part solid, and which will render relief by tapping 
up, from this it will appear evident the necessity of 
giving a guarded [illegible] in this Disease.- If the solid
part is situated anteriorly, the common trocar will
not evacuate the Water, in this case it is probable
on a greater length might be of Service.-
The begining of this disease is seldom noticed
tho' there will be somthing perceived to move on the 
side affected on the Body being put into different
positions, this affection seldom produces so much
derangement of the System, as cases of common Dropsy.
Her water collected in the Ovaria varies very much
in some instances being perfectly thus and Lymped 




89
in others viscid and glutinous, when the fluid is 
in this state the constitution is generally giving way 
Different modes of cure have been recomended,
on of which was to extirpate them in the early stage
but this would be attended with many difficulties,
as from the difficulty of distinguishing them before they 
were considerably enlarged, and when this is the case the 
opening required for their removal would be so large
as to render the operation extremely dangerous, and many
other besides these. It has been proposed to cure
them by causing inflamation in the cavity in the 
same way in in the cure of Hydrocele, but there are 
no facts in support of this.-
The treatment of this disease is only palliative
which is by tapping, the use of Medicine has never
been of any service, tho' these have been instances of 
a cure taking place by accidents, which have burst
the Cyst.-
When both Ovaria are affected with this Disease
impregnation cant take place, tho' this may 
if only one is diseased, and when this is the case 
very unpleasant effects are the consequence, more 
particularly during Labour, and this may be more 
so if the Tumour is small than if it is larger,
from its descending more into to cavity of the Pelvis
and obstructing the passage of the head.- They way
to distinguish a Tumor of this sort from the head of 




90
the child is by its being compressible, and yeilding
which is not the case with the head of the child.
When this is the case, a question arises whether
it would be best to open the head of the child or to draw
of the the water from the Tumor by the tapping, there have not 
been a sufficient number of cases on record to say 
which of these is the most eligable, as no general Rule
should be laid down from solitary cases tho' when the 
whole should prefer the latter.-
Round Ligaments, an attached to the 
upper part of the Uterus, and often passing towards the 
lower, go thro' the abdominal Ring like the Spermatic 
chord in the Male, and are the distributed
about the Mons Veneris &c. The structure of these
Ligaments is muscular and Vascular, and their 
use appears to be for the purpose of supporting the 
Womb, and keeping it steady.- During pregnancy
there is somtimes a painfull uneasiness about 
the Abdominal Ring and Mons Veneris, from these 
Ligaments being put on the stretch, and which 
may require the use of Anodynes &c. for the purpose
of worsening relief
Broad Ligaments, consist of a doubling
of the Peritoneum, enveloping the other appendages of the 
Uterus with its vessels, and attached to the sides of the 
Pelvis, dividing it into two Cavities. These Ligaments




91
are formed by the Peritoneum being reflected over
the Fundus, and posterior part of the Bladder, over 
a small portion of the anterior part of the Uterus, over 
the fundus and posterior part, and then over the Rectum
leaving a portion of the back part of the last uncovered.-
From this it appears that the Neck of 
the Bladder and a small portion of the posterior part of 
this, near the neck, and part of the anterior portion is 
not covered by the Peritoneum, and there is likwise
part of the anterior portion of the Uterus with the Neck
and Vagina, which are not covered by it, nor is 
the lower and posterior part of the Rectum.-
From a knowledge of these circumstances
some practical hints may be derived, as for instance
that of tapping the Bladder (in case of suppression
of Urine) from the Vagina, by means of a curved
Trocar, when a Catheter cant be introdced
[illegible] [illegible] supposed the Tapping might be done
with advantages in Ascites from the [illegible] but
the Intestine would be a great [illegible] of [illegible]
the Broad Ligaments are attached



92
Gravid Uterus.
The Gravid Uterus comprehends a series of changes
induced on the Uterus and its appendages, also the Ovum
contained within it, consisting of the Fœtus, Navel
String, and Placenta, the Water called Liquor Amnii,
with the different membranes, as the decidua,
chorion, Amnios &c.
We shall first describe the Ovum and afterwards
the Uterus &c. The Ovum being the produce
of conception, this merits a previous consideration.
Conception, there is great variety in the mode 
which impregnation takes place in different Animals,
in some there is the power of impregnation in
themselves, having both sexes contained within themselves
in others, the organs of both sexes are perfect, but then
require sexual intercourse, and a double or reciprocal 
impregnation follows.-
The things necessary to impregnation in the male
are Testes, secreting semen, in the Female ovaries
in a healthy state, with a determination of Blood
to the whole Uterine System. The Oestrum or disposition
to impregnation and the coitus are the occasional
causes.- It is not necessary that both Testicles shoud
be perfect, as one testicle and one Ovarium in a healthy 



13
93 
state are sufficient for this purpose, and tho' there
is a necessity for a determination of Blood to the parts
yet impregnation may take place, when there has 
been no menstrual Evacuation provided there is 
this determination to the Uterus &c.-
Different opinions have been formed with 
one put to the part the fecunditating fluid of the Male
is conveyed to produce impregnation, as whether it
is only conveyed to the Vagina, or Mouth of the Womb
in to the Body of the Uterus, or whether it is conveyed by
the fallopian tubes to the Ovaria, but from the result
of several experiments it appears, that sympathy or 
consent of parts, and which opinion receives additional
strength, by the Breasts sympathizing with the action
of the Uterus.- The Stimulus of impregnation is probably
first given to the Uterus, the Ovaria then harmonize,
afterwards the fallopian tubes &c.-
The alteration which takes place in impregnation
is, after the Stimulus of impregnation is given
one of the Vesicles of De Graaf, this swelling and projects,
before the rest, after a time this bursts and the
Ovum escapes, which is imbraced by the fimbriated
extremity of Fallopian Tube, and by this is conveyed
to the Uterus, there is then a particular membranous
attachment formed to prevent the Ovum from escaping
this membrane is called Tunica Decidua, there 



94
likwise a secretion of thick mucus which pluggs
up the mouth of the Womb, and thus becomes a farther
security.- The substance of the Vesicles does not take 
on the form of a Ovum immediately on its entering the 
cavity of the Uterus, but the membrane before mentioned
is first formed, and the different parts of the Fœtus are
not immediately formed, but take place in some little
time from this.- The parts for it formed are the Organs
of Sense, as the Brain, the head is first formed then
the Skin, is seen projected, and soon after this the Eyes are
seen and afterwards the extremeties.- The heart is too,
very early formed.-
Super fetation may take place if there is a 
second coition, before the Ostrum is gone off, an instance
of this occured, in a Married Woman of Jamaica,
who had twins, one of which was white and the 
other Black, she endeavoured to account for it by an
affection of the Mind from fright in the same way as 
Navi Materni are supposed to arise.-
From circumstances it is probable, that the
fecunditating fluid of the male, has nothing to do
with the formation of the Fetus, except by giving a proper
stimulus.-
After impregnation and the contents of the Vesicles
of De Graaf is evacuated the Cavity then becomes
filled by a Yellow Matter and which is called Corpus 




95
Lutei, and this is the course of some time gradually
disappear, probably may do this in the course of about
12 months.- There Corpus Lutei always correspond
with the number of Fœtuses, except in some instances
when there are the Rudiments of two Fœtuses in
one of the Vesicles and which is very rare.-
It has by some been supposed that this was 
not the case, from a greater number of these Bodies
being found than fœtuses, but there must then have 
been a corresponding number of impregnation, and 
most probably miscarriages
The Navel String is that chord which 
passes from the middle of the Abdomen of the Child to 
the placenta, the place when it is attached to the Placenta
is not always in the center, being frequently
to one side or very near the Edge.-
The Length of the chord varies very much, being in
some instances no more than 6 In. long, and has been
found as long as 57 In.- Both these extremes have
their disadvantages, for when very short, there is danger
either of inverting the womb, or breaking the chord
on the expulsion of the child, or there may be in consequence
of this a partial seperation of the Placenta,
and by its being done before the Vessels have any 



96
ways contracted may cause a proper hemorrhage,
from this circumstance, care should always
be taken not to move the child far from the 
mother, when expelled, or rather to bend it towards
the mother as it is passing the external parts.-
When the chord is of more than common length
it may possibly get down before the head of the Child
and being this way compressed the circulation will
be stopped, and as the Lungs are not in this case
in action, the Death of the child very soon takes
place, or the chord may be passed round the Neck
of the child.- Somtimes there is a Knot formed upon
the chord, this probably is done during Labour, by 
the Chord, passing over the Child.-
In some cases the chord may be felt, by the 
Pulsatory feel, before the Bagg of Waters is broke, in this
case you should avoid, breaking these as long as possible
and endeavour to alter its situation, or it possibly
by some motion of the child may be spontaneously
changed.-
The umbilical chord is composed of two
Arteries, and one Vein, connected together by a [cross out]
Cellular substance & covered by a Membrane substance, which contains a mucous
substance, but it has neither absorbents nor Nerves
entering its composition at least so far as at present



97
present is known.- The umbilical Vein in the adult
is so far obliterated is to destroy its cavity, and forms
that part called the Ligamentum Rotundua of the 
Liver.- These Vessels not only convey Blood but
likwise nourishment to the fœtus.-
The Vessels of which the chord is composed pass 
in different direction, somtimes the Arteries pass
in a spiral direction round the Vein, and in other
cases the reverse, in some instances they pass in
paralel lines with each other, and they somtimes
form a Coil.- The different directions which the
Vessels take may possibly be for the purpose of retarding
the Velocity of the Blood, and possibly for some other
Parlous.- From their being no Nerves in the composition
of the Chord, it appears improbable that 
the mind of the mother should have any power
in the formation of what are called Nevi Materni
and other circumstances, that have been attributed to 
the influence of the mind, as the case of the Jamaican
Lady before mentioned.-
The Placenta is that part which forms the 
medium of connection between the Mother and 
Fœtuses, and correspond with the Fœtuses in respect
to number, thus if there are one, two, or three fœtuses
there are the same number of Placenta, except in
case of one of the Vesicles of De Graaf containing the 



98
Rudiments of two Fœtuses, in this case there will
be only one placenta and on Bag of Waters.-
When there are two or more placenta, the Vessels
of each have in general no communication, tho'
in some instances they have, and it is from this 
circumstance, that the necessity of tying the chord or 
each side the part you divide it, for if the Vessels
of the two placenta communicate, and this was not 
done, it is most likly the Death of that Fœtus in
Utero would take place, from the discharge of Blood
owing to this communication, it is on this account
and not on account of the Quantity being injurious
to the Mother, the necessity arises.-
The thickness of the Placenta varies, in general
about an inch thick in the middle, and gradually
becomes thinner towards the Edge, and its forgive is 
in general round & flat.- Its attachment is to different
parts in different cases, in general it is to the 
upper part or fundus, and which is the best place
for the attachment, in some instances it is placed
over the mouth of the Womb, and which constitute
one of the most dangerous cases in Midwifery.
The Placenta has an external and internal
surface, the external is that which is in contact
with the Uterus, on which there are several fissures



99
dividing into lobes, which probably are for the purpose
of slowing it to accomodate itself.--
The Arteries are spread chiefly on the internal
surface the Veins on the external, before the Arteries
in the substance of the Placenta, they communicate with 
each other.-
The Placenta consists of two parts, the Maternal
and Fœtal the maternal part is cellular, the other
which is the Fœtal is Vascular, there are no communication 
between the two parts by continuation
of Canal.- There are two distinct circulation going 
on in the Placenta, one between the Mother and 
Placenta, the Blood passing by the Arteries into the 
Cells of the Placenta and returning to the mother
by the Veins, the other between the Fœtus and placenta,
the Blood passing by the Arteries into the Vascular 
or Fœtal part of the Placenta, and returning
by the Veins.- The communication between the 
Maternal and fœtal part of the Placenta, is probably
by Lymphatic Vessels, and which may probably 
arise in a similar way to the Lacteals, from
the cellular part of the Placenta.- The way in which 
the Fœtus is nourished is not as some have supposed
by the mouth or Skin, but by the chord, which 
is not from its receiving red Blood, but coagulable 



100
Lymph, which it converts into Red Blood by its own 
sanguifying powers, the same as the chick is Ovo.-
The more this is examined the more it appears
to be like the process of Vegitation, that the Fœtus is 
nourished.- From several circumstances it 
appears that the placenta her forms a similar office
in the fœtus, upon the Blood, to what the Lungs do 
in the adult, except in the power of evolving heat
which is not necessary in the Fœtus, rendering it 
fit for circulation, and this is evident in case
the chord is compressed so as to stop the circulation,
before the child can breath. Death is the consequence,
and which cant be from the supply of 
nourishment being cut off.-
The circulation of Blood in the Fœtus is different 
from that of the adult, as there is a communication
between the right and left Auricle, called
the Foramen Ovale, and thro' which a great portion
of the Blood passes, a small portion only going 
thro' the Lungs for their nourishment.
Membranes, are the bag in which the fœtus,
Navel string, and Waters are contained, the number
of these bags in general correspond with the number
of Fœtuses, the use of this is obvious, for in case there 



14
101
were two or more Fœtuses, if one of the Bags gives
way the other Fœtus or Fœtuses is not effected.-
The number of the membranes vary in the 
early and later periods of Pregnancy, in the early
Period there are 4 Membranes, namly Tunica
Decidua Uteri, Tunica Decidua reflex, Chorion,
and Amnios, in the later periods then are only
three, namly, the Tunica Decidua Uteri, commonly
called, the Spongy Chorion, the true Chorion, and 
the Amnion.- In the early stages of impregnation
these membranes appear more like a portion of 
coagulable Lymph, than distinct membranes.
After some little time the Tunica Decidua
reflexa disappears, in consequence of a discontinuation
of Growth, and not by condensation, as John
Hunter, and some others have supposed.-
The Spongy Chorion is formed by coagulable
Lymph thrown out by the Uterus, which afterwards
becomes organized the same as under other circumstances, 
at the time of the Ovum descending from the 
Fallopian Tube, this Lymph is thrown out for the
purpose, of its being imbedded in it, there is then a 
process of this spread over it, which forms the Tunica
Decidua reflexa, and which as before observed after a 
little time disappears, the use of this last membrane



102
appears to form an attachment before than is done
by means of Vessels.- John Hunter was of opinion
the Spongy Chorion was formed of the internal membrane
of the Uterus.- The Spongy chorion is very Vascular,
which Vessels are derived from the Uterus, it is of 
greater thickness than the other membranes, and has 
a Granulous Surface, with numerous Foraminula,
which probably act the same as Lacteals,
in the nurishment of the Fœtus.- In some cases 
this membrane is expelled, when this is the case
you may be certain of Abortion following, when it is 
expelled in this way, is has very much the resemblance
of a Piece of Brussels Lace.-
The spongy Chorion is that which conserve
contact with the Uterus, next to which is the true
Chorion, the structure of this is more firm and 
compact the that last mentioned, and is probably
Vascular.-
The next or inner most membrane is the 
Amnion, this is thinner than the other two, but of 
a much firmer texture.-
The Placenta is situated between the Spongy
Chorion, and the true Chorion, and the maternal
part of which is formed by a portion of the Spongy
Chorion, but the Fetal or Vascular part of the Placenta



103
is formed by the ramification of the Umbilical
Vessels, this substance may be said to convey Nutriment
to the Fœtus in a similar way to what 
the Lacteals and Absorbents do in the adult.
The use of the membranes is for the purpose of 
containing the water and defending the child, and 
for some other purpose which will be mentioned
when speaking of the Waters.-
Water called likwise Liquor Amnii from 
its being contained in the Amnion, is divided into 
true and false, the false is a collection between
two of the membranes, and which is somtimes evacuated,
giving the Idea of the membranes having 
been ruptured, somtimes a quantity of Urine is 
suddenly evacuated from the Bladder, by some 
motion of the Child, and which is mistaken for the 
escape of the Waters.- The Properties of this fluid
very much resemble that which is effused into different
cavities of the Body.-
The quantity of Water is subject to considerable
variation, is somtimes in as small a quantity
as from half an Ounce to an Ounce, and in other
instances a pint, or even two or three pints have been
found, but in general from half a pint to a pint 
is the quantity.- With respect to the relative proportion



104
proportion to the Fœtus, this likwise varies, in the early
periods the Water very much exceeds the Fœtus in 
Bulk, and the reverse in the late periods, not but
that the Water keeps increasing in quantity, tho'
not in the same degree as the Fœtus. They very
near agree in quantity at the third month.-
The Water appears appears to be a secretion
from the Amnion.- When the Water are by any 
means evacuated at an early period. Abortion
must follow.- In case of actual Labour, when 
the Waters are evacuated, the time at which Labour
shall actually take place from this is uncertain
or in case the Water, has by any means been Discharged.
The Uses of the Waters, are to defend the child, and 
together with the membranes, to dilate the passages
in the early stages of Labour, and lastly to facilitate
the Passage of the child by lubricating the Parts.
The reason why larger in proportion early in the 
fœtus being soft so as to be liable to give way
to any slight [illegible]. It will be pressed [illegible]
at the 3 or 4th month



105
Changes on the Uterus by Impregnation.
The alteration produced by impregnation upon the 
Uterus, are considerable and in may respects, as in 
Shape, size, Weight, and in the size of the Cavity.-
Those alterations have considerable effect upon the 
ajacent parts, as by pressure upon the Bladder, a
frequent discharge of its Urine or a suppression
takes place, according to the part acted upon, thus if 
the upper part of the Bladder is pressed, the size of the 
cavity is diminished, and this causes frequent evacuation,
and if the lower part about the Neck is pressed
upon, a suppression is the consequence.- In these cases 
change of posture may be of service, and in case of suppression,
pressing up the Womb by means of the finger, will
releive the Bladder or it may be necessary to introduce
the Catheter.-
The enlargement of the Uterus is confined to the 
Body of the Womb till the end of the 5th month, after which
time the Cervix Uteri begins to strech, and is obliterated
at the end of the Ninth month.- Some practitioners
have supposed the neck of the Womb to have began to shorten
before this Period, but it is not the case, as it is of 
the full length, that of 1 1/2 In. till the end end of the 5th month



106
The shortening of the neck of the Womb does not take 
place in a regular gradual manner, but proceeds
faster at some periods than others, at the 6th month it 
is a little shorter, at the 7th month it has lost two thirds
of its length, being then only 1/2 In. long, at the 8th month
it is still shorter, and at the 9th month is entirely obliterated.-
Great advantage arises from this Order
of the Womb enlargment, for if the neck of the Womb was
obliterated at an earlier period, any sudden action of 
the parts might force of the mouth prematurely, and 
which is prevented, by this state of the parts.
During this enlargement of the Uterus it somtimes
spontaneously bursts, and the child escapes into 
the cavity of the Abdomen, the symptoms by which you
may ascertain this having taken place, an sense
of something suddenly giving way, attended with considerable
pains different from that of Labour, and you may 
distinguish the different parts of the Child thro' the Parietes
of the Abdomen.- This is more often the consequence
of bad practice in turning the child, from too great
a degree of force being used.- When this has taken 
place, it is certain to end in death or nearly so.
The practice recommended under these circumstances 
is to pass the hand thro' the opening and to 
find the feet, and endeavour to extract this way.



107
The part that gives way from violence during Labour
may be either the Uterus or Vagina.- From this it 
will appear the great necessity there is for case in 
case of a necessity for turning.-
The chief alteration produced upon the Os. Uteri
a Mouth of the Womb, from impregnation, consists in 
a more developed condition of the Mucuos follicles
occasioning a considerable discharge from these parts
in many instances, and which which has by some 
Women been mistaken for fluor Albus, and an account
of the quantity have been alarmed, but it is not a 
Matter of any consequence as it does not produce
any weakness, and upon the whole may be said
to indicate a more favorable Labour, from the 
parts being generally in a more relaxed state, than 
when there is no discharge.- There is always a discharge
of mucus preceding Labour, but which is in that 
case tinged with Blood, this is by them called the 
Shew.- The figure of the Os. Uteri likwise varies
gradually becoming less prominent, and Broader.
The ascent of the Womb when impregnated
is in a ratio corresponding with the Period of 
Pregnancy, at the third month, it is just above the 



108
Brim of the Pelvis, at the 5th Month it is half way
between the Umbilicus, and brim of the Pelvis, at the 
6th Month it is nearly at the Umbilicus, and at 
the 7th Month a little above it, at the 8th Month, it 
is half way between the Umbilicus, and Ensiform
Cartilage, and at the 9th Month is as high as this 
Cartilage.-
This enlargment and ascent of the Womb, produces
considerable effect upon the different parts
contained in the Abdomen, as upon the Bladder, Rectum,
Stomach &c.- The Nausea and Vomiting
which takes place at the early periods of Pregnancy,
cant be owing to pressure upon the Stomach
but must arise from irritability, or Sympathy.-
The Figure of the Womb in general is between
the Oval and Pysiform, tho' it is subject to variation
from several causes, as from the number
and position of the Fœtuses, quantity of Water &c.
The Position of the Womb is generally in the 
center of the Abdomen.-
The Arteries of the Uterus are 4 in number,
two of which arise from the Spermatic Arteries
and two from the Hypogastric, these are distributed



15
109
distributed upon the Uterus in a Serpentine direction
the Veins which return the Blood from the Uterus
in general accompany the Arteries, but instead
of taking a spiral direction, go nearly in a straight
course, they go from the Uterus to the Vena Cava
on the right side, and on the left side to the Emulgent
Veins. There have been different Opinions
respecting the Serpentine direction of the Arteries, 
some supposing it to be for the purpose of slowing the 
Uterus to enlarge, but as they are in the same spiral
direction when the Uterus is at the full size,
this cant be the reason, it must be for the Purpose
of retarding the motion of the Blood in these 
parts.- There are likwise Nerves and Absorbents
in the Structure of the Uterus both of which become enlarged
in the impregnated state, the Absorbents have 
at times very important actions to perform
as it is by their action the Uterus is reduced to its 
proper size after delivery.- The womb does not only
enlarge in circumference but in substance, during 
pregnancy, and different opinions have been
formed, respecting the thickness of the Womb at the 
time of Labour, whether it is thicker or thinner than
in the unimpregnated state, both these circumstances
may be right in different cases, in general the 



110
thickness is about 3/8 In.- The Womb at the time of 
Labour is supposed to contain 51 Cubic Inches and 
in the unimpregnated state 4 1/2 Cubic Inches, which
is nearly 11 times the Bulk. all this is to be taken
up by the Absorbents.- The size of the Womb should
be remembered after the expulsion of the child on 
account of its weight occasioning some inconvenience,
and rendering a horizontal position necessary.
Different opinions have been formed respecting
the substance of the Womb, some supposing it to 
be muscular, and others not, but there is not the least
doubt of its being Muscular from the actions which
the Womb performs, these muscular fibres are distributed
in different directions.- It is by the contraction 
of these muscular fibres, that the child is expelled and 
by a farther contraction, the expulsion of the Placenta
is effected, in many cases entirely without assistance.
This contractile state of the Womb is of very great
consequence in the prevention of hemorrhage, diminishing 
the size of the Vessels, for if no diminution of their 
capaciousness was to take place there must be much more 
hemorrhage after delivery, and from this circumstance
practical hints may be taken in flooding to assist 
the wombs contraction by any means as pressure upon
the Abdomen &c. or if the Placenta is not yet expelled 




111
and is the cause, extracting it, and which will slow the Uterus
to contract, and in this way stop the hemorrhage.-
Pregnancy.
Pregnancy has been already treated of Physiologically
but we must now take a different view of the subject
and in the first place speak of the signs by which
it is known.-
Signs of Pregnancy, these are numerous, but 
any one of them alone is fallacious, therefore in forming 
an Opinion, several of these should be taken
into consideration, the usual symptoms which 
take place in pregnancy are Amenorrhea
sickness and vomiting, frightful Dreams, loss of 
appetite, emaciation, peevishness, enlarged Breasts,
dark and enlarged Areola, quickening, enlargememt
of the Abdomen &c. shall now consider each of these
Symptoms seperatly.-
Amenorrhea, this is frequently a symptom
of Disease as well as pregnancy, as it may arise
from accident, such as taking cold at the time
or just before, the menstrual period, but this should 
be taken into consideration. At a certain time
of Life there is always a cessation of this discharge and 



112
which takes place at an earlier period in some 
Women than others, in general those who begin to 
menstruate at an early Period, have a cessation at
an early Period likwise; in a general way this takes
place at about the 45th Year.- Women never have the
natural menstrual Discharge during Pregnancy,
tho' there will in some Women be a discharge of Blood
at times, and which may be in some cases at regular
Periods, when this is the case it is accidental
and is frequently owing to portions of the placenta
being detached, probably in consequence of its being 
situated over the Mouth of the Womb.-
Sickness and Vomiting is likwise a very 
doubtfull sign, as this frequently arises from many
other causes, from the readiness with which the Stomach
Sympathizes with other parts, that which occurs
during Pregnancy is more particularly in the 
morning
Frightful Dreams this is amongst the 
most doubtful of the signs but in some particular
patients, is rather a certain symptom.-
Loss of Appetite this is a sign upon which 
no dependance can be placed if alone, as it arises from 
so many different causes.-

4th Month
Stethoscope= Inf Pulsation- Placental
Breast Softens

113
Emaciation and Peevishness, these are likwise
subject to very great uncertainty and deserve very
little Notice in general.-
Enlargment of the Breasts, this when attended
with the secretion of milk, is a probable Symptom;
but various instances have occurred, which prove
its fallibility
Areola, when this is enlarged and of a Dark
colour, is thought by some to be the best single Sign
but requires experience, to form a judgement from
this correctly.- The seat of this is in the Rota Mucosa 
surrounding the Nipple, and in the unimpregnated
state, resembles in colour, new plained Mahogany,
but becomes of a Darker colour in the impregnated
state.- In the unimpregnated state, it 
is in general about 1 1/2 In across, but in the impregnated
state becomes considerably larger.- After delivery
the Areola will in general regain its natural colour
and size in the course of some little time, except impregnation
takes place again very soon, in which case
it will become still larger and Darker.
Quickening, this is likwise a very fallacious 
sign, and both Patient and Practitioner may be
Deceived, pressing on each side of the Abdomen with the 



114
hands, may occasion uneasiness to the child, and that
way its movements be felt
Enlargement of the Abdomen, this is likwise
fallacious as it may be owing to various morbid causes
as well as from pregnancy, this it may assist in 
forming the opinion if combined with some other 
of the usual Symptoms, where this is connected with 
suppression of the Menses, and begins 3 or 4 Months
after the time of supposed impregnation, begining at
the lower part of the Abdomen, and gradually extending
upwards, more particularly if this has been
preceded by a degree of flatness of the Abdomen the 
first month or two, in this case, it becomes rather a 
strong Symptom, tho' there is no one on which so 
much dependance can be placed as upon the Attention
of the Areola.
Besides these there are several other Anomalous 
Symptoms somtimes attend pregnancy, but 
which appear to have very little apparent connexion
with it.-
Enlargement of the Abdomen may be combined
with Dropsy or with a Diseased state of One of the 
Ovaria. When the swelling is entirely owing to either
of these it may be distinguished by the undulation in 
one, and by the enlargment begining on one side in the other. 



115
Reckoning.
This is commonly divided into long and short reckong
the short is callendar Months, and the other Lunar Months,
the duration of Pregnancy is in general about 40 weeks
and which makes about 9 Callender, and exactly 10 Lunar
Months.- There are different times from which this 
reckoning is dated, either from suppression of the Menses,
Quickening, and coitus.-
That from which you can form an Opinion
of the Stage of pregnancy, with the greatest accuracy
is from the suppression of the Menses, but this in many
instances, cant be done on account of the Woman not 
having been regular in this respect, or not having 
the Discharge at all, as for instance in the case of a 
Wet Nurse, who will frequently have no menstrual Discharge
and yet become pregnant.- To form a judgment
with any degree of accuracy from this it is necessary
she should have been regular in the discharge.-
Different Opinions have been formed respecting
the period, at which impregnation takes place previous
to the stoppage of the menses, but in a general way
it may be said to be the second Week, or in some instances
may be the third, but no precise time can be 
mentioned




116
Some Women reckon from the time of quickening
that is the first time they have perceived the child
to move, and this has been said by some to be at the 
third, and by others the fifth month, but from observation
which was made upon 100 cases, 80 of them were
found to be at the fourth month, and this therefore appears
to be the Average time, being found to occur 8 
out of 10 times.-
Reckoning from the time of Coitus can only
be depended upon, under particular circumstances.
Management during Pregnancy.
Pregnant Women are liable to be in commoded
by causes, which to others, in a different state would
be harmless, hence attention to the Rules of living
are expedient, these Rules are comprehended in the 
non-naturals, namely Diet, Air, Rest, Exercise, Pathemata,
and Evacuations.-
With respect to diet, this must be regulated 
according to circumstances, but in general 
that which is found to agree best with the Stomach
is the best.- It is very seldom necessary
to recommend a change of Air, except under 



16
117
very particular circumstances, and with respect
to rest that.- Exercise in moderation is often
very serviceable, except under particular circumstances,
as in case of slight floodings, Pains &c.
or in case there has been repeated miscarriges
at some certain Period, under which circumstances
rest must be enjoined, with respect to proper
exercise, that must depend very much upon former
habits, tho' none very violent should be alowed
such as riding on horseback, dancing &c.-
It is frequently of consequence to attend to the 
Dress, as the mode of tight lacing formerly practiced,
must be very injurious, preventing the Uterus
from enlarging in the proper place, and causing
the mouth of the Uterus to be dilated prematurely.
The make of the Shoes should be attended 
to as the high heeled must be very injurious
attending the center of Gravity, and throwing the 
Womb forwards upon the forepart of the Pelvis
in making an alteration in this respect, it should
be done gradually, for if they have been worn for 
any length of time, the muscles will be attend in
their length, and on this account it should be gradual.-
The Passions of the mind have very 



118
great influence upon the Body and therefore
all violent emotion should to avoided as much 
as possible, and care should be taken against any 
thing causing alarm.-
Evacuations are of different kinds, on Practioners
have been of different Opinions respecting 
some of these, it is frequently necessary to act gently
upon the Bowels during pregnancy, as costiveness
is very common, this is best done by any gentle
Purgative in a Pillular form, or may be given
in any form most agreeable to the Patient.-
With respect to the exhibition of Emetics, there
is a general prejudice against them, but which
appears to be without much foundation, as Women
frequently Vomit spontaneously, even with considerable
straining and with impunity, from this 
it appears, that in cases when their use is required,
they may be safely given provided they are
not of too violent a Nature, tho' in account of the 
Prejudice, it will be best to be guarded in their use
and to avoid giving them when the Purpose can 
be answered by any other means, and when absolutly 
necessary, may in some instances be right to give 



119
them without in forming the patients that they 
are Emetics.
Bleeding during pregnancy has been very
much recommended by some, and as much condemned 
by others, it is certainly serviceable in some 
cases, as in case of Plethora, local or general inflamation,
or in case of a rigidity of fibre, it may
be a means of rendering the subsequent Labour
more easy. But you will in many instances
be under the necessity of doing it, on account of Prejudice,
and it may be right to do it from this except
there is some particular circumstance to forbid
its use, as in case of debility, or a disposition to 
a Dropsical state.-
Pathology of Pregnancy.
Diseases occurring at this time, are either arising
out of the Pregnant condition, or accidentally connected
with it, and are distinguished into those 
which occur in the early or latter stages.-
Particular attention should be paid to the mitigation
of their immediate causes, as this will
assist very much in forming a prognosis, and 
in the mode of treatment.-
Most these Diseases may be refered to one 



120
of the following general causes, namly, Plethora,
irritability of constitution, and Mechanical Pressure
this is to be understood to apply to Diseases arising
from the Pregnant State.-
When the Diseases arose from a Plethoric state
that state is known by the usual Symptoms of 
Plethora, and may be relieved by Blood letting, Purging
&c. or by attention to Diet, or Perhaps by both.-
When they arise from irritability of constitution,
the treatment must be varied according to circumstances,
so likwise must it, when in consequence
of Mechanical pressure
Particular Diseases of Pregnancy.
in the early Months.-
Nausea and Vomiting, these may arise from disease
as well as pregnancy, and it should therefore be
distinguished from which of these causes it may arises.
When they arise from a Disordered state of the Prima
Viæ, removing this by means of Aperients &c. will
be the means of cure, in this case you will be unwilling
to give an Emetic on account of the Prejudice
there is against it, but if you cant effectually remove
the complaint without, you may give it with
safety.- When there is much relaxation of the Stomach 



121
a good Emetic in this case will be Zinc. Vitriol. in
the Dose of from zss to zi, this in some measure bracing
the Stomach.-
When these are Sympathetic of Plethora, attending
this by bleeding, Purging &c. is indicated.-
When sickness is a Symptom of internal inflamation,
it may be distinguished by the usual Symptoms
denoting that state, and must be treated in a Secondary
way, regard being chiefly had to the primary complaint
by Bloodletting, purging &c. and by a strict Antiphlogistic
Plan, exactly the same as when unconnected
with Pregnancy.-
When symptomatic of mere Uterine irritation,
or Pregnancy, it will in different instances give 
way to different remedies, as Opiates, Saline Medicines
in the state of effervescence, Stomachic bitters &c. in 
this case, the quantity or bulk of the Medicine is often
very necessary to be attended to, as it will often be rejected
from from the Stomach on account of its quantity
then in giving Opium, a grain of solid Opium will
frequently be of service, when given in the form of a 
Draught it will be rejected.- In giving Saline
Draughts great attention is necessary, in respect
to quantity, and in being properly regulated in respect
to the proper quantity of each, a powder composed of 



122
Common Tart. and Sal. Soda, in proportion of two 
parts of the former, and one part of the Latter, this 
mixed in a small quantity of Water at the time of 
exhibition.- It is often necessary to give the food
in very small quantities, and which should be of the 
most nutritious kind.- In some cases it is necessary
to keep the Stomach perfectly empty for twelve
or twenty four hours, and occasionly giving a little 
solid Opium.- Nourishing Glysters may be 
thrown up the Rectum, and a little of their parts may 
be absorbed, and conveyed into the circulation. 
Warm Plastiers, or Rubifacients to the Scrobiculo
Cordis may afford relief, but in some instances
there will be a complete cessation at the time of 
quickening.- Somtimes it is owing to some particular
smell or effluvia, which was inoffensive 
at another time, in this case the cure is obvious
Pain in the Head and Breast, there are often
Symptoms of Plethora, and relieved by Bloodletting &c.
tho' in some instances, may arise from Sympathy,
in which case the treatment will vary according
to circumstances
Inability to Walk, attended with a sense of 
bearing down, a yellowish Discharge, and painfull 



123
Discharge of Urine, somtimes amounting to 
suppression.- This disease is to be distinguished
from gonorrhea, and may be done by attending to 
the Symptoms, in Gonorrhea, there is pain in making
water, but of a different kind than in this Disease, and the 
the discharge is different, the difficulty in making 
water is relieved by varying the posture, or by pressing
the neck of the Uterus up with the Finger, in some 
cases it may be necessary to introduce the Catheter
The cure of this disease is generally spontaneous,
as the Womb becomes enlarged, taking of 
the Pressure upon these parts, the Disease arising
from pressure
Retroversion of the Uterus, this consists
in the fundus of the Womb being thrown backwards
and which by its situation between the Bladder
and Rectum causes different affections of these 
Parts.- This disease can only be ascertained
by actual examination, for if the Uterus is retroverted,
the fundus is thrown back upon the Rectum
and the mouth of the is thrown forwards towards
the Pubis, and on examination if there is retroversion,
you will find the Os. Uteri in that situation
instead of its natural place, for whenever this is in 
the natural situation, there can be no retroversion.



124
Retroversion of the womb is not confined to the 
impregnated state, as the Womb may be enlarged
from Disease and become in consequence retroverted,
and it may be retroverted in the natural
state, but not be known 'till the Uterus becomes enlarged
either from Pregnancy or other causes, bring on the usual
Symptoms.-
The Symptoms of this Disease usually come on 
about the third month of Pregnancy, as at this time
the Uterus becomes of the size so as to cause these Symptoms,
they consist of Pain, Difficulty of voiding Urine,
constipation of the Bowels, Tenesmus &c.-
The Period of the Symptoms coming on may be 
a little varied, tho' they are always confined to the 
early months, as it cant take place after the Womb
is of a certain size.-
The most common cause of Retroversion of
the Uterus, is a Distended state of the Bladder, and this 
acts by pressing upon the fundus of the Womb so
as to force it downwards and backwards, and at 
the same time by its arising higher up in the Pelvis
it draws up the mouth of the Uterus in consequence
of the connection of these parts, in this way it acts 
in two ways, that is at the time it is forcing the 
fundus down, it is pulling the mouth of the Uterus
up.- Other causes have been mentioned, as a  



17
125
Blow upon the lower part of the Abdomen, but the
Bladder must be in a distended state.- An enlarged
state of the Ovaria, either from a collection of water
within them, or from other causes, may occasion this 
Disease.- Distention of the Bladder may in
some cases be an effect as well as a cause of this 
Disease.- From these circumstances it appears
evident how particularly carefull Women in the 
early stage of Pregnancy, should be to avoid a distended
state of the Bladder.- When the Bladder becomes
very much distended in this complaint there 
is great danger of its being ruptured, and on this 
account it should be frequently emptied by the 
use of the Catheter or by other means, and when this 
cant be done, it will be necessary to puncture the 
Bladder by means of a small Trocar, above the 
Pubis. In some instances when a common female 
Catheter cant be introduced, one of a smaller
size or a different form may, as that which is for a 
Boy.- The Danger in Retroversion is according 
to the state of the Bladder, and Degree of irritation.
The treatment in this case, consists in obviating
the distentention of the Bladder by the introduction
of the Catheter 3 or 4 times a Day, and this in 
some cases is sufficient alone, tho' not always
the length of time this should be tried depends upon



126
the Degree of irritability &c.- Before you attempt
the reduction of the Uterus, the Bladder and Rectum
should be emptied, and the patient should then be 
placed on the Knees and Elbows, and then introduce
a finger or two up the Rectum, and press
the fundus of the Womb upwards, at the same time
with the finger of the other hand up the Vagina
endeavour to bring the mouth of the Womb down,
in case the fingers are too short it may necessary
to have recourse to an instrument, which 
may be made by a piece of cured Cane or Whale bone
which should not be too weak, and at the end a 
Piece of sponge covered over with soft Leather, this 
should not be too small, and should be well secured
upon the end of the Stick, in using this the finger should
be passed up the Rectum along with it, and the force
with which which it is and should be regulated with 
some degree of ninty. The end may in some instances
slip up the Rectum by the projection of the fundus
but this will in a great measure depend upon 
the mode of using the instrument.- The more 
difficulty there is in the reduction the greater
softly there is against a natural.-
It was proposed by Dr Hunter to puncture Her
Uterus, but this must be attended with very great 



127
Danger and has no facts to support it.-
Mr. Cruikshanks thought the Division of the 
Symphisis Pubis might be of some advantage,
this certainly diserves some attention, but has not any
facts to support it, in this case the Patient would not 
be placed on the Knees and Elbows, in attempting the 
Reduction.-
Diseases of the latter Months.
Sickness and Vomiting, may occur now as well 
as in the early stages of Pregnancy, or may continue
from the early stage.- They may arise from Plethora
or from a foul state of the Stomach from irritability
or pressure of the womb upon the Stomach.
If from Plethora, the loss of Blood or gentle Laxative
Medicines &c. may be of Service, and when 
the Stomach being in a disoredend state, an Emetic
will be serviceable, if nothing particular contraindicates,
and afterwards proper Stomachic Medicines.
When irritability or pressure is the cause, these
exhibition of Opium Saline Medicines in the State
of efferverscence &c. must be resorted to, and food
must be given in very small quantities, and frequently
repeated, and should be of the most Nutritive
quality.- In case all these remedies fail in producing



128
producing any mitigation of the Symptoms, and the 
patient appears to be sinking under the complaint,
and not likly to support it 'till delivery takes place
naturally, it may be right under such circumstances
to bring on Labour prematurely, by puncturing
the Bag of Waters so as to alow of their Discharge
and Labour will then come on the course of some 
time, perhaps may be a Day or even two
Jaundice, when this is merely a consequence
of Pregnancy, there is little Danger and the treatment
may be confined to the Palliative, where 
there is much pain in the Epigastrium, the use
of Opium Aperients &c. may be necessary.- The way
Pregnancy causes Jaundice is by pressure, which 
tho' not directly yet may be indirectly upon the 
Billiary Duct.-
Jaundice during pregnancy may somtimes
depend on a Schirrous state of the Liver, or Diseases
of the Billiary Ducts; such cases are more complicated,
and the mode of treatment must depend upon
the Particular part effected.-
Costiveness may depend either on torpor of 
the Intestines or upon Mechanical pressure, and 
may become very inconvenient, and therefore should 



129
be obviated by means of Purgative Medicines, and 
by the use of Glysters. In some cases the Feces become
very much indurated, rendering it necessary
to break them down by means of a large Bougie, and 
them to inject a Glyster for the Purpose of bringing
them away.-
Hemorrhoids are in two states namly
Bleeding and Blind Piles, and a third Kind particularly
noticed by the German Practitioners,
which is called Hemorrhoidal Cholic, the Symptoms
of this complaint are Cholicky pains in the Intestines
and which may be traced along the Colon, Caecum
and Rectum, and which are relieved by a Discharge
of Blood, these pains are not cured by the common
thing in the use for pains in these parts.
As Mechanical Pressure is intimatly connected
with the Production of Piles, they will often continue
'till delivery takes place, but it will be advisable
to Palliate the Symptoms, by means of Leeches applied
to the parts, or by Saturnine ointments or washes,
a good ointment for this Purpose is one composed
of Simple ointment, with a portion of fine powdered
Galls and Opium. Patients are frequently alarmed
for fear the Piles should produce Fistula in End
but this is seldom or never the case.
There are some other complaints remain to be 



130
mentioned, but which are not of very great consequence,
as the swelling of the lower extremeties, this 
may be relieved by means of a Laced Stocking.-
Some Women have considerable uneasiness
from the violent movements of the child, in this 
case you may moderate the Symptoms by means
of Opium.-
There will in some instances Black Spots
appear upon different parts of the Abdomen, and 
which may alarm the Patient, but are of no consequence,
and will disappear after delivery, they are 
probably owing to the rupture of some of the small 
vessels, in consequence of the Distention.-
Diseases accidentally connected with Pregnancy.
Lues Venera, when this Disease is in the 
form of Gonorrhea, the treatment is so gentle
as not to require particularly to be mentioned in 
this place, but when in the form of Chancre, it then
becomes a matter of much more consequence, for 
tho' they are only primary sores, yet from their slowing
absorption of Matter, constitutional Symptoms
may be produced, as Ulcerated throat, Eruptions &c.



131
Chancres are often cured without Mercury by 
the parts being destroyed with a Caustic, but the constitutional
or secondary Symptom require the 
use of a considerable quantity.-
When Salivation is produced during Pregnancy,
some have apprehended dangerous effects, but this 
is not necessarily the case, as the only thing of consequence
is its disposing to premature Labour.
Different opinions have been formed respecting
the mode of conduct proper under these circumstances
some have given Mercury in the alterative way so
as to produce a temporary cure of Symptoms, and 
this way gaining time 'till delivery has been effected,
but this must depend upon the Stage of Pregnancy
and upon the urgency of Symptoms, for if the Symptoms
are such as wont admit of Delay, you must
then proceed to the Cure, conducting the course with 
more caution, tho' with even so much, Abortion
will frequently take place.-
Dropsy, by this is meant Ascites, not Ovarian 
Dropsy, this Disease when connected with Pregnancy
comprehends some subjects for enquiry, namely,
whether Delivery is possible, whether the Patient will
live after Delivery, wether the Child will be Dropsical
whether tapping in proper, and whether a Cure will 



132 
succeed. With respect to the first of these, that is, the 
possibility of Delivery, experience proves this to be the case,
and without any extra Difficulty, for tho' the expelling
Powers are less, yet those of resistance are proportionally
diminished, but with regard to the second subject,
that of her living after Delivery, this is extremely doubtfull
on many accounts, one of which is the degree of 
Debility then present, and which will be very much
increased by the discharge which necessarily attends delivery,
and which is somtimes greater than others.
The third question is the child being necessarily
affected with the same Disease as the Mother, this [cross out]
is not the case, but it is impossible to say whether
the child will be Dropsical, for it may or may not 
be the case, as children are frequently born Dropsical
of sound and healthy Parents and the reverse, but a 
Dropsical state of the Mother entails no such state
in the Child.-
The Fourth circumstance; is the propriety of 
tapping under these circumstance, this is always
proper, whenever, the Disease is in that state to require
it, but should be done with caution on account
of the Danger of the Trocar being forced into the Uterus,
but this danger is entirely done away, by inabling



18
133
an incision with a Lancett, carefully thro' the integuments
in the course of the Linea Alba, the hole
into the Cavity of the Abdomen being about the size 
of the Canula of a Trocar, a Probe should be introduced,
into this opening, and upon this Probe or 
Canula slided into the opening.-
The last of these questions, is whether a Cure
will succeed Delivery, this has in many instances
taken place, and the way this is generally affected
is by the fluid escaping thro' the Fallopian Tubes
into the Uterus, and in this way been evacuated, the 
extremeties of these tubes are loose and floating in 
the abdomen, and tho' in the natural state it may
not be possible for any fluid to escape by this way
yet a certain action may take place in them
which may be the means of evacuating the fluid.
Hernia, are frequently very much effected 
by Pregnancy, and the purpose of considering this subject
more effectually, it will be necessary to divide
them into two states namely, Reducible and Irreducible.-
When the Hernia are Reducible, the Phenomena
are subject to variations, depending on the seat of 
the Rupture, as being either Femoral, Inguinal, Ventral, 



134
or Umbilical.- Reducible Hernia are generally
cured, that is temporally, by Pregnancy, except in particular
situations, as at the Umbilicus &c. which it
somtimes increases, and in some Women Pregnancy
always produces Hernia, when they are not subject to
it at other times.- It is very seldom proper to use 
a Truss for the Ruptures during Pregnancy on account
of the Pressure necessary to keep the parts reduced.-
Irreducible Hernia are dangerous in the extreme
as the ascent of the Uterus, may bring on Strangulation.
Whenever amongst other Symptoms, a patient informs
you of having a Hernia, and which she has 
not been able to reduce for some time, you should lay 
particular stress on the necessity of keeping the Bowels
compleatly open, and this should be done even if the 
Hernia is reducible.-
Women out of Delicacy will frequently avoid mentioning 
their being subject to Hernia, therefore in all
cases of violent pain in the Bowels, more particularly
if confined to any particular part, and this 
does not give way to the common modes treatment in
a moderate space of time, you should make particular 
enquiry and examination, to ascertain whether
there is any thing of this kind.
When Pregnancy is somewhat advanced, perhaps  



135
about the fifth month and Symptoms of Strangulation
come on, the treatment then becomes very complicated
and the event uncertain. It has been proposed, (when
the common methods of proceeding have failed) to bring 
on premature delivery, and by this to take off the exciting 
cause, but the mouth of the Womb is in general so rigidly
closed, that this could not be done without using a greater
Degree of violence than would be consistent with 
safety.- When the parts are in a relaxed state, and 
easily dilatable, this is a favorable circumstance and 
you may then proceed to dilate the parts in a slow 
and gradual manner and this way bring on Labour,
taking care not to use any violence.-
When the os. Uteri is in a rigid state, introducing an 
instrument and puncturing the membranes to evacuate the Waters, has been proposed,
for the purpose of bringing on Labour as this will follow
sooner or later, but this must depend upon the state of 
the Hernia, for if in the advanced stage there wont be 
sufficient time to wait for this, nor even to wait for 
bringing on Labour in the other way [cross out] when the parts
are dilatable, if it is in a still more advanced stage.-
When this is the case the operation becomes absolutely
necessary, but which is attended with considerable
difficulty, an account of the adhesions, and other circumstances.-
The operation should be performed in 
the usual way, and when the hernial Sac is laid bare
this should either be divided or not according to circumstances,



136
circumstances if it does not adhere, and you have reason to 
suppose the Contents are in a state proper to be returned
you may then do so without opening it, but if there is 
considerable adhesion, or you have any doubts about 
the state of the contents you should then lay open the 
Sac, for the purpose of examining them
Stone, when speaking of Stone as connected with 
Pregnancy, not only Urinary, but likewise Biliary
Calculi are comprehended.-
Gall Stones when in the Biliary passages, produce
Symptoms which should be distinguished from Labour
Pains, the Pain arising from the presence of a Gall
Stone in the Biliary Ducts, is about the Scrobicula Cordis,
is attended with considerable sickness and vomiting, and 
now not slow of that compeat intermission, which takes 
place in Labour pains, then will likwise after some 
little time be an affection of the Urine and Skin, and 
in the course of some length of time the pain will cease
from the Passage of the Stone into the intestines, a quantity
of Bile will be evacuated by stool, and the whole
of the Symptoms will disappear, at least 'till another
of these calculi obstruct the Passage.-
For the Purpose of moderating the Symptoms, Opium
should occasionally be given, and gentle aperients, and 
Bladders of warm warm Water should be applied to the 



137
part, or fomentations &c.- It would be very advantageous
to prevent a fit of the Gall Stone, at this time
and which may be attempted by ordering a greater
Degree of Exercise, and at the same time giving Aloctics
combined with Saponaceous Medicines, or by the exhibition
of Lixis Sapon. in the Dose of 30 or 40 Drops, three
times a Day and which may be gradually increased to 
a teaspooonfull, it should be given largely diluted, a convenient
vehicle, is a quantity of Mutton Broth, as this very
much sheaths the acrimony of the medicine, but the effects
of these remedies are very doubtfull.-
Urinary Calculi may either be seated in the 
Kidney, Ureters or Bladder, which may be distinguished
by attending to the Different Symptoms, when the Stone
is in the Kidney, the will be considerable pain in that
part of the back opposite the Kidneys, and which pain
will extend down the Thigh along the course of the Nerves
and as the Stone passes along the Ureter, the seat of the 
pain in the Back will be changed, and often a time all 
the Symptoms will cease from the Passage of the Stone
into the Bladder, when other Symptoms will come on,
the Urine will likwise be tinged with Blood at times.
By attention to these circumstances, and by the continuation
of pain, this may be easily Distinguished from
Labour pains.- The treatment will be different according



138
according to circumstance, as whether there is inflamation 
and fever or not, it will be right under all circumstances
to keep the Bowels sufficiently open, a good medicine
for the purpose is Castor oil, this may be made 
into a Mixture by the addition of a little Kali &c. and
along with this, opium should be given joined with Ipecacuhana, 
or Antimonials, and Bleeding if necessary should be 
had recourse to.-
When calculi a situated in the Bladder being formed
there or have passed from the Kidneys, different Symptoms
take place, as sudden suppression of Urine, discharge of 
a quantity Mucus &c. in the Urine, and occasional pain,
but as these Symptoms may arise from some other 
affection of the Bladder it may be right to try the use of 
some remedy in the first place, as by giving Uva Ursi
in the quantity of from 3ss to 3i two or three times a Day,
for some time [time].- If the Symptoms dont 
give way to these [illegible] of treatment, you should
then make examination, and in case you ascertain
the existance of a Stone different opinions have been
entertained respecting the propriety of performing the 
operation for its removal, but if this cant be effected
by any other in cases it may be done.- You may
somtimes ascertain the size of the stone by passing your
finger up the Vagina, and getting the Stone upon it, if
it is small it may possibly be got away without an 



139
incision being made, by dilating the Urethra, by a 
series of Bougies, or by the introduction of an intestine 
(with the end tyed up) into the Urethra, upon a long probe
or Bougie, and then forcing a quantity of Warm Water
into the Intestine to dilate it, and likwise the Urethra
this last method has been found successfull.-
If the Parts cant be sufficiently dilated in this 
way, recourse must be had to a cutting instrument,
but in using this it must be remembered, that there 
is some danger of wounding the Crura Clitoris, this 
renders the operation less perfect, this does not add to 
the danger of it.- The incision should be made in 
an oblique direction, the edge of the Gorgett being 
inclined obliquly downwards, and in this way the 
danger of wounding the Crura is lessened.-
If the existence of a Stone in the Bladder is 
not known till labour comes on, a good deal of management 
is necessary to prevent mischievous
consequeces, and for this purpose different ways 
of proceeding have been recommended, Dr. Smellie
advised the raising up of the Stone, and this is a very
eligable mode of practice of it can be done, if on
examination in the early stage of Labour the Stone
is found below the head of the Child, if this has not 
descended much, the Stone may be raised above the 
Brim of the Pelvis, and this way prevent serious consequences,



140
consequences, for this purpose a Male Catheter or a Sound 
may be introduced into the Urethra, and two finger
(one on each side the Instrument,) up the Vagina, and 
in this way acting upon the Stone, and raising up, and 
when you have done this you should keep it raised
for some time, 'till pains come on, and force the 
head of the Child lower down, and preventing the descent
of the Stone.- To effect this some time may possibly 
be required, and the woman should be placed in the 
most favorable situation.-
Some have recommended the introduction of a pair
of Forceps up the Urethra, and extracting the Stone by 
that means, but there a great objections to this mode
if much force is used, on account of the injury which 
must be done to the Parts.-
Another mode of proceeding has been recommended,
and which is much more eligable, that is, the making 
an incision from the Vagina, into [cross out] lower part
of the Bladder, opposite its superior Curve, as the Stone
generally lays there.- The way of doing this, is by carrying 
a finger up the Vagina opposite to that part, and 
introducing a curved Bistory upon it, and in this way
making an opening into the Bladder.- The Bistory
should be covered by means of somthing passed round
it, except towards the end.-
It has been advised in a case of this sort to open 



19
141
the childs head when the other methods fail, this 
may somtimes be necessary, but there is one thing 
to be taken into consideration, which is the Death
of the Child.
Examination.
By this is meant manual examination, and 
which should always be conducted with the greatest
Delicacy and gentleness, so as to give as little pain
as possible.- The reasons for examining are comprehended
under five particular views, namely.
1st. To ascertain the existence of Pregnancy. 2d. To
determine its period. 3d. To know if Labour is present.
4th. To know the precise kind of Labour, 5th.
To investigate the true nature of a Disease.
Some Dexterity is required in making examination,
and in case you find it necessary to examine
by the Rectum likwise, it is much better to mention
it, to prevent then forming a bad opinion of your
judgment, supposing you make a mistake.- When
ever you find it necessary to examine, it will be 
adviserable to have another female in the Room
more particularly if the Person is a Stranger.-
Shall now proceed the different views separatly.



142
1st. To know if a Woman is Pregnant. There is very
little to be gained from examination on this account
before the third month, on account of the enlargement
not being sufficient to alow of a determination being
formed, and this may be still increased if there is 
a Degree of corpulency, or from a distended state of 
the Bladder, but this last circumstance may be removed.-
From these circumstances it is always
much better to decline examining, except particularly 
requested, and then it is best to mention the 
uncertainty.- The best position for the Purpose of 
making examination is half sitting and half lying as
this places the Pelvis on a horizontal situation, and 
before you attempt to examine the Bladder should
be emptied.- The way to examine is to pass two 
or three fingers of one hand up the Vagina, to feel for 
the neck of the Womb &c. and with the other press
upon the Abdomen, doing this alternatly, and you 
may somtimes be able to ascertain the size and 
state of the Womb, the larger the Uterus is, the more easily
will Pregnancy be ascertained.
2d. To ascertain the Period of Pregnancy.- This is 
done either by observing the degree of the Wombs ascent
in the Abdomen; or by the shortening of its Neck.-
Shall first mention the circumstance of the Wombs



143
ascent at the third month the fundus of the Womb is 
just above the Brim of the Pelvis, at the 5th,, Month, half
way between this and the Umbilicus. 6th,, Month, a little
higher, 7th,, Month, even with or a little above the Umbilicus,
8th,, Month, halfway between the Umbilicus and Scrobiculs 
Cordis 9th,, Month, at the Scrobiculs Cordis.-
With respect to the shortening of the neck of the 
Womb, that remains of its full length 'till the end of the 5th,, Month
namely 1 1/2 In. after which time it begins to shorten,
at the 5th,, Month 1 1/2 In. 6th,, Month a little shorter 7th,,
Month 1/2 In. 8th,, Month, somthing less 9th,, Month, entirely
gone, the way to form this measurement is 
by passing the finger up the Vagina and pressing against
the Body of the womb, and forming your measurement
by the finger.- But in forming a judgement
it is best to compare both these methods, along
with other circumstances
3d,, To determine the existence of Labour.
Before this can be done it is necessary that Labour.-
should be defined.- Labour consists in the evacuation
of the fetus and Involucra, from the Uterus,
and is divided into natural, laborious, and preternatural
Labour.- Natural Labour, is when the 
head of the Child presents, and the Labour is terminated
without instrumental assistance.-



144
[illegible]. see after
Laborious Labour, is when the Head likwise
presents, but from circumstances, as a greater degree
of resistance from any cause, the aid of Instruments
is necessary.-
Preternatural Labour, consists in the Presentation
of any other part but the head, as the Arm,
Breech &c.-
The Symptoms of Labour, are pain, dilatation
of the Os. Uteri protrusion of the Membranes & Water,
tension or relaxation of the membranes, during the 
Presence or absence of Pain, and you may form some
opinion of the Stage of Labour, and of the kind, and length,
of time it is likely to be before its termination, from
there, and from the advancement and recession of 
the child during the presence or absence of Pain.-
Pain alone is not to be depended upon as a Symptom
of the existence of Labour, as this may arise from 
many other causes, as Cholic &c. nor even if with combined
with some dilatation of the Os Uteri, as this may 
be in a relaxed state, from some cause, but if along
with these you can feel the protrusion in some measure
of the Bag of Waters, it then becomes a certain sign.
4th,, To know the kind of Labour, this should always
be ascertained as soon as the Progress of the Labour
will permit, more particularly if the Waters have been
evacuated, as if there is a necessity for turning or any 



145
thing else to be done, this is the most favorable opportunity
for doing this.- I making examination to
ascertain the kind of Labour, the three different kinds
must be kept in View.-
Natural Labour, supposes proper Presentation
of the Head, sufficient Room in the Pelvis, and 
sufficient Pains.-
Laborious Labour supposes either want of Room
or want of Pains.-
Preternatural, when any other part except the 
Head presents.-
When the head of the child presents the Labour
may still not be Natural, and the aid of instruments
will become necessary, but you should wait some time
to see what nature will do (if there is nothing contraindicates)
for you cant always determine whether there
is want of Room or not, tho' this may be done after
some time, for tho' the Pelvis may be sufficiently large
and the head not larger than common, yet if the Bones
of the head are more ossified than usual, this may
prevent its passing, and the Reverse of this may be 
the case.- With respect to the sufficiency of pain
you cant form a correct judgement from the quantity
of Vociferation, but from the effect it has on the 
muscular actions of the Different parts, in general the 
most is done, when the patient holds in her Breath
and bears down, as the breath the Lungs contain, assists 



146
the action of the Muscles in forcing down.-
5th,, To distinguish the Disease in Question, various
Diseases require examination which have been before
mentioned, such, Cancer Uteri, Polypus, Retroversio Uteri &c.
Natural Labour.
Natural Labour is divided into quick or lingering
Labour according to the time necessary for its
completion, as in some cases the Labour is over in 
the course of two or three hours, in other cases much
longer, as for instance 2 or 3 Days or more, when ever the 
duration of Labour is protracted more than 12 hours
it then becomes lingering. There is another Distinction,
made by Women, that is into Sick, Wet or Dry
Labour, according as Sickness occurs, or the parts are 
in a moist or Dry state from the quantity of Mucus
secreted.-
Labour is likwise divided into three Different stages,
the first stage is the dilating process, and every thing
that takes place 'till rupturing of the Membranes.
The 2d,, stage is from the evacuation of the Waters 'till
the Birth of the Child is compleated.-
The 3d,, Stage includes every thing which occurs after
this as the expulsion of the Placenta &c.
[illegible] bound



147
Preparatory Considerations.
A young Practitioner should adopt the Customs
of the Country in which he resides, the position in
which a Woman is delivered varies, in some places
she sits on the lap of another Woman, in other a 
stool or Chair of a particular form is used, but 
these modes are very objectionable, for this throws
the Pelvis on a horizontal position, and if the parts
are in a relaxed state, and the Pelvis large, the Child
may be expelled so suddenly as to produce considerable
injury by either breaking the Umbilicus, suddenly
detaching the Placenta, bringing on hemorrhages
or by inverting the Womb, which will be very easily
done when in this state.- Her Position in general
use in this Country is the left side, and is by far the
best, the Patient may be either above or under the Bed
cloaths, tho' in general under them is preferable.-
Guarding the Bed is another circumstance
necessary to be known, this is by means of a Skin of 
Leather or any thing that wont alow the wet to penetrate 
to the Bed, and over this a Blanket &c.-
All postures are not the same tho' the Patient is
on the left side, for the purpose of rendering the Posture
the most convenient, the Patient should lay on the left



148
side, with the Knees bended, and brought towards
the Abdomen, and with the breech to the side or bottom
of the Bed, facing the Practitioner.-
It is adviseable more particularly if you any
Distance, to take somthing for the Purpose of making
a Purging Glyster, and a little R a Opii, for in many
instances, when the Pains are weak, and instead of forwarding
the Labour, only teaze and weaken the Patient
25 or 30 Drops of Tinct. Opii will be of great use, by
putting of the Pains entirely for some time alowing
the Patient to get some sleep and by that means being
refreshed, the Pains will after a time return with 
more vigour, and compleat the Labour.-
With respect to the Propriety of taking Instruments,
that must depend upon circumstances, as 
the Distance &c. and upon the command the Practitioner 
has over himself, as whether his having them
with him will cause to use them unnecessarily,
these things taken into the account, it may under certain
restrictions be adviseable to take some simple
Instrument as the Lever.-
Incidents connected with the first stage of 
Labour.- Pain is one of the first signs, this originates
in the Back and Loins, in the begining the Pain is confined,
but becomes more diffused as Labour advances,



20
149
Sometimes the pain begins in the fore instead of the back part,
and if this recurs at intervals in the same way as the 
other, it may be equally a sign of Labour, but if this pain
is continued, or has only very slight intermissions it
probably is owing either to Cholic, or to inflamation
if there are at the same other symptoms joined with this 
as a degree of fever, quickness of Pulse &c.-
The Pain in the begining is very slight, and in 
the begining continues perhaps 1/4 or 1/6 a Minute, recuring
at intervals of 15 or 20 Minutes, but as the Labour advances
the Pain becomes more violent, and continues longer
recuring at shorter intervals, so as towards the last
to be nearly continued pain and exertion.-
The cause of this Pain is the contraction of the 
Womb upon the Fœtus, for the purpose of effecting its
expulsion.-
Show. This is another sign of Labour, this is 
a discharge of Mucus secreted by the Mucuos Fallicles
about the mouth of the Womb, and when this becomes
a sign of Labour is tinged with Blood, this discharge
will somtimes take place a Day or Perhaps more, before
the commencement of Labour.- The red tinge 
is probably owing to some small vessels being ruptured,
in consequence of the mouth of the Womb becoming
a little Dilated.- Somtimes Labour comes on without
any discharge of this sort taking place.-



150
The Use of this Discharge is for the purpose of lubricating
the parts and rendering the dilating process more 
easy, and facilitating the Passage of the Child.-
Women will frequently this Discharge of Mucus
(untinged with Blood) for a considerable time previous
to Delivery, and in very considerable quantities, and 
will frequently be very much alarmed on account
of the supposition that it will weaken them and be 
a cause of difficult Labour, but this is not found
to be the case, and the Labour in some instances
appear to have been easier on this account, from 
there being a greater Degree of Relaxation. It is seldom
necessary to do any thing on this account, except
they appear anxious for somthing to be done,
in this case you make a Tonic Mixture of some 
kind as Decoct. Cort. &c.-- In some cases they 
may suppose themselves injured, and will make 
inquiries respecting this, you must be very cautious
of giving an Opinion, and before you do have some 
other circumstances than discharge alone.-
Show is not a sign of actual Labour, only of 
its approach, Pain is the first Symptom of actual
Labour.-
Rigor.- Labour is frequently ushered in 
by a Rigor, and frequently as a Symptom of Strong
Pain is a favourable circumstance, but this is likewise



156
likewise a Symptom of Fever, or internal Inflamation, it then becomes
an unfavorable symptom.- It becomes
necessary to distinguish the cause which gives rise to 
this Rigor, and which may be done by attending to
circumstances.- That from Labour may be distinguished
from Rigor as a Symptom of Fever, or Inflamation,
in having not hot stage, going directly from 
this to a state of Perspiration, and in the being no whiteness
of the Tongue &c.-
Vomiting. This is frequently Symptomatic
of strong Pains, but somtimes of internal inflamation.-
Vomiting as a Symptom a Labour may be 
distinguished, from the same symptom as connected
with fever or inflamation, by the Absence of Fever, state
of the Tongue &c.- If a Symptom of Labour and it is 
very violent, and frequent, it may reduce the Strength
of the Patient very much, and therefore should be moderated,
by the exhibition of R [illegible] Opii. Aq. Menth. or by 
the use of Saline Draughts in the state of effervescence.
Micturition and Ischury. These may both
occur during Labour, and arise from the Pressure of 
the Womb upon different parts of the Bladder, on this account,
(if micturition) you should never stay long in the
Room at a time.- If there is suppression, it may sometimes
be necessary to draw off the Urine with the Catheter
tho' pressing up the Womb with the finger will frequently
be sufficient.- 



157
Tenesmus. This often occurs and more particularly
in the latter stage of Labour from the Pressure of
the Childs head upon the Rectum.- In some cases, when
there is considerable relaxation of Parts, and the Labour
is considerably advanced, it will not be safe to alow
the Patient to make use of the close Stool, as the Child
might by the action at that time be expelled, but if any
thing passes away as the Patient lays it must be removed
by means of Cloths, &c.-
Observations &c.
On certain proprieties of conduct concerning
Labours.-
Always go as soon as sent for, as this may
somtimes be necessary and will always give more 
satisfaction, and be carefull to avoid any conduct
that may occasion alarm, is this tends to check and 
somtimes to divert the Labour Pains.-
If the Labour be in the early stage, do not stay
in the Room too long at once.-
Never be anxious about making examination
if the Labour is not much advanced, for you cant determine
much by it in this stage, and the Nurse or Attendants
will either ask, or set a Chair by the side of 
the Bed, with some Pomatum &c. which be to the same 
Purpose. The proper time for examination is 
when Labour is somewhat advanced, and the parts 



158
are become Dilated or when the bag of Waters has been
broken if this has not been done before.-
It is not necessary to repeat the examination
very often, and in doing the Presentation, and Progress of 
the Labour should be kept in View.
The Patient need not constantly be confined to the 
left side or to the Bed during the whole of the Labour
but either occasionally walk or sit in a Chair, in the 
begining Labour, tho' this cant be alowed in the 
later stages.-
First Stage of Labour. This begins with pain
in the Loins, which in the begining is confined, and 
continues only for a short length of time, and recurring
at long intervals, but after some time this becomes
more diffused, continues longer, and recurs at 
shorter intervals, and along with this a bearing down
of the Uterus, the external Parts become relaxed, and 
the mouth of the Womb a little dilated, after a little time this becomes
more dilated, and the membranes protrude, or you may
feel the fetus, [in] making examination, which should always
be done during during Pain, as not only give less
Pain, but feel every thing much more distinctly.-
There is frequently more time required to gain
a Dilatation to the size of half a Crown that to effect
the remaining Dilatation.
The dilating process gradually goes on and the 



159
Bag of Waters becomes considerably more protruded
and if these after a time are not ruptured, it will
be necessary to do this by means of the Finger Nail,
or pressure with the finger upon the Bag, if there is much Water,
for if this was to go on and the Child was to be expelled 
with the membranes whole, it would be literaly
drowned in its own waters, the same as in any other
fluid, as the supplies from the Mother are cut off.-
The proper time for rupturing the Membranes
is when the Mouth of the Womb is considerably dilated,
so as to alow the head of the Child to act as a 
Wedge, for the farther dilatation. There is great
disadvantage in evacuating the Waters too soon, for 
the Head is not able to effect the Dilatation, so well
in the begining as with their assistance, therefore
you should never rupture the membranes too
early.- If there is a considerable quantity of Waters
it will be better to collect them upon a Cloth &c.-
When the Waters are evacuated if you have
not before examined, or if you have any Doubts
about the case, this is the proper time for examination,
and to ascertain the situation &c. for if
there is a necessity for any thing to be Done, this 
is the most favorable time for doing this, such
as turning &c. for if the Womb is alowed to contract
more force will be required, and of course more pain
and Danger to the Patient



160
Second Stage of Labour.- This comprehends
all that takes place from the Rupture of the Membranes
'till the birth of the Child is compleated.-
The begining of this Stage is the proper time for 
ascertaining the situation and presentation, if this
has not been done before. If the Pains are Strong
and the parts relaxed the Labour now proceeds very
quickly.- When there is great relaxation of the external
parts, and this not the first Child, it will not 
be safe to alow the Woman to sit up or Walk about 
as the Child might be suddenly forced away and if she 
walking, fall in the Floor, and be a cause of considerable
Danger.-- In quick natural Labour, the 
head is very much forced down by a few pains, after
the escape of the Waters, and when the head has been
small or the Pelvis large, the same pain that has 
ruptured the membranes, has expelled the Child.-
The time when assistance becomes necessary
is when the head becomes forced against the Perineum
as there is some danger of its becoming lacerated, and 
which laceration may extend to the Rectum, this 
is a Matter of very great consequence, as there is generally
a high degree of irritation comes on, and the parts
wont again unite, and the power of retaining the fœces
is the consequence.- This is often occasioned by 
the improper use of Instruments. They way to prevent
the laceration of the Perineum is to press against 
it by means of the Hand or a Cloth, or by pressing against 



161
the head of the Child so as to regulate its passage, this 
must be done no more than is actually necessary
on account of retarding the Labour.-
The way in which the head passes the external
parts is with the Occiput to the Pubes of the Mother.-
When the head has passed the external parts, you
should examine to know if the Chord be round the 
neck of the Child, and if it is, it must be put over the 
Occiput, or the opening dilated, and slided over the 
Body of the Child as it passes.-
When the head has passed you must apply
one hand on each side, for the purpose of making
a little extension, and direct to Patient to hold in her
Breath and force down, you must extend gradually
pull down, giving the Body the proper turn, that is with 
the Shoulders to the Sacrum and Pubes, the long Ax is 
opposed.- When the shoulder have passed, you must 
make extension by them.
You must not remove the child from the parts of 
the Mother, for if the Navel string is short, you run the 
risque of breaking it, or detaching the Placent, or of inverting 
the Womb, all of which are of very great consequence 
as the Child passes, you should bend the Child
towards the Mother.-
You should not immediatly tye the Chord, but feel
for the Pulsation, tho' it is not necessary to wait till that 
ceases before you apply the Ligature.- If from the Pulsation



21
162
Pulsation you have reason suppose the Child alive, you
must not tye the Chord 'till the  Child breaths, and 
after waiting a little time it does not, the Body may
be rubed with gentle stimulants, or it may be necessary
to throw air into the Lungs, by stopping the Nose, and 
blowing into the mouth, at the same time pressing upon
the Thyroid & Crycoid Cartilages, so as to prevent the 
air escaping into the Stomach, for that would be doing
injury, and you must endeavour to immitate respiration
by pressing the air out again continuing this 
for some time.- Another way of inflating the Lungs is 
by means of a small curved pipe of a proper construction
introduced into the Epiglottis, they way of doing this 
is by passing your finger down into the Œsophagus 
'till you feel the Glottis, you must then pass down the 
Tube by the direction of the finger into the Epiglottis
and by that means throw in Air. This last mode
preferable.- Whilst these attempts are going on the 
Body should be kept warm.- If tho' the Pulsation
in the Chord was strong at first, this gradually becomes 
weaker, and after a time ceases, this is an indication
of Death.
The Ligature is generally made about 2 or 3 Inches
from the abdomen tho' 1 In. would be quite sufficient tho'
it would be inconvenient to make very near to the Abdomen
as a small portion of Intestine might be protruded at 



163
the Part, or if the Ligature was to come off there would be
difficulty in fixing on another.- A second Ligature
must be made nearer the mother, and the part between
the two divided by means of a Knife or pair of Scissors.
The necessity of making this second Ligature occurs
very seldom, but it is right always to do it, it occurs only 
when there is another child and the Vessels of each
Placenta communicate, in this case the second Child
would bleed to Death if this Ligature was neglected, tho'
then would be no danger to the Mother
Third stage of Labour. This consists
in the expulsion or extraction of the Placenta.-
The Placenta is not to be extracted immediatly
after the expulsion of the Child, for as the womb
is not yet contracted the Vessels of the Uterus remain
of their full size, and a considerable Hemorrhage.
would be the consequence. The interval may be 
employed with advantage in attending to the Child
and if there is much faintness in the mother, as 
there frequently will be, a small quantity of 
some Cordial may be given, but you must be particularly 
carefull that too much is not given, or 
it may do considerable mischief.-
Before you attempt to extract the Placenta
always be certain there are no more fœtuses, and 



164
which you may do by laying your hand upon the 
Abdomen, and making gentle pressure, if there is no 
more, you will feel the parieties of the Abdomen fluid
and Uterus in the center, contracted into a hard round
substance, but if there is another Child, there will
still remain a general enlargement of the Abdomen.-
Somtimes the Uterus is not disposed to 
contract, and this may give rise to a supposition of their
being another Child, but by making pressure upon
the Abdomen to assist the contraction, will very 
soon determine the Case.-
With respect to the time which you should
wait before extracting the Placenta, this must 
depend very much upon circumstances, if there 
are no unpleasant Symptoms you may wait 
longer, but if flooding &c. comes you must extract
more speedily, as a general Rule from 15 to 20 Minutes
may be the proper time.-
Nature will very frequently expect the Placenta
without any assistance, but if this becomes
necessary, this is given by taking hold of the Chord
with a Cloth in one Hand, and pass the two fore
fingers of the other hand up the Chord to the Placenta
then separate them taking hold of the Placenta between
them, making extension both by Chord 
and by means of the Fingers, endeavour to extract it 



165
which if there are no adhasions you will be able
to effect.- When the Placenta is extracted, or is 
expelled, you should apply a Cloth to the parts, squeezed 
out of warm Water, and another under the Thigh, as 
it may be adviseable to let the Patient remain a
little time before she is moved.-
When the Uterus shews no disposition to contract
and expel the Placenta, if there is no flooding
you may endeavour to excite this contraction, by
rubing the Abdomen with some kind of Liniment
tho' it is the friction which renders the service.
Practitioners have varied very much in 
this opinions respecting the Extraction of the Placenta,
some advising in all cases to extract immediatly 
whether there is flooding or not, others recommend
leaving it entirely to Nature.- Both these 
extremes a wrong and Dangerous, a middle course
of proceeding is best.-
The speedy extraction may bring on profuse
Hemorrhage, by detaching the Placenta
whilst the Vessels are yet large and uncontracted,
when this is the case assisting the contraction of the 
Uterus by pressure upon the Abdomen or by other
means will answer a good purpose.- The speedy
extraction may likewise cause inversion of the Uterus
more particularly if the Placenta is attached to the 

The inversion of the Womb is somtimes partial
which may be known by passing the fingers up
the vagina.- This may be mistaken for a Polypus
are you are not carefull in making the Distinction.
The reduction must be attempted by pressing upon
the middle of the Tumor.- 

166
Fundus, and the attempt to extract has been made
by the Chord.- Flooding chiefly occurs when the 
Placenta is partially detached.-
When the Uterus is inverted the reduction should
be immediatly effected, for any time is alowed to 
elapse before this is attempted, the Uterus will have 
began to contract, and render the reduction either 
extremely difficult or else impossible.-
To prevent inversion of the Uterus, you should
wait 'till the Uterus is in some degree contracted,
except in case of flooding, in which case, before you
attempt to pull the Placenta [cross out] away you should compleatly
detach it, by passing up your hand and grasping
it, so as to effect a separation before you pull down.
The way to attempt the reduction is by pressing
upon the fundus of the Uterus so as to dent it in 
gradually proceeding in this way 'till you have
compleatly returned the Parts, not only within the 
Vagina, but compleatly into this natural situation,
which may be known by the way the hand 
passes up, and by feeling with the other Hand upon
the abdomen.- If the reduction cant be effected
it then becomes a Matter of very great consequence.
Death will somtimes take place very shortly 



167
from the shock given to the System, and if this does 
not then take place, it will do so generally after a 
length of time perhaps a may a Year or two.-
The Part which forms the external Surface 
of the Tumor is the internal part of the Uterus, than 
part from which the Menses flow, this flow not
only takes place at the usual Periods, but with greater
violence, and often recurs at shorter intervals,
and in the intermediate times a Discharge of a Serous
kind generally occurs, this produces a great degree
off irritation, and Debility, and generally ends in Death.
When the Uterus is inverted with the Placenta
attached, it becomes a question whether it will best
to separate it or not before reduction, this last appears
to be most eligable.-
Leaving the expulsion of the Placenta entirely
to Nature, is attended with Danger, as many
Die in consequence of it from its producing a 
high degree of irritation &c. and which my perhaps
by moderated by the use of R a Opii &c and the Discharge
corrected by Antisceptic washes or injections.
Somtimes the Uterus will contract so forcibly
if the Placenta has been left for a length of time, as 
to prevent the introduction of the hand, without 



168
doing more injury by the Violence used, that will
arise from leaving the Placenta, in which case
it must be left, and the Symptoms moderated by 
proper treatment.-
The Navel String is somtimes broken off in 
this case you must pass your hand up into the 
Uterus, and separate the Placenta & bring it away.-
Impediments to the Extraction of the Placenta
somtimes arise from Schirrous adhesion at 
others from irregular contraction of the Uterus.-
Schirrous adhesion does not so often take
place as has been generally supposed, when it has 
done, there must have been some Previous pain 
in the Part, and Chronic inflamation, in consequence 
of which a quantity of Coagulable Lymph is thrown 
out, which forms an adhesion betwext the Maternal
part of the Placenta and the Uterus.
In this case the Child will be expelled and every
thing will appear to be going on well, the Uterus
will contract and form the round Tumor in the 
Abdomen, after waiting a proper time, on attempting
to bring the Placenta away this cant do [illegible] and 
upon introducing the hand, the Placenta will be
found to adhere, if this adhesion is small, a little
force will effect the separation, but if the portion 
Sevri Cartilaginous?



169
which adheres is large it will be very Difficult if 
not impossible to effect the separation. Probably a 
Pair of Forceps might answer a good Purpose in 
assisting the separation, in using them you give no 
pain if only the Placenta is taken hold of.- You
must either by means of these or other means separate as 
much of the Placenta as possible, comparing the different
Portion when extracted.-
If any portion of the Placenta is unaviodably
left, (but none should if possible to extract it) Symptoms
of Fever and very high irritation will come on, and 
the use of various medicines and Remedies will be 
required to alay these as by Opium, Saline Draught
in a state of effervescence, internally, and likwise
antiseptic injections, as an injection of Ag. Hord.
℥vj Vis. Rubr. ℥ij.
When the Difficulty arises from irregular
contraction of the Womb, this may be from untimely
contraction of the Os. Uteri or a preternatural 
contraction at any one part of its Body.
The mode of treatment in both these Cases is 
nearly the same, but is different according on these
is or is not flooding, if there is no flooding you may
wait a little time and possibly the contraction may 



22
170
go off, or a Dose of Tinct. Opii may be given, and 
which in some cases will take off the Spasm.-
In some cases the Spasm only recurs at 
intervals, in this case on passing up your fingers
the part may contract upon them, but by proceeding
gradually you will overcome this, and be 
able to extract the Placenta.-
But when there is flooding, the case is different,
as there is then considerable Danger, this 
flooding somtimes brought on by puling at the 
Chord or perhaps by breaking it off, this could not 
have happened if both Hands had been used, as the 
cause of the Difficulty would than have been discovered.-
In case of flooding you must proceed
more rapidly, yet not so as to use any violence
you must introduce the hand gradually passing
it into the contraction, and by degrees Dilate the 
part 'till you have passed your Hand, and can
take hold of the Placenta, you must then endeavour 
to extract it, if you have only in the first
instance got hold of a small portion you should
endeavour to take hold of a larger, or it may be 
torn off, and which will frequently be the case
removing it by Degrees 'till you have extracted
the Whole, comparing the Different portions and proceed



171
proceed 'till the whole is extracted.- I will not be 
necessary to take the hand out, every time you have
detached a portion, but to slide that part downwards.-
Lingering Labour. This is when the Child
is a greater length of time than common, in expulsion, 
it is not called lingering if over in the course of the 
Day.- The cause of lingering Labour either deficiency
in the expelling Powers, or increased resistance,
or both.-
Defect of Pain, may depend upon Debility,
Plethora, Passions of the Mind, Over distention
of the Uterus, or any thing that may check the general
Exertions of Nature.
Debility requires the use of means that 
can give strength and afterwards to stimulate
the parts to act, such as Cordials of Different Kinds
as Ag. Menth. &c. and occasionally a little wine,
and this in most cases will be sufficient, tho' in
some cases a stimulus will be necessary, such as 
walking about, or by the introduction of the finger
or the Lever, not for the purpose of Delivery, but of 
exciting the Uterus to action.- In some cases when
than is only weak, with giving any assistance towards
the Progress of the Labour, only teazing the Patient and 



172
keeping her awake, a Dose of Ra Opii will afford considerable
Service.- Some have supposed that Debility 
could not be a cause of Lingering Labour, as 
Women have been Delivered when labouring under
Phthisis, and with the greatest Ease, but in this 
case the powers of Resistance are likwise diminished.-
Plethora.- This may be a cause of Lingering
Labour.- You may easily Distinguish this State 
the Countenance and other usual Symptoms, this 
Plethora should be removed by Bloodletting &c. and 
then the Pains will frequently come on sufficiently
if not you may Stimulate the parts to action as 
above.- If you apply this Stimulus before you
have made the evacuations, you run the risque
of some Vessel being ruptured, and this happen
in any part of the Body as the Lungs &c.-
Passions of the Mind. These always divert
the Pain, therefore all causes of Mental Agitation
should be avoided. If any thing of this sort has 
taken place, it may sometimes be necessary to 
take away a little Blood, or to exhibit some Tinct:
Opii.-
Over Distention of the Uterus. This acts 



173
in the same way as an over distention of the Bladder,
if this is from a larger quantity of Water than common,
rupturing the membranes more early than
common will be of Service, this may be slow when
the Os. Uteri is not more Dilated than 1/2 Crown, but
before this is done the case should be will ascertained
for if you evacuate the Waters and they were not 
the cause you do injury.-
Impediments to the general Exertion of Nature.
there may be from different causes, as inflamation
of the Lungs V.S. preventing the action of these parts
in assisting Labour.- Cholicky pains, along
with those of Labour may be another cause in
this case a Purging Carminative Glyster may 
be injected, or Purgatives joined with Carminative
may be given, these will be of Service by procuring
a Discharge of Filatus.- If Opium is given
before the remedies above have been tried it will
do injury, and will be of Service if given after.
Increased Resistance.
Toughness of the membranes may be another 
cause, acting upon the Principle of increased resistance,
when the Mouth of the Womb is sufficiently
Dilated.- Rigidity of Passages, Disproportion
of Parts, and Unfavorable Situation of the Head,
are likwise causes of increased Resistance.-




174
Toughness of the Membranes. This cant impede
the progess of Labour in the early Stage, only
when Labour is somwhat advanced, and the Os. Uteri
considerably dilated, in this case you should Rupture
them, for if this is not done the Whole Ovum
may be expelled together, but this would require
very great Exertion and the Child must be still
born for it becomes drowned in its own Waters in 
consequence of the communication with the
mother being cut off. There is danger too on this
account to the Mother, for the Womb being Distended
for a length of time after the Placenta has been
Detached, a considerable Hemorrhage may be 
the consequence.-
Rigidity of the Passages. This is more frequently
the cause of lingering Labour than any other
and may easily be ascertained.- In a case of this 
sort it will be much better to mention the Delay
that is likely to take place. Under these circumstances,
the objects to be kept in View, are to effect
a relaxation of Parts, to gain time, to guard against
accidents, and to encourage the Patient.
When there is rigidity the loose of some Blooding
possibly be of Service, keeping the Patient still and 



175
and cool, and not alowing much company to 
be in the Room, and keeping the Patient upon a low 
Diet not alowing any thing of Strength to be given.
Whatever will produce relaxation will be of Service
tho' very little can be done by Medicine, it may be right
to give somthing Simple to satisfy the Patients Mind.
Antimonials in nauseating Doses have been recommended,
tho' the continued nausea must be 
very unpleasant. If the Pains are weak and 
only teaze the Patient, a Dose of Ra Opii may be 
of Service by procuring Sleep and that way gaining
time and Strength, and a Glyster may be occasionally
given with advantage.- The Patient may
likwise have warm Fomentations applied to the 
Part, or sit over the Night Chair with some Warm
water in it, these are not of much real Use, tho they
may shew the appearance of Doing somthing.-
A considerable time will elapse before there 
is much Dilatation of the Os. Uteri, perhaps a Day
or more before it has gained the Size of 1/2 Crown.
and the Labour may be 2, 3 or even 4 Days before it 
is terminated.-
If Women of a Rigid Fibre, Blood should be taken
away two or three times during Pregnancy and 
she should live upon rather a low Diet if nothing 
Particular contraindicates.- 



176
During this dilating process, there will sometimes, 
Symptoms come on which are attended
with Danger, as Convulsions, and which is generally
indicated some time before they actually take place
by particular Symptoms, as Pain in the head
Loss of Sight, a Morbid Sensibility of the Eye &c. this 
Pain in the Head is very much different from 
the common Headach, being a violent darting, Shooting
Pain.- When these Symptoms take place
it may be right to inform the Friends of the Patient
what is likely to follow, and there is Plethora
the loss of Blood may be a means of preventing 
this may be taken from a Branch of the Temporal
Artery or Jugular Vein, if there appears a Determination
to the Head.-
Disproportion. This is understood to be 
only slight, and only requires time to alow the Bones
of the head to accommodate themselves to the Passages
this should be ascertained when you examine and 
this should be done not only in one or two points
but entirely round
Unfavorable Situation. This may likewise
be a cause of lingering Labour, as any situation
different from the Natural one is more unfavorable,
and some of these more than others.-

[words crossed out] with its Pearson
23 and [Rem???])

23
177
There are some other Causes which are supposed
to be a cause of lingering Labour, but 
which are somwhat Doubtful, as the Premature
bursting of the Membranes, this may in some 
measure be a cause by reason of their assisting
in the Dilation of the Os. Uteri in the begining
before the head cant to advantage, and the violent
Action of the Parts may force the Womb, down
out of its Place, and if it does not do this, the injury
done may dispose to procidentia Uteri.-
The Cord being round the Neck of the Child has
been supposed by some to be a cause of lingering
Labour, but this cant possibly be the case.-
The Shoulder of the Child hitching upon the 
Pubis, is another cause supposed by some to be
a cause of this kind of Labour, this cant retard the 
Passage of the head, tho' when the Head has passed
the external parts, it may be a cause of preventing
the Body from being expelled, you may remedy
this by pressing with the Finger upon the Neck
of the Child so as to depress the Shoulder, and then
give it the proper turn, and when you can take 
hold of the Shoulder you should pull by them, being
always carefull of applying pressure in the Axilla
on account of the Axillary Plexus of Nerves.



178
Whenever you are called to a Labour which is 
lingering you should always make inquiry, what
this arises from, and whatever that may be, you
must take measures accordingly.-
Laborious Labour. This is when Nature
is not able to expel the Child, tho' the Head presents.
These cause of this is either disproportion between
the Pelvis & Head, Defect of Pain, or a greater
degree of Ossification of the Bones of the Head.-
Disproportion may either be on the Side of the 
head or Pelvis, as the Pelvis being deformed, or the 
head enlarged from any cause as Hydrocephalus
or the extra Ossification preventing the Bones yielding
as they commonly do.- There may in some 
instances be disproportion both on the side of the head
and Pelvis.-
Disproportion varies in its Degrees, the lesser
of which may be relieved by the more gentle means
the greater by more severe treatment.
Nature in all these cases should be alowed
to exert herself to see what can be done without
assistance.-
The milder kinds of Laborious Labour are 



179
manageable by the use of the Lever or Forceps
which do no injury either to the Mother or Child
if properly used,- The more severe kinds require
the Perforator and Crotchet to remove the 
disproportion.- For the milder kinds of Laborious
Labour, [crossed out] Fillet has been recomended
but from the difficulty with which it was applied
the use of it is laid aside.-
An Instrument resembling the Lever was 
invented by a Mr,, Chamberlin, but which had 
very little curve, and on that account would be
applied with very little advantage.- After a time
the Lever, which is more curved was invented, and which
is now very much used and with advantage in the 
milder kinds of Laborious Labour:- The Lever now
in use, is considerably more curved than what was 
formerly used.- The Lever acts with advantage and without
injury if properly used but may do considerable
mischief if applied improperly.-
The Forceps were afterwards invented and which 
act with advantage when the Lever frequently
wont succeed.- The French make use of longer
Forceps than is the Practice in this Country
an apply them under different circumstances
that is when the Head rests [cross out] at the Brim of the 
Pelvis.- The Lever may be be of Service when the 



180
Head rests upon the Brim of the Pelvis, and is out of 
the reach of the common Short Forceps, tho' the long
curved Forceps have been applied with advantage
when the head rested at the Brim in consequence
of some disproportion, and in a case or two when it 
would have been necessary to open the head, only
for the use of these.
The Forceps in common use in this Country are
considerably Shorter, and are only applied when the Head
is low down in the Pelvis.
Dr,, Luke invented Forceps with three Blades
but two are used much more readily and with
greater advantage, as they will alow as much
force to be used as either of Service or consistent
with Utility.- Those Forceps are the best which
will alow the protuberance of the Parietal Bones
to go it into the opening in the Blades, and at 
the same time are bevilled off so as to lay close
to the Head, for the part which gives the Resistance
is that protuberance, and the Forceps cover this
they add to the Back of the Childs Head.-
The intention for using the Forceps are to 
bring the Child away alive, without injury to the 
Mother.
Consideration regarding the Use of the 
Forceps. There comprehend the Propriety of using  



181
them, the Rules to be attended to in all cases, and 
Rules applicable in Particular Cases.-
Various reasons have been assinged for the 
use of this Instrument, but these are not all of 
equal weight.- One very good reason when a 
Woman has been in Labour for a considerable
length of time the head low down in the Pelvis, the
Pains have been Strong but are now going off the 
Patient much exhausted, and Floodings or Convulsions
attending, but the Forceps may be applied
with propriety and advantage in cases much
less urgent.-
Another reason for the use of the Forceps has
been assigned, which is when the Navel String comes
down before the head if the Child, there is no danger
Danger from this circumstance to the Mother
tho' very great to the Child, you may endeavour
to put this to one side when it wont be pressed
upon by the head, but if this cant be done the the 
Forceps may possibly be of Service by bringing the 
Head more quickly this the external parts.-
The Bladder and Rectum should always 
be emptied before the Forceps are introduced.
The Patient may lay on the left side in any 
position of the head with respect to the Pelvis,



182
but with the Breech opposed to the Practitioner, and 
very near the edge of the Bed, it will somtimes be
necessary to support the Feet by means of a 
Chair.-
The Forceps should always be used Warm.
The Os. Uteri fully Dilated.-
The Head descended low down.-
The instrument introduced during pain
as both Blades have the same construction
it is immaterial which is introduced first.
The direction of the Blades must be determined
by the Ears of the Child, as the Forceps should
be applied on each side of the Head.- There is 
one exception to this when the head of the Child is 
just entering the Brim of the Pelvis, and this is 
narrower from the Pubis to Sacrum, and the face
of the Child is to either side, the Long Forceps are 
required here and they may be applied to the 
Face and Occiput, this case may somtimes
be relieved by the Forceps tho it will frequently be
necessary to open the Head
If you warm the Forceps and are carefull in 
using them you may somtimes do this without
the Knowledge of the Patient or by Standers, more particularly
if introduced during pain, which should  
a



183
always do, not that you can introduce them with
more ease, but you will give less sensible pain.
You cant often introduce the Forceps unknown
tho' the Lever frequently may.
If you attempt to introduce the Blades before the 
mouth of the Womb is compleatly Dilated, you run
some risque of doing injury by forcing the end of the 
instrument against that portion of the Vagina, which
is joined to the Uterus.- From this cause the Rule
of keeping the point of the instrument close to the 
Head arises.-
When you are about to introduce the Blades
it is immaterial which of them is introduced first
as they are both formed alike, tho' it is best to introduce
that with the left hand first (if you introduce
them sideways) and the right hand Blade over this,
and when you introduce them above and below, it
is best to introduce the lower Blade first.-
When are about to introduce the instrument
you must prepare the way by the introduction of 
the Fingers to separate the Labia &c.- then take one 
of the Blades loosely between the Thumb & fingers, and
introduce the Point under the Fingers, carrying it
gently or with the Point close to the head, 'till you have 
passed it sufficiently high up.- If you meet with 



184
any resistance, you must not use force to overcome
this but gently alter the Direction &c.- When you 
have introduced the first Blade, you must fix this
by means of the third and fourth finger and the Thumb
of our hand, whilst with the first and second you
prepare the way for the other, which you must introduce
in the same gradual manner, always taking
particular care respecting the Locking of the Blades.
If you find you have not got good hold it is not 
necessary to withdraw the Blades, but to move them
gently and by that means fix than properly.-
When you have fixed the forceps properly you
should not immediately begin to draw down, but wait
'till pains come on, and then make extension, having
off when the pains ceases &c.
You must not make the extension in a direct
Line, with in a line to correspond with the Axis of 
the Pelvis, gently moving the instrument from side 
to side as you extend.- Considerable care is necessary
when the head approaches the external parts,
if the Perineum does not Dilate sufficiently, you
must attempt to do this forcibly, but by keeping up
a regular degree of extension, and inclining the 
Handles of the Forceps to the Abdomen.-
Some care is necessary in taking the Forceps



24
185
off more particularly if you have used them without
the Patients knowledge
Application of these Rules, to particular
Cases. No Part except the head is proper for the 
application of the Forceps, tho' they have been applied
to the Breech and might act with considerable force
but the points will press upon the Abdomen, and 
may do considerable injury, in this case the Blunt
Hook acts with much more advantage and safely
but this will be mentioned hereafter.-
The Forceps can only be applied to head in
to two presentations, the Vertex and Face.-
When the Vortex presents, the Face may have
different situation with regard to the Pelvis, the
French have formed six cases from this, but these
may be divided into two namely, the Ears to the 
sides of the Pelvis or opposed to the Pubis and Sacrum. 
When the Ears are to the Sides of the Pelvis with
the face in the Hollow of the Sacrum, the Woman being
laid on the left side with the parts as near the edge  
of the Bed as possible, you must then introduce the 
Blades as directed first [cross out] below than [cross out] above, as by this
means you secure the Locking much more easy.
In some cases you are not able to bring the parts 



186
sufficiently near the edge of the Bed to alow of the introduction
of the Second Blade, you may then pass it sideways
over the face of the Child, for a little way, and 
then turning the Handle downwards, you bring the 
Blade opposite the other, and by carrying it a little 
forwards easily bring them to a Lock.- You must 
then proceed according to the general Rules
When Ears are situated to the Sides of the Pelvis
with the Face to the Pubis. This is attended with 
much more difficulty on account of the parts
not being so well adapted to each other in Shape
In this case if the presentation is ascertained
early before it has entered the Brim of the Pelvis in
any degree, Dr,, Smellie, recommends passing up
the hand to find the feet, and bringing the Child
away by that means.- This may be advisable if the 
case is early ascertained.- When the head has passed 
only a little way within the Pelvis, Dr S. recommends
passing up a long pair of Forceps, and fixing
them on the Head, to raise it up by Degrees 'till he 
can give it the turn with the Face to either side, and 
afterwards when the Head has descended somwhat
lower to turn it with the face to the Sacrum.
In some cases this practice may be adviseable.



187
adviseable.- Objections have been made to this if the
Uterus acts with much force, on account of the 
Vertebra of the Neck being injured, or the Uterus ruptured,
but these depend very much upon the way in 
which the attempt is made.-
In this case the Forceps must be applied on
each side the same as in the last, but the utmost
care will be necessary to prevent a laceration of the 
Perineum, the extension must be made gradually
and the occiput depressed as much as possible to make 
the Axis of the head as Short as Possible.- In speaking
in this way of the application of the Forceps the head
is understood to be low down in the Pelvis. so as tummy
is out of the Question
It will often be a question whether it may not
be better to open the Head of the Child than to use the 
degree of force which would be necessary for the Extraction
of the Head, as the Child will be still born, and a
considerable Degree of injury must be done to the soft
Parts.- When the head is considerably descended, it 
will somtimes be very difficult to ascertain the presentation
and Situation on account of the accumulation
of Scalp, obscuring the Fontanels &c.-
When the Ears are to the Pubis and Sacrum.
The head is considered as low down for they are 
always in this situation, at the time of entering the 



189
Pelvis.- The situation should be clearly ascertained
to form a judgment which way you should give
the Head the Turn, for if you make a mistake
and instead of turning the Face into the hollow
of the Sacrum, should bring it towards the Pubes
you render the case extremely difficult instead
of an easy one.- In some cases when you cant
feel either Sutures or Fontanels from the accumulation
of Scalp, you may determine the situation by
this circumstance, as the accumulation is always
greatest at the Occiput.- The Blades of the Forceps
must be applied towards the Pubis and Sacrum, the 
Blade towards the Pubis first.- When the Blades are 
properly fixed upon the Head, you must gradually
turn the Face into the Hollow of the Sacrum.
The Face Presentation. This is when the 
face presents with the Nose in the Center. In 
this case the Chin may be to any part of the 
Pelvis.- The head wont pass so easily as in 
the Vertex presentation, tho' it will in many
instance pass without any assistance, the Forceps
are sometimes necessary.- To gain a perfect
knowledge of the mode applying them with the 
greatest advantage, it will be necessary to understand
the way in which the head passes without 



190
assistance.- The most simple case is when
the Chin is opposed to the Pubis, as in this the
head passes with the greatest ease. In this case
the Chin is forced forwards and downwards by
the Spine acting upon it, and as it passes takes
exactly the same turn as the Vertex presentation
the Chin gradually emerging under the Pubis.
When the Forceps become necessary you must 
have the above circumstances in view, exactly the 
same as when the Vertex Presents.- The Blades
must Lock over the Mouth of the Child, but you
will not find the so well adapted to the Shape of 
the head as in the other presentation.- When you have
got good hold by the Forceps, you must draw down 
depressing the Chin so as to alow it to pass out under
the Pubis, and then elevate the Handles of the 
Instrument so as to bring them towards the Abdomen
of the Mother 'till you have effected the Passage
of the head, and then proceed as in a Vertex Case.
When the Chin is situated to either side, the 
object is to incline the Chin to the Pubis, and 
proceed as before.- If the head is high up, it may
be necessary to bring it down rather lower, before 
you attempt to give the turn.-

 

191
The Chin is somtimes situated towards the 
Sacrum, here the extraction of the Child alive is
scarcely possible unless the Head be very small.
Fortunately these cases rarely occur.-
On the Use of the Lever.
The management of the Lever supposes a Knowledge 
of the general Rules for using the Forceps,
also the necessity for using it should be well ascertained.-
The cases which render the use of the 
Lever proper, are when nature has done a good
deal but wants some assistance to compleat
the Business.- This instrument is improperly
called a Lever, as this might lead to a wrong mode
of application, it is not to act on the Principles of a 
Lever, but when applied to the head, and its action opposed
by means of 2 fingers, it acts similar to the 
Forceps tho with less advantage.-
It has been recommended to make use of 
the Lever when the head is at the Brim of the Pelvis
but this can seldom be done with advantage, and 
may often do much injury by bringing a Vertex Presentation
to that of an Ear &c.-



192
This instrument can only be applied with advantage 
to two parts of the head, namely the Occiput,
or by passing it along the Side of the Face fix the Fenestra 
of the Blade upon the Chin.-
It is necessary to ascertain the exact Situation
before you apply it, for in case of a Vertex Presentation,
of it was wanted to bring Down the Occiput
and the Instrument by mistake is fixed upon the 
Chin, the case will be changed to a face Presentation.-
When the Head is about to make the Turn
it is better to leave this to Nature, as the Face may 
possibly be turned Forwards, and then you do injury.
The same general Rules are to be observed
as in the introduction of the Forceps.-
You may know when the instrument is fixed
upon the Chin by comparing the Part of the Head
you can feel, with the Blade of the Instrument.
When the instrument is applied you may apply
two or three fingers of the other hand upon the head
of the Child to oppose it, and act in the same way
as with the Forceps, gradually puling down, and at 
the same time makeing use of lateral Motion.
You should be carefull in applying it to the fore
part of the Pelvis in account of the Urethra.-



193
Perforator & Crotchet.
In cases when neither the Lever nor Forceps
can effect the Extraction of the Head, either in consequence
of the Narrowness of the Pelvis, largeness
of the Head, or any other cause, the disagreeable
alternative of opening the head by means of the 
Perforator and Crotchet must be resorted too.-
As the child must in this way be destroyed
the necessity of doing this must be well ascertained,
and if there is the least possibility of bringing 
the Child away (alive) without this, and without
very much endangering the Life of the Woman, this
should be done, this is in case the Child is alive
but if it is already Dead, you may frequently
save the Woman very much by lessening the head
sooner that you would do provided it was alive.
You may often form some Idea of the Business
provided she has had former Labour, and 
thsen have been difficult, tho' this will not amount
to any thing like certainty, for tho' it may
have been necessary to open the head of the Child in
2 or 3 former Labours, yet there may have been 



25
194
some alternation in the Pelvis, or the head of this
child may be small, so that it may pass.
This circumstance may assist the judgment 
and proceed without so much Hesitation.-
If this necessity has only happened once, you
cant reply upon it so much.-
It is much safer to trust to the measurement
of the Pelvis together with accurate observation
respecting the head, and in making 
this measurement and examination you should
do it compleatly in all parts.-
The Necessity of opening the Head may depend
on different causes, but which are resolveable
chiefly into one, namely, Defect of Room.
This may be either from the Pelvis being smaller
or the head larger or more Ossified, so as to prevent
its yielding.-
But it is sometimes admissable to open
the Head where the Disproportion is slight,
this is in case the Child is Dead, but in doing 
this there should not be the least Doubt respecting
the Death of the Child, and the different Signs
of which should be well examined, these any great
Mobility of the Bones of the Cranium, Separation
of the Cuticle, Emphysema, want of Pulsation 





195
in the Cord, Putrid Discharge, want of Motion
in the Child, Discharge of the Meconium &c.-
All these Symptoms are fallacious, tho'
some of much more consequence than others.-
Great mobility of the Bones, this is a vague
term, but by it is meant, a very high Degree
so that the Bones may be formed into any 
Shape, and feels as tho' the Substance of the brain was
destroyed.-
Separation of the Cuticle, this has taken place
without the Child being Dead, tho' is one of the best
single signs.-
Emphysema, this arises from many other
causes, but may assist in forming an Opinion.-
Want of Pulsation in the Cord. If this can
be felt (as Cord), it is a very good sign, for the Child cant
live long after this ceases to beat, tho' it may for 
a Short time.-
Putrid Discharge.- This may arise from 
many other causes.-
Want of Motion in the Child. This is the 
most ambiguous sign of any, for the Child is
frequently not felt for a great length of time
before Delivery and yet may be born alive.-



196
Discharge of the Meconium.- If the breech does not 
present this is one of the Strongest Signs of the Death
of the Child, but somtimes when the Breech presents
this will be forced away tho' the Child is alive, by the
pressure of the Thighs and Knees upon the Abdomen.-
Others Symptoms have been mentioned but 
which are of very little consequence, as want of Pulsation
at the Fontanel, but this can be very seldom
be felt.- Movement of the Child from side to side
this of no consequence.-
But in forming the opinion several of these 
Symptoms should be combined, as they are all liable
to fail singly, and if you cant compleatly make 
up your mind respecting its Death, you must
then proceed on the Supposition that is alive.
Different instruments have been invented
for the purpose of opening and extracting the Head,
but those now in use, are the Perforator, Crotchet,
and Blunt Hook, and in some cases a pair of 
large Forceps with long Teeth.-
When you are about to use these Instruments
the Woman should lay on the left Side, with the 
Breech very near the Edge of the Bed, and you should
be seated opposite the Breech to give as much command



197
command as possible, for the Business will often be attended
with very great Fatigue.-
You must first introduce the left Hand
to find the Sagittal Suture or Fontanel, and then
pass up the Perforator up the Groove made by
the hand, to the Cranium, and then with a motion
the same as when using a boreing instrument,
pass it into the Scull, and before you attempt
to open the Handles, be certain the Point is in 
Cranium, not slided on one Side, you must then
take hold of the Handles, and open them, and then
change the position and open them again, and 
afterwards move them round when open to break 
down the Substance of the Brain, you may then
introduce a Spoon for the purpose of scooping
out part of the Brain.- After this has been done
some have recommended to wait and see if 
nature wont finish the Business, but this should
never be done, but should immediately proceed to 
extract the Child.- If the disproportion was not 
very great very little assistance will effect the 
extraction, but if the Disproportion was very 
considerable, then will be often a great deal of Difficulty.-
When slight, the Blunt hook passed up 



198
so as to fix upon some part of the Cranium, will
affect the extraction, by drawing gently down, and
is best done during pains.- If the Blunt Hook
is not sufficient, you must then have recourse
to the Crotchet, by passing it up and fixing the 
Point on some part within the Cranium, you 
must pull down, but always have your fingers
opposite the Point of the Instrument to prevent 
its injuring the Mother in case it should Slip off
or the Bone give way.- Somtimes different portion
of Bone will give way, and become detached, you 
must be very carefull in effecting the removal 
of these to prevent their injuring the Parts, by
bring them down with some Care, or by Doubling
them between the Thumb and fingers before you attempt
to bring them away.-
The Instrument may somtimes be fixed
with advantage on the ouside of the Cranium
when the rest of the Bones are very much Detached.
If the Pelvis is very narrow it may sometimes
be necessary to bring the Basis of the Cranium
down sideways.-
The large Forceps may be employed with advantage,
by taking hold of the sides of the Scull after the 
Summit has been detached.- After the Child has
been brough away it will be better either to cover the head



199
with a Cloth or unite the parts by means of a Suture,
to render its appearance less disagreeable.-
After opening the Head, some practitioners have
recommended passing up the hand to find the feet
and bring them down, but this should not be done,
for the portions of Bone may injure the internal
Surface of the Uterus very much.-
If the head is enlarged from a collection of 
Water called Hydrocephalus, simply puncturing the 
Head may be sufficient.-
In all cases of this kind it will be much
better to call in another Practitioner, before you attempt
to open the Head.-
If the Resistance is at the Brim of the Pelvis
the long Curved Forceps may possibly bring the 
head down when it otherwise would have required
being opened, they may be used with advantage if
the Disproportion is small, but if it is considerable
the Child will die from the necessary force being
applied therefore it will be better to open the head
as this does less injury to the Mother.-
The Patient living abstemiously during Pregnancy
will somtimes be attended with good effect  



200
It has been proposed and in some instances
practiced with success, to save the Life of the Child
by bringing on premature Birth, in case of Distortion
of the Pelvis.- The Period at which this must 
be done must in some measure depend on the 
degree of Distortion, but cant be done to answer the 
intended purpose, before a certain Period.- Most
of the Children die, that are are born at or before the 
7th,, Month whether accidentally expelled or this excited
by act, therefore seldom should be proposed at that 
period, but will be much more likly to succeed if 
deferred till Pregnancy has continued 7 1/2 or
8 Months, but you cant do this with Propriety
except you know the exact Period of Pregnancy,
and to do this the Woman must be very accurate
in her Reckonings, and this may be done with 
the greatest certainty from the cessation of the 
Menstrual Discharge, if she has been regular
previous to that time.- Quickening is much
more uncertain, but that has been spoken of before.
The mode of bringing on premature Labour
is by evacuating the Waters, this is done by means
of the Stilet or a Catheter, you should pass your
finger up as a guide, and then pass this 2 to let up
the neck of the Womb, which is not yet compleatly 



201
obliterated, and Puncture the Bag of Water, not 
using any force afterwards to bring on Labour, but
this after some time (perhaps 2 or 3 days) will come
on.- You will know when you have punctured
the Bag of Water by its drilling away
Preternatural Labour.
In Preternatural Labour the Head comes away
the last part. These may be divided into two 
Classes, as requiring turning or not.-
The first Class will comprehend the Presentation
of the Feet, Knees or Breech, as the Child can 
pass thro' the Pelvis in that Direction.-
The second, comprehends the presentations of any
other Parts as the Arm Back &c. these requiring
turning before they can pass.-
The Presentation of the Feet being the most Simple,
shall first speak of that.-
In this case the Mouth of the Womb must 
be sufficiently dilated, or you will meet with considerable
Difficulty in compleating the Extraction
therefore never pull down 'till the Os. Uteri & external Parts is compleatly



20
202
compleatly dilated, for if this is not the case, when 
the Breech or Shoulders are at that Part they will
occasion considerable delay, and if it is the Shoulders
or head, the Death of the Child will be the consequence
as it cant Breath, and the communication with 
the mother is cut off.-
The Belly of the Child should be to the Sacrum
to alow it to pass with the greatest case, and if by the 
situation of the Toes you find this not to be the case
you should turn it in this direction in pulling down
by doing this as soon as you have got hold of the 
Thighs, not deferring it longer or you will find much
more difficulty in doing it.-
When the Parts are sufficiently dilated, you
must then take hold of the feet by means of a 
Cloth, and pull down gently, moving the Child from
side to side as you extend, when the Child is come
low down as for instance the Breech near the 
external Parts, you must not then wait for pain
but go on extending; and direct the Woman to hold 
in her Breath and force down, for if you wait
in this stage the Child will be lost from the Pressure
made upon the Navel string.- When you 
have brought the Child so low that the Shoulders



203
are approaching the external parts, you must
then bring the Arms down, one after the other, this 
must be done by passing up your finger and pressing 
upon the Arm at the elbow joint for the purpose
of giving the hand a sweeping direction over the 
face of the Child, when you have got one Arm
down, you must proceed the same with the other
and when both arms are extracted, you must
not then pull down, but pass the forefinger of 
one Hand into the Mouth, and take the Occiput
between two fingers of the other Hand, you have
them compleat command of the head, which
you must give 1/4 of a turn to make the Head
correspond with the long line formed by Cavity
between the Sacrum and Illium, but the Head
wont pass out in this direction, you must therefore
turn it back again, with the Face to the 
Hallow of the Sacrum, then by depressing the 
Chin you are able to bring the Head out without
much difficulty.-
There will be more difficulty attending this 
case if it is the first Child, more particularly
if the Woman is advanced in Years, in this case
you should wait 'till the Parts are more fully 
Dilated



204
Breech Presentation. This is when the presenting
Part is the Breech with the Anus in the Center.-
This should be distinguished from a Hip presentation
which wont pass, but which may be changed
into a Breech case.-
In this presentation the back of the Child
may be situated towards any part of the Woman
tho' the most favorable is when the Back of the 
Child is towards the Belly of the Mother.-
The situation may be know by feeling the 
Notes, and the opening between this; and the Scrotum
which somtimes becomes very much Distended 
by the pressure made upon the Abdomen, forcing
fluid down into the Tunica Vaginalis Testis 
When the Back of the Child is opposed to the 
Belly of the Mother, [and] and Both Child and Pelvis
are standard, if the Pains are sufficiently 
strong, Nature will frequently terminate the 
case without assistance, but when there is either
disproportion or deficiency of Pain, assistance
becomes necessary, and if the Child is near the 
outlet a finger may be introduced into the 
Groin, and gradually pulling Down first on 
one side and then the other; but the Breech is



205
situated higher up, a Blunt Hook may be used
acting first on one side and then or the other 'till
you can act with the Fingers.- You must go on 
in this way 'till you can grasp the Breech, which
you must do as soon as possible, and then go on 
pulling down 'till the Feet drop out and then the
case must be finished as in the Foot case.-
You must not attempt to pull the Thighs
out but kept going on pulling by the Breech,'till
they fall out of themselves.-
In applying the Finger or the Blunt Hook
in the Groin you must not act upon the Thigh
but upon the Pelvis of the Child above the Groin.
When the Pelvis is too narrow to admit of the 
Breech passing, you must pass up the Hand or
find the feet, bringing them down, and endeavour
to extract the Child singly, if this cant be done
the Head must be opened.-
When the sides of the Child are to the Sacrum
and Pubis if it is necessary to make any extension
by the Finger or Blunt Hook in the Groin
you must have the Axis of the Pelvis in view, and pull down
3 times as much in the back as in the forpart 
'till you can grasp the Breech, and then you
must do it and turn the Child with the back to
the Belly of the Mother which brings it to the first case. 



206
When the Back of the Child is to the Sacrum. In 
this case you should endeavour to bring the Child into
the first situation, by taking hold of the Breech as
soon as you are Able, and give it 1/4 of a turn, and 
in the course of a little time longer, another 1/4 turn, and 
which will bring the Back to the Belly of the Mother
and make it the same as the first case.-
In this case it might be adviseable to endeavour
to turn the Child with the Face to the Sacrum
before it has descend much with in the Pelvis, by means
of a Pain of long Forceps fixed on each Hip, and often
the turn was affected to take them off and proceed as 
in the first case.-
When one Foot presents.- This is to be managed
in part like a foot and in part like a Breech
case, by gradually extending &c. 'till the foot Drops
out, and then finish as before mentioned.-
When one or both Knees present. In this 
case you must draw down by the Thighs, 'till the 
Legs drop out, and then proceed according to the 
directions laid down for the foot case.- 



207
Turning.
Turning consists in passing up the hand to find
the Feet, when any other part presents, and is divided
into turning from Necessity and turning from Choice.
When turning from Choice is mentiond it must 
not be understood to be from caprice, but that in this 
case the Child might possibly be born without turn
yet, if the Child is turned, the Danger will be less.-
When neither the Head, Breech nor lower Extremities
present, then turning is required to affect Delivery, this 
is turning from Necessity.- In cases of this sort
it was the Practice of the Ancients, to take the Child
in Pieces, for the purpose of extraction, if they could
not by any means bring down the Head.-
Hypocrates directed the Woman to be shook, under
the Idea of changing the situation of the Child.- 
Ambrose Puree was the first who recommended the 
the turning the Child in cases of this sort by passing 
up the hand to find the Feet, much in the secure way
as now directed.
Tho' the Operation of turning is an improvement
it is not altogether without Danger in itself, more 



208
Particularly if proceeded about in a rough improper 
manner.- The Danger from turing is in proportion
to the Degree of Pain, and the shape of the Uterus
and direction in which the Child lays whether in 
a round or oblong form, for the rounder the Child
lays with the more ease will the the turning be effected.
Turing is somtimes thought proper when
the Head presents, here the concomitant Symptoms
must determine the propriety, these circumstances
usually are, unfavourable Situation of 
the Head. Flooding. Convulsions. want of Pains.
want of Room in the Pelvis.- Oblique situation
of the Uterus.- Prolapse of the Navel String with 
the Head.- These will be each considered separatly.-
In all these cases the head is supposed 
not to have entered the Brim of the Pelvis in any 
Degree, for if it has you must not attempt to 
turns but give assistance in another way, by the 
use of the Lever and Forceps.- You should likewise
have the parts sufficiently dilated before you
attempt to pull down.-
Unfavourable Situation of the Head. This may 
require turning if this cant be rectified, by means
of the Hand or Lever as in case of the Ear presenting
you may sometimes alter the presentation to the 



209
Vertex Case by acting on the Head with the Lever.-
Flooding and Convulsions. The propriety of turning
will be treated of when treating of these particular Subjects.
Want of Pain. This does not require turning if 
there are no unfavorable Symptoms come on, this may
be known by the Pulse and Strength, &c. and if there are
no unfavourable Symptoms you must wait and 
Nature after some time will be able to expel the Child.
With respect to the time you must wait, this depends
very much upon circumstances.- A Patient has 
been in Labour 2 or 3 Days, and during almost the 
whole of this time, the Os. Uteri has been considerably dilated,
but very little pains, these have then come on
and the Labour has soon terminated favourably.-
But if whilst you are waiting any unfavourable
Symptoms come on, and the Patient appears to be 
Sinking, you must then proceed to turn, or in case
the Head has entered the Brim of the Pelvis, the long 
Forceps will then be preferable.-
Want of Room. This is understood to be 
in a slight degree for if disproportion is considerable, 
it will be impossible by any means
to bring the Head away without opening. When 



27
210
the Disproportion is slight, Practioners say in
their Opinions respecting the propriety of turning
at all on that account, very few recommend
it, for the object of turning in this case is to save
the Life of the Child, and it will be a very difficult
matter to bring the head away soon enough to do this 
if you turn on account of Deficiency of Room.
In this case the Lever of Long Forceps would
probably answer better, and save the Life of the 
Child when turning would fail.-
Obliquity of the Uterus. Turning is very
seldom necessary on this account, as this may
generally remedied by changing the Position of the 
Woman so as to alter the bearing of the Womb.
Prolapse of the Navel String. When the 
Navel String comes down before the head of the 
Child, there are different Opinions respecting the 
propriety of turning, some Favour it and others
not.- In cases of this sort if you dont turn 8 in
10 of the Children will be Born Dead, and if you do 
5 in 10, this is understood as a general Rule. In 
certain cases it may be right to turn but if the 
Object is to save the Child, and not on account of 



211
any benefit to the Mother you should never turn
without a probability of Success, and the following
circumstances must be taken into consideration.
Whether the Child is alive this may be known
by the Pulsation of the Chord.-
Whether or not the Head has entered the Pelvis
if the Head has entered the Pelvis turning is out of 
the Question.
Pains Strong or not. If the Pains are Strong there
is an objection to turning, as the degree of force necessary
may injure the Woman, and the Life of 
the Child wont be saved.-
Rigidity of the Passages. If these are in a rigid state
this will prevent the head being extracted time
enough to save the Life of the Child, therefore the 
parts must be in relaxed State to admit of turning,
with any probability of Success.- **
You may sometimes feel the pulsation of the 
Chord before the Membranes are ruptured in this 
case you should endeavour to keep the Bag of Waters
whole 'till the os. Uteri and parts are compleatly
dilated, for whilst Membranes are whole
the Cord is not pressed upon, and it likwise alows
the Child to be much more speedily expelled after they



212
are ruptured.- When the Chord is come down you
should endeavour to put it to some part of the Pelvis
when there is most Room, or to put it entirely
up; if this cant be affected, turning may be then
admissible under certain circumstances before mentioned.-
No Practioner is justified in turning the Child
from any motives of convenience to himself.-
There are certain circumstances which affect
turning rendering more difficult or easy, according
as one or other take place, the Child will be turned
with greater ease according as it lays in a round
form, and more difficult as it form and that of 
the Uterus becomes more oblong.- Another circumstances
to be taken into consideration is want of 
Room in the Uterus, this may depend either upon
Waters having been off a great length of time or upon
the violent action or rigidity of the Uterus.
In these cases if the turning is from Choice
it is much better to be backward in doing it unless
the are pressing Symptoms, but if the turning is 
from necessity, it is then right to do it, but at the 
same time will be adviseable to mention the Danger 
to the Friends.- If the Patient is labouring under
certain Diseases, Phthisis, Fever &c. you should be 



213
backward in attempting to turn, except from necessity.-
When it is necessary to turn, you will always
do this to the greatest advantage, immediatly after
the evacuation of the Waters, and from this you will
perceive the necessity of ascertaining the precise
presentation and Situation immediatly after the 
Waters have been evacuated.
Whenever you have reason from any circumstances
to suppose turning will be necessary, you
should never be in haste to break the Bag of Waters,
but alow the parts to be sufficiently dilated before this 
is done.- In cases you may feel a part, which 
will indicate the necessity of turning, before the Bag
of Waters is broken, in this case alow the Waters to remain
'till the parts are sufficiently dilated, and
the membranes a ruptured immediatly pass your
Hand up, and if possible plugg up the Mouth of the 
Womb so as to keep in a Portion of the Waters, this 
will facilitate the Turning.-
When the Waters are evacuated before the Os. Uteri
is sufficiently dilated, and the presenting part
is not well adapted to effect this dilation, as for 
instance in the Back Presentation; you may then
assist the dilating process by passing up your fingers



214
fingers and acting as a Speculum, but this must be 
done with the greatest gentleness
Before attempting to turn the Rectum and Bladder
should be emptied, for if the Bladder is distended
there is Danger of its being ruptured.-
The Patient in all cases may lay on the left
Side, except in some few Instances, and the Parts
should be brought as near the edge of the Bed as possible.-
In some few cases the right Side may be another
more advantageous, this depends upon the Situation
of the Child, but very little benefit can arise
from the Patient being placed in the Hands & Knees 
as some have recommended, and this is in general
a Painfull Situation.-
The Child will seldom require turning before 
the 7th,, Month, but this will depend upon circumstances,
in saying this the Child & Pelvis are supposed 
to be Standard.-
With respect to the Hand most proper to be 
used, that will depend upon the Situation of the Child,
the Back of the Hand should always be opposed to 
the Bones of the Pelvis and the Palm of the Hand to 
the Child.- In passing up the Hand no great degree
off force should be used, but it should be done in a gentle 



215
gradual manner. When you are about to turn, you
should take off your Coat, and do this in way so as to excite
as little alarm as possible to the Patient, and rub
the Back of the Hand (and not the inside) with some oil
or Pomatum, to facilitate its passage.- 
When introducing your hand, this must be done
in a Slow and gradual manner, and if you meet with 
any resistance, you must wait a little to alow the 
Parts to dilate and attempt to overcome this by any
violent degree of force suddenly applied.- There will
generally be a considerable degree of Pain, when the 
Knuckles are about to pass the external parts, and 
when they have passed, somthing less and the wrist will
become grasped, on account of then being more Room
in the Vagina.- In this Stage you should put
your hand in a proper position for finding the 
Feet, the part to which they are situated should have
been well ascertained before, as on this depends the introduction
of the Proper Hand, and in the Proper direction.- 
In passing up the Hand you must 
take care it passes in contact with the Child and 
not on the outside of the Membranes, for these will
prevent you taking hold of the Feet, and will endanger 
the bringing on a Flooding by the Separation of 



216
the Placenta, you may know when your Hand is on 
the outside of the membranes by feeling the interposition
of the membranous Substance between your Hand and 
the Child.- The Uterus should be supported by an Assistant
whilst introducing your Hand, and you should
introduce the hand gently and during the absence of 
Pain, desisting from the attempt during Pain.-
If the Uterus acts frequently and strongly, a Dose 
of R [illegible] Opii may be of Service by lessening the Pain, both
in frequency and Strength, to produce this effect it 
should be given in a full Dose, from 30 to 50 Drops or
more, alowing time for this to produce its effect, perhaps
waiting an hour or an hour & half will be sufficient.
Shd the violence of the pains prevent turning immediately after this [illegible] 
-You should likwise take care to carry the 
hand sufficiently high to find the Feet, and to avoid
mistaking a hand for a Foot, this may be done by 
feeling for the Elbow, or the heel.- Take care likewise
that both feet belong to the same Fetus, this will
be in general the case, as each Fetus is mostly contained
in a separate Bag, tho' is not always the case,
you may ascertain this by passing your hand up
to the Perineum.- If you have only got hold of 
one Foot you should not draw down 'till you have
got the other, and when you have get hold of both 



217
you should draw down in a gradual gentle manner.- 
In some cases when you have got hold of the 
Feet and are attending to bring them down, the head
will descend at the same time, in this case you cant
leave hold of the feet to elevate the Head, but you
may pass a Fillet round one or both Feet, for the 
purpose of keeping them down, and the press upon
the Head so as to elevate it, and alow the Feet to come 
Down.-
In turning, the object to be kept in view is to 
bring the Belly of the Child to the Back of the Mother.
The Difficulties are sometimes such as you cant 
get the better off, so that you wont be able to turn the 
Child and Mutilation will be necessary.-
When you have brought the Feet down, past
the external parts the case must be finished as 
the Foot case.-
Application of the Rules to particular Cases.
The general principles already mentioned being 
perfectly understood, their application to particular
cases will not be attended with much Difficulty.-
As the general principles in all cases are the same
it will not be necessary to mention every individual
variety that may occur.- 



28
218
Back Presentation.
This requires training, and may be distinguished
by feeling the Spinous Processes of the Vertebra in
the middle of the Pelvis, and the Situation may be
determined by the different distances of these at the 
lower and upper part, as this is much greater towards
the Loins & Sacrum.- This in general is not 
a very difficult case.- The Peculiarity in the mode
of turning in this case, consists in conveying the 
Hand up to the Feet by crossing the Back.- In
this case the Back of the Hand should be opposed
to the Sacrum.- The Situation of the Feet must
determine which hand is most proper.-
In the Back Presentation, some have recommeded,
pushing up the Shoulders and alowing
the Breech to come down, but as pushing up
is always attended with Danger, this should never
be done.-



219
Arm Presentation.
If the water have been evacuated for any length
of time, and the Shoulder is wedged into the Pelvis
and at the same time the Pains are Strong, it will
be extremely difficult if not impossible to turn
the Child.- An Arm Presentation seldom requires 
turning before the sixth Month, but is generally necessary
at the Seventh, and somtimes earlier, therefore
particular enquiries should be made respecting the 
Stage of Pregnancy, and if no longer than the Sixth
Month, you may then take hold of the Arm and pull
down and the Head will pass in that Direction.
This is only a general Rule, as in this case the 
Head & Pelvis are supposed to be Standard, and as
there may be deviations on either side, these of course
will affect it, there for you should not rely wholly
upon the Stage but, but take other things into the 
account, as examination &c. make of the Woman
state of the Parts &c.- But in all cases if you
have the least doubt either in respect to the Stage
of Labour or Proportion, you should pass up the Hand
and find the Feet.- Somtimes a hand comes 



290
down with the Head, this is not a true Arm Case.
In this case you must not take hold of the hand
and pull, or you bring it to an Arm presentation,
but you must endeavour to raise the Hand up, and 
keep it up 'till the Head comes down and presents
its returning, perhaps the Lever may be of use here
in bringing the Head down more Speedily.-
If the head is small or the Pelvis large they will
somtimes pass in this direction together.-
But in case the hand becomes jammed in along
with the head and it will neither pass, and your are 
not able to raise it, it will then become necessary
to open the Head.-
A true Arm case is when the Arm alone
descends and when this was the case it was formerly
recommended to push the Hand up, under the 
supposition that some other part would descend, but 
this is bad practice and should never be done, for in all
cases there is danger from pushing up, of rupturing
the Uterus, and in this there is no advantage gained, you
must not likwise pull down by the Arm, except in case
of the Elbow presenting, when you may pull down the 
forearm to make more room to pass up the Hand.
In some case of Arm Presentation, the Child has
spontaneously turned in the Uterus, the Arm going up and 



221
the Breech becoming the presenting part, this is what 
is called Spontaneous Evolution, from this circumstance
Dr,, Denman recommended waiting to see if this would not 
be the case, but from its frequently failing and when
it did succeed the Child was almost always born Dead,
he afterwards restricted this to when the Children were
known to be dead, but this should not be done in any case
except the Child is evidently upon the move, for if you
wait any time the Shoulder of the Child becomes wedged
in the Pelvis so firmly, as to render turning extremely
difficult or impossible.-
In the Arm Presentation where the Shoulder is wedged
in the Pelvis, and the Pains are Strong turning is extremely 
difficult, in this case the Pains may be moderated by
full Doses of Opium, alowing sufficient time for them
to produce their effect, perhaps waiting an hour or an
hour and half, and endeavour to pass up your hand by
gently elevating the Shoulder, and in doing this the greatest
dexterity will frequently be necessary, always using
as little force as possible, in doing this the general Rules
respecting turning must be kept in View, and the Woman
must lay on the right or left side according to the 
situation of the Child, and this must likwise determine
the hand proper to be introduced.- The situation of the Child 



222
may be known by examining the Direction of the palm
of the Hand likwise, the Thumb and Radius, and you 
are not certain from this pass your hand to the bend of 
the Elbow and Axilla.-
In cases when the Difficulty is such as to prevent
your being able turn the Child and bring it away, it then
becomes necessary to mutilate the Child, this is called 
Embryotomy, and may be done by means of the Perforating
Scissors. The mode of doing this is by passing up the 
Scissors guarded by the Hand, and separating the Arm
not at the Shoulder Joint, but by taking of the Scapula
and then making an Opening into the Thorax and Abdomen,
to evacuate their Contents, this will make sufficient
Room to alow of the introduction of the Hand, which you
should do and extract the Child by the feet.
Before you proceed to do this all possible means to 
bring the Child away should be used, consistent with the 
safety of the Mother, if the Child is alive, but in case 
the Child is known to be dead, you may then do it without
so much Hesitation.-
In some instances after the Child has been turned
there will be difficulty in the extraction of the Body
this may be from Air or Water in the Cavity of the Ab



223
this may be relieved by a puncture made into the 
Cavity of the Abdomen.- Sometimes there will be difficulty
in the Extraction of the Shoulders, rendering the 
Blunt Hook necessary, but this should be used with 
great care if the Child is alive, but if dead, so much
caution is not necessary, and if it is great the Arm may
then be separated. 
The greatest difficulty is in the extraction of the 
Head in many cases, and arises either from unfavourable 
position or disproportion, the former of 
these is owing to mismanagement, in not attending
to the Rules laid down for turning, the latter is 
inevitable.- From this it will appear evident
how necessary it is to attend to the Rules.-
If the disproportion is slight, putting the Head
in the position best adapted to the Shape of the Pelvis, will
often effect the extraction, but in case it is in the 
degree so as not to be brought away by this means
some have recommeded long Forceps, but they can 
be of no use as sufficient force may be applied by 
introducing our finger into the Mouth and the 
other hand upon the Shoulder with the Finger on the 
Occiput, this gives you a sufficient command of 
the Head likwise.- If you cant effect the Extraction



224
Extraction of the Head this way it then becomes necessary
to open the Head by means of the Perforator..
If your are able to extract the Head, and there has 
been considerable difficulty, tho' the Child may appear
Dead, yet it may be adviseable to inflate the Lungs
by means of a Proper instrument.-
When it is necessary to open the Head, this must
be done by means of the Perforator, and the part
most convenient for this purpose is the Lambdoidal
Suture, and after the Brain is broke down, you 
may then extract either by extension, or by the introduction
of the Crotchet.- Some have recommended
separating the head from the Body in this case,
but this should never be done.-
In case the Head has been separated from the Body
it has been recommended to trust the expulsion to
Nature, but this cant be done with propriety, more 
particularly if there is Disproportion.-
When a case of this sort occurs, you should make
particular enquiry, whether the Difficulty has arisen
from Malposition or Disproportion, and if from Malposition,
and there is at the same time a Spasmodic affection
relieving that Spasm by means of Opinion, may alow the 
Womb to expel the Head.- Somtimes there will be a Spasmodic
constriction of the Mouth of the Womb, so as to compleatly



225
compleatly in close the Head, it would not be adviseable to 
overcome this Spasm by force, but to give a full
Dose of Tinct. Opii. and wait 'till it produces some 
effect, and then endeavour gradually to Dilate the part.
Different Instruments have been invented for 
the extraction of the Head, but very few of them are 
worth notice, one invented by Gregwaar, to pass into
the Foramen Occipitale, might be of Service when 
there was no disproportion and might assist in 
fixing the Head for the Use of the Perforator and 
Crotchet, which are the only means that will
effect the extraction where there is disproportion,
in using them you must fix the head, either by 
somthing passed into the foramen Occipitale, or by
pressure upon the Abdomen, and the lessen the head
by the Perforator and introduce the Crotchet, for the 
purpose of extraction.- It will somtimes be necessary
to pass the Basis of the Scull sideways if the Disproportion
is great.- You will have much firmer
Hold by the Crotchet, at the Basis, than if it was the 
Summit of the Cranium.- 



29
226
Twins.
Somtimes instead of there being only one Child
there, or 2 or more, have been 3, 4, and in one case
5 Children. When the management of Labour
where there is only one Child is perfectly understood,
that when there is twins &c. cant be difficult
to comprehend, as circumstances are much the 
same.- When there are more than one Child, the
Labour is in general easier, as the Children for the 
most part are less, tho' there have been some exceptions
to this Rule where there were two Children.
If there are 3 or more, the Woman is generally
delivered before the termination of the usual Period
of Pregnancy, as the Womb wont alow of that Distention
necessary for their compleat growth.
The symptoms which indicate the existence of 
Twins during pregnancy are very equivocal, as 
the size of the Abdomen, double quickening &c. as 
this extra enlargment may be from a greater quantity
of Water &c. double quickening not of any consequence
as it may be from the same Child moving
at these different times. There are other Signs mentioned
but which are of no consequence.- 



227
During the time of Labour, and before the Birth of 
the first Child, circumstances sometimes occur which
indicate the existence of Twins, as the presentation
of two Heads, their feet, or Anus &c.-
The time most proper to ascertain whether there
are Twins &c. is often the Birth of the first Child, either
by the Pains, or by laying the Hand on the lower part
of the Abdomen, or by examination internally by the 
Vagina.- It will seldom be necessary to examine internally,
as you may in general determine this by 
laying your hand on the Abdomen, if there is another
Child it will feel full and distended, if not, the Uterus
may be felt contracted in the middle of the Abdomen
in a round hard Body, this way of examination
is preferable.- If you examine internally you
may either feel some part of the second Child, if there 
is another, or the Bag of Waters, but you may possibly
be deceived in this last respect, by a collection of 
Blood &c.-
If you feel a second Bag of Waters you should
immediatly rupture this, as the purpose of alowing 
them to remain that of Dilating the parts, is not 
wanted, and as the parts are relaxed and dilated
by the passage of the first, the second will generally
pass with very little Difficulty, on this account it may 



228
in some cases be better to conceal their being a second
Child from the Patient and bystanders, as they may 
suppose there will be the same difficulty attending the
expulsion of this as the first, this you may do, under
the pretense of assisting the expulsion of the Placenta.
Different Opinions have been formed respecting
the management of the second Child, some have advised
immediate Delivery, others to commit the 
expulsion entirely to Nature, and others have advised
are intermediate Course, which is preferable.-
After the birth of the first Child you should immediatly
ascertain the presentation of the second, for 
it is necessary to turn, this can be done at this time
with the greatest ease, and in case of a presentation
which does not require turning and pains come on
the Labour must be conducted as in other cases.
If pains go off, some have recommeded waiting
'till the again come on, but this is not good practice
for the mouth of the womb may again contract, and render
the expulsion more difficult. Dr,, Louden in
all cases, often waiting an hour, tho' the head was the 
presenting part and no unpleasant Symptoms
cause on, always turned.- If unpleasant Symptoms
come on you must attempt Delivery sooner 



229
such cases as require turning in case of 
only one Child require it equally when there
are two or more.-
When all the Children are born, you must
then proceed to the extraction of the Placenta,
as this must not be attempted before, on account
of bringing on flooding &c. and occasioning
other bad effects.- The manner of doing
this is to take hold of the different Chords, together
and proceed as in other cases, taking care
not to invert the Womb.-
Monsters.
There are Fetuses, which differ from the common
form, and do so in different ways.-
The mode of formation is very obscure, and 
the causes which divert Nature from the ordinary
course of evolution are not well understood.-
They are frequently attributed to some effect
which has been produced upon the mind, during 



230
Pregnancy, but this is not at all probable, as
many of these happen when the different parts of the 
Fetus are fully formed, if ever it does it must
be at a very early period.-
A knowledge of the different forms of Monsters
is as full in practice, as they may somtimes
occasion a little embarrassment.- A Brainless
Monster may possible be mistake for one 
whose head has been opened, a mistake of this 
sort occured to a Practitioner, who supposed the 
Head has been Opened
Monsters considered relatively to practice
may be divided into such, as have deficiency
Redundency, Mal Formation and Mal Situation.-
Those that are Deficient can occasion
no difficulty in Labour, except in case of turning
being necessary when the Extremities are
wanting, if there are the lower ones, some embarrassment
will be the consequence, and it may be 
necessary to open the Head.-
When there is redundency, it may be a cause
of Difficulty. It may in this place be right to



231
mention that in case two Children adhere by 
there Chests, that the internal parts are common
to both, this to prevent any thing being done
by way of separation.-
Our circumstance which is favourable, is 
that in [cross out] most cases of monstrosity, there is a disposition
to premature birth.-
Deviations from the common Period of Birth.
Most Labour occur at the end of Nine Callendar
Months or 40 Weeks, and many happen before 
this time, but there are different Opinions, respecting
the possibility of this time bring exceeded.-
From the observation made upon Brutes
it is probable that this may take place in the 
Human subject, but to what extent it is extremly
difficult to determine, this subjects comprehends
a Question of Law relative to the Legitimacy of 
Children, but it is impossible to draw a line of 
Distinction, if the Period is protracted beyond the 



232
45th,, or 46th,, Week, it then admits of a Doubt.-
Premature Birth.
This may take place to any period of Pregnancy,
but as some of these Children live after
Birth, and others not, they are from this Distinguished
into Vital and non Vital, this is likewise frequently
a Question of Law, and on this account
the Line is generally drawn at the 7th,, Month,
but this admits of some Latitude both ways.
Pulsation of the Chord is a sign of Life in a 
Physiological View, but wont be sufficient in 
the other view of the subject.- If the Child cries
it is a certain sign of Life, and if it could be proved
to have breathed that may be sufficient.-
Miscarriages are supposed to occur more 
frequently at some Periods than others, as the 
6th,, Week or third Month, attending to this circumstances
and more particularly if the same Person
has repeatedly miscarried at any certain Period,
may be of some consequence, as by keeping the 
Patient cool and quiet, at that time, miscarriage



233
may frequently be avoided, and at the same 
time giving gentle aperients &c.-
When a Woman has repeatedly miscarried
she will often begin to despair, and there will
be in some reason an assisting cause of this 
taking place, and should by all means be removed
if possibly and for this purpose any thing may
be done to divert this either by way of Medicine
or any other way.-
The immediate cause of Miscarriage is 
the same as that of Labour, which is the contraction
of the Uterus to expel its contents, therefore pains from
Uterine contractions should either be moderated or 
removed.-
Miscarriage may be produced, either by separation
of the Placenta; premature breaking of the 
membranes from any cause, or any thing that only
occasion the Death of the Fetus, tho' abortion does 
not always immediatly follow the Death of the Fetus
as this may take place at a length of time, before 
it is expelled even 4 Months or longer.
Miscarriage from accident will sometimes occasion
a susceptibility to future miscarriages, when 



30
234
this is the case particular care should be paid
in avoiding any of the exciting causes, keeping
the Patient cool and quite and attending to the 
different Symptoms as they may occur.-
A Miscarriage sometimes is not preceded
by any considerable Discharge of Blood, at others it 
is, this is owing to the exciting cause, if it is from 
any thing causing a contraction of the Womb, as 
the rupture of the Membranes &c. there is [cross out] no 
large discharge of Blood, in this case the Uterus proceeds
the same as in Natural Labour; first expelling
the Child then the Membranes, but when miscarriage
proceeds from the Placenta being either partially or 
wholly detached, there is then considerable Hemorrhage
and the case is then much more dangerous than
the Former, and on that account merits particular
attention.-
Miscarriage preceded by a Discharge of Blood.
These are much more dangerous than the other
kind, and this in proportion to the stage of Pregnancy,
as the more advanced, the larger the Vessels
are and consequently the greater Danger.
The cause in this case is the separation of the 



235
Placenta either partially or entirely, when this is only
partial Miscarriage does not always follow, but 
great care in this case is necessary.-
The signs are a Discharge of Blood, taking place
at unexpected Periods, which will coagulate; with 
pain, bearing down &c.-
Some judgment is somtimes necessary to
discriminate between such discharges and the 
menstruations in the early Months of Pregnancy
but this may be done by attending to circumstances,
as whether it occurs at the periods when the 
Menses [wa?] expected, or is accompanied with 
pain or not, or whether the Discharge will coagulate.-
Menstruation very seldom occurs so late 
or later than the third Month, and shews no disposition
to coagulate.- Enquiry may likwise
be made whether the Discharge proceeded from
any accidental cause.-
It is usual to divide these as they occur in 
the early or late Stage of Pregnancy, the time between
the two is generally drawn at the fourth
Month.- Those which occur in the later Periods
of Pregnancy are much more Dangerous, tho' the
others are attended with considerable Danger.-



236
Treatment of Miscarriage in the early Stage.
When there are any Symptoms which indicate 
on approaching Miscarriage, the Patient
should be kept as much as possible in a Horizontal
position, and as cool as possible, the room
should be as cold as conveniently can be, and the 
Bed Cloathing very tight, every thing heating or
Stimulating should be avoided, it is a very common
practice to give Red Wine under the Idea
of its being an Astringent, but this is very wrong
as it acts as a Cordial and of course does injury.
Then somtimes comes on faintness, this should
not be removed by Cordials &c. as it is upon the 
whole a favourable circumstance, alowing the 
formation of a Coagulum, and that way preventing
a return of Hemorrhage except the 
action of the Heart becomes very much affected, and 
the Extremities cold, it may then be necessary to give
some Cordial.-
In some cases instead of immediatly giving
Astringents it may be necessary to take away
Blood from the Arm, but this must be determined
by the State of the Pulse and other circumstances. 



237
Nitre, Mineral Acids, Opium &c. must be given
according to circumstances.- A common remedy
is an Infusion of Roses with Nitre, this does not
appear a very eligable way of giving the Medicine on
the Acid of the Roses may decompose the Nitre, tho' as
it does so only in a small Degree, it may still be 
very serviceable, an Infusion of Roses with the addition
of Natron. Vitriol. is equally well adapted for 
the purpose and is not liable to that inconvenience.
Opium is serviceable only under certain circumstances,
as in case of great irritability, when it answers
best if given in small Doses and repeated frequently or 
2 or 3 Drops every 3 or 4 hours.- If there is no hemorrhage,
at may sometimes do good given in full doses.
Digitalis would appear likely to answer a 
good purpose under certain circumstances, but is
so uncertain in its operation as not to be adviseable.
When the flooding has ceased, the Patient shd,,
be particularly carefull to prevent a return
by attending to the Bowels &c. and by avoiding any
exertion. This mode of treatment in supposed
to be necessary and proper during a state of Strength,
but when the Disease has continued somtimes a



238
different mode of treatment becomes necessary, instead
of giving Nitre &c. Astringents rather of the Tonic
kind become necessary, as the Mineral Acids, or Alum
this last in Doses of from 4 or 5 grains to 8 or 10.-
Preparations of Lead are somtimes given, or Tinct.
Saturn. g tt,, xx. ad g tt, x4, or the Cariess. Acetat. gr, 76 ad
gr. i sal gr,, ii - iii; this in general should be joined with 
small quantities of Opium to prevent its affecting
the Bowels.
Frequent returns of Hemorrhage may 
lead to considerations on the propriety of promoting
Miscarriage, it is better not to do this except
Nature appears to tend that way, except under particular
circumstances, as the Bag of Waters having
been ruptured, or the patient very much reduced
by the discharge, when you may proper examination,
tho' it will be better to avoid this in the early
Stage.- If on examination you feel the Mouth of the 
Womb soft and dilatable, or the Membranes protruding
you may then introduce your finger and act as a speculum,
gradually Dilating the parts &c. but if you
find the Os. Uteri rigid and closed, it will be much
better to leave the case to Nature only making use 



239
of the proper means before mentioned. If on examination
you find the Ovum in the Mouth of the Womb
this is the actual state of Miscarriage, and you should
do nothing for a time except you have reason to suppose
there is an internal bleeding going on, in which case
you may attempt the removal to alow the Uterus
to contract.-
Various instruments have been invented for 
the purpose of Dilating the womb but they are very 
seldom wanted, and may often do injury if used, the 
fingers are in general quite sufficient, and answer
the purpose much the best.-
Some have recommended the application of Styptics 
to the os. Uteri by means of Plugs, this is what 
the French call Tampon these are very objectionable
as they might possibly cause the os. Uteri to close but 
at the same time alow an internal hemorrhage
to go on.- They might be serviceable after the expulsion
of the Contents of the Uterus, when it was not disposed
to contract.- A Patient has considerable Thirst
in general, Cold Water may be alowed, tho' it will
be better if acidulated, as in this case a smaller
quantity will be effectual, and which is adviseable  



240
If on examination you find the Ovum wedged in 
the Mouth of the Womb, and the hemorrhage has continued 
for a length of time, it may be right to endeavour
to bring that away.- It is not in general
necessary to stay with a Patient under these circumstances,
but to see her occasionally.-
You should always carefully examine all discharges
that come away for there will frequently be
Coaguli discharged, and which may be mistaken
for an Ovum.- You should always examine to 
ascertain whether there is a Cavity or a Membranous
substance which may have been the Cavity, if this is 
the case, it is a Miscarriage, but if it is perfectly
Solid, it then is a Coagulum.-
You should likwise examine to know whether
the Placenta is expelled, if not you must not 
attempt the extraction, but leave it to Nature, and 
correct the putrid Discharge which may take 
from time to time by means of antiseptics, as 
Decoct. Hord. in R a,, Myrrh. Decoct. Cort. Inject.
Vis. Rubr. &c.- The Placenta is somtimes expelled
with pains, at others not.-



241
Miscarriages in the latter Months.
The Danger from miscarriage in the latter Months
of Pregnancy, is much greater than that of the 
early Months, on account of the Vessels of the parts
being so much larger.- The Degree of Danger is 
in proportion to the quantity of Blood discharged
and its effects upon the constitution.-
Separation of a Part or the whole of the Placenta
is the cause of this, and which be either from accidental
causes or from the Placenta being attached 
over the Mouth of the Womb, or very near to it.
You may endeavour to ascertain the cause
of this flooding and may do so with a considerable
degree of accuracy by attending to the different circumstances,
as whether it has come on in consequence
of any accidental cause, or whether it has occured without
any such thing, as when perfectly at rest, or
in Bed.- If it arises from separation taking place
owing to its attachment, it will in general come on
about the middle of the 5th,, or 6th,, Month, as the Neck
of the Womb at that time begins to stretch, and not 
much before.- It will likwise be repeated at times
without any evident cause as Neck of the Womb continues



31
242
to Dilate.- If the Discharge is either violent or 
so often repeated, as have considerable effect upon
the constitution, you should examine to ascertain
the state of the Parts, if the mouth of the Womb is any 
ways dilated so as to alow of the introduction of one 
or two fingers, you may then distinguish whether the 
placenta is situated over the mouth of the Womb or 
not, if it is the Placenta that presents, you will
feel a fleshy substance, but if not, you will feel
the Membranes protruding.-
In cases of this sort all the different means 
of stopping the Hemorrhage in the early months
must be had recourse to according to circumstances,
and if the discharge is either checked or stopped
great care should be taken to prevent a return.
If the discharges continue or are so often repeated
as to weaken the Patient very much, it then becomes
a question respecting the propriety of bringing on Delivery,
and which should not be deferred to long or the 
Woman may not have sufficient strength carry her
thro'.- Delivery may be brought on two ways
either by inviting natural Labour, or by the 
more active practice of turning, the violence
of the Hemorrhage, Disposition of Parts, and state 
of pain, will have very great influence in the 



243
determination of the mode most proper.- They 
way to invite natural Labour, is by passing up
the finger to the mouth of the Womb, introducing
one or two of them and making gentle pressure, and 
it the same time acting in a gentle manner as 
a Speculum, this way endeavouring to excite
the Womb to action.- You will somtimes feel
the Bag of Waters protrude, and when this is the 
case you should rupture them, which may be 
done with much propriety sooner than in natural
Labour when there is no hemorrhage, as you now 
want to reduce the size of the Womb, and doing 
this by evacuating the Waters has in some instances
been sufficient.- But in some cases there
is such a Degree of debility as to prevent the 
Womb from be able to expel its contents, in this 
case it becomes necessary to have recourse to 
more active means, that of passing up the hand 
and bringing down the Feet.- When the Hemorrhage
is more violent, as in case the Placenta
is attached over the mouth of the Womb, you must
not then wait for the bringing on natural Labour
but deliver as soon as possible without using violence 

After the Child is extracted, the Placenta must be 
immediately brought away, to slow the Womb to contract
speedily as possible.- 

244
pass up the hand and turn.- The center of the 
Placenta is not always immediately attached
over the Mouth of the Womb, somtimes only a small
portion, in this case the Danger is not so great, but 
when the middle of the Placenta is attached, it is 
then an extremely dangerous case, when this is 
the case you must not attempt to separate the 
Placenta from the Womb, for the Purpose of alowing
the introduction of the Hand, [illegible] that would be multiplying
the number of Bleeding Orifices; and under
the case of the Woman more dangerous but you
must pass your hand thro' the Substance of the 
Placenta to the Feet.- In these last cases the 
Child must necessarily be destroyed by the loss 
of Blood.- Manual assistance may somtimes
be necessary before the Uterus is of a sufficient size
to alow of the introduction of the Hand, as at the 3d,,
or 4th,, Month, in this case you may puncture the 
Bag of Waters by the use of the Stiletto or a Catheter, and
Labour will in general come on in the course of from
one to three or four Days.- It will be necessary to 
alay the irritability which will be produced, by
means of opiates occasionally, but there wont be 
than degree of irritability produced in the early as in 



245
latter periods of Pregnancy.-
Flooding after Delivery.- This is often the 
consequence of an inert condition of the Uterus, and
cannot in many cases be trusted to Nature with 
safety, if upon laying your hand upon the Abdomen
you dont find the Uterus contracted, you may in
many instances excite this gentle pressure upon
the Abdomen, or you may apply Clothes wetted in 
cold Water to the Abdomen.- The common mode of 
applying Clothes moistened in Vinegar and Water
to the external parts is injudicious and often does
injury by causing excoriation, and as the action
of this is not from any astringent property independant
of its coldness, cold water will answer way
purpose and that applied to the Abdomen, as near
the part affected.- It very violent cases it has 
been recommended to throw cold Water into the 
Cavity of the Uterus by means of a proper Syringe
in want of which a long Glyster pipe might answer
the purpose.- You may likwise endeavour to 
rouse the Womb to action by passing your finger
the the Os. Uteri and making pressure, or by passing
passing your hand into the Cavity and recovering it round
[cross out] 



246
[cross out]
[cross out]
[cross out]
[cross out]
[cross out]
Flooding does not always come on immediately
after Delivery, but in some cases occurs 3 or 4 Days
or even a Week or two after Delivery, if this is not owing
to some accidental cause, there is great reason to 
suppose the Uterus is in a Diseased state.-
In flooding after Delivery the usual remedies as 
in other cases must be had recourse to according 
to circumstances, as Infus. Rosa. Carcess. Acetat.
Alum in &c.- It is somtimes the case to give the 
Infusion of Roses, joined with Carcess Acetat, under
the Idea of their assisting each other, but this is not 
the case, as the render is each other less usefull by their 
combination.- A degree of faintness frequently
comes on, and which should not be obviated except
when in an alarming degree, as it is upon the whole
rather a favourable circumstance, alowing the Vessels
to form a Coagulaum &c.- If in a very alarming degree,
a small quantity of some Cordial may be 
given and repeated according to circumstances.-



247
The plugg or Tampons has been recommended
in these cases, but does not appear to be well adapted
as it may act as an Astringent to the Neck of the 
Womb causing it to contract, and alowing an internal
bleeding to go on.- The way it may be 
applied is by means of a piece of Spong, and which 
may be moistened in any astringent Liquid.-
Pain of the Head connected with Flooding.
This is the effect of [ina??ition] and usually continues
'till that state is removed, consequently any 
medicine for its Cure will be of little Service, but 
the best mode of attempting its removal is by 
giving nourishing food, and in small quantities
and frequently repeating it, according as the Stomach
will bear it.- Leeches to the Temples do have, tho'
a Blister may afford some relief.-
Excessive Restlessness. This is another consequence
of violent flooding, and is extremely Dangerous, 
some few have recovered when this has 
been only in a slight degree, tho' it is generally
a Symptom of approaching Death, it marks a very 
high Degree of Depletion.- In cases of great loss 



248
of Blood, transfusion might be of very great Service,
if not for prejudice, as the Blood should be 
Arterial, it cant be taken from the Human Subject, 
but might from a Sheep, by laying bare the
Carotid Artery, and introducing one end of a Tube
and the other into the Saphena Vein, and in 
this way a portion of Blood might be introduced.
In great loss of Blood upon other occasions
the practice might be serviceable.-
Fevers connected with Parturition.-
Any fever which is Dangerous when occuring at
other times is more particularly so now, those
attended with the least danger are intermittants,
tho' there are some few exceptions to this, as in case
there is a considerable degree of Stupefaction &c. showing 
a considerable determination to the Head, this
often proves fatal, at the 3d,, or 4th,, attack, in this
case, actives means must be employed and then
early.- The Distinct kind of small pox as 
having but little Fever, is not exceeding Dangerous,
tho' the confluent is attended with considerable 
Danger.- In all Fevers the danger is agravated
by parturition, for if the Fever is of the low Typhus 



32
249
kind, the loss of Blood would do injury, and there
is generally a considerable Discharge attending Delivery.-
If the Fever is of the inflamatory kind
the violent exertions increase the inflamatory
affection.-
Delivery is not consequently rendered more
difficult by the presence of Fever, some think it 
either rather more easy.-
When there is Delirium, the progress of the Labour
should be diligently attended to, for when there 
has been Delirium, the Child has been expelled, without
the knowledge of the Bystanders, therefore particular
attention should be paid.- After Delivery
has been effected during the presence of Delirium, this 
will frequently subside, and the patient appear
better, but in many cases this is only transient,
and the patient very soon begins to sink, and 
Death follows. Speedily
The general treatment of Fevers will be the 
same as under other circumstances.-
Convulsions. These are particularly
Dangerous during Pregnancy.- They exist under
to different forms, Acute and Chronic.- Convulsions
must be distinguished from Hysteria.- The cause 



250
Convulsions has been referred to two opposite
conditions of the Body, namely Plethora and Inanition,
but there dont appear sufficient without a
certain degree of irritation.-
When Plethora is the cause Bleeding &c. will be of 
Service, if the Plethora is general, but it somtimes is
local, consisting in a determination to some particular
part as the Head, in this case the application
of Leeches, Cupping &c. will be of Service, and this
by way of preventative, a perature is an indication
of their approach by Vertigo, &c.
If the cause is from inanition, it is then 
much more dangerous, as this is much more difficult
to remedy, it must be attempted by means
the most nourishing kinds of food given in small
quantities or as the Stomach will bare it, and frequently
repeated.-
If Convulsions arise from irritation, the 
cause of that should be removed if possible, but the 
seat of that irritation must be first attended to, if 
the seat of irritation is in the Primæ Viæ, the 
exhibition of an Emetic, and afterwards clearing the 
Bowels, by a gentle Purgative or a Glyster may be of 
Service, afterwards giving Tinct Opii. Assa Fœtid.
or different kinds of Antispasmodics may be of Service



251
or Some of them as Opinion or Assa Fœtida may be 
given in the form of Enema.- The warm bath may
occasionally be of Service, and as this takes some time
in preparing it will be always right to have this 
in readiness early.- If the seat of the irritation is 
in any other part that must be attended to, if from 
Distention of the Bladder, the Water must be drawn off.
If the Uterus is the seat of irritation, it may in
right in some cases to bring on delivery, as in 
case this is much danger apprehended to the Life 
the Mother, from former Labours &c.- If on examination,
you find the Os. Uteri relaxed, and a Disposition
to Labour, this may be improved, but should
be done by the gentlest means possible, for there is 
frequently great injury done by using to much
force.- Even if there is no Disposition to 
Labour if you have ascertained the necessity or propriety
of bringing on premature Labour, making 
gentle and persevering attempts will generally succeed,
at the same time assisting the relaxation of 
Parts by different means as warm glysters throw 
into the Rectum.- Advantage will be gained by 
the early Rupture of the membranes.- During the 
convulsions it will be right to interpose some substance
between the Teeth to prevent the Tongue being injured.



251
Convulsions during pregnancy are very
frequently fatal, the Danger is in proportion
to their frequency of recurrence and Degree of 
Violence.-
When Convulsions are so violent & frequent 
as not to alow of any lucid interval, there is great
reason to suppose a Determination to the Brain
to be present, in this case you should endeavour
to make a Derivation, by purging &c. only opening
the Jugular Vein.-
Extra Uterine Cases.
These do not terminate by the common Passages
as other kinds do, but somtimes from an Abscess being 
formed in the Abdomen from which a Putrid Fœtus or its 
Bones are discharged; eithr by Nature or Art at other times these Bones escape
by the Rectum, from this being ulcerated Through.
Extra Uterine cases are of three kinds, namely
in the Fallopian Tubes, Ovariae, and Ventral case.
The way the Ovarian is formed, is by the Stimulus
of impregnation being given to one of the Vesicles of 
De Graaf, but which does not escape from the Ovarium
but goes on evolving itself.- When the Vesicle of impregnation



253
impregnation escapes from the Ovarium, but instead of 
being embraced by the fimbriated extremity of the Fallopian
Tube escapes into the Cavity of the Abdomen, it attaches
itself to any part it comes in contact with, the Vessels
of the Maternal part of the Placenta, in osculate with
the Vessels of that part, and evolution goes on.- 
When the Fallopian tube is the seat, it arises from 
the ovum being detained in that part, and evolution
takes place as before.
Mun 4th, kind
Evolution goes on in their cases 'till about the 
usual period at which time pain and the usual
Symptoms of Labour come on, but this does not advance,
these recur at times, but after some time, they 
entirely cease, the enlargement still continuing.
When the Child is contained in the Uterus, when the 
Symptoms of Labour come on at the usual Period
of the Child on any account cant be expelled, or attached &c such
Symptoms come on as inevitably end in the Death
of the Woman, therefore whenever even the Symptoms of 
Labour come on, and then after a time subside, and 
go off entirely, it must then be an extra Uterine case.
Somtimes during Labour, the Child will escape
thro' the Uterus or Vagina into the Cavity of the Abdomen,
a case of this sort occured, and when the Child afterwards



254
afterwards remained afterwards for upwards of 40 Years,
on examination after Death the Child was found in 
an Ossified State.- If a case of this sort was to occur
it would be right to pass up the hand after the Child, and 
endeavour to bring the Child away by the Feet, tho' the 
Woman most probably would Die.-
A Woman may live with an extra Uterine Case
for Years, and it afterwards be discharged either by the
ways before mentioned, or by an Operation which consists
in cutting into the Cavity containing the Child, and 
extracting it, afterwards closing the Wound by Sutures.
The Child does not continue to increase in size
after the 9th,, Month, at which time it becomes Dead.-
In cases of this sort you should never attempt to 
extract the Child by an incision 'till Nature appears
to point that way, by the formation of an Abscess as then
the Cavity is circumscribed, and Air is not admitted
into the Cavity of the Abdomen.- This Operation has 
been called the Cesarian Operation but improperly-  



255
Cesarian Operation.
The true Cesarian Operation always supposes one 
incission made into the Uterus, and may in some cases
be necessary both in the living and Dead Subject.
When the Woman is dead, if the Operation is 
performed it should be done immediatly, or the Child
will likwise be dead.- It is useless to perform the 
Operation in this case before the 7th,, Month of Pregnancy.-
In some cases where the Woman has died
suddenly undelivered, the hand has been passed up the Vagina
and the Child extracted by the Feet, if this is done it 
should likwise be done immediatly.-
In the living subject the Chances of compleat
success are very few, and therefore it should never be 
proposed, where delivery by the Natural Passages is possible.-
Different causes have been assigned for the frequent
failures of this Operation, as the admission
of Air &c. this cant be the case, as air is not found
to produce so much injury, when admitted into any
Cavity as has formerly been supposed.- As Death
in general take place in the course of 24 hours, it as



256
to be owing either to loss of Blood or to the Shock which
is given to the System and from extravasation into the 
Cavity of the Abdomen &c. 
Different Parts have been recommended for the 
incission, as towards one side, but the Epigastric 
Artery would be divided.- The best part for the incission
is in the course of the Linea Alba.
The incission should be begun at or rather above the Navel, and 
extended downwards 6 In. the external incission may 
be rather more, but that thro' the Uterus should be 
only 6 In. in length.- It is rather unfortunate when 
the Placenta is attached to the anterior part, of the 
Uterus, if there is a considerable portion attached
it may be better to make the incission directly thro'
it, but if only a small portion, it may be adviseable
to separate it.- When the Uterus is laid bare
you may possibly find somthing which may indicate
the attachment of the Placenta when before in 
this case making the incission rather to one side 
may be adviseable.-
The Bladder should be emptied before the incission
is made.- When the incission is made the hand 
must be passed, and the Feet takes hold off.- There 
will somtimes be difficulty in extracting the Shoulders.



33
257
the Head must be placed in the most favourable Position
and Head, on this account no time should be 
alowed for the Uterus to contract.- After the 
Child is extracted, the Hand must be again introduced,
for the extraction of the Placenta.-
The external Wound should be then closed by means
of the Quilled Suture, but the Ligatures should by no 
means be passed either thro' the Uterus or Peritoneum.-
A Very slight Bandage must be used.-
After the Operation an Opiate must be given, and 
which should be repeated from time to time, joined
with other remedies to allay the irritation, and occasionally
Laxatives, Glysters, fomentations &c.-
Section of the Symphisis Pubis.
This has been proposed as a Substitute for the 
Cesarian Operation but is only an imperfect one 
and is now fallen into neglect. 
In case any advantage was gained in respect 
to Room, the soft parts were so much injured,
as to almost certainly destroy the Patient.



258
Treatment of Women after Delivery.
When the Woman is delivered, that is when the Child
and Placenta are expelled, all moisture should be 
removed by means of Cloths, and a Cloth wrung
out of Warm Water applied to the Perineum, and 
another under the Breech.- The woman should
lay some little time perhaps 1/2 an hour, but this 
must depend upon circumstances, if there is flooding
she must remain a greater length of time, before
she is put to Bed.-
It is right to examine the different portions
of Placenta, is this has come away in detached
portions, comparing the to Satisfy the Nurse and 
attendants.- It has been usual to pass a Bandage 
round the Abdomen, but this should only be 
a Simple Napkin.-
The Room &c. should be kept moderately cool
not so hot as was formerly done.-
The Diet should be Simple, nothing either in 
form of food or Drink that is Strong should be alowed
for the first few Days.-
If either from any irregularity or from other 
causes, any unpleasant Symptoms come on 
purging will generally be found preferable to 



259
Bleeding. Always determine the necessity of the Bleeding
befor you attempt to do it.- The Bowels should
always be kept moderatly open by means of some 
gentle Laxative.- Opium will occasionally be 
Serviceable to alay irritability, but will generally require
either to be joined with Aperients, or those to be 
occasionally given.-
After Pains.
These arise from the contraction of the Womb, and 
continue to take place 'till that is compleatly
affected.. After pains should distinguished from 
Pains arising from other causes, as from internal
inflamations of Different parts, namely Enteritis, Inflamation
of the Uterus, Puerperal Fever &c. and this 
may done by attending to the Different Symptoms
after Pains, recur at intervals, [cross out] the Pain arising
from inflamation is constant, and the Pulse are affected.
In Pain from costiveness the Pulse may not be affected
yet the pain is more constant.-
Women who have had several Children have the 
after pains more violent.- The usually continue about
2 or 3 Days.- The treatment is generally by Opium 



260
but which is better joined with Aperients, more particularly
if there is costiveness.-
Symptoms of flatulent Cholic sometimes
attend, in this case Carminatives and Aperients
or Carminative Glysters may be Serviceable, and 
afterwards Opium
Lochia.
This is a Discharge which takes place from the 
Uterus after Delivery, and arises from the Vessels
of the Uterus which communicated with the Maternal
part of the Placenta.-
The Qauantity and duration of this Discharge
is very variable, in general it continues about 10
or 12 Days, but you must judge whether the Discharge
is too excessive or continues too long by its affect upon 
the constitution.- If the quantity is such as to produce
some unpleasant affect upon the Constitution
you must must then endeavour to check it either by
astringents, or if it arise from any other cause as 
Cough, that cause must be attended to, and the 
treatment must be the same as in flooding after
Delivery.- In some cases flooding will come on 



261
several Days after Delivery, when this is the case there
is great reason to suppose a Diseased State of the Uterus
to be the Cause.-
Women are Somtimes alarmed if the Lochia, become
suddenly suppressed, but if this does not arise
from any particular cause, as inflamation &c. [??ed]
is not followed by unpleasant Symptoms, it is of 
no consequence, but if it is caused by or is accompanied
with Symptoms of inflamation, those must be 
attended to.- Before you proceed to take away Blood
it will be generally right to give a Purge, and that 
alone will often be sufficient.- 
Somtimes the Lochia will only be suppressed
for a short time by a Clotter of Blood stopping up the 
mouth of the Womb, the Uterus be be excited to act for the 
expulsion of this, and the Lochia will then again flow.
In some cases of Stoppage of the Lochia, a discharge
of another kind will take place, which supplies its place.
The Discharge is at first composed of Blood, but it 
gradually changes, and after sometime only tinges the
Linen of a Pale Red, and afterwards of a Greenish Colour
and it then very soon ceases altogether  



262
Inflammation of the Uterus
The Symptoms of this are pain below the Navel
taking place the second or third Day after Delivery
and which has no intermissions.- If Pressure is 
applied, it gives considerable pain, and there is a 
considerable Degree of Fever and this of the Acute kind
attended with a Suppression of the Lochia.-
It may arise either from violent Labour or 
improper management, perhaps in the use of Instruments.-
A gradual Diminution of Pain, and return
of the Lochia, are favourable Signs
The Treatment in this complaint must be of 
the active kind kind and early employed, or Death
will take place.-
Bloodletting must be had recourse to early
and occasionally repeated according to the Constitution
of the Patient, not alowing to long intervals between
each evacuation, also Leeches may be applied to 
the Abdomen, and a Blister will somtimes be adviseable,
also fomentations &c. The Bowels must be 
kept freely open, and the Patient kept upon the strict
antiphlogistic Plan.- Before you proceed to this 



263
active mode of Treatment, you must be certain of 
this being the Disease, and that it is not from irritation.-
If you have any Doubt it may be better to 
give a Purge, and take away a small Quantity of Blood,
and from this you may be enabled to form a judgment
with more certainty.-
Puerperal Fever.
This term, if literally employed, might comprehend
any fever happening in the Puerperal State,
but is is used to denote one particular form of fever
which only occurs at that time.
This Fever is attended attended with, Pain in
the Head, and intense Pain in the Abdomen, and is 
contagious.-
The Abdominal pain should be distinguished
from arising from other complaints, as Distention
of the Bladder, Cholic, After Pains, Enteritis, Inflamed 
Uterus &c.-
You may know whether the pain arise from 
distention of the Bladder by the introduction of the 
Catheter or by other circumstances, and likwise from
Cholic by attending to circumstances.- After pains  



264
intermit at times, which is not the case with pain
in Puerperal Fever, tho' it suffers slight remissions.
After pains may be accompanied by accidental 
Fever.-
In Enteritis there always considerable Difficulty
in procuring Stools which is not the case, in Puerperal
Fever, as there is often a Degree of Purging.
It is more Difficult to distinguish between this complaint
and Inflamation of the Uterus, but by attending
to all the circumstances you may generally distinguish
between the two, in the Puerperal Fever
the Lochia are not suppressed, which is the case 
in inflamation of the Uterus.- The mode of attack
in the two complaints is different.- The Pain is often
in a different part, as in Puerperal Fever the Pain
may be in any situation which is not the cas in 
Inflamation of the Uterus.-
From many facts it is proved that this Disease
is contagious, and sometimes very actively so, no 
Women except those in Puerperal State, are liable
to be affected by it.-
The attack is by a Rigor followed by a Degree
of feverish heat, and pain in the Abdomen.
The Disease is not always equally contagious
often depends upon the mode of Life, Situation &c.



34
265
In many instances when a Practitioner has 
been attending a Patient Labouring under Puerperal
Fever, and is immediatly called to a Woman in Labour,
the complaint has been communicated.-
The commencement of this Disease from the 
time of Labour is various, generally on the second
or third Day, sometimes as late as the fifth, and
has been observed much later, even a late as a Month.
The attack is by a Rigor attended with Pain
in the Abdomen, the Rigor after some time goes off 
and is succeeded by pain in the Head and feverish
Heat.- 
The Duration is very indefinite, it has terminated
fatally in 36 hours after the attack, and 
as late as the 9th,, or 10th,, Day, in generall if it continues
'till the 6th,, or 7th,, Day the Patients recover.
The Peritoneum is the seat of inflamation, and 
has been found in all the Different Stages, as that 
of adhesion, in one part in others, effusion, and Suppuration,
and the seat of the Pain will be various
according to the seat and stage of the inflamation.
Different Writers have described the Pain to be in
different situation, they may have all been right, as 



266
the situation will vary according to the situation
and stage of the inflamation.
Prognosis.- This is always unfavorable, but
not at all times equally so.- A Very quick Pulse
with much tension of the Abdomen indicate extreme
Danger.- What in other fevers would be considered
a quick Pulse is in this rather slow, as 120
in this Disease the Pulse are of often 140 or 160, or even
so quick as not to be numbered distinctly.-
In this complaint the Pulse assist more in 
forming a judgment than in most others, if the 
Pain abates it is not of much consequence except
there is an alteration of the Pulse likewise. A sudden
cessation of Pain that has before been violent, unless
attended with a favourable Pulse, should be regarded
with Distrust.- It is a favourable sign when
quickness of Pulse and degree of Pain, gradually abate.-
Delirium very seldom attends this complaint
tho' there is such great quickness of the Pulse, the 
mind being generally tranquil.
Treatment. Different and opposite modes of 
Treatment have been recommended in this som 



269
complaint, some strongly recommending Bleeding
others condemning it.- In cases where active Inflamation
exists, with a degree of strength in the constitution,
Bloodletting is proper and should be taken in
rather a large quantity and in the early Stage, but 
if there is a Degree of weakness and the complaint is
more advanced, it will then be injurious, but this 
must entirely depend on the nature and Stage of the 
Complaint and the Patients constitution.-
Dr. Gordon of Edenburgh says that in all cases
when the Patient was bled to the quantity of 20 oz.
early, they recovered, and another respectable Practitioner
says that in all cases when bleeding was 
employed the Patients Died.- It will be right to 
take away a small quantity and this will assist
in determining the Propriety of Bleeding more freely.-
Local bleedings either by Leeches or cupping
may be had recourse to with advantage, but 
as the inflamation is only a consequence not
a cause of the Fever, it must be attended to only 
secondarily.-
Vomiting is strongly recommed by the French
Practitioners, and certainly always affords relief, it 



268
always be employed early, and is best given in
repeated Doses so as to produce the full effect,
Ipecacuanha answers the Purpose best.-
Somtimes a spontaneous vomiting of a Dark
grumous Matter comes on, when this is the case
the Patients generally Die.-
Purging has been strongly recommended
and may frequently be given with advantage
the purging should be kept up by giving the 
Medicine in repeated Doses so as to procure
5 or 6 Stools Daily, a good purge a a Solution of 
Natron. Vitriol. in Aq. Mentha. A good Rule
for the exhibition of Purges may be to give so 
long as the Patient is relived and not weakened.
Somtimes a Spontaneous Diarrhea comes 
on which relieves very much, on which account
you should never be in parts to check any thing
of that sort which takes place, except it weakens
the Patient, then you may moderate or Check it.
Blisters to the Abdomen may be of Service
and should not be to small, and should be 
applied early.-
If the disease changes from the inflamatory
kind, and puts on Symptoms of Typhus, the 



269
mode of treatment must be changed, Medicines
of the Cordial Diaphoretic kind may be had recourse
to as Camphor &c. or Wine, and Bark, somtimes
rather freely, in the advanced Stages of the complaint.
Attention must likwise be paid to the 
Palliation of Urgent Symptoms, as Pain, by
Fomentations, Anodyne Liniments, Rubefacients
&c. a Liniment composed of Ol. Olivar. ℥i Camphor.
ʒij R a,, Opii ʒij M. will often relieve.- The Warm
Bath is not adviseable on account of its disturbing 
the Patient so much.-
Sickness and Vomiting may be relieved by 
Opium, or the Saline Draughts in the State of 
effervescence 
Milk Fever.
This comes on about the second or third Day 
after Delivery, with Rigors and other Febrile Symptoms,
attended with a Painfull Sensation of the 
Breasts, all which are abated by a Discharge of the 
Milk, hence the remedy is Obvious, and the Child
should be put to the Breast, as the first Discharge of 
Milk is proper and Serviceable to the Child.-  



270
If during the cold Stage any thing hot or Stimulating
is given, a considerable Degree of Fever will
be excited, and will render the exhibition of Purge
necessary.-
Many Women dont wish to give the Child the 
Breast but want this Milk repelling, this is sometimes
effected with care and safety, at other times
not. When this is wanted to be effected, you shd,,
act moderately upon the Bowels, procuring 4 or 5
Stools daily, and ordering a low Diet, and the application
of some simple Plaster to the Breast.-
It will sometimes be necessary to take small
quantities of Milk away by means of proper
Glasses &c. or the Thinner parts being absorbed, will
leave a portion inspissated, this causing irritation
will bring on a Milk Abcess.- When Inflamation
takes place a few Leeches may be applied &
the Saturnine washes.-
Somtimes inflamation will put a stop
to the Secretion of Milk.-
When by the application of Leeches, Saturnine application,
Purging &c. you cant subdue the inflamation,



271
inflamation, you must have recourse to poultices, to 
forward Suppuration, and evacuate the Matter
by means of an Opening when formed.-
This Disease very seldom terminates in Cancer.-
Soreness of the Nipples. This is relieved or 
cured by washing them with Brandy or a Weak
Solution of Alum.- wearing Leads &c-
Swelling of the lower Limbs
This is an œdamatous swelling of the lower Limbs
which comes on after Delivery, which begins at the 
Groins and extends downwards to the Feet.
The complaint may attack either one or both
sides.
The time of its commencement from delivery 
is variable, may come on in the course of a Week, or 
two, and has been as late as 6 or even 9 Weeks.-
The Limb in the beginning is œdamatous, but 
after the Disease has remained some time it looses
its softness, and becomes considerably more hard.
The cause of this Disease is inflamation and 



272
obstruction of the Lymphatic Glands about the Groin
and Poupart's Ligament, probably owing to some portions
of Blood remaining in the Uterus, which becoming
Acrid, Stimulate the absorbents, causing irritation, and 
inflamation of the Glands situated about the Groin.
The Disease has been distinguished into mild
and violent according to the Symptoms.-
The Hardness which takes place after a time
is owing to a quantity of coagulable Lymph, which 
is thrown out becoming inspissated.-
Success in the treatment of this Complaint, depends
on the early resolution of the inflamation, rendering
them pervious to the Passage of the Lymph
and afterwards to invigorate them by means of 
Tonics and Stimulants.
In the early Stage Leeches applied to the Part
and other means of reducing the inflamation
may be applied.- Purges may be frequently administered
with advantage.- Emetics likwise from 
the goods effects in other cases of a Similar Nature,
as Hernia Humoralis, may be employed with advantage, 
and should be given in full Doses.-
When the Disease is more advanced and a Degree
of Hardness has taken place, you must then have recourse
to a different mode of treatment. Ungt Hydroy.



35
273
Fort. rubbed in upon the lower extremities will be of 
service, and this may be done with great freedom
without producing any effect on the constitution, on account
of the impervious state of the Vessels.- If the
Mercury does affect the Mouth it is upon the whole a 
favourable sign, shewing that the Vessels are not entirely 
obstructed.- In this stage of the complaint, Pulv.
Ipecac. Comp. may sometimes be given with advantage.-
This Disease very seldom terminates in Suppuration
tho' it does somtimes, this should be prevented if 
possible, for if an Abcess bursts, it is extremely difficult
to Heal, and there are many abcesses generally form, and
this repeatedly for a length of time.-
Laceration of the Perineum.
This is much less disposed to Heal than an incised
Wound in the Same part, yet the attempt should
be made.- You must keep the parts in contact as 
much as possible, by passing a Roller round the 
Thighs, as neither Sutures not adhesions can be 
made use of with propriety, or advantage.
Some gentle stimulant application may be made 



274
use of to promote the growth of Granulations, as
Tinct. Myrrh. Simpl. &c.
When the laceration extends to the Rectum
the loss of power to retain the Feces is the consequence.-
In case the Head of the Child is so large as to 
render it very probable that the Perineum may 
be lacerated, it may be a Question whether making 
a slight incision would not be more adviseable
than alowing the parts to be lacerated.-
Excoriation of the Labia.
When the Labour has been Difficult, and the Head
has rested a considerable time upon the external
parts, they are frequently Excoriated, and sometimes
Ulcerate, and if the constitution is irritable will put
on a flabby unhealthy aspect, and have frequently
been mistaken for Venereal, on this account you
should always take particular care to Distinguish
between the two, for if you employ Mercury in a case 
of this kind, you will do very great injury.-
The mode of treatment must by by any means
that will alay irritation locally an constitutionally, as
fomentations of Poppy heads, Opium, Cicuta &c. or occasionally 



275
occasionally Bark and Wine, sometimes very freely.
When Simply an excoriation, a little simple Ointment,
or Saturnine wash may be employed.-
Diseases of Children.
The Diseases mentioned are to be confined to those
which prevail in early infancy.- Some of these
are Surgical cases, and others belong to the Physician.
Some of the Surgical Cases, arises from the 
Birth, others existed while in Utero, and others appear
after Birth.- 
Of the first kind are the different effects of Pressure
on the Scalp, producing Inflamation, Abcess & Gangrene,
the are to be treated according to the common Rules
of Surgery.-
When the Shape of the Head has been altered, forming
what are called a mole shot, or Horseshoe head,
it has been recommended to press on the head in 
the opposite direction, but this very wrong and shd,,
never be done.-
Others have recommended apply a cupping
Glass over the part, or a Piece of Adhesive Plaster, or 



276
or wet Leather, with a String to the Center, to alow
of extension being made, this may sometimes be 
Serviceable.-
Paralysis of the Arm somtimes takes place from
pressure made on the Axillary Plexus of Nerves, more 
particularly if the Blunt Hook has been used, the
way to avoid this is make the Pressure on the back
Part of the Arm.- What [illegible] produced? [illegible] slight Galvanic [illegible]
Fractures sometimes take place during birth
more particularly of the Humerus or Femur, in 
Breech, or Feet presentations, these must be treated
like other fractures.-
It will be adviseable to examine the Child, immediately 
after birth, or the Nurse may break any
Bone &c. and say it occurred during Labour.-
Fractures are most liable to occur when the 
Blunt Hook is used.- 



277
Diseases existing before Birth.
Swellings of the Head containing a Fluid. These
are often seated on the Parietal Bones, and contain
a Gainy fluid.- These Tumors must be Distinguished
from Hernia Cerebri.-
Some have supposed these Tumors to arise
from some injury received during birth
but this is not the case.- The Bone is not 
necessarily affected, tho' is somtimes, but appears
to be in a secondary way, from pressure.
These Tumors will in general be cured by the 
use of Astringent Embrocations, as a strong Solution
of Alum.- If the Tumor does not give
way to this, it may be adviseable to evacuate
the fluid by a Small opening, to prevent the 
affects of Pressure upon the Bone.-
Cohesion of the Genitals. If this is of the 
Labia Pudenda you should examine to ascertain
whether the internal parts are perfect, and 
the external parts only adhering, if this is the 



278
case you may divide the Parts by means of the 
Knife, afterwards dressing the Parts to prevent
them again adhereing.- If you have any doubt
you had better wait 'till the Age of Puberty, and
these Symptoms may occur which may direct
your Judgement, for if it is only the Hymen being
imperforated the Menses will be found collected
behind it.- 
Cohesion of the Eye-Lids. If these are in 
other respects well formed, this adhesion may
be divided by means or a Small Bistory, or a 
Direction, avoiding wounding the Puncta Lachrymalia
&c.
Tongue Tied. This should always be remedied
early, or the Tongue will grow in the curved
position, and prevent the Childs speaking.-
This is remedied by dividing the Frenum by
means of a proper pair of Scissors, taking care
to avoid the Sublingual Vessels, and Ducts of the 
Maxillary Glands. Women often suppose the Child 



279
is Tonge tied when it is not, and it may be better
to draw Blood to satisfy these.- The Child is not 
Tongue tied if it can elevate the tip to the Roof of
the Mouth, or put it over the lower Lip.-
Hair Lip. The proper time for curing this
is only to be considered here, namely whether before 
putting the Child to the Breast or after it is weaned.
If there is a fissure in the Palate and the Child
is not able to suck it will be adviseable to perform
it early, that is before it takes the breast at all, but
in a general way it will be better to defer it 'till the 
Child is weaned.-
Umbilical Hernia. Children are often born
with small protrusion at or near the Umbilicus,
and sometimes with larger ones if there are small
a cure may generally affected by a constant and 
regular pressure made upon the part either by 
adhesive Plaster, and sheet Lead, or by means of 
a well constructed Truss.- No Circular Bandage
can be used with advantage, as it would
tend to increase the Tumor by its pressure on 
the sides of the Abdomen.- When these Tumors are 



280
larger they generally prove fatal, as there is likewise
a Defect of the Parietes of the Abdomen.- 
Spina bifida. It receives this name
from the spine in the part when the Tumor is 
situated being split into two portions.
This Disease may be distinguished by passing 
the Finger along the Spine, if it is Spina Bifida,
you will perceive the Defect in the Bone.-
It is most commonly seated in the Loins.
The appearance is sometimes a small Tumor
at others, the Skin is flat and shrivelled, this is 
owing to the Tumor being burst During births
when this is the case Children are generally born Dead.
This Disease is somtimes combined with Hydrocephalus.-
This Disease is formed by a 
quantity of Water distending the Membranous, covering
of the Spinal Marrow.-
The sensation of the lower Limbs is generally
impaired.- The Tumor should be kept from 
bursting as long as possible, for when this takes
place Death in general soon follows, this maybe
attempted by astringents and Bandage.- 



36
281
Malformation of the Urinary Passages.
These are of different kinds. When the Pressure 
is imporated, a small portion of the end 
may be taken of by a Scalpel.- When is elongated
or constricted a small part may be taken off
or it may be slit up the same as in the 
Operation for Phymosis.
When the Glands Penis are imperforated,
different modes of treatment may be necessary
according as there is a preternatural opening
or not, but the success off any operation is very
uncertain.- If there is not any opening it will
be extremely Difficult to affect one by art, and 
if there is a preternatural one, endeavouring 
to make one in the proper part will be extremely
Difficult or impossible, for tho' an opening
might be made, yet it will almost to a certainly
close again, as as Membranous Living cant be given.
Sometimes there will be a retention of Urine
without any malformation, in this cas a bent
Probe or small Catheter will be useful, if a Male 



282
or if a female, washing the Parts with a Spong
and Warm Water, to cleanse away any sebaceous
matter, may be of use.-
Imperforate Anus. When this is the case 
the Child will not have the usual Discharges, and 
on examination, (if the imperforation is only at the 
Anus) the Meconium, may be felt fluctuating
behind the part, in this case a puncture may
be made or a small crucial incission, keeping 
the parts from again adhereing.-
If the Stricture is situated higher up, relief
is less certain, and that in proportion as the seat
is higher.- Somtimes the Anus terminates
in the Bladder or Vagina, if in the Bladder Death
may soon takes place, but if in the Vagina, the
Patient may live, but will be in a Distressing
state, and not remediable.-
Lues Venera. This Symptoms of this complaint
are in general less evident in this state than
in the adult, as there is not that regular pain



283
of Symptoms.- When these are dubious Symptoms,
which dont yield to the common modes of 
treatment, it will be right to give Mercury a
trial.
The best way of giving Mercury to Children is 
by giving a grain of Calomel every night or again
of Quicksilver rubbed down with any common Substance,
or what may perhaps be still better, giving
a little Calomel, which has been washed with Aq:
Calcis to divert it of its Acid.-
It may not in all cases be prudent to betray
suspicion.
Different opinions have been formed respecting
the way in which a Child can receive the 
Disease from the Mother, one Opinion is that 
there must be actual contact of Matter, and that 
this takes place during its passage thro' the Vagina.
John Hunter is of this Opinion, but there are 
facts which tend to prove than this is not absolutly
necessary, but that sucking the Breast of 
a Diseased Woman is sufficient.-
Swallowing the Tongue. This is owing to the 
Frenum being to short, alowing the end to be turned



284
back towards the Throat, and bringing on evident
coughing, with a sense of Suffocation.- This is 
relieved by bring the Tongue forwards by means
of the Finger or the Handle of a Teaspoon. 
Elongation of the Uvula. This often brings on 
similar Symptoms, and is owing to a relaxed State.
Anstringent washes, composed of a Solution of Alum
or a powder with a portion of Alum will be of Service.
Purulent Eye. This complaint is most common
among indigent people, and those who are 
filthy.- The first Symptom are a degree of fullness
and redness of the Eyelids, which takes place a
few Days after birth, soon after this the Eyelids adhere
together, and on separating them, a quantity
of Purulent Matter will be discharged, if the Disease
is alowed to go on, the Eyelids become tumid, and 
inverted so that they cant be closed, opacity of the 
Cornea follows, and incurable blindness.-
This is owing to a larger quantity of fluids
being determined to the Conjunctiva, from their
being in a relaxed state.-
In the begining astringents in the form of Lotion.



285
or Tinct. Opii. will be of Service, a Solution of Alum
or vitriolated Zinc. in the proportion of 4 or 5 Grains to an
Ounce will answer very well, this should be applied
as is very common to the side of the Face, but should
be dropped between the Eyelids.- When there is much
Tumefaction it may be necessary to divide some of 
the Vessels to take off the Distention.-
When there opacity of the Cornea a Solution
of Hydrary. Muriat in the proportion of gr. ss and gr. in,,
to ℥j.
Purulent Discharge from the Ears.
This somtimes arises from behind the Ears, and
at others from the Meatus Auditorius.-
When from behind the Ear, the discharge may 
be stopped by Astringent washes or Calomel Ointment.
When the Discharge proceeds from [cross out] within the
Ear, it probably originates from behind the Typanum,
and as a portion of this with probably some of the 
Bones will be destroyed, it may be of very great
consequence.- The cure may be attempted by
means of Astringent injections.-



286
Diseases of Infants requiring Medical Treatment
Much uncertainty often attends this part of Medical
Practice, from the uncertain of Diagnosis, on account
of Children not being able to express themselves except 
by the signs of Nature.-
The state of the Pulse in Children is but an uncertain
Criterion of Disease.- In Infancy the Pulse
are in the natural state, about 120 or rather more 
and this corresponding with 72 in the Adult, but to
she any remarkable degree of increase of quickness
they must be 200, or much more, and which can not 
be counted.-
The Degree of fever in Children, is much better ascertained
by the Degree of heat, Thirst and frequency
of respiration.-
Children are much more irritable than Adults
this in consequence of the Brain and Nerves, bearing
so much greater proportion to the rest of the Body
than in the Adult.-
Diseases of early infancy depend principally
upon these causes, namely irritability, Acid Acrimony
in the Primæ Viæ, and over feeding.



287
Irritability, as depending in part upon the 
cause before mentioned, cannot be compleatly removed,
but it may frequently be much moderated,
by removing any irritating cause, or by the 
action of certain remedies, as antispasmodics &c.
according to circumstances.-
Acidity in the Primæ Viæ, this existence of this 
is evident from many Symptoms, as from the smell
&c. and indicates the use of Antacids, in giving these
it may not be necessary to entirely subdue the Acidity
but only to moderate it.- As alway will coagulate
Over feeding is a very common cause of Disease
in Children and often takes place of the Child being
fed to quieten it, when it is uneasy from other causes,
in this case Nature will frequently relieve herself
by Vomiting. The Cure is obvious.-
Red Gum, this is a Disease of very little consequence,
except to distinguish it from Measles,
which the eruption somewhat resembles, only is not 
attended with the usual Symptoms, as Cough, Fever
&c. the eruption making its appearance without
any previous Symptoms.-



288
Apthæ, may be suspected, when pain is expressed
during sucking, and there is soreness of the Nipples,
it is easily determined on examination, by white Specks
on the Tongue, Fauces &c.
This Disease is distinguished into mild and 
Malignant, these are distinguished by the Colour
of the Specks. &c. if they are of a White colour and unattended
with Fever, this kind is curable by local
applications, as honey Borax &c. tho' it may be 
sometimes necessary to give a Purge, or some 
Cretaceous Medicine with R [illegible],, Opii in small
Doses.-
When the Pustules are of a Brown dusky colour,
attended with fever, irritation and a considerable
degree of Debility, besides cleansing the Mouth,
attention must be paid to the Fever.- The 
Primæ Viæ must be cleaned by Emetics or Purgatives, 
and afterwards, Bark, Wine and Opium
may be had recourse to.- The Bark may be 
rendered more pleasant by the addition of a bitter
Liquorice, to the Decoction, and it should be given Warm.



289
Convulsions may be distinguished into the Acute
and Chronic.- In the acute form of the Disease
the Child often dies on the first attack, therefore active
treatment becomes necessary.-
Children are very much disposed to Convulsions
from their excessive irritability, consequently
all irritating causes should be avoided or removed.
The irritating causes may be either seated
in the Primæ Viæ or in the constitution at 
large.- When the Stomach is the seat Vomiting
or Purging may frequently effect the removal
and it may somtimes be necessary to excite the
action of Vomiting sooner than can be done by
Medicine, that is by irritating the Fauces.-
Stools may be procured by Suppositories as
a Piece of Soap in a Conical Shape &c.-
General irritation will cause convulsions
as is the case in fever, Small Pox &c. you must
then endeavour to alay it by different means, as 
the Warm Bath, Opium, Musk, Assafœtida, or 
by Glysters of some of the Articles before mentioned 



290
in which you may in general give about 3 times
the quantity you would give by the Mouth.
Sometimes the milk disagrees with the Stomach
when this is the case it is evident what must be 
done.-
Convulsions succeeding an Acute Disease in 
the advanced State, are generally fatal.-
In the Chronic form of the Disease, several
of the remedies before mentioned may be had recourse
to, and external applications as Volatile
Liniments may be used. These frequently end in
Idiotism.-
Icterus. Children are after born with this Disease
but which in general disappear in a few Days by 
the Discharge of the Meconium.- Somtimes are 
Emetic, or a little Rhubarb may be of Service.-
Vir. Aloctic. Alkalin. has been recommended.
There is a Species of this Disease attended with
Emaciation, wrinkled face, and Shrill Voice, which
is fatal.-
Watery Gripes. This is often a consequence
of a deprivation of proper breast milk.- The 



291
remedy therefore is obvious.- The Testaceous powder
with Aromatics and Opium are sometimes
usefull.- This Disease is more easily prevented
than cured.- If these things dont do proper milk
must be had.
Erysipelas Infantilis.- When the Navel
string comes off there will somtimes be a slight
Erysipelatous Affection, but which is of no consequence
and is generally cured by the Nurse with singed Rags.
But there is another Disease of much more consequence,
and attack, either the parts about the 
Navel, or the Genitals, spreading to the Back and 
Belly and which puts on a putrid appearance,
it attacks different constitutions, and its progress
is very rapid, frequently ending in Mortification.
Bark and wine may be given internally, and 
Camphorated Spirit applied locally
Periodical Cholic. This often takes place at 
the time the Nurse menstruates. (which they sometimes
do) May be moderated by gentle opiates 



297
You will frequently be asked to recommend a 
Wet Nurse, but which should if possible be declined
and when asked respecting the health of any one you
should be extremely guarded, and only speak in general
Terms, as you cant always possitively say, whether
or not the Woman as free from Disease.-







































Lectures
ON THE
Practice of Midwifery
by
Dr. Haighton.
1803
&
1804.



1
Introduction.
Persons unaquainted with the sbject of Midwifery
may form very limited Ideas respecting it, supposing
it only to the actual delivery of the woman but it not 
only consists in this, but in the explanation and treatment
of a number of Disease connected with Pregnancy
and after actual Delivery.
Pregnancy has a begining, which is called conception,
a duration which is called Gestation and a 
termination which is called Labour or delivery, and 
after delivery then is a time which is called the Recovery
at which time Women is subject to many Diseases peculiar 
this this state, and as a Supplementary branch
may be added, such infantile Diseases as occur 
within the Month.
Conception supposes a previous knowledge of 
the Fruition, and Aconemy of the Organs of Generation
which consists in the parts mainly, Anatomical,
Physiological, and Pathological.
The Anatomical part comprehends a knowledge
of the Pelvis, as giving attachment to the Genitals



2
as containing the Womb and its appendages as 
being the part thro' which the child must pass to 
come into the World, the situation and structure
of the organs of Generation, both external and internal,
including the Mons Veneris, Labia Pudendi frenum
Perineum, Pudendum, Fossa Navicularis, Clitoris,
Plexus retiformis, Nymphae, Orifice of the Urethra,
hymen, Caruncula Myrtiformis, Vagina, Uterus and
its appendages.- 
The Physiological part, consists in the explanation
of the natural and healthy actions of the above
mentioned Organs, or their uses as far as it is known.
The Pathological part, in the description of the 
Various diseases, to which the Generative Organs
are incident, and the most effectual method of administering
relief.-
Many practice very successfully without any
knowledge of the Alteration which is produced by conception,
but it is expected that all who practice this 
branch should have a knowledge of it. In some cases
when conception has taken place considerable alteration



3
alteration is produced in others not any of consequence.
The external parts of Generation in the female are 
subject to several Diseases which will during the 
course be treated of End then is great variation with 
respect to Labour, each cavity will be fully treated of
rotation, but from have only a view of giving an 
Idea of the mode in which they will be treated of 
and shall begin with a description of the Pelvis as 
a knowledge of this necessary to form a proper Idea
of the other parts.
The Pelvis is formed of that assemblage of 
Bones at the lower part of the Abdomen, below the 
fifth or last Vertebrae of the Loins.
It is an easy matter to distinguish between
the Male and female Pelvis, the female being much
more capacious, and of a different shape, being formed
to alow the passage of the Child, where as the Male is 
only for the [illegible] of containing certain parts, and 
giving attachment to the Muscles &c.
The Pelvis in fœtal state is composed of a 
greater number of Bones than in the adult, and 
which is of considerable advantage in delivery as 



4
in the breech presentation, the Bones will on that account
give way more, and more easily pass.
The Bones which form the Pelvis will not be particularly
considered as that more properly belongs to 
an anatomical Description, but will be considered
together as forming the Pelvis.
In the adult the Pelvis is composed of three
Bones namely the 2 Os. Innomenata, and the Os. Sacrum
to which may be added the Os Coccigis which makes 
them 4 in number. The number of Bones in the fœtal
state is eight, each of the Os. Innomenata being divided
into 3 Bones namely the Illium or haunch Bones
the Ischium or sitting Bone, and the Pubis or shorse
Bone, the [illegible] of the Os. Sacrum is the Rump
Bone and the Os. Coccigis is called Huckle Bone, a 
knowledge of this becomes necessary to understand
what the Women Midwifes mean by the Names they
commonly use.
The formation of the different parts into 4 Bones
does not take place to after the Age of Puberty.
There are three parts of the Pelvis more particularly
interesting, namely the Brim, Cavity and 



5
outlet, the shape of the Brim [Cavity] is rather of an Oval
form, but in some measure resembling a heart.
The line in the fore part which joins the two 
Ossa Pubis is called the Symphisis Pubis. 
It is sometimes the case that the upper
Part of the Brim of the Pelvis, instead of being 
round and smooth forms a sharpe ridge, and 
which from the womb pressing on this ridge gives
a sense of cutting in this case a Bandage with 
compress round the Abdomen and placing the 
patient in a more upright posture, a rather 
reclining Backwards, to take off the bearing
upon the part will be of Service.
The size the Pelvis varies in different People
but from one particular size being more often found
that is called the standard Pelvis, and which is of 
the following dimensions a line drawn from 
the upper edge of the Symphisis Pubis is 4 In. long
a line across the Brim of the Pelvis from side 
to side, is 5 In. long and a line in an oblique
Direction, from the Sacro Iliac Symphisis is 5 1/8 In.
a knowledge of the Dimensions, is necessary in practice,



6
practice, for the purpose of adjusting the long Axis of the 
head to that of the Pelvis.
In general the head of the child enters the 
Pelvis without any assistance, and of course then
cant be any thing done with respect to the way 
in which it enters, but in case the child is turned
and brought away by the feet, the way in which the 
head enters entirely rests with the practitioner,
in this case the long Axis of each must be Kept in 
view at the brim, and changed as it passes to bring
them to correspond at the lower part or outlet.
In the case of turning no delay is admissable
when the Body of the child is partly passed, for if the 
head is confined long the child must inevitably Die
on account of its supplies from the mother being cut
off and respiration being at the same time prevented.
Shall now conside the Dimensions of outlet
the lower edge an outlet, a line drawn from the 
lower edge of the Symphisis Pubis to the extremity
of the Os. Coccigis is 4 In long, but by this bone giving way
during Labour this line becomes an inch longer in 



7
way making the line 5 In. long. a line drawn
across from one tuberosity of the Ischium to the 
other is 4 In. long. thus long axis of the Brim and outlet
are in opposite directions, so that it becomes
necessary for the head of the child the to turn in its
passage thro the Pelvis, and which is very much
assisted by the oblique direction of the Os. Innomenata
it is necessary to attend to this in making use of 
instruments. The form of the outlet is rendered
more complete by the Sacro Sciatic Ligaments, extending
from the Spinous proofs and tuberosity of the 
Ischium, to the False transverse processes of the Sacrum.
In considering the Cavity there are two things
to be attended to, namly the Depth and Axis, the 
Depth of the Pelvis at the fore part is about 1 1/2 In. and 
at the sides twice the Depth of the front, and three
times the Depth at the Back part, but the matter
of the greatest important is the Axis this must 
be either in direct or curved line, but is certainly
that of a curve, a knowledge of this circumstance
is necessary in the application of instruments, as 
in case the head of the child wont enter the brim of 



8
the Pelvis, in this case if there is disproportion it 
may be necessary to make use of the long forceps or 
the perforoter & Crotchet.
There are frequently deviations from the Standard
Pelvis, and which may be either in shape or 
size when the lines drawn across in different directions
are longer it is called a large Pelvis, and where
they are shorter, a small one, and when the shape deviates 
from the well formed Pelvis it is called a deformed
or distorted Pelvis. To render a Pelvis deformed there
must be some cause, and which cause either consists 
in Ricketts, or Mollities Ossium. Bone is composed
of a quantity of Earthy Matter and Animal Gluten
the cause of Ricketts consists in a deficiency of 
Earthy Matter and which causes a yielding of the 
Bones. In some cases there is a destruction of 
Symmetry, the deformity not being equal in both 
sides, a knowledge of this circumstance, wits of 
great ability in some cases, as advantage may in 
some instances be taken of this circumstance, of
inclining the child to the part where there is most 
Room. Some have supposed the Pelvis may be 



9
partially distorted, that is, the brim may be narrower
without the outlet being effected and the Reverse, but in most
if not all cases when the Brim is narrower, the outlet 
is enlarged tho' in some cases they are both contracted.
The Pelvis may be narrower from before 
backwards, or the reverse that is to say from side
to side, tho' the former is most common in some 
cases the fore part of the Pelvis appear to be pressed inwards
by the weight of the Body. The Spine in some
cases projects forwards into the Pelvis and in
this way occasions a want of Room.
A knowledge of the form of the Pelvis will
in many cases be of consequence in respect to 
forming an Opinion in what way the Progress
of the Labour is likly to proceed, as in case of the 
Brim of the Pelvis being narrower, the head of the 
Child will frequently rest a considerable time before 
it enters, as it cant do this till the Bones
of the head have given way, and which requires some 
time to be effected after which the progress of the Labour
will be quick, as there is no more obstacle to its proceeding.
In this case the lever or long Forceps may 
be of service, as by their use the head may be brought



10
quarter or half an inch down and which in many
cases is all that is wanting.
If the Pelvis is narrower below, the case will
be reversed and the Labour will proceed at first 
rapidly and when the head comes to the lower part
of the Pelvis, the will be considerable delay, from 
this it will appear evident what caution is necessary
in giving an opinion of the trim Labour is likely
to terminate, except you exactly ascertained the form
of the Pelvis &c.
In some cases Instruments will be 
of Service in assisting the expulsion of the Child, but
in many cases when the deformity is considerable
it will be impossible to bring the child away without
opening the head. In some instances the
Os. Coccigi will project very much forward, and
the projections of the Tuberosities of Ischii will frequently
at the same time be forced in which 
renders the passage of the child extremly difficult.
Must now take a practical view of the 
Business, as the means necessary to Know the 
Degree of deformity, or whether there is deformity in



11
not, there are two ways of judging one of which is 
probable and the other certain.
The Probable way is by judging from the presence
of a Ricketty state of the Body, or from a deformity
of other parts as the curvation of the Spine Os.
as it is probable a Woman with a curved Spine
will have a deformed Pelvis, but this is not always
the case, as this curvation may be owing to accident,
or posture, or from other causes, as particular employments,
but when this is the case other parts of 
the Body are seldom deformed, if then is no general
Disease, but if it is from a degree of softness
or weakness of the Bones the projection of the Sacrum
will frequently be forced forwards and diminish
the diameter of the Pelvis.
The diameter of the Pelvis may in some 
cases be diminished by Exastosis, and other Bony
Projections.
The certain way of ascertaining the demensions 
of the Pelvis is by measurement, and for 
this purpose, different ways have been proposed, our
way is by different instruments, but which dont 



12
appear deserving of notice, and no instrument is 
necessary for this purpose the fingers answering
best, the method of doing this is by passing your finger 
to the centre of the Base of the Sacrum, and then
mark what part come opposite the Symphisis
Pubis, you then measure the length from that 
part to the end of the finger, deducting 3/4 In. for the 
oblique line, and it then gives the proper length of 
the direct line as for instance if these oblique line
is 4 3/4 In. deducting 3/4 In. leaves 4 In. the length of the 
line in the standard Pelvis. Another way of measuring
is by opening the two fore finger, and thus ascertaining
the length of the line, but this requires practice
to determine it with accuracy.
The way to ascertain whether the fore part
of the Pelvis has the proper degree of curve, is by
passing 2, 3 or 4 finger up the fore part and by the 
ascertaining the degree of Curve, thus if you can lay
3 or 4 finger flat you may be certain then is the proper
degree of curve, but if you cant bring more 
than two or three fingers to touch without laying
them over each other the must the be a more acute





13
angle than in the well formed Pelvis.
To determine whether the outlet is well formed
you may place your finger in the Angle formed by 
the two projections of the Ischium, in the natural and
well formed Pelvis they form an Angle of about 60 Dg.
which is somthing less than a right angle, any deviation
from this constitutes a degree of deformity.
You may ascertain wether the Os. Coccigis is 
properly formed by feeling it.
In proportion to the degree of deformity or diminution
of the size of the Pelvis, is the difficulty in extracting
the head.- If the deformity or diminution
is in a small degree, tho' the head wont pass, yet
this may be effected by the assistance of the Lever or 
Forceps, but if this is greater then the perfortor and 
Crotchet become necessary, and when it is in a very
great degree the child cant possibly be extracted
by any means thro' the natural passage in their 
case the Cesarian Operation becomes necessary.
Actual measurement is not of so much consequence
as at first sight appear to be the case 
as it frequently will depend upon disproportion of 



14
of the head to the Pelvis, thus a Pelvis may be of the 
natural size, and yet the child wont pass on account
of the head being particularly large, or the state of 
Ossification more advanced or soft parts rigid.
From what is already mentioned it would
at first sight appear as tho' a large Pelvis would
be advantageous, but this is not the case, as there 
is danger from this circumstance, for as there
is not that degree of resistance to the quick expulsion
of the child as in the standard Pelvis, the soft
parts are liable to be lacerated, on account of there
not being sufficient time for their proper dilatation,
and from the quick expulsion of the child the 
womb has not time to contract in a proper degree 
and this way hemorrhage is produced. Or invert the womb.
Labour pains are not always to be distinguished
from the sensation of a want to evacute to contents
of the Rectum, a mistake of this sort may 
possibly be attended with very serious consequences
as the child may be expelled in this way without 
the Patient being aware of it, a mistake of this 
kind of very great importance should it happen
to an unmarried woman, as it may appear as 
tho' the child was killed and afterwards thrown 



15
away, for the purpose of concealing the affair.
A Medical Man in Yorkshire gave his opinion,
in a case of this sort, that a Woman may 
in all cases distinguish between the pains of 
Labour, and the inclination to go to stool, but he
afterwards had reason to alter his opinion, and 
was on that account under considerable uneasiness.
In all cases when you are called upon
to give your opinion, in a Business of this sort
you will do well to call in the aid of several colateral
circumstances, or whether she has made 
any preparations &c. and upon all occasions if 
either be favorable, this sudden expulsion of the 
child can only take place when the soft parts are 
relaxed and disposed for labour, but in case of rigidity,
and the womb acts violently, when there is a large
Pelvis, there is danger of a Prolapsus Uteri, or 
of a laceration of the Perineum, or of a retroversion
of the Womb.
In this case to prevent these effects, you 
must press upon the mouth of the Womb, during 
pain to prevent its being forced down before the 



16
external parts are sufficiently dilated, and it will
be of service to endeavour to open the mouth of the 
Womb, by degrees, by the introduction of 2 or 3 finger
gradually dilating the parts, the same treatment
is necessary in its passage thro' the external parts,
gradually opposing the passage of the child 'till the 
parts are sufficiently dilated.
Retroversion of the Womb is not peculiar to
a large Pelvis, tho' there is in this case danger of 
its taking place for a greater length of time, and if 
there is much relaxation may take place at as 
great a distance of time from the Labour as the 
fourth Month.
Shall now make a few remarks between the 
formation of the male & female Pelvis. The Male 
Pelvis is only formed for the insertion of Muscles
and to contain certain parts &c. whereas the 
female is not only to answer there purposes but to
alow the passage of the child. The male pelvis is 
more mossy, and projections in different parts
longer, for the purpose of giving greater strength
and slowing the muscles to act with greater advantage, 
tho' it is not so capacious as the female



17
the female Pelvis has not so much Bony substance
as the male tho' it is more capacious, its depth is not 
so great as the male.- The difference in suspect to
desasions is taken notice of by Artists, and their 
rule is that the male exceeds the female as much 
in breadth across the Shoulder, as the female does 
the male across the Hips.- The difference in respect
to the size of the Pelvis is chiefly in the degree of curve
in the Ossa Innomenata the male being less curved, but 
the Sacrum in the female is rather Broader,and also curved.
But there is the greatest difference in the Angle
which the two Ischii make in front, as that in
the male is much more acute, the projection of 
the tuberosity of the Ischium below the Acetabulum
is longer, and which slows a greater power for the 
action of the Muscles, the Acetabulae are smaller.
The female Pelvis is much shallower than 
the Male, which is an advantage with respect to 
the passage of the child.
The next consideration is the bearing of the 
Pelvis with respect to the Body, and this is necessary
to be know for the purpose of adjusting one by the 



18
other, so as to bring the brim of the Pelvis Vertical, horizontical,
oblique &c.- A straight line will not pass
thro' the Axis of each, but lines which pass thro'
the Axis of each would intersect each other so as to form 
an Angle making a right angle. When the Body is erect the plain of the
Brim of the Pelvis is downwards and forward in 
some cases placing the plain of the Brim of the Pelvis
in a Horizontal direction is advantageous, for different
purposes, as to slow the Womb to gravitate, this
is done by placing the Woman in a posture half sitting
and half lying, which is at an Angle of about 45 Dg.
in some cases it is advantageous to fix the patient
so as to bring the lower edge of the Pelvis upwards
in a horizontal direction, as in reducing a retroversion 
of the Womb, or Prolapsus Uteri, you may
effect this by placing the Patient on the Knees and 
elbows.- In making examination the best position
of the Pelvis is obtained by laying the patient on the 
side.
We must now consider the child with relation
to the Pelvis. A standard child or a one of the 
common size can only pass thro' a standard Pelvis
in these directions, that of the Head which is most 
common, that of the Breech, and that of the lower extremities, 



19
extremities, the head being the largest part, requires more 
particular consideration, as in case of the head presenting 
if it passes all the rest of the Body will follow, and 
it will pass with more or less ease according to the 
part which presents, and likewise the situation.-
From this it will appear evident that [illegible]
notions respecting presentation and situation are 
necessary, for this purpose it will be necessary to compare
the standard head with the Standard Pelvis.-
A standard head is one which corresponds with the 
generality of heads in shape size and mobility.
The Presentation is that part which is in the 
center of the Pelvis, and the presentation may be the 
same tho' the situation may vary, as it may be 
to any part of the Pelvis, then the Vertex may present,
and the face may be to any part of the Pelvis,
the same rules are applicable to the Breech presentation,
as in case the Anus is in the center, the 
Back of the child may be to any part of the urethra.
These two terms presentation and situation, are 
vary frequently confounded.-
The presentations of the head are divided
into 4 namely the Face, Vertex, Ear and Forehead,
and as before said the Head will pass with 




20
more or less case according to the part which presents.
The Vertex presentation will pass with more 
or less case according to the degree of depression of the 
occiput, thus in case of a Vertex presentations and 
it wont pass, depressing the occiput, by means of 
the Liver, or by any means will frequently be
of great service in facilitating the Passage of the 
head. Thus the best possible presentation is when 
the Vertex presents, with the occiput depressed.
The Vertex presentation will pass with greater 
ease, than the face, and this with greater ease
than the forehead, the Ear presentation passes
with the greatest difficulty. In general the 
forehead presentation terminates in the face 
case.-
When the head enters the Brim of the Pelvis it 
does not exactly come down sideways, but rather in 
an Oblique direction, as that is the long Axis, [illegible] Pelvis but as
it descends it gradually changes its position
to that with the face to the Sacrum, and their way
the long axis of each is opposed at the outlet.
In some instances there is a deviation from 
this as the long axis of the head may be opposed to the 
short one of the Pelvis, or the face will come forwards 



21
to the Pubis instead of Sacrum, this by some is called
the face presentation, but is not as the Vertex presents
only the situation is wrong. This is not so favourable
a position, as the other, the parts not agreeing in the 
form of parts so well, and there is more danger of a 
laceration of the Perineum.
When the head is low down there are four things
necessary, to render this the best possible position,
the Vertex must present, the occiput be depressed
the occiput must be to the Pubis, and the Sagittal Suture
must be in a direct line from before backwards
in the middle of the Pelvis.-
The Face presentation is when the Nose is 
in the center of the Pelvis.- When the head of the child
is at the Brim of the Pelvis, the best situation is
when the chin of the child is to either side as in this 
case the long Axis of the head and Pelvis correspond,
and as it descends the chin is gradually thrown
forwards, but in some cases the situation is different
the face being placed so that the long Axis of each
dont correspond, in this case help may be necessary
and a Knowledge of these circumstances will be necessary
in giving the assistance.- The long Axis is of each 




22
generally correspond, and as it descends the chin in 
thrown forwards, and the occiput emerges. The
chin is sometimes placed to the back part of the
Pelvis tho' situation is very rare, if this situation
is not altered in a very little time it will be a very
difficult matter to save the Life of the child.-
They way that the forehead presentation is changed
to the face is by the action of the Uterus on the Body of 
the child it pushes the Body down and the chin 
for as the chin forwards.- 
The Ear presentation is when that part is 
in the center of the Pelvis, and in this case the Vertex
may be situated to any part of the Pelvis, in some 
of these cases assistance becomes necessary, tho' not in 
general, this assistance may be given by means of 
the Lever, acting on that part of the head so as to bring
the Vertex down, and by that means bring it to a 
Vertex Presentation.- In using instruments,
great care is necessary in their application either at 
the fore or back part of the Pelvis on account of injuring
the Urethra or Rectum.-
Shall now take a more particular View of the 
Fœtal head.- The Figure of the head is Oval, or Ovi-form




23
Ovi-form, the long Axis of which varies according to the 
part which presents, from this it will appear
instant the necessity of taking dimensions from 
different parts in measuring the different Axises
of the head.- There are two expressions which tho'
different are essentially the same, that is raising
the Chin and depressing the occiput.
A Line drawn from the Vertex to the Chin is 
5 1/6 In. Long, one drawn from the upper part of the 
Occiput to the forehead is 4 1/2 In Long, whereas a line 
from the lower part of the occiput to the upper part 
of the forehead is only 4 1/8 In. long this therefore is the 
shortest Line of the long axis, the short axis is from 
the protuberance of one Parietal Bone to the other and 
which measures 3 1/2 In. this is the different dimensions
of the standard head. But the case with which 
the head will pass does not depend altogether upon
size but in a great degree likewise upon mobility
of the different parts.-
The Fœtal head consists of a greater number 
of Bones than the Adult, the adult head consists 
of 6 Bones, and the Fœtal of 12. The Bones of 
the adult are the Frontal, the Occipital, two Parietal



24
Parietal and two Temporal, with the Sphenoid and Ethmoid 
Bones, but these two last are common to both
head and face.- In the fœtus the Frontal Bone is 
divided into two, the occipital into four, each
Temporal is composed of two parts the Squamous
and Petrous portion, which with the two Parietal Bones
make the number 12.- Thus different Bones are 
joined together by Sutures but which vary in the 
Fœtus very much from those of the adult, for in the
fœtal state they are moveable, whereas in the adult
the Sutures are immovable. The mobility arising
from this formatition of the head is of very great ability
in presentation, as it slows the head to accomodate
itself more to the passage, by the edge of one Bone in 
some cases being forced over the other.-
The Sutures are first the Coronal, which extends
over the fore and upper part of the head and joins the 
Os. Frontis to the two parietal Bones, second the
Sagittal, this extends along the upper part of the head
from before backwards, it begins from the Coronal
Suture, and extends as far back as the upper edge
of the occipital Bone, it joins the two Parietal Bones
together, third the Lambdoidal Suture, this joins the



25
occiptial to the two parietal Bones, and besides this 
then is in the Fœtal state a Suture which joins the 
two portions of the Os. Frontis together, and one to
form a junction between the Squamous and Petrous
Portions of the Temporal Bones, Besides these there is 
another called Squamous or Temporal, which joins the Temporal to the 
Parietal Bones. On the fore and upper part of the head, when the 
Sagittal Suture arises from the Coronal, then a defect
of Bone in the fœtal head, which is called the greater
Fontanel to distinguish it from another similar
defect, at the part when tho Sagittal Suture terminates
in the Lambdoidal, which is called the less or 
fontanel, this besides being smaller is of a different
Shape from the others it being Triangular, where as 
the other is quadrangular, each angle projecting
into a portion of Suture, thus one into each of the portion
of the Coronal, into the Sagittal, and into the 
Frontal.- The lesser fontanel has only their angles
one into each portion of the Lambdoidal, and into the
Sagittal Suture.- By means of these Fontanels and  
the Sagittal Suture, the Situation of the head may be 
ascertained.- Besides this, there is another advantage
arising from these Sutures, as they will slow of the head 



26
being more compressed by a greater degree of mobility,
for in many instances where different parts of 
head are in a more advanced state of Ossification, it 
has been necessary to open the head, and when it has not 
been of an increased size, but only from this want of 
mobility.-
In some cases the Sutures are seperated in a much
greater degree than natural, and the head is considerably
increased in size, tho opening may be to the 
extent of one, two, or three fingers breadth when this 
is the case it is from a collection of Water in the head,
and you must judge from the size whether it is necessary
to open it or not for the purpose of extraction.-
The head may easily distinguished from other
parts of the Body by the larger Bony surface, and by 
the degree of convexity. The Shoulder Blade presents
a large surface of Bone, but you may easily
distinguish the head from this by passing your finger
round. In some cases the head will feel much 
more soft than common, this more particularly if 
examined during pain, this from a larger collection 
of Scalp.- The head may be easily distinguished from 
the back by feeling the Spinous processes of the Vertebra
it may be distinguished from the Breech, by the quantity 



27
of soft Parts, and by the Anus and Organs of Generations.
Besides presentation it is necessary to know the situation,
as tho' the Vertex presents the face may be to any 
part of the Mother.- This is done by feeling for the great
and little fontanel, and by passing you finger along the 
Sagittal Suture, and by comparing the form of the
fore and back part of the head.-
In a case of Hydrocephalus where the Sutures
were very much open it was mistaken by a Medical
Gentleman for a Back presentation, but this might 
be easily distinguished by the want of Spinous processes.
If when you feel the head you can feel the greater
Fontanel, and along the course of the Sagittal Suture you 
feel the Lesser Fontanel, you may then be certain it 
is a Vertex Presentation.-
A face presentation is easily distinguished by
its different parts as the Nose, Eyes &c.-
The forehead presentation is a mixed one, being 
in part the face, and in part the Vertex presentation,
on examination, you will find the greater fontanel
with part of the Sagittal Suture are one part, and 
on the other part you will find part of the face.-
The Ear presentation cant be easily mistaken.-



28
Besides presentation, the situation is necessary
to be known, as for instance in the Vertex presentation
the face may be to any part. In the Vertex presentation
you may know the situation, by feeling for 
the Sagittal Suture, and the Fontanels, if the head is 
low down in the Pelvis, but you cant at all times determine
this way, when this is the case you must 
feel for the ear by passing your finger up, and if you 
can feel this you determine which way the face 
is, by the projecting part of the Ears, as this is always
towards the back part of the head.- There are several 
other circumstances which may assist in the forming
the judgement, and which should be all taken into 
consideration as the whole of different parts of the 
head &c.- It is much the best in all cases when 
you examine to be carefull in giving an opinion
in respect to the Progress of the Labour as there are 
many circumstances which may render it more 
difficult, than you may at first imagine.
The Bones of the Pelvis are connected together
by Ligaments. Ligaments are that substance which 



29
connects the different Bones of the Body together, and 
and is divided into two kinds, namely Elastic and 
inelastic, the elastic Ligaments in some parts of 
the Body act the same as Muscles, as they in some 
degree antagonize the muscles, for instance the 
Ligament which extends along the Spine, in some 
Animals. The Ligaments of the Pelvis an inelastic
as they are made for the purpose of joining the Bones
so firmly together, for the purpose of sustaining the 
weight of the upper part of the Body, and likewise
any additional weight which the Body may at 
any time sustain.-
The different Ligaments which connect the 
Bones of the Pelvis together are first the Ligament
which connects the the last Lumbar Vertabrae and 
the Illium, second and third the Sacro Illiac
Ligament, both external and internal, fourth, the 
Sacro Ischiatic Ligament, external & internal fifth the Sacro Coccigeal 
Ligament, which is for the purpose of slowing
a degree of mobility in the Os. Coccigis, sixth the 
Ligamentum Foramen role, which serves for 
the insertion of Muscles, and thro' a vacancy



30
which is left in the Foramen Ovale by this 
Ligament, the Obturator Nerves and Artery & Vein
pass.- Seventh, the Ligament which connects
the Symphisis Pubis, this is formed by a cartilaginous
covering over each Bony Surface,
and with a portion of intervening Ligamentous
substance, but the chief strenth of this connection
depends upon the strong Ligamentous Fibre
which surround, the junction of the two Bones.
The Symphisis Pubis is sometimes the seat 
of disease, being subject to a collection of gelatinous
substance, or of Matter, and which is a matter of very
great importance, as the Ligaments which form the 
junction of the two portions of Bone, are in a great 
measure destroyed.- When matter is formed, a 
great deal cant be done except evacuating 
it, and keeping a depending opening, and this way
arousing Granulation to shoot up and fill up 
the cavity, but the time when you may be of the 
most service is before the formation of the Matter during
the inflamatory stage, when the application of



5
31
Leeches, Blisters &c. may possibly subdue this inflamation,
and prevent the future bad consequences.-
But if from symptoms you have reason
to suppose there is matter formed you should make 
an opening into the part to evacuate the Matter, and 
upon making this opening you should not find any 
matter, you then have done no injury as the operation,
has not done any injury to parts of any 
importance, and the opening will again heal.-
The Symptoms of this disease are a fixed and 
acute pain in the part, and which is very much
increased on the patients attempting to move or
walk.-
This disease has by some been supposed
to arise from some injury received during Labour
but this does not appear to be the case, but seems
to be owing to the same Scrophulous Habit, as that 
in which Disease of the other joints arise in, and 
begins from the same kind of inflamation.-
When there is a formation of Matter, and you
have evacuated it by an opening, if you keep open
this opening, granulation will spring up and 



32
a cure will sometimes be effected, but the Disease
is in a more advanced stage, and Symptoms of 
irritation, and hectic have come on, then the termination
of this Disease is different, as these Symptoms
go on increasing, and Death is the consequence.
Some practioners have supposed the Ligaments
of the Pelvis gave way in laborious parturition, but
there is no reason to suppose they do, except from 
very violent injury or disease, and when ever this
does take place, the patient is a great length of 
time before she perfectly recovers.-
The cure may be assisted by means of the cold
bath, and the local application of cold to the part, and 
by means of Bark and Corrborants internally, and 
by means of a proper bandage to support the part.
The Os. Coccigis has in some instances become
anchylosed and has rendered it necessary from this
circumstance to open the childs head.
The Uterus in the unimpregnated state is contained
in Cavity of the Pelvis, and is small, but when
impregnated becomes considerably larger, and rises
higher up, before it is placed the Bladder, and behind



33
it the Rectum, and there are likewise other parts
as Blood vessels, absorbents &c. which contribute to
diminish the size of the cavity of the Pelvis, and to 
lessen the size of the opening thro which the head must 
pass.-
From the pressure of the Uterus (when impregnated)
upon the Bladder, a retention of Urine or frequent indication
to make water called micturition is produced, this 
opposite effect from the same cause arises from the 
different parts of the Bladder upon which the pressure
is made.- If the pressure is applied to the part below
the entrance of the Ureters, a suppression of Urine
is the consequence, if this is above this part more 
upon that part towards the frenem of the Bladder, it 
then diminishes the size of the cavity, and that way 
induces the frequent indication to make Water.
When this part presses on the Rectum, tenesmus
constipation, or hemorrhoids are produced, for if it 
produces a degree of irritation, tenesmus is the consequence
or this pressure may cause constipation
by preventing the proper passage of the contents of 
the Rectum. This Pressure by obstructing the motion
of the Blood by the Veins, will cause the Hemorrhoids
this from the Blood in the Anterior not being obstructed 



34
in the same degree. A Woman under these circumstances,
cant expect a cure of those disease till
the cause which produces them is removed, and 
which cant take place 'till after delivery, tho' the 
symptoms may be moderated by means of the application
of a few Leeches to the part, or by other means
and internally by the exhibition of gentle Laxatives.
Some patients are very much alarmed by these
circumstances, and it may right to quit their 
apprehension by explaining the Business to them.
There are other parts besides these which may 
suffer considerably by this pressure, and produce a 
variety of Symptoms, such as swelling of the lower
Extremeties &c. this swelling is frequently called by 
the name of breeding with a Dropsy, but this Disease
is of quite a different notion from that of Dropsy, as 
in Dropsy there are a great variety of Symptoms,
which are not present in this Disease, as in it there 
are Symptoms of a broken down constitution, difficulty
of breathing, scarcity of Urine &c. whereas
Women during Pregnancy in generally labour under none of their Symptoms,
having only what arises from the distention of



35
parts.- From what has been before said, it will
appear evident that pressure sooner effects the
circulation in the Veins that in the Arteries and this 
pressure causing an obstruction of the free return
of the Blood by the Veins, the Arteries act more forciably
to overcome this resistance, a greater quantity
of fluid is thrown out by the seriferous Arteries,
this increased evacuation might possibly be of no consequence
if this pressure was not acting on the Absorbents, 
which should take up and return this fluid.
It is seldom necessary to evacuate this Water
by means of openings made into the part, as proper
pressure by means of Bandage or a Laced Stocking
will in general be sufficient, tho' if not, then is so
larger, for a few small punctures made into
the part, and which may afford relief.- It is necessary to 
attend to the state of the Bowels, and to keep
then sufficiently open.
There are three large Nerves, which are subject
to pressure by this cause, the first is the Anterior
Crural Nerve, but which is not much
subject to this pressure, the next is the Obturator
Nerve, which passes thro' the opening left in the foramen



36
foramen Ovale, and which will cause cramps, and 
spasms in different parts of the lower Limbs, but that 
which is the most subject to this pressure is the 
great Sciatic Nerve, which sends off various branches
to different parts about hind parts.-
The head of the Child in its passage thro the 
Pelvis, frequently presses upon the Obturator and Sciatic
Nerve, and will in many cases cause convulsive,
or spasmodic actions of the Muscles of the lower
limbs, one or both according to circumstances.-
The same Symptoms may be produced by 
the application of instruments, more particularly
when improperly used.- The Lymphatics from 
this pressure, sometimes become very much enlarged.
Somtimes encysted Tumors are formed in these
parts or Tumors of different Kinds, and be the 
cause of considerable difficulty during the time 
of Labour.- In some cases the Kidneas are 
situated very low down and become enlarged, and 
be a mean of difficulty.- Another Disease which 
may take place in these parts, as an enlargement
of the Ovariæ, which may be for different cause
one of which is a collection of Water in the Cavity
constituting the ovarian Dropsy.- [illegible] by [illegible]



37
Organs of Generation.
External and internal.-
The external Organs of Generation comprehend
the Mons Veneris, Labia Pudenda, Frœnum, Clitoris.
Fossa Navicularis, Nympha, Hymen, and Carunculœ
Myrtiformes, to which may be added the Orificium
Urethra.
The Labia are subject to various diseases, as 
inflamation, pruritus, cohesion from malformation
or excoriation, Ulceration, Tumors &c.-
Inflamation if it arises from common causes
is to be treated by the usual mode of treating inflamation
in any other part, but if it is attended with 
darting, shooting pains &c. it is probably an indication
of some internal disease.
Pruritus, is a peculiar and distressing itching 
of the parts, and is often in so great a degree as to 
render the patient almost miserable. The treatment
of this Disease must be various, according
to the cause, when it arises from Herpetic eruption
on the parts, preparations of Lead externally



38
and internally Neutral Salts &c. Some times this disease
is caused by Ascarides which infect the Rectum and 
which may have got to these parts and cause this 
disease, in this case a Glyster composed of a Mixture
with Aloes, or the Extract. Colocynth. Comp. may be of 
Service, and assisted by the exhibition of purges by the 
mouth, such as Calomel Aloes &c.- When this Disease
is Sympathetic of irritation in the Bladder or Urethra,
the use of Mucilagenous and Anodyne injection
may be of Service, and internally Uva Ursi, Bark,
Opium &c. may be given with advantage. A good
injection for this purpose is one composed of Oil
and Tinctum of Opium in the proportion 8 oz. of 
Oil, and 72 oz of R. & Opii. thus recommend an injection
of Aq. Coleis and Oil.- Thus peculiar sensation is 
in some instances only present during pregnancy
and frequently comes on at the time the menses
disappear, and is in many instances very difficult
to cure more particularly if there is no very
evident cause, if it is connected with Plethora, the 
taking away Blood may be of Service, joined with
the exhibition of Cathartics.- Cold applications will



6
39
generally afford more relief than warm ones.
There is no remedy which appear to have any
specific power over the Disease.- The application
of Blister may in some instances afford relief and 
the Ung 1/2 Alb. Camphor (Dr. Bateari) was of service
when many other things had failed, likewise an 
Infusion of Nicotianæ may be of Service, or the injection
of cold Water, into the internal parts.- An Ointment
composed of Ung 1/2 Simplex and Pulv. Gotta
Abp: succeeded after many other things had failed
in the proportion if 3 iss of Pulv. Gotta. to 3j Ung 1/11
Sin Alox.-
Ulceration when seated on the parts of generation
should not hastily be considered Veneral, those
frequently arise after delivery.- This frequently
arises from excoriation of the parts, and which instead
of healing, degenerate into Ulcers, forming sloughs &c.
and in many instances have been mistaken for 
Venereal, and treated as such, but which treatment
instead of being of Service, has agravated the Symptoms
considering.- This Disease frequently arises
from some injury received during Labour.-



40
Somtimes there will be small Ulcerations about 
the Genitals of Children, and which have a very much the 
Chancrous appearance, this is somtimes the case
at about the Age of Puberty.- The exhibition of 
Opium, Bark &c. will frequently of Service or a lot
will tend to alay irritability, in giving the 
Bark to children it may be necessary to take off
the nauseous taste of the Bark by joining it with
other things as Rad. Glyeyrrkis. &c.- and given a 
little R a|1 Opii according to the age of the Patient and 
degree of irritability. Externally a wash composed
of Ag Calcis and Calomel will answer a good purpose,
by the means the [illegible] of the Ulcer will
be stopped, and yellow surface will be changed to
a healthy granulating one.- If by this method
a Venereal Ulcer should be healed, secondary Symptoms
will after a time come on, and you may proceed,
upon the plan of treatment with certainty.
Sometimes the Labia adhere together at 
the time of birth and may require an operation,
but there certain consideration, necessary before 
the operation should be performed, or with respect



41
respect to state which the internal parts are likly
to be found in &c. When this the consequence of the 
parts adhereing after birth, from excoriation &c. there
can be no doubt respecting the propriety of the Operation.-
When this cohesion is partial, the parts may
by mechanical means dilated sufficiently. When these
are seperated by an Operation, it will acquire particular
attention, to prevent the parts again adhering.
The Labia are subject to tumefaction from 
various causes, as from a collection of Water from extravasated
Blood, or from hernia. or of Matter.
Hernia may be distinguished from the other 
kinds of Tumor, by the common means, as the size
of the Tumor varying on the posture being changed, and 
by its receding when in a recumbent posture.
The cure of hernia in these parts may be [illegible] procured
by the common means, by proper bandages
except it proceeds thro the foramen Ovale, in which 
case, a bandage cant be applied to act on the part 
with any kind of propriety. The part from which 
the rupture proceeds, may be distinguished by 
attending to the [illegible] where it disappears on its receding,
as whether it goes over the edge of the Brim



42
of the Pelvis or not.-
The Labia are somtimes distended with Water
and to that degree so as to impede the free motion
of the parts, and causing abrasion.- This disease
very seldom requires any punctures being made, for 
the purpose of evacuating the Water, tho' there is no danger
from this being done, but it in general will give
way to pressure made upon the part, by means of the 
T bandage, at the same time acting upon the Bowels
so as to keep the Body tolerably open.- Should the 
parts be in this state, and the time of Labour coming 
on it will be a matter of no consequence, as when this 
is the case, the parts are generally in a relaxed state
These parts are somtimes swelled from extravasated
Blood, this somtimes takes place after delivery,
and may arise at any time from the parts being 
bruised by accident, the sooner this Blood is evacuated
the better, or if not, it will very soon coagulate, and then 
it will be impossible to remove it. This is done best
by making a few small punctures into the part,
by which means the greatest portion of blood will
be evacuated, and the absorbents will generally take 
up the rest.- Leeches very seldom afford any relief
in this case as the Blood lays too deep for the action



43
If the patient wont submit to the removal of the
Blood by the punctures with early stage, it very soon
becomes coagulated, after a time a Throbing sensation
comes on, attended with increase of heat, and an Abcess
will follow.- If this extravasation is in a small
quantity, it may possibly be taken up by the Absorbents
the action of which may be assisted by Astringents, or 
by the application of Red Wine Lays &c.- If you precede
an Abcess is likely to form, you must then assist the 
process by the application of Poultices &c.- An Abcess
will somtimes form after you have evacuated the 
Blood by punctures, but it will then be proportionally
smaller.
Clitoris is that part which projects at the upper
part of Labia, and is in some instance considerably enlarged,
and has been mistaken for a Penis, but may easily
be distinguished from that, by its not having an 
Urethra, and it has likewise no corpus spongiosum.
In children the Clitoris generally projects more
than in adults, and has when this is the case been
taken for the parts of an Hemophrodite.
In a case of the Penis adhering to the Scrotum
a Gentleman mistook this for a Hemophrodite, as 
the Scrotum projected on each side so as to give the 



44
appearance of Labia.- The Plexus Retiformis is
composed of the Veins which return the Blood from 
the Clitoris, and which in part surrounds the Vagina
and by their distention in coitu, assist in diminishing
the diameter of Vagina, as they are placed just
over the Sphincter of the Vagina.- The Clitoris is in 
some instances very irritable, the least motion or touch
giving pain, a good application in this case, is a Mixture 
of Ol. Oliva and Tinct. Opii.-
Nympha, so called from the supposition
that they directed the stream of Urine.- Their figures
very much resembles a Myrtle leaf.- The Nympha
are somtimes very much enlarged, and require
an Operation being performed for their removal, this is 
not very common in this Country, tho' is somtimes
the case, but in the Warmer Climate, this Disease
is very common, it is called Nymphatomia, and is 
easily performed by putting a piece of past board
on one side and cutting upon it.- The Nympha
somtimes adhere, and it becomes necessary to make 
an incission for the purpose of seperating them, and 
considerable care is necessary after the operation
to prevent them from again adhering.-



45
Urethra, a correct knowledge of this, and more particularly
of the orifice, is of the greatest importance
in practice, from the frequent necessity then is of 
introducing the Catheter and which should be done 
without exposing the Parts, for this purpose it is necessary
to have some common Rules as a direction.
For this purpose there are three different directions,
one of which is, to find the lower edge of the Symphisis
Pubis, and the orifice of the Urethra, is situated
just below that part.- Another rule is, to find
the Orifice of the Vagina, and as the Urethra is 
situated just above that part, by raising your finger
a little, you will feel the orifices which you may 
distinguish, by its circular form;- A third rule for
finding it, is to feel for the Clitoris, and the Orifice of 
the Urethra is situated just an inch below this part,
just in the middle between the Nympha.-
One objection to finding this by the orifice of the 
Vagina, is from there being several Lacuna in this part,
and which may be mistaken, for this part, and likwise
Ruga, the Lacuna are generally so small as not to 
admit the end of the Catheter, tho' somtimes they are
sufficiently enlarged to do that.- You may know when 



46
the instrument is in the Urethra by its passing forwards,
whereas if in a Lacuna it wont pass more than 
the eight part of an inch, on account of this circumstance
the way of finding the Urethra by the Clitoris is best, as 
the part between the Clitoris and Urethra is perfectly smooth.
The Female Urethra is much shorter than the 
Male, being in general about 2 In. long.-
The course of the Urethra is in the direction of a 
Curve, and in passing the Catheter this must be attended
to, for if passed in a straight direction this is danger
of its being forced thro' the sides of the Urethra into
the Vagina, as been the case, and is a matter of very
great consequence, from the Urine irritating the 
parts &c.-
The Urethra in the female in a great measure
resembles the Male in structure, its internal
membrane being the same, and like it having several
Lacuna, it is much larger in diameter than
the male, and from this circumstance females are 
not near so liable to Stone as males.- In females
there is no prostate gland.- The prostate Gland in 
the male is about the size of a Nutt, and is a secreting
gland, the exact use of which is not known.-
The situation and direction of the Urethra may be varied



7
47
varied from different causes as prolapsus Uteri &c.
in the cases the Catheter must not be introduced in 
the common direction, but according to the present
direction of the Urethra.-
From the situation of the Urethra it will appear 
evident that the Urethra is liable to injury, in difficult
Labours, and by the use of instruments, if applied
so as to act on the fore part of the Pelvis.-
Retention of Urine.-
The Symptoms of retention of Urine, are pain
and tension in the Region of the Bladder accompanied 
with Symptoms of irritation, and 
great distention, somtimes there is a Stillicidium
an involuntary drifting away of the Urine, and 
which Symptom has often deceived the Practitioner
as from this be supposing this case an incontinence 
of Urine, but the true nature of the case
may be easily known by attending to the other 
Symptoms.- -
The consequence of this Disease if not relieved
by proper means, is bursting of the Bladder
and the Urine escaping into the cavity of the abdomen,
causing a high Degree of inflamation of 
the Peritoneum and Death.- There is more danger



48
danger from the bursting of the Bladder on the back 
than the forepart for when it gives way on the 
back part, the urine escape into the cavity of 
the Abdomen, whereas when the rupture is on the 
fore part, and where the Bladder is not covered by 
the Peritoneum, the Urine may possibly escape 
without getting into the cavity of the Abdomen.
It is in this part that the Bladder should
be punctured if done at all above the Pubes.-
The causes of suppression of Urine are either
from Pressure inflamation or Spasm.-
Suppression of Urine from pressure may be 
either from the enlarged state of the Womb, or from 
inversion or Prolapsus Vagina &c. or from Tumor
found in the parts
The treatment of this Disease will be different
according to the cause producing it. If it 
arises from pressure, introducing the finger or 
laying in a posture, so as to take of the pressure from 
these parts will effect the evacuation of the Urine
there in case of Pregnancy Woman will frequently
be able to discharge the Urine by putting themselves
in a reclining posture, and introducing the finger
press up the Womb, so as to take off the Pressure upon



49
the Urethra.- When inflamation is the cause of 
suppression of Urine, the treatment must be divided
to the removal of that inflamation, this by means 
of Bleeding, purging, the warm bath &c.-
If this disease arises from spasm, opium
will afford the greatest relief, given bitten by the 
mouth or in the form of Glyster, in the proportion
of 50 or 60 Drops.- The Warm bath may in this case
be of Service.
In all these cases the distention of the Bladder
must be relieved by means of the Catheter, and for this 
purpose you should be provided with different sized
Catheters taking care before their introduction, that 
the orifices at the end are open.- The next consideration
is the best position for you to stand in with 
respect to the patient, as it wont be pleasant for you
to stand with your face towards that of the Patient,
but what is much better and more convenient is 
to stand on the right side of the patient, and introduce
the instrument with the right hand, in this 
way your back will be towards the face of the Patient.
You should make use of two small Basons for 
the purpose of receiving the Urine.- Somtimes there 



50
will be a sudden stoppage of the flow Urine, in
consequence of the instrument being pressed against
the side of the Bladder, or from the pressure being applied
to the middle of the Bladder, forming it into two 
seperate Cavities. Whenever the Urine suddenly
stops recurring, more particularly if there is a sense
of fullness remaining you may be certain the Urine
is not all evacuated.
A suppression of Urine somtimes takes place
from a dropsical state of the Body, when this is 
the case, considerable attention should be paid, as 
mistakes under these circumstances have very frequently
been made, and the Bladder has been punctured
by mistake with the Trocar, when the tumefaction
from the Distended state of the Bladder has been mistaken
for Dropsy.- A greater mistake than this 
has been made, by the Trocar being Avoid into the 
thro' the Bladder, into the Uterus, when in an impregnated
state, and thro' the Uterus into the head of the 
child, and occasioning the Death of the Patient.-
It is right upon all occasions, to draw off the 
Urine before the operation of tapping is performed, for 
the Bladder is much distended it may be injured by



51
the Trocar.- A Lady had an enlargement of the 
Abdomen, and which came on rather suddenly, that 
is to say in a few Days, and during which time she 
had made very little Water, she was attended by two Physicians,
one of which proposed tapping but the other was
of Opinion it was not necessary, and after a little farther
consultation, they agreed to call in Dr. Orure, to examine
the state of the Bladder, and on his introducing the Catheter,
he drew off a Gallon of Urine, and the Tumefaction
was entirely removed.-
The Bladder does not swell exactly in the same 
way during pregnancy as at other times, in this case
the swelling is more sideways, from the Pressure of the
Womb on its middle, and this may possibly give an 
Idea of its being a collection of Water in the Cavity of the 
Abdomen, but you may easily distinguish between the 
two by the absense of fluctuation more to the back part.
Incontinence of Urine, may arise either from
loss of tone in the parts or from loss of Substance,
the loss of power of retaining the Urine, frequently
arises from a pressure upon the parts during delivery
and will in a general way, gradually recover in
the course of a few Days.- If this Disease arises from 



52
loss of substance, the Disease will be permanent, as then 
is generally a communication with the Vagina.-
This last circumstance generally arises from
some injury received during Labour, more particularly
if instruments have been used.- A Lady who had
a few Days before been delivered by the Forceps, had Symptom
of inflamation and suppression of Urine came
on, after a little time, a drilling away of the Urine came 
on, and a substance was discharged from the parts, and 
which was a portion of the Urethra and Vagina, which 
had sloughed off.-
When a patient applies to you for this Disease
it is necessary to know whether you can afford any
relief or not, you may know this by passing a Catheter
into the Urethra, and your finger into the 
Vagina, if there is a communication between the two,
you will feel the Catheter in contact with the finger,
and in this case very little relief can be expected.
But if it proceeds from loss of tone, time, with
the assistance of the cold bath, Chalybeates &c. and 
Cantharides externally and internally may possibly
effect a cure.-
1



53
Caruncula Myrtiformes, so called from their
supposed resemblance to Myrtle Berries, the number of 
them is various, somtimes being two, at other 4 or 5 in number,
these parts are not always to be found, as they depend
upon a certain circumstance, being formed by the 
ruptured portions of the hymen.- These parts sometimes
become painfull and inflamed, and require
the application of cooling remedies.- They somtimes
become considerably enlarged, and may require removal.-
They somtimes become Ulcerated, and give
rise to a supposition of their being Venereal, but you
must always be very carefull in forming an Opinion.
Hymen, is situated and the lower part of the 
opening between the Labia, its situation in children
is very evident, but is very often found wanting in 
adults, and which may depend entirely upon accident.
It is the part from which the caruncula Myrtiforms
are formed, and is a membranous projection
of no regular determined stroke, and in general
forms a somwhat circular irregular constricting
membrane.-
Somtimes there are a number of small
openings in this Membrane, forming what is called
the Cribrated Hymen, it has been long a Question



54
whether the cribrated Hymen was an Obstacle to impregnation,
but from the following case it does not appear
to be the case.-
A Lady who was married to a Medical, laboured
under this obstruction, after a time an enlargment
of the Abdomen took place, but from the above circumstance
it was supposed this could not be pregnancy,
she was treated as a Dropsical patient, but the enlargment
went on gradually increasing, she was
ordered to Bath, when she remained some time, but
without any effect being produced on the swelling,
on her return home, she was attacked with pain
but which she would not alow to be labour pains, a 
Practitioner in the neighbourhood, was sent for, and 
on his arrival found the head of the child low down
in the Pubis pressing against the external parts, and 
on a crucial incision being made, the child passed.
The Hymen are somtimes found imperforated,
and which the coeval with the birth of the patient is 
very often not found out 'till the Age of Puberty, as 
then will be all the usual Symptoms of Menstruation
but no external appearance.- This fluid when collected
behind the membrane in considerable quantity



55
has been mistaken for the Water in the fetal membranes.-
When this collection has been evacuated by 
an incision, it is generally found of a cream colour
and to be in a fluid state, tho' it may have been
collected in these parts for a great Length of time, in
this respect differing from Blood.- Her Menstrual
Discharge is composed of the serous parts of the Blood &
the Red particles, but with no portion of the coagulable
Lymph.- The fluid before it is exposed to the external
Air, is perfectly free from acrimony, but when
exposed by an incision it becomes considerably so, this
renders it necessary after the operation to wash out 
the parts by means of a Syringe and warm Water.-
The operation consists in making a longitudinal
incision into the parts, and afterwards a short transverse
on, which should be sufficiently large to alow 
of contraction.- In performing this operation, you
should not only have the evacuation of the fluid in
view, but likwise future sexual purposes.- When
the fluid is evacuated you should apply Dossils of
Lint to prevent the parts again adhering.- 



56
Internal Organs of Generation.
These comprehend a part of the Clitoris with 
its erector Muscles, the Vagina with its Sphincter,
the Plexus Retiformis, and the Uterus with its appendges.-
The Clitoris and plexus retiformis have been
already mentioned, and it now remains to mention
the Vagina, and the Uterus with its appendages.-
Vagina, this is the canal leading to the Uterus
from the external parts, and is situated between
the Bladder and Urethra on the forepart and the 
Rectum behind, and connected to them by cellular
membrane, its figure is not cylindrical,
but Oval is the most capaceous, in the middle, its 
course is moderatly curved, making an obtuse Angle
with the Uterus, the structure of this part is 
of a peculiar Kind, and these enter into its composition
Arteries, Veins, Absorbents and Nerves, and its internal
surface, consists of a plicated membrane, disposed
in different directions, called Ruga, these Ruga
are for the purpose of alowing of dilation, and may
possibly be formed to answer some other sexual purpose.



57
purpose.- The length of the canal varies, but in
general is about 5 or 6 In. tho' it has been found
much shorter.- The Figure of the canal should
be attended to in the use of Pessaries.-
The canal of the Vagina is somtimes divided
by a septum, and in some instances, has been 
found double, forming two Vagina, each having 
seperate hymen and and an Uterus.-
The diseases of this part are inflamation
and its effects, such as cohesion, suppuration,
contraction from cicatrices, mortification and 
sloughing away of a portion of its substance &c.
The treatment of inflamation will be different
according to the Kind and case, and likwise
the stage of the inflamation, as whether it is 
Phlegmonous, or irrisipelatous.- When inflamation
of this part arises from injury during 
Labour it is generally of the Phlegmonous Kind.
Irrisipelatous inflamation is more disposed
to attack the surfaces of Parts, and Phlegmonous
the Reverse.- The pain in irrisipelatous inflamation
is of the hot burning kind, and in Phlegmonous
of the throbing kind.- In irrisipelatous there
is always a considerable degree of irritibility, and 
Debility, and which must be attended to in the constitutional




58
constitutional treatment, as local applications, moderately
astringent injections will answer the best purpose.-
In Plegmonous inflamation the Symptoms
are more of the Tonic kind and which must be 
attended to in the treatment both constitutional
and local, as local, injection of the cooling sedative
kind answer the best purpose.-
If cicatrices have formed, they will prevent
the parts from yielding, and may require either
mechanical or instrumental Dilation.-
When there is cohesion, the cavity may be very
much obstructed, and render it necessary to seperate
these by means of the knife, but much dexterity is
required, and the parts should be kept assunder
by means, of a piece of Sponge or Lint.- This disease
is owing to want of proper alteration, when
inflamed.-
When there is a sloughing of a portion of 
these parts, it may form a communication between
the Vagina and rectum, or with the Urethra
and alow the Feces and Urine to pass thro' the 
Vagina, and which are very distressing circumstances.-



59
Uterus.
The Uterus is to be considered in two states, namly
that of vacuity, and in the impregnated state.
The shape of the Uterus when in the unimpregnated
state, is Pyriform and flattened, and has by some been
compared to a wine flask inverted, and from which 
resemblance different names have been given to different
parts, as the Body, Fundus, Neck, and Mouth.
The surface of the Uterus is flatter on the fore than the 
back part.- The Uterus is in general 3 In. long, one
half of which goes to the neck, and the other to the Body
this Division into Body and neck does not appear
evident on the external surface, but when Laid [illegible]
appears very evident on the internal part, as there
evidently appear a contraction of the cavity in the 
middle, and there is a difference in the membrane
which lines the cavity, that of the Body is smooth
whereas, that which lines the neck is not.-
The Substance of the Womb is Muscular, the fibers
of which rear in different directions, and Arteries, Veins,
Absorbents and Nerves, enter the composition being 
connected together by dense cellular membrane.-
The cavity of the Uterus is divided into two parts 



60
one of which is larger and triangular, the other conical
with the narrow end approaching the Angle of the other
this last is the neck, and the other the Body.-
The situation of the Uterus is nearly in the middle
of the Pelvis, between the Bladder and Rectum, and is 
as high, as the top part of the Uterus would touch a
line drawn across the Pelvis, from the upper edge of 
the Symphisis Pubis, to the top of the Sacrum.-
The Uterus in young subjects is situated higher, for 
in them, a line drawn in this direction would pass thro'
the middle of the Body of the Uterus.-
The situation of the Uterus may be varied from
different causes, as procidentia Uterii &c. Retroversion.
The Uterus may be retroverted if in the unimpregnated
state, and without being perceived, but if it becomes
impregnated, it than becomes a matter of very great
consequence.- Instance have been related of the 
Uterus being contained in the cavity of a hernia, but 
this is very rare, Sennutus relates one in the wife
of a Cooker, who whilst at Work, perceived somthing
suddenly give way, and an enlargment was perceived
in the Groin, after a time she became pregnant
and, and it Here appeared that this swelling in the Groin
contained the Uterus, it went on enlarging the usual way 



61
and at the proper period particular Symptoms came
on, an opening was made into the Tumor, and the Child
extracted, but the result of the case is not related.-
The Retroversion of the Uterus will be considered
when on the Pathology of Pregnancy.
Procidentia Uteri and Prolapsus, are the same 
kind of Disease, only meaning different degrees, thus
the smaller degrees of the Disease are called prolapsus,
as in case it projects so much as to be even
with the external parts.- When there is a Prolapsus
or Procidentia Uteri, you may distinguish it from the 
tumors found in these Parts, as Polypi &c.- by the 
Rugeous character of the Vagina, and by its having 
a hole in the center corresponding with the mouth of 
the Womb, and if it is at the proper time of Life, it will
be the hole thro' which the menstrual discharge will loss.
In some cases the Uterus is forced down behind the 
Vagina, pushing this forwards, in this case there is 
no opening, but you may know the nature of the affection
by the Roya.-
Women who have born children are more subject 
to their Disease, more particularly than who have
a large Pelvis, then should be particularly attended
to during Labour.- Women of a relaxed habit of Body 



62
are particularly liable to this complaint.-
Women who are subject to this Disease in a small 
degree frequently have a difficulty in making Water,
and which may be relieved by passing up the finger
and pressing against the Parts.-
Women labouring under this complaint are subject 
to the fluor albus.-
Procidentia Uteri has been mistaken for other
disease, or Polypus or inversion of the Womb, this last
disease as a turning of the Womb inside out, and is
often brought on by pulling at the placenta for the 
purpose of bringing it away, before the womb has began
to contract, and this way bringing the fundus of the 
womb down.-
You may distinguish between Polypus and Procidentia
Uteri, by the Orifice or Cavity in the middle of the 
Tumor in procidentia, and by the Periodical return
of the menses which will be found to flow thro' this 
opening, and by the Rugae.- Somtimes you cant perceive
the opening, but in this case the Rugae, will be 
a mark of Distinction.-
The Prolopsus Vagina will frequently reduce
itself on the patient being put in a recumbent posture
but on again returning to the event, it will again
appear, sometimes it wont recede even tho' a slight
force should be applied, in this case much Dexterity is 



9
63
required with reduction, and in doing this you must 
the pressure backwards towards the Perineum.-
If the part has been down for any length of time 
it will often be very difficult to reduce, and in this case
some have advised the application of warm fomentation,
but which is very wrong, the treatment in this 
case should be exactly the same as in strangulated 
Hernia, and cold application should be made use of as
they diminish the size of the Vessels, whereas as warm
fomentation &c. increase their size.-
Somtimes a sloughing of the part comes on, now in
this case some have recomended waiting 'till the parts
had seperated, but this should not be done, for it should always
be immediatly returned, and not alowed to remain
'till the seperation of the slough.-
When a Prolapsus Vagina has been reduced, proper
means should be resorted to, to prevent its return
and this is done by means of Pessaries.- For this purpose
different kinds have been used, some are in the form of a 
globe, and others of a flat circular form, then last are 
the best, and are commonly made of Box Wood, and 
with a small hole in the middle, which should not be too
large, the size of the opening must be of that size to admit 
of the end of your finger.- This opening answers two
purposes, one of which is to alow the menstrual Discharge
to pass, the other is for the introduction of the finger, for the 



64
purpose of introducing the Pessary in the Vagina, this hole
should not be made too large or it will admit of a portion
of the Parts above to escape thro' it, and cause Strangulation.-
The form of the Pessary is generally circular, tho'
they are somtimes made of an Oval form, and possibly
with advantage, the edge should not be too narrow, and 
should be rounded off, for the purpose of making it more 
easy.- It should be oiled at the time of introduction.
With respect to the size of the Pessary, that will be serious,
but it should be sufficiently large to stick in the 
Vagina, when introduced, but to begin with one small
enough and gradually increase the size 'till you find it 
sufficiently large.- This form of Pessary is of service
only when the Perinœum is whole, for in case this is 
injured, they wont be of any use, another sort has been 
invented for this purpose, and which is composed of 
a ring Pessary, with a stem to it, and with a moveable
Ball & Socket at the other end end, this slows of 
the movements of the Body without its affecting the part
within the Vagina.- For the purpose of confining this in
the Place, takes on fixed to the part without the Body.
A Piece of Sponge cut in a proper shape is under
some circumstances the best Pessary, as it will alow of 
being medicated, but they require frequent removal 



65
for the purpose of cleaning them.- They should have a
Piece of Tape fastened round them.-
The mode of introducing the common Pessary
is to introduce it sideways 'till you get it within the 
Vagina, and then with your finger in the opening, put
it in the right position.- In introducing it, you should 
not press directly upwards, but press towards the
back part of the Perineum.- It will somtimes cause
excoriation and soreness of the parts on its first introduction,
to remedy this you must advise the use of the 
Saturnine wash.--
The mouth of the Womb is called the Os. Uteri
likewise the Os. Tinca from its resemblance to a 
Finches mouth, and by other Names.- A precise knowledge
of this is necessary to form a judgment either 
with respect to Disease or Pregnancy.- The size of this 
Part varies very much in the healthy state, and under different
circumstances.- In some cases you will find 
a very small protuberance, in others a flat surface,
the size of the opening likwise varies very much, in those 
who have not had children it is very small, about the 
size of the Bulbous end of a Probe, but in those who
have had children it is considerably larger.-
The shape of the opening too, varies very much.



66
The feel of the part likwise varies very much, being 
in general smooth, but sometimes has a particular
roughness and yet be in a healthy states.-
Cancer Uteri.
No age is perfectly exempt from this Disease tho
it most commonly attacks Women, at the middle and
more advanced periods of Life.- Its commencement is 
somtimes insidious begining with a Discharge like 
the fluor Albus, and attended with irregular Menstruation,
in old Women it resembles returning Menstrual 
Discharge, but which occurs at irregular periods.-
Some have supposed that People who not borne Children
are most subject to this Disease, but others are of a 
Different Opinion.- The Symptom which denote the 
presence of this Disease, are darting shooting pains, attended
with an Ichorous Discharge, this from its somtimes being
tinged with Blood, has been mistaken for the Menstrual
Discharge returning to often, and when it has not been
much discoloured, has been mistaken for the fluor Albus,
but it may be easily Distinguished from this by the 
Degree of Arcimony &c. If you make examination, you 



67
will find a rough scabrous surface, and occasion
considerable pain, and probably a slight hemorrhage.
The Disease in this way goes on 'till the neck of the 
[Bladder] Uterus is destroyed, and then it attacks the Body of the 
womb, destroying the greatest part of this and likwise a 
portion of the Bladder and Rectum, the Urine and Feces
will pass thro' the Vagina, occasioning considerable degree
of excoriation, and great irritation and Symptomatic Fever
coming on, Death closes the Scene.- This Disease more
commonly begins at the Os. Uteri, and shreding as before
mentioned to the different parts.-
The treatment of this Disease is confined entirely to 
Palliatives.- The warm bath has been frequently and 
and with some advantage in procuring case, but from
the degree of weakness it produces, is not a remedy very
advisable, the application of fomentations to the part may
be had recourse to.- Cicuta is of service in procuring
case and is found somtimes successfull when Opium
fails.- Opium likwise must be had recourse to.-
Dr. Johnson relates a case which terminated successfully
and in his case, and in which he made use of 
are Electuary composed chiefly of Aethiops mineral, but 
the remedy he placed the most dependance whose, was 



68
a fomentation or wash composed of a Decoction of the 
common Herbs, with a large portion Goose's Fat, melted
in it, which he applied warm to the part, but it appear
very doubtfull whether this was a case of Cancer, and more 
particularlly so, as there are no more cases on record when
it again succeeded.- In some cases an injection of 
a Solution of Sacch. Saturn will be of Service, this joined
with opium in the following way. Rx Sacch Satum. Pulv.
Opii a| 3ss Aq: Hord. Hss, this injected, and the parts
washed with it may afford temporary relief. But towards
the latter stage of the Disease, full Doses of Opium
internally are all that will afford relief.-
Schirrous.- A Schirrous state of the Uterus 
is often mistaken for cancer, and when it becomes
Ulcerated, in some measure resembles it in some of its 
Symptoms, as in both there is violent pain, but the 
pain is of a different kind, so in schirrous the pain is 
of the dull heavy kind, with a sense of bearing down
whereas in cancer the pain is of the sharp lacinating
kind.- In schirrous, the mouth of the Womb
is somtimes dilated, and you may feel the internal 
part of the neck which is rough and Scabrous.-
The size of the Tumor gradually increase somtimes



69
so much so, as to impede the regular action of the Rectum
and Bladder.-
In the incipient state of the Disease, the use of 
Calomel in small Doses, and occasionally giving gentler
Laxatives has in some instances been of Service.-
When Schirrous is in the more advanced stage, there
is always considerable pain, and when the parts are 
in an Ulcerated state, there is frequently some irregularity
of discharges.- The size of the womb is considerably
increased, and which may frequently be felt on
examination by the Rectum, and by its size impeding the 
action of that part.-
When it is in the Ulcerated state, little can be done
except as palliative, Chalybeates have been recommended
on R. o Ferri Ammon. but their action as well as any 
other seems to be upon the Stomach and secondary Symptoms.-
The application of warm fomentations or the 
warm bath may afford Temporary relief.-
The Symptom will somtimes subside for a time 
but generally return again, if this is during the use 
of any remedy, it gives the Idea of having performed
a Cure.



70
Polypus Uteri.
Polypi are situated in different parts of these Organs
as in its Cavity Neck and Mouth, and they are somtimes
attached to the Vagina.- Polypi are somtimes attached
by a small neck, at others by a Broad surface are the 
surface is in some cases sought like a Caulifower,
but is in general smooth.-
Polypi have their origin from different parts 
and great advantage arises from a perfect knowledge
& their Origin in the treatment.-
When the origin is from the internal part of the 
womb, they possibly may not be perceived for a length
of time and from the increasing in size till they fill
the Cavity, often appear as tho' suddenly produced from 
their being by some sudden exertion forced thro' the Mouth
of the Womb, in this case you may distinguish its origin
by passing your finger up as far as you can, and 
feeling entirely round the Tumor, you will feel somthing
corresponding with the Os. Uteri, and be able to pass your
finger entirely round, in this case you may be certain
its origin is from the internal part or Cavity.-
When on your attempting to pass your finger round
the Tumor, you meet with some destruction, you may then



10
71
be certain, its origin is not from the Cavity, but from the 
Neck, or part when you feell the resistance.-
The Veins of a Polypus are situated on its surface
and are somtimes large at others small, and upon these
depend the hemorrhage. It has been supposed that 
the Hemorrhage is more violent, when they are attached
to the Body of the Womb, that when to the Neck.-
When their Origin is from the Cavity of the Body of 
the Womb, and this by a narrow neck, they somtimes
fall off spontaneously, this appears to owing to the mouth
of the Womb, pressing upon the Neck of the Tumor, and 
this way acting as a Ligature.-
There is somtimes a Disposition in the Uterus to
form Coaguli, and which come away spontaneously
and have been mistaken for Polypi.-
It is necessary to distinguish this Disease from
others which occur in these parts, and in some measure
bear a resemblance, as Prolapsus Vagina, Procidentia
Uteri, or Inversion &c. this may be easily done
if the tumor is situated low down, in prolapsus Vagina
the Rugeous Character will sufficiently distinguish
the Nature of the case, and in Procidentia Uteri, you
may know the part which forms the Tumour, by the 
hole you will feel in the center of the Tumor, and by 
by other circumstances, as by its receding when in



72
a recumbent posture. This Disease is more likely 
to be confounded with an inversion of the Womb, but
you may ascertain the Nature of the complaint by 
inquiring into the History of the complaint, as in the 
way it first made its appearance. If it is inversion
of the Womb, there will be frequent discharges of Blood
from the Tumor, and at the menstrual periods this evacuation
will be found to exude from its surface, and 
if you press the Tumor, you will find it to have a greater 
Degree of sensibility.-
Polypus is frequently connected with a Schirrous
state of the Uterus, and under these circumstances their removal 
can produce very little good effect and they may 
likwise be combined with a cancerous affection.-
In some cases where a Polypus is formed in the 
internal parts of the womb, more particular if at the 
Fundus it may by its weight, bring down the womb 
and cause inversion, and if the neck of the Womb
is short, the nature of the case may not be known
and a Ligature may be applied for the removal of the 
Polypus, and which instead of being applied upon the 
Diseasd part is put upon the inverted Uterus, this happened
to John Hunter, who in a case of this kind applied
the Ligature upon a portion of the Womb, and which 



73
brought on great Symptoms of high irritation, and in the 
end Death, he was at a loss to account for the Symptoms
but upon examination after Death he found the cause.
From this case he laid down the following practical 
Rule, never to tye a Polypus without you can feel
the mouth of the Womb. But this is not at all times to 
be felt, and it seems doubtfull if you can distinguish
the part where one terminates and the other begins, if the 
Ligature should be applied to that part, as there is a possibility 
that a portion of the Uterus may project into 
the Tumor, and can should always be taken Not to include
any portion of the Uterus in the Tumor.-
Mr. J. Hunter's Rule is certainly a very good one
but should be joined with the following in case you
cant feel the mouth of the Womb, which is to press
upon the Tumor gradually proceeding upwards, 'till you
find the pressure gives pain, and apply the Ligature
just below this, in the insensible part.-
When they appear of the cancerous kind, they are
not of a proper description for the application of the Ligature.-
Somtimes their growth is very rapid, and 
it is possible, if they are removed by Ligature they will
be very soon reproduced, but tho' their removal in this 
way is not entirely successfull, yet it is right to do it



74
if merely on account of temporary relief.- When the 
size of the Tumor is small and attached by a slender Barr
there is the greatest probability of the operation being 
successful.-
For the purpose of applying the Ligature upon
Polypi different instruments, have been invented, one 
of which is composed of two long tubes, which are fastened
together, and the ligature which is a piece of fine wire
is passed thro' both these tubes, leaving a portion out
at one end forming a bow or loop, this is passed over
the Tumor, and drawn tight so as to stop the circulation 
thro' the part, but John Hunter invented a 
better instrument, and which is composed of a Piece
of Iron, rather acorded and in the end is a small hole,
this is fixed in a handle, and in which is fixed a 
small cross Barr.- This instrument may be used in 
two ways, one of which is by passing a Ligature, single,
thro' the opening in the end, this by Means of the instrument
is passed round the Tumor, and then the other end 
of the Ligature is passed thro' the loop, and in this way
you may draw it as tight as you please, fixing the 
Threads round the cross Barr at the Handle.-
The other way of using the instrument is by passing the 
Ligature, double, thro' the hole in the instrument, forming 



75
forming a loop, this is passed over the Tumor, and fastened as
before.- When you apply the Ligature, you should take 
notice whether you give much pain, a little is always
the consequence, if there is much, the Ligature is applied
to high and should be altered.- The Ligature will
require straightening & Tightening daily on account of the Shrinking
of the Tumor.- The Polypus somtimes requires
supporting as from its weight giving considerable uneasiness,
and in some cases a considerable degree of
Putrefaction takes place, and it may on this account
and on account of its producing a considerable degree
of irritability, be necessary to remove it by the Knife before
its entire seperation by the Ligature.-
There will frequently be considerable Degree of irritability 
come and a particular uneasiness at the 
Stomach, and which will require proper Medical 
assistance.
For the purpose of obviating the putrescent
effects in some measure cloths moistened in Vinegar 
and Water may be applied to the external parts
and a Lotion of Aq. Hord. with R a| Myrrh may be 
applied more particularly to the parts.-



76
Fluor Albus.
This is a discharge which takes place in Women, and 
which continues for a length of time if not cured by the use 
of the Medicine or from some cause. It is a secretion from 
the internal surface of the Vagina, and the mucous follicles
about the mouth of the Womb, and the Cervex Uteri.
The discharge is generally of whitish colour, but not 
always being somtimes of green, or yellow colour, and has 
somtimes a Purulent appearance.-
Women labouring under this discharge are generally
more or less affected in their health, tho' there are some few 
exceptions to this Rule, as there are some Women, who are 
in the best health when labouring under this discharge, more 
so than when it is not the case.
This discharge may accompany a Plethoric state 
of the Body, or the reverse, and this will cause variation in 
the mode of treatment.- When this discharge is present, the 
Patient generally complains of pain and Weakness in 
the Loins, with a general appearance of debility, such as 
listlessness &c. tho' as before observed there is somtimes a 
Plethoric state of the Body.- Some Women have a Discharge
during Pregnancy, of a thick white Mucus, then proceeds
from the Mucous follicles about the mouth of the Womb.
This discharge should be distinguished, from discharges
from these parts arising from other causes, as from, 



77
cancer, Gonorrhea &c. it may be easily distinguished 
from that arising from Cancer by the Absence of Pain &c.
but is not so easily distinguished from the Discharge of 
Gonorrhea, more particularly in the more advanced
stage of this Disease, tho' it possibly may in the beginning
as there is always more or less inflamation in the beginning
of a Gonorrhea, which is never the case in this Disease,
other circumstances must be taken into consideration
as the moral Character of the Patient &c.-
The Aura of this disease will be different according 
to circumstances, as whether than is a Plethoric state or the 
reverse, if there is Plethora, Bleeding, Purging &c. will be 
indicated, but if there is a state of Debility, the Tonics, and 
astringents as Bark, Preparations of Iron, Astringents
of the mineral kind, the cold Bath, Balsams, such as Bals.
Capioi &c. may be of Service, tho' this last does not appear 
so likely to relieve as some other things.- Preparations
of Lead internally have been recommended, but this use
is rather more precarious than some other remedies.-
Along with these internal remedies, injections of different 
kinds may be used, as an Infusion of Green Tea,
Rose leaves &c. with the addition of Alum or other things of 
the astringent kind, these should be injected into the part
by means of a Proper Syringe, Along with these modes
of treatment, attention should be paid to Diet.-



11
78
Tympanites Uteri.
This is a collection of Air in the cavity of the Uterus 
and which escapes frequently by different movements
of the Body.- Every case of discharge of Air from these
parts is not to be considered, as a Disease of this kind, as 
discharge of Air may take place from Various causes
from the death & Putrefaction of the Child in Uterus &c.
but this disease arises with out any such cause, and 
appears to be owing to the Vessels of the part having a 
disposition to form Air. The occurance of this Disease
is very rare, and the Cure extremely difficult.-
The Cure should be attempted by means of Tonic 
and Nervous Medicines, and by a strengthening Regimen,
and it possibly might be of Service to inject, by 
means of a proper apparatus, gently astringent Medicines
into the Cavity of the Uterus.
Menstrual Discharge.
This discharge is that periodical discharge which 
takes place in Women at a certain period of Life, and 
generally occurs at stated periods, which are generally
at the distance of a Month, from which circumstance
it takes the Name of Menses or Menstrual Discharge.
This discharge is not Blood which proceeded from 



79
the rupture of Vessels is was formerly supposed, but is a 
regular secretion from the extremities of the Arties, by
a proper organization for that purpose.- It is composed 
of the Serum and Red particles of the Blood without 
the coagulable Lymph. This discharge in its natural
state wont coagulate, and whenever it will, it is a morbid
state of the discharge as there must then be the presence
of Coagulable Lymph, this constitutes the Disease called Menorrhagia.-
The Age at which this evacuation first makes 
its appearance is about the fifteenth Year in this Country,
but there are many varieties in this respect, as it is 
in many cases much earlier, and in thus much later
than this.- There is variety in this respect in different
countries, in the warmer Climates, the time of their appearance
is much earlier, and in the colder Climates much
later.- Tho' the period of the appearance is these various
yet, if there is no constitutional affection is consequence
of this, it cant be called a Morbid state.-
When the Menses are about to make their appearance
there will be always more or less constitutional affection,
great variety of Symptoms being present, frequently a 
state very much resembling Pthisis Pulmonalis, when 
there are symptoms of this kind present, a considerable
short discrimination is often necessary to distinguish 
the Nature of the case, and it is impossible in some instance



80
instances to say what the nature of the case is, 'till by the use 
of some remedies, it becomes more clear, as the remedies for 
these Disease are quite of a Different kind, are requiring
Tonics &c. which would to injury in the other Disease.
It is frequently the case that a considerable degree
of Langour, and diminution of strength takes place at 
the time of the menses being about to appear, and by some
it is the practice to order the to use an extra Degree
of exercise, this plan is very injurious, so the System
should be invigorated by proper remedies, as Chalybeates
and what are usually called emmenagogues &c. and the 
the usual vivacity and inclination for exercise will return,
whereas if you order exercise to be used, when the 
strength is so much diminished you are in danger
of producing some bad consequence.-
Chlorosis is in many instance only a Symptom
of a dificiency in the proper secretion of Blood, and when 
this is the case the first indication is to assist that
process by proper nourishing treatment, both in the medical
Depeartnent and in respect to Diet, when this is 
the case emmenagogues are improper 'till the constition
has been strengthened, then their use will be of Service.
Electricity is only proper when there is a proper secretion
going on.-
The discharge is seldom regular in respect to its 




81
recurence, for some little time after its first appearance.-
Before the appearance of the discharge in the 
regular way, there will generally be some particular
Symptoms come on for a few Days, as a sense of dullness
and heaviness, pain in the back and Loins, Vertigo &c.
and there usually is a whitish discharge for a few Days
or for a Day or two, before the appearance of the Red discharge.
The Length of time which the discharge continues is very 
various, but in general is about 3 Days.- The Quantity too
is subject to great variety in some instance only just 
tipping the Linea, in others the quantity is considerable
accounting to several Ounces, and at the same 
time does not produce any bad effect on the constitution
it is not quantity discharged which constitutes
a morbid state, but it when this quantity produce
some ill effect on the constitution, the same Rule
is applicable with respect to duration.-
There is obstruction of another kind occasionally
taking place, when the Body is in other respects in 
a healthy state, this disease may arise from different
circumstances as from the application of cold
&c. in their case quite a different mode of treatment
is proper, from that pursued when the Body
is in a debilitated state, in this case Bleeding in 
small quantities, Electricity, Aloctic Purges, this Service



82
Service pieces &c. will be of Service.- If by the use of then
means the affection is not releived, other Symptoms
will come on, as an effusion within the Cellular
membrane, producing a swelling of the lower Extremeties,
and a Dropsical state.-
All obstructions of this discharge are not to be 
considered as morbid is there is always a disappear
of this evacuation during pregnancy, and in general
this is the case, tho' not always during the secretion
of milk. There will frequently be a Discharge
of Blood at different times during pregnancy, but this 
is quite of a different Nature from the Menstrual Discharge
as this is a discharge of Blood, and probably comes
on in consequence of partial seperations of the Placenta,
as from its being situated over the mouth of 
the Womb &c.-
The menses at a certain Period of Life cease
to flow, the Age at which this takes place as various, in
general about 65, the it will take place both before and 
after this period at considerable distance of time it is generally
the case, that those Women who had the menses
first appear at an early period, will likwise have their 
cessation early and the reverse of at a late Period before
their first appearance. This change is considered by 
them as a matter of very great consequence and with 




83
very good reason, for these are frequently symptoms of very
great consequence come on at this time.- When the discharge
has ceased to appear for two or three periods, there will frequently
be a Plethoric state of the System more particularly if no 
attention has been paid to the Diet, and there will then take 
place a Discharge, and this may be repeated at intervals,
this discharge is not of the same nature as the menstrual
but is a discharge of Blood, containing coagulable Lymph and 
from this circumstance produces more debilitating effects
and if repeated may cause such a Degree of weakness as 
to be the cause of other Diseases as Dropsy &c.
In Women who have born several children, there 
will frequently be a cessation for a month or two, and then 
a sudden and perhaps profuse discharge of Blood take place
and if this in any part comes away in a coagulated form
gives them the Idea of having miscarried, this is a case of 
Menorrhogia, and should be treated as such, these discharges
will recur at intervals. It has been usual in all cases 
to give tonic and astringent Medicines under these circumstances,
but which in many instances in a wrong practice
as a treatment similar to what is pursued in case of 
Hemoptoe, will in general be more proper as at the time 
when from certain symptoms the discharge is likly to take 
place if the Pulse is is generally case, are rather full and
have the jerking feel, the loss of a small quantity of Blood 



84
from the Arm, as from 4 to 8 oz. according to circumstances
will be of service, and at the same time giving gentle apperients
as small Doses of Neutral Salts &c. and in the intervals
giving gentle Tonics and astringents, the common
tonics and astringents may not be so proper in this case
as some others, a good one for this purpose, is Infusion of 
Roses, with a small portion of Glaubur Salts, the basis of both
their being the same thus does not any decomposition take place
each has its basis the Sulphuric Acid.-
It possibly may answer a very good purpose at the time 
the menses are about to disappear, to take away as small
quantity of Blood for a few times once in two months, and this 
perhaps with a little attention to the Bowels & Diet might prevent
any of the consequence ensuing.-
When the disease has continued for a length of time
this plan wont be proper, but recourse must be had to 
Tonics as the Bark, Chalybeates mineral Acids &c. and 
a nourishing diet, as the System has been very much reduced
and must be recruited.-
At this time there will frequently be an affection
of the intestinal Canal, that is a disposition to flatulency
producing a sense of fullness and a swelling of the Abdomen,
and which by Women has been mistaken for Pregnancy
tho' it may be easily distinguished from this state, this
state may be remedied by the use of aperients Medicines
joined with Aromatics and those of the Nervous kind as 
Pill. Gall. Comp. &c.



85
Appendages of the Uterus 
The appendages of the Uterus are four in Number namely,
The Fallopian Tubes, Ovaries, Round Ligaments, and Broad
Ligaments.
The fallopia Tubes go off from the upper part of 
the Uterus sideways terminating in a fimbriated extremity
they are in general about 5 In. long, but are subject to rarity
as they may be very much lengthened from certain causes,
and from an enlargement of the Ovariæ &c.
The diameter of the tube is smallest where it joins the 
Uterus, and becomes considerably enlarged at the other extremity.-
This tube is subject to variety in several respects
its course being in general straight tho' somtimes in a Spiral
direction.-
The Fallopian Tube is subject to a varity of affection
and is somtimes found imperious or obliterated, they are
likwise subject to a collection of Matter in their cavity, and 
to a Dropsical state, the quantity of Water is seldom large
not being more than an ounce in general, this Disease is seldom
of any consequence in respect to its effects on the constitution,
nor are their any Symptoms whereby its presence
may be known.- If both the tubes are in this state, it 
must certainly be a cause of sterility as the passage of the 
Ovum is entirely prevented.- Matter when formed in 



12
86
Ovaria has escaped by these Tubes into the Uterus and 
this way found an outlet.-
The structure of the fallopian Tubes must 
be in part muscular tho' muscular fibres cant 
be discovered, yet there can be no Doubt of this from the 
actions they perform.
The office of the fallopian Tubes will be more 
particularly explained, when treating of impregnation,
yet this is evident that they are for the purpose of carrying
the Ovum from the Ovaria to the Uterus.-
Another office, which is that of carrying the [illegible]
fluid of the male to the ovaria has been
ascribed to them, but this does not appear to be the 
case as will be here often explained.-
Ovariae.
The figure of the Ovaries is very much like that 
of the testes, the surface is irregular, they are vesicular
internally, more obviously so between the Age
of Puberty and the middle period, these vesicles are 
unequal in size, and indefinite in number.-
When one of these vesicles has received the Stimulus
of impregnation, it gradually begins to enlarge
and after a time bursts, the Ovum escapes, and is embraced 
by the fimbriated extremity of the fallopian
tube and carried to the Uterus.- The Ovaria have 



87
in some instances been found wanting.-
The Ovaria are subject to different diseases, to 
inflamation, and suppuration, the matter from which 
may be discharged in different ways, one of which 
is by the fallopian Tube into the Uterus, and may 
give an Idea of its having been formed in that part.
They are likwise subject to an enlargement of 
the Schirrous kind, and which may keep gradually
increasing in size for several years, in many cases 
without having any material effect on the constitution,
tho' somtimes it is the reverse.- This enlargement
has in some instances been mistaken for 
Pregnancy, but may be distinguished by the Tumour
begining on one side.- Nothing can be done in 
this disease except in the Palliative way, so by giving
Opium, Aperients &c.-
These parts are likwise somtimes found
in a state of ossification, and have somtimes been
found to contain, the different parts of a fetus as 
Hair, Bones &c. and in some instances it appear
difficult to account for the formation.
When parts of the fœtus have been contained in
the Ovaria, this constitutes an [cross out] extra Uterine
case, in this case the usual Symptoms of impregnation
go on for a length of time, there cease but the 
enlargement continues, after a length of time an Abcess



88
forms and the different parts are evacuated.-
The Ovaria are subject to a collection of Water
in their cavity constituting a Dropsical state, the qantity
of water which be contained is various, has in some 
instances been found to be to the quantity of 10, 12 or 
even 15 Gallons.- Women about the middle age are 
most subject to this disease, but no Age is entirely
except.- The disease in the first place begins 
in one of the Vesicles, somtimes in two or three, these dont 
at first communicate with each other tho' they afterwards
so, this is a fortunate circumstance in drawing
of the water by tapping.- The substance which is contained
in the Ovaria, is somtimes partly fluid and 
in part solid, and which will render relief by tapping 
up, from this it will appear evident the necessity of 
giving a guarded [illegible] in this Disease.- If the solid
part is situated anteriorly, the common trocar will
not evacuate the Water, in this case it is probable
on a greater length might be of Service.-
The begining of this disease is seldom noticed
tho' there will be somthing perceived to move on the 
side affected on the Body being put into different
positions, this affection seldom produces so much
derangement of the System, as cases of common Dropsy.
Her water collected in the Ovaria varies very much
in some instances being perfectly thus and Lymped 




89
in others viscid and glutinous, when the fluid is 
in this state the constitution is generally giving way 
Different modes of cure have been recomended,
on of which was to extirpate them in the early stage
but this would be attended with many difficulties,
as from the difficulty of distinguishing them before they 
were considerably enlarged, and when this is the case the 
opening required for their removal would be so large
as to render the operation extremely dangerous, and many
other besides these. It has been proposed to cure
them by causing inflamation in the cavity in the 
same way in in the cure of Hydrocele, but there are 
no facts in support of this.-
The treatment of this disease is only palliative
which is by tapping, the use of Medicine has never
been of any service, tho' these have been instances of 
a cure taking place by accidents, which have burst
the Cyst.-
When both Ovaria are affected with this Disease
impregnation cant take place, tho' this may 
if only one is diseased, and when this is the case 
very unpleasant effects are the consequence, more 
particularly during Labour, and this may be more 
so if the Tumour is small than if it is larger,
from its descending more into to cavity of the Pelvis
and obstructing the passage of the head.- They way
to distinguish a Tumor of this sort from the head of 




90
the child is by its being compressible, and yeilding
which is not the case with the head of the child.
When this is the case, a question arises whether
it would be best to open the head of the child or to draw
of the the water from the Tumor by the tapping, there have not 
been a sufficient number of cases on record to say 
which of these is the most eligable, as no general Rule
should be laid down from solitary cases tho' when the 
whole should prefer the latter.-
Round Ligaments, an attached to the 
upper part of the Uterus, and often passing towards the 
lower, go thro' the abdominal Ring like the Spermatic 
chord in the Male, and are the distributed
about the Mons Veneris &c. The structure of these
Ligaments is muscular and Vascular, and their 
use appears to be for the purpose of supporting the 
Womb, and keeping it steady.- During pregnancy
there is somtimes a painfull uneasiness about 
the Abdominal Ring and Mons Veneris, from these 
Ligaments being put on the stretch, and which 
may require the use of Anodynes &c. for the purpose
of worsening relief
Broad Ligaments, consist of a doubling
of the Peritoneum, enveloping the other appendages of the 
Uterus with its vessels, and attached to the sides of the 
Pelvis, dividing it into two Cavities. These Ligaments




91
are formed by the Peritoneum being reflected over
the Fundus, and posterior part of the Bladder, over 
a small portion of the anterior part of the Uterus, over 
the fundus and posterior part, and then over the Rectum
leaving a portion of the back part of the last uncovered.-
From this it appears that the Neck of 
the Bladder and a small portion of the posterior part of 
this, near the neck, and part of the anterior portion is 
not covered by the Peritoneum, and there is likwise
part of the anterior portion of the Uterus with the Neck
and Vagina, which are not covered by it, nor is 
the lower and posterior part of the Rectum.-
From a knowledge of these circumstances
some practical hints may be derived, as for instance
that of tapping the Bladder (in case of suppression
of Urine) from the Vagina, by means of a curved
Trocar, when a Catheter cant be introdced
[illegible] [illegible] supposed the Tapping might be done
with advantages in Ascites from the [illegible] but
the Intestine would be a great [illegible] of [illegible]
the Broad Ligaments are attached



92
Gravid Uterus.
The Gravid Uterus comprehends a series of changes
induced on the Uterus and its appendages, also the Ovum
contained within it, consisting of the Fœtus, Navel
String, and Placenta, the Water called Liquor Amnii,
with the different membranes, as the decidua,
chorion, Amnios &c.
We shall first describe the Ovum and afterwards
the Uterus &c. The Ovum being the produce
of conception, this merits a previous consideration.
Conception, there is great variety in the mode 
which impregnation takes place in different Animals,
in some there is the power of impregnation in
themselves, having both sexes contained within themselves
in others, the organs of both sexes are perfect, but then
require sexual intercourse, and a double or reciprocal 
impregnation follows.-
The things necessary to impregnation in the male
are Testes, secreting semen, in the Female ovaries
in a healthy state, with a determination of Blood
to the whole Uterine System. The Oestrum or disposition
to impregnation and the coitus are the occasional
causes.- It is not necessary that both Testicles shoud
be perfect, as one testicle and one Ovarium in a healthy 



13
93 
state are sufficient for this purpose, and tho' there
is a necessity for a determination of Blood to the parts
yet impregnation may take place, when there has 
been no menstrual Evacuation provided there is 
this determination to the Uterus &c.-
Different opinions have been formed with 
one put to the part the fecunditating fluid of the Male
is conveyed to produce impregnation, as whether it
is only conveyed to the Vagina, or Mouth of the Womb
in to the Body of the Uterus, or whether it is conveyed by
the fallopian tubes to the Ovaria, but from the result
of several experiments it appears, that sympathy or 
consent of parts, and which opinion receives additional
strength, by the Breasts sympathizing with the action
of the Uterus.- The Stimulus of impregnation is probably
first given to the Uterus, the Ovaria then harmonize,
afterwards the fallopian tubes &c.-
The alteration which takes place in impregnation
is, after the Stimulus of impregnation is given
one of the Vesicles of De Graaf, this swelling and projects,
before the rest, after a time this bursts and the
Ovum escapes, which is imbraced by the fimbriated
extremity of Fallopian Tube, and by this is conveyed
to the Uterus, there is then a particular membranous
attachment formed to prevent the Ovum from escaping
this membrane is called Tunica Decidua, there 



94
likwise a secretion of thick mucus which pluggs
up the mouth of the Womb, and thus becomes a farther
security.- The substance of the Vesicles does not take 
on the form of a Ovum immediately on its entering the 
cavity of the Uterus, but the membrane before mentioned
is first formed, and the different parts of the Fœtus are
not immediately formed, but take place in some little
time from this.- The parts for it formed are the Organs
of Sense, as the Brain, the head is first formed then
the Skin, is seen projected, and soon after this the Eyes are
seen and afterwards the extremeties.- The heart is too,
very early formed.-
Super fetation may take place if there is a 
second coition, before the Ostrum is gone off, an instance
of this occured, in a Married Woman of Jamaica,
who had twins, one of which was white and the 
other Black, she endeavoured to account for it by an
affection of the Mind from fright in the same way as 
Navi Materni are supposed to arise.-
From circumstances it is probable, that the
fecunditating fluid of the male, has nothing to do
with the formation of the Fetus, except by giving a proper
stimulus.-
After impregnation and the contents of the Vesicles
of De Graaf is evacuated the Cavity then becomes
filled by a Yellow Matter and which is called Corpus 




95
Lutei, and this is the course of some time gradually
disappear, probably may do this in the course of about
12 months.- There Corpus Lutei always correspond
with the number of Fœtuses, except in some instances
when there are the Rudiments of two Fœtuses in
one of the Vesicles and which is very rare.-
It has by some been supposed that this was 
not the case, from a greater number of these Bodies
being found than fœtuses, but there must then have 
been a corresponding number of impregnation, and 
most probably miscarriages
The Navel String is that chord which 
passes from the middle of the Abdomen of the Child to 
the placenta, the place when it is attached to the Placenta
is not always in the center, being frequently
to one side or very near the Edge.-
The Length of the chord varies very much, being in
some instances no more than 6 In. long, and has been
found as long as 57 In.- Both these extremes have
their disadvantages, for when very short, there is danger
either of inverting the womb, or breaking the chord
on the expulsion of the child, or there may be in consequence
of this a partial seperation of the Placenta,
and by its being done before the Vessels have any 



96
ways contracted may cause a proper hemorrhage,
from this circumstance, care should always
be taken not to move the child far from the 
mother, when expelled, or rather to bend it towards
the mother as it is passing the external parts.-
When the chord is of more than common length
it may possibly get down before the head of the Child
and being this way compressed the circulation will
be stopped, and as the Lungs are not in this case
in action, the Death of the child very soon takes
place, or the chord may be passed round the Neck
of the child.- Somtimes there is a Knot formed upon
the chord, this probably is done during Labour, by 
the Chord, passing over the Child.-
In some cases the chord may be felt, by the 
Pulsatory feel, before the Bagg of Waters is broke, in this
case you should avoid, breaking these as long as possible
and endeavour to alter its situation, or it possibly
by some motion of the child may be spontaneously
changed.-
The umbilical chord is composed of two
Arteries, and one Vein, connected together by a [cross out]
Cellular substance & covered by a Membrane substance, which contains a mucous
substance, but it has neither absorbents nor Nerves
entering its composition at least so far as at present



97
present is known.- The umbilical Vein in the adult
is so far obliterated is to destroy its cavity, and forms
that part called the Ligamentum Rotundua of the 
Liver.- These Vessels not only convey Blood but
likwise nourishment to the fœtus.-
The Vessels of which the chord is composed pass 
in different direction, somtimes the Arteries pass
in a spiral direction round the Vein, and in other
cases the reverse, in some instances they pass in
paralel lines with each other, and they somtimes
form a Coil.- The different directions which the
Vessels take may possibly be for the purpose of retarding
the Velocity of the Blood, and possibly for some other
Parlous.- From their being no Nerves in the composition
of the Chord, it appears improbable that 
the mind of the mother should have any power
in the formation of what are called Nevi Materni
and other circumstances, that have been attributed to 
the influence of the mind, as the case of the Jamaican
Lady before mentioned.-
The Placenta is that part which forms the 
medium of connection between the Mother and 
Fœtuses, and correspond with the Fœtuses in respect
to number, thus if there are one, two, or three fœtuses
there are the same number of Placenta, except in
case of one of the Vesicles of De Graaf containing the 



98
Rudiments of two Fœtuses, in this case there will
be only one placenta and on Bag of Waters.-
When there are two or more placenta, the Vessels
of each have in general no communication, tho'
in some instances they have, and it is from this 
circumstance, that the necessity of tying the chord or 
each side the part you divide it, for if the Vessels
of the two placenta communicate, and this was not 
done, it is most likly the Death of that Fœtus in
Utero would take place, from the discharge of Blood
owing to this communication, it is on this account
and not on account of the Quantity being injurious
to the Mother, the necessity arises.-
The thickness of the Placenta varies, in general
about an inch thick in the middle, and gradually
becomes thinner towards the Edge, and its forgive is 
in general round & flat.- Its attachment is to different
parts in different cases, in general it is to the 
upper part or fundus, and which is the best place
for the attachment, in some instances it is placed
over the mouth of the Womb, and which constitute
one of the most dangerous cases in Midwifery.
The Placenta has an external and internal
surface, the external is that which is in contact
with the Uterus, on which there are several fissures



99
dividing into lobes, which probably are for the purpose
of slowing it to accomodate itself.--
The Arteries are spread chiefly on the internal
surface the Veins on the external, before the Arteries
in the substance of the Placenta, they communicate with 
each other.-
The Placenta consists of two parts, the Maternal
and Fœtal the maternal part is cellular, the other
which is the Fœtal is Vascular, there are no communication 
between the two parts by continuation
of Canal.- There are two distinct circulation going 
on in the Placenta, one between the Mother and 
Placenta, the Blood passing by the Arteries into the 
Cells of the Placenta and returning to the mother
by the Veins, the other between the Fœtus and placenta,
the Blood passing by the Arteries into the Vascular 
or Fœtal part of the Placenta, and returning
by the Veins.- The communication between the 
Maternal and fœtal part of the Placenta, is probably
by Lymphatic Vessels, and which may probably 
arise in a similar way to the Lacteals, from
the cellular part of the Placenta.- The way in which 
the Fœtus is nourished is not as some have supposed
by the mouth or Skin, but by the chord, which 
is not from its receiving red Blood, but coagulable 



100
Lymph, which it converts into Red Blood by its own 
sanguifying powers, the same as the chick is Ovo.-
The more this is examined the more it appears
to be like the process of Vegitation, that the Fœtus is 
nourished.- From several circumstances it 
appears that the placenta her forms a similar office
in the fœtus, upon the Blood, to what the Lungs do 
in the adult, except in the power of evolving heat
which is not necessary in the Fœtus, rendering it 
fit for circulation, and this is evident in case
the chord is compressed so as to stop the circulation,
before the child can breath. Death is the consequence,
and which cant be from the supply of 
nourishment being cut off.-
The circulation of Blood in the Fœtus is different 
from that of the adult, as there is a communication
between the right and left Auricle, called
the Foramen Ovale, and thro' which a great portion
of the Blood passes, a small portion only going 
thro' the Lungs for their nourishment.
Membranes, are the bag in which the fœtus,
Navel string, and Waters are contained, the number
of these bags in general correspond with the number
of Fœtuses, the use of this is obvious, for in case there 



14
101
were two or more Fœtuses, if one of the Bags gives
way the other Fœtus or Fœtuses is not effected.-
The number of the membranes vary in the 
early and later periods of Pregnancy, in the early
Period there are 4 Membranes, namly Tunica
Decidua Uteri, Tunica Decidua reflex, Chorion,
and Amnios, in the later periods then are only
three, namly, the Tunica Decidua Uteri, commonly
called, the Spongy Chorion, the true Chorion, and 
the Amnion.- In the early stages of impregnation
these membranes appear more like a portion of 
coagulable Lymph, than distinct membranes.
After some little time the Tunica Decidua
reflexa disappears, in consequence of a discontinuation
of Growth, and not by condensation, as John
Hunter, and some others have supposed.-
The Spongy Chorion is formed by coagulable
Lymph thrown out by the Uterus, which afterwards
becomes organized the same as under other circumstances, 
at the time of the Ovum descending from the 
Fallopian Tube, this Lymph is thrown out for the
purpose, of its being imbedded in it, there is then a 
process of this spread over it, which forms the Tunica
Decidua reflexa, and which as before observed after a 
little time disappears, the use of this last membrane



102
appears to form an attachment before than is done
by means of Vessels.- John Hunter was of opinion
the Spongy Chorion was formed of the internal membrane
of the Uterus.- The Spongy chorion is very Vascular,
which Vessels are derived from the Uterus, it is of 
greater thickness than the other membranes, and has 
a Granulous Surface, with numerous Foraminula,
which probably act the same as Lacteals,
in the nurishment of the Fœtus.- In some cases 
this membrane is expelled, when this is the case
you may be certain of Abortion following, when it is 
expelled in this way, is has very much the resemblance
of a Piece of Brussels Lace.-
The spongy Chorion is that which conserve
contact with the Uterus, next to which is the true
Chorion, the structure of this is more firm and 
compact the that last mentioned, and is probably
Vascular.-
The next or inner most membrane is the 
Amnion, this is thinner than the other two, but of 
a much firmer texture.-
The Placenta is situated between the Spongy
Chorion, and the true Chorion, and the maternal
part of which is formed by a portion of the Spongy
Chorion, but the Fetal or Vascular part of the Placenta



103
is formed by the ramification of the Umbilical
Vessels, this substance may be said to convey Nutriment
to the Fœtus in a similar way to what 
the Lacteals and Absorbents do in the adult.
The use of the membranes is for the purpose of 
containing the water and defending the child, and 
for some other purpose which will be mentioned
when speaking of the Waters.-
Water called likwise Liquor Amnii from 
its being contained in the Amnion, is divided into 
true and false, the false is a collection between
two of the membranes, and which is somtimes evacuated,
giving the Idea of the membranes having 
been ruptured, somtimes a quantity of Urine is 
suddenly evacuated from the Bladder, by some 
motion of the Child, and which is mistaken for the 
escape of the Waters.- The Properties of this fluid
very much resemble that which is effused into different
cavities of the Body.-
The quantity of Water is subject to considerable
variation, is somtimes in as small a quantity
as from half an Ounce to an Ounce, and in other
instances a pint, or even two or three pints have been
found, but in general from half a pint to a pint 
is the quantity.- With respect to the relative proportion



104
proportion to the Fœtus, this likwise varies, in the early
periods the Water very much exceeds the Fœtus in 
Bulk, and the reverse in the late periods, not but
that the Water keeps increasing in quantity, tho'
not in the same degree as the Fœtus. They very
near agree in quantity at the third month.-
The Water appears appears to be a secretion
from the Amnion.- When the Water are by any 
means evacuated at an early period. Abortion
must follow.- In case of actual Labour, when 
the Waters are evacuated, the time at which Labour
shall actually take place from this is uncertain
or in case the Water, has by any means been Discharged.
The Uses of the Waters, are to defend the child, and 
together with the membranes, to dilate the passages
in the early stages of Labour, and lastly to facilitate
the Passage of the child by lubricating the Parts.
The reason why larger in proportion early in the 
fœtus being soft so as to be liable to give way
to any slight [illegible]. It will be pressed [illegible]
at the 3 or 4th month



105
Changes on the Uterus by Impregnation.
The alteration produced by impregnation upon the 
Uterus, are considerable and in may respects, as in 
Shape, size, Weight, and in the size of the Cavity.-
Those alterations have considerable effect upon the 
ajacent parts, as by pressure upon the Bladder, a
frequent discharge of its Urine or a suppression
takes place, according to the part acted upon, thus if 
the upper part of the Bladder is pressed, the size of the 
cavity is diminished, and this causes frequent evacuation,
and if the lower part about the Neck is pressed
upon, a suppression is the consequence.- In these cases 
change of posture may be of service, and in case of suppression,
pressing up the Womb by means of the finger, will
releive the Bladder or it may be necessary to introduce
the Catheter.-
The enlargement of the Uterus is confined to the 
Body of the Womb till the end of the 5th month, after which
time the Cervix Uteri begins to strech, and is obliterated
at the end of the Ninth month.- Some practitioners
have supposed the neck of the Womb to have began to shorten
before this Period, but it is not the case, as it is of 
the full length, that of 1 1/2 In. till the end end of the 5th month



106
The shortening of the neck of the Womb does not take 
place in a regular gradual manner, but proceeds
faster at some periods than others, at the 6th month it 
is a little shorter, at the 7th month it has lost two thirds
of its length, being then only 1/2 In. long, at the 8th month
it is still shorter, and at the 9th month is entirely obliterated.-
Great advantage arises from this Order
of the Womb enlargment, for if the neck of the Womb was
obliterated at an earlier period, any sudden action of 
the parts might force of the mouth prematurely, and 
which is prevented, by this state of the parts.
During this enlargement of the Uterus it somtimes
spontaneously bursts, and the child escapes into 
the cavity of the Abdomen, the symptoms by which you
may ascertain this having taken place, an sense
of something suddenly giving way, attended with considerable
pains different from that of Labour, and you may 
distinguish the different parts of the Child thro' the Parietes
of the Abdomen.- This is more often the consequence
of bad practice in turning the child, from too great
a degree of force being used.- When this has taken 
place, it is certain to end in death or nearly so.
The practice recommended under these circumstances 
is to pass the hand thro' the opening and to 
find the feet, and endeavour to extract this way.



107
The part that gives way from violence during Labour
may be either the Uterus or Vagina.- From this it 
will appear the great necessity there is for case in 
case of a necessity for turning.-
The chief alteration produced upon the Os. Uteri
a Mouth of the Womb, from impregnation, consists in 
a more developed condition of the Mucuos follicles
occasioning a considerable discharge from these parts
in many instances, and which which has by some 
Women been mistaken for fluor Albus, and an account
of the quantity have been alarmed, but it is not a 
Matter of any consequence as it does not produce
any weakness, and upon the whole may be said
to indicate a more favorable Labour, from the 
parts being generally in a more relaxed state, than 
when there is no discharge.- There is always a discharge
of mucus preceding Labour, but which is in that 
case tinged with Blood, this is by them called the 
Shew.- The figure of the Os. Uteri likwise varies
gradually becoming less prominent, and Broader.
The ascent of the Womb when impregnated
is in a ratio corresponding with the Period of 
Pregnancy, at the third month, it is just above the 



108
Brim of the Pelvis, at the 5th Month it is half way
between the Umbilicus, and brim of the Pelvis, at the 
6th Month it is nearly at the Umbilicus, and at 
the 7th Month a little above it, at the 8th Month, it 
is half way between the Umbilicus, and Ensiform
Cartilage, and at the 9th Month is as high as this 
Cartilage.-
This enlargment and ascent of the Womb, produces
considerable effect upon the different parts
contained in the Abdomen, as upon the Bladder, Rectum,
Stomach &c.- The Nausea and Vomiting
which takes place at the early periods of Pregnancy,
cant be owing to pressure upon the Stomach
but must arise from irritability, or Sympathy.-
The Figure of the Womb in general is between
the Oval and Pysiform, tho' it is subject to variation
from several causes, as from the number
and position of the Fœtuses, quantity of Water &c.
The Position of the Womb is generally in the 
center of the Abdomen.-
The Arteries of the Uterus are 4 in number,
two of which arise from the Spermatic Arteries
and two from the Hypogastric, these are distributed



15
109
distributed upon the Uterus in a Serpentine direction
the Veins which return the Blood from the Uterus
in general accompany the Arteries, but instead
of taking a spiral direction, go nearly in a straight
course, they go from the Uterus to the Vena Cava
on the right side, and on the left side to the Emulgent
Veins. There have been different Opinions
respecting the Serpentine direction of the Arteries, 
some supposing it to be for the purpose of slowing the 
Uterus to enlarge, but as they are in the same spiral
direction when the Uterus is at the full size,
this cant be the reason, it must be for the Purpose
of retarding the motion of the Blood in these 
parts.- There are likwise Nerves and Absorbents
in the Structure of the Uterus both of which become enlarged
in the impregnated state, the Absorbents have 
at times very important actions to perform
as it is by their action the Uterus is reduced to its 
proper size after delivery.- The womb does not only
enlarge in circumference but in substance, during 
pregnancy, and different opinions have been
formed, respecting the thickness of the Womb at the 
time of Labour, whether it is thicker or thinner than
in the unimpregnated state, both these circumstances
may be right in different cases, in general the 



110
thickness is about 3/8 In.- The Womb at the time of 
Labour is supposed to contain 51 Cubic Inches and 
in the unimpregnated state 4 1/2 Cubic Inches, which
is nearly 11 times the Bulk. all this is to be taken
up by the Absorbents.- The size of the Womb should
be remembered after the expulsion of the child on 
account of its weight occasioning some inconvenience,
and rendering a horizontal position necessary.
Different opinions have been formed respecting
the substance of the Womb, some supposing it to 
be muscular, and others not, but there is not the least
doubt of its being Muscular from the actions which
the Womb performs, these muscular fibres are distributed
in different directions.- It is by the contraction 
of these muscular fibres, that the child is expelled and 
by a farther contraction, the expulsion of the Placenta
is effected, in many cases entirely without assistance.
This contractile state of the Womb is of very great
consequence in the prevention of hemorrhage, diminishing 
the size of the Vessels, for if no diminution of their 
capaciousness was to take place there must be much more 
hemorrhage after delivery, and from this circumstance
practical hints may be taken in flooding to assist 
the wombs contraction by any means as pressure upon
the Abdomen &c. or if the Placenta is not yet expelled 




111
and is the cause, extracting it, and which will slow the Uterus
to contract, and in this way stop the hemorrhage.-
Pregnancy.
Pregnancy has been already treated of Physiologically
but we must now take a different view of the subject
and in the first place speak of the signs by which
it is known.-
Signs of Pregnancy, these are numerous, but 
any one of them alone is fallacious, therefore in forming 
an Opinion, several of these should be taken
into consideration, the usual symptoms which 
take place in pregnancy are Amenorrhea
sickness and vomiting, frightful Dreams, loss of 
appetite, emaciation, peevishness, enlarged Breasts,
dark and enlarged Areola, quickening, enlargememt
of the Abdomen &c. shall now consider each of these
Symptoms seperatly.-
Amenorrhea, this is frequently a symptom
of Disease as well as pregnancy, as it may arise
from accident, such as taking cold at the time
or just before, the menstrual period, but this should 
be taken into consideration. At a certain time
of Life there is always a cessation of this discharge and 



112
which takes place at an earlier period in some 
Women than others, in general those who begin to 
menstruate at an early Period, have a cessation at
an early Period likwise; in a general way this takes
place at about the 45th Year.- Women never have the
natural menstrual Discharge during Pregnancy,
tho' there will in some Women be a discharge of Blood
at times, and which may be in some cases at regular
Periods, when this is the case it is accidental
and is frequently owing to portions of the placenta
being detached, probably in consequence of its being 
situated over the Mouth of the Womb.-
Sickness and Vomiting is likwise a very 
doubtfull sign, as this frequently arises from many
other causes, from the readiness with which the Stomach
Sympathizes with other parts, that which occurs
during Pregnancy is more particularly in the 
morning
Frightful Dreams this is amongst the 
most doubtful of the signs but in some particular
patients, is rather a certain symptom.-
Loss of Appetite this is a sign upon which 
no dependance can be placed if alone, as it arises from 
so many different causes.-

4th Month
Stethoscope= Inf Pulsation- Placental
Breast Softens

113
Emaciation and Peevishness, these are likwise
subject to very great uncertainty and deserve very
little Notice in general.-
Enlargment of the Breasts, this when attended
with the secretion of milk, is a probable Symptom;
but various instances have occurred, which prove
its fallibility
Areola, when this is enlarged and of a Dark
colour, is thought by some to be the best single Sign
but requires experience, to form a judgement from
this correctly.- The seat of this is in the Rota Mucosa 
surrounding the Nipple, and in the unimpregnated
state, resembles in colour, new plained Mahogany,
but becomes of a Darker colour in the impregnated
state.- In the unimpregnated state, it 
is in general about 1 1/2 In across, but in the impregnated
state becomes considerably larger.- After delivery
the Areola will in general regain its natural colour
and size in the course of some little time, except impregnation
takes place again very soon, in which case
it will become still larger and Darker.
Quickening, this is likwise a very fallacious 
sign, and both Patient and Practitioner may be
Deceived, pressing on each side of the Abdomen with the 



114
hands, may occasion uneasiness to the child, and that
way its movements be felt
Enlargement of the Abdomen, this is likwise
fallacious as it may be owing to various morbid causes
as well as from pregnancy, this it may assist in 
forming the opinion if combined with some other 
of the usual Symptoms, where this is connected with 
suppression of the Menses, and begins 3 or 4 Months
after the time of supposed impregnation, begining at
the lower part of the Abdomen, and gradually extending
upwards, more particularly if this has been
preceded by a degree of flatness of the Abdomen the 
first month or two, in this case, it becomes rather a 
strong Symptom, tho' there is no one on which so 
much dependance can be placed as upon the Attention
of the Areola.
Besides these there are several other Anomalous 
Symptoms somtimes attend pregnancy, but 
which appear to have very little apparent connexion
with it.-
Enlargement of the Abdomen may be combined
with Dropsy or with a Diseased state of One of the 
Ovaria. When the swelling is entirely owing to either
of these it may be distinguished by the undulation in 
one, and by the enlargment begining on one side in the other. 



115
Reckoning.
This is commonly divided into long and short reckong
the short is callendar Months, and the other Lunar Months,
the duration of Pregnancy is in general about 40 weeks
and which makes about 9 Callender, and exactly 10 Lunar
Months.- There are different times from which this 
reckoning is dated, either from suppression of the Menses,
Quickening, and coitus.-
That from which you can form an Opinion
of the Stage of pregnancy, with the greatest accuracy
is from the suppression of the Menses, but this in many
instances, cant be done on account of the Woman not 
having been regular in this respect, or not having 
the Discharge at all, as for instance in the case of a 
Wet Nurse, who will frequently have no menstrual Discharge
and yet become pregnant.- To form a judgment
with any degree of accuracy from this it is necessary
she should have been regular in the discharge.-
Different Opinions have been formed respecting
the period, at which impregnation takes place previous
to the stoppage of the menses, but in a general way
it may be said to be the second Week, or in some instances
may be the third, but no precise time can be 
mentioned




116
Some Women reckon from the time of quickening
that is the first time they have perceived the child
to move, and this has been said by some to be at the 
third, and by others the fifth month, but from observation
which was made upon 100 cases, 80 of them were
found to be at the fourth month, and this therefore appears
to be the Average time, being found to occur 8 
out of 10 times.-
Reckoning from the time of Coitus can only
be depended upon, under particular circumstances.
Management during Pregnancy.
Pregnant Women are liable to be in commoded
by causes, which to others, in a different state would
be harmless, hence attention to the Rules of living
are expedient, these Rules are comprehended in the 
non-naturals, namely Diet, Air, Rest, Exercise, Pathemata,
and Evacuations.-
With respect to diet, this must be regulated 
according to circumstances, but in general 
that which is found to agree best with the Stomach
is the best.- It is very seldom necessary
to recommend a change of Air, except under 



16
117
very particular circumstances, and with respect
to rest that.- Exercise in moderation is often
very serviceable, except under particular circumstances,
as in case of slight floodings, Pains &c.
or in case there has been repeated miscarriges
at some certain Period, under which circumstances
rest must be enjoined, with respect to proper
exercise, that must depend very much upon former
habits, tho' none very violent should be alowed
such as riding on horseback, dancing &c.-
It is frequently of consequence to attend to the 
Dress, as the mode of tight lacing formerly practiced,
must be very injurious, preventing the Uterus
from enlarging in the proper place, and causing
the mouth of the Uterus to be dilated prematurely.
The make of the Shoes should be attended 
to as the high heeled must be very injurious
attending the center of Gravity, and throwing the 
Womb forwards upon the forepart of the Pelvis
in making an alteration in this respect, it should
be done gradually, for if they have been worn for 
any length of time, the muscles will be attend in
their length, and on this account it should be gradual.-
The Passions of the mind have very 



118
great influence upon the Body and therefore
all violent emotion should to avoided as much 
as possible, and care should be taken against any 
thing causing alarm.-
Evacuations are of different kinds, on Practioners
have been of different Opinions respecting 
some of these, it is frequently necessary to act gently
upon the Bowels during pregnancy, as costiveness
is very common, this is best done by any gentle
Purgative in a Pillular form, or may be given
in any form most agreeable to the Patient.-
With respect to the exhibition of Emetics, there
is a general prejudice against them, but which
appears to be without much foundation, as Women
frequently Vomit spontaneously, even with considerable
straining and with impunity, from this 
it appears, that in cases when their use is required,
they may be safely given provided they are
not of too violent a Nature, tho' in account of the 
Prejudice, it will be best to be guarded in their use
and to avoid giving them when the Purpose can 
be answered by any other means, and when absolutly 
necessary, may in some instances be right to give 



119
them without in forming the patients that they 
are Emetics.
Bleeding during pregnancy has been very
much recommended by some, and as much condemned 
by others, it is certainly serviceable in some 
cases, as in case of Plethora, local or general inflamation,
or in case of a rigidity of fibre, it may
be a means of rendering the subsequent Labour
more easy. But you will in many instances
be under the necessity of doing it, on account of Prejudice,
and it may be right to do it from this except
there is some particular circumstance to forbid
its use, as in case of debility, or a disposition to 
a Dropsical state.-
Pathology of Pregnancy.
Diseases occurring at this time, are either arising
out of the Pregnant condition, or accidentally connected
with it, and are distinguished into those 
which occur in the early or latter stages.-
Particular attention should be paid to the mitigation
of their immediate causes, as this will
assist very much in forming a prognosis, and 
in the mode of treatment.-
Most these Diseases may be refered to one 



120
of the following general causes, namly, Plethora,
irritability of constitution, and Mechanical Pressure
this is to be understood to apply to Diseases arising
from the Pregnant State.-
When the Diseases arose from a Plethoric state
that state is known by the usual Symptoms of 
Plethora, and may be relieved by Blood letting, Purging
&c. or by attention to Diet, or Perhaps by both.-
When they arise from irritability of constitution,
the treatment must be varied according to circumstances,
so likwise must it, when in consequence
of Mechanical pressure
Particular Diseases of Pregnancy.
in the early Months.-
Nausea and Vomiting, these may arise from disease
as well as pregnancy, and it should therefore be
distinguished from which of these causes it may arises.
When they arise from a Disordered state of the Prima
Viæ, removing this by means of Aperients &c. will
be the means of cure, in this case you will be unwilling
to give an Emetic on account of the Prejudice
there is against it, but if you cant effectually remove
the complaint without, you may give it with
safety.- When there is much relaxation of the Stomach 



121
a good Emetic in this case will be Zinc. Vitriol. in
the Dose of from zss to zi, this in some measure bracing
the Stomach.-
When these are Sympathetic of Plethora, attending
this by bleeding, Purging &c. is indicated.-
When sickness is a Symptom of internal inflamation,
it may be distinguished by the usual Symptoms
denoting that state, and must be treated in a Secondary
way, regard being chiefly had to the primary complaint
by Bloodletting, purging &c. and by a strict Antiphlogistic
Plan, exactly the same as when unconnected
with Pregnancy.-
When symptomatic of mere Uterine irritation,
or Pregnancy, it will in different instances give 
way to different remedies, as Opiates, Saline Medicines
in the state of effervescence, Stomachic bitters &c. in 
this case, the quantity or bulk of the Medicine is often
very necessary to be attended to, as it will often be rejected
from from the Stomach on account of its quantity
then in giving Opium, a grain of solid Opium will
frequently be of service, when given in the form of a 
Draught it will be rejected.- In giving Saline
Draughts great attention is necessary, in respect
to quantity, and in being properly regulated in respect
to the proper quantity of each, a powder composed of 



122
Common Tart. and Sal. Soda, in proportion of two 
parts of the former, and one part of the Latter, this 
mixed in a small quantity of Water at the time of 
exhibition.- It is often necessary to give the food
in very small quantities, and which should be of the 
most nutritious kind.- In some cases it is necessary
to keep the Stomach perfectly empty for twelve
or twenty four hours, and occasionly giving a little 
solid Opium.- Nourishing Glysters may be 
thrown up the Rectum, and a little of their parts may 
be absorbed, and conveyed into the circulation. 
Warm Plastiers, or Rubifacients to the Scrobiculo
Cordis may afford relief, but in some instances
there will be a complete cessation at the time of 
quickening.- Somtimes it is owing to some particular
smell or effluvia, which was inoffensive 
at another time, in this case the cure is obvious
Pain in the Head and Breast, there are often
Symptoms of Plethora, and relieved by Bloodletting &c.
tho' in some instances, may arise from Sympathy,
in which case the treatment will vary according
to circumstances
Inability to Walk, attended with a sense of 
bearing down, a yellowish Discharge, and painfull 



123
Discharge of Urine, somtimes amounting to 
suppression.- This disease is to be distinguished
from gonorrhea, and may be done by attending to 
the Symptoms, in Gonorrhea, there is pain in making
water, but of a different kind than in this Disease, and the 
the discharge is different, the difficulty in making 
water is relieved by varying the posture, or by pressing
the neck of the Uterus up with the Finger, in some 
cases it may be necessary to introduce the Catheter
The cure of this disease is generally spontaneous,
as the Womb becomes enlarged, taking of 
the Pressure upon these parts, the Disease arising
from pressure
Retroversion of the Uterus, this consists
in the fundus of the Womb being thrown backwards
and which by its situation between the Bladder
and Rectum causes different affections of these 
Parts.- This disease can only be ascertained
by actual examination, for if the Uterus is retroverted,
the fundus is thrown back upon the Rectum
and the mouth of the is thrown forwards towards
the Pubis, and on examination if there is retroversion,
you will find the Os. Uteri in that situation
instead of its natural place, for whenever this is in 
the natural situation, there can be no retroversion.



124
Retroversion of the womb is not confined to the 
impregnated state, as the Womb may be enlarged
from Disease and become in consequence retroverted,
and it may be retroverted in the natural
state, but not be known 'till the Uterus becomes enlarged
either from Pregnancy or other causes, bring on the usual
Symptoms.-
The Symptoms of this Disease usually come on 
about the third month of Pregnancy, as at this time
the Uterus becomes of the size so as to cause these Symptoms,
they consist of Pain, Difficulty of voiding Urine,
constipation of the Bowels, Tenesmus &c.-
The Period of the Symptoms coming on may be 
a little varied, tho' they are always confined to the 
early months, as it cant take place after the Womb
is of a certain size.-
The most common cause of Retroversion of
the Uterus, is a Distended state of the Bladder, and this 
acts by pressing upon the fundus of the Womb so
as to force it downwards and backwards, and at 
the same time by its arising higher up in the Pelvis
it draws up the mouth of the Uterus in consequence
of the connection of these parts, in this way it acts 
in two ways, that is at the time it is forcing the 
fundus down, it is pulling the mouth of the Uterus
up.- Other causes have been mentioned, as a  



17
125
Blow upon the lower part of the Abdomen, but the
Bladder must be in a distended state.- An enlarged
state of the Ovaria, either from a collection of water
within them, or from other causes, may occasion this 
Disease.- Distention of the Bladder may in
some cases be an effect as well as a cause of this 
Disease.- From these circumstances it appears
evident how particularly carefull Women in the 
early stage of Pregnancy, should be to avoid a distended
state of the Bladder.- When the Bladder becomes
very much distended in this complaint there 
is great danger of its being ruptured, and on this 
account it should be frequently emptied by the 
use of the Catheter or by other means, and when this 
cant be done, it will be necessary to puncture the 
Bladder by means of a small Trocar, above the 
Pubis. In some instances when a common female 
Catheter cant be introduced, one of a smaller
size or a different form may, as that which is for a 
Boy.- The Danger in Retroversion is according 
to the state of the Bladder, and Degree of irritation.
The treatment in this case, consists in obviating
the distentention of the Bladder by the introduction
of the Catheter 3 or 4 times a Day, and this in 
some cases is sufficient alone, tho' not always
the length of time this should be tried depends upon



126
the Degree of irritability &c.- Before you attempt
the reduction of the Uterus, the Bladder and Rectum
should be emptied, and the patient should then be 
placed on the Knees and Elbows, and then introduce
a finger or two up the Rectum, and press
the fundus of the Womb upwards, at the same time
with the finger of the other hand up the Vagina
endeavour to bring the mouth of the Womb down,
in case the fingers are too short it may necessary
to have recourse to an instrument, which 
may be made by a piece of cured Cane or Whale bone
which should not be too weak, and at the end a 
Piece of sponge covered over with soft Leather, this 
should not be too small, and should be well secured
upon the end of the Stick, in using this the finger should
be passed up the Rectum along with it, and the force
with which which it is and should be regulated with 
some degree of ninty. The end may in some instances
slip up the Rectum by the projection of the fundus
but this will in a great measure depend upon 
the mode of using the instrument.- The more 
difficulty there is in the reduction the greater
softly there is against a natural.-
It was proposed by Dr Hunter to puncture Her
Uterus, but this must be attended with very great 



127
Danger and has no facts to support it.-
Mr. Cruikshanks thought the Division of the 
Symphisis Pubis might be of some advantage,
this certainly diserves some attention, but has not any
facts to support it, in this case the Patient would not 
be placed on the Knees and Elbows, in attempting the 
Reduction.-
Diseases of the latter Months.
Sickness and Vomiting, may occur now as well 
as in the early stages of Pregnancy, or may continue
from the early stage.- They may arise from Plethora
or from a foul state of the Stomach from irritability
or pressure of the womb upon the Stomach.
If from Plethora, the loss of Blood or gentle Laxative
Medicines &c. may be of Service, and when 
the Stomach being in a disoredend state, an Emetic
will be serviceable, if nothing particular contraindicates,
and afterwards proper Stomachic Medicines.
When irritability or pressure is the cause, these
exhibition of Opium Saline Medicines in the State
of efferverscence &c. must be resorted to, and food
must be given in very small quantities, and frequently
repeated, and should be of the most Nutritive
quality.- In case all these remedies fail in producing



128
producing any mitigation of the Symptoms, and the 
patient appears to be sinking under the complaint,
and not likly to support it 'till delivery takes place
naturally, it may be right under such circumstances
to bring on Labour prematurely, by puncturing
the Bag of Waters so as to alow of their Discharge
and Labour will then come on the course of some 
time, perhaps may be a Day or even two
Jaundice, when this is merely a consequence
of Pregnancy, there is little Danger and the treatment
may be confined to the Palliative, where 
there is much pain in the Epigastrium, the use
of Opium Aperients &c. may be necessary.- The way
Pregnancy causes Jaundice is by pressure, which 
tho' not directly yet may be indirectly upon the 
Billiary Duct.-
Jaundice during pregnancy may somtimes
depend on a Schirrous state of the Liver, or Diseases
of the Billiary Ducts; such cases are more complicated,
and the mode of treatment must depend upon
the Particular part effected.-
Costiveness may depend either on torpor of 
the Intestines or upon Mechanical pressure, and 
may become very inconvenient, and therefore should 



129
be obviated by means of Purgative Medicines, and 
by the use of Glysters. In some cases the Feces become
very much indurated, rendering it necessary
to break them down by means of a large Bougie, and 
them to inject a Glyster for the Purpose of bringing
them away.-
Hemorrhoids are in two states namly
Bleeding and Blind Piles, and a third Kind particularly
noticed by the German Practitioners,
which is called Hemorrhoidal Cholic, the Symptoms
of this complaint are Cholicky pains in the Intestines
and which may be traced along the Colon, Caecum
and Rectum, and which are relieved by a Discharge
of Blood, these pains are not cured by the common
thing in the use for pains in these parts.
As Mechanical Pressure is intimatly connected
with the Production of Piles, they will often continue
'till delivery takes place, but it will be advisable
to Palliate the Symptoms, by means of Leeches applied
to the parts, or by Saturnine ointments or washes,
a good ointment for this Purpose is one composed
of Simple ointment, with a portion of fine powdered
Galls and Opium. Patients are frequently alarmed
for fear the Piles should produce Fistula in End
but this is seldom or never the case.
There are some other complaints remain to be 



130
mentioned, but which are not of very great consequence,
as the swelling of the lower extremeties, this 
may be relieved by means of a Laced Stocking.-
Some Women have considerable uneasiness
from the violent movements of the child, in this 
case you may moderate the Symptoms by means
of Opium.-
There will in some instances Black Spots
appear upon different parts of the Abdomen, and 
which may alarm the Patient, but are of no consequence,
and will disappear after delivery, they are 
probably owing to the rupture of some of the small 
vessels, in consequence of the Distention.-
Diseases accidentally connected with Pregnancy.
Lues Venera, when this Disease is in the 
form of Gonorrhea, the treatment is so gentle
as not to require particularly to be mentioned in 
this place, but when in the form of Chancre, it then
becomes a matter of much more consequence, for 
tho' they are only primary sores, yet from their slowing
absorption of Matter, constitutional Symptoms
may be produced, as Ulcerated throat, Eruptions &c.



131
Chancres are often cured without Mercury by 
the parts being destroyed with a Caustic, but the constitutional
or secondary Symptom require the 
use of a considerable quantity.-
When Salivation is produced during Pregnancy,
some have apprehended dangerous effects, but this 
is not necessarily the case, as the only thing of consequence
is its disposing to premature Labour.
Different opinions have been formed respecting
the mode of conduct proper under these circumstances
some have given Mercury in the alterative way so
as to produce a temporary cure of Symptoms, and 
this way gaining time 'till delivery has been effected,
but this must depend upon the Stage of Pregnancy
and upon the urgency of Symptoms, for if the Symptoms
are such as wont admit of Delay, you must
then proceed to the Cure, conducting the course with 
more caution, tho' with even so much, Abortion
will frequently take place.-
Dropsy, by this is meant Ascites, not Ovarian 
Dropsy, this Disease when connected with Pregnancy
comprehends some subjects for enquiry, namely,
whether Delivery is possible, whether the Patient will
live after Delivery, wether the Child will be Dropsical
whether tapping in proper, and whether a Cure will 



132 
succeed. With respect to the first of these, that is, the 
possibility of Delivery, experience proves this to be the case,
and without any extra Difficulty, for tho' the expelling
Powers are less, yet those of resistance are proportionally
diminished, but with regard to the second subject,
that of her living after Delivery, this is extremely doubtfull
on many accounts, one of which is the degree of 
Debility then present, and which will be very much
increased by the discharge which necessarily attends delivery,
and which is somtimes greater than others.
The third question is the child being necessarily
affected with the same Disease as the Mother, this [cross out]
is not the case, but it is impossible to say whether
the child will be Dropsical, for it may or may not 
be the case, as children are frequently born Dropsical
of sound and healthy Parents and the reverse, but a 
Dropsical state of the Mother entails no such state
in the Child.-
The Fourth circumstance; is the propriety of 
tapping under these circumstance, this is always
proper, whenever, the Disease is in that state to require
it, but should be done with caution on account
of the Danger of the Trocar being forced into the Uterus,
but this danger is entirely done away, by inabling



18
133
an incision with a Lancett, carefully thro' the integuments
in the course of the Linea Alba, the hole
into the Cavity of the Abdomen being about the size 
of the Canula of a Trocar, a Probe should be introduced,
into this opening, and upon this Probe or 
Canula slided into the opening.-
The last of these questions, is whether a Cure
will succeed Delivery, this has in many instances
taken place, and the way this is generally affected
is by the fluid escaping thro' the Fallopian Tubes
into the Uterus, and in this way been evacuated, the 
extremeties of these tubes are loose and floating in 
the abdomen, and tho' in the natural state it may
not be possible for any fluid to escape by this way
yet a certain action may take place in them
which may be the means of evacuating the fluid.
Hernia, are frequently very much effected 
by Pregnancy, and the purpose of considering this subject
more effectually, it will be necessary to divide
them into two states namely, Reducible and Irreducible.-
When the Hernia are Reducible, the Phenomena
are subject to variations, depending on the seat of 
the Rupture, as being either Femoral, Inguinal, Ventral, 



134
or Umbilical.- Reducible Hernia are generally
cured, that is temporally, by Pregnancy, except in particular
situations, as at the Umbilicus &c. which it
somtimes increases, and in some Women Pregnancy
always produces Hernia, when they are not subject to
it at other times.- It is very seldom proper to use 
a Truss for the Ruptures during Pregnancy on account
of the Pressure necessary to keep the parts reduced.-
Irreducible Hernia are dangerous in the extreme
as the ascent of the Uterus, may bring on Strangulation.
Whenever amongst other Symptoms, a patient informs
you of having a Hernia, and which she has 
not been able to reduce for some time, you should lay 
particular stress on the necessity of keeping the Bowels
compleatly open, and this should be done even if the 
Hernia is reducible.-
Women out of Delicacy will frequently avoid mentioning 
their being subject to Hernia, therefore in all
cases of violent pain in the Bowels, more particularly
if confined to any particular part, and this 
does not give way to the common modes treatment in
a moderate space of time, you should make particular 
enquiry and examination, to ascertain whether
there is any thing of this kind.
When Pregnancy is somewhat advanced, perhaps  



135
about the fifth month and Symptoms of Strangulation
come on, the treatment then becomes very complicated
and the event uncertain. It has been proposed, (when
the common methods of proceeding have failed) to bring 
on premature delivery, and by this to take off the exciting 
cause, but the mouth of the Womb is in general so rigidly
closed, that this could not be done without using a greater
Degree of violence than would be consistent with 
safety.- When the parts are in a relaxed state, and 
easily dilatable, this is a favorable circumstance and 
you may then proceed to dilate the parts in a slow 
and gradual manner and this way bring on Labour,
taking care not to use any violence.-
When the os. Uteri is in a rigid state, introducing an 
instrument and puncturing the membranes to evacuate the Waters, has been proposed,
for the purpose of bringing on Labour as this will follow
sooner or later, but this must depend upon the state of 
the Hernia, for if in the advanced stage there wont be 
sufficient time to wait for this, nor even to wait for 
bringing on Labour in the other way [cross out] when the parts
are dilatable, if it is in a still more advanced stage.-
When this is the case the operation becomes absolutely
necessary, but which is attended with considerable
difficulty, an account of the adhesions, and other circumstances.-
The operation should be performed in 
the usual way, and when the hernial Sac is laid bare
this should either be divided or not according to circumstances,



136
circumstances if it does not adhere, and you have reason to 
suppose the Contents are in a state proper to be returned
you may then do so without opening it, but if there is 
considerable adhesion, or you have any doubts about 
the state of the contents you should then lay open the 
Sac, for the purpose of examining them
Stone, when speaking of Stone as connected with 
Pregnancy, not only Urinary, but likewise Biliary
Calculi are comprehended.-
Gall Stones when in the Biliary passages, produce
Symptoms which should be distinguished from Labour
Pains, the Pain arising from the presence of a Gall
Stone in the Biliary Ducts, is about the Scrobicula Cordis,
is attended with considerable sickness and vomiting, and 
now not slow of that compeat intermission, which takes 
place in Labour pains, then will likwise after some 
little time be an affection of the Urine and Skin, and 
in the course of some length of time the pain will cease
from the Passage of the Stone into the intestines, a quantity
of Bile will be evacuated by stool, and the whole
of the Symptoms will disappear, at least 'till another
of these calculi obstruct the Passage.-
For the Purpose of moderating the Symptoms, Opium
should occasionally be given, and gentle aperients, and 
Bladders of warm warm Water should be applied to the 



137
part, or fomentations &c.- It would be very advantageous
to prevent a fit of the Gall Stone, at this time
and which may be attempted by ordering a greater
Degree of Exercise, and at the same time giving Aloctics
combined with Saponaceous Medicines, or by the exhibition
of Lixis Sapon. in the Dose of 30 or 40 Drops, three
times a Day and which may be gradually increased to 
a teaspooonfull, it should be given largely diluted, a convenient
vehicle, is a quantity of Mutton Broth, as this very
much sheaths the acrimony of the medicine, but the effects
of these remedies are very doubtfull.-
Urinary Calculi may either be seated in the 
Kidney, Ureters or Bladder, which may be distinguished
by attending to the Different Symptoms, when the Stone
is in the Kidney, the will be considerable pain in that
part of the back opposite the Kidneys, and which pain
will extend down the Thigh along the course of the Nerves
and as the Stone passes along the Ureter, the seat of the 
pain in the Back will be changed, and often a time all 
the Symptoms will cease from the Passage of the Stone
into the Bladder, when other Symptoms will come on,
the Urine will likwise be tinged with Blood at times.
By attention to these circumstances, and by the continuation
of pain, this may be easily Distinguished from
Labour pains.- The treatment will be different according



138
according to circumstance, as whether there is inflamation 
and fever or not, it will be right under all circumstances
to keep the Bowels sufficiently open, a good medicine
for the purpose is Castor oil, this may be made 
into a Mixture by the addition of a little Kali &c. and
along with this, opium should be given joined with Ipecacuhana, 
or Antimonials, and Bleeding if necessary should be 
had recourse to.-
When calculi a situated in the Bladder being formed
there or have passed from the Kidneys, different Symptoms
take place, as sudden suppression of Urine, discharge of 
a quantity Mucus &c. in the Urine, and occasional pain,
but as these Symptoms may arise from some other 
affection of the Bladder it may be right to try the use of 
some remedy in the first place, as by giving Uva Ursi
in the quantity of from 3ss to 3i two or three times a Day,
for some time [time].- If the Symptoms dont 
give way to these [illegible] of treatment, you should
then make examination, and in case you ascertain
the existance of a Stone different opinions have been
entertained respecting the propriety of performing the 
operation for its removal, but if this cant be effected
by any other in cases it may be done.- You may
somtimes ascertain the size of the stone by passing your
finger up the Vagina, and getting the Stone upon it, if
it is small it may possibly be got away without an 



139
incision being made, by dilating the Urethra, by a 
series of Bougies, or by the introduction of an intestine 
(with the end tyed up) into the Urethra, upon a long probe
or Bougie, and then forcing a quantity of Warm Water
into the Intestine to dilate it, and likwise the Urethra
this last method has been found successfull.-
If the Parts cant be sufficiently dilated in this 
way, recourse must be had to a cutting instrument,
but in using this it must be remembered, that there 
is some danger of wounding the Crura Clitoris, this 
renders the operation less perfect, this does not add to 
the danger of it.- The incision should be made in 
an oblique direction, the edge of the Gorgett being 
inclined obliquly downwards, and in this way the 
danger of wounding the Crura is lessened.-
If the existence of a Stone in the Bladder is 
not known till labour comes on, a good deal of management 
is necessary to prevent mischievous
consequeces, and for this purpose different ways 
of proceeding have been recommended, Dr. Smellie
advised the raising up of the Stone, and this is a very
eligable mode of practice of it can be done, if on
examination in the early stage of Labour the Stone
is found below the head of the Child, if this has not 
descended much, the Stone may be raised above the 
Brim of the Pelvis, and this way prevent serious consequences,



140
consequences, for this purpose a Male Catheter or a Sound 
may be introduced into the Urethra, and two finger
(one on each side the Instrument,) up the Vagina, and 
in this way acting upon the Stone, and raising up, and 
when you have done this you should keep it raised
for some time, 'till pains come on, and force the 
head of the Child lower down, and preventing the descent
of the Stone.- To effect this some time may possibly 
be required, and the woman should be placed in the 
most favorable situation.-
Some have recommended the introduction of a pair
of Forceps up the Urethra, and extracting the Stone by 
that means, but there a great objections to this mode
if much force is used, on account of the injury which 
must be done to the Parts.-
Another mode of proceeding has been recommended,
and which is much more eligable, that is, the making 
an incision from the Vagina, into [cross out] lower part
of the Bladder, opposite its superior Curve, as the Stone
generally lays there.- The way of doing this, is by carrying 
a finger up the Vagina opposite to that part, and 
introducing a curved Bistory upon it, and in this way
making an opening into the Bladder.- The Bistory
should be covered by means of somthing passed round
it, except towards the end.-
It has been advised in a case of this sort to open 



19
141
the childs head when the other methods fail, this 
may somtimes be necessary, but there is one thing 
to be taken into consideration, which is the Death
of the Child.
Examination.
By this is meant manual examination, and 
which should always be conducted with the greatest
Delicacy and gentleness, so as to give as little pain
as possible.- The reasons for examining are comprehended
under five particular views, namely.
1st. To ascertain the existence of Pregnancy. 2d. To
determine its period. 3d. To know if Labour is present.
4th. To know the precise kind of Labour, 5th.
To investigate the true nature of a Disease.
Some Dexterity is required in making examination,
and in case you find it necessary to examine
by the Rectum likwise, it is much better to mention
it, to prevent then forming a bad opinion of your
judgment, supposing you make a mistake.- When
ever you find it necessary to examine, it will be 
adviserable to have another female in the Room
more particularly if the Person is a Stranger.-
Shall now proceed the different views separatly.



142
1st. To know if a Woman is Pregnant. There is very
little to be gained from examination on this account
before the third month, on account of the enlargement
not being sufficient to alow of a determination being
formed, and this may be still increased if there is 
a Degree of corpulency, or from a distended state of 
the Bladder, but this last circumstance may be removed.-
From these circumstances it is always
much better to decline examining, except particularly 
requested, and then it is best to mention the 
uncertainty.- The best position for the Purpose of 
making examination is half sitting and half lying as
this places the Pelvis on a horizontal situation, and 
before you attempt to examine the Bladder should
be emptied.- The way to examine is to pass two 
or three fingers of one hand up the Vagina, to feel for 
the neck of the Womb &c. and with the other press
upon the Abdomen, doing this alternatly, and you 
may somtimes be able to ascertain the size and 
state of the Womb, the larger the Uterus is, the more easily
will Pregnancy be ascertained.
2d. To ascertain the Period of Pregnancy.- This is 
done either by observing the degree of the Wombs ascent
in the Abdomen; or by the shortening of its Neck.-
Shall first mention the circumstance of the Wombs



143
ascent at the third month the fundus of the Womb is 
just above the Brim of the Pelvis, at the 5th,, Month, half
way between this and the Umbilicus. 6th,, Month, a little
higher, 7th,, Month, even with or a little above the Umbilicus,
8th,, Month, halfway between the Umbilicus and Scrobiculs 
Cordis 9th,, Month, at the Scrobiculs Cordis.-
With respect to the shortening of the neck of the 
Womb, that remains of its full length 'till the end of the 5th,, Month
namely 1 1/2 In. after which time it begins to shorten,
at the 5th,, Month 1 1/2 In. 6th,, Month a little shorter 7th,,
Month 1/2 In. 8th,, Month, somthing less 9th,, Month, entirely
gone, the way to form this measurement is 
by passing the finger up the Vagina and pressing against
the Body of the womb, and forming your measurement
by the finger.- But in forming a judgement
it is best to compare both these methods, along
with other circumstances
3d,, To determine the existence of Labour.
Before this can be done it is necessary that Labour.-
should be defined.- Labour consists in the evacuation
of the fetus and Involucra, from the Uterus,
and is divided into natural, laborious, and preternatural
Labour.- Natural Labour, is when the 
head of the Child presents, and the Labour is terminated
without instrumental assistance.-



144
[illegible]. see after
Laborious Labour, is when the Head likwise
presents, but from circumstances, as a greater degree
of resistance from any cause, the aid of Instruments
is necessary.-
Preternatural Labour, consists in the Presentation
of any other part but the head, as the Arm,
Breech &c.-
The Symptoms of Labour, are pain, dilatation
of the Os. Uteri protrusion of the Membranes & Water,
tension or relaxation of the membranes, during the 
Presence or absence of Pain, and you may form some
opinion of the Stage of Labour, and of the kind, and length,
of time it is likely to be before its termination, from
there, and from the advancement and recession of 
the child during the presence or absence of Pain.-
Pain alone is not to be depended upon as a Symptom
of the existence of Labour, as this may arise from 
many other causes, as Cholic &c. nor even if with combined
with some dilatation of the Os Uteri, as this may 
be in a relaxed state, from some cause, but if along
with these you can feel the protrusion in some measure
of the Bag of Waters, it then becomes a certain sign.
4th,, To know the kind of Labour, this should always
be ascertained as soon as the Progress of the Labour
will permit, more particularly if the Waters have been
evacuated, as if there is a necessity for turning or any 



145
thing else to be done, this is the most favorable opportunity
for doing this.- I making examination to
ascertain the kind of Labour, the three different kinds
must be kept in View.-
Natural Labour, supposes proper Presentation
of the Head, sufficient Room in the Pelvis, and 
sufficient Pains.-
Laborious Labour supposes either want of Room
or want of Pains.-
Preternatural, when any other part except the 
Head presents.-
When the head of the child presents the Labour
may still not be Natural, and the aid of instruments
will become necessary, but you should wait some time
to see what nature will do (if there is nothing contraindicates)
for you cant always determine whether there
is want of Room or not, tho' this may be done after
some time, for tho' the Pelvis may be sufficiently large
and the head not larger than common, yet if the Bones
of the head are more ossified than usual, this may
prevent its passing, and the Reverse of this may be 
the case.- With respect to the sufficiency of pain
you cant form a correct judgement from the quantity
of Vociferation, but from the effect it has on the 
muscular actions of the Different parts, in general the 
most is done, when the patient holds in her Breath
and bears down, as the breath the Lungs contain, assists 



146
the action of the Muscles in forcing down.-
5th,, To distinguish the Disease in Question, various
Diseases require examination which have been before
mentioned, such, Cancer Uteri, Polypus, Retroversio Uteri &c.
Natural Labour.
Natural Labour is divided into quick or lingering
Labour according to the time necessary for its
completion, as in some cases the Labour is over in 
the course of two or three hours, in other cases much
longer, as for instance 2 or 3 Days or more, when ever the 
duration of Labour is protracted more than 12 hours
it then becomes lingering. There is another Distinction,
made by Women, that is into Sick, Wet or Dry
Labour, according as Sickness occurs, or the parts are 
in a moist or Dry state from the quantity of Mucus
secreted.-
Labour is likwise divided into three Different stages,
the first stage is the dilating process, and every thing
that takes place 'till rupturing of the Membranes.
The 2d,, stage is from the evacuation of the Waters 'till
the Birth of the Child is compleated.-
The 3d,, Stage includes every thing which occurs after
this as the expulsion of the Placenta &c.
[illegible] bound



147
Preparatory Considerations.
A young Practitioner should adopt the Customs
of the Country in which he resides, the position in
which a Woman is delivered varies, in some places
she sits on the lap of another Woman, in other a 
stool or Chair of a particular form is used, but 
these modes are very objectionable, for this throws
the Pelvis on a horizontal position, and if the parts
are in a relaxed state, and the Pelvis large, the Child
may be expelled so suddenly as to produce considerable
injury by either breaking the Umbilicus, suddenly
detaching the Placenta, bringing on hemorrhages
or by inverting the Womb, which will be very easily
done when in this state.- Her Position in general
use in this Country is the left side, and is by far the
best, the Patient may be either above or under the Bed
cloaths, tho' in general under them is preferable.-
Guarding the Bed is another circumstance
necessary to be known, this is by means of a Skin of 
Leather or any thing that wont alow the wet to penetrate 
to the Bed, and over this a Blanket &c.-
All postures are not the same tho' the Patient is
on the left side, for the purpose of rendering the Posture
the most convenient, the Patient should lay on the left



148
side, with the Knees bended, and brought towards
the Abdomen, and with the breech to the side or bottom
of the Bed, facing the Practitioner.-
It is adviseable more particularly if you any
Distance, to take somthing for the Purpose of making
a Purging Glyster, and a little R a Opii, for in many
instances, when the Pains are weak, and instead of forwarding
the Labour, only teaze and weaken the Patient
25 or 30 Drops of Tinct. Opii will be of great use, by
putting of the Pains entirely for some time alowing
the Patient to get some sleep and by that means being
refreshed, the Pains will after a time return with 
more vigour, and compleat the Labour.-
With respect to the Propriety of taking Instruments,
that must depend upon circumstances, as 
the Distance &c. and upon the command the Practitioner 
has over himself, as whether his having them
with him will cause to use them unnecessarily,
these things taken into the account, it may under certain
restrictions be adviseable to take some simple
Instrument as the Lever.-
Incidents connected with the first stage of 
Labour.- Pain is one of the first signs, this originates
in the Back and Loins, in the begining the Pain is confined,
but becomes more diffused as Labour advances,



20
149
Sometimes the pain begins in the fore instead of the back part,
and if this recurs at intervals in the same way as the 
other, it may be equally a sign of Labour, but if this pain
is continued, or has only very slight intermissions it
probably is owing either to Cholic, or to inflamation
if there are at the same other symptoms joined with this 
as a degree of fever, quickness of Pulse &c.-
The Pain in the begining is very slight, and in 
the begining continues perhaps 1/4 or 1/6 a Minute, recuring
at intervals of 15 or 20 Minutes, but as the Labour advances
the Pain becomes more violent, and continues longer
recuring at shorter intervals, so as towards the last
to be nearly continued pain and exertion.-
The cause of this Pain is the contraction of the 
Womb upon the Fœtus, for the purpose of effecting its
expulsion.-
Show. This is another sign of Labour, this is 
a discharge of Mucus secreted by the Mucuos Fallicles
about the mouth of the Womb, and when this becomes
a sign of Labour is tinged with Blood, this discharge
will somtimes take place a Day or Perhaps more, before
the commencement of Labour.- The red tinge 
is probably owing to some small vessels being ruptured,
in consequence of the mouth of the Womb becoming
a little Dilated.- Somtimes Labour comes on without
any discharge of this sort taking place.-



150
The Use of this Discharge is for the purpose of lubricating
the parts and rendering the dilating process more 
easy, and facilitating the Passage of the Child.-
Women will frequently this Discharge of Mucus
(untinged with Blood) for a considerable time previous
to Delivery, and in very considerable quantities, and 
will frequently be very much alarmed on account
of the supposition that it will weaken them and be 
a cause of difficult Labour, but this is not found
to be the case, and the Labour in some instances
appear to have been easier on this account, from 
there being a greater Degree of Relaxation. It is seldom
necessary to do any thing on this account, except
they appear anxious for somthing to be done,
in this case you make a Tonic Mixture of some 
kind as Decoct. Cort. &c.-- In some cases they 
may suppose themselves injured, and will make 
inquiries respecting this, you must be very cautious
of giving an Opinion, and before you do have some 
other circumstances than discharge alone.-
Show is not a sign of actual Labour, only of 
its approach, Pain is the first Symptom of actual
Labour.-
Rigor.- Labour is frequently ushered in 
by a Rigor, and frequently as a Symptom of Strong
Pain is a favourable circumstance, but this is likewise



156
likewise a Symptom of Fever, or internal Inflamation, it then becomes
an unfavorable symptom.- It becomes
necessary to distinguish the cause which gives rise to 
this Rigor, and which may be done by attending to
circumstances.- That from Labour may be distinguished
from Rigor as a Symptom of Fever, or Inflamation,
in having not hot stage, going directly from 
this to a state of Perspiration, and in the being no whiteness
of the Tongue &c.-
Vomiting. This is frequently Symptomatic
of strong Pains, but somtimes of internal inflamation.-
Vomiting as a Symptom a Labour may be 
distinguished, from the same symptom as connected
with fever or inflamation, by the Absence of Fever, state
of the Tongue &c.- If a Symptom of Labour and it is 
very violent, and frequent, it may reduce the Strength
of the Patient very much, and therefore should be moderated,
by the exhibition of R [illegible] Opii. Aq. Menth. or by 
the use of Saline Draughts in the state of effervescence.
Micturition and Ischury. These may both
occur during Labour, and arise from the Pressure of 
the Womb upon different parts of the Bladder, on this account,
(if micturition) you should never stay long in the
Room at a time.- If there is suppression, it may sometimes
be necessary to draw off the Urine with the Catheter
tho' pressing up the Womb with the finger will frequently
be sufficient.- 



157
Tenesmus. This often occurs and more particularly
in the latter stage of Labour from the Pressure of
the Childs head upon the Rectum.- In some cases, when
there is considerable relaxation of Parts, and the Labour
is considerably advanced, it will not be safe to alow
the Patient to make use of the close Stool, as the Child
might by the action at that time be expelled, but if any
thing passes away as the Patient lays it must be removed
by means of Cloths, &c.-
Observations &c.
On certain proprieties of conduct concerning
Labours.-
Always go as soon as sent for, as this may
somtimes be necessary and will always give more 
satisfaction, and be carefull to avoid any conduct
that may occasion alarm, is this tends to check and 
somtimes to divert the Labour Pains.-
If the Labour be in the early stage, do not stay
in the Room too long at once.-
Never be anxious about making examination
if the Labour is not much advanced, for you cant determine
much by it in this stage, and the Nurse or Attendants
will either ask, or set a Chair by the side of 
the Bed, with some Pomatum &c. which be to the same 
Purpose. The proper time for examination is 
when Labour is somewhat advanced, and the parts 



158
are become Dilated or when the bag of Waters has been
broken if this has not been done before.-
It is not necessary to repeat the examination
very often, and in doing the Presentation, and Progress of 
the Labour should be kept in View.
The Patient need not constantly be confined to the 
left side or to the Bed during the whole of the Labour
but either occasionally walk or sit in a Chair, in the 
begining Labour, tho' this cant be alowed in the 
later stages.-
First Stage of Labour. This begins with pain
in the Loins, which in the begining is confined, and 
continues only for a short length of time, and recurring
at long intervals, but after some time this becomes
more diffused, continues longer, and recurs at 
shorter intervals, and along with this a bearing down
of the Uterus, the external Parts become relaxed, and 
the mouth of the Womb a little dilated, after a little time this becomes
more dilated, and the membranes protrude, or you may
feel the fetus, [in] making examination, which should always
be done during during Pain, as not only give less
Pain, but feel every thing much more distinctly.-
There is frequently more time required to gain
a Dilatation to the size of half a Crown that to effect
the remaining Dilatation.
The dilating process gradually goes on and the 



159
Bag of Waters becomes considerably more protruded
and if these after a time are not ruptured, it will
be necessary to do this by means of the Finger Nail,
or pressure with the finger upon the Bag, if there is much Water,
for if this was to go on and the Child was to be expelled 
with the membranes whole, it would be literaly
drowned in its own waters, the same as in any other
fluid, as the supplies from the Mother are cut off.-
The proper time for rupturing the Membranes
is when the Mouth of the Womb is considerably dilated,
so as to alow the head of the Child to act as a 
Wedge, for the farther dilatation. There is great
disadvantage in evacuating the Waters too soon, for 
the Head is not able to effect the Dilatation, so well
in the begining as with their assistance, therefore
you should never rupture the membranes too
early.- If there is a considerable quantity of Waters
it will be better to collect them upon a Cloth &c.-
When the Waters are evacuated if you have
not before examined, or if you have any Doubts
about the case, this is the proper time for examination,
and to ascertain the situation &c. for if
there is a necessity for any thing to be Done, this 
is the most favorable time for doing this, such
as turning &c. for if the Womb is alowed to contract
more force will be required, and of course more pain
and Danger to the Patient



160
Second Stage of Labour.- This comprehends
all that takes place from the Rupture of the Membranes
'till the birth of the Child is compleated.-
The begining of this Stage is the proper time for 
ascertaining the situation and presentation, if this
has not been done before. If the Pains are Strong
and the parts relaxed the Labour now proceeds very
quickly.- When there is great relaxation of the external
parts, and this not the first Child, it will not 
be safe to alow the Woman to sit up or Walk about 
as the Child might be suddenly forced away and if she 
walking, fall in the Floor, and be a cause of considerable
Danger.-- In quick natural Labour, the 
head is very much forced down by a few pains, after
the escape of the Waters, and when the head has been
small or the Pelvis large, the same pain that has 
ruptured the membranes, has expelled the Child.-
The time when assistance becomes necessary
is when the head becomes forced against the Perineum
as there is some danger of its becoming lacerated, and 
which laceration may extend to the Rectum, this 
is a Matter of very great consequence, as there is generally
a high degree of irritation comes on, and the parts
wont again unite, and the power of retaining the fœces
is the consequence.- This is often occasioned by 
the improper use of Instruments. They way to prevent
the laceration of the Perineum is to press against 
it by means of the Hand or a Cloth, or by pressing against 



161
the head of the Child so as to regulate its passage, this 
must be done no more than is actually necessary
on account of retarding the Labour.-
The way in which the head passes the external
parts is with the Occiput to the Pubes of the Mother.-
When the head has passed the external parts, you
should examine to know if the Chord be round the 
neck of the Child, and if it is, it must be put over the 
Occiput, or the opening dilated, and slided over the 
Body of the Child as it passes.-
When the head has passed you must apply
one hand on each side, for the purpose of making
a little extension, and direct to Patient to hold in her
Breath and force down, you must extend gradually
pull down, giving the Body the proper turn, that is with 
the Shoulders to the Sacrum and Pubes, the long Ax is 
opposed.- When the shoulder have passed, you must 
make extension by them.
You must not remove the child from the parts of 
the Mother, for if the Navel string is short, you run the 
risque of breaking it, or detaching the Placent, or of inverting 
the Womb, all of which are of very great consequence 
as the Child passes, you should bend the Child
towards the Mother.-
You should not immediatly tye the Chord, but feel
for the Pulsation, tho' it is not necessary to wait till that 
ceases before you apply the Ligature.- If from the Pulsation



21
162
Pulsation you have reason suppose the Child alive, you
must not tye the Chord 'till the  Child breaths, and 
after waiting a little time it does not, the Body may
be rubed with gentle stimulants, or it may be necessary
to throw air into the Lungs, by stopping the Nose, and 
blowing into the mouth, at the same time pressing upon
the Thyroid & Crycoid Cartilages, so as to prevent the 
air escaping into the Stomach, for that would be doing
injury, and you must endeavour to immitate respiration
by pressing the air out again continuing this 
for some time.- Another way of inflating the Lungs is 
by means of a small curved pipe of a proper construction
introduced into the Epiglottis, they way of doing this 
is by passing your finger down into the Œsophagus 
'till you feel the Glottis, you must then pass down the 
Tube by the direction of the finger into the Epiglottis
and by that means throw in Air. This last mode
preferable.- Whilst these attempts are going on the 
Body should be kept warm.- If tho' the Pulsation
in the Chord was strong at first, this gradually becomes 
weaker, and after a time ceases, this is an indication
of Death.
The Ligature is generally made about 2 or 3 Inches
from the abdomen tho' 1 In. would be quite sufficient tho'
it would be inconvenient to make very near to the Abdomen
as a small portion of Intestine might be protruded at 



163
the Part, or if the Ligature was to come off there would be
difficulty in fixing on another.- A second Ligature
must be made nearer the mother, and the part between
the two divided by means of a Knife or pair of Scissors.
The necessity of making this second Ligature occurs
very seldom, but it is right always to do it, it occurs only 
when there is another child and the Vessels of each
Placenta communicate, in this case the second Child
would bleed to Death if this Ligature was neglected, tho'
then would be no danger to the Mother
Third stage of Labour. This consists
in the expulsion or extraction of the Placenta.-
The Placenta is not to be extracted immediatly
after the expulsion of the Child, for as the womb
is not yet contracted the Vessels of the Uterus remain
of their full size, and a considerable Hemorrhage.
would be the consequence. The interval may be 
employed with advantage in attending to the Child
and if there is much faintness in the mother, as 
there frequently will be, a small quantity of 
some Cordial may be given, but you must be particularly 
carefull that too much is not given, or 
it may do considerable mischief.-
Before you attempt to extract the Placenta
always be certain there are no more fœtuses, and 



164
which you may do by laying your hand upon the 
Abdomen, and making gentle pressure, if there is no 
more, you will feel the parieties of the Abdomen fluid
and Uterus in the center, contracted into a hard round
substance, but if there is another Child, there will
still remain a general enlargement of the Abdomen.-
Somtimes the Uterus is not disposed to 
contract, and this may give rise to a supposition of their
being another Child, but by making pressure upon
the Abdomen to assist the contraction, will very 
soon determine the Case.-
With respect to the time which you should
wait before extracting the Placenta, this must 
depend very much upon circumstances, if there 
are no unpleasant Symptoms you may wait 
longer, but if flooding &c. comes you must extract
more speedily, as a general Rule from 15 to 20 Minutes
may be the proper time.-
Nature will very frequently expect the Placenta
without any assistance, but if this becomes
necessary, this is given by taking hold of the Chord
with a Cloth in one Hand, and pass the two fore
fingers of the other hand up the Chord to the Placenta
then separate them taking hold of the Placenta between
them, making extension both by Chord 
and by means of the Fingers, endeavour to extract it 



165
which if there are no adhasions you will be able
to effect.- When the Placenta is extracted, or is 
expelled, you should apply a Cloth to the parts, squeezed 
out of warm Water, and another under the Thigh, as 
it may be adviseable to let the Patient remain a
little time before she is moved.-
When the Uterus shews no disposition to contract
and expel the Placenta, if there is no flooding
you may endeavour to excite this contraction, by
rubing the Abdomen with some kind of Liniment
tho' it is the friction which renders the service.
Practitioners have varied very much in 
this opinions respecting the Extraction of the Placenta,
some advising in all cases to extract immediatly 
whether there is flooding or not, others recommend
leaving it entirely to Nature.- Both these 
extremes a wrong and Dangerous, a middle course
of proceeding is best.-
The speedy extraction may bring on profuse
Hemorrhage, by detaching the Placenta
whilst the Vessels are yet large and uncontracted,
when this is the case assisting the contraction of the 
Uterus by pressure upon the Abdomen or by other
means will answer a good purpose.- The speedy
extraction may likewise cause inversion of the Uterus
more particularly if the Placenta is attached to the 

The inversion of the Womb is somtimes partial
which may be known by passing the fingers up
the vagina.- This may be mistaken for a Polypus
are you are not carefull in making the Distinction.
The reduction must be attempted by pressing upon
the middle of the Tumor.- 

166
Fundus, and the attempt to extract has been made
by the Chord.- Flooding chiefly occurs when the 
Placenta is partially detached.-
When the Uterus is inverted the reduction should
be immediatly effected, for any time is alowed to 
elapse before this is attempted, the Uterus will have 
began to contract, and render the reduction either 
extremely difficult or else impossible.-
To prevent inversion of the Uterus, you should
wait 'till the Uterus is in some degree contracted,
except in case of flooding, in which case, before you
attempt to pull the Placenta [cross out] away you should compleatly
detach it, by passing up your hand and grasping
it, so as to effect a separation before you pull down.
The way to attempt the reduction is by pressing
upon the fundus of the Uterus so as to dent it in 
gradually proceeding in this way 'till you have
compleatly returned the Parts, not only within the 
Vagina, but compleatly into this natural situation,
which may be known by the way the hand 
passes up, and by feeling with the other Hand upon
the abdomen.- If the reduction cant be effected
it then becomes a Matter of very great consequence.
Death will somtimes take place very shortly 



167
from the shock given to the System, and if this does 
not then take place, it will do so generally after a 
length of time perhaps a may a Year or two.-
The Part which forms the external Surface 
of the Tumor is the internal part of the Uterus, than 
part from which the Menses flow, this flow not
only takes place at the usual Periods, but with greater
violence, and often recurs at shorter intervals,
and in the intermediate times a Discharge of a Serous
kind generally occurs, this produces a great degree
off irritation, and Debility, and generally ends in Death.
When the Uterus is inverted with the Placenta
attached, it becomes a question whether it will best
to separate it or not before reduction, this last appears
to be most eligable.-
Leaving the expulsion of the Placenta entirely
to Nature, is attended with Danger, as many
Die in consequence of it from its producing a 
high degree of irritation &c. and which my perhaps
by moderated by the use of R a Opii &c and the Discharge
corrected by Antisceptic washes or injections.
Somtimes the Uterus will contract so forcibly
if the Placenta has been left for a length of time, as 
to prevent the introduction of the hand, without 



168
doing more injury by the Violence used, that will
arise from leaving the Placenta, in which case
it must be left, and the Symptoms moderated by 
proper treatment.-
The Navel String is somtimes broken off in 
this case you must pass your hand up into the 
Uterus, and separate the Placenta & bring it away.-
Impediments to the Extraction of the Placenta
somtimes arise from Schirrous adhesion at 
others from irregular contraction of the Uterus.-
Schirrous adhesion does not so often take
place as has been generally supposed, when it has 
done, there must have been some Previous pain 
in the Part, and Chronic inflamation, in consequence 
of which a quantity of Coagulable Lymph is thrown 
out, which forms an adhesion betwext the Maternal
part of the Placenta and the Uterus.
In this case the Child will be expelled and every
thing will appear to be going on well, the Uterus
will contract and form the round Tumor in the 
Abdomen, after waiting a proper time, on attempting
to bring the Placenta away this cant do [illegible] and 
upon introducing the hand, the Placenta will be
found to adhere, if this adhesion is small, a little
force will effect the separation, but if the portion 
Sevri Cartilaginous?



169
which adheres is large it will be very Difficult if 
not impossible to effect the separation. Probably a 
Pair of Forceps might answer a good Purpose in 
assisting the separation, in using them you give no 
pain if only the Placenta is taken hold of.- You
must either by means of these or other means separate as 
much of the Placenta as possible, comparing the different
Portion when extracted.-
If any portion of the Placenta is unaviodably
left, (but none should if possible to extract it) Symptoms
of Fever and very high irritation will come on, and 
the use of various medicines and Remedies will be 
required to alay these as by Opium, Saline Draught
in a state of effervescence, internally, and likwise
antiseptic injections, as an injection of Ag. Hord.
℥vj Vis. Rubr. ℥ij.
When the Difficulty arises from irregular
contraction of the Womb, this may be from untimely
contraction of the Os. Uteri or a preternatural 
contraction at any one part of its Body.
The mode of treatment in both these Cases is 
nearly the same, but is different according on these
is or is not flooding, if there is no flooding you may
wait a little time and possibly the contraction may 



22
170
go off, or a Dose of Tinct. Opii may be given, and 
which in some cases will take off the Spasm.-
In some cases the Spasm only recurs at 
intervals, in this case on passing up your fingers
the part may contract upon them, but by proceeding
gradually you will overcome this, and be 
able to extract the Placenta.-
But when there is flooding, the case is different,
as there is then considerable Danger, this 
flooding somtimes brought on by puling at the 
Chord or perhaps by breaking it off, this could not 
have happened if both Hands had been used, as the 
cause of the Difficulty would than have been discovered.-
In case of flooding you must proceed
more rapidly, yet not so as to use any violence
you must introduce the hand gradually passing
it into the contraction, and by degrees Dilate the 
part 'till you have passed your Hand, and can
take hold of the Placenta, you must then endeavour 
to extract it, if you have only in the first
instance got hold of a small portion you should
endeavour to take hold of a larger, or it may be 
torn off, and which will frequently be the case
removing it by Degrees 'till you have extracted
the Whole, comparing the Different portions and proceed



171
proceed 'till the whole is extracted.- I will not be 
necessary to take the hand out, every time you have
detached a portion, but to slide that part downwards.-
Lingering Labour. This is when the Child
is a greater length of time than common, in expulsion, 
it is not called lingering if over in the course of the 
Day.- The cause of lingering Labour either deficiency
in the expelling Powers, or increased resistance,
or both.-
Defect of Pain, may depend upon Debility,
Plethora, Passions of the Mind, Over distention
of the Uterus, or any thing that may check the general
Exertions of Nature.
Debility requires the use of means that 
can give strength and afterwards to stimulate
the parts to act, such as Cordials of Different Kinds
as Ag. Menth. &c. and occasionally a little wine,
and this in most cases will be sufficient, tho' in
some cases a stimulus will be necessary, such as 
walking about, or by the introduction of the finger
or the Lever, not for the purpose of Delivery, but of 
exciting the Uterus to action.- In some cases when
than is only weak, with giving any assistance towards
the Progress of the Labour, only teazing the Patient and 



172
keeping her awake, a Dose of Ra Opii will afford considerable
Service.- Some have supposed that Debility 
could not be a cause of Lingering Labour, as 
Women have been Delivered when labouring under
Phthisis, and with the greatest Ease, but in this 
case the powers of Resistance are likwise diminished.-
Plethora.- This may be a cause of Lingering
Labour.- You may easily Distinguish this State 
the Countenance and other usual Symptoms, this 
Plethora should be removed by Bloodletting &c. and 
then the Pains will frequently come on sufficiently
if not you may Stimulate the parts to action as 
above.- If you apply this Stimulus before you
have made the evacuations, you run the risque
of some Vessel being ruptured, and this happen
in any part of the Body as the Lungs &c.-
Passions of the Mind. These always divert
the Pain, therefore all causes of Mental Agitation
should be avoided. If any thing of this sort has 
taken place, it may sometimes be necessary to 
take away a little Blood, or to exhibit some Tinct:
Opii.-
Over Distention of the Uterus. This acts 



173
in the same way as an over distention of the Bladder,
if this is from a larger quantity of Water than common,
rupturing the membranes more early than
common will be of Service, this may be slow when
the Os. Uteri is not more Dilated than 1/2 Crown, but
before this is done the case should be will ascertained
for if you evacuate the Waters and they were not 
the cause you do injury.-
Impediments to the general Exertion of Nature.
there may be from different causes, as inflamation
of the Lungs V.S. preventing the action of these parts
in assisting Labour.- Cholicky pains, along
with those of Labour may be another cause in
this case a Purging Carminative Glyster may 
be injected, or Purgatives joined with Carminative
may be given, these will be of Service by procuring
a Discharge of Filatus.- If Opium is given
before the remedies above have been tried it will
do injury, and will be of Service if given after.
Increased Resistance.
Toughness of the membranes may be another 
cause, acting upon the Principle of increased resistance,
when the Mouth of the Womb is sufficiently
Dilated.- Rigidity of Passages, Disproportion
of Parts, and Unfavorable Situation of the Head,
are likwise causes of increased Resistance.-




174
Toughness of the Membranes. This cant impede
the progess of Labour in the early Stage, only
when Labour is somwhat advanced, and the Os. Uteri
considerably dilated, in this case you should Rupture
them, for if this is not done the Whole Ovum
may be expelled together, but this would require
very great Exertion and the Child must be still
born for it becomes drowned in its own Waters in 
consequence of the communication with the
mother being cut off. There is danger too on this
account to the Mother, for the Womb being Distended
for a length of time after the Placenta has been
Detached, a considerable Hemorrhage may be 
the consequence.-
Rigidity of the Passages. This is more frequently
the cause of lingering Labour than any other
and may easily be ascertained.- In a case of this 
sort it will be much better to mention the Delay
that is likely to take place. Under these circumstances,
the objects to be kept in View, are to effect
a relaxation of Parts, to gain time, to guard against
accidents, and to encourage the Patient.
When there is rigidity the loose of some Blooding
possibly be of Service, keeping the Patient still and 



175
and cool, and not alowing much company to 
be in the Room, and keeping the Patient upon a low 
Diet not alowing any thing of Strength to be given.
Whatever will produce relaxation will be of Service
tho' very little can be done by Medicine, it may be right
to give somthing Simple to satisfy the Patients Mind.
Antimonials in nauseating Doses have been recommended,
tho' the continued nausea must be 
very unpleasant. If the Pains are weak and 
only teaze the Patient, a Dose of Ra Opii may be 
of Service by procuring Sleep and that way gaining
time and Strength, and a Glyster may be occasionally
given with advantage.- The Patient may
likwise have warm Fomentations applied to the 
Part, or sit over the Night Chair with some Warm
water in it, these are not of much real Use, tho they
may shew the appearance of Doing somthing.-
A considerable time will elapse before there 
is much Dilatation of the Os. Uteri, perhaps a Day
or more before it has gained the Size of 1/2 Crown.
and the Labour may be 2, 3 or even 4 Days before it 
is terminated.-
If Women of a Rigid Fibre, Blood should be taken
away two or three times during Pregnancy and 
she should live upon rather a low Diet if nothing 
Particular contraindicates.- 



176
During this dilating process, there will sometimes, 
Symptoms come on which are attended
with Danger, as Convulsions, and which is generally
indicated some time before they actually take place
by particular Symptoms, as Pain in the head
Loss of Sight, a Morbid Sensibility of the Eye &c. this 
Pain in the Head is very much different from 
the common Headach, being a violent darting, Shooting
Pain.- When these Symptoms take place
it may be right to inform the Friends of the Patient
what is likely to follow, and there is Plethora
the loss of Blood may be a means of preventing 
this may be taken from a Branch of the Temporal
Artery or Jugular Vein, if there appears a Determination
to the Head.-
Disproportion. This is understood to be 
only slight, and only requires time to alow the Bones
of the head to accommodate themselves to the Passages
this should be ascertained when you examine and 
this should be done not only in one or two points
but entirely round
Unfavorable Situation. This may likewise
be a cause of lingering Labour, as any situation
different from the Natural one is more unfavorable,
and some of these more than others.-

[words crossed out] with its Pearson
23 and [Rem???])

23
177
There are some other Causes which are supposed
to be a cause of lingering Labour, but 
which are somwhat Doubtful, as the Premature
bursting of the Membranes, this may in some 
measure be a cause by reason of their assisting
in the Dilation of the Os. Uteri in the begining
before the head cant to advantage, and the violent
Action of the Parts may force the Womb, down
out of its Place, and if it does not do this, the injury
done may dispose to procidentia Uteri.-
The Cord being round the Neck of the Child has
been supposed by some to be a cause of lingering
Labour, but this cant possibly be the case.-
The Shoulder of the Child hitching upon the 
Pubis, is another cause supposed by some to be
a cause of this kind of Labour, this cant retard the 
Passage of the head, tho' when the Head has passed
the external parts, it may be a cause of preventing
the Body from being expelled, you may remedy
this by pressing with the Finger upon the Neck
of the Child so as to depress the Shoulder, and then
give it the proper turn, and when you can take 
hold of the Shoulder you should pull by them, being
always carefull of applying pressure in the Axilla
on account of the Axillary Plexus of Nerves.



178
Whenever you are called to a Labour which is 
lingering you should always make inquiry, what
this arises from, and whatever that may be, you
must take measures accordingly.-
Laborious Labour. This is when Nature
is not able to expel the Child, tho' the Head presents.
These cause of this is either disproportion between
the Pelvis & Head, Defect of Pain, or a greater
degree of Ossification of the Bones of the Head.-
Disproportion may either be on the Side of the 
head or Pelvis, as the Pelvis being deformed, or the 
head enlarged from any cause as Hydrocephalus
or the extra Ossification preventing the Bones yielding
as they commonly do.- There may in some 
instances be disproportion both on the side of the head
and Pelvis.-
Disproportion varies in its Degrees, the lesser
of which may be relieved by the more gentle means
the greater by more severe treatment.
Nature in all these cases should be alowed
to exert herself to see what can be done without
assistance.-
The milder kinds of Laborious Labour are 



179
manageable by the use of the Lever or Forceps
which do no injury either to the Mother or Child
if properly used,- The more severe kinds require
the Perforator and Crotchet to remove the 
disproportion.- For the milder kinds of Laborious
Labour, [crossed out] Fillet has been recomended
but from the difficulty with which it was applied
the use of it is laid aside.-
An Instrument resembling the Lever was 
invented by a Mr,, Chamberlin, but which had 
very little curve, and on that account would be
applied with very little advantage.- After a time
the Lever, which is more curved was invented, and which
is now very much used and with advantage in the 
milder kinds of Laborious Labour:- The Lever now
in use, is considerably more curved than what was 
formerly used.- The Lever acts with advantage and without
injury if properly used but may do considerable
mischief if applied improperly.-
The Forceps were afterwards invented and which 
act with advantage when the Lever frequently
wont succeed.- The French make use of longer
Forceps than is the Practice in this Country
an apply them under different circumstances
that is when the Head rests [cross out] at the Brim of the 
Pelvis.- The Lever may be be of Service when the 



180
Head rests upon the Brim of the Pelvis, and is out of 
the reach of the common Short Forceps, tho' the long
curved Forceps have been applied with advantage
when the head rested at the Brim in consequence
of some disproportion, and in a case or two when it 
would have been necessary to open the head, only
for the use of these.
The Forceps in common use in this Country are
considerably Shorter, and are only applied when the Head
is low down in the Pelvis.
Dr,, Luke invented Forceps with three Blades
but two are used much more readily and with
greater advantage, as they will alow as much
force to be used as either of Service or consistent
with Utility.- Those Forceps are the best which
will alow the protuberance of the Parietal Bones
to go it into the opening in the Blades, and at 
the same time are bevilled off so as to lay close
to the Head, for the part which gives the Resistance
is that protuberance, and the Forceps cover this
they add to the Back of the Childs Head.-
The intention for using the Forceps are to 
bring the Child away alive, without injury to the 
Mother.
Consideration regarding the Use of the 
Forceps. There comprehend the Propriety of using  



181
them, the Rules to be attended to in all cases, and 
Rules applicable in Particular Cases.-
Various reasons have been assinged for the 
use of this Instrument, but these are not all of 
equal weight.- One very good reason when a 
Woman has been in Labour for a considerable
length of time the head low down in the Pelvis, the
Pains have been Strong but are now going off the 
Patient much exhausted, and Floodings or Convulsions
attending, but the Forceps may be applied
with propriety and advantage in cases much
less urgent.-
Another reason for the use of the Forceps has
been assigned, which is when the Navel String comes
down before the head if the Child, there is no danger
Danger from this circumstance to the Mother
tho' very great to the Child, you may endeavour
to put this to one side when it wont be pressed
upon by the head, but if this cant be done the the 
Forceps may possibly be of Service by bringing the 
Head more quickly this the external parts.-
The Bladder and Rectum should always 
be emptied before the Forceps are introduced.
The Patient may lay on the left side in any 
position of the head with respect to the Pelvis,



182
but with the Breech opposed to the Practitioner, and 
very near the edge of the Bed, it will somtimes be
necessary to support the Feet by means of a 
Chair.-
The Forceps should always be used Warm.
The Os. Uteri fully Dilated.-
The Head descended low down.-
The instrument introduced during pain
as both Blades have the same construction
it is immaterial which is introduced first.
The direction of the Blades must be determined
by the Ears of the Child, as the Forceps should
be applied on each side of the Head.- There is 
one exception to this when the head of the Child is 
just entering the Brim of the Pelvis, and this is 
narrower from the Pubis to Sacrum, and the face
of the Child is to either side, the Long Forceps are 
required here and they may be applied to the 
Face and Occiput, this case may somtimes
be relieved by the Forceps tho it will frequently be
necessary to open the Head
If you warm the Forceps and are carefull in 
using them you may somtimes do this without
the Knowledge of the Patient or by Standers, more particularly
if introduced during pain, which should  
a



183
always do, not that you can introduce them with
more ease, but you will give less sensible pain.
You cant often introduce the Forceps unknown
tho' the Lever frequently may.
If you attempt to introduce the Blades before the 
mouth of the Womb is compleatly Dilated, you run
some risque of doing injury by forcing the end of the 
instrument against that portion of the Vagina, which
is joined to the Uterus.- From this cause the Rule
of keeping the point of the instrument close to the 
Head arises.-
When you are about to introduce the Blades
it is immaterial which of them is introduced first
as they are both formed alike, tho' it is best to introduce
that with the left hand first (if you introduce
them sideways) and the right hand Blade over this,
and when you introduce them above and below, it
is best to introduce the lower Blade first.-
When are about to introduce the instrument
you must prepare the way by the introduction of 
the Fingers to separate the Labia &c.- then take one 
of the Blades loosely between the Thumb & fingers, and
introduce the Point under the Fingers, carrying it
gently or with the Point close to the head, 'till you have 
passed it sufficiently high up.- If you meet with 



184
any resistance, you must not use force to overcome
this but gently alter the Direction &c.- When you 
have introduced the first Blade, you must fix this
by means of the third and fourth finger and the Thumb
of our hand, whilst with the first and second you
prepare the way for the other, which you must introduce
in the same gradual manner, always taking
particular care respecting the Locking of the Blades.
If you find you have not got good hold it is not 
necessary to withdraw the Blades, but to move them
gently and by that means fix than properly.-
When you have fixed the forceps properly you
should not immediately begin to draw down, but wait
'till pains come on, and then make extension, having
off when the pains ceases &c.
You must not make the extension in a direct
Line, with in a line to correspond with the Axis of 
the Pelvis, gently moving the instrument from side 
to side as you extend.- Considerable care is necessary
when the head approaches the external parts,
if the Perineum does not Dilate sufficiently, you
must attempt to do this forcibly, but by keeping up
a regular degree of extension, and inclining the 
Handles of the Forceps to the Abdomen.-
Some care is necessary in taking the Forceps



24
185
off more particularly if you have used them without
the Patients knowledge
Application of these Rules, to particular
Cases. No Part except the head is proper for the 
application of the Forceps, tho' they have been applied
to the Breech and might act with considerable force
but the points will press upon the Abdomen, and 
may do considerable injury, in this case the Blunt
Hook acts with much more advantage and safely
but this will be mentioned hereafter.-
The Forceps can only be applied to head in
to two presentations, the Vertex and Face.-
When the Vortex presents, the Face may have
different situation with regard to the Pelvis, the
French have formed six cases from this, but these
may be divided into two namely, the Ears to the 
sides of the Pelvis or opposed to the Pubis and Sacrum. 
When the Ears are to the Sides of the Pelvis with
the face in the Hollow of the Sacrum, the Woman being
laid on the left side with the parts as near the edge  
of the Bed as possible, you must then introduce the 
Blades as directed first [cross out] below than [cross out] above, as by this
means you secure the Locking much more easy.
In some cases you are not able to bring the parts 



186
sufficiently near the edge of the Bed to alow of the introduction
of the Second Blade, you may then pass it sideways
over the face of the Child, for a little way, and 
then turning the Handle downwards, you bring the 
Blade opposite the other, and by carrying it a little 
forwards easily bring them to a Lock.- You must 
then proceed according to the general Rules
When Ears are situated to the Sides of the Pelvis
with the Face to the Pubis. This is attended with 
much more difficulty on account of the parts
not being so well adapted to each other in Shape
In this case if the presentation is ascertained
early before it has entered the Brim of the Pelvis in
any degree, Dr,, Smellie, recommends passing up
the hand to find the feet, and bringing the Child
away by that means.- This may be advisable if the 
case is early ascertained.- When the head has passed 
only a little way within the Pelvis, Dr S. recommends
passing up a long pair of Forceps, and fixing
them on the Head, to raise it up by Degrees 'till he 
can give it the turn with the Face to either side, and 
afterwards when the Head has descended somwhat
lower to turn it with the face to the Sacrum.
In some cases this practice may be adviseable.



187
adviseable.- Objections have been made to this if the
Uterus acts with much force, on account of the 
Vertebra of the Neck being injured, or the Uterus ruptured,
but these depend very much upon the way in 
which the attempt is made.-
In this case the Forceps must be applied on
each side the same as in the last, but the utmost
care will be necessary to prevent a laceration of the 
Perineum, the extension must be made gradually
and the occiput depressed as much as possible to make 
the Axis of the head as Short as Possible.- In speaking
in this way of the application of the Forceps the head
is understood to be low down in the Pelvis. so as tummy
is out of the Question
It will often be a question whether it may not
be better to open the Head of the Child than to use the 
degree of force which would be necessary for the Extraction
of the Head, as the Child will be still born, and a
considerable Degree of injury must be done to the soft
Parts.- When the head is considerably descended, it 
will somtimes be very difficult to ascertain the presentation
and Situation on account of the accumulation
of Scalp, obscuring the Fontanels &c.-
When the Ears are to the Pubis and Sacrum.
The head is considered as low down for they are 
always in this situation, at the time of entering the 



189
Pelvis.- The situation should be clearly ascertained
to form a judgment which way you should give
the Head the Turn, for if you make a mistake
and instead of turning the Face into the hollow
of the Sacrum, should bring it towards the Pubes
you render the case extremely difficult instead
of an easy one.- In some cases when you cant
feel either Sutures or Fontanels from the accumulation
of Scalp, you may determine the situation by
this circumstance, as the accumulation is always
greatest at the Occiput.- The Blades of the Forceps
must be applied towards the Pubis and Sacrum, the 
Blade towards the Pubis first.- When the Blades are 
properly fixed upon the Head, you must gradually
turn the Face into the Hollow of the Sacrum.
The Face Presentation. This is when the 
face presents with the Nose in the Center. In 
this case the Chin may be to any part of the 
Pelvis.- The head wont pass so easily as in 
the Vertex presentation, tho' it will in many
instance pass without any assistance, the Forceps
are sometimes necessary.- To gain a perfect
knowledge of the mode applying them with the 
greatest advantage, it will be necessary to understand
the way in which the head passes without 



190
assistance.- The most simple case is when
the Chin is opposed to the Pubis, as in this the
head passes with the greatest ease. In this case
the Chin is forced forwards and downwards by
the Spine acting upon it, and as it passes takes
exactly the same turn as the Vertex presentation
the Chin gradually emerging under the Pubis.
When the Forceps become necessary you must 
have the above circumstances in view, exactly the 
same as when the Vertex Presents.- The Blades
must Lock over the Mouth of the Child, but you
will not find the so well adapted to the Shape of 
the head as in the other presentation.- When you have
got good hold by the Forceps, you must draw down 
depressing the Chin so as to alow it to pass out under
the Pubis, and then elevate the Handles of the 
Instrument so as to bring them towards the Abdomen
of the Mother 'till you have effected the Passage
of the head, and then proceed as in a Vertex Case.
When the Chin is situated to either side, the 
object is to incline the Chin to the Pubis, and 
proceed as before.- If the head is high up, it may
be necessary to bring it down rather lower, before 
you attempt to give the turn.-

 

191
The Chin is somtimes situated towards the 
Sacrum, here the extraction of the Child alive is
scarcely possible unless the Head be very small.
Fortunately these cases rarely occur.-
On the Use of the Lever.
The management of the Lever supposes a Knowledge 
of the general Rules for using the Forceps,
also the necessity for using it should be well ascertained.-
The cases which render the use of the 
Lever proper, are when nature has done a good
deal but wants some assistance to compleat
the Business.- This instrument is improperly
called a Lever, as this might lead to a wrong mode
of application, it is not to act on the Principles of a 
Lever, but when applied to the head, and its action opposed
by means of 2 fingers, it acts similar to the 
Forceps tho with less advantage.-
It has been recommended to make use of 
the Lever when the head is at the Brim of the Pelvis
but this can seldom be done with advantage, and 
may often do much injury by bringing a Vertex Presentation
to that of an Ear &c.-



192
This instrument can only be applied with advantage 
to two parts of the head, namely the Occiput,
or by passing it along the Side of the Face fix the Fenestra 
of the Blade upon the Chin.-
It is necessary to ascertain the exact Situation
before you apply it, for in case of a Vertex Presentation,
of it was wanted to bring Down the Occiput
and the Instrument by mistake is fixed upon the 
Chin, the case will be changed to a face Presentation.-
When the Head is about to make the Turn
it is better to leave this to Nature, as the Face may 
possibly be turned Forwards, and then you do injury.
The same general Rules are to be observed
as in the introduction of the Forceps.-
You may know when the instrument is fixed
upon the Chin by comparing the Part of the Head
you can feel, with the Blade of the Instrument.
When the instrument is applied you may apply
two or three fingers of the other hand upon the head
of the Child to oppose it, and act in the same way
as with the Forceps, gradually puling down, and at 
the same time makeing use of lateral Motion.
You should be carefull in applying it to the fore
part of the Pelvis in account of the Urethra.-



193
Perforator & Crotchet.
In cases when neither the Lever nor Forceps
can effect the Extraction of the Head, either in consequence
of the Narrowness of the Pelvis, largeness
of the Head, or any other cause, the disagreeable
alternative of opening the head by means of the 
Perforator and Crotchet must be resorted too.-
As the child must in this way be destroyed
the necessity of doing this must be well ascertained,
and if there is the least possibility of bringing 
the Child away (alive) without this, and without
very much endangering the Life of the Woman, this
should be done, this is in case the Child is alive
but if it is already Dead, you may frequently
save the Woman very much by lessening the head
sooner that you would do provided it was alive.
You may often form some Idea of the Business
provided she has had former Labour, and 
thsen have been difficult, tho' this will not amount
to any thing like certainty, for tho' it may
have been necessary to open the head of the Child in
2 or 3 former Labours, yet there may have been 



25
194
some alternation in the Pelvis, or the head of this
child may be small, so that it may pass.
This circumstance may assist the judgment 
and proceed without so much Hesitation.-
If this necessity has only happened once, you
cant reply upon it so much.-
It is much safer to trust to the measurement
of the Pelvis together with accurate observation
respecting the head, and in making 
this measurement and examination you should
do it compleatly in all parts.-
The Necessity of opening the Head may depend
on different causes, but which are resolveable
chiefly into one, namely, Defect of Room.
This may be either from the Pelvis being smaller
or the head larger or more Ossified, so as to prevent
its yielding.-
But it is sometimes admissable to open
the Head where the Disproportion is slight,
this is in case the Child is Dead, but in doing 
this there should not be the least Doubt respecting
the Death of the Child, and the different Signs
of which should be well examined, these any great
Mobility of the Bones of the Cranium, Separation
of the Cuticle, Emphysema, want of Pulsation 





195
in the Cord, Putrid Discharge, want of Motion
in the Child, Discharge of the Meconium &c.-
All these Symptoms are fallacious, tho'
some of much more consequence than others.-
Great mobility of the Bones, this is a vague
term, but by it is meant, a very high Degree
so that the Bones may be formed into any 
Shape, and feels as tho' the Substance of the brain was
destroyed.-
Separation of the Cuticle, this has taken place
without the Child being Dead, tho' is one of the best
single signs.-
Emphysema, this arises from many other
causes, but may assist in forming an Opinion.-
Want of Pulsation in the Cord. If this can
be felt (as Cord), it is a very good sign, for the Child cant
live long after this ceases to beat, tho' it may for 
a Short time.-
Putrid Discharge.- This may arise from 
many other causes.-
Want of Motion in the Child. This is the 
most ambiguous sign of any, for the Child is
frequently not felt for a great length of time
before Delivery and yet may be born alive.-



196
Discharge of the Meconium.- If the breech does not 
present this is one of the Strongest Signs of the Death
of the Child, but somtimes when the Breech presents
this will be forced away tho' the Child is alive, by the
pressure of the Thighs and Knees upon the Abdomen.-
Others Symptoms have been mentioned but 
which are of very little consequence, as want of Pulsation
at the Fontanel, but this can be very seldom
be felt.- Movement of the Child from side to side
this of no consequence.-
But in forming the opinion several of these 
Symptoms should be combined, as they are all liable
to fail singly, and if you cant compleatly make 
up your mind respecting its Death, you must
then proceed on the Supposition that is alive.
Different instruments have been invented
for the purpose of opening and extracting the Head,
but those now in use, are the Perforator, Crotchet,
and Blunt Hook, and in some cases a pair of 
large Forceps with long Teeth.-
When you are about to use these Instruments
the Woman should lay on the left Side, with the 
Breech very near the Edge of the Bed, and you should
be seated opposite the Breech to give as much command



197
command as possible, for the Business will often be attended
with very great Fatigue.-
You must first introduce the left Hand
to find the Sagittal Suture or Fontanel, and then
pass up the Perforator up the Groove made by
the hand, to the Cranium, and then with a motion
the same as when using a boreing instrument,
pass it into the Scull, and before you attempt
to open the Handles, be certain the Point is in 
Cranium, not slided on one Side, you must then
take hold of the Handles, and open them, and then
change the position and open them again, and 
afterwards move them round when open to break 
down the Substance of the Brain, you may then
introduce a Spoon for the purpose of scooping
out part of the Brain.- After this has been done
some have recommended to wait and see if 
nature wont finish the Business, but this should
never be done, but should immediately proceed to 
extract the Child.- If the disproportion was not 
very great very little assistance will effect the 
extraction, but if the Disproportion was very 
considerable, then will be often a great deal of Difficulty.-
When slight, the Blunt hook passed up 



198
so as to fix upon some part of the Cranium, will
affect the extraction, by drawing gently down, and
is best done during pains.- If the Blunt Hook
is not sufficient, you must then have recourse
to the Crotchet, by passing it up and fixing the 
Point on some part within the Cranium, you 
must pull down, but always have your fingers
opposite the Point of the Instrument to prevent 
its injuring the Mother in case it should Slip off
or the Bone give way.- Somtimes different portion
of Bone will give way, and become detached, you 
must be very carefull in effecting the removal 
of these to prevent their injuring the Parts, by
bring them down with some Care, or by Doubling
them between the Thumb and fingers before you attempt
to bring them away.-
The Instrument may somtimes be fixed
with advantage on the ouside of the Cranium
when the rest of the Bones are very much Detached.
If the Pelvis is very narrow it may sometimes
be necessary to bring the Basis of the Cranium
down sideways.-
The large Forceps may be employed with advantage,
by taking hold of the sides of the Scull after the 
Summit has been detached.- After the Child has
been brough away it will be better either to cover the head



199
with a Cloth or unite the parts by means of a Suture,
to render its appearance less disagreeable.-
After opening the Head, some practitioners have
recommended passing up the hand to find the feet
and bring them down, but this should not be done,
for the portions of Bone may injure the internal
Surface of the Uterus very much.-
If the head is enlarged from a collection of 
Water called Hydrocephalus, simply puncturing the 
Head may be sufficient.-
In all cases of this kind it will be much
better to call in another Practitioner, before you attempt
to open the Head.-
If the Resistance is at the Brim of the Pelvis
the long Curved Forceps may possibly bring the 
head down when it otherwise would have required
being opened, they may be used with advantage if
the Disproportion is small, but if it is considerable
the Child will die from the necessary force being
applied therefore it will be better to open the head
as this does less injury to the Mother.-
The Patient living abstemiously during Pregnancy
will somtimes be attended with good effect  



200
It has been proposed and in some instances
practiced with success, to save the Life of the Child
by bringing on premature Birth, in case of Distortion
of the Pelvis.- The Period at which this must 
be done must in some measure depend on the 
degree of Distortion, but cant be done to answer the 
intended purpose, before a certain Period.- Most
of the Children die, that are are born at or before the 
7th,, Month whether accidentally expelled or this excited
by act, therefore seldom should be proposed at that 
period, but will be much more likly to succeed if 
deferred till Pregnancy has continued 7 1/2 or
8 Months, but you cant do this with Propriety
except you know the exact Period of Pregnancy,
and to do this the Woman must be very accurate
in her Reckonings, and this may be done with 
the greatest certainty from the cessation of the 
Menstrual Discharge, if she has been regular
previous to that time.- Quickening is much
more uncertain, but that has been spoken of before.
The mode of bringing on premature Labour
is by evacuating the Waters, this is done by means
of the Stilet or a Catheter, you should pass your
finger up as a guide, and then pass this 2 to let up
the neck of the Womb, which is not yet compleatly 



201
obliterated, and Puncture the Bag of Water, not 
using any force afterwards to bring on Labour, but
this after some time (perhaps 2 or 3 days) will come
on.- You will know when you have punctured
the Bag of Water by its drilling away
Preternatural Labour.
In Preternatural Labour the Head comes away
the last part. These may be divided into two 
Classes, as requiring turning or not.-
The first Class will comprehend the Presentation
of the Feet, Knees or Breech, as the Child can 
pass thro' the Pelvis in that Direction.-
The second, comprehends the presentations of any
other Parts as the Arm Back &c. these requiring
turning before they can pass.-
The Presentation of the Feet being the most Simple,
shall first speak of that.-
In this case the Mouth of the Womb must 
be sufficiently dilated, or you will meet with considerable
Difficulty in compleating the Extraction
therefore never pull down 'till the Os. Uteri & external Parts is compleatly



20
202
compleatly dilated, for if this is not the case, when 
the Breech or Shoulders are at that Part they will
occasion considerable delay, and if it is the Shoulders
or head, the Death of the Child will be the consequence
as it cant Breath, and the communication with 
the mother is cut off.-
The Belly of the Child should be to the Sacrum
to alow it to pass with the greatest case, and if by the 
situation of the Toes you find this not to be the case
you should turn it in this direction in pulling down
by doing this as soon as you have got hold of the 
Thighs, not deferring it longer or you will find much
more difficulty in doing it.-
When the Parts are sufficiently dilated, you
must then take hold of the feet by means of a 
Cloth, and pull down gently, moving the Child from
side to side as you extend, when the Child is come
low down as for instance the Breech near the 
external Parts, you must not then wait for pain
but go on extending; and direct the Woman to hold 
in her Breath and force down, for if you wait
in this stage the Child will be lost from the Pressure
made upon the Navel string.- When you 
have brought the Child so low that the Shoulders



203
are approaching the external parts, you must
then bring the Arms down, one after the other, this 
must be done by passing up your finger and pressing 
upon the Arm at the elbow joint for the purpose
of giving the hand a sweeping direction over the 
face of the Child, when you have got one Arm
down, you must proceed the same with the other
and when both arms are extracted, you must
not then pull down, but pass the forefinger of 
one Hand into the Mouth, and take the Occiput
between two fingers of the other Hand, you have
them compleat command of the head, which
you must give 1/4 of a turn to make the Head
correspond with the long line formed by Cavity
between the Sacrum and Illium, but the Head
wont pass out in this direction, you must therefore
turn it back again, with the Face to the 
Hallow of the Sacrum, then by depressing the 
Chin you are able to bring the Head out without
much difficulty.-
There will be more difficulty attending this 
case if it is the first Child, more particularly
if the Woman is advanced in Years, in this case
you should wait 'till the Parts are more fully 
Dilated



204
Breech Presentation. This is when the presenting
Part is the Breech with the Anus in the Center.-
This should be distinguished from a Hip presentation
which wont pass, but which may be changed
into a Breech case.-
In this presentation the back of the Child
may be situated towards any part of the Woman
tho' the most favorable is when the Back of the 
Child is towards the Belly of the Mother.-
The situation may be know by feeling the 
Notes, and the opening between this; and the Scrotum
which somtimes becomes very much Distended 
by the pressure made upon the Abdomen, forcing
fluid down into the Tunica Vaginalis Testis 
When the Back of the Child is opposed to the 
Belly of the Mother, [and] and Both Child and Pelvis
are standard, if the Pains are sufficiently 
strong, Nature will frequently terminate the 
case without assistance, but when there is either
disproportion or deficiency of Pain, assistance
becomes necessary, and if the Child is near the 
outlet a finger may be introduced into the 
Groin, and gradually pulling Down first on 
one side and then the other; but the Breech is



205
situated higher up, a Blunt Hook may be used
acting first on one side and then or the other 'till
you can act with the Fingers.- You must go on 
in this way 'till you can grasp the Breech, which
you must do as soon as possible, and then go on 
pulling down 'till the Feet drop out and then the
case must be finished as in the Foot case.-
You must not attempt to pull the Thighs
out but kept going on pulling by the Breech,'till
they fall out of themselves.-
In applying the Finger or the Blunt Hook
in the Groin you must not act upon the Thigh
but upon the Pelvis of the Child above the Groin.
When the Pelvis is too narrow to admit of the 
Breech passing, you must pass up the Hand or
find the feet, bringing them down, and endeavour
to extract the Child singly, if this cant be done
the Head must be opened.-
When the sides of the Child are to the Sacrum
and Pubis if it is necessary to make any extension
by the Finger or Blunt Hook in the Groin
you must have the Axis of the Pelvis in view, and pull down
3 times as much in the back as in the forpart 
'till you can grasp the Breech, and then you
must do it and turn the Child with the back to
the Belly of the Mother which brings it to the first case. 



206
When the Back of the Child is to the Sacrum. In 
this case you should endeavour to bring the Child into
the first situation, by taking hold of the Breech as
soon as you are Able, and give it 1/4 of a turn, and 
in the course of a little time longer, another 1/4 turn, and 
which will bring the Back to the Belly of the Mother
and make it the same as the first case.-
In this case it might be adviseable to endeavour
to turn the Child with the Face to the Sacrum
before it has descend much with in the Pelvis, by means
of a Pain of long Forceps fixed on each Hip, and often
the turn was affected to take them off and proceed as 
in the first case.-
When one Foot presents.- This is to be managed
in part like a foot and in part like a Breech
case, by gradually extending &c. 'till the foot Drops
out, and then finish as before mentioned.-
When one or both Knees present. In this 
case you must draw down by the Thighs, 'till the 
Legs drop out, and then proceed according to the 
directions laid down for the foot case.- 



207
Turning.
Turning consists in passing up the hand to find
the Feet, when any other part presents, and is divided
into turning from Necessity and turning from Choice.
When turning from Choice is mentiond it must 
not be understood to be from caprice, but that in this 
case the Child might possibly be born without turn
yet, if the Child is turned, the Danger will be less.-
When neither the Head, Breech nor lower Extremities
present, then turning is required to affect Delivery, this 
is turning from Necessity.- In cases of this sort
it was the Practice of the Ancients, to take the Child
in Pieces, for the purpose of extraction, if they could
not by any means bring down the Head.-
Hypocrates directed the Woman to be shook, under
the Idea of changing the situation of the Child.- 
Ambrose Puree was the first who recommended the 
the turning the Child in cases of this sort by passing 
up the hand to find the Feet, much in the secure way
as now directed.
Tho' the Operation of turning is an improvement
it is not altogether without Danger in itself, more 



208
Particularly if proceeded about in a rough improper 
manner.- The Danger from turing is in proportion
to the Degree of Pain, and the shape of the Uterus
and direction in which the Child lays whether in 
a round or oblong form, for the rounder the Child
lays with the more ease will the the turning be effected.
Turing is somtimes thought proper when
the Head presents, here the concomitant Symptoms
must determine the propriety, these circumstances
usually are, unfavourable Situation of 
the Head. Flooding. Convulsions. want of Pains.
want of Room in the Pelvis.- Oblique situation
of the Uterus.- Prolapse of the Navel String with 
the Head.- These will be each considered separatly.-
In all these cases the head is supposed 
not to have entered the Brim of the Pelvis in any 
Degree, for if it has you must not attempt to 
turns but give assistance in another way, by the 
use of the Lever and Forceps.- You should likewise
have the parts sufficiently dilated before you
attempt to pull down.-
Unfavourable Situation of the Head. This may 
require turning if this cant be rectified, by means
of the Hand or Lever as in case of the Ear presenting
you may sometimes alter the presentation to the 



209
Vertex Case by acting on the Head with the Lever.-
Flooding and Convulsions. The propriety of turning
will be treated of when treating of these particular Subjects.
Want of Pain. This does not require turning if 
there are no unfavorable Symptoms come on, this may
be known by the Pulse and Strength, &c. and if there are
no unfavourable Symptoms you must wait and 
Nature after some time will be able to expel the Child.
With respect to the time you must wait, this depends
very much upon circumstances.- A Patient has 
been in Labour 2 or 3 Days, and during almost the 
whole of this time, the Os. Uteri has been considerably dilated,
but very little pains, these have then come on
and the Labour has soon terminated favourably.-
But if whilst you are waiting any unfavourable
Symptoms come on, and the Patient appears to be 
Sinking, you must then proceed to turn, or in case
the Head has entered the Brim of the Pelvis, the long 
Forceps will then be preferable.-
Want of Room. This is understood to be 
in a slight degree for if disproportion is considerable, 
it will be impossible by any means
to bring the Head away without opening. When 



27
210
the Disproportion is slight, Practioners say in
their Opinions respecting the propriety of turning
at all on that account, very few recommend
it, for the object of turning in this case is to save
the Life of the Child, and it will be a very difficult
matter to bring the head away soon enough to do this 
if you turn on account of Deficiency of Room.
In this case the Lever of Long Forceps would
probably answer better, and save the Life of the 
Child when turning would fail.-
Obliquity of the Uterus. Turning is very
seldom necessary on this account, as this may
generally remedied by changing the Position of the 
Woman so as to alter the bearing of the Womb.
Prolapse of the Navel String. When the 
Navel String comes down before the head of the 
Child, there are different Opinions respecting the 
propriety of turning, some Favour it and others
not.- In cases of this sort if you dont turn 8 in
10 of the Children will be Born Dead, and if you do 
5 in 10, this is understood as a general Rule. In 
certain cases it may be right to turn but if the 
Object is to save the Child, and not on account of 



211
any benefit to the Mother you should never turn
without a probability of Success, and the following
circumstances must be taken into consideration.
Whether the Child is alive this may be known
by the Pulsation of the Chord.-
Whether or not the Head has entered the Pelvis
if the Head has entered the Pelvis turning is out of 
the Question.
Pains Strong or not. If the Pains are Strong there
is an objection to turning, as the degree of force necessary
may injure the Woman, and the Life of 
the Child wont be saved.-
Rigidity of the Passages. If these are in a rigid state
this will prevent the head being extracted time
enough to save the Life of the Child, therefore the 
parts must be in relaxed State to admit of turning,
with any probability of Success.- **
You may sometimes feel the pulsation of the 
Chord before the Membranes are ruptured in this 
case you should endeavour to keep the Bag of Waters
whole 'till the os. Uteri and parts are compleatly
dilated, for whilst Membranes are whole
the Cord is not pressed upon, and it likwise alows
the Child to be much more speedily expelled after they



212
are ruptured.- When the Chord is come down you
should endeavour to put it to some part of the Pelvis
when there is most Room, or to put it entirely
up; if this cant be affected, turning may be then
admissible under certain circumstances before mentioned.-
No Practioner is justified in turning the Child
from any motives of convenience to himself.-
There are certain circumstances which affect
turning rendering more difficult or easy, according
as one or other take place, the Child will be turned
with greater ease according as it lays in a round
form, and more difficult as it form and that of 
the Uterus becomes more oblong.- Another circumstances
to be taken into consideration is want of 
Room in the Uterus, this may depend either upon
Waters having been off a great length of time or upon
the violent action or rigidity of the Uterus.
In these cases if the turning is from Choice
it is much better to be backward in doing it unless
the are pressing Symptoms, but if the turning is 
from necessity, it is then right to do it, but at the 
same time will be adviseable to mention the Danger 
to the Friends.- If the Patient is labouring under
certain Diseases, Phthisis, Fever &c. you should be 



213
backward in attempting to turn, except from necessity.-
When it is necessary to turn, you will always
do this to the greatest advantage, immediatly after
the evacuation of the Waters, and from this you will
perceive the necessity of ascertaining the precise
presentation and Situation immediatly after the 
Waters have been evacuated.
Whenever you have reason from any circumstances
to suppose turning will be necessary, you
should never be in haste to break the Bag of Waters,
but alow the parts to be sufficiently dilated before this 
is done.- In cases you may feel a part, which 
will indicate the necessity of turning, before the Bag
of Waters is broken, in this case alow the Waters to remain
'till the parts are sufficiently dilated, and
the membranes a ruptured immediatly pass your
Hand up, and if possible plugg up the Mouth of the 
Womb so as to keep in a Portion of the Waters, this 
will facilitate the Turning.-
When the Waters are evacuated before the Os. Uteri
is sufficiently dilated, and the presenting part
is not well adapted to effect this dilation, as for 
instance in the Back Presentation; you may then
assist the dilating process by passing up your fingers



214
fingers and acting as a Speculum, but this must be 
done with the greatest gentleness
Before attempting to turn the Rectum and Bladder
should be emptied, for if the Bladder is distended
there is Danger of its being ruptured.-
The Patient in all cases may lay on the left
Side, except in some few Instances, and the Parts
should be brought as near the edge of the Bed as possible.-
In some few cases the right Side may be another
more advantageous, this depends upon the Situation
of the Child, but very little benefit can arise
from the Patient being placed in the Hands & Knees 
as some have recommended, and this is in general
a Painfull Situation.-
The Child will seldom require turning before 
the 7th,, Month, but this will depend upon circumstances,
in saying this the Child & Pelvis are supposed 
to be Standard.-
With respect to the Hand most proper to be 
used, that will depend upon the Situation of the Child,
the Back of the Hand should always be opposed to 
the Bones of the Pelvis and the Palm of the Hand to 
the Child.- In passing up the Hand no great degree
off force should be used, but it should be done in a gentle 



215
gradual manner. When you are about to turn, you
should take off your Coat, and do this in way so as to excite
as little alarm as possible to the Patient, and rub
the Back of the Hand (and not the inside) with some oil
or Pomatum, to facilitate its passage.- 
When introducing your hand, this must be done
in a Slow and gradual manner, and if you meet with 
any resistance, you must wait a little to alow the 
Parts to dilate and attempt to overcome this by any
violent degree of force suddenly applied.- There will
generally be a considerable degree of Pain, when the 
Knuckles are about to pass the external parts, and 
when they have passed, somthing less and the wrist will
become grasped, on account of then being more Room
in the Vagina.- In this Stage you should put
your hand in a proper position for finding the 
Feet, the part to which they are situated should have
been well ascertained before, as on this depends the introduction
of the Proper Hand, and in the Proper direction.- 
In passing up the Hand you must 
take care it passes in contact with the Child and 
not on the outside of the Membranes, for these will
prevent you taking hold of the Feet, and will endanger 
the bringing on a Flooding by the Separation of 



216
the Placenta, you may know when your Hand is on 
the outside of the membranes by feeling the interposition
of the membranous Substance between your Hand and 
the Child.- The Uterus should be supported by an Assistant
whilst introducing your Hand, and you should
introduce the hand gently and during the absence of 
Pain, desisting from the attempt during Pain.-
If the Uterus acts frequently and strongly, a Dose 
of R [illegible] Opii may be of Service by lessening the Pain, both
in frequency and Strength, to produce this effect it 
should be given in a full Dose, from 30 to 50 Drops or
more, alowing time for this to produce its effect, perhaps
waiting an hour or an hour & half will be sufficient.
Shd the violence of the pains prevent turning immediately after this [illegible] 
-You should likwise take care to carry the 
hand sufficiently high to find the Feet, and to avoid
mistaking a hand for a Foot, this may be done by 
feeling for the Elbow, or the heel.- Take care likewise
that both feet belong to the same Fetus, this will
be in general the case, as each Fetus is mostly contained
in a separate Bag, tho' is not always the case,
you may ascertain this by passing your hand up
to the Perineum.- If you have only got hold of 
one Foot you should not draw down 'till you have
got the other, and when you have get hold of both 



217
you should draw down in a gradual gentle manner.- 
In some cases when you have got hold of the 
Feet and are attending to bring them down, the head
will descend at the same time, in this case you cant
leave hold of the feet to elevate the Head, but you
may pass a Fillet round one or both Feet, for the 
purpose of keeping them down, and the press upon
the Head so as to elevate it, and alow the Feet to come 
Down.-
In turning, the object to be kept in view is to 
bring the Belly of the Child to the Back of the Mother.
The Difficulties are sometimes such as you cant 
get the better off, so that you wont be able to turn the 
Child and Mutilation will be necessary.-
When you have brought the Feet down, past
the external parts the case must be finished as 
the Foot case.-
Application of the Rules to particular Cases.
The general principles already mentioned being 
perfectly understood, their application to particular
cases will not be attended with much Difficulty.-
As the general principles in all cases are the same
it will not be necessary to mention every individual
variety that may occur.- 



28
218
Back Presentation.
This requires training, and may be distinguished
by feeling the Spinous Processes of the Vertebra in
the middle of the Pelvis, and the Situation may be
determined by the different distances of these at the 
lower and upper part, as this is much greater towards
the Loins & Sacrum.- This in general is not 
a very difficult case.- The Peculiarity in the mode
of turning in this case, consists in conveying the 
Hand up to the Feet by crossing the Back.- In
this case the Back of the Hand should be opposed
to the Sacrum.- The Situation of the Feet must
determine which hand is most proper.-
In the Back Presentation, some have recommeded,
pushing up the Shoulders and alowing
the Breech to come down, but as pushing up
is always attended with Danger, this should never
be done.-



219
Arm Presentation.
If the water have been evacuated for any length
of time, and the Shoulder is wedged into the Pelvis
and at the same time the Pains are Strong, it will
be extremely difficult if not impossible to turn
the Child.- An Arm Presentation seldom requires 
turning before the sixth Month, but is generally necessary
at the Seventh, and somtimes earlier, therefore
particular enquiries should be made respecting the 
Stage of Pregnancy, and if no longer than the Sixth
Month, you may then take hold of the Arm and pull
down and the Head will pass in that Direction.
This is only a general Rule, as in this case the 
Head & Pelvis are supposed to be Standard, and as
there may be deviations on either side, these of course
will affect it, there for you should not rely wholly
upon the Stage but, but take other things into the 
account, as examination &c. make of the Woman
state of the Parts &c.- But in all cases if you
have the least doubt either in respect to the Stage
of Labour or Proportion, you should pass up the Hand
and find the Feet.- Somtimes a hand comes 



290
down with the Head, this is not a true Arm Case.
In this case you must not take hold of the hand
and pull, or you bring it to an Arm presentation,
but you must endeavour to raise the Hand up, and 
keep it up 'till the Head comes down and presents
its returning, perhaps the Lever may be of use here
in bringing the Head down more Speedily.-
If the head is small or the Pelvis large they will
somtimes pass in this direction together.-
But in case the hand becomes jammed in along
with the head and it will neither pass, and your are 
not able to raise it, it will then become necessary
to open the Head.-
A true Arm case is when the Arm alone
descends and when this was the case it was formerly
recommended to push the Hand up, under the 
supposition that some other part would descend, but 
this is bad practice and should never be done, for in all
cases there is danger from pushing up, of rupturing
the Uterus, and in this there is no advantage gained, you
must not likwise pull down by the Arm, except in case
of the Elbow presenting, when you may pull down the 
forearm to make more room to pass up the Hand.
In some case of Arm Presentation, the Child has
spontaneously turned in the Uterus, the Arm going up and 



221
the Breech becoming the presenting part, this is what 
is called Spontaneous Evolution, from this circumstance
Dr,, Denman recommended waiting to see if this would not 
be the case, but from its frequently failing and when
it did succeed the Child was almost always born Dead,
he afterwards restricted this to when the Children were
known to be dead, but this should not be done in any case
except the Child is evidently upon the move, for if you
wait any time the Shoulder of the Child becomes wedged
in the Pelvis so firmly, as to render turning extremely
difficult or impossible.-
In the Arm Presentation where the Shoulder is wedged
in the Pelvis, and the Pains are Strong turning is extremely 
difficult, in this case the Pains may be moderated by
full Doses of Opium, alowing sufficient time for them
to produce their effect, perhaps waiting an hour or an
hour and half, and endeavour to pass up your hand by
gently elevating the Shoulder, and in doing this the greatest
dexterity will frequently be necessary, always using
as little force as possible, in doing this the general Rules
respecting turning must be kept in View, and the Woman
must lay on the right or left side according to the 
situation of the Child, and this must likwise determine
the hand proper to be introduced.- The situation of the Child 



222
may be known by examining the Direction of the palm
of the Hand likwise, the Thumb and Radius, and you 
are not certain from this pass your hand to the bend of 
the Elbow and Axilla.-
In cases when the Difficulty is such as to prevent
your being able turn the Child and bring it away, it then
becomes necessary to mutilate the Child, this is called 
Embryotomy, and may be done by means of the Perforating
Scissors. The mode of doing this is by passing up the 
Scissors guarded by the Hand, and separating the Arm
not at the Shoulder Joint, but by taking of the Scapula
and then making an Opening into the Thorax and Abdomen,
to evacuate their Contents, this will make sufficient
Room to alow of the introduction of the Hand, which you
should do and extract the Child by the feet.
Before you proceed to do this all possible means to 
bring the Child away should be used, consistent with the 
safety of the Mother, if the Child is alive, but in case 
the Child is known to be dead, you may then do it without
so much Hesitation.-
In some instances after the Child has been turned
there will be difficulty in the extraction of the Body
this may be from Air or Water in the Cavity of the Ab



223
this may be relieved by a puncture made into the 
Cavity of the Abdomen.- Sometimes there will be difficulty
in the Extraction of the Shoulders, rendering the 
Blunt Hook necessary, but this should be used with 
great care if the Child is alive, but if dead, so much
caution is not necessary, and if it is great the Arm may
then be separated. 
The greatest difficulty is in the extraction of the 
Head in many cases, and arises either from unfavourable 
position or disproportion, the former of 
these is owing to mismanagement, in not attending
to the Rules laid down for turning, the latter is 
inevitable.- From this it will appear evident
how necessary it is to attend to the Rules.-
If the disproportion is slight, putting the Head
in the position best adapted to the Shape of the Pelvis, will
often effect the extraction, but in case it is in the 
degree so as not to be brought away by this means
some have recommeded long Forceps, but they can 
be of no use as sufficient force may be applied by 
introducing our finger into the Mouth and the 
other hand upon the Shoulder with the Finger on the 
Occiput, this gives you a sufficient command of 
the Head likwise.- If you cant effect the Extraction



224
Extraction of the Head this way it then becomes necessary
to open the Head by means of the Perforator..
If your are able to extract the Head, and there has 
been considerable difficulty, tho' the Child may appear
Dead, yet it may be adviseable to inflate the Lungs
by means of a Proper instrument.-
When it is necessary to open the Head, this must
be done by means of the Perforator, and the part
most convenient for this purpose is the Lambdoidal
Suture, and after the Brain is broke down, you 
may then extract either by extension, or by the introduction
of the Crotchet.- Some have recommended
separating the head from the Body in this case,
but this should never be done.-
In case the Head has been separated from the Body
it has been recommended to trust the expulsion to
Nature, but this cant be done with propriety, more 
particularly if there is Disproportion.-
When a case of this sort occurs, you should make
particular enquiry, whether the Difficulty has arisen
from Malposition or Disproportion, and if from Malposition,
and there is at the same time a Spasmodic affection
relieving that Spasm by means of Opinion, may alow the 
Womb to expel the Head.- Somtimes there will be a Spasmodic
constriction of the Mouth of the Womb, so as to compleatly



225
compleatly in close the Head, it would not be adviseable to 
overcome this Spasm by force, but to give a full
Dose of Tinct. Opii. and wait 'till it produces some 
effect, and then endeavour gradually to Dilate the part.
Different Instruments have been invented for 
the extraction of the Head, but very few of them are 
worth notice, one invented by Gregwaar, to pass into
the Foramen Occipitale, might be of Service when 
there was no disproportion and might assist in 
fixing the Head for the Use of the Perforator and 
Crotchet, which are the only means that will
effect the extraction where there is disproportion,
in using them you must fix the head, either by 
somthing passed into the foramen Occipitale, or by
pressure upon the Abdomen, and the lessen the head
by the Perforator and introduce the Crotchet, for the 
purpose of extraction.- It will somtimes be necessary
to pass the Basis of the Scull sideways if the Disproportion
is great.- You will have much firmer
Hold by the Crotchet, at the Basis, than if it was the 
Summit of the Cranium.- 



29
226
Twins.
Somtimes instead of there being only one Child
there, or 2 or more, have been 3, 4, and in one case
5 Children. When the management of Labour
where there is only one Child is perfectly understood,
that when there is twins &c. cant be difficult
to comprehend, as circumstances are much the 
same.- When there are more than one Child, the
Labour is in general easier, as the Children for the 
most part are less, tho' there have been some exceptions
to this Rule where there were two Children.
If there are 3 or more, the Woman is generally
delivered before the termination of the usual Period
of Pregnancy, as the Womb wont alow of that Distention
necessary for their compleat growth.
The symptoms which indicate the existence of 
Twins during pregnancy are very equivocal, as 
the size of the Abdomen, double quickening &c. as 
this extra enlargment may be from a greater quantity
of Water &c. double quickening not of any consequence
as it may be from the same Child moving
at these different times. There are other Signs mentioned
but which are of no consequence.- 



227
During the time of Labour, and before the Birth of 
the first Child, circumstances sometimes occur which
indicate the existence of Twins, as the presentation
of two Heads, their feet, or Anus &c.-
The time most proper to ascertain whether there
are Twins &c. is often the Birth of the first Child, either
by the Pains, or by laying the Hand on the lower part
of the Abdomen, or by examination internally by the 
Vagina.- It will seldom be necessary to examine internally,
as you may in general determine this by 
laying your hand on the Abdomen, if there is another
Child it will feel full and distended, if not, the Uterus
may be felt contracted in the middle of the Abdomen
in a round hard Body, this way of examination
is preferable.- If you examine internally you
may either feel some part of the second Child, if there 
is another, or the Bag of Waters, but you may possibly
be deceived in this last respect, by a collection of 
Blood &c.-
If you feel a second Bag of Waters you should
immediatly rupture this, as the purpose of alowing 
them to remain that of Dilating the parts, is not 
wanted, and as the parts are relaxed and dilated
by the passage of the first, the second will generally
pass with very little Difficulty, on this account it may 



228
in some cases be better to conceal their being a second
Child from the Patient and bystanders, as they may 
suppose there will be the same difficulty attending the
expulsion of this as the first, this you may do, under
the pretense of assisting the expulsion of the Placenta.
Different Opinions have been formed respecting
the management of the second Child, some have advised
immediate Delivery, others to commit the 
expulsion entirely to Nature, and others have advised
are intermediate Course, which is preferable.-
After the birth of the first Child you should immediatly
ascertain the presentation of the second, for 
it is necessary to turn, this can be done at this time
with the greatest ease, and in case of a presentation
which does not require turning and pains come on
the Labour must be conducted as in other cases.
If pains go off, some have recommeded waiting
'till the again come on, but this is not good practice
for the mouth of the womb may again contract, and render
the expulsion more difficult. Dr,, Louden in
all cases, often waiting an hour, tho' the head was the 
presenting part and no unpleasant Symptoms
cause on, always turned.- If unpleasant Symptoms
come on you must attempt Delivery sooner 



229
such cases as require turning in case of 
only one Child require it equally when there
are two or more.-
When all the Children are born, you must
then proceed to the extraction of the Placenta,
as this must not be attempted before, on account
of bringing on flooding &c. and occasioning
other bad effects.- The manner of doing
this is to take hold of the different Chords, together
and proceed as in other cases, taking care
not to invert the Womb.-
Monsters.
There are Fetuses, which differ from the common
form, and do so in different ways.-
The mode of formation is very obscure, and 
the causes which divert Nature from the ordinary
course of evolution are not well understood.-
They are frequently attributed to some effect
which has been produced upon the mind, during 



230
Pregnancy, but this is not at all probable, as
many of these happen when the different parts of the 
Fetus are fully formed, if ever it does it must
be at a very early period.-
A knowledge of the different forms of Monsters
is as full in practice, as they may somtimes
occasion a little embarrassment.- A Brainless
Monster may possible be mistake for one 
whose head has been opened, a mistake of this 
sort occured to a Practitioner, who supposed the 
Head has been Opened
Monsters considered relatively to practice
may be divided into such, as have deficiency
Redundency, Mal Formation and Mal Situation.-
Those that are Deficient can occasion
no difficulty in Labour, except in case of turning
being necessary when the Extremities are
wanting, if there are the lower ones, some embarrassment
will be the consequence, and it may be 
necessary to open the Head.-
When there is redundency, it may be a cause
of Difficulty. It may in this place be right to



231
mention that in case two Children adhere by 
there Chests, that the internal parts are common
to both, this to prevent any thing being done
by way of separation.-
Our circumstance which is favourable, is 
that in [cross out] most cases of monstrosity, there is a disposition
to premature birth.-
Deviations from the common Period of Birth.
Most Labour occur at the end of Nine Callendar
Months or 40 Weeks, and many happen before 
this time, but there are different Opinions, respecting
the possibility of this time bring exceeded.-
From the observation made upon Brutes
it is probable that this may take place in the 
Human subject, but to what extent it is extremly
difficult to determine, this subjects comprehends
a Question of Law relative to the Legitimacy of 
Children, but it is impossible to draw a line of 
Distinction, if the Period is protracted beyond the 



232
45th,, or 46th,, Week, it then admits of a Doubt.-
Premature Birth.
This may take place to any period of Pregnancy,
but as some of these Children live after
Birth, and others not, they are from this Distinguished
into Vital and non Vital, this is likewise frequently
a Question of Law, and on this account
the Line is generally drawn at the 7th,, Month,
but this admits of some Latitude both ways.
Pulsation of the Chord is a sign of Life in a 
Physiological View, but wont be sufficient in 
the other view of the subject.- If the Child cries
it is a certain sign of Life, and if it could be proved
to have breathed that may be sufficient.-
Miscarriages are supposed to occur more 
frequently at some Periods than others, as the 
6th,, Week or third Month, attending to this circumstances
and more particularly if the same Person
has repeatedly miscarried at any certain Period,
may be of some consequence, as by keeping the 
Patient cool and quiet, at that time, miscarriage



233
may frequently be avoided, and at the same 
time giving gentle aperients &c.-
When a Woman has repeatedly miscarried
she will often begin to despair, and there will
be in some reason an assisting cause of this 
taking place, and should by all means be removed
if possibly and for this purpose any thing may
be done to divert this either by way of Medicine
or any other way.-
The immediate cause of Miscarriage is 
the same as that of Labour, which is the contraction
of the Uterus to expel its contents, therefore pains from
Uterine contractions should either be moderated or 
removed.-
Miscarriage may be produced, either by separation
of the Placenta; premature breaking of the 
membranes from any cause, or any thing that only
occasion the Death of the Fetus, tho' abortion does 
not always immediatly follow the Death of the Fetus
as this may take place at a length of time, before 
it is expelled even 4 Months or longer.
Miscarriage from accident will sometimes occasion
a susceptibility to future miscarriages, when 



30
234
this is the case particular care should be paid
in avoiding any of the exciting causes, keeping
the Patient cool and quite and attending to the 
different Symptoms as they may occur.-
A Miscarriage sometimes is not preceded
by any considerable Discharge of Blood, at others it 
is, this is owing to the exciting cause, if it is from 
any thing causing a contraction of the Womb, as 
the rupture of the Membranes &c. there is [cross out] no 
large discharge of Blood, in this case the Uterus proceeds
the same as in Natural Labour; first expelling
the Child then the Membranes, but when miscarriage
proceeds from the Placenta being either partially or 
wholly detached, there is then considerable Hemorrhage
and the case is then much more dangerous than
the Former, and on that account merits particular
attention.-
Miscarriage preceded by a Discharge of Blood.
These are much more dangerous than the other
kind, and this in proportion to the stage of Pregnancy,
as the more advanced, the larger the Vessels
are and consequently the greater Danger.
The cause in this case is the separation of the 



235
Placenta either partially or entirely, when this is only
partial Miscarriage does not always follow, but 
great care in this case is necessary.-
The signs are a Discharge of Blood, taking place
at unexpected Periods, which will coagulate; with 
pain, bearing down &c.-
Some judgment is somtimes necessary to
discriminate between such discharges and the 
menstruations in the early Months of Pregnancy
but this may be done by attending to circumstances,
as whether it occurs at the periods when the 
Menses [wa?] expected, or is accompanied with 
pain or not, or whether the Discharge will coagulate.-
Menstruation very seldom occurs so late 
or later than the third Month, and shews no disposition
to coagulate.- Enquiry may likwise
be made whether the Discharge proceeded from
any accidental cause.-
It is usual to divide these as they occur in 
the early or late Stage of Pregnancy, the time between
the two is generally drawn at the fourth
Month.- Those which occur in the later Periods
of Pregnancy are much more Dangerous, tho' the
others are attended with considerable Danger.-



236
Treatment of Miscarriage in the early Stage.
When there are any Symptoms which indicate 
on approaching Miscarriage, the Patient
should be kept as much as possible in a Horizontal
position, and as cool as possible, the room
should be as cold as conveniently can be, and the 
Bed Cloathing very tight, every thing heating or
Stimulating should be avoided, it is a very common
practice to give Red Wine under the Idea
of its being an Astringent, but this is very wrong
as it acts as a Cordial and of course does injury.
Then somtimes comes on faintness, this should
not be removed by Cordials &c. as it is upon the 
whole a favourable circumstance, alowing the 
formation of a Coagulum, and that way preventing
a return of Hemorrhage except the 
action of the Heart becomes very much affected, and 
the Extremities cold, it may then be necessary to give
some Cordial.-
In some cases instead of immediatly giving
Astringents it may be necessary to take away
Blood from the Arm, but this must be determined
by the State of the Pulse and other circumstances. 



237
Nitre, Mineral Acids, Opium &c. must be given
according to circumstances.- A common remedy
is an Infusion of Roses with Nitre, this does not
appear a very eligable way of giving the Medicine on
the Acid of the Roses may decompose the Nitre, tho' as
it does so only in a small Degree, it may still be 
very serviceable, an Infusion of Roses with the addition
of Natron. Vitriol. is equally well adapted for 
the purpose and is not liable to that inconvenience.
Opium is serviceable only under certain circumstances,
as in case of great irritability, when it answers
best if given in small Doses and repeated frequently or 
2 or 3 Drops every 3 or 4 hours.- If there is no hemorrhage,
at may sometimes do good given in full doses.
Digitalis would appear likely to answer a 
good purpose under certain circumstances, but is
so uncertain in its operation as not to be adviseable.
When the flooding has ceased, the Patient shd,,
be particularly carefull to prevent a return
by attending to the Bowels &c. and by avoiding any
exertion. This mode of treatment in supposed
to be necessary and proper during a state of Strength,
but when the Disease has continued somtimes a



238
different mode of treatment becomes necessary, instead
of giving Nitre &c. Astringents rather of the Tonic
kind become necessary, as the Mineral Acids, or Alum
this last in Doses of from 4 or 5 grains to 8 or 10.-
Preparations of Lead are somtimes given, or Tinct.
Saturn. g tt,, xx. ad g tt, x4, or the Cariess. Acetat. gr, 76 ad
gr. i sal gr,, ii - iii; this in general should be joined with 
small quantities of Opium to prevent its affecting
the Bowels.
Frequent returns of Hemorrhage may 
lead to considerations on the propriety of promoting
Miscarriage, it is better not to do this except
Nature appears to tend that way, except under particular
circumstances, as the Bag of Waters having
been ruptured, or the patient very much reduced
by the discharge, when you may proper examination,
tho' it will be better to avoid this in the early
Stage.- If on examination you feel the Mouth of the 
Womb soft and dilatable, or the Membranes protruding
you may then introduce your finger and act as a speculum,
gradually Dilating the parts &c. but if you
find the Os. Uteri rigid and closed, it will be much
better to leave the case to Nature only making use 



239
of the proper means before mentioned. If on examination
you find the Ovum in the Mouth of the Womb
this is the actual state of Miscarriage, and you should
do nothing for a time except you have reason to suppose
there is an internal bleeding going on, in which case
you may attempt the removal to alow the Uterus
to contract.-
Various instruments have been invented for 
the purpose of Dilating the womb but they are very 
seldom wanted, and may often do injury if used, the 
fingers are in general quite sufficient, and answer
the purpose much the best.-
Some have recommended the application of Styptics 
to the os. Uteri by means of Plugs, this is what 
the French call Tampon these are very objectionable
as they might possibly cause the os. Uteri to close but 
at the same time alow an internal hemorrhage
to go on.- They might be serviceable after the expulsion
of the Contents of the Uterus, when it was not disposed
to contract.- A Patient has considerable Thirst
in general, Cold Water may be alowed, tho' it will
be better if acidulated, as in this case a smaller
quantity will be effectual, and which is adviseable  



240
If on examination you find the Ovum wedged in 
the Mouth of the Womb, and the hemorrhage has continued 
for a length of time, it may be right to endeavour
to bring that away.- It is not in general
necessary to stay with a Patient under these circumstances,
but to see her occasionally.-
You should always carefully examine all discharges
that come away for there will frequently be
Coaguli discharged, and which may be mistaken
for an Ovum.- You should always examine to 
ascertain whether there is a Cavity or a Membranous
substance which may have been the Cavity, if this is 
the case, it is a Miscarriage, but if it is perfectly
Solid, it then is a Coagulum.-
You should likwise examine to know whether
the Placenta is expelled, if not you must not 
attempt the extraction, but leave it to Nature, and 
correct the putrid Discharge which may take 
from time to time by means of antiseptics, as 
Decoct. Hord. in R a,, Myrrh. Decoct. Cort. Inject.
Vis. Rubr. &c.- The Placenta is somtimes expelled
with pains, at others not.-



241
Miscarriages in the latter Months.
The Danger from miscarriage in the latter Months
of Pregnancy, is much greater than that of the 
early Months, on account of the Vessels of the parts
being so much larger.- The Degree of Danger is 
in proportion to the quantity of Blood discharged
and its effects upon the constitution.-
Separation of a Part or the whole of the Placenta
is the cause of this, and which be either from accidental
causes or from the Placenta being attached 
over the Mouth of the Womb, or very near to it.
You may endeavour to ascertain the cause
of this flooding and may do so with a considerable
degree of accuracy by attending to the different circumstances,
as whether it has come on in consequence
of any accidental cause, or whether it has occured without
any such thing, as when perfectly at rest, or
in Bed.- If it arises from separation taking place
owing to its attachment, it will in general come on
about the middle of the 5th,, or 6th,, Month, as the Neck
of the Womb at that time begins to stretch, and not 
much before.- It will likwise be repeated at times
without any evident cause as Neck of the Womb continues



31
242
to Dilate.- If the Discharge is either violent or 
so often repeated, as have considerable effect upon
the constitution, you should examine to ascertain
the state of the Parts, if the mouth of the Womb is any 
ways dilated so as to alow of the introduction of one 
or two fingers, you may then distinguish whether the 
placenta is situated over the mouth of the Womb or 
not, if it is the Placenta that presents, you will
feel a fleshy substance, but if not, you will feel
the Membranes protruding.-
In cases of this sort all the different means 
of stopping the Hemorrhage in the early months
must be had recourse to according to circumstances,
and if the discharge is either checked or stopped
great care should be taken to prevent a return.
If the discharges continue or are so often repeated
as to weaken the Patient very much, it then becomes
a question respecting the propriety of bringing on Delivery,
and which should not be deferred to long or the 
Woman may not have sufficient strength carry her
thro'.- Delivery may be brought on two ways
either by inviting natural Labour, or by the 
more active practice of turning, the violence
of the Hemorrhage, Disposition of Parts, and state 
of pain, will have very great influence in the 



243
determination of the mode most proper.- They 
way to invite natural Labour, is by passing up
the finger to the mouth of the Womb, introducing
one or two of them and making gentle pressure, and 
it the same time acting in a gentle manner as 
a Speculum, this way endeavouring to excite
the Womb to action.- You will somtimes feel
the Bag of Waters protrude, and when this is the 
case you should rupture them, which may be 
done with much propriety sooner than in natural
Labour when there is no hemorrhage, as you now 
want to reduce the size of the Womb, and doing 
this by evacuating the Waters has in some instances
been sufficient.- But in some cases there
is such a Degree of debility as to prevent the 
Womb from be able to expel its contents, in this 
case it becomes necessary to have recourse to 
more active means, that of passing up the hand 
and bringing down the Feet.- When the Hemorrhage
is more violent, as in case the Placenta
is attached over the mouth of the Womb, you must
not then wait for the bringing on natural Labour
but deliver as soon as possible without using violence 

After the Child is extracted, the Placenta must be 
immediately brought away, to slow the Womb to contract
speedily as possible.- 

244
pass up the hand and turn.- The center of the 
Placenta is not always immediately attached
over the Mouth of the Womb, somtimes only a small
portion, in this case the Danger is not so great, but 
when the middle of the Placenta is attached, it is 
then an extremely dangerous case, when this is 
the case you must not attempt to separate the 
Placenta from the Womb, for the Purpose of alowing
the introduction of the Hand, [illegible] that would be multiplying
the number of Bleeding Orifices; and under
the case of the Woman more dangerous but you
must pass your hand thro' the Substance of the 
Placenta to the Feet.- In these last cases the 
Child must necessarily be destroyed by the loss 
of Blood.- Manual assistance may somtimes
be necessary before the Uterus is of a sufficient size
to alow of the introduction of the Hand, as at the 3d,,
or 4th,, Month, in this case you may puncture the 
Bag of Waters by the use of the Stiletto or a Catheter, and
Labour will in general come on in the course of from
one to three or four Days.- It will be necessary to 
alay the irritability which will be produced, by
means of opiates occasionally, but there wont be 
than degree of irritability produced in the early as in 



245
latter periods of Pregnancy.-
Flooding after Delivery.- This is often the 
consequence of an inert condition of the Uterus, and
cannot in many cases be trusted to Nature with 
safety, if upon laying your hand upon the Abdomen
you dont find the Uterus contracted, you may in
many instances excite this gentle pressure upon
the Abdomen, or you may apply Clothes wetted in 
cold Water to the Abdomen.- The common mode of 
applying Clothes moistened in Vinegar and Water
to the external parts is injudicious and often does
injury by causing excoriation, and as the action
of this is not from any astringent property independant
of its coldness, cold water will answer way
purpose and that applied to the Abdomen, as near
the part affected.- It very violent cases it has 
been recommended to throw cold Water into the 
Cavity of the Uterus by means of a proper Syringe
in want of which a long Glyster pipe might answer
the purpose.- You may likwise endeavour to 
rouse the Womb to action by passing your finger
the the Os. Uteri and making pressure, or by passing
passing your hand into the Cavity and recovering it round
[cross out] 



246
[cross out]
[cross out]
[cross out]
[cross out]
[cross out]
Flooding does not always come on immediately
after Delivery, but in some cases occurs 3 or 4 Days
or even a Week or two after Delivery, if this is not owing
to some accidental cause, there is great reason to 
suppose the Uterus is in a Diseased state.-
In flooding after Delivery the usual remedies as 
in other cases must be had recourse to according 
to circumstances, as Infus. Rosa. Carcess. Acetat.
Alum in &c.- It is somtimes the case to give the 
Infusion of Roses, joined with Carcess Acetat, under
the Idea of their assisting each other, but this is not 
the case, as the render is each other less usefull by their 
combination.- A degree of faintness frequently
comes on, and which should not be obviated except
when in an alarming degree, as it is upon the whole
rather a favourable circumstance, alowing the Vessels
to form a Coagulaum &c.- If in a very alarming degree,
a small quantity of some Cordial may be 
given and repeated according to circumstances.-



247
The plugg or Tampons has been recommended
in these cases, but does not appear to be well adapted
as it may act as an Astringent to the Neck of the 
Womb causing it to contract, and alowing an internal
bleeding to go on.- The way it may be 
applied is by means of a piece of Spong, and which 
may be moistened in any astringent Liquid.-
Pain of the Head connected with Flooding.
This is the effect of [ina??ition] and usually continues
'till that state is removed, consequently any 
medicine for its Cure will be of little Service, but 
the best mode of attempting its removal is by 
giving nourishing food, and in small quantities
and frequently repeating it, according as the Stomach
will bear it.- Leeches to the Temples do have, tho'
a Blister may afford some relief.-
Excessive Restlessness. This is another consequence
of violent flooding, and is extremely Dangerous, 
some few have recovered when this has 
been only in a slight degree, tho' it is generally
a Symptom of approaching Death, it marks a very 
high Degree of Depletion.- In cases of great loss 



248
of Blood, transfusion might be of very great Service,
if not for prejudice, as the Blood should be 
Arterial, it cant be taken from the Human Subject, 
but might from a Sheep, by laying bare the
Carotid Artery, and introducing one end of a Tube
and the other into the Saphena Vein, and in 
this way a portion of Blood might be introduced.
In great loss of Blood upon other occasions
the practice might be serviceable.-
Fevers connected with Parturition.-
Any fever which is Dangerous when occuring at
other times is more particularly so now, those
attended with the least danger are intermittants,
tho' there are some few exceptions to this, as in case
there is a considerable degree of Stupefaction &c. showing 
a considerable determination to the Head, this
often proves fatal, at the 3d,, or 4th,, attack, in this
case, actives means must be employed and then
early.- The Distinct kind of small pox as 
having but little Fever, is not exceeding Dangerous,
tho' the confluent is attended with considerable 
Danger.- In all Fevers the danger is agravated
by parturition, for if the Fever is of the low Typhus 



32
249
kind, the loss of Blood would do injury, and there
is generally a considerable Discharge attending Delivery.-
If the Fever is of the inflamatory kind
the violent exertions increase the inflamatory
affection.-
Delivery is not consequently rendered more
difficult by the presence of Fever, some think it 
either rather more easy.-
When there is Delirium, the progress of the Labour
should be diligently attended to, for when there 
has been Delirium, the Child has been expelled, without
the knowledge of the Bystanders, therefore particular
attention should be paid.- After Delivery
has been effected during the presence of Delirium, this 
will frequently subside, and the patient appear
better, but in many cases this is only transient,
and the patient very soon begins to sink, and 
Death follows. Speedily
The general treatment of Fevers will be the 
same as under other circumstances.-
Convulsions. These are particularly
Dangerous during Pregnancy.- They exist under
to different forms, Acute and Chronic.- Convulsions
must be distinguished from Hysteria.- The cause 



250
Convulsions has been referred to two opposite
conditions of the Body, namely Plethora and Inanition,
but there dont appear sufficient without a
certain degree of irritation.-
When Plethora is the cause Bleeding &c. will be of 
Service, if the Plethora is general, but it somtimes is
local, consisting in a determination to some particular
part as the Head, in this case the application
of Leeches, Cupping &c. will be of Service, and this
by way of preventative, a perature is an indication
of their approach by Vertigo, &c.
If the cause is from inanition, it is then 
much more dangerous, as this is much more difficult
to remedy, it must be attempted by means
the most nourishing kinds of food given in small
quantities or as the Stomach will bare it, and frequently
repeated.-
If Convulsions arise from irritation, the 
cause of that should be removed if possible, but the 
seat of that irritation must be first attended to, if 
the seat of irritation is in the Primæ Viæ, the 
exhibition of an Emetic, and afterwards clearing the 
Bowels, by a gentle Purgative or a Glyster may be of 
Service, afterwards giving Tinct Opii. Assa Fœtid.
or different kinds of Antispasmodics may be of Service



251
or Some of them as Opinion or Assa Fœtida may be 
given in the form of Enema.- The warm bath may
occasionally be of Service, and as this takes some time
in preparing it will be always right to have this 
in readiness early.- If the seat of the irritation is 
in any other part that must be attended to, if from 
Distention of the Bladder, the Water must be drawn off.
If the Uterus is the seat of irritation, it may in
right in some cases to bring on delivery, as in 
case this is much danger apprehended to the Life 
the Mother, from former Labours &c.- If on examination,
you find the Os. Uteri relaxed, and a Disposition
to Labour, this may be improved, but should
be done by the gentlest means possible, for there is 
frequently great injury done by using to much
force.- Even if there is no Disposition to 
Labour if you have ascertained the necessity or propriety
of bringing on premature Labour, making 
gentle and persevering attempts will generally succeed,
at the same time assisting the relaxation of 
Parts by different means as warm glysters throw 
into the Rectum.- Advantage will be gained by 
the early Rupture of the membranes.- During the 
convulsions it will be right to interpose some substance
between the Teeth to prevent the Tongue being injured.



251
Convulsions during pregnancy are very
frequently fatal, the Danger is in proportion
to their frequency of recurrence and Degree of 
Violence.-
When Convulsions are so violent & frequent 
as not to alow of any lucid interval, there is great
reason to suppose a Determination to the Brain
to be present, in this case you should endeavour
to make a Derivation, by purging &c. only opening
the Jugular Vein.-
Extra Uterine Cases.
These do not terminate by the common Passages
as other kinds do, but somtimes from an Abscess being 
formed in the Abdomen from which a Putrid Fœtus or its 
Bones are discharged; eithr by Nature or Art at other times these Bones escape
by the Rectum, from this being ulcerated Through.
Extra Uterine cases are of three kinds, namely
in the Fallopian Tubes, Ovariae, and Ventral case.
The way the Ovarian is formed, is by the Stimulus
of impregnation being given to one of the Vesicles of 
De Graaf, but which does not escape from the Ovarium
but goes on evolving itself.- When the Vesicle of impregnation



253
impregnation escapes from the Ovarium, but instead of 
being embraced by the fimbriated extremity of the Fallopian
Tube escapes into the Cavity of the Abdomen, it attaches
itself to any part it comes in contact with, the Vessels
of the Maternal part of the Placenta, in osculate with
the Vessels of that part, and evolution goes on.- 
When the Fallopian tube is the seat, it arises from 
the ovum being detained in that part, and evolution
takes place as before.
Mun 4th, kind
Evolution goes on in their cases 'till about the 
usual period at which time pain and the usual
Symptoms of Labour come on, but this does not advance,
these recur at times, but after some time, they 
entirely cease, the enlargement still continuing.
When the Child is contained in the Uterus, when the 
Symptoms of Labour come on at the usual Period
of the Child on any account cant be expelled, or attached &c such
Symptoms come on as inevitably end in the Death
of the Woman, therefore whenever even the Symptoms of 
Labour come on, and then after a time subside, and 
go off entirely, it must then be an extra Uterine case.
Somtimes during Labour, the Child will escape
thro' the Uterus or Vagina into the Cavity of the Abdomen,
a case of this sort occured, and when the Child afterwards



254
afterwards remained afterwards for upwards of 40 Years,
on examination after Death the Child was found in 
an Ossified State.- If a case of this sort was to occur
it would be right to pass up the hand after the Child, and 
endeavour to bring the Child away by the Feet, tho' the 
Woman most probably would Die.-
A Woman may live with an extra Uterine Case
for Years, and it afterwards be discharged either by the
ways before mentioned, or by an Operation which consists
in cutting into the Cavity containing the Child, and 
extracting it, afterwards closing the Wound by Sutures.
The Child does not continue to increase in size
after the 9th,, Month, at which time it becomes Dead.-
In cases of this sort you should never attempt to 
extract the Child by an incision 'till Nature appears
to point that way, by the formation of an Abscess as then
the Cavity is circumscribed, and Air is not admitted
into the Cavity of the Abdomen.- This Operation has 
been called the Cesarian Operation but improperly-  



255
Cesarian Operation.
The true Cesarian Operation always supposes one 
incission made into the Uterus, and may in some cases
be necessary both in the living and Dead Subject.
When the Woman is dead, if the Operation is 
performed it should be done immediatly, or the Child
will likwise be dead.- It is useless to perform the 
Operation in this case before the 7th,, Month of Pregnancy.-
In some cases where the Woman has died
suddenly undelivered, the hand has been passed up the Vagina
and the Child extracted by the Feet, if this is done it 
should likwise be done immediatly.-
In the living subject the Chances of compleat
success are very few, and therefore it should never be 
proposed, where delivery by the Natural Passages is possible.-
Different causes have been assigned for the frequent
failures of this Operation, as the admission
of Air &c. this cant be the case, as air is not found
to produce so much injury, when admitted into any
Cavity as has formerly been supposed.- As Death
in general take place in the course of 24 hours, it as



256
to be owing either to loss of Blood or to the Shock which
is given to the System and from extravasation into the 
Cavity of the Abdomen &c. 
Different Parts have been recommended for the 
incission, as towards one side, but the Epigastric 
Artery would be divided.- The best part for the incission
is in the course of the Linea Alba.
The incission should be begun at or rather above the Navel, and 
extended downwards 6 In. the external incission may 
be rather more, but that thro' the Uterus should be 
only 6 In. in length.- It is rather unfortunate when 
the Placenta is attached to the anterior part, of the 
Uterus, if there is a considerable portion attached
it may be better to make the incission directly thro'
it, but if only a small portion, it may be adviseable
to separate it.- When the Uterus is laid bare
you may possibly find somthing which may indicate
the attachment of the Placenta when before in 
this case making the incission rather to one side 
may be adviseable.-
The Bladder should be emptied before the incission
is made.- When the incission is made the hand 
must be passed, and the Feet takes hold off.- There 
will somtimes be difficulty in extracting the Shoulders.



33
257
the Head must be placed in the most favourable Position
and Head, on this account no time should be 
alowed for the Uterus to contract.- After the 
Child is extracted, the Hand must be again introduced,
for the extraction of the Placenta.-
The external Wound should be then closed by means
of the Quilled Suture, but the Ligatures should by no 
means be passed either thro' the Uterus or Peritoneum.-
A Very slight Bandage must be used.-
After the Operation an Opiate must be given, and 
which should be repeated from time to time, joined
with other remedies to allay the irritation, and occasionally
Laxatives, Glysters, fomentations &c.-
Section of the Symphisis Pubis.
This has been proposed as a Substitute for the 
Cesarian Operation but is only an imperfect one 
and is now fallen into neglect. 
In case any advantage was gained in respect 
to Room, the soft parts were so much injured,
as to almost certainly destroy the Patient.



258
Treatment of Women after Delivery.
When the Woman is delivered, that is when the Child
and Placenta are expelled, all moisture should be 
removed by means of Cloths, and a Cloth wrung
out of Warm Water applied to the Perineum, and 
another under the Breech.- The woman should
lay some little time perhaps 1/2 an hour, but this 
must depend upon circumstances, if there is flooding
she must remain a greater length of time, before
she is put to Bed.-
It is right to examine the different portions
of Placenta, is this has come away in detached
portions, comparing the to Satisfy the Nurse and 
attendants.- It has been usual to pass a Bandage 
round the Abdomen, but this should only be 
a Simple Napkin.-
The Room &c. should be kept moderately cool
not so hot as was formerly done.-
The Diet should be Simple, nothing either in 
form of food or Drink that is Strong should be alowed
for the first few Days.-
If either from any irregularity or from other 
causes, any unpleasant Symptoms come on 
purging will generally be found preferable to 



259
Bleeding. Always determine the necessity of the Bleeding
befor you attempt to do it.- The Bowels should
always be kept moderatly open by means of some 
gentle Laxative.- Opium will occasionally be 
Serviceable to alay irritability, but will generally require
either to be joined with Aperients, or those to be 
occasionally given.-
After Pains.
These arise from the contraction of the Womb, and 
continue to take place 'till that is compleatly
affected.. After pains should distinguished from 
Pains arising from other causes, as from internal
inflamations of Different parts, namely Enteritis, Inflamation
of the Uterus, Puerperal Fever &c. and this 
may done by attending to the Different Symptoms
after Pains, recur at intervals, [cross out] the Pain arising
from inflamation is constant, and the Pulse are affected.
In Pain from costiveness the Pulse may not be affected
yet the pain is more constant.-
Women who have had several Children have the 
after pains more violent.- The usually continue about
2 or 3 Days.- The treatment is generally by Opium 



260
but which is better joined with Aperients, more particularly
if there is costiveness.-
Symptoms of flatulent Cholic sometimes
attend, in this case Carminatives and Aperients
or Carminative Glysters may be Serviceable, and 
afterwards Opium
Lochia.
This is a Discharge which takes place from the 
Uterus after Delivery, and arises from the Vessels
of the Uterus which communicated with the Maternal
part of the Placenta.-
The Qauantity and duration of this Discharge
is very variable, in general it continues about 10
or 12 Days, but you must judge whether the Discharge
is too excessive or continues too long by its affect upon 
the constitution.- If the quantity is such as to produce
some unpleasant affect upon the Constitution
you must must then endeavour to check it either by
astringents, or if it arise from any other cause as 
Cough, that cause must be attended to, and the 
treatment must be the same as in flooding after
Delivery.- In some cases flooding will come on 



261
several Days after Delivery, when this is the case there
is great reason to suppose a Diseased State of the Uterus
to be the Cause.-
Women are Somtimes alarmed if the Lochia, become
suddenly suppressed, but if this does not arise
from any particular cause, as inflamation &c. [??ed]
is not followed by unpleasant Symptoms, it is of 
no consequence, but if it is caused by or is accompanied
with Symptoms of inflamation, those must be 
attended to.- Before you proceed to take away Blood
it will be generally right to give a Purge, and that 
alone will often be sufficient.- 
Somtimes the Lochia will only be suppressed
for a short time by a Clotter of Blood stopping up the 
mouth of the Womb, the Uterus be be excited to act for the 
expulsion of this, and the Lochia will then again flow.
In some cases of Stoppage of the Lochia, a discharge
of another kind will take place, which supplies its place.
The Discharge is at first composed of Blood, but it 
gradually changes, and after sometime only tinges the
Linen of a Pale Red, and afterwards of a Greenish Colour
and it then very soon ceases altogether  



262
Inflammation of the Uterus
The Symptoms of this are pain below the Navel
taking place the second or third Day after Delivery
and which has no intermissions.- If Pressure is 
applied, it gives considerable pain, and there is a 
considerable Degree of Fever and this of the Acute kind
attended with a Suppression of the Lochia.-
It may arise either from violent Labour or 
improper management, perhaps in the use of Instruments.-
A gradual Diminution of Pain, and return
of the Lochia, are favourable Signs
The Treatment in this complaint must be of 
the active kind kind and early employed, or Death
will take place.-
Bloodletting must be had recourse to early
and occasionally repeated according to the Constitution
of the Patient, not alowing to long intervals between
each evacuation, also Leeches may be applied to 
the Abdomen, and a Blister will somtimes be adviseable,
also fomentations &c. The Bowels must be 
kept freely open, and the Patient kept upon the strict
antiphlogistic Plan.- Before you proceed to this 



263
active mode of Treatment, you must be certain of 
this being the Disease, and that it is not from irritation.-
If you have any Doubt it may be better to 
give a Purge, and take away a small Quantity of Blood,
and from this you may be enabled to form a judgment
with more certainty.-
Puerperal Fever.
This term, if literally employed, might comprehend
any fever happening in the Puerperal State,
but is is used to denote one particular form of fever
which only occurs at that time.
This Fever is attended attended with, Pain in
the Head, and intense Pain in the Abdomen, and is 
contagious.-
The Abdominal pain should be distinguished
from arising from other complaints, as Distention
of the Bladder, Cholic, After Pains, Enteritis, Inflamed 
Uterus &c.-
You may know whether the pain arise from 
distention of the Bladder by the introduction of the 
Catheter or by other circumstances, and likwise from
Cholic by attending to circumstances.- After pains  



264
intermit at times, which is not the case with pain
in Puerperal Fever, tho' it suffers slight remissions.
After pains may be accompanied by accidental 
Fever.-
In Enteritis there always considerable Difficulty
in procuring Stools which is not the case, in Puerperal
Fever, as there is often a Degree of Purging.
It is more Difficult to distinguish between this complaint
and Inflamation of the Uterus, but by attending
to all the circumstances you may generally distinguish
between the two, in the Puerperal Fever
the Lochia are not suppressed, which is the case 
in inflamation of the Uterus.- The mode of attack
in the two complaints is different.- The Pain is often
in a different part, as in Puerperal Fever the Pain
may be in any situation which is not the cas in 
Inflamation of the Uterus.-
From many facts it is proved that this Disease
is contagious, and sometimes very actively so, no 
Women except those in Puerperal State, are liable
to be affected by it.-
The attack is by a Rigor followed by a Degree
of feverish heat, and pain in the Abdomen.
The Disease is not always equally contagious
often depends upon the mode of Life, Situation &c.



34
265
In many instances when a Practitioner has 
been attending a Patient Labouring under Puerperal
Fever, and is immediatly called to a Woman in Labour,
the complaint has been communicated.-
The commencement of this Disease from the 
time of Labour is various, generally on the second
or third Day, sometimes as late as the fifth, and
has been observed much later, even a late as a Month.
The attack is by a Rigor attended with Pain
in the Abdomen, the Rigor after some time goes off 
and is succeeded by pain in the Head and feverish
Heat.- 
The Duration is very indefinite, it has terminated
fatally in 36 hours after the attack, and 
as late as the 9th,, or 10th,, Day, in generall if it continues
'till the 6th,, or 7th,, Day the Patients recover.
The Peritoneum is the seat of inflamation, and 
has been found in all the Different Stages, as that 
of adhesion, in one part in others, effusion, and Suppuration,
and the seat of the Pain will be various
according to the seat and stage of the inflamation.
Different Writers have described the Pain to be in
different situation, they may have all been right, as 



266
the situation will vary according to the situation
and stage of the inflamation.
Prognosis.- This is always unfavorable, but
not at all times equally so.- A Very quick Pulse
with much tension of the Abdomen indicate extreme
Danger.- What in other fevers would be considered
a quick Pulse is in this rather slow, as 120
in this Disease the Pulse are of often 140 or 160, or even
so quick as not to be numbered distinctly.-
In this complaint the Pulse assist more in 
forming a judgment than in most others, if the 
Pain abates it is not of much consequence except
there is an alteration of the Pulse likewise. A sudden
cessation of Pain that has before been violent, unless
attended with a favourable Pulse, should be regarded
with Distrust.- It is a favourable sign when
quickness of Pulse and degree of Pain, gradually abate.-
Delirium very seldom attends this complaint
tho' there is such great quickness of the Pulse, the 
mind being generally tranquil.
Treatment. Different and opposite modes of 
Treatment have been recommended in this som 



269
complaint, some strongly recommending Bleeding
others condemning it.- In cases where active Inflamation
exists, with a degree of strength in the constitution,
Bloodletting is proper and should be taken in
rather a large quantity and in the early Stage, but 
if there is a Degree of weakness and the complaint is
more advanced, it will then be injurious, but this 
must entirely depend on the nature and Stage of the 
Complaint and the Patients constitution.-
Dr. Gordon of Edenburgh says that in all cases
when the Patient was bled to the quantity of 20 oz.
early, they recovered, and another respectable Practitioner
says that in all cases when bleeding was 
employed the Patients Died.- It will be right to 
take away a small quantity and this will assist
in determining the Propriety of Bleeding more freely.-
Local bleedings either by Leeches or cupping
may be had recourse to with advantage, but 
as the inflamation is only a consequence not
a cause of the Fever, it must be attended to only 
secondarily.-
Vomiting is strongly recommed by the French
Practitioners, and certainly always affords relief, it 



268
always be employed early, and is best given in
repeated Doses so as to produce the full effect,
Ipecacuanha answers the Purpose best.-
Somtimes a spontaneous vomiting of a Dark
grumous Matter comes on, when this is the case
the Patients generally Die.-
Purging has been strongly recommended
and may frequently be given with advantage
the purging should be kept up by giving the 
Medicine in repeated Doses so as to procure
5 or 6 Stools Daily, a good purge a a Solution of 
Natron. Vitriol. in Aq. Mentha. A good Rule
for the exhibition of Purges may be to give so 
long as the Patient is relived and not weakened.
Somtimes a Spontaneous Diarrhea comes 
on which relieves very much, on which account
you should never be in parts to check any thing
of that sort which takes place, except it weakens
the Patient, then you may moderate or Check it.
Blisters to the Abdomen may be of Service
and should not be to small, and should be 
applied early.-
If the disease changes from the inflamatory
kind, and puts on Symptoms of Typhus, the 



269
mode of treatment must be changed, Medicines
of the Cordial Diaphoretic kind may be had recourse
to as Camphor &c. or Wine, and Bark, somtimes
rather freely, in the advanced Stages of the complaint.
Attention must likwise be paid to the 
Palliation of Urgent Symptoms, as Pain, by
Fomentations, Anodyne Liniments, Rubefacients
&c. a Liniment composed of Ol. Olivar. ℥i Camphor.
ʒij R a,, Opii ʒij M. will often relieve.- The Warm
Bath is not adviseable on account of its disturbing 
the Patient so much.-
Sickness and Vomiting may be relieved by 
Opium, or the Saline Draughts in the State of 
effervescence 
Milk Fever.
This comes on about the second or third Day 
after Delivery, with Rigors and other Febrile Symptoms,
attended with a Painfull Sensation of the 
Breasts, all which are abated by a Discharge of the 
Milk, hence the remedy is Obvious, and the Child
should be put to the Breast, as the first Discharge of 
Milk is proper and Serviceable to the Child.-  



270
If during the cold Stage any thing hot or Stimulating
is given, a considerable Degree of Fever will
be excited, and will render the exhibition of Purge
necessary.-
Many Women dont wish to give the Child the 
Breast but want this Milk repelling, this is sometimes
effected with care and safety, at other times
not. When this is wanted to be effected, you shd,,
act moderately upon the Bowels, procuring 4 or 5
Stools daily, and ordering a low Diet, and the application
of some simple Plaster to the Breast.-
It will sometimes be necessary to take small
quantities of Milk away by means of proper
Glasses &c. or the Thinner parts being absorbed, will
leave a portion inspissated, this causing irritation
will bring on a Milk Abcess.- When Inflamation
takes place a few Leeches may be applied &
the Saturnine washes.-
Somtimes inflamation will put a stop
to the Secretion of Milk.-
When by the application of Leeches, Saturnine application,
Purging &c. you cant subdue the inflamation,



271
inflamation, you must have recourse to poultices, to 
forward Suppuration, and evacuate the Matter
by means of an Opening when formed.-
This Disease very seldom terminates in Cancer.-
Soreness of the Nipples. This is relieved or 
cured by washing them with Brandy or a Weak
Solution of Alum.- wearing Leads &c-
Swelling of the lower Limbs
This is an œdamatous swelling of the lower Limbs
which comes on after Delivery, which begins at the 
Groins and extends downwards to the Feet.
The complaint may attack either one or both
sides.
The time of its commencement from delivery 
is variable, may come on in the course of a Week, or 
two, and has been as late as 6 or even 9 Weeks.-
The Limb in the beginning is œdamatous, but 
after the Disease has remained some time it looses
its softness, and becomes considerably more hard.
The cause of this Disease is inflamation and 



272
obstruction of the Lymphatic Glands about the Groin
and Poupart's Ligament, probably owing to some portions
of Blood remaining in the Uterus, which becoming
Acrid, Stimulate the absorbents, causing irritation, and 
inflamation of the Glands situated about the Groin.
The Disease has been distinguished into mild
and violent according to the Symptoms.-
The Hardness which takes place after a time
is owing to a quantity of coagulable Lymph, which 
is thrown out becoming inspissated.-
Success in the treatment of this Complaint, depends
on the early resolution of the inflamation, rendering
them pervious to the Passage of the Lymph
and afterwards to invigorate them by means of 
Tonics and Stimulants.
In the early Stage Leeches applied to the Part
and other means of reducing the inflamation
may be applied.- Purges may be frequently administered
with advantage.- Emetics likwise from 
the goods effects in other cases of a Similar Nature,
as Hernia Humoralis, may be employed with advantage, 
and should be given in full Doses.-
When the Disease is more advanced and a Degree
of Hardness has taken place, you must then have recourse
to a different mode of treatment. Ungt Hydroy.



35
273
Fort. rubbed in upon the lower extremities will be of 
service, and this may be done with great freedom
without producing any effect on the constitution, on account
of the impervious state of the Vessels.- If the
Mercury does affect the Mouth it is upon the whole a 
favourable sign, shewing that the Vessels are not entirely 
obstructed.- In this stage of the complaint, Pulv.
Ipecac. Comp. may sometimes be given with advantage.-
This Disease very seldom terminates in Suppuration
tho' it does somtimes, this should be prevented if 
possible, for if an Abcess bursts, it is extremely difficult
to Heal, and there are many abcesses generally form, and
this repeatedly for a length of time.-
Laceration of the Perineum.
This is much less disposed to Heal than an incised
Wound in the Same part, yet the attempt should
be made.- You must keep the parts in contact as 
much as possible, by passing a Roller round the 
Thighs, as neither Sutures not adhesions can be 
made use of with propriety, or advantage.
Some gentle stimulant application may be made 



274
use of to promote the growth of Granulations, as
Tinct. Myrrh. Simpl. &c.
When the laceration extends to the Rectum
the loss of power to retain the Feces is the consequence.-
In case the Head of the Child is so large as to 
render it very probable that the Perineum may 
be lacerated, it may be a Question whether making 
a slight incision would not be more adviseable
than alowing the parts to be lacerated.-
Excoriation of the Labia.
When the Labour has been Difficult, and the Head
has rested a considerable time upon the external
parts, they are frequently Excoriated, and sometimes
Ulcerate, and if the constitution is irritable will put
on a flabby unhealthy aspect, and have frequently
been mistaken for Venereal, on this account you
should always take particular care to Distinguish
between the two, for if you employ Mercury in a case 
of this kind, you will do very great injury.-
The mode of treatment must by by any means
that will alay irritation locally an constitutionally, as
fomentations of Poppy heads, Opium, Cicuta &c. or occasionally 



275
occasionally Bark and Wine, sometimes very freely.
When Simply an excoriation, a little simple Ointment,
or Saturnine wash may be employed.-
Diseases of Children.
The Diseases mentioned are to be confined to those
which prevail in early infancy.- Some of these
are Surgical cases, and others belong to the Physician.
Some of the Surgical Cases, arises from the 
Birth, others existed while in Utero, and others appear
after Birth.- 
Of the first kind are the different effects of Pressure
on the Scalp, producing Inflamation, Abcess & Gangrene,
the are to be treated according to the common Rules
of Surgery.-
When the Shape of the Head has been altered, forming
what are called a mole shot, or Horseshoe head,
it has been recommended to press on the head in 
the opposite direction, but this very wrong and shd,,
never be done.-
Others have recommended apply a cupping
Glass over the part, or a Piece of Adhesive Plaster, or 



276
or wet Leather, with a String to the Center, to alow
of extension being made, this may sometimes be 
Serviceable.-
Paralysis of the Arm somtimes takes place from
pressure made on the Axillary Plexus of Nerves, more 
particularly if the Blunt Hook has been used, the
way to avoid this is make the Pressure on the back
Part of the Arm.- What [illegible] produced? [illegible] slight Galvanic [illegible]
Fractures sometimes take place during birth
more particularly of the Humerus or Femur, in 
Breech, or Feet presentations, these must be treated
like other fractures.-
It will be adviseable to examine the Child, immediately 
after birth, or the Nurse may break any
Bone &c. and say it occurred during Labour.-
Fractures are most liable to occur when the 
Blunt Hook is used.- 



277
Diseases existing before Birth.
Swellings of the Head containing a Fluid. These
are often seated on the Parietal Bones, and contain
a Gainy fluid.- These Tumors must be Distinguished
from Hernia Cerebri.-
Some have supposed these Tumors to arise
from some injury received during birth
but this is not the case.- The Bone is not 
necessarily affected, tho' is somtimes, but appears
to be in a secondary way, from pressure.
These Tumors will in general be cured by the 
use of Astringent Embrocations, as a strong Solution
of Alum.- If the Tumor does not give
way to this, it may be adviseable to evacuate
the fluid by a Small opening, to prevent the 
affects of Pressure upon the Bone.-
Cohesion of the Genitals. If this is of the 
Labia Pudenda you should examine to ascertain
whether the internal parts are perfect, and 
the external parts only adhering, if this is the 



278
case you may divide the Parts by means of the 
Knife, afterwards dressing the Parts to prevent
them again adhereing.- If you have any doubt
you had better wait 'till the Age of Puberty, and
these Symptoms may occur which may direct
your Judgement, for if it is only the Hymen being
imperforated the Menses will be found collected
behind it.- 
Cohesion of the Eye-Lids. If these are in 
other respects well formed, this adhesion may
be divided by means or a Small Bistory, or a 
Direction, avoiding wounding the Puncta Lachrymalia
&c.
Tongue Tied. This should always be remedied
early, or the Tongue will grow in the curved
position, and prevent the Childs speaking.-
This is remedied by dividing the Frenum by
means of a proper pair of Scissors, taking care
to avoid the Sublingual Vessels, and Ducts of the 
Maxillary Glands. Women often suppose the Child 



279
is Tonge tied when it is not, and it may be better
to draw Blood to satisfy these.- The Child is not 
Tongue tied if it can elevate the tip to the Roof of
the Mouth, or put it over the lower Lip.-
Hair Lip. The proper time for curing this
is only to be considered here, namely whether before 
putting the Child to the Breast or after it is weaned.
If there is a fissure in the Palate and the Child
is not able to suck it will be adviseable to perform
it early, that is before it takes the breast at all, but
in a general way it will be better to defer it 'till the 
Child is weaned.-
Umbilical Hernia. Children are often born
with small protrusion at or near the Umbilicus,
and sometimes with larger ones if there are small
a cure may generally affected by a constant and 
regular pressure made upon the part either by 
adhesive Plaster, and sheet Lead, or by means of 
a well constructed Truss.- No Circular Bandage
can be used with advantage, as it would
tend to increase the Tumor by its pressure on 
the sides of the Abdomen.- When these Tumors are 



280
larger they generally prove fatal, as there is likewise
a Defect of the Parietes of the Abdomen.- 
Spina bifida. It receives this name
from the spine in the part when the Tumor is 
situated being split into two portions.
This Disease may be distinguished by passing 
the Finger along the Spine, if it is Spina Bifida,
you will perceive the Defect in the Bone.-
It is most commonly seated in the Loins.
The appearance is sometimes a small Tumor
at others, the Skin is flat and shrivelled, this is 
owing to the Tumor being burst During births
when this is the case Children are generally born Dead.
This Disease is somtimes combined with Hydrocephalus.-
This Disease is formed by a 
quantity of Water distending the Membranous, covering
of the Spinal Marrow.-
The sensation of the lower Limbs is generally
impaired.- The Tumor should be kept from 
bursting as long as possible, for when this takes
place Death in general soon follows, this maybe
attempted by astringents and Bandage.- 



36
281
Malformation of the Urinary Passages.
These are of different kinds. When the Pressure 
is imporated, a small portion of the end 
may be taken of by a Scalpel.- When is elongated
or constricted a small part may be taken off
or it may be slit up the same as in the 
Operation for Phymosis.
When the Glands Penis are imperforated,
different modes of treatment may be necessary
according as there is a preternatural opening
or not, but the success off any operation is very
uncertain.- If there is not any opening it will
be extremely Difficult to affect one by art, and 
if there is a preternatural one, endeavouring 
to make one in the proper part will be extremely
Difficult or impossible, for tho' an opening
might be made, yet it will almost to a certainly
close again, as as Membranous Living cant be given.
Sometimes there will be a retention of Urine
without any malformation, in this cas a bent
Probe or small Catheter will be useful, if a Male 



282
or if a female, washing the Parts with a Spong
and Warm Water, to cleanse away any sebaceous
matter, may be of use.-
Imperforate Anus. When this is the case 
the Child will not have the usual Discharges, and 
on examination, (if the imperforation is only at the 
Anus) the Meconium, may be felt fluctuating
behind the part, in this case a puncture may
be made or a small crucial incission, keeping 
the parts from again adhereing.-
If the Stricture is situated higher up, relief
is less certain, and that in proportion as the seat
is higher.- Somtimes the Anus terminates
in the Bladder or Vagina, if in the Bladder Death
may soon takes place, but if in the Vagina, the
Patient may live, but will be in a Distressing
state, and not remediable.-
Lues Venera. This Symptoms of this complaint
are in general less evident in this state than
in the adult, as there is not that regular pain



283
of Symptoms.- When these are dubious Symptoms,
which dont yield to the common modes of 
treatment, it will be right to give Mercury a
trial.
The best way of giving Mercury to Children is 
by giving a grain of Calomel every night or again
of Quicksilver rubbed down with any common Substance,
or what may perhaps be still better, giving
a little Calomel, which has been washed with Aq:
Calcis to divert it of its Acid.-
It may not in all cases be prudent to betray
suspicion.
Different opinions have been formed respecting
the way in which a Child can receive the 
Disease from the Mother, one Opinion is that 
there must be actual contact of Matter, and that 
this takes place during its passage thro' the Vagina.
John Hunter is of this Opinion, but there are 
facts which tend to prove than this is not absolutly
necessary, but that sucking the Breast of 
a Diseased Woman is sufficient.-
Swallowing the Tongue. This is owing to the 
Frenum being to short, alowing the end to be turned



284
back towards the Throat, and bringing on evident
coughing, with a sense of Suffocation.- This is 
relieved by bring the Tongue forwards by means
of the Finger or the Handle of a Teaspoon. 
Elongation of the Uvula. This often brings on 
similar Symptoms, and is owing to a relaxed State.
Anstringent washes, composed of a Solution of Alum
or a powder with a portion of Alum will be of Service.
Purulent Eye. This complaint is most common
among indigent people, and those who are 
filthy.- The first Symptom are a degree of fullness
and redness of the Eyelids, which takes place a
few Days after birth, soon after this the Eyelids adhere
together, and on separating them, a quantity
of Purulent Matter will be discharged, if the Disease
is alowed to go on, the Eyelids become tumid, and 
inverted so that they cant be closed, opacity of the 
Cornea follows, and incurable blindness.-
This is owing to a larger quantity of fluids
being determined to the Conjunctiva, from their
being in a relaxed state.-
In the begining astringents in the form of Lotion.



285
or Tinct. Opii. will be of Service, a Solution of Alum
or vitriolated Zinc. in the proportion of 4 or 5 Grains to an
Ounce will answer very well, this should be applied
as is very common to the side of the Face, but should
be dropped between the Eyelids.- When there is much
Tumefaction it may be necessary to divide some of 
the Vessels to take off the Distention.-
When there opacity of the Cornea a Solution
of Hydrary. Muriat in the proportion of gr. ss and gr. in,,
to ℥j.
Purulent Discharge from the Ears.
This somtimes arises from behind the Ears, and
at others from the Meatus Auditorius.-
When from behind the Ear, the discharge may 
be stopped by Astringent washes or Calomel Ointment.
When the Discharge proceeds from [cross out] within the
Ear, it probably originates from behind the Typanum,
and as a portion of this with probably some of the 
Bones will be destroyed, it may be of very great
consequence.- The cure may be attempted by
means of Astringent injections.-



286
Diseases of Infants requiring Medical Treatment
Much uncertainty often attends this part of Medical
Practice, from the uncertain of Diagnosis, on account
of Children not being able to express themselves except 
by the signs of Nature.-
The state of the Pulse in Children is but an uncertain
Criterion of Disease.- In Infancy the Pulse
are in the natural state, about 120 or rather more 
and this corresponding with 72 in the Adult, but to
she any remarkable degree of increase of quickness
they must be 200, or much more, and which can not 
be counted.-
The Degree of fever in Children, is much better ascertained
by the Degree of heat, Thirst and frequency
of respiration.-
Children are much more irritable than Adults
this in consequence of the Brain and Nerves, bearing
so much greater proportion to the rest of the Body
than in the Adult.-
Diseases of early infancy depend principally
upon these causes, namely irritability, Acid Acrimony
in the Primæ Viæ, and over feeding.



287
Irritability, as depending in part upon the 
cause before mentioned, cannot be compleatly removed,
but it may frequently be much moderated,
by removing any irritating cause, or by the 
action of certain remedies, as antispasmodics &c.
according to circumstances.-
Acidity in the Primæ Viæ, this existence of this 
is evident from many Symptoms, as from the smell
&c. and indicates the use of Antacids, in giving these
it may not be necessary to entirely subdue the Acidity
but only to moderate it.- As alway will coagulate
Over feeding is a very common cause of Disease
in Children and often takes place of the Child being
fed to quieten it, when it is uneasy from other causes,
in this case Nature will frequently relieve herself
by Vomiting. The Cure is obvious.-
Red Gum, this is a Disease of very little consequence,
except to distinguish it from Measles,
which the eruption somewhat resembles, only is not 
attended with the usual Symptoms, as Cough, Fever
&c. the eruption making its appearance without
any previous Symptoms.-



288
Apthæ, may be suspected, when pain is expressed
during sucking, and there is soreness of the Nipples,
it is easily determined on examination, by white Specks
on the Tongue, Fauces &c.
This Disease is distinguished into mild and 
Malignant, these are distinguished by the Colour
of the Specks. &c. if they are of a White colour and unattended
with Fever, this kind is curable by local
applications, as honey Borax &c. tho' it may be 
sometimes necessary to give a Purge, or some 
Cretaceous Medicine with R [illegible],, Opii in small
Doses.-
When the Pustules are of a Brown dusky colour,
attended with fever, irritation and a considerable
degree of Debility, besides cleansing the Mouth,
attention must be paid to the Fever.- The 
Primæ Viæ must be cleaned by Emetics or Purgatives, 
and afterwards, Bark, Wine and Opium
may be had recourse to.- The Bark may be 
rendered more pleasant by the addition of a bitter
Liquorice, to the Decoction, and it should be given Warm.



289
Convulsions may be distinguished into the Acute
and Chronic.- In the acute form of the Disease
the Child often dies on the first attack, therefore active
treatment becomes necessary.-
Children are very much disposed to Convulsions
from their excessive irritability, consequently
all irritating causes should be avoided or removed.
The irritating causes may be either seated
in the Primæ Viæ or in the constitution at 
large.- When the Stomach is the seat Vomiting
or Purging may frequently effect the removal
and it may somtimes be necessary to excite the
action of Vomiting sooner than can be done by
Medicine, that is by irritating the Fauces.-
Stools may be procured by Suppositories as
a Piece of Soap in a Conical Shape &c.-
General irritation will cause convulsions
as is the case in fever, Small Pox &c. you must
then endeavour to alay it by different means, as 
the Warm Bath, Opium, Musk, Assafœtida, or 
by Glysters of some of the Articles before mentioned 



290
in which you may in general give about 3 times
the quantity you would give by the Mouth.
Sometimes the milk disagrees with the Stomach
when this is the case it is evident what must be 
done.-
Convulsions succeeding an Acute Disease in 
the advanced State, are generally fatal.-
In the Chronic form of the Disease, several
of the remedies before mentioned may be had recourse
to, and external applications as Volatile
Liniments may be used. These frequently end in
Idiotism.-
Icterus. Children are after born with this Disease
but which in general disappear in a few Days by 
the Discharge of the Meconium.- Somtimes are 
Emetic, or a little Rhubarb may be of Service.-
Vir. Aloctic. Alkalin. has been recommended.
There is a Species of this Disease attended with
Emaciation, wrinkled face, and Shrill Voice, which
is fatal.-
Watery Gripes. This is often a consequence
of a deprivation of proper breast milk.- The 



291
remedy therefore is obvious.- The Testaceous powder
with Aromatics and Opium are sometimes
usefull.- This Disease is more easily prevented
than cured.- If these things dont do proper milk
must be had.
Erysipelas Infantilis.- When the Navel
string comes off there will somtimes be a slight
Erysipelatous Affection, but which is of no consequence
and is generally cured by the Nurse with singed Rags.
But there is another Disease of much more consequence,
and attack, either the parts about the 
Navel, or the Genitals, spreading to the Back and 
Belly and which puts on a putrid appearance,
it attacks different constitutions, and its progress
is very rapid, frequently ending in Mortification.
Bark and wine may be given internally, and 
Camphorated Spirit applied locally
Periodical Cholic. This often takes place at 
the time the Nurse menstruates. (which they sometimes
do) May be moderated by gentle opiates 



297
You will frequently be asked to recommend a 
Wet Nurse, but which should if possible be declined
and when asked respecting the health of any one you
should be extremely guarded, and only speak in general
Terms, as you cant always possitively say, whether
or not the Woman as free from Disease.-







































Lectures
ON THE
Practice of Midwifery
by
Dr. Haighton.
1803
&
1804.



1
Introduction.
Persons unaquainted with the sbject of Midwifery
may form very limited Ideas respecting it, supposing
it only to the actual delivery of the woman but it not 
only consists in this, but in the explanation and treatment
of a number of Disease connected with Pregnancy
and after actual Delivery.
Pregnancy has a begining, which is called conception,
a duration which is called Gestation and a 
termination which is called Labour or delivery, and 
after delivery then is a time which is called the Recovery
at which time Women is subject to many Diseases peculiar 
this this state, and as a Supplementary branch
may be added, such infantile Diseases as occur 
within the Month.
Conception supposes a previous knowledge of 
the Fruition, and Aconemy of the Organs of Generation
which consists in the parts mainly, Anatomical,
Physiological, and Pathological.
The Anatomical part comprehends a knowledge
of the Pelvis, as giving attachment to the Genitals



2
as containing the Womb and its appendages as 
being the part thro' which the child must pass to 
come into the World, the situation and structure
of the organs of Generation, both external and internal,
including the Mons Veneris, Labia Pudendi frenum
Perineum, Pudendum, Fossa Navicularis, Clitoris,
Plexus retiformis, Nymphae, Orifice of the Urethra,
hymen, Caruncula Myrtiformis, Vagina, Uterus and
its appendages.- 
The Physiological part, consists in the explanation
of the natural and healthy actions of the above
mentioned Organs, or their uses as far as it is known.
The Pathological part, in the description of the 
Various diseases, to which the Generative Organs
are incident, and the most effectual method of administering
relief.-
Many practice very successfully without any
knowledge of the Alteration which is produced by conception,
but it is expected that all who practice this 
branch should have a knowledge of it. In some cases
when conception has taken place considerable alteration



3
alteration is produced in others not any of consequence.
The external parts of Generation in the female are 
subject to several Diseases which will during the 
course be treated of End then is great variation with 
respect to Labour, each cavity will be fully treated of
rotation, but from have only a view of giving an 
Idea of the mode in which they will be treated of 
and shall begin with a description of the Pelvis as 
a knowledge of this necessary to form a proper Idea
of the other parts.
The Pelvis is formed of that assemblage of 
Bones at the lower part of the Abdomen, below the 
fifth or last Vertebrae of the Loins.
It is an easy matter to distinguish between
the Male and female Pelvis, the female being much
more capacious, and of a different shape, being formed
to alow the passage of the Child, where as the Male is 
only for the [illegible] of containing certain parts, and 
giving attachment to the Muscles &c.
The Pelvis in fœtal state is composed of a 
greater number of Bones than in the adult, and 
which is of considerable advantage in delivery as 



4
in the breech presentation, the Bones will on that account
give way more, and more easily pass.
The Bones which form the Pelvis will not be particularly
considered as that more properly belongs to 
an anatomical Description, but will be considered
together as forming the Pelvis.
In the adult the Pelvis is composed of three
Bones namely the 2 Os. Innomenata, and the Os. Sacrum
to which may be added the Os Coccigis which makes 
them 4 in number. The number of Bones in the fœtal
state is eight, each of the Os. Innomenata being divided
into 3 Bones namely the Illium or haunch Bones
the Ischium or sitting Bone, and the Pubis or shorse
Bone, the [illegible] of the Os. Sacrum is the Rump
Bone and the Os. Coccigis is called Huckle Bone, a 
knowledge of this becomes necessary to understand
what the Women Midwifes mean by the Names they
commonly use.
The formation of the different parts into 4 Bones
does not take place to after the Age of Puberty.
There are three parts of the Pelvis more particularly
interesting, namely the Brim, Cavity and 



5
outlet, the shape of the Brim [Cavity] is rather of an Oval
form, but in some measure resembling a heart.
The line in the fore part which joins the two 
Ossa Pubis is called the Symphisis Pubis. 
It is sometimes the case that the upper
Part of the Brim of the Pelvis, instead of being 
round and smooth forms a sharpe ridge, and 
which from the womb pressing on this ridge gives
a sense of cutting in this case a Bandage with 
compress round the Abdomen and placing the 
patient in a more upright posture, a rather 
reclining Backwards, to take off the bearing
upon the part will be of Service.
The size the Pelvis varies in different People
but from one particular size being more often found
that is called the standard Pelvis, and which is of 
the following dimensions a line drawn from 
the upper edge of the Symphisis Pubis is 4 In. long
a line across the Brim of the Pelvis from side 
to side, is 5 In. long and a line in an oblique
Direction, from the Sacro Iliac Symphisis is 5 1/8 In.
a knowledge of the Dimensions, is necessary in practice,



6
practice, for the purpose of adjusting the long Axis of the 
head to that of the Pelvis.
In general the head of the child enters the 
Pelvis without any assistance, and of course then
cant be any thing done with respect to the way 
in which it enters, but in case the child is turned
and brought away by the feet, the way in which the 
head enters entirely rests with the practitioner,
in this case the long Axis of each must be Kept in 
view at the brim, and changed as it passes to bring
them to correspond at the lower part or outlet.
In the case of turning no delay is admissable
when the Body of the child is partly passed, for if the 
head is confined long the child must inevitably Die
on account of its supplies from the mother being cut
off and respiration being at the same time prevented.
Shall now conside the Dimensions of outlet
the lower edge an outlet, a line drawn from the 
lower edge of the Symphisis Pubis to the extremity
of the Os. Coccigis is 4 In long, but by this bone giving way
during Labour this line becomes an inch longer in 



7
way making the line 5 In. long. a line drawn
across from one tuberosity of the Ischium to the 
other is 4 In. long. thus long axis of the Brim and outlet
are in opposite directions, so that it becomes
necessary for the head of the child the to turn in its
passage thro the Pelvis, and which is very much
assisted by the oblique direction of the Os. Innomenata
it is necessary to attend to this in making use of 
instruments. The form of the outlet is rendered
more complete by the Sacro Sciatic Ligaments, extending
from the Spinous proofs and tuberosity of the 
Ischium, to the False transverse processes of the Sacrum.
In considering the Cavity there are two things
to be attended to, namly the Depth and Axis, the 
Depth of the Pelvis at the fore part is about 1 1/2 In. and 
at the sides twice the Depth of the front, and three
times the Depth at the Back part, but the matter
of the greatest important is the Axis this must 
be either in direct or curved line, but is certainly
that of a curve, a knowledge of this circumstance
is necessary in the application of instruments, as 
in case the head of the child wont enter the brim of 



8
the Pelvis, in this case if there is disproportion it 
may be necessary to make use of the long forceps or 
the perforoter & Crotchet.
There are frequently deviations from the Standard
Pelvis, and which may be either in shape or 
size when the lines drawn across in different directions
are longer it is called a large Pelvis, and where
they are shorter, a small one, and when the shape deviates 
from the well formed Pelvis it is called a deformed
or distorted Pelvis. To render a Pelvis deformed there
must be some cause, and which cause either consists 
in Ricketts, or Mollities Ossium. Bone is composed
of a quantity of Earthy Matter and Animal Gluten
the cause of Ricketts consists in a deficiency of 
Earthy Matter and which causes a yielding of the 
Bones. In some cases there is a destruction of 
Symmetry, the deformity not being equal in both 
sides, a knowledge of this circumstance, wits of 
great ability in some cases, as advantage may in 
some instances be taken of this circumstance, of
inclining the child to the part where there is most 
Room. Some have supposed the Pelvis may be 



9
partially distorted, that is, the brim may be narrower
without the outlet being effected and the Reverse, but in most
if not all cases when the Brim is narrower, the outlet 
is enlarged tho' in some cases they are both contracted.
The Pelvis may be narrower from before 
backwards, or the reverse that is to say from side
to side, tho' the former is most common in some 
cases the fore part of the Pelvis appear to be pressed inwards
by the weight of the Body. The Spine in some
cases projects forwards into the Pelvis and in
this way occasions a want of Room.
A knowledge of the form of the Pelvis will
in many cases be of consequence in respect to 
forming an Opinion in what way the Progress
of the Labour is likly to proceed, as in case of the 
Brim of the Pelvis being narrower, the head of the 
Child will frequently rest a considerable time before 
it enters, as it cant do this till the Bones
of the head have given way, and which requires some 
time to be effected after which the progress of the Labour
will be quick, as there is no more obstacle to its proceeding.
In this case the lever or long Forceps may 
be of service, as by their use the head may be brought



10
quarter or half an inch down and which in many
cases is all that is wanting.
If the Pelvis is narrower below, the case will
be reversed and the Labour will proceed at first 
rapidly and when the head comes to the lower part
of the Pelvis, the will be considerable delay, from 
this it will appear evident what caution is necessary
in giving an opinion of the trim Labour is likely
to terminate, except you exactly ascertained the form
of the Pelvis &c.
In some cases Instruments will be 
of Service in assisting the expulsion of the Child, but
in many cases when the deformity is considerable
it will be impossible to bring the child away without
opening the head. In some instances the
Os. Coccigi will project very much forward, and
the projections of the Tuberosities of Ischii will frequently
at the same time be forced in which 
renders the passage of the child extremly difficult.
Must now take a practical view of the 
Business, as the means necessary to Know the 
Degree of deformity, or whether there is deformity in



11
not, there are two ways of judging one of which is 
probable and the other certain.
The Probable way is by judging from the presence
of a Ricketty state of the Body, or from a deformity
of other parts as the curvation of the Spine Os.
as it is probable a Woman with a curved Spine
will have a deformed Pelvis, but this is not always
the case, as this curvation may be owing to accident,
or posture, or from other causes, as particular employments,
but when this is the case other parts of 
the Body are seldom deformed, if then is no general
Disease, but if it is from a degree of softness
or weakness of the Bones the projection of the Sacrum
will frequently be forced forwards and diminish
the diameter of the Pelvis.
The diameter of the Pelvis may in some 
cases be diminished by Exastosis, and other Bony
Projections.
The certain way of ascertaining the demensions 
of the Pelvis is by measurement, and for 
this purpose, different ways have been proposed, our
way is by different instruments, but which dont 



12
appear deserving of notice, and no instrument is 
necessary for this purpose the fingers answering
best, the method of doing this is by passing your finger 
to the centre of the Base of the Sacrum, and then
mark what part come opposite the Symphisis
Pubis, you then measure the length from that 
part to the end of the finger, deducting 3/4 In. for the 
oblique line, and it then gives the proper length of 
the direct line as for instance if these oblique line
is 4 3/4 In. deducting 3/4 In. leaves 4 In. the length of the 
line in the standard Pelvis. Another way of measuring
is by opening the two fore finger, and thus ascertaining
the length of the line, but this requires practice
to determine it with accuracy.
The way to ascertain whether the fore part
of the Pelvis has the proper degree of curve, is by
passing 2, 3 or 4 finger up the fore part and by the 
ascertaining the degree of Curve, thus if you can lay
3 or 4 finger flat you may be certain then is the proper
degree of curve, but if you cant bring more 
than two or three fingers to touch without laying
them over each other the must the be a more acute





13
angle than in the well formed Pelvis.
To determine whether the outlet is well formed
you may place your finger in the Angle formed by 
the two projections of the Ischium, in the natural and
well formed Pelvis they form an Angle of about 60 Dg.
which is somthing less than a right angle, any deviation
from this constitutes a degree of deformity.
You may ascertain wether the Os. Coccigis is 
properly formed by feeling it.
In proportion to the degree of deformity or diminution
of the size of the Pelvis, is the difficulty in extracting
the head.- If the deformity or diminution
is in a small degree, tho' the head wont pass, yet
this may be effected by the assistance of the Lever or 
Forceps, but if this is greater then the perfortor and 
Crotchet become necessary, and when it is in a very
great degree the child cant possibly be extracted
by any means thro' the natural passage in their 
case the Cesarian Operation becomes necessary.
Actual measurement is not of so much consequence
as at first sight appear to be the case 
as it frequently will depend upon disproportion of 



14
of the head to the Pelvis, thus a Pelvis may be of the 
natural size, and yet the child wont pass on account
of the head being particularly large, or the state of 
Ossification more advanced or soft parts rigid.
From what is already mentioned it would
at first sight appear as tho' a large Pelvis would
be advantageous, but this is not the case, as there 
is danger from this circumstance, for as there
is not that degree of resistance to the quick expulsion
of the child as in the standard Pelvis, the soft
parts are liable to be lacerated, on account of there
not being sufficient time for their proper dilatation,
and from the quick expulsion of the child the 
womb has not time to contract in a proper degree 
and this way hemorrhage is produced. Or invert the womb.
Labour pains are not always to be distinguished
from the sensation of a want to evacute to contents
of the Rectum, a mistake of this sort may 
possibly be attended with very serious consequences
as the child may be expelled in this way without 
the Patient being aware of it, a mistake of this 
kind of very great importance should it happen
to an unmarried woman, as it may appear as 
tho' the child was killed and afterwards thrown 



15
away, for the purpose of concealing the affair.
A Medical Man in Yorkshire gave his opinion,
in a case of this sort, that a Woman may 
in all cases distinguish between the pains of 
Labour, and the inclination to go to stool, but he
afterwards had reason to alter his opinion, and 
was on that account under considerable uneasiness.
In all cases when you are called upon
to give your opinion, in a Business of this sort
you will do well to call in the aid of several colateral
circumstances, or whether she has made 
any preparations &c. and upon all occasions if 
either be favorable, this sudden expulsion of the 
child can only take place when the soft parts are 
relaxed and disposed for labour, but in case of rigidity,
and the womb acts violently, when there is a large
Pelvis, there is danger of a Prolapsus Uteri, or 
of a laceration of the Perineum, or of a retroversion
of the Womb.
In this case to prevent these effects, you 
must press upon the mouth of the Womb, during 
pain to prevent its being forced down before the 



16
external parts are sufficiently dilated, and it will
be of service to endeavour to open the mouth of the 
Womb, by degrees, by the introduction of 2 or 3 finger
gradually dilating the parts, the same treatment
is necessary in its passage thro' the external parts,
gradually opposing the passage of the child 'till the 
parts are sufficiently dilated.
Retroversion of the Womb is not peculiar to
a large Pelvis, tho' there is in this case danger of 
its taking place for a greater length of time, and if 
there is much relaxation may take place at as 
great a distance of time from the Labour as the 
fourth Month.
Shall now make a few remarks between the 
formation of the male & female Pelvis. The Male 
Pelvis is only formed for the insertion of Muscles
and to contain certain parts &c. whereas the 
female is not only to answer there purposes but to
alow the passage of the child. The male pelvis is 
more mossy, and projections in different parts
longer, for the purpose of giving greater strength
and slowing the muscles to act with greater advantage, 
tho' it is not so capacious as the female



17
the female Pelvis has not so much Bony substance
as the male tho' it is more capacious, its depth is not 
so great as the male.- The difference in suspect to
desasions is taken notice of by Artists, and their 
rule is that the male exceeds the female as much 
in breadth across the Shoulder, as the female does 
the male across the Hips.- The difference in respect
to the size of the Pelvis is chiefly in the degree of curve
in the Ossa Innomenata the male being less curved, but 
the Sacrum in the female is rather Broader,and also curved.
But there is the greatest difference in the Angle
which the two Ischii make in front, as that in
the male is much more acute, the projection of 
the tuberosity of the Ischium below the Acetabulum
is longer, and which slows a greater power for the 
action of the Muscles, the Acetabulae are smaller.
The female Pelvis is much shallower than 
the Male, which is an advantage with respect to 
the passage of the child.
The next consideration is the bearing of the 
Pelvis with respect to the Body, and this is necessary
to be know for the purpose of adjusting one by the 



18
other, so as to bring the brim of the Pelvis Vertical, horizontical,
oblique &c.- A straight line will not pass
thro' the Axis of each, but lines which pass thro'
the Axis of each would intersect each other so as to form 
an Angle making a right angle. When the Body is erect the plain of the
Brim of the Pelvis is downwards and forward in 
some cases placing the plain of the Brim of the Pelvis
in a Horizontal direction is advantageous, for different
purposes, as to slow the Womb to gravitate, this
is done by placing the Woman in a posture half sitting
and half lying, which is at an Angle of about 45 Dg.
in some cases it is advantageous to fix the patient
so as to bring the lower edge of the Pelvis upwards
in a horizontal direction, as in reducing a retroversion 
of the Womb, or Prolapsus Uteri, you may
effect this by placing the Patient on the Knees and 
elbows.- In making examination the best position
of the Pelvis is obtained by laying the patient on the 
side.
We must now consider the child with relation
to the Pelvis. A standard child or a one of the 
common size can only pass thro' a standard Pelvis
in these directions, that of the Head which is most 
common, that of the Breech, and that of the lower extremities, 



19
extremities, the head being the largest part, requires more 
particular consideration, as in case of the head presenting 
if it passes all the rest of the Body will follow, and 
it will pass with more or less ease according to the 
part which presents, and likewise the situation.-
From this it will appear evident that [illegible]
notions respecting presentation and situation are 
necessary, for this purpose it will be necessary to compare
the standard head with the Standard Pelvis.-
A standard head is one which corresponds with the 
generality of heads in shape size and mobility.
The Presentation is that part which is in the 
center of the Pelvis, and the presentation may be the 
same tho' the situation may vary, as it may be 
to any part of the Pelvis, then the Vertex may present,
and the face may be to any part of the Pelvis,
the same rules are applicable to the Breech presentation,
as in case the Anus is in the center, the 
Back of the child may be to any part of the urethra.
These two terms presentation and situation, are 
vary frequently confounded.-
The presentations of the head are divided
into 4 namely the Face, Vertex, Ear and Forehead,
and as before said the Head will pass with 




20
more or less case according to the part which presents.
The Vertex presentation will pass with more 
or less case according to the degree of depression of the 
occiput, thus in case of a Vertex presentations and 
it wont pass, depressing the occiput, by means of 
the Liver, or by any means will frequently be
of great service in facilitating the Passage of the 
head. Thus the best possible presentation is when 
the Vertex presents, with the occiput depressed.
The Vertex presentation will pass with greater 
ease, than the face, and this with greater ease
than the forehead, the Ear presentation passes
with the greatest difficulty. In general the 
forehead presentation terminates in the face 
case.-
When the head enters the Brim of the Pelvis it 
does not exactly come down sideways, but rather in 
an Oblique direction, as that is the long Axis, [illegible] Pelvis but as
it descends it gradually changes its position
to that with the face to the Sacrum, and their way
the long axis of each is opposed at the outlet.
In some instances there is a deviation from 
this as the long axis of the head may be opposed to the 
short one of the Pelvis, or the face will come forwards 



21
to the Pubis instead of Sacrum, this by some is called
the face presentation, but is not as the Vertex presents
only the situation is wrong. This is not so favourable
a position, as the other, the parts not agreeing in the 
form of parts so well, and there is more danger of a 
laceration of the Perineum.
When the head is low down there are four things
necessary, to render this the best possible position,
the Vertex must present, the occiput be depressed
the occiput must be to the Pubis, and the Sagittal Suture
must be in a direct line from before backwards
in the middle of the Pelvis.-
The Face presentation is when the Nose is 
in the center of the Pelvis.- When the head of the child
is at the Brim of the Pelvis, the best situation is
when the chin of the child is to either side as in this 
case the long Axis of the head and Pelvis correspond,
and as it descends the chin is gradually thrown
forwards, but in some cases the situation is different
the face being placed so that the long Axis of each
dont correspond, in this case help may be necessary
and a Knowledge of these circumstances will be necessary
in giving the assistance.- The long Axis is of each 




22
generally correspond, and as it descends the chin in 
thrown forwards, and the occiput emerges. The
chin is sometimes placed to the back part of the
Pelvis tho' situation is very rare, if this situation
is not altered in a very little time it will be a very
difficult matter to save the Life of the child.-
They way that the forehead presentation is changed
to the face is by the action of the Uterus on the Body of 
the child it pushes the Body down and the chin 
for as the chin forwards.- 
The Ear presentation is when that part is 
in the center of the Pelvis, and in this case the Vertex
may be situated to any part of the Pelvis, in some 
of these cases assistance becomes necessary, tho' not in 
general, this assistance may be given by means of 
the Lever, acting on that part of the head so as to bring
the Vertex down, and by that means bring it to a 
Vertex Presentation.- In using instruments,
great care is necessary in their application either at 
the fore or back part of the Pelvis on account of injuring
the Urethra or Rectum.-
Shall now take a more particular View of the 
Fœtal head.- The Figure of the head is Oval, or Ovi-form




23
Ovi-form, the long Axis of which varies according to the 
part which presents, from this it will appear
instant the necessity of taking dimensions from 
different parts in measuring the different Axises
of the head.- There are two expressions which tho'
different are essentially the same, that is raising
the Chin and depressing the occiput.
A Line drawn from the Vertex to the Chin is 
5 1/6 In. Long, one drawn from the upper part of the 
Occiput to the forehead is 4 1/2 In Long, whereas a line 
from the lower part of the occiput to the upper part 
of the forehead is only 4 1/8 In. long this therefore is the 
shortest Line of the long axis, the short axis is from 
the protuberance of one Parietal Bone to the other and 
which measures 3 1/2 In. this is the different dimensions
of the standard head. But the case with which 
the head will pass does not depend altogether upon
size but in a great degree likewise upon mobility
of the different parts.-
The Fœtal head consists of a greater number 
of Bones than the Adult, the adult head consists 
of 6 Bones, and the Fœtal of 12. The Bones of 
the adult are the Frontal, the Occipital, two Parietal



24
Parietal and two Temporal, with the Sphenoid and Ethmoid 
Bones, but these two last are common to both
head and face.- In the fœtus the Frontal Bone is 
divided into two, the occipital into four, each
Temporal is composed of two parts the Squamous
and Petrous portion, which with the two Parietal Bones
make the number 12.- Thus different Bones are 
joined together by Sutures but which vary in the 
Fœtus very much from those of the adult, for in the
fœtal state they are moveable, whereas in the adult
the Sutures are immovable. The mobility arising
from this formatition of the head is of very great ability
in presentation, as it slows the head to accomodate
itself more to the passage, by the edge of one Bone in 
some cases being forced over the other.-
The Sutures are first the Coronal, which extends
over the fore and upper part of the head and joins the 
Os. Frontis to the two parietal Bones, second the
Sagittal, this extends along the upper part of the head
from before backwards, it begins from the Coronal
Suture, and extends as far back as the upper edge
of the occipital Bone, it joins the two Parietal Bones
together, third the Lambdoidal Suture, this joins the



25
occiptial to the two parietal Bones, and besides this 
then is in the Fœtal state a Suture which joins the 
two portions of the Os. Frontis together, and one to
form a junction between the Squamous and Petrous
Portions of the Temporal Bones, Besides these there is 
another called Squamous or Temporal, which joins the Temporal to the 
Parietal Bones. On the fore and upper part of the head, when the 
Sagittal Suture arises from the Coronal, then a defect
of Bone in the fœtal head, which is called the greater
Fontanel to distinguish it from another similar
defect, at the part when tho Sagittal Suture terminates
in the Lambdoidal, which is called the less or 
fontanel, this besides being smaller is of a different
Shape from the others it being Triangular, where as 
the other is quadrangular, each angle projecting
into a portion of Suture, thus one into each of the portion
of the Coronal, into the Sagittal, and into the 
Frontal.- The lesser fontanel has only their angles
one into each portion of the Lambdoidal, and into the
Sagittal Suture.- By means of these Fontanels and  
the Sagittal Suture, the Situation of the head may be 
ascertained.- Besides this, there is another advantage
arising from these Sutures, as they will slow of the head 



26
being more compressed by a greater degree of mobility,
for in many instances where different parts of 
head are in a more advanced state of Ossification, it 
has been necessary to open the head, and when it has not 
been of an increased size, but only from this want of 
mobility.-
In some cases the Sutures are seperated in a much
greater degree than natural, and the head is considerably
increased in size, tho opening may be to the 
extent of one, two, or three fingers breadth when this 
is the case it is from a collection of Water in the head,
and you must judge from the size whether it is necessary
to open it or not for the purpose of extraction.-
The head may easily distinguished from other
parts of the Body by the larger Bony surface, and by 
the degree of convexity. The Shoulder Blade presents
a large surface of Bone, but you may easily
distinguish the head from this by passing your finger
round. In some cases the head will feel much 
more soft than common, this more particularly if 
examined during pain, this from a larger collection 
of Scalp.- The head may be easily distinguished from 
the back by feeling the Spinous processes of the Vertebra
it may be distinguished from the Breech, by the quantity 



27
of soft Parts, and by the Anus and Organs of Generations.
Besides presentation it is necessary to know the situation,
as tho' the Vertex presents the face may be to any 
part of the Mother.- This is done by feeling for the great
and little fontanel, and by passing you finger along the 
Sagittal Suture, and by comparing the form of the
fore and back part of the head.-
In a case of Hydrocephalus where the Sutures
were very much open it was mistaken by a Medical
Gentleman for a Back presentation, but this might 
be easily distinguished by the want of Spinous processes.
If when you feel the head you can feel the greater
Fontanel, and along the course of the Sagittal Suture you 
feel the Lesser Fontanel, you may then be certain it 
is a Vertex Presentation.-
A face presentation is easily distinguished by
its different parts as the Nose, Eyes &c.-
The forehead presentation is a mixed one, being 
in part the face, and in part the Vertex presentation,
on examination, you will find the greater fontanel
with part of the Sagittal Suture are one part, and 
on the other part you will find part of the face.-
The Ear presentation cant be easily mistaken.-



28
Besides presentation, the situation is necessary
to be known, as for instance in the Vertex presentation
the face may be to any part. In the Vertex presentation
you may know the situation, by feeling for 
the Sagittal Suture, and the Fontanels, if the head is 
low down in the Pelvis, but you cant at all times determine
this way, when this is the case you must 
feel for the ear by passing your finger up, and if you 
can feel this you determine which way the face 
is, by the projecting part of the Ears, as this is always
towards the back part of the head.- There are several 
other circumstances which may assist in the forming
the judgement, and which should be all taken into 
consideration as the whole of different parts of the 
head &c.- It is much the best in all cases when 
you examine to be carefull in giving an opinion
in respect to the Progress of the Labour as there are 
many circumstances which may render it more 
difficult, than you may at first imagine.
The Bones of the Pelvis are connected together
by Ligaments. Ligaments are that substance which 



29
connects the different Bones of the Body together, and 
and is divided into two kinds, namely Elastic and 
inelastic, the elastic Ligaments in some parts of 
the Body act the same as Muscles, as they in some 
degree antagonize the muscles, for instance the 
Ligament which extends along the Spine, in some 
Animals. The Ligaments of the Pelvis an inelastic
as they are made for the purpose of joining the Bones
so firmly together, for the purpose of sustaining the 
weight of the upper part of the Body, and likewise
any additional weight which the Body may at 
any time sustain.-
The different Ligaments which connect the 
Bones of the Pelvis together are first the Ligament
which connects the the last Lumbar Vertabrae and 
the Illium, second and third the Sacro Illiac
Ligament, both external and internal, fourth, the 
Sacro Ischiatic Ligament, external & internal fifth the Sacro Coccigeal 
Ligament, which is for the purpose of slowing
a degree of mobility in the Os. Coccigis, sixth the 
Ligamentum Foramen role, which serves for 
the insertion of Muscles, and thro' a vacancy



30
which is left in the Foramen Ovale by this 
Ligament, the Obturator Nerves and Artery & Vein
pass.- Seventh, the Ligament which connects
the Symphisis Pubis, this is formed by a cartilaginous
covering over each Bony Surface,
and with a portion of intervening Ligamentous
substance, but the chief strenth of this connection
depends upon the strong Ligamentous Fibre
which surround, the junction of the two Bones.
The Symphisis Pubis is sometimes the seat 
of disease, being subject to a collection of gelatinous
substance, or of Matter, and which is a matter of very
great importance, as the Ligaments which form the 
junction of the two portions of Bone, are in a great 
measure destroyed.- When matter is formed, a 
great deal cant be done except evacuating 
it, and keeping a depending opening, and this way
arousing Granulation to shoot up and fill up 
the cavity, but the time when you may be of the 
most service is before the formation of the Matter during
the inflamatory stage, when the application of



5
31
Leeches, Blisters &c. may possibly subdue this inflamation,
and prevent the future bad consequences.-
But if from symptoms you have reason
to suppose there is matter formed you should make 
an opening into the part to evacuate the Matter, and 
upon making this opening you should not find any 
matter, you then have done no injury as the operation,
has not done any injury to parts of any 
importance, and the opening will again heal.-
The Symptoms of this disease are a fixed and 
acute pain in the part, and which is very much
increased on the patients attempting to move or
walk.-
This disease has by some been supposed
to arise from some injury received during Labour
but this does not appear to be the case, but seems
to be owing to the same Scrophulous Habit, as that 
in which Disease of the other joints arise in, and 
begins from the same kind of inflamation.-
When there is a formation of Matter, and you
have evacuated it by an opening, if you keep open
this opening, granulation will spring up and 



32
a cure will sometimes be effected, but the Disease
is in a more advanced stage, and Symptoms of 
irritation, and hectic have come on, then the termination
of this Disease is different, as these Symptoms
go on increasing, and Death is the consequence.
Some practioners have supposed the Ligaments
of the Pelvis gave way in laborious parturition, but
there is no reason to suppose they do, except from 
very violent injury or disease, and when ever this
does take place, the patient is a great length of 
time before she perfectly recovers.-
The cure may be assisted by means of the cold
bath, and the local application of cold to the part, and 
by means of Bark and Corrborants internally, and 
by means of a proper bandage to support the part.
The Os. Coccigis has in some instances become
anchylosed and has rendered it necessary from this
circumstance to open the childs head.
The Uterus in the unimpregnated state is contained
in Cavity of the Pelvis, and is small, but when
impregnated becomes considerably larger, and rises
higher up, before it is placed the Bladder, and behind



33
it the Rectum, and there are likewise other parts
as Blood vessels, absorbents &c. which contribute to
diminish the size of the cavity of the Pelvis, and to 
lessen the size of the opening thro which the head must 
pass.-
From the pressure of the Uterus (when impregnated)
upon the Bladder, a retention of Urine or frequent indication
to make water called micturition is produced, this 
opposite effect from the same cause arises from the 
different parts of the Bladder upon which the pressure
is made.- If the pressure is applied to the part below
the entrance of the Ureters, a suppression of Urine
is the consequence, if this is above this part more 
upon that part towards the frenem of the Bladder, it 
then diminishes the size of the cavity, and that way 
induces the frequent indication to make Water.
When this part presses on the Rectum, tenesmus
constipation, or hemorrhoids are produced, for if it 
produces a degree of irritation, tenesmus is the consequence
or this pressure may cause constipation
by preventing the proper passage of the contents of 
the Rectum. This Pressure by obstructing the motion
of the Blood by the Veins, will cause the Hemorrhoids
this from the Blood in the Anterior not being obstructed 



34
in the same degree. A Woman under these circumstances,
cant expect a cure of those disease till
the cause which produces them is removed, and 
which cant take place 'till after delivery, tho' the 
symptoms may be moderated by means of the application
of a few Leeches to the part, or by other means
and internally by the exhibition of gentle Laxatives.
Some patients are very much alarmed by these
circumstances, and it may right to quit their 
apprehension by explaining the Business to them.
There are other parts besides these which may 
suffer considerably by this pressure, and produce a 
variety of Symptoms, such as swelling of the lower
Extremeties &c. this swelling is frequently called by 
the name of breeding with a Dropsy, but this Disease
is of quite a different notion from that of Dropsy, as 
in Dropsy there are a great variety of Symptoms,
which are not present in this Disease, as in it there 
are Symptoms of a broken down constitution, difficulty
of breathing, scarcity of Urine &c. whereas
Women during Pregnancy in generally labour under none of their Symptoms,
having only what arises from the distention of



35
parts.- From what has been before said, it will
appear evident that pressure sooner effects the
circulation in the Veins that in the Arteries and this 
pressure causing an obstruction of the free return
of the Blood by the Veins, the Arteries act more forciably
to overcome this resistance, a greater quantity
of fluid is thrown out by the seriferous Arteries,
this increased evacuation might possibly be of no consequence
if this pressure was not acting on the Absorbents, 
which should take up and return this fluid.
It is seldom necessary to evacuate this Water
by means of openings made into the part, as proper
pressure by means of Bandage or a Laced Stocking
will in general be sufficient, tho' if not, then is so
larger, for a few small punctures made into
the part, and which may afford relief.- It is necessary to 
attend to the state of the Bowels, and to keep
then sufficiently open.
There are three large Nerves, which are subject
to pressure by this cause, the first is the Anterior
Crural Nerve, but which is not much
subject to this pressure, the next is the Obturator
Nerve, which passes thro' the opening left in the foramen



36
foramen Ovale, and which will cause cramps, and 
spasms in different parts of the lower Limbs, but that 
which is the most subject to this pressure is the 
great Sciatic Nerve, which sends off various branches
to different parts about hind parts.-
The head of the Child in its passage thro the 
Pelvis, frequently presses upon the Obturator and Sciatic
Nerve, and will in many cases cause convulsive,
or spasmodic actions of the Muscles of the lower
limbs, one or both according to circumstances.-
The same Symptoms may be produced by 
the application of instruments, more particularly
when improperly used.- The Lymphatics from 
this pressure, sometimes become very much enlarged.
Somtimes encysted Tumors are formed in these
parts or Tumors of different Kinds, and be the 
cause of considerable difficulty during the time 
of Labour.- In some cases the Kidneas are 
situated very low down and become enlarged, and 
be a mean of difficulty.- Another Disease which 
may take place in these parts, as an enlargement
of the Ovariæ, which may be for different cause
one of which is a collection of Water in the Cavity
constituting the ovarian Dropsy.- [illegible] by [illegible]



37
Organs of Generation.
External and internal.-
The external Organs of Generation comprehend
the Mons Veneris, Labia Pudenda, Frœnum, Clitoris.
Fossa Navicularis, Nympha, Hymen, and Carunculœ
Myrtiformes, to which may be added the Orificium
Urethra.
The Labia are subject to various diseases, as 
inflamation, pruritus, cohesion from malformation
or excoriation, Ulceration, Tumors &c.-
Inflamation if it arises from common causes
is to be treated by the usual mode of treating inflamation
in any other part, but if it is attended with 
darting, shooting pains &c. it is probably an indication
of some internal disease.
Pruritus, is a peculiar and distressing itching 
of the parts, and is often in so great a degree as to 
render the patient almost miserable. The treatment
of this Disease must be various, according
to the cause, when it arises from Herpetic eruption
on the parts, preparations of Lead externally



38
and internally Neutral Salts &c. Some times this disease
is caused by Ascarides which infect the Rectum and 
which may have got to these parts and cause this 
disease, in this case a Glyster composed of a Mixture
with Aloes, or the Extract. Colocynth. Comp. may be of 
Service, and assisted by the exhibition of purges by the 
mouth, such as Calomel Aloes &c.- When this Disease
is Sympathetic of irritation in the Bladder or Urethra,
the use of Mucilagenous and Anodyne injection
may be of Service, and internally Uva Ursi, Bark,
Opium &c. may be given with advantage. A good
injection for this purpose is one composed of Oil
and Tinctum of Opium in the proportion 8 oz. of 
Oil, and 72 oz of R. & Opii. thus recommend an injection
of Aq. Coleis and Oil.- Thus peculiar sensation is 
in some instances only present during pregnancy
and frequently comes on at the time the menses
disappear, and is in many instances very difficult
to cure more particularly if there is no very
evident cause, if it is connected with Plethora, the 
taking away Blood may be of Service, joined with
the exhibition of Cathartics.- Cold applications will



6
39
generally afford more relief than warm ones.
There is no remedy which appear to have any
specific power over the Disease.- The application
of Blister may in some instances afford relief and 
the Ung 1/2 Alb. Camphor (Dr. Bateari) was of service
when many other things had failed, likewise an 
Infusion of Nicotianæ may be of Service, or the injection
of cold Water, into the internal parts.- An Ointment
composed of Ung 1/2 Simplex and Pulv. Gotta
Abp: succeeded after many other things had failed
in the proportion if 3 iss of Pulv. Gotta. to 3j Ung 1/11
Sin Alox.-
Ulceration when seated on the parts of generation
should not hastily be considered Veneral, those
frequently arise after delivery.- This frequently
arises from excoriation of the parts, and which instead
of healing, degenerate into Ulcers, forming sloughs &c.
and in many instances have been mistaken for 
Venereal, and treated as such, but which treatment
instead of being of Service, has agravated the Symptoms
considering.- This Disease frequently arises
from some injury received during Labour.-



40
Somtimes there will be small Ulcerations about 
the Genitals of Children, and which have a very much the 
Chancrous appearance, this is somtimes the case
at about the Age of Puberty.- The exhibition of 
Opium, Bark &c. will frequently of Service or a lot
will tend to alay irritability, in giving the 
Bark to children it may be necessary to take off
the nauseous taste of the Bark by joining it with
other things as Rad. Glyeyrrkis. &c.- and given a 
little R a|1 Opii according to the age of the Patient and 
degree of irritability. Externally a wash composed
of Ag Calcis and Calomel will answer a good purpose,
by the means the [illegible] of the Ulcer will
be stopped, and yellow surface will be changed to
a healthy granulating one.- If by this method
a Venereal Ulcer should be healed, secondary Symptoms
will after a time come on, and you may proceed,
upon the plan of treatment with certainty.
Sometimes the Labia adhere together at 
the time of birth and may require an operation,
but there certain consideration, necessary before 
the operation should be performed, or with respect



41
respect to state which the internal parts are likly
to be found in &c. When this the consequence of the 
parts adhereing after birth, from excoriation &c. there
can be no doubt respecting the propriety of the Operation.-
When this cohesion is partial, the parts may
by mechanical means dilated sufficiently. When these
are seperated by an Operation, it will acquire particular
attention, to prevent the parts again adhering.
The Labia are subject to tumefaction from 
various causes, as from a collection of Water from extravasated
Blood, or from hernia. or of Matter.
Hernia may be distinguished from the other 
kinds of Tumor, by the common means, as the size
of the Tumor varying on the posture being changed, and 
by its receding when in a recumbent posture.
The cure of hernia in these parts may be [illegible] procured
by the common means, by proper bandages
except it proceeds thro the foramen Ovale, in which 
case, a bandage cant be applied to act on the part 
with any kind of propriety. The part from which 
the rupture proceeds, may be distinguished by 
attending to the [illegible] where it disappears on its receding,
as whether it goes over the edge of the Brim



42
of the Pelvis or not.-
The Labia are somtimes distended with Water
and to that degree so as to impede the free motion
of the parts, and causing abrasion.- This disease
very seldom requires any punctures being made, for 
the purpose of evacuating the Water, tho' there is no danger
from this being done, but it in general will give
way to pressure made upon the part, by means of the 
T bandage, at the same time acting upon the Bowels
so as to keep the Body tolerably open.- Should the 
parts be in this state, and the time of Labour coming 
on it will be a matter of no consequence, as when this 
is the case, the parts are generally in a relaxed state
These parts are somtimes swelled from extravasated
Blood, this somtimes takes place after delivery,
and may arise at any time from the parts being 
bruised by accident, the sooner this Blood is evacuated
the better, or if not, it will very soon coagulate, and then 
it will be impossible to remove it. This is done best
by making a few small punctures into the part,
by which means the greatest portion of blood will
be evacuated, and the absorbents will generally take 
up the rest.- Leeches very seldom afford any relief
in this case as the Blood lays too deep for the action



43
If the patient wont submit to the removal of the
Blood by the punctures with early stage, it very soon
becomes coagulated, after a time a Throbing sensation
comes on, attended with increase of heat, and an Abcess
will follow.- If this extravasation is in a small
quantity, it may possibly be taken up by the Absorbents
the action of which may be assisted by Astringents, or 
by the application of Red Wine Lays &c.- If you precede
an Abcess is likely to form, you must then assist the 
process by the application of Poultices &c.- An Abcess
will somtimes form after you have evacuated the 
Blood by punctures, but it will then be proportionally
smaller.
Clitoris is that part which projects at the upper
part of Labia, and is in some instance considerably enlarged,
and has been mistaken for a Penis, but may easily
be distinguished from that, by its not having an 
Urethra, and it has likewise no corpus spongiosum.
In children the Clitoris generally projects more
than in adults, and has when this is the case been
taken for the parts of an Hemophrodite.
In a case of the Penis adhering to the Scrotum
a Gentleman mistook this for a Hemophrodite, as 
the Scrotum projected on each side so as to give the 



44
appearance of Labia.- The Plexus Retiformis is
composed of the Veins which return the Blood from 
the Clitoris, and which in part surrounds the Vagina
and by their distention in coitu, assist in diminishing
the diameter of Vagina, as they are placed just
over the Sphincter of the Vagina.- The Clitoris is in 
some instances very irritable, the least motion or touch
giving pain, a good application in this case, is a Mixture 
of Ol. Oliva and Tinct. Opii.-
Nympha, so called from the supposition
that they directed the stream of Urine.- Their figures
very much resembles a Myrtle leaf.- The Nympha
are somtimes very much enlarged, and require
an Operation being performed for their removal, this is 
not very common in this Country, tho' is somtimes
the case, but in the Warmer Climate, this Disease
is very common, it is called Nymphatomia, and is 
easily performed by putting a piece of past board
on one side and cutting upon it.- The Nympha
somtimes adhere, and it becomes necessary to make 
an incission for the purpose of seperating them, and 
considerable care is necessary after the operation
to prevent them from again adhering.-



45
Urethra, a correct knowledge of this, and more particularly
of the orifice, is of the greatest importance
in practice, from the frequent necessity then is of 
introducing the Catheter and which should be done 
without exposing the Parts, for this purpose it is necessary
to have some common Rules as a direction.
For this purpose there are three different directions,
one of which is, to find the lower edge of the Symphisis
Pubis, and the orifice of the Urethra, is situated
just below that part.- Another rule is, to find
the Orifice of the Vagina, and as the Urethra is 
situated just above that part, by raising your finger
a little, you will feel the orifices which you may 
distinguish, by its circular form;- A third rule for
finding it, is to feel for the Clitoris, and the Orifice of 
the Urethra is situated just an inch below this part,
just in the middle between the Nympha.-
One objection to finding this by the orifice of the 
Vagina, is from there being several Lacuna in this part,
and which may be mistaken, for this part, and likwise
Ruga, the Lacuna are generally so small as not to 
admit the end of the Catheter, tho' somtimes they are
sufficiently enlarged to do that.- You may know when 



46
the instrument is in the Urethra by its passing forwards,
whereas if in a Lacuna it wont pass more than 
the eight part of an inch, on account of this circumstance
the way of finding the Urethra by the Clitoris is best, as 
the part between the Clitoris and Urethra is perfectly smooth.
The Female Urethra is much shorter than the 
Male, being in general about 2 In. long.-
The course of the Urethra is in the direction of a 
Curve, and in passing the Catheter this must be attended
to, for if passed in a straight direction this is danger
of its being forced thro' the sides of the Urethra into
the Vagina, as been the case, and is a matter of very
great consequence, from the Urine irritating the 
parts &c.-
The Urethra in the female in a great measure
resembles the Male in structure, its internal
membrane being the same, and like it having several
Lacuna, it is much larger in diameter than
the male, and from this circumstance females are 
not near so liable to Stone as males.- In females
there is no prostate gland.- The prostate Gland in 
the male is about the size of a Nutt, and is a secreting
gland, the exact use of which is not known.-
The situation and direction of the Urethra may be varied



7
47
varied from different causes as prolapsus Uteri &c.
in the cases the Catheter must not be introduced in 
the common direction, but according to the present
direction of the Urethra.-
From the situation of the Urethra it will appear 
evident that the Urethra is liable to injury, in difficult
Labours, and by the use of instruments, if applied
so as to act on the fore part of the Pelvis.-
Retention of Urine.-
The Symptoms of retention of Urine, are pain
and tension in the Region of the Bladder accompanied 
with Symptoms of irritation, and 
great distention, somtimes there is a Stillicidium
an involuntary drifting away of the Urine, and 
which Symptom has often deceived the Practitioner
as from this be supposing this case an incontinence 
of Urine, but the true nature of the case
may be easily known by attending to the other 
Symptoms.- -
The consequence of this Disease if not relieved
by proper means, is bursting of the Bladder
and the Urine escaping into the cavity of the abdomen,
causing a high Degree of inflamation of 
the Peritoneum and Death.- There is more danger



48
danger from the bursting of the Bladder on the back 
than the forepart for when it gives way on the 
back part, the urine escape into the cavity of 
the Abdomen, whereas when the rupture is on the 
fore part, and where the Bladder is not covered by 
the Peritoneum, the Urine may possibly escape 
without getting into the cavity of the Abdomen.
It is in this part that the Bladder should
be punctured if done at all above the Pubes.-
The causes of suppression of Urine are either
from Pressure inflamation or Spasm.-
Suppression of Urine from pressure may be 
either from the enlarged state of the Womb, or from 
inversion or Prolapsus Vagina &c. or from Tumor
found in the parts
The treatment of this Disease will be different
according to the cause producing it. If it 
arises from pressure, introducing the finger or 
laying in a posture, so as to take of the pressure from 
these parts will effect the evacuation of the Urine
there in case of Pregnancy Woman will frequently
be able to discharge the Urine by putting themselves
in a reclining posture, and introducing the finger
press up the Womb, so as to take off the Pressure upon



49
the Urethra.- When inflamation is the cause of 
suppression of Urine, the treatment must be divided
to the removal of that inflamation, this by means 
of Bleeding, purging, the warm bath &c.-
If this disease arises from spasm, opium
will afford the greatest relief, given bitten by the 
mouth or in the form of Glyster, in the proportion
of 50 or 60 Drops.- The Warm bath may in this case
be of Service.
In all these cases the distention of the Bladder
must be relieved by means of the Catheter, and for this 
purpose you should be provided with different sized
Catheters taking care before their introduction, that 
the orifices at the end are open.- The next consideration
is the best position for you to stand in with 
respect to the patient, as it wont be pleasant for you
to stand with your face towards that of the Patient,
but what is much better and more convenient is 
to stand on the right side of the patient, and introduce
the instrument with the right hand, in this 
way your back will be towards the face of the Patient.
You should make use of two small Basons for 
the purpose of receiving the Urine.- Somtimes there 



50
will be a sudden stoppage of the flow Urine, in
consequence of the instrument being pressed against
the side of the Bladder, or from the pressure being applied
to the middle of the Bladder, forming it into two 
seperate Cavities. Whenever the Urine suddenly
stops recurring, more particularly if there is a sense
of fullness remaining you may be certain the Urine
is not all evacuated.
A suppression of Urine somtimes takes place
from a dropsical state of the Body, when this is 
the case, considerable attention should be paid, as 
mistakes under these circumstances have very frequently
been made, and the Bladder has been punctured
by mistake with the Trocar, when the tumefaction
from the Distended state of the Bladder has been mistaken
for Dropsy.- A greater mistake than this 
has been made, by the Trocar being Avoid into the 
thro' the Bladder, into the Uterus, when in an impregnated
state, and thro' the Uterus into the head of the 
child, and occasioning the Death of the Patient.-
It is right upon all occasions, to draw off the 
Urine before the operation of tapping is performed, for 
the Bladder is much distended it may be injured by



51
the Trocar.- A Lady had an enlargement of the 
Abdomen, and which came on rather suddenly, that 
is to say in a few Days, and during which time she 
had made very little Water, she was attended by two Physicians,
one of which proposed tapping but the other was
of Opinion it was not necessary, and after a little farther
consultation, they agreed to call in Dr. Orure, to examine
the state of the Bladder, and on his introducing the Catheter,
he drew off a Gallon of Urine, and the Tumefaction
was entirely removed.-
The Bladder does not swell exactly in the same 
way during pregnancy as at other times, in this case
the swelling is more sideways, from the Pressure of the
Womb on its middle, and this may possibly give an 
Idea of its being a collection of Water in the Cavity of the 
Abdomen, but you may easily distinguish between the 
two by the absense of fluctuation more to the back part.
Incontinence of Urine, may arise either from
loss of tone in the parts or from loss of Substance,
the loss of power of retaining the Urine, frequently
arises from a pressure upon the parts during delivery
and will in a general way, gradually recover in
the course of a few Days.- If this Disease arises from 



52
loss of substance, the Disease will be permanent, as then 
is generally a communication with the Vagina.-
This last circumstance generally arises from
some injury received during Labour, more particularly
if instruments have been used.- A Lady who had
a few Days before been delivered by the Forceps, had Symptom
of inflamation and suppression of Urine came
on, after a little time, a drilling away of the Urine came 
on, and a substance was discharged from the parts, and 
which was a portion of the Urethra and Vagina, which 
had sloughed off.-
When a patient applies to you for this Disease
it is necessary to know whether you can afford any
relief or not, you may know this by passing a Catheter
into the Urethra, and your finger into the 
Vagina, if there is a communication between the two,
you will feel the Catheter in contact with the finger,
and in this case very little relief can be expected.
But if it proceeds from loss of tone, time, with
the assistance of the cold bath, Chalybeates &c. and 
Cantharides externally and internally may possibly
effect a cure.-
1



53
Caruncula Myrtiformes, so called from their
supposed resemblance to Myrtle Berries, the number of 
them is various, somtimes being two, at other 4 or 5 in number,
these parts are not always to be found, as they depend
upon a certain circumstance, being formed by the 
ruptured portions of the hymen.- These parts sometimes
become painfull and inflamed, and require
the application of cooling remedies.- They somtimes
become considerably enlarged, and may require removal.-
They somtimes become Ulcerated, and give
rise to a supposition of their being Venereal, but you
must always be very carefull in forming an Opinion.
Hymen, is situated and the lower part of the 
opening between the Labia, its situation in children
is very evident, but is very often found wanting in 
adults, and which may depend entirely upon accident.
It is the part from which the caruncula Myrtiforms
are formed, and is a membranous projection
of no regular determined stroke, and in general
forms a somwhat circular irregular constricting
membrane.-
Somtimes there are a number of small
openings in this Membrane, forming what is called
the Cribrated Hymen, it has been long a Question



54
whether the cribrated Hymen was an Obstacle to impregnation,
but from the following case it does not appear
to be the case.-
A Lady who was married to a Medical, laboured
under this obstruction, after a time an enlargment
of the Abdomen took place, but from the above circumstance
it was supposed this could not be pregnancy,
she was treated as a Dropsical patient, but the enlargment
went on gradually increasing, she was
ordered to Bath, when she remained some time, but
without any effect being produced on the swelling,
on her return home, she was attacked with pain
but which she would not alow to be labour pains, a 
Practitioner in the neighbourhood, was sent for, and 
on his arrival found the head of the child low down
in the Pubis pressing against the external parts, and 
on a crucial incision being made, the child passed.
The Hymen are somtimes found imperforated,
and which the coeval with the birth of the patient is 
very often not found out 'till the Age of Puberty, as 
then will be all the usual Symptoms of Menstruation
but no external appearance.- This fluid when collected
behind the membrane in considerable quantity



55
has been mistaken for the Water in the fetal membranes.-
When this collection has been evacuated by 
an incision, it is generally found of a cream colour
and to be in a fluid state, tho' it may have been
collected in these parts for a great Length of time, in
this respect differing from Blood.- Her Menstrual
Discharge is composed of the serous parts of the Blood &
the Red particles, but with no portion of the coagulable
Lymph.- The fluid before it is exposed to the external
Air, is perfectly free from acrimony, but when
exposed by an incision it becomes considerably so, this
renders it necessary after the operation to wash out 
the parts by means of a Syringe and warm Water.-
The operation consists in making a longitudinal
incision into the parts, and afterwards a short transverse
on, which should be sufficiently large to alow 
of contraction.- In performing this operation, you
should not only have the evacuation of the fluid in
view, but likwise future sexual purposes.- When
the fluid is evacuated you should apply Dossils of
Lint to prevent the parts again adhering.- 



56
Internal Organs of Generation.
These comprehend a part of the Clitoris with 
its erector Muscles, the Vagina with its Sphincter,
the Plexus Retiformis, and the Uterus with its appendges.-
The Clitoris and plexus retiformis have been
already mentioned, and it now remains to mention
the Vagina, and the Uterus with its appendages.-
Vagina, this is the canal leading to the Uterus
from the external parts, and is situated between
the Bladder and Urethra on the forepart and the 
Rectum behind, and connected to them by cellular
membrane, its figure is not cylindrical,
but Oval is the most capaceous, in the middle, its 
course is moderatly curved, making an obtuse Angle
with the Uterus, the structure of this part is 
of a peculiar Kind, and these enter into its composition
Arteries, Veins, Absorbents and Nerves, and its internal
surface, consists of a plicated membrane, disposed
in different directions, called Ruga, these Ruga
are for the purpose of alowing of dilation, and may
possibly be formed to answer some other sexual purpose.



57
purpose.- The length of the canal varies, but in
general is about 5 or 6 In. tho' it has been found
much shorter.- The Figure of the canal should
be attended to in the use of Pessaries.-
The canal of the Vagina is somtimes divided
by a septum, and in some instances, has been 
found double, forming two Vagina, each having 
seperate hymen and and an Uterus.-
The diseases of this part are inflamation
and its effects, such as cohesion, suppuration,
contraction from cicatrices, mortification and 
sloughing away of a portion of its substance &c.
The treatment of inflamation will be different
according to the Kind and case, and likwise
the stage of the inflamation, as whether it is 
Phlegmonous, or irrisipelatous.- When inflamation
of this part arises from injury during 
Labour it is generally of the Phlegmonous Kind.
Irrisipelatous inflamation is more disposed
to attack the surfaces of Parts, and Phlegmonous
the Reverse.- The pain in irrisipelatous inflamation
is of the hot burning kind, and in Phlegmonous
of the throbing kind.- In irrisipelatous there
is always a considerable degree of irritibility, and 
Debility, and which must be attended to in the constitutional




58
constitutional treatment, as local applications, moderately
astringent injections will answer the best purpose.-
In Plegmonous inflamation the Symptoms
are more of the Tonic kind and which must be 
attended to in the treatment both constitutional
and local, as local, injection of the cooling sedative
kind answer the best purpose.-
If cicatrices have formed, they will prevent
the parts from yielding, and may require either
mechanical or instrumental Dilation.-
When there is cohesion, the cavity may be very
much obstructed, and render it necessary to seperate
these by means of the knife, but much dexterity is
required, and the parts should be kept assunder
by means, of a piece of Sponge or Lint.- This disease
is owing to want of proper alteration, when
inflamed.-
When there is a sloughing of a portion of 
these parts, it may form a communication between
the Vagina and rectum, or with the Urethra
and alow the Feces and Urine to pass thro' the 
Vagina, and which are very distressing circumstances.-



59
Uterus.
The Uterus is to be considered in two states, namly
that of vacuity, and in the impregnated state.
The shape of the Uterus when in the unimpregnated
state, is Pyriform and flattened, and has by some been
compared to a wine flask inverted, and from which 
resemblance different names have been given to different
parts, as the Body, Fundus, Neck, and Mouth.
The surface of the Uterus is flatter on the fore than the 
back part.- The Uterus is in general 3 In. long, one
half of which goes to the neck, and the other to the Body
this Division into Body and neck does not appear
evident on the external surface, but when Laid [illegible]
appears very evident on the internal part, as there
evidently appear a contraction of the cavity in the 
middle, and there is a difference in the membrane
which lines the cavity, that of the Body is smooth
whereas, that which lines the neck is not.-
The Substance of the Womb is Muscular, the fibers
of which rear in different directions, and Arteries, Veins,
Absorbents and Nerves, enter the composition being 
connected together by dense cellular membrane.-
The cavity of the Uterus is divided into two parts 



60
one of which is larger and triangular, the other conical
with the narrow end approaching the Angle of the other
this last is the neck, and the other the Body.-
The situation of the Uterus is nearly in the middle
of the Pelvis, between the Bladder and Rectum, and is 
as high, as the top part of the Uterus would touch a
line drawn across the Pelvis, from the upper edge of 
the Symphisis Pubis, to the top of the Sacrum.-
The Uterus in young subjects is situated higher, for 
in them, a line drawn in this direction would pass thro'
the middle of the Body of the Uterus.-
The situation of the Uterus may be varied from
different causes, as procidentia Uterii &c. Retroversion.
The Uterus may be retroverted if in the unimpregnated
state, and without being perceived, but if it becomes
impregnated, it than becomes a matter of very great
consequence.- Instance have been related of the 
Uterus being contained in the cavity of a hernia, but 
this is very rare, Sennutus relates one in the wife
of a Cooker, who whilst at Work, perceived somthing
suddenly give way, and an enlargment was perceived
in the Groin, after a time she became pregnant
and, and it Here appeared that this swelling in the Groin
contained the Uterus, it went on enlarging the usual way 



61
and at the proper period particular Symptoms came
on, an opening was made into the Tumor, and the Child
extracted, but the result of the case is not related.-
The Retroversion of the Uterus will be considered
when on the Pathology of Pregnancy.
Procidentia Uteri and Prolapsus, are the same 
kind of Disease, only meaning different degrees, thus
the smaller degrees of the Disease are called prolapsus,
as in case it projects so much as to be even
with the external parts.- When there is a Prolapsus
or Procidentia Uteri, you may distinguish it from the 
tumors found in these Parts, as Polypi &c.- by the 
Rugeous character of the Vagina, and by its having 
a hole in the center corresponding with the mouth of 
the Womb, and if it is at the proper time of Life, it will
be the hole thro' which the menstrual discharge will loss.
In some cases the Uterus is forced down behind the 
Vagina, pushing this forwards, in this case there is 
no opening, but you may know the nature of the affection
by the Roya.-
Women who have born children are more subject 
to their Disease, more particularly than who have
a large Pelvis, then should be particularly attended
to during Labour.- Women of a relaxed habit of Body 



62
are particularly liable to this complaint.-
Women who are subject to this Disease in a small 
degree frequently have a difficulty in making Water,
and which may be relieved by passing up the finger
and pressing against the Parts.-
Women labouring under this complaint are subject 
to the fluor albus.-
Procidentia Uteri has been mistaken for other
disease, or Polypus or inversion of the Womb, this last
disease as a turning of the Womb inside out, and is
often brought on by pulling at the placenta for the 
purpose of bringing it away, before the womb has began
to contract, and this way bringing the fundus of the 
womb down.-
You may distinguish between Polypus and Procidentia
Uteri, by the Orifice or Cavity in the middle of the 
Tumor in procidentia, and by the Periodical return
of the menses which will be found to flow thro' this 
opening, and by the Rugae.- Somtimes you cant perceive
the opening, but in this case the Rugae, will be 
a mark of Distinction.-
The Prolopsus Vagina will frequently reduce
itself on the patient being put in a recumbent posture
but on again returning to the event, it will again
appear, sometimes it wont recede even tho' a slight
force should be applied, in this case much Dexterity is 



9
63
required with reduction, and in doing this you must 
the pressure backwards towards the Perineum.-
If the part has been down for any length of time 
it will often be very difficult to reduce, and in this case
some have advised the application of warm fomentation,
but which is very wrong, the treatment in this 
case should be exactly the same as in strangulated 
Hernia, and cold application should be made use of as
they diminish the size of the Vessels, whereas as warm
fomentation &c. increase their size.-
Somtimes a sloughing of the part comes on, now in
this case some have recomended waiting 'till the parts
had seperated, but this should not be done, for it should always
be immediatly returned, and not alowed to remain
'till the seperation of the slough.-
When a Prolapsus Vagina has been reduced, proper
means should be resorted to, to prevent its return
and this is done by means of Pessaries.- For this purpose
different kinds have been used, some are in the form of a 
globe, and others of a flat circular form, then last are 
the best, and are commonly made of Box Wood, and 
with a small hole in the middle, which should not be too
large, the size of the opening must be of that size to admit 
of the end of your finger.- This opening answers two
purposes, one of which is to alow the menstrual Discharge
to pass, the other is for the introduction of the finger, for the 



64
purpose of introducing the Pessary in the Vagina, this hole
should not be made too large or it will admit of a portion
of the Parts above to escape thro' it, and cause Strangulation.-
The form of the Pessary is generally circular, tho'
they are somtimes made of an Oval form, and possibly
with advantage, the edge should not be too narrow, and 
should be rounded off, for the purpose of making it more 
easy.- It should be oiled at the time of introduction.
With respect to the size of the Pessary, that will be serious,
but it should be sufficiently large to stick in the 
Vagina, when introduced, but to begin with one small
enough and gradually increase the size 'till you find it 
sufficiently large.- This form of Pessary is of service
only when the Perinœum is whole, for in case this is 
injured, they wont be of any use, another sort has been 
invented for this purpose, and which is composed of 
a ring Pessary, with a stem to it, and with a moveable
Ball & Socket at the other end end, this slows of 
the movements of the Body without its affecting the part
within the Vagina.- For the purpose of confining this in
the Place, takes on fixed to the part without the Body.
A Piece of Sponge cut in a proper shape is under
some circumstances the best Pessary, as it will alow of 
being medicated, but they require frequent removal 



65
for the purpose of cleaning them.- They should have a
Piece of Tape fastened round them.-
The mode of introducing the common Pessary
is to introduce it sideways 'till you get it within the 
Vagina, and then with your finger in the opening, put
it in the right position.- In introducing it, you should 
not press directly upwards, but press towards the
back part of the Perineum.- It will somtimes cause
excoriation and soreness of the parts on its first introduction,
to remedy this you must advise the use of the 
Saturnine wash.--
The mouth of the Womb is called the Os. Uteri
likewise the Os. Tinca from its resemblance to a 
Finches mouth, and by other Names.- A precise knowledge
of this is necessary to form a judgment either 
with respect to Disease or Pregnancy.- The size of this 
Part varies very much in the healthy state, and under different
circumstances.- In some cases you will find 
a very small protuberance, in others a flat surface,
the size of the opening likwise varies very much, in those 
who have not had children it is very small, about the 
size of the Bulbous end of a Probe, but in those who
have had children it is considerably larger.-
The shape of the opening too, varies very much.



66
The feel of the part likwise varies very much, being 
in general smooth, but sometimes has a particular
roughness and yet be in a healthy states.-
Cancer Uteri.
No age is perfectly exempt from this Disease tho
it most commonly attacks Women, at the middle and
more advanced periods of Life.- Its commencement is 
somtimes insidious begining with a Discharge like 
the fluor Albus, and attended with irregular Menstruation,
in old Women it resembles returning Menstrual 
Discharge, but which occurs at irregular periods.-
Some have supposed that People who not borne Children
are most subject to this Disease, but others are of a 
Different Opinion.- The Symptom which denote the 
presence of this Disease, are darting shooting pains, attended
with an Ichorous Discharge, this from its somtimes being
tinged with Blood, has been mistaken for the Menstrual
Discharge returning to often, and when it has not been
much discoloured, has been mistaken for the fluor Albus,
but it may be easily Distinguished from this by the 
Degree of Arcimony &c. If you make examination, you 



67
will find a rough scabrous surface, and occasion
considerable pain, and probably a slight hemorrhage.
The Disease in this way goes on 'till the neck of the 
[Bladder] Uterus is destroyed, and then it attacks the Body of the 
womb, destroying the greatest part of this and likwise a 
portion of the Bladder and Rectum, the Urine and Feces
will pass thro' the Vagina, occasioning considerable degree
of excoriation, and great irritation and Symptomatic Fever
coming on, Death closes the Scene.- This Disease more
commonly begins at the Os. Uteri, and shreding as before
mentioned to the different parts.-
The treatment of this Disease is confined entirely to 
Palliatives.- The warm bath has been frequently and 
and with some advantage in procuring case, but from
the degree of weakness it produces, is not a remedy very
advisable, the application of fomentations to the part may
be had recourse to.- Cicuta is of service in procuring
case and is found somtimes successfull when Opium
fails.- Opium likwise must be had recourse to.-
Dr. Johnson relates a case which terminated successfully
and in his case, and in which he made use of 
are Electuary composed chiefly of Aethiops mineral, but 
the remedy he placed the most dependance whose, was 



68
a fomentation or wash composed of a Decoction of the 
common Herbs, with a large portion Goose's Fat, melted
in it, which he applied warm to the part, but it appear
very doubtfull whether this was a case of Cancer, and more 
particularlly so, as there are no more cases on record when
it again succeeded.- In some cases an injection of 
a Solution of Sacch. Saturn will be of Service, this joined
with opium in the following way. Rx Sacch Satum. Pulv.
Opii a| 3ss Aq: Hord. Hss, this injected, and the parts
washed with it may afford temporary relief. But towards
the latter stage of the Disease, full Doses of Opium
internally are all that will afford relief.-
Schirrous.- A Schirrous state of the Uterus 
is often mistaken for cancer, and when it becomes
Ulcerated, in some measure resembles it in some of its 
Symptoms, as in both there is violent pain, but the 
pain is of a different kind, so in schirrous the pain is 
of the dull heavy kind, with a sense of bearing down
whereas in cancer the pain is of the sharp lacinating
kind.- In schirrous, the mouth of the Womb
is somtimes dilated, and you may feel the internal 
part of the neck which is rough and Scabrous.-
The size of the Tumor gradually increase somtimes



69
so much so, as to impede the regular action of the Rectum
and Bladder.-
In the incipient state of the Disease, the use of 
Calomel in small Doses, and occasionally giving gentler
Laxatives has in some instances been of Service.-
When Schirrous is in the more advanced stage, there
is always considerable pain, and when the parts are 
in an Ulcerated state, there is frequently some irregularity
of discharges.- The size of the womb is considerably
increased, and which may frequently be felt on
examination by the Rectum, and by its size impeding the 
action of that part.-
When it is in the Ulcerated state, little can be done
except as palliative, Chalybeates have been recommended
on R. o Ferri Ammon. but their action as well as any 
other seems to be upon the Stomach and secondary Symptoms.-
The application of warm fomentations or the 
warm bath may afford Temporary relief.-
The Symptom will somtimes subside for a time 
but generally return again, if this is during the use 
of any remedy, it gives the Idea of having performed
a Cure.



70
Polypus Uteri.
Polypi are situated in different parts of these Organs
as in its Cavity Neck and Mouth, and they are somtimes
attached to the Vagina.- Polypi are somtimes attached
by a small neck, at others by a Broad surface are the 
surface is in some cases sought like a Caulifower,
but is in general smooth.-
Polypi have their origin from different parts 
and great advantage arises from a perfect knowledge
& their Origin in the treatment.-
When the origin is from the internal part of the 
womb, they possibly may not be perceived for a length
of time and from the increasing in size till they fill
the Cavity, often appear as tho' suddenly produced from 
their being by some sudden exertion forced thro' the Mouth
of the Womb, in this case you may distinguish its origin
by passing your finger up as far as you can, and 
feeling entirely round the Tumor, you will feel somthing
corresponding with the Os. Uteri, and be able to pass your
finger entirely round, in this case you may be certain
its origin is from the internal part or Cavity.-
When on your attempting to pass your finger round
the Tumor, you meet with some destruction, you may then



10
71
be certain, its origin is not from the Cavity, but from the 
Neck, or part when you feell the resistance.-
The Veins of a Polypus are situated on its surface
and are somtimes large at others small, and upon these
depend the hemorrhage. It has been supposed that 
the Hemorrhage is more violent, when they are attached
to the Body of the Womb, that when to the Neck.-
When their Origin is from the Cavity of the Body of 
the Womb, and this by a narrow neck, they somtimes
fall off spontaneously, this appears to owing to the mouth
of the Womb, pressing upon the Neck of the Tumor, and 
this way acting as a Ligature.-
There is somtimes a Disposition in the Uterus to
form Coaguli, and which come away spontaneously
and have been mistaken for Polypi.-
It is necessary to distinguish this Disease from
others which occur in these parts, and in some measure
bear a resemblance, as Prolapsus Vagina, Procidentia
Uteri, or Inversion &c. this may be easily done
if the tumor is situated low down, in prolapsus Vagina
the Rugeous Character will sufficiently distinguish
the Nature of the case, and in Procidentia Uteri, you
may know the part which forms the Tumour, by the 
hole you will feel in the center of the Tumor, and by 
by other circumstances, as by its receding when in



72
a recumbent posture. This Disease is more likely 
to be confounded with an inversion of the Womb, but
you may ascertain the Nature of the complaint by 
inquiring into the History of the complaint, as in the 
way it first made its appearance. If it is inversion
of the Womb, there will be frequent discharges of Blood
from the Tumor, and at the menstrual periods this evacuation
will be found to exude from its surface, and 
if you press the Tumor, you will find it to have a greater 
Degree of sensibility.-
Polypus is frequently connected with a Schirrous
state of the Uterus, and under these circumstances their removal 
can produce very little good effect and they may 
likwise be combined with a cancerous affection.-
In some cases where a Polypus is formed in the 
internal parts of the womb, more particular if at the 
Fundus it may by its weight, bring down the womb 
and cause inversion, and if the neck of the Womb
is short, the nature of the case may not be known
and a Ligature may be applied for the removal of the 
Polypus, and which instead of being applied upon the 
Diseasd part is put upon the inverted Uterus, this happened
to John Hunter, who in a case of this kind applied
the Ligature upon a portion of the Womb, and which 



73
brought on great Symptoms of high irritation, and in the 
end Death, he was at a loss to account for the Symptoms
but upon examination after Death he found the cause.
From this case he laid down the following practical 
Rule, never to tye a Polypus without you can feel
the mouth of the Womb. But this is not at all times to 
be felt, and it seems doubtfull if you can distinguish
the part where one terminates and the other begins, if the 
Ligature should be applied to that part, as there is a possibility 
that a portion of the Uterus may project into 
the Tumor, and can should always be taken Not to include
any portion of the Uterus in the Tumor.-
Mr. J. Hunter's Rule is certainly a very good one
but should be joined with the following in case you
cant feel the mouth of the Womb, which is to press
upon the Tumor gradually proceeding upwards, 'till you
find the pressure gives pain, and apply the Ligature
just below this, in the insensible part.-
When they appear of the cancerous kind, they are
not of a proper description for the application of the Ligature.-
Somtimes their growth is very rapid, and 
it is possible, if they are removed by Ligature they will
be very soon reproduced, but tho' their removal in this 
way is not entirely successfull, yet it is right to do it



74
if merely on account of temporary relief.- When the 
size of the Tumor is small and attached by a slender Barr
there is the greatest probability of the operation being 
successful.-
For the purpose of applying the Ligature upon
Polypi different instruments, have been invented, one 
of which is composed of two long tubes, which are fastened
together, and the ligature which is a piece of fine wire
is passed thro' both these tubes, leaving a portion out
at one end forming a bow or loop, this is passed over
the Tumor, and drawn tight so as to stop the circulation 
thro' the part, but John Hunter invented a 
better instrument, and which is composed of a Piece
of Iron, rather acorded and in the end is a small hole,
this is fixed in a handle, and in which is fixed a 
small cross Barr.- This instrument may be used in 
two ways, one of which is by passing a Ligature, single,
thro' the opening in the end, this by Means of the instrument
is passed round the Tumor, and then the other end 
of the Ligature is passed thro' the loop, and in this way
you may draw it as tight as you please, fixing the 
Threads round the cross Barr at the Handle.-
The other way of using the instrument is by passing the 
Ligature, double, thro' the hole in the instrument, forming 



75
forming a loop, this is passed over the Tumor, and fastened as
before.- When you apply the Ligature, you should take 
notice whether you give much pain, a little is always
the consequence, if there is much, the Ligature is applied
to high and should be altered.- The Ligature will
require straightening & Tightening daily on account of the Shrinking
of the Tumor.- The Polypus somtimes requires
supporting as from its weight giving considerable uneasiness,
and in some cases a considerable degree of
Putrefaction takes place, and it may on this account
and on account of its producing a considerable degree
of irritability, be necessary to remove it by the Knife before
its entire seperation by the Ligature.-
There will frequently be considerable Degree of irritability 
come and a particular uneasiness at the 
Stomach, and which will require proper Medical 
assistance.
For the purpose of obviating the putrescent
effects in some measure cloths moistened in Vinegar 
and Water may be applied to the external parts
and a Lotion of Aq. Hord. with R a| Myrrh may be 
applied more particularly to the parts.-



76
Fluor Albus.
This is a discharge which takes place in Women, and 
which continues for a length of time if not cured by the use 
of the Medicine or from some cause. It is a secretion from 
the internal surface of the Vagina, and the mucous follicles
about the mouth of the Womb, and the Cervex Uteri.
The discharge is generally of whitish colour, but not 
always being somtimes of green, or yellow colour, and has 
somtimes a Purulent appearance.-
Women labouring under this discharge are generally
more or less affected in their health, tho' there are some few 
exceptions to this Rule, as there are some Women, who are 
in the best health when labouring under this discharge, more 
so than when it is not the case.
This discharge may accompany a Plethoric state 
of the Body, or the reverse, and this will cause variation in 
the mode of treatment.- When this discharge is present, the 
Patient generally complains of pain and Weakness in 
the Loins, with a general appearance of debility, such as 
listlessness &c. tho' as before observed there is somtimes a 
Plethoric state of the Body.- Some Women have a Discharge
during Pregnancy, of a thick white Mucus, then proceeds
from the Mucous follicles about the mouth of the Womb.
This discharge should be distinguished, from discharges
from these parts arising from other causes, as from, 



77
cancer, Gonorrhea &c. it may be easily distinguished 
from that arising from Cancer by the Absence of Pain &c.
but is not so easily distinguished from the Discharge of 
Gonorrhea, more particularly in the more advanced
stage of this Disease, tho' it possibly may in the beginning
as there is always more or less inflamation in the beginning
of a Gonorrhea, which is never the case in this Disease,
other circumstances must be taken into consideration
as the moral Character of the Patient &c.-
The Aura of this disease will be different according 
to circumstances, as whether than is a Plethoric state or the 
reverse, if there is Plethora, Bleeding, Purging &c. will be 
indicated, but if there is a state of Debility, the Tonics, and 
astringents as Bark, Preparations of Iron, Astringents
of the mineral kind, the cold Bath, Balsams, such as Bals.
Capioi &c. may be of Service, tho' this last does not appear 
so likely to relieve as some other things.- Preparations
of Lead internally have been recommended, but this use
is rather more precarious than some other remedies.-
Along with these internal remedies, injections of different 
kinds may be used, as an Infusion of Green Tea,
Rose leaves &c. with the addition of Alum or other things of 
the astringent kind, these should be injected into the part
by means of a Proper Syringe, Along with these modes
of treatment, attention should be paid to Diet.-



11
78
Tympanites Uteri.
This is a collection of Air in the cavity of the Uterus 
and which escapes frequently by different movements
of the Body.- Every case of discharge of Air from these
parts is not to be considered, as a Disease of this kind, as 
discharge of Air may take place from Various causes
from the death & Putrefaction of the Child in Uterus &c.
but this disease arises with out any such cause, and 
appears to be owing to the Vessels of the part having a 
disposition to form Air. The occurance of this Disease
is very rare, and the Cure extremely difficult.-
The Cure should be attempted by means of Tonic 
and Nervous Medicines, and by a strengthening Regimen,
and it possibly might be of Service to inject, by 
means of a proper apparatus, gently astringent Medicines
into the Cavity of the Uterus.
Menstrual Discharge.
This discharge is that periodical discharge which 
takes place in Women at a certain period of Life, and 
generally occurs at stated periods, which are generally
at the distance of a Month, from which circumstance
it takes the Name of Menses or Menstrual Discharge.
This discharge is not Blood which proceeded from 



79
the rupture of Vessels is was formerly supposed, but is a 
regular secretion from the extremities of the Arties, by
a proper organization for that purpose.- It is composed 
of the Serum and Red particles of the Blood without 
the coagulable Lymph. This discharge in its natural
state wont coagulate, and whenever it will, it is a morbid
state of the discharge as there must then be the presence
of Coagulable Lymph, this constitutes the Disease called Menorrhagia.-
The Age at which this evacuation first makes 
its appearance is about the fifteenth Year in this Country,
but there are many varieties in this respect, as it is 
in many cases much earlier, and in thus much later
than this.- There is variety in this respect in different
countries, in the warmer Climates, the time of their appearance
is much earlier, and in the colder Climates much
later.- Tho' the period of the appearance is these various
yet, if there is no constitutional affection is consequence
of this, it cant be called a Morbid state.-
When the Menses are about to make their appearance
there will be always more or less constitutional affection,
great variety of Symptoms being present, frequently a 
state very much resembling Pthisis Pulmonalis, when 
there are symptoms of this kind present, a considerable
short discrimination is often necessary to distinguish 
the Nature of the case, and it is impossible in some instance



80
instances to say what the nature of the case is, 'till by the use 
of some remedies, it becomes more clear, as the remedies for 
these Disease are quite of a Different kind, are requiring
Tonics &c. which would to injury in the other Disease.
It is frequently the case that a considerable degree
of Langour, and diminution of strength takes place at 
the time of the menses being about to appear, and by some
it is the practice to order the to use an extra Degree
of exercise, this plan is very injurious, so the System
should be invigorated by proper remedies, as Chalybeates
and what are usually called emmenagogues &c. and the 
the usual vivacity and inclination for exercise will return,
whereas if you order exercise to be used, when the 
strength is so much diminished you are in danger
of producing some bad consequence.-
Chlorosis is in many instance only a Symptom
of a dificiency in the proper secretion of Blood, and when 
this is the case the first indication is to assist that
process by proper nourishing treatment, both in the medical
Depeartnent and in respect to Diet, when this is 
the case emmenagogues are improper 'till the constition
has been strengthened, then their use will be of Service.
Electricity is only proper when there is a proper secretion
going on.-
The discharge is seldom regular in respect to its 




81
recurence, for some little time after its first appearance.-
Before the appearance of the discharge in the 
regular way, there will generally be some particular
Symptoms come on for a few Days, as a sense of dullness
and heaviness, pain in the back and Loins, Vertigo &c.
and there usually is a whitish discharge for a few Days
or for a Day or two, before the appearance of the Red discharge.
The Length of time which the discharge continues is very 
various, but in general is about 3 Days.- The Quantity too
is subject to great variety in some instance only just 
tipping the Linea, in others the quantity is considerable
accounting to several Ounces, and at the same 
time does not produce any bad effect on the constitution
it is not quantity discharged which constitutes
a morbid state, but it when this quantity produce
some ill effect on the constitution, the same Rule
is applicable with respect to duration.-
There is obstruction of another kind occasionally
taking place, when the Body is in other respects in 
a healthy state, this disease may arise from different
circumstances as from the application of cold
&c. in their case quite a different mode of treatment
is proper, from that pursued when the Body
is in a debilitated state, in this case Bleeding in 
small quantities, Electricity, Aloctic Purges, this Service



82
Service pieces &c. will be of Service.- If by the use of then
means the affection is not releived, other Symptoms
will come on, as an effusion within the Cellular
membrane, producing a swelling of the lower Extremeties,
and a Dropsical state.-
All obstructions of this discharge are not to be 
considered as morbid is there is always a disappear
of this evacuation during pregnancy, and in general
this is the case, tho' not always during the secretion
of milk. There will frequently be a Discharge
of Blood at different times during pregnancy, but this 
is quite of a different Nature from the Menstrual Discharge
as this is a discharge of Blood, and probably comes
on in consequence of partial seperations of the Placenta,
as from its being situated over the mouth of 
the Womb &c.-
The menses at a certain Period of Life cease
to flow, the Age at which this takes place as various, in
general about 65, the it will take place both before and 
after this period at considerable distance of time it is generally
the case, that those Women who had the menses
first appear at an early period, will likwise have their 
cessation early and the reverse of at a late Period before
their first appearance. This change is considered by 
them as a matter of very great consequence and with 




83
very good reason, for these are frequently symptoms of very
great consequence come on at this time.- When the discharge
has ceased to appear for two or three periods, there will frequently
be a Plethoric state of the System more particularly if no 
attention has been paid to the Diet, and there will then take 
place a Discharge, and this may be repeated at intervals,
this discharge is not of the same nature as the menstrual
but is a discharge of Blood, containing coagulable Lymph and 
from this circumstance produces more debilitating effects
and if repeated may cause such a Degree of weakness as 
to be the cause of other Diseases as Dropsy &c.
In Women who have born several children, there 
will frequently be a cessation for a month or two, and then 
a sudden and perhaps profuse discharge of Blood take place
and if this in any part comes away in a coagulated form
gives them the Idea of having miscarried, this is a case of 
Menorrhogia, and should be treated as such, these discharges
will recur at intervals. It has been usual in all cases 
to give tonic and astringent Medicines under these circumstances,
but which in many instances in a wrong practice
as a treatment similar to what is pursued in case of 
Hemoptoe, will in general be more proper as at the time 
when from certain symptoms the discharge is likly to take 
place if the Pulse is is generally case, are rather full and
have the jerking feel, the loss of a small quantity of Blood 



84
from the Arm, as from 4 to 8 oz. according to circumstances
will be of service, and at the same time giving gentle apperients
as small Doses of Neutral Salts &c. and in the intervals
giving gentle Tonics and astringents, the common
tonics and astringents may not be so proper in this case
as some others, a good one for this purpose, is Infusion of 
Roses, with a small portion of Glaubur Salts, the basis of both
their being the same thus does not any decomposition take place
each has its basis the Sulphuric Acid.-
It possibly may answer a very good purpose at the time 
the menses are about to disappear, to take away as small
quantity of Blood for a few times once in two months, and this 
perhaps with a little attention to the Bowels & Diet might prevent
any of the consequence ensuing.-
When the disease has continued for a length of time
this plan wont be proper, but recourse must be had to 
Tonics as the Bark, Chalybeates mineral Acids &c. and 
a nourishing diet, as the System has been very much reduced
and must be recruited.-
At this time there will frequently be an affection
of the intestinal Canal, that is a disposition to flatulency
producing a sense of fullness and a swelling of the Abdomen,
and which by Women has been mistaken for Pregnancy
tho' it may be easily distinguished from this state, this
state may be remedied by the use of aperients Medicines
joined with Aromatics and those of the Nervous kind as 
Pill. Gall. Comp. &c.



85
Appendages of the Uterus 
The appendages of the Uterus are four in Number namely,
The Fallopian Tubes, Ovaries, Round Ligaments, and Broad
Ligaments.
The fallopia Tubes go off from the upper part of 
the Uterus sideways terminating in a fimbriated extremity
they are in general about 5 In. long, but are subject to rarity
as they may be very much lengthened from certain causes,
and from an enlargement of the Ovariæ &c.
The diameter of the tube is smallest where it joins the 
Uterus, and becomes considerably enlarged at the other extremity.-
This tube is subject to variety in several respects
its course being in general straight tho' somtimes in a Spiral
direction.-
The Fallopian Tube is subject to a varity of affection
and is somtimes found imperious or obliterated, they are
likwise subject to a collection of Matter in their cavity, and 
to a Dropsical state, the quantity of Water is seldom large
not being more than an ounce in general, this Disease is seldom
of any consequence in respect to its effects on the constitution,
nor are their any Symptoms whereby its presence
may be known.- If both the tubes are in this state, it 
must certainly be a cause of sterility as the passage of the 
Ovum is entirely prevented.- Matter when formed in 



12
86
Ovaria has escaped by these Tubes into the Uterus and 
this way found an outlet.-
The structure of the fallopian Tubes must 
be in part muscular tho' muscular fibres cant 
be discovered, yet there can be no Doubt of this from the 
actions they perform.
The office of the fallopian Tubes will be more 
particularly explained, when treating of impregnation,
yet this is evident that they are for the purpose of carrying
the Ovum from the Ovaria to the Uterus.-
Another office, which is that of carrying the [illegible]
fluid of the male to the ovaria has been
ascribed to them, but this does not appear to be the 
case as will be here often explained.-
Ovariae.
The figure of the Ovaries is very much like that 
of the testes, the surface is irregular, they are vesicular
internally, more obviously so between the Age
of Puberty and the middle period, these vesicles are 
unequal in size, and indefinite in number.-
When one of these vesicles has received the Stimulus
of impregnation, it gradually begins to enlarge
and after a time bursts, the Ovum escapes, and is embraced 
by the fimbriated extremity of the fallopian
tube and carried to the Uterus.- The Ovaria have 



87
in some instances been found wanting.-
The Ovaria are subject to different diseases, to 
inflamation, and suppuration, the matter from which 
may be discharged in different ways, one of which 
is by the fallopian Tube into the Uterus, and may 
give an Idea of its having been formed in that part.
They are likwise subject to an enlargement of 
the Schirrous kind, and which may keep gradually
increasing in size for several years, in many cases 
without having any material effect on the constitution,
tho' somtimes it is the reverse.- This enlargement
has in some instances been mistaken for 
Pregnancy, but may be distinguished by the Tumour
begining on one side.- Nothing can be done in 
this disease except in the Palliative way, so by giving
Opium, Aperients &c.-
These parts are likwise somtimes found
in a state of ossification, and have somtimes been
found to contain, the different parts of a fetus as 
Hair, Bones &c. and in some instances it appear
difficult to account for the formation.
When parts of the fœtus have been contained in
the Ovaria, this constitutes an [cross out] extra Uterine
case, in this case the usual Symptoms of impregnation
go on for a length of time, there cease but the 
enlargement continues, after a length of time an Abcess



88
forms and the different parts are evacuated.-
The Ovaria are subject to a collection of Water
in their cavity constituting a Dropsical state, the qantity
of water which be contained is various, has in some 
instances been found to be to the quantity of 10, 12 or 
even 15 Gallons.- Women about the middle age are 
most subject to this disease, but no Age is entirely
except.- The disease in the first place begins 
in one of the Vesicles, somtimes in two or three, these dont 
at first communicate with each other tho' they afterwards
so, this is a fortunate circumstance in drawing
of the water by tapping.- The substance which is contained
in the Ovaria, is somtimes partly fluid and 
in part solid, and which will render relief by tapping 
up, from this it will appear evident the necessity of 
giving a guarded [illegible] in this Disease.- If the solid
part is situated anteriorly, the common trocar will
not evacuate the Water, in this case it is probable
on a greater length might be of Service.-
The begining of this disease is seldom noticed
tho' there will be somthing perceived to move on the 
side affected on the Body being put into different
positions, this affection seldom produces so much
derangement of the System, as cases of common Dropsy.
Her water collected in the Ovaria varies very much
in some instances being perfectly thus and Lymped 




89
in others viscid and glutinous, when the fluid is 
in this state the constitution is generally giving way 
Different modes of cure have been recomended,
on of which was to extirpate them in the early stage
but this would be attended with many difficulties,
as from the difficulty of distinguishing them before they 
were considerably enlarged, and when this is the case the 
opening required for their removal would be so large
as to render the operation extremely dangerous, and many
other besides these. It has been proposed to cure
them by causing inflamation in the cavity in the 
same way in in the cure of Hydrocele, but there are 
no facts in support of this.-
The treatment of this disease is only palliative
which is by tapping, the use of Medicine has never
been of any service, tho' these have been instances of 
a cure taking place by accidents, which have burst
the Cyst.-
When both Ovaria are affected with this Disease
impregnation cant take place, tho' this may 
if only one is diseased, and when this is the case 
very unpleasant effects are the consequence, more 
particularly during Labour, and this may be more 
so if the Tumour is small than if it is larger,
from its descending more into to cavity of the Pelvis
and obstructing the passage of the head.- They way
to distinguish a Tumor of this sort from the head of 




90
the child is by its being compressible, and yeilding
which is not the case with the head of the child.
When this is the case, a question arises whether
it would be best to open the head of the child or to draw
of the the water from the Tumor by the tapping, there have not 
been a sufficient number of cases on record to say 
which of these is the most eligable, as no general Rule
should be laid down from solitary cases tho' when the 
whole should prefer the latter.-
Round Ligaments, an attached to the 
upper part of the Uterus, and often passing towards the 
lower, go thro' the abdominal Ring like the Spermatic 
chord in the Male, and are the distributed
about the Mons Veneris &c. The structure of these
Ligaments is muscular and Vascular, and their 
use appears to be for the purpose of supporting the 
Womb, and keeping it steady.- During pregnancy
there is somtimes a painfull uneasiness about 
the Abdominal Ring and Mons Veneris, from these 
Ligaments being put on the stretch, and which 
may require the use of Anodynes &c. for the purpose
of worsening relief
Broad Ligaments, consist of a doubling
of the Peritoneum, enveloping the other appendages of the 
Uterus with its vessels, and attached to the sides of the 
Pelvis, dividing it into two Cavities. These Ligaments




91
are formed by the Peritoneum being reflected over
the Fundus, and posterior part of the Bladder, over 
a small portion of the anterior part of the Uterus, over 
the fundus and posterior part, and then over the Rectum
leaving a portion of the back part of the last uncovered.-
From this it appears that the Neck of 
the Bladder and a small portion of the posterior part of 
this, near the neck, and part of the anterior portion is 
not covered by the Peritoneum, and there is likwise
part of the anterior portion of the Uterus with the Neck
and Vagina, which are not covered by it, nor is 
the lower and posterior part of the Rectum.-
From a knowledge of these circumstances
some practical hints may be derived, as for instance
that of tapping the Bladder (in case of suppression
of Urine) from the Vagina, by means of a curved
Trocar, when a Catheter cant be introdced
[illegible] [illegible] supposed the Tapping might be done
with advantages in Ascites from the [illegible] but
the Intestine would be a great [illegible] of [illegible]
the Broad Ligaments are attached



92
Gravid Uterus.
The Gravid Uterus comprehends a series of changes
induced on the Uterus and its appendages, also the Ovum
contained within it, consisting of the Fœtus, Navel
String, and Placenta, the Water called Liquor Amnii,
with the different membranes, as the decidua,
chorion, Amnios &c.
We shall first describe the Ovum and afterwards
the Uterus &c. The Ovum being the produce
of conception, this merits a previous consideration.
Conception, there is great variety in the mode 
which impregnation takes place in different Animals,
in some there is the power of impregnation in
themselves, having both sexes contained within themselves
in others, the organs of both sexes are perfect, but then
require sexual intercourse, and a double or reciprocal 
impregnation follows.-
The things necessary to impregnation in the male
are Testes, secreting semen, in the Female ovaries
in a healthy state, with a determination of Blood
to the whole Uterine System. The Oestrum or disposition
to impregnation and the coitus are the occasional
causes.- It is not necessary that both Testicles shoud
be perfect, as one testicle and one Ovarium in a healthy 



13
93 
state are sufficient for this purpose, and tho' there
is a necessity for a determination of Blood to the parts
yet impregnation may take place, when there has 
been no menstrual Evacuation provided there is 
this determination to the Uterus &c.-
Different opinions have been formed with 
one put to the part the fecunditating fluid of the Male
is conveyed to produce impregnation, as whether it
is only conveyed to the Vagina, or Mouth of the Womb
in to the Body of the Uterus, or whether it is conveyed by
the fallopian tubes to the Ovaria, but from the result
of several experiments it appears, that sympathy or 
consent of parts, and which opinion receives additional
strength, by the Breasts sympathizing with the action
of the Uterus.- The Stimulus of impregnation is probably
first given to the Uterus, the Ovaria then harmonize,
afterwards the fallopian tubes &c.-
The alteration which takes place in impregnation
is, after the Stimulus of impregnation is given
one of the Vesicles of De Graaf, this swelling and projects,
before the rest, after a time this bursts and the
Ovum escapes, which is imbraced by the fimbriated
extremity of Fallopian Tube, and by this is conveyed
to the Uterus, there is then a particular membranous
attachment formed to prevent the Ovum from escaping
this membrane is called Tunica Decidua, there 



94
likwise a secretion of thick mucus which pluggs
up the mouth of the Womb, and thus becomes a farther
security.- The substance of the Vesicles does not take 
on the form of a Ovum immediately on its entering the 
cavity of the Uterus, but the membrane before mentioned
is first formed, and the different parts of the Fœtus are
not immediately formed, but take place in some little
time from this.- The parts for it formed are the Organs
of Sense, as the Brain, the head is first formed then
the Skin, is seen projected, and soon after this the Eyes are
seen and afterwards the extremeties.- The heart is too,
very early formed.-
Super fetation may take place if there is a 
second coition, before the Ostrum is gone off, an instance
of this occured, in a Married Woman of Jamaica,
who had twins, one of which was white and the 
other Black, she endeavoured to account for it by an
affection of the Mind from fright in the same way as 
Navi Materni are supposed to arise.-
From circumstances it is probable, that the
fecunditating fluid of the male, has nothing to do
with the formation of the Fetus, except by giving a proper
stimulus.-
After impregnation and the contents of the Vesicles
of De Graaf is evacuated the Cavity then becomes
filled by a Yellow Matter and which is called Corpus 




95
Lutei, and this is the course of some time gradually
disappear, probably may do this in the course of about
12 months.- There Corpus Lutei always correspond
with the number of Fœtuses, except in some instances
when there are the Rudiments of two Fœtuses in
one of the Vesicles and which is very rare.-
It has by some been supposed that this was 
not the case, from a greater number of these Bodies
being found than fœtuses, but there must then have 
been a corresponding number of impregnation, and 
most probably miscarriages
The Navel String is that chord which 
passes from the middle of the Abdomen of the Child to 
the placenta, the place when it is attached to the Placenta
is not always in the center, being frequently
to one side or very near the Edge.-
The Length of the chord varies very much, being in
some instances no more than 6 In. long, and has been
found as long as 57 In.- Both these extremes have
their disadvantages, for when very short, there is danger
either of inverting the womb, or breaking the chord
on the expulsion of the child, or there may be in consequence
of this a partial seperation of the Placenta,
and by its being done before the Vessels have any 



96
ways contracted may cause a proper hemorrhage,
from this circumstance, care should always
be taken not to move the child far from the 
mother, when expelled, or rather to bend it towards
the mother as it is passing the external parts.-
When the chord is of more than common length
it may possibly get down before the head of the Child
and being this way compressed the circulation will
be stopped, and as the Lungs are not in this case
in action, the Death of the child very soon takes
place, or the chord may be passed round the Neck
of the child.- Somtimes there is a Knot formed upon
the chord, this probably is done during Labour, by 
the Chord, passing over the Child.-
In some cases the chord may be felt, by the 
Pulsatory feel, before the Bagg of Waters is broke, in this
case you should avoid, breaking these as long as possible
and endeavour to alter its situation, or it possibly
by some motion of the child may be spontaneously
changed.-
The umbilical chord is composed of two
Arteries, and one Vein, connected together by a [cross out]
Cellular substance & covered by a Membrane substance, which contains a mucous
substance, but it has neither absorbents nor Nerves
entering its composition at least so far as at present



97
present is known.- The umbilical Vein in the adult
is so far obliterated is to destroy its cavity, and forms
that part called the Ligamentum Rotundua of the 
Liver.- These Vessels not only convey Blood but
likwise nourishment to the fœtus.-
The Vessels of which the chord is composed pass 
in different direction, somtimes the Arteries pass
in a spiral direction round the Vein, and in other
cases the reverse, in some instances they pass in
paralel lines with each other, and they somtimes
form a Coil.- The different directions which the
Vessels take may possibly be for the purpose of retarding
the Velocity of the Blood, and possibly for some other
Parlous.- From their being no Nerves in the composition
of the Chord, it appears improbable that 
the mind of the mother should have any power
in the formation of what are called Nevi Materni
and other circumstances, that have been attributed to 
the influence of the mind, as the case of the Jamaican
Lady before mentioned.-
The Placenta is that part which forms the 
medium of connection between the Mother and 
Fœtuses, and correspond with the Fœtuses in respect
to number, thus if there are one, two, or three fœtuses
there are the same number of Placenta, except in
case of one of the Vesicles of De Graaf containing the 



98
Rudiments of two Fœtuses, in this case there will
be only one placenta and on Bag of Waters.-
When there are two or more placenta, the Vessels
of each have in general no communication, tho'
in some instances they have, and it is from this 
circumstance, that the necessity of tying the chord or 
each side the part you divide it, for if the Vessels
of the two placenta communicate, and this was not 
done, it is most likly the Death of that Fœtus in
Utero would take place, from the discharge of Blood
owing to this communication, it is on this account
and not on account of the Quantity being injurious
to the Mother, the necessity arises.-
The thickness of the Placenta varies, in general
about an inch thick in the middle, and gradually
becomes thinner towards the Edge, and its forgive is 
in general round & flat.- Its attachment is to different
parts in different cases, in general it is to the 
upper part or fundus, and which is the best place
for the attachment, in some instances it is placed
over the mouth of the Womb, and which constitute
one of the most dangerous cases in Midwifery.
The Placenta has an external and internal
surface, the external is that which is in contact
with the Uterus, on which there are several fissures



99
dividing into lobes, which probably are for the purpose
of slowing it to accomodate itself.--
The Arteries are spread chiefly on the internal
surface the Veins on the external, before the Arteries
in the substance of the Placenta, they communicate with 
each other.-
The Placenta consists of two parts, the Maternal
and Fœtal the maternal part is cellular, the other
which is the Fœtal is Vascular, there are no communication 
between the two parts by continuation
of Canal.- There are two distinct circulation going 
on in the Placenta, one between the Mother and 
Placenta, the Blood passing by the Arteries into the 
Cells of the Placenta and returning to the mother
by the Veins, the other between the Fœtus and placenta,
the Blood passing by the Arteries into the Vascular 
or Fœtal part of the Placenta, and returning
by the Veins.- The communication between the 
Maternal and fœtal part of the Placenta, is probably
by Lymphatic Vessels, and which may probably 
arise in a similar way to the Lacteals, from
the cellular part of the Placenta.- The way in which 
the Fœtus is nourished is not as some have supposed
by the mouth or Skin, but by the chord, which 
is not from its receiving red Blood, but coagulable 



100
Lymph, which it converts into Red Blood by its own 
sanguifying powers, the same as the chick is Ovo.-
The more this is examined the more it appears
to be like the process of Vegitation, that the Fœtus is 
nourished.- From several circumstances it 
appears that the placenta her forms a similar office
in the fœtus, upon the Blood, to what the Lungs do 
in the adult, except in the power of evolving heat
which is not necessary in the Fœtus, rendering it 
fit for circulation, and this is evident in case
the chord is compressed so as to stop the circulation,
before the child can breath. Death is the consequence,
and which cant be from the supply of 
nourishment being cut off.-
The circulation of Blood in the Fœtus is different 
from that of the adult, as there is a communication
between the right and left Auricle, called
the Foramen Ovale, and thro' which a great portion
of the Blood passes, a small portion only going 
thro' the Lungs for their nourishment.
Membranes, are the bag in which the fœtus,
Navel string, and Waters are contained, the number
of these bags in general correspond with the number
of Fœtuses, the use of this is obvious, for in case there 



14
101
were two or more Fœtuses, if one of the Bags gives
way the other Fœtus or Fœtuses is not effected.-
The number of the membranes vary in the 
early and later periods of Pregnancy, in the early
Period there are 4 Membranes, namly Tunica
Decidua Uteri, Tunica Decidua reflex, Chorion,
and Amnios, in the later periods then are only
three, namly, the Tunica Decidua Uteri, commonly
called, the Spongy Chorion, the true Chorion, and 
the Amnion.- In the early stages of impregnation
these membranes appear more like a portion of 
coagulable Lymph, than distinct membranes.
After some little time the Tunica Decidua
reflexa disappears, in consequence of a discontinuation
of Growth, and not by condensation, as John
Hunter, and some others have supposed.-
The Spongy Chorion is formed by coagulable
Lymph thrown out by the Uterus, which afterwards
becomes organized the same as under other circumstances, 
at the time of the Ovum descending from the 
Fallopian Tube, this Lymph is thrown out for the
purpose, of its being imbedded in it, there is then a 
process of this spread over it, which forms the Tunica
Decidua reflexa, and which as before observed after a 
little time disappears, the use of this last membrane



102
appears to form an attachment before than is done
by means of Vessels.- John Hunter was of opinion
the Spongy Chorion was formed of the internal membrane
of the Uterus.- The Spongy chorion is very Vascular,
which Vessels are derived from the Uterus, it is of 
greater thickness than the other membranes, and has 
a Granulous Surface, with numerous Foraminula,
which probably act the same as Lacteals,
in the nurishment of the Fœtus.- In some cases 
this membrane is expelled, when this is the case
you may be certain of Abortion following, when it is 
expelled in this way, is has very much the resemblance
of a Piece of Brussels Lace.-
The spongy Chorion is that which conserve
contact with the Uterus, next to which is the true
Chorion, the structure of this is more firm and 
compact the that last mentioned, and is probably
Vascular.-
The next or inner most membrane is the 
Amnion, this is thinner than the other two, but of 
a much firmer texture.-
The Placenta is situated between the Spongy
Chorion, and the true Chorion, and the maternal
part of which is formed by a portion of the Spongy
Chorion, but the Fetal or Vascular part of the Placenta



103
is formed by the ramification of the Umbilical
Vessels, this substance may be said to convey Nutriment
to the Fœtus in a similar way to what 
the Lacteals and Absorbents do in the adult.
The use of the membranes is for the purpose of 
containing the water and defending the child, and 
for some other purpose which will be mentioned
when speaking of the Waters.-
Water called likwise Liquor Amnii from 
its being contained in the Amnion, is divided into 
true and false, the false is a collection between
two of the membranes, and which is somtimes evacuated,
giving the Idea of the membranes having 
been ruptured, somtimes a quantity of Urine is 
suddenly evacuated from the Bladder, by some 
motion of the Child, and which is mistaken for the 
escape of the Waters.- The Properties of this fluid
very much resemble that which is effused into different
cavities of the Body.-
The quantity of Water is subject to considerable
variation, is somtimes in as small a quantity
as from half an Ounce to an Ounce, and in other
instances a pint, or even two or three pints have been
found, but in general from half a pint to a pint 
is the quantity.- With respect to the relative proportion



104
proportion to the Fœtus, this likwise varies, in the early
periods the Water very much exceeds the Fœtus in 
Bulk, and the reverse in the late periods, not but
that the Water keeps increasing in quantity, tho'
not in the same degree as the Fœtus. They very
near agree in quantity at the third month.-
The Water appears appears to be a secretion
from the Amnion.- When the Water are by any 
means evacuated at an early period. Abortion
must follow.- In case of actual Labour, when 
the Waters are evacuated, the time at which Labour
shall actually take place from this is uncertain
or in case the Water, has by any means been Discharged.
The Uses of the Waters, are to defend the child, and 
together with the membranes, to dilate the passages
in the early stages of Labour, and lastly to facilitate
the Passage of the child by lubricating the Parts.
The reason why larger in proportion early in the 
fœtus being soft so as to be liable to give way
to any slight [illegible]. It will be pressed [illegible]
at the 3 or 4th month



105
Changes on the Uterus by Impregnation.
The alteration produced by impregnation upon the 
Uterus, are considerable and in may respects, as in 
Shape, size, Weight, and in the size of the Cavity.-
Those alterations have considerable effect upon the 
ajacent parts, as by pressure upon the Bladder, a
frequent discharge of its Urine or a suppression
takes place, according to the part acted upon, thus if 
the upper part of the Bladder is pressed, the size of the 
cavity is diminished, and this causes frequent evacuation,
and if the lower part about the Neck is pressed
upon, a suppression is the consequence.- In these cases 
change of posture may be of service, and in case of suppression,
pressing up the Womb by means of the finger, will
releive the Bladder or it may be necessary to introduce
the Catheter.-
The enlargement of the Uterus is confined to the 
Body of the Womb till the end of the 5th month, after which
time the Cervix Uteri begins to strech, and is obliterated
at the end of the Ninth month.- Some practitioners
have supposed the neck of the Womb to have began to shorten
before this Period, but it is not the case, as it is of 
the full length, that of 1 1/2 In. till the end end of the 5th month



106
The shortening of the neck of the Womb does not take 
place in a regular gradual manner, but proceeds
faster at some periods than others, at the 6th month it 
is a little shorter, at the 7th month it has lost two thirds
of its length, being then only 1/2 In. long, at the 8th month
it is still shorter, and at the 9th month is entirely obliterated.-
Great advantage arises from this Order
of the Womb enlargment, for if the neck of the Womb was
obliterated at an earlier period, any sudden action of 
the parts might force of the mouth prematurely, and 
which is prevented, by this state of the parts.
During this enlargement of the Uterus it somtimes
spontaneously bursts, and the child escapes into 
the cavity of the Abdomen, the symptoms by which you
may ascertain this having taken place, an sense
of something suddenly giving way, attended with considerable
pains different from that of Labour, and you may 
distinguish the different parts of the Child thro' the Parietes
of the Abdomen.- This is more often the consequence
of bad practice in turning the child, from too great
a degree of force being used.- When this has taken 
place, it is certain to end in death or nearly so.
The practice recommended under these circumstances 
is to pass the hand thro' the opening and to 
find the feet, and endeavour to extract this way.



107
The part that gives way from violence during Labour
may be either the Uterus or Vagina.- From this it 
will appear the great necessity there is for case in 
case of a necessity for turning.-
The chief alteration produced upon the Os. Uteri
a Mouth of the Womb, from impregnation, consists in 
a more developed condition of the Mucuos follicles
occasioning a considerable discharge from these parts
in many instances, and which which has by some 
Women been mistaken for fluor Albus, and an account
of the quantity have been alarmed, but it is not a 
Matter of any consequence as it does not produce
any weakness, and upon the whole may be said
to indicate a more favorable Labour, from the 
parts being generally in a more relaxed state, than 
when there is no discharge.- There is always a discharge
of mucus preceding Labour, but which is in that 
case tinged with Blood, this is by them called the 
Shew.- The figure of the Os. Uteri likwise varies
gradually becoming less prominent, and Broader.
The ascent of the Womb when impregnated
is in a ratio corresponding with the Period of 
Pregnancy, at the third month, it is just above the 



108
Brim of the Pelvis, at the 5th Month it is half way
between the Umbilicus, and brim of the Pelvis, at the 
6th Month it is nearly at the Umbilicus, and at 
the 7th Month a little above it, at the 8th Month, it 
is half way between the Umbilicus, and Ensiform
Cartilage, and at the 9th Month is as high as this 
Cartilage.-
This enlargment and ascent of the Womb, produces
considerable effect upon the different parts
contained in the Abdomen, as upon the Bladder, Rectum,
Stomach &c.- The Nausea and Vomiting
which takes place at the early periods of Pregnancy,
cant be owing to pressure upon the Stomach
but must arise from irritability, or Sympathy.-
The Figure of the Womb in general is between
the Oval and Pysiform, tho' it is subject to variation
from several causes, as from the number
and position of the Fœtuses, quantity of Water &c.
The Position of the Womb is generally in the 
center of the Abdomen.-
The Arteries of the Uterus are 4 in number,
two of which arise from the Spermatic Arteries
and two from the Hypogastric, these are distributed



15
109
distributed upon the Uterus in a Serpentine direction
the Veins which return the Blood from the Uterus
in general accompany the Arteries, but instead
of taking a spiral direction, go nearly in a straight
course, they go from the Uterus to the Vena Cava
on the right side, and on the left side to the Emulgent
Veins. There have been different Opinions
respecting the Serpentine direction of the Arteries, 
some supposing it to be for the purpose of slowing the 
Uterus to enlarge, but as they are in the same spiral
direction when the Uterus is at the full size,
this cant be the reason, it must be for the Purpose
of retarding the motion of the Blood in these 
parts.- There are likwise Nerves and Absorbents
in the Structure of the Uterus both of which become enlarged
in the impregnated state, the Absorbents have 
at times very important actions to perform
as it is by their action the Uterus is reduced to its 
proper size after delivery.- The womb does not only
enlarge in circumference but in substance, during 
pregnancy, and different opinions have been
formed, respecting the thickness of the Womb at the 
time of Labour, whether it is thicker or thinner than
in the unimpregnated state, both these circumstances
may be right in different cases, in general the 



110
thickness is about 3/8 In.- The Womb at the time of 
Labour is supposed to contain 51 Cubic Inches and 
in the unimpregnated state 4 1/2 Cubic Inches, which
is nearly 11 times the Bulk. all this is to be taken
up by the Absorbents.- The size of the Womb should
be remembered after the expulsion of the child on 
account of its weight occasioning some inconvenience,
and rendering a horizontal position necessary.
Different opinions have been formed respecting
the substance of the Womb, some supposing it to 
be muscular, and others not, but there is not the least
doubt of its being Muscular from the actions which
the Womb performs, these muscular fibres are distributed
in different directions.- It is by the contraction 
of these muscular fibres, that the child is expelled and 
by a farther contraction, the expulsion of the Placenta
is effected, in many cases entirely without assistance.
This contractile state of the Womb is of very great
consequence in the prevention of hemorrhage, diminishing 
the size of the Vessels, for if no diminution of their 
capaciousness was to take place there must be much more 
hemorrhage after delivery, and from this circumstance
practical hints may be taken in flooding to assist 
the wombs contraction by any means as pressure upon
the Abdomen &c. or if the Placenta is not yet expelled 




111
and is the cause, extracting it, and which will slow the Uterus
to contract, and in this way stop the hemorrhage.-
Pregnancy.
Pregnancy has been already treated of Physiologically
but we must now take a different view of the subject
and in the first place speak of the signs by which
it is known.-
Signs of Pregnancy, these are numerous, but 
any one of them alone is fallacious, therefore in forming 
an Opinion, several of these should be taken
into consideration, the usual symptoms which 
take place in pregnancy are Amenorrhea
sickness and vomiting, frightful Dreams, loss of 
appetite, emaciation, peevishness, enlarged Breasts,
dark and enlarged Areola, quickening, enlargememt
of the Abdomen &c. shall now consider each of these
Symptoms seperatly.-
Amenorrhea, this is frequently a symptom
of Disease as well as pregnancy, as it may arise
from accident, such as taking cold at the time
or just before, the menstrual period, but this should 
be taken into consideration. At a certain time
of Life there is always a cessation of this discharge and 



112
which takes place at an earlier period in some 
Women than others, in general those who begin to 
menstruate at an early Period, have a cessation at
an early Period likwise; in a general way this takes
place at about the 45th Year.- Women never have the
natural menstrual Discharge during Pregnancy,
tho' there will in some Women be a discharge of Blood
at times, and which may be in some cases at regular
Periods, when this is the case it is accidental
and is frequently owing to portions of the placenta
being detached, probably in consequence of its being 
situated over the Mouth of the Womb.-
Sickness and Vomiting is likwise a very 
doubtfull sign, as this frequently arises from many
other causes, from the readiness with which the Stomach
Sympathizes with other parts, that which occurs
during Pregnancy is more particularly in the 
morning
Frightful Dreams this is amongst the 
most doubtful of the signs but in some particular
patients, is rather a certain symptom.-
Loss of Appetite this is a sign upon which 
no dependance can be placed if alone, as it arises from 
so many different causes.-

4th Month
Stethoscope= Inf Pulsation- Placental
Breast Softens

113
Emaciation and Peevishness, these are likwise
subject to very great uncertainty and deserve very
little Notice in general.-
Enlargment of the Breasts, this when attended
with the secretion of milk, is a probable Symptom;
but various instances have occurred, which prove
its fallibility
Areola, when this is enlarged and of a Dark
colour, is thought by some to be the best single Sign
but requires experience, to form a judgement from
this correctly.- The seat of this is in the Rota Mucosa 
surrounding the Nipple, and in the unimpregnated
state, resembles in colour, new plained Mahogany,
but becomes of a Darker colour in the impregnated
state.- In the unimpregnated state, it 
is in general about 1 1/2 In across, but in the impregnated
state becomes considerably larger.- After delivery
the Areola will in general regain its natural colour
and size in the course of some little time, except impregnation
takes place again very soon, in which case
it will become still larger and Darker.
Quickening, this is likwise a very fallacious 
sign, and both Patient and Practitioner may be
Deceived, pressing on each side of the Abdomen with the 



114
hands, may occasion uneasiness to the child, and that
way its movements be felt
Enlargement of the Abdomen, this is likwise
fallacious as it may be owing to various morbid causes
as well as from pregnancy, this it may assist in 
forming the opinion if combined with some other 
of the usual Symptoms, where this is connected with 
suppression of the Menses, and begins 3 or 4 Months
after the time of supposed impregnation, begining at
the lower part of the Abdomen, and gradually extending
upwards, more particularly if this has been
preceded by a degree of flatness of the Abdomen the 
first month or two, in this case, it becomes rather a 
strong Symptom, tho' there is no one on which so 
much dependance can be placed as upon the Attention
of the Areola.
Besides these there are several other Anomalous 
Symptoms somtimes attend pregnancy, but 
which appear to have very little apparent connexion
with it.-
Enlargement of the Abdomen may be combined
with Dropsy or with a Diseased state of One of the 
Ovaria. When the swelling is entirely owing to either
of these it may be distinguished by the undulation in 
one, and by the enlargment begining on one side in the other. 



115
Reckoning.
This is commonly divided into long and short reckong
the short is callendar Months, and the other Lunar Months,
the duration of Pregnancy is in general about 40 weeks
and which makes about 9 Callender, and exactly 10 Lunar
Months.- There are different times from which this 
reckoning is dated, either from suppression of the Menses,
Quickening, and coitus.-
That from which you can form an Opinion
of the Stage of pregnancy, with the greatest accuracy
is from the suppression of the Menses, but this in many
instances, cant be done on account of the Woman not 
having been regular in this respect, or not having 
the Discharge at all, as for instance in the case of a 
Wet Nurse, who will frequently have no menstrual Discharge
and yet become pregnant.- To form a judgment
with any degree of accuracy from this it is necessary
she should have been regular in the discharge.-
Different Opinions have been formed respecting
the period, at which impregnation takes place previous
to the stoppage of the menses, but in a general way
it may be said to be the second Week, or in some instances
may be the third, but no precise time can be 
mentioned




116
Some Women reckon from the time of quickening
that is the first time they have perceived the child
to move, and this has been said by some to be at the 
third, and by others the fifth month, but from observation
which was made upon 100 cases, 80 of them were
found to be at the fourth month, and this therefore appears
to be the Average time, being found to occur 8 
out of 10 times.-
Reckoning from the time of Coitus can only
be depended upon, under particular circumstances.
Management during Pregnancy.
Pregnant Women are liable to be in commoded
by causes, which to others, in a different state would
be harmless, hence attention to the Rules of living
are expedient, these Rules are comprehended in the 
non-naturals, namely Diet, Air, Rest, Exercise, Pathemata,
and Evacuations.-
With respect to diet, this must be regulated 
according to circumstances, but in general 
that which is found to agree best with the Stomach
is the best.- It is very seldom necessary
to recommend a change of Air, except under 



16
117
very particular circumstances, and with respect
to rest that.- Exercise in moderation is often
very serviceable, except under particular circumstances,
as in case of slight floodings, Pains &c.
or in case there has been repeated miscarriges
at some certain Period, under which circumstances
rest must be enjoined, with respect to proper
exercise, that must depend very much upon former
habits, tho' none very violent should be alowed
such as riding on horseback, dancing &c.-
It is frequently of consequence to attend to the 
Dress, as the mode of tight lacing formerly practiced,
must be very injurious, preventing the Uterus
from enlarging in the proper place, and causing
the mouth of the Uterus to be dilated prematurely.
The make of the Shoes should be attended 
to as the high heeled must be very injurious
attending the center of Gravity, and throwing the 
Womb forwards upon the forepart of the Pelvis
in making an alteration in this respect, it should
be done gradually, for if they have been worn for 
any length of time, the muscles will be attend in
their length, and on this account it should be gradual.-
The Passions of the mind have very 



118
great influence upon the Body and therefore
all violent emotion should to avoided as much 
as possible, and care should be taken against any 
thing causing alarm.-
Evacuations are of different kinds, on Practioners
have been of different Opinions respecting 
some of these, it is frequently necessary to act gently
upon the Bowels during pregnancy, as costiveness
is very common, this is best done by any gentle
Purgative in a Pillular form, or may be given
in any form most agreeable to the Patient.-
With respect to the exhibition of Emetics, there
is a general prejudice against them, but which
appears to be without much foundation, as Women
frequently Vomit spontaneously, even with considerable
straining and with impunity, from this 
it appears, that in cases when their use is required,
they may be safely given provided they are
not of too violent a Nature, tho' in account of the 
Prejudice, it will be best to be guarded in their use
and to avoid giving them when the Purpose can 
be answered by any other means, and when absolutly 
necessary, may in some instances be right to give 



119
them without in forming the patients that they 
are Emetics.
Bleeding during pregnancy has been very
much recommended by some, and as much condemned 
by others, it is certainly serviceable in some 
cases, as in case of Plethora, local or general inflamation,
or in case of a rigidity of fibre, it may
be a means of rendering the subsequent Labour
more easy. But you will in many instances
be under the necessity of doing it, on account of Prejudice,
and it may be right to do it from this except
there is some particular circumstance to forbid
its use, as in case of debility, or a disposition to 
a Dropsical state.-
Pathology of Pregnancy.
Diseases occurring at this time, are either arising
out of the Pregnant condition, or accidentally connected
with it, and are distinguished into those 
which occur in the early or latter stages.-
Particular attention should be paid to the mitigation
of their immediate causes, as this will
assist very much in forming a prognosis, and 
in the mode of treatment.-
Most these Diseases may be refered to one 



120
of the following general causes, namly, Plethora,
irritability of constitution, and Mechanical Pressure
this is to be understood to apply to Diseases arising
from the Pregnant State.-
When the Diseases arose from a Plethoric state
that state is known by the usual Symptoms of 
Plethora, and may be relieved by Blood letting, Purging
&c. or by attention to Diet, or Perhaps by both.-
When they arise from irritability of constitution,
the treatment must be varied according to circumstances,
so likwise must it, when in consequence
of Mechanical pressure
Particular Diseases of Pregnancy.
in the early Months.-
Nausea and Vomiting, these may arise from disease
as well as pregnancy, and it should therefore be
distinguished from which of these causes it may arises.
When they arise from a Disordered state of the Prima
Viæ, removing this by means of Aperients &c. will
be the means of cure, in this case you will be unwilling
to give an Emetic on account of the Prejudice
there is against it, but if you cant effectually remove
the complaint without, you may give it with
safety.- When there is much relaxation of the Stomach 



121
a good Emetic in this case will be Zinc. Vitriol. in
the Dose of from zss to zi, this in some measure bracing
the Stomach.-
When these are Sympathetic of Plethora, attending
this by bleeding, Purging &c. is indicated.-
When sickness is a Symptom of internal inflamation,
it may be distinguished by the usual Symptoms
denoting that state, and must be treated in a Secondary
way, regard being chiefly had to the primary complaint
by Bloodletting, purging &c. and by a strict Antiphlogistic
Plan, exactly the same as when unconnected
with Pregnancy.-
When symptomatic of mere Uterine irritation,
or Pregnancy, it will in different instances give 
way to different remedies, as Opiates, Saline Medicines
in the state of effervescence, Stomachic bitters &c. in 
this case, the quantity or bulk of the Medicine is often
very necessary to be attended to, as it will often be rejected
from from the Stomach on account of its quantity
then in giving Opium, a grain of solid Opium will
frequently be of service, when given in the form of a 
Draught it will be rejected.- In giving Saline
Draughts great attention is necessary, in respect
to quantity, and in being properly regulated in respect
to the proper quantity of each, a powder composed of 



122
Common Tart. and Sal. Soda, in proportion of two 
parts of the former, and one part of the Latter, this 
mixed in a small quantity of Water at the time of 
exhibition.- It is often necessary to give the food
in very small quantities, and which should be of the 
most nutritious kind.- In some cases it is necessary
to keep the Stomach perfectly empty for twelve
or twenty four hours, and occasionly giving a little 
solid Opium.- Nourishing Glysters may be 
thrown up the Rectum, and a little of their parts may 
be absorbed, and conveyed into the circulation. 
Warm Plastiers, or Rubifacients to the Scrobiculo
Cordis may afford relief, but in some instances
there will be a complete cessation at the time of 
quickening.- Somtimes it is owing to some particular
smell or effluvia, which was inoffensive 
at another time, in this case the cure is obvious
Pain in the Head and Breast, there are often
Symptoms of Plethora, and relieved by Bloodletting &c.
tho' in some instances, may arise from Sympathy,
in which case the treatment will vary according
to circumstances
Inability to Walk, attended with a sense of 
bearing down, a yellowish Discharge, and painfull 



123
Discharge of Urine, somtimes amounting to 
suppression.- This disease is to be distinguished
from gonorrhea, and may be done by attending to 
the Symptoms, in Gonorrhea, there is pain in making
water, but of a different kind than in this Disease, and the 
the discharge is different, the difficulty in making 
water is relieved by varying the posture, or by pressing
the neck of the Uterus up with the Finger, in some 
cases it may be necessary to introduce the Catheter
The cure of this disease is generally spontaneous,
as the Womb becomes enlarged, taking of 
the Pressure upon these parts, the Disease arising
from pressure
Retroversion of the Uterus, this consists
in the fundus of the Womb being thrown backwards
and which by its situation between the Bladder
and Rectum causes different affections of these 
Parts.- This disease can only be ascertained
by actual examination, for if the Uterus is retroverted,
the fundus is thrown back upon the Rectum
and the mouth of the is thrown forwards towards
the Pubis, and on examination if there is retroversion,
you will find the Os. Uteri in that situation
instead of its natural place, for whenever this is in 
the natural situation, there can be no retroversion.



124
Retroversion of the womb is not confined to the 
impregnated state, as the Womb may be enlarged
from Disease and become in consequence retroverted,
and it may be retroverted in the natural
state, but not be known 'till the Uterus becomes enlarged
either from Pregnancy or other causes, bring on the usual
Symptoms.-
The Symptoms of this Disease usually come on 
about the third month of Pregnancy, as at this time
the Uterus becomes of the size so as to cause these Symptoms,
they consist of Pain, Difficulty of voiding Urine,
constipation of the Bowels, Tenesmus &c.-
The Period of the Symptoms coming on may be 
a little varied, tho' they are always confined to the 
early months, as it cant take place after the Womb
is of a certain size.-
The most common cause of Retroversion of
the Uterus, is a Distended state of the Bladder, and this 
acts by pressing upon the fundus of the Womb so
as to force it downwards and backwards, and at 
the same time by its arising higher up in the Pelvis
it draws up the mouth of the Uterus in consequence
of the connection of these parts, in this way it acts 
in two ways, that is at the time it is forcing the 
fundus down, it is pulling the mouth of the Uterus
up.- Other causes have been mentioned, as a  



17
125
Blow upon the lower part of the Abdomen, but the
Bladder must be in a distended state.- An enlarged
state of the Ovaria, either from a collection of water
within them, or from other causes, may occasion this 
Disease.- Distention of the Bladder may in
some cases be an effect as well as a cause of this 
Disease.- From these circumstances it appears
evident how particularly carefull Women in the 
early stage of Pregnancy, should be to avoid a distended
state of the Bladder.- When the Bladder becomes
very much distended in this complaint there 
is great danger of its being ruptured, and on this 
account it should be frequently emptied by the 
use of the Catheter or by other means, and when this 
cant be done, it will be necessary to puncture the 
Bladder by means of a small Trocar, above the 
Pubis. In some instances when a common female 
Catheter cant be introduced, one of a smaller
size or a different form may, as that which is for a 
Boy.- The Danger in Retroversion is according 
to the state of the Bladder, and Degree of irritation.
The treatment in this case, consists in obviating
the distentention of the Bladder by the introduction
of the Catheter 3 or 4 times a Day, and this in 
some cases is sufficient alone, tho' not always
the length of time this should be tried depends upon



126
the Degree of irritability &c.- Before you attempt
the reduction of the Uterus, the Bladder and Rectum
should be emptied, and the patient should then be 
placed on the Knees and Elbows, and then introduce
a finger or two up the Rectum, and press
the fundus of the Womb upwards, at the same time
with the finger of the other hand up the Vagina
endeavour to bring the mouth of the Womb down,
in case the fingers are too short it may necessary
to have recourse to an instrument, which 
may be made by a piece of cured Cane or Whale bone
which should not be too weak, and at the end a 
Piece of sponge covered over with soft Leather, this 
should not be too small, and should be well secured
upon the end of the Stick, in using this the finger should
be passed up the Rectum along with it, and the force
with which which it is and should be regulated with 
some degree of ninty. The end may in some instances
slip up the Rectum by the projection of the fundus
but this will in a great measure depend upon 
the mode of using the instrument.- The more 
difficulty there is in the reduction the greater
softly there is against a natural.-
It was proposed by Dr Hunter to puncture Her
Uterus, but this must be attended with very great 



127
Danger and has no facts to support it.-
Mr. Cruikshanks thought the Division of the 
Symphisis Pubis might be of some advantage,
this certainly diserves some attention, but has not any
facts to support it, in this case the Patient would not 
be placed on the Knees and Elbows, in attempting the 
Reduction.-
Diseases of the latter Months.
Sickness and Vomiting, may occur now as well 
as in the early stages of Pregnancy, or may continue
from the early stage.- They may arise from Plethora
or from a foul state of the Stomach from irritability
or pressure of the womb upon the Stomach.
If from Plethora, the loss of Blood or gentle Laxative
Medicines &c. may be of Service, and when 
the Stomach being in a disoredend state, an Emetic
will be serviceable, if nothing particular contraindicates,
and afterwards proper Stomachic Medicines.
When irritability or pressure is the cause, these
exhibition of Opium Saline Medicines in the State
of efferverscence &c. must be resorted to, and food
must be given in very small quantities, and frequently
repeated, and should be of the most Nutritive
quality.- In case all these remedies fail in producing



128
producing any mitigation of the Symptoms, and the 
patient appears to be sinking under the complaint,
and not likly to support it 'till delivery takes place
naturally, it may be right under such circumstances
to bring on Labour prematurely, by puncturing
the Bag of Waters so as to alow of their Discharge
and Labour will then come on the course of some 
time, perhaps may be a Day or even two
Jaundice, when this is merely a consequence
of Pregnancy, there is little Danger and the treatment
may be confined to the Palliative, where 
there is much pain in the Epigastrium, the use
of Opium Aperients &c. may be necessary.- The way
Pregnancy causes Jaundice is by pressure, which 
tho' not directly yet may be indirectly upon the 
Billiary Duct.-
Jaundice during pregnancy may somtimes
depend on a Schirrous state of the Liver, or Diseases
of the Billiary Ducts; such cases are more complicated,
and the mode of treatment must depend upon
the Particular part effected.-
Costiveness may depend either on torpor of 
the Intestines or upon Mechanical pressure, and 
may become very inconvenient, and therefore should 



129
be obviated by means of Purgative Medicines, and 
by the use of Glysters. In some cases the Feces become
very much indurated, rendering it necessary
to break them down by means of a large Bougie, and 
them to inject a Glyster for the Purpose of bringing
them away.-
Hemorrhoids are in two states namly
Bleeding and Blind Piles, and a third Kind particularly
noticed by the German Practitioners,
which is called Hemorrhoidal Cholic, the Symptoms
of this complaint are Cholicky pains in the Intestines
and which may be traced along the Colon, Caecum
and Rectum, and which are relieved by a Discharge
of Blood, these pains are not cured by the common
thing in the use for pains in these parts.
As Mechanical Pressure is intimatly connected
with the Production of Piles, they will often continue
'till delivery takes place, but it will be advisable
to Palliate the Symptoms, by means of Leeches applied
to the parts, or by Saturnine ointments or washes,
a good ointment for this Purpose is one composed
of Simple ointment, with a portion of fine powdered
Galls and Opium. Patients are frequently alarmed
for fear the Piles should produce Fistula in End
but this is seldom or never the case.
There are some other complaints remain to be 



130
mentioned, but which are not of very great consequence,
as the swelling of the lower extremeties, this 
may be relieved by means of a Laced Stocking.-
Some Women have considerable uneasiness
from the violent movements of the child, in this 
case you may moderate the Symptoms by means
of Opium.-
There will in some instances Black Spots
appear upon different parts of the Abdomen, and 
which may alarm the Patient, but are of no consequence,
and will disappear after delivery, they are 
probably owing to the rupture of some of the small 
vessels, in consequence of the Distention.-
Diseases accidentally connected with Pregnancy.
Lues Venera, when this Disease is in the 
form of Gonorrhea, the treatment is so gentle
as not to require particularly to be mentioned in 
this place, but when in the form of Chancre, it then
becomes a matter of much more consequence, for 
tho' they are only primary sores, yet from their slowing
absorption of Matter, constitutional Symptoms
may be produced, as Ulcerated throat, Eruptions &c.



131
Chancres are often cured without Mercury by 
the parts being destroyed with a Caustic, but the constitutional
or secondary Symptom require the 
use of a considerable quantity.-
When Salivation is produced during Pregnancy,
some have apprehended dangerous effects, but this 
is not necessarily the case, as the only thing of consequence
is its disposing to premature Labour.
Different opinions have been formed respecting
the mode of conduct proper under these circumstances
some have given Mercury in the alterative way so
as to produce a temporary cure of Symptoms, and 
this way gaining time 'till delivery has been effected,
but this must depend upon the Stage of Pregnancy
and upon the urgency of Symptoms, for if the Symptoms
are such as wont admit of Delay, you must
then proceed to the Cure, conducting the course with 
more caution, tho' with even so much, Abortion
will frequently take place.-
Dropsy, by this is meant Ascites, not Ovarian 
Dropsy, this Disease when connected with Pregnancy
comprehends some subjects for enquiry, namely,
whether Delivery is possible, whether the Patient will
live after Delivery, wether the Child will be Dropsical
whether tapping in proper, and whether a Cure will 



132 
succeed. With respect to the first of these, that is, the 
possibility of Delivery, experience proves this to be the case,
and without any extra Difficulty, for tho' the expelling
Powers are less, yet those of resistance are proportionally
diminished, but with regard to the second subject,
that of her living after Delivery, this is extremely doubtfull
on many accounts, one of which is the degree of 
Debility then present, and which will be very much
increased by the discharge which necessarily attends delivery,
and which is somtimes greater than others.
The third question is the child being necessarily
affected with the same Disease as the Mother, this [cross out]
is not the case, but it is impossible to say whether
the child will be Dropsical, for it may or may not 
be the case, as children are frequently born Dropsical
of sound and healthy Parents and the reverse, but a 
Dropsical state of the Mother entails no such state
in the Child.-
The Fourth circumstance; is the propriety of 
tapping under these circumstance, this is always
proper, whenever, the Disease is in that state to require
it, but should be done with caution on account
of the Danger of the Trocar being forced into the Uterus,
but this danger is entirely done away, by inabling



18
133
an incision with a Lancett, carefully thro' the integuments
in the course of the Linea Alba, the hole
into the Cavity of the Abdomen being about the size 
of the Canula of a Trocar, a Probe should be introduced,
into this opening, and upon this Probe or 
Canula slided into the opening.-
The last of these questions, is whether a Cure
will succeed Delivery, this has in many instances
taken place, and the way this is generally affected
is by the fluid escaping thro' the Fallopian Tubes
into the Uterus, and in this way been evacuated, the 
extremeties of these tubes are loose and floating in 
the abdomen, and tho' in the natural state it may
not be possible for any fluid to escape by this way
yet a certain action may take place in them
which may be the means of evacuating the fluid.
Hernia, are frequently very much effected 
by Pregnancy, and the purpose of considering this subject
more effectually, it will be necessary to divide
them into two states namely, Reducible and Irreducible.-
When the Hernia are Reducible, the Phenomena
are subject to variations, depending on the seat of 
the Rupture, as being either Femoral, Inguinal, Ventral, 



134
or Umbilical.- Reducible Hernia are generally
cured, that is temporally, by Pregnancy, except in particular
situations, as at the Umbilicus &c. which it
somtimes increases, and in some Women Pregnancy
always produces Hernia, when they are not subject to
it at other times.- It is very seldom proper to use 
a Truss for the Ruptures during Pregnancy on account
of the Pressure necessary to keep the parts reduced.-
Irreducible Hernia are dangerous in the extreme
as the ascent of the Uterus, may bring on Strangulation.
Whenever amongst other Symptoms, a patient informs
you of having a Hernia, and which she has 
not been able to reduce for some time, you should lay 
particular stress on the necessity of keeping the Bowels
compleatly open, and this should be done even if the 
Hernia is reducible.-
Women out of Delicacy will frequently avoid mentioning 
their being subject to Hernia, therefore in all
cases of violent pain in the Bowels, more particularly
if confined to any particular part, and this 
does not give way to the common modes treatment in
a moderate space of time, you should make particular 
enquiry and examination, to ascertain whether
there is any thing of this kind.
When Pregnancy is somewhat advanced, perhaps  



135
about the fifth month and Symptoms of Strangulation
come on, the treatment then becomes very complicated
and the event uncertain. It has been proposed, (when
the common methods of proceeding have failed) to bring 
on premature delivery, and by this to take off the exciting 
cause, but the mouth of the Womb is in general so rigidly
closed, that this could not be done without using a greater
Degree of violence than would be consistent with 
safety.- When the parts are in a relaxed state, and 
easily dilatable, this is a favorable circumstance and 
you may then proceed to dilate the parts in a slow 
and gradual manner and this way bring on Labour,
taking care not to use any violence.-
When the os. Uteri is in a rigid state, introducing an 
instrument and puncturing the membranes to evacuate the Waters, has been proposed,
for the purpose of bringing on Labour as this will follow
sooner or later, but this must depend upon the state of 
the Hernia, for if in the advanced stage there wont be 
sufficient time to wait for this, nor even to wait for 
bringing on Labour in the other way [cross out] when the parts
are dilatable, if it is in a still more advanced stage.-
When this is the case the operation becomes absolutely
necessary, but which is attended with considerable
difficulty, an account of the adhesions, and other circumstances.-
The operation should be performed in 
the usual way, and when the hernial Sac is laid bare
this should either be divided or not according to circumstances,



136
circumstances if it does not adhere, and you have reason to 
suppose the Contents are in a state proper to be returned
you may then do so without opening it, but if there is 
considerable adhesion, or you have any doubts about 
the state of the contents you should then lay open the 
Sac, for the purpose of examining them
Stone, when speaking of Stone as connected with 
Pregnancy, not only Urinary, but likewise Biliary
Calculi are comprehended.-
Gall Stones when in the Biliary passages, produce
Symptoms which should be distinguished from Labour
Pains, the Pain arising from the presence of a Gall
Stone in the Biliary Ducts, is about the Scrobicula Cordis,
is attended with considerable sickness and vomiting, and 
now not slow of that compeat intermission, which takes 
place in Labour pains, then will likwise after some 
little time be an affection of the Urine and Skin, and 
in the course of some length of time the pain will cease
from the Passage of the Stone into the intestines, a quantity
of Bile will be evacuated by stool, and the whole
of the Symptoms will disappear, at least 'till another
of these calculi obstruct the Passage.-
For the Purpose of moderating the Symptoms, Opium
should occasionally be given, and gentle aperients, and 
Bladders of warm warm Water should be applied to the 



137
part, or fomentations &c.- It would be very advantageous
to prevent a fit of the Gall Stone, at this time
and which may be attempted by ordering a greater
Degree of Exercise, and at the same time giving Aloctics
combined with Saponaceous Medicines, or by the exhibition
of Lixis Sapon. in the Dose of 30 or 40 Drops, three
times a Day and which may be gradually increased to 
a teaspooonfull, it should be given largely diluted, a convenient
vehicle, is a quantity of Mutton Broth, as this very
much sheaths the acrimony of the medicine, but the effects
of these remedies are very doubtfull.-
Urinary Calculi may either be seated in the 
Kidney, Ureters or Bladder, which may be distinguished
by attending to the Different Symptoms, when the Stone
is in the Kidney, the will be considerable pain in that
part of the back opposite the Kidneys, and which pain
will extend down the Thigh along the course of the Nerves
and as the Stone passes along the Ureter, the seat of the 
pain in the Back will be changed, and often a time all 
the Symptoms will cease from the Passage of the Stone
into the Bladder, when other Symptoms will come on,
the Urine will likwise be tinged with Blood at times.
By attention to these circumstances, and by the continuation
of pain, this may be easily Distinguished from
Labour pains.- The treatment will be different according



138
according to circumstance, as whether there is inflamation 
and fever or not, it will be right under all circumstances
to keep the Bowels sufficiently open, a good medicine
for the purpose is Castor oil, this may be made 
into a Mixture by the addition of a little Kali &c. and
along with this, opium should be given joined with Ipecacuhana, 
or Antimonials, and Bleeding if necessary should be 
had recourse to.-
When calculi a situated in the Bladder being formed
there or have passed from the Kidneys, different Symptoms
take place, as sudden suppression of Urine, discharge of 
a quantity Mucus &c. in the Urine, and occasional pain,
but as these Symptoms may arise from some other 
affection of the Bladder it may be right to try the use of 
some remedy in the first place, as by giving Uva Ursi
in the quantity of from 3ss to 3i two or three times a Day,
for some time [time].- If the Symptoms dont 
give way to these [illegible] of treatment, you should
then make examination, and in case you ascertain
the existance of a Stone different opinions have been
entertained respecting the propriety of performing the 
operation for its removal, but if this cant be effected
by any other in cases it may be done.- You may
somtimes ascertain the size of the stone by passing your
finger up the Vagina, and getting the Stone upon it, if
it is small it may possibly be got away without an 



139
incision being made, by dilating the Urethra, by a 
series of Bougies, or by the introduction of an intestine 
(with the end tyed up) into the Urethra, upon a long probe
or Bougie, and then forcing a quantity of Warm Water
into the Intestine to dilate it, and likwise the Urethra
this last method has been found successfull.-
If the Parts cant be sufficiently dilated in this 
way, recourse must be had to a cutting instrument,
but in using this it must be remembered, that there 
is some danger of wounding the Crura Clitoris, this 
renders the operation less perfect, this does not add to 
the danger of it.- The incision should be made in 
an oblique direction, the edge of the Gorgett being 
inclined obliquly downwards, and in this way the 
danger of wounding the Crura is lessened.-
If the existence of a Stone in the Bladder is 
not known till labour comes on, a good deal of management 
is necessary to prevent mischievous
consequeces, and for this purpose different ways 
of proceeding have been recommended, Dr. Smellie
advised the raising up of the Stone, and this is a very
eligable mode of practice of it can be done, if on
examination in the early stage of Labour the Stone
is found below the head of the Child, if this has not 
descended much, the Stone may be raised above the 
Brim of the Pelvis, and this way prevent serious consequences,



140
consequences, for this purpose a Male Catheter or a Sound 
may be introduced into the Urethra, and two finger
(one on each side the Instrument,) up the Vagina, and 
in this way acting upon the Stone, and raising up, and 
when you have done this you should keep it raised
for some time, 'till pains come on, and force the 
head of the Child lower down, and preventing the descent
of the Stone.- To effect this some time may possibly 
be required, and the woman should be placed in the 
most favorable situation.-
Some have recommended the introduction of a pair
of Forceps up the Urethra, and extracting the Stone by 
that means, but there a great objections to this mode
if much force is used, on account of the injury which 
must be done to the Parts.-
Another mode of proceeding has been recommended,
and which is much more eligable, that is, the making 
an incision from the Vagina, into [cross out] lower part
of the Bladder, opposite its superior Curve, as the Stone
generally lays there.- The way of doing this, is by carrying 
a finger up the Vagina opposite to that part, and 
introducing a curved Bistory upon it, and in this way
making an opening into the Bladder.- The Bistory
should be covered by means of somthing passed round
it, except towards the end.-
It has been advised in a case of this sort to open 



19
141
the childs head when the other methods fail, this 
may somtimes be necessary, but there is one thing 
to be taken into consideration, which is the Death
of the Child.
Examination.
By this is meant manual examination, and 
which should always be conducted with the greatest
Delicacy and gentleness, so as to give as little pain
as possible.- The reasons for examining are comprehended
under five particular views, namely.
1st. To ascertain the existence of Pregnancy. 2d. To
determine its period. 3d. To know if Labour is present.
4th. To know the precise kind of Labour, 5th.
To investigate the true nature of a Disease.
Some Dexterity is required in making examination,
and in case you find it necessary to examine
by the Rectum likwise, it is much better to mention
it, to prevent then forming a bad opinion of your
judgment, supposing you make a mistake.- When
ever you find it necessary to examine, it will be 
adviserable to have another female in the Room
more particularly if the Person is a Stranger.-
Shall now proceed the different views separatly.



142
1st. To know if a Woman is Pregnant. There is very
little to be gained from examination on this account
before the third month, on account of the enlargement
not being sufficient to alow of a determination being
formed, and this may be still increased if there is 
a Degree of corpulency, or from a distended state of 
the Bladder, but this last circumstance may be removed.-
From these circumstances it is always
much better to decline examining, except particularly 
requested, and then it is best to mention the 
uncertainty.- The best position for the Purpose of 
making examination is half sitting and half lying as
this places the Pelvis on a horizontal situation, and 
before you attempt to examine the Bladder should
be emptied.- The way to examine is to pass two 
or three fingers of one hand up the Vagina, to feel for 
the neck of the Womb &c. and with the other press
upon the Abdomen, doing this alternatly, and you 
may somtimes be able to ascertain the size and 
state of the Womb, the larger the Uterus is, the more easily
will Pregnancy be ascertained.
2d. To ascertain the Period of Pregnancy.- This is 
done either by observing the degree of the Wombs ascent
in the Abdomen; or by the shortening of its Neck.-
Shall first mention the circumstance of the Wombs



143
ascent at the third month the fundus of the Womb is 
just above the Brim of the Pelvis, at the 5th,, Month, half
way between this and the Umbilicus. 6th,, Month, a little
higher, 7th,, Month, even with or a little above the Umbilicus,
8th,, Month, halfway between the Umbilicus and Scrobiculs 
Cordis 9th,, Month, at the Scrobiculs Cordis.-
With respect to the shortening of the neck of the 
Womb, that remains of its full length 'till the end of the 5th,, Month
namely 1 1/2 In. after which time it begins to shorten,
at the 5th,, Month 1 1/2 In. 6th,, Month a little shorter 7th,,
Month 1/2 In. 8th,, Month, somthing less 9th,, Month, entirely
gone, the way to form this measurement is 
by passing the finger up the Vagina and pressing against
the Body of the womb, and forming your measurement
by the finger.- But in forming a judgement
it is best to compare both these methods, along
with other circumstances
3d,, To determine the existence of Labour.
Before this can be done it is necessary that Labour.-
should be defined.- Labour consists in the evacuation
of the fetus and Involucra, from the Uterus,
and is divided into natural, laborious, and preternatural
Labour.- Natural Labour, is when the 
head of the Child presents, and the Labour is terminated
without instrumental assistance.-



144
[illegible]. see after
Laborious Labour, is when the Head likwise
presents, but from circumstances, as a greater degree
of resistance from any cause, the aid of Instruments
is necessary.-
Preternatural Labour, consists in the Presentation
of any other part but the head, as the Arm,
Breech &c.-
The Symptoms of Labour, are pain, dilatation
of the Os. Uteri protrusion of the Membranes & Water,
tension or relaxation of the membranes, during the 
Presence or absence of Pain, and you may form some
opinion of the Stage of Labour, and of the kind, and length,
of time it is likely to be before its termination, from
there, and from the advancement and recession of 
the child during the presence or absence of Pain.-
Pain alone is not to be depended upon as a Symptom
of the existence of Labour, as this may arise from 
many other causes, as Cholic &c. nor even if with combined
with some dilatation of the Os Uteri, as this may 
be in a relaxed state, from some cause, but if along
with these you can feel the protrusion in some measure
of the Bag of Waters, it then becomes a certain sign.
4th,, To know the kind of Labour, this should always
be ascertained as soon as the Progress of the Labour
will permit, more particularly if the Waters have been
evacuated, as if there is a necessity for turning or any 



145
thing else to be done, this is the most favorable opportunity
for doing this.- I making examination to
ascertain the kind of Labour, the three different kinds
must be kept in View.-
Natural Labour, supposes proper Presentation
of the Head, sufficient Room in the Pelvis, and 
sufficient Pains.-
Laborious Labour supposes either want of Room
or want of Pains.-
Preternatural, when any other part except the 
Head presents.-
When the head of the child presents the Labour
may still not be Natural, and the aid of instruments
will become necessary, but you should wait some time
to see what nature will do (if there is nothing contraindicates)
for you cant always determine whether there
is want of Room or not, tho' this may be done after
some time, for tho' the Pelvis may be sufficiently large
and the head not larger than common, yet if the Bones
of the head are more ossified than usual, this may
prevent its passing, and the Reverse of this may be 
the case.- With respect to the sufficiency of pain
you cant form a correct judgement from the quantity
of Vociferation, but from the effect it has on the 
muscular actions of the Different parts, in general the 
most is done, when the patient holds in her Breath
and bears down, as the breath the Lungs contain, assists 



146
the action of the Muscles in forcing down.-
5th,, To distinguish the Disease in Question, various
Diseases require examination which have been before
mentioned, such, Cancer Uteri, Polypus, Retroversio Uteri &c.
Natural Labour.
Natural Labour is divided into quick or lingering
Labour according to the time necessary for its
completion, as in some cases the Labour is over in 
the course of two or three hours, in other cases much
longer, as for instance 2 or 3 Days or more, when ever the 
duration of Labour is protracted more than 12 hours
it then becomes lingering. There is another Distinction,
made by Women, that is into Sick, Wet or Dry
Labour, according as Sickness occurs, or the parts are 
in a moist or Dry state from the quantity of Mucus
secreted.-
Labour is likwise divided into three Different stages,
the first stage is the dilating process, and every thing
that takes place 'till rupturing of the Membranes.
The 2d,, stage is from the evacuation of the Waters 'till
the Birth of the Child is compleated.-
The 3d,, Stage includes every thing which occurs after
this as the expulsion of the Placenta &c.
[illegible] bound



147
Preparatory Considerations.
A young Practitioner should adopt the Customs
of the Country in which he resides, the position in
which a Woman is delivered varies, in some places
she sits on the lap of another Woman, in other a 
stool or Chair of a particular form is used, but 
these modes are very objectionable, for this throws
the Pelvis on a horizontal position, and if the parts
are in a relaxed state, and the Pelvis large, the Child
may be expelled so suddenly as to produce considerable
injury by either breaking the Umbilicus, suddenly
detaching the Placenta, bringing on hemorrhages
or by inverting the Womb, which will be very easily
done when in this state.- Her Position in general
use in this Country is the left side, and is by far the
best, the Patient may be either above or under the Bed
cloaths, tho' in general under them is preferable.-
Guarding the Bed is another circumstance
necessary to be known, this is by means of a Skin of 
Leather or any thing that wont alow the wet to penetrate 
to the Bed, and over this a Blanket &c.-
All postures are not the same tho' the Patient is
on the left side, for the purpose of rendering the Posture
the most convenient, the Patient should lay on the left



148
side, with the Knees bended, and brought towards
the Abdomen, and with the breech to the side or bottom
of the Bed, facing the Practitioner.-
It is adviseable more particularly if you any
Distance, to take somthing for the Purpose of making
a Purging Glyster, and a little R a Opii, for in many
instances, when the Pains are weak, and instead of forwarding
the Labour, only teaze and weaken the Patient
25 or 30 Drops of Tinct. Opii will be of great use, by
putting of the Pains entirely for some time alowing
the Patient to get some sleep and by that means being
refreshed, the Pains will after a time return with 
more vigour, and compleat the Labour.-
With respect to the Propriety of taking Instruments,
that must depend upon circumstances, as 
the Distance &c. and upon the command the Practitioner 
has over himself, as whether his having them
with him will cause to use them unnecessarily,
these things taken into the account, it may under certain
restrictions be adviseable to take some simple
Instrument as the Lever.-
Incidents connected with the first stage of 
Labour.- Pain is one of the first signs, this originates
in the Back and Loins, in the begining the Pain is confined,
but becomes more diffused as Labour advances,



20
149
Sometimes the pain begins in the fore instead of the back part,
and if this recurs at intervals in the same way as the 
other, it may be equally a sign of Labour, but if this pain
is continued, or has only very slight intermissions it
probably is owing either to Cholic, or to inflamation
if there are at the same other symptoms joined with this 
as a degree of fever, quickness of Pulse &c.-
The Pain in the begining is very slight, and in 
the begining continues perhaps 1/4 or 1/6 a Minute, recuring
at intervals of 15 or 20 Minutes, but as the Labour advances
the Pain becomes more violent, and continues longer
recuring at shorter intervals, so as towards the last
to be nearly continued pain and exertion.-
The cause of this Pain is the contraction of the 
Womb upon the Fœtus, for the purpose of effecting its
expulsion.-
Show. This is another sign of Labour, this is 
a discharge of Mucus secreted by the Mucuos Fallicles
about the mouth of the Womb, and when this becomes
a sign of Labour is tinged with Blood, this discharge
will somtimes take place a Day or Perhaps more, before
the commencement of Labour.- The red tinge 
is probably owing to some small vessels being ruptured,
in consequence of the mouth of the Womb becoming
a little Dilated.- Somtimes Labour comes on without
any discharge of this sort taking place.-



150
The Use of this Discharge is for the purpose of lubricating
the parts and rendering the dilating process more 
easy, and facilitating the Passage of the Child.-
Women will frequently this Discharge of Mucus
(untinged with Blood) for a considerable time previous
to Delivery, and in very considerable quantities, and 
will frequently be very much alarmed on account
of the supposition that it will weaken them and be 
a cause of difficult Labour, but this is not found
to be the case, and the Labour in some instances
appear to have been easier on this account, from 
there being a greater Degree of Relaxation. It is seldom
necessary to do any thing on this account, except
they appear anxious for somthing to be done,
in this case you make a Tonic Mixture of some 
kind as Decoct. Cort. &c.-- In some cases they 
may suppose themselves injured, and will make 
inquiries respecting this, you must be very cautious
of giving an Opinion, and before you do have some 
other circumstances than discharge alone.-
Show is not a sign of actual Labour, only of 
its approach, Pain is the first Symptom of actual
Labour.-
Rigor.- Labour is frequently ushered in 
by a Rigor, and frequently as a Symptom of Strong
Pain is a favourable circumstance, but this is likewise



156
likewise a Symptom of Fever, or internal Inflamation, it then becomes
an unfavorable symptom.- It becomes
necessary to distinguish the cause which gives rise to 
this Rigor, and which may be done by attending to
circumstances.- That from Labour may be distinguished
from Rigor as a Symptom of Fever, or Inflamation,
in having not hot stage, going directly from 
this to a state of Perspiration, and in the being no whiteness
of the Tongue &c.-
Vomiting. This is frequently Symptomatic
of strong Pains, but somtimes of internal inflamation.-
Vomiting as a Symptom a Labour may be 
distinguished, from the same symptom as connected
with fever or inflamation, by the Absence of Fever, state
of the Tongue &c.- If a Symptom of Labour and it is 
very violent, and frequent, it may reduce the Strength
of the Patient very much, and therefore should be moderated,
by the exhibition of R [illegible] Opii. Aq. Menth. or by 
the use of Saline Draughts in the state of effervescence.
Micturition and Ischury. These may both
occur during Labour, and arise from the Pressure of 
the Womb upon different parts of the Bladder, on this account,
(if micturition) you should never stay long in the
Room at a time.- If there is suppression, it may sometimes
be necessary to draw off the Urine with the Catheter
tho' pressing up the Womb with the finger will frequently
be sufficient.- 



157
Tenesmus. This often occurs and more particularly
in the latter stage of Labour from the Pressure of
the Childs head upon the Rectum.- In some cases, when
there is considerable relaxation of Parts, and the Labour
is considerably advanced, it will not be safe to alow
the Patient to make use of the close Stool, as the Child
might by the action at that time be expelled, but if any
thing passes away as the Patient lays it must be removed
by means of Cloths, &c.-
Observations &c.
On certain proprieties of conduct concerning
Labours.-
Always go as soon as sent for, as this may
somtimes be necessary and will always give more 
satisfaction, and be carefull to avoid any conduct
that may occasion alarm, is this tends to check and 
somtimes to divert the Labour Pains.-
If the Labour be in the early stage, do not stay
in the Room too long at once.-
Never be anxious about making examination
if the Labour is not much advanced, for you cant determine
much by it in this stage, and the Nurse or Attendants
will either ask, or set a Chair by the side of 
the Bed, with some Pomatum &c. which be to the same 
Purpose. The proper time for examination is 
when Labour is somewhat advanced, and the parts 



158
are become Dilated or when the bag of Waters has been
broken if this has not been done before.-
It is not necessary to repeat the examination
very often, and in doing the Presentation, and Progress of 
the Labour should be kept in View.
The Patient need not constantly be confined to the 
left side or to the Bed during the whole of the Labour
but either occasionally walk or sit in a Chair, in the 
begining Labour, tho' this cant be alowed in the 
later stages.-
First Stage of Labour. This begins with pain
in the Loins, which in the begining is confined, and 
continues only for a short length of time, and recurring
at long intervals, but after some time this becomes
more diffused, continues longer, and recurs at 
shorter intervals, and along with this a bearing down
of the Uterus, the external Parts become relaxed, and 
the mouth of the Womb a little dilated, after a little time this becomes
more dilated, and the membranes protrude, or you may
feel the fetus, [in] making examination, which should always
be done during during Pain, as not only give less
Pain, but feel every thing much more distinctly.-
There is frequently more time required to gain
a Dilatation to the size of half a Crown that to effect
the remaining Dilatation.
The dilating process gradually goes on and the 



159
Bag of Waters becomes considerably more protruded
and if these after a time are not ruptured, it will
be necessary to do this by means of the Finger Nail,
or pressure with the finger upon the Bag, if there is much Water,
for if this was to go on and the Child was to be expelled 
with the membranes whole, it would be literaly
drowned in its own waters, the same as in any other
fluid, as the supplies from the Mother are cut off.-
The proper time for rupturing the Membranes
is when the Mouth of the Womb is considerably dilated,
so as to alow the head of the Child to act as a 
Wedge, for the farther dilatation. There is great
disadvantage in evacuating the Waters too soon, for 
the Head is not able to effect the Dilatation, so well
in the begining as with their assistance, therefore
you should never rupture the membranes too
early.- If there is a considerable quantity of Waters
it will be better to collect them upon a Cloth &c.-
When the Waters are evacuated if you have
not before examined, or if you have any Doubts
about the case, this is the proper time for examination,
and to ascertain the situation &c. for if
there is a necessity for any thing to be Done, this 
is the most favorable time for doing this, such
as turning &c. for if the Womb is alowed to contract
more force will be required, and of course more pain
and Danger to the Patient



160
Second Stage of Labour.- This comprehends
all that takes place from the Rupture of the Membranes
'till the birth of the Child is compleated.-
The begining of this Stage is the proper time for 
ascertaining the situation and presentation, if this
has not been done before. If the Pains are Strong
and the parts relaxed the Labour now proceeds very
quickly.- When there is great relaxation of the external
parts, and this not the first Child, it will not 
be safe to alow the Woman to sit up or Walk about 
as the Child might be suddenly forced away and if she 
walking, fall in the Floor, and be a cause of considerable
Danger.-- In quick natural Labour, the 
head is very much forced down by a few pains, after
the escape of the Waters, and when the head has been
small or the Pelvis large, the same pain that has 
ruptured the membranes, has expelled the Child.-
The time when assistance becomes necessary
is when the head becomes forced against the Perineum
as there is some danger of its becoming lacerated, and 
which laceration may extend to the Rectum, this 
is a Matter of very great consequence, as there is generally
a high degree of irritation comes on, and the parts
wont again unite, and the power of retaining the fœces
is the consequence.- This is often occasioned by 
the improper use of Instruments. They way to prevent
the laceration of the Perineum is to press against 
it by means of the Hand or a Cloth, or by pressing against 



161
the head of the Child so as to regulate its passage, this 
must be done no more than is actually necessary
on account of retarding the Labour.-
The way in which the head passes the external
parts is with the Occiput to the Pubes of the Mother.-
When the head has passed the external parts, you
should examine to know if the Chord be round the 
neck of the Child, and if it is, it must be put over the 
Occiput, or the opening dilated, and slided over the 
Body of the Child as it passes.-
When the head has passed you must apply
one hand on each side, for the purpose of making
a little extension, and direct to Patient to hold in her
Breath and force down, you must extend gradually
pull down, giving the Body the proper turn, that is with 
the Shoulders to the Sacrum and Pubes, the long Ax is 
opposed.- When the shoulder have passed, you must 
make extension by them.
You must not remove the child from the parts of 
the Mother, for if the Navel string is short, you run the 
risque of breaking it, or detaching the Placent, or of inverting 
the Womb, all of which are of very great consequence 
as the Child passes, you should bend the Child
towards the Mother.-
You should not immediatly tye the Chord, but feel
for the Pulsation, tho' it is not necessary to wait till that 
ceases before you apply the Ligature.- If from the Pulsation



21
162
Pulsation you have reason suppose the Child alive, you
must not tye the Chord 'till the  Child breaths, and 
after waiting a little time it does not, the Body may
be rubed with gentle stimulants, or it may be necessary
to throw air into the Lungs, by stopping the Nose, and 
blowing into the mouth, at the same time pressing upon
the Thyroid & Crycoid Cartilages, so as to prevent the 
air escaping into the Stomach, for that would be doing
injury, and you must endeavour to immitate respiration
by pressing the air out again continuing this 
for some time.- Another way of inflating the Lungs is 
by means of a small curved pipe of a proper construction
introduced into the Epiglottis, they way of doing this 
is by passing your finger down into the Œsophagus 
'till you feel the Glottis, you must then pass down the 
Tube by the direction of the finger into the Epiglottis
and by that means throw in Air. This last mode
preferable.- Whilst these attempts are going on the 
Body should be kept warm.- If tho' the Pulsation
in the Chord was strong at first, this gradually becomes 
weaker, and after a time ceases, this is an indication
of Death.
The Ligature is generally made about 2 or 3 Inches
from the abdomen tho' 1 In. would be quite sufficient tho'
it would be inconvenient to make very near to the Abdomen
as a small portion of Intestine might be protruded at 



163
the Part, or if the Ligature was to come off there would be
difficulty in fixing on another.- A second Ligature
must be made nearer the mother, and the part between
the two divided by means of a Knife or pair of Scissors.
The necessity of making this second Ligature occurs
very seldom, but it is right always to do it, it occurs only 
when there is another child and the Vessels of each
Placenta communicate, in this case the second Child
would bleed to Death if this Ligature was neglected, tho'
then would be no danger to the Mother
Third stage of Labour. This consists
in the expulsion or extraction of the Placenta.-
The Placenta is not to be extracted immediatly
after the expulsion of the Child, for as the womb
is not yet contracted the Vessels of the Uterus remain
of their full size, and a considerable Hemorrhage.
would be the consequence. The interval may be 
employed with advantage in attending to the Child
and if there is much faintness in the mother, as 
there frequently will be, a small quantity of 
some Cordial may be given, but you must be particularly 
carefull that too much is not given, or 
it may do considerable mischief.-
Before you attempt to extract the Placenta
always be certain there are no more fœtuses, and 



164
which you may do by laying your hand upon the 
Abdomen, and making gentle pressure, if there is no 
more, you will feel the parieties of the Abdomen fluid
and Uterus in the center, contracted into a hard round
substance, but if there is another Child, there will
still remain a general enlargement of the Abdomen.-
Somtimes the Uterus is not disposed to 
contract, and this may give rise to a supposition of their
being another Child, but by making pressure upon
the Abdomen to assist the contraction, will very 
soon determine the Case.-
With respect to the time which you should
wait before extracting the Placenta, this must 
depend very much upon circumstances, if there 
are no unpleasant Symptoms you may wait 
longer, but if flooding &c. comes you must extract
more speedily, as a general Rule from 15 to 20 Minutes
may be the proper time.-
Nature will very frequently expect the Placenta
without any assistance, but if this becomes
necessary, this is given by taking hold of the Chord
with a Cloth in one Hand, and pass the two fore
fingers of the other hand up the Chord to the Placenta
then separate them taking hold of the Placenta between
them, making extension both by Chord 
and by means of the Fingers, endeavour to extract it 



165
which if there are no adhasions you will be able
to effect.- When the Placenta is extracted, or is 
expelled, you should apply a Cloth to the parts, squeezed 
out of warm Water, and another under the Thigh, as 
it may be adviseable to let the Patient remain a
little time before she is moved.-
When the Uterus shews no disposition to contract
and expel the Placenta, if there is no flooding
you may endeavour to excite this contraction, by
rubing the Abdomen with some kind of Liniment
tho' it is the friction which renders the service.
Practitioners have varied very much in 
this opinions respecting the Extraction of the Placenta,
some advising in all cases to extract immediatly 
whether there is flooding or not, others recommend
leaving it entirely to Nature.- Both these 
extremes a wrong and Dangerous, a middle course
of proceeding is best.-
The speedy extraction may bring on profuse
Hemorrhage, by detaching the Placenta
whilst the Vessels are yet large and uncontracted,
when this is the case assisting the contraction of the 
Uterus by pressure upon the Abdomen or by other
means will answer a good purpose.- The speedy
extraction may likewise cause inversion of the Uterus
more particularly if the Placenta is attached to the 

The inversion of the Womb is somtimes partial
which may be known by passing the fingers up
the vagina.- This may be mistaken for a Polypus
are you are not carefull in making the Distinction.
The reduction must be attempted by pressing upon
the middle of the Tumor.- 

166
Fundus, and the attempt to extract has been made
by the Chord.- Flooding chiefly occurs when the 
Placenta is partially detached.-
When the Uterus is inverted the reduction should
be immediatly effected, for any time is alowed to 
elapse before this is attempted, the Uterus will have 
began to contract, and render the reduction either 
extremely difficult or else impossible.-
To prevent inversion of the Uterus, you should
wait 'till the Uterus is in some degree contracted,
except in case of flooding, in which case, before you
attempt to pull the Placenta [cross out] away you should compleatly
detach it, by passing up your hand and grasping
it, so as to effect a separation before you pull down.
The way to attempt the reduction is by pressing
upon the fundus of the Uterus so as to dent it in 
gradually proceeding in this way 'till you have
compleatly returned the Parts, not only within the 
Vagina, but compleatly into this natural situation,
which may be known by the way the hand 
passes up, and by feeling with the other Hand upon
the abdomen.- If the reduction cant be effected
it then becomes a Matter of very great consequence.
Death will somtimes take place very shortly 



167
from the shock given to the System, and if this does 
not then take place, it will do so generally after a 
length of time perhaps a may a Year or two.-
The Part which forms the external Surface 
of the Tumor is the internal part of the Uterus, than 
part from which the Menses flow, this flow not
only takes place at the usual Periods, but with greater
violence, and often recurs at shorter intervals,
and in the intermediate times a Discharge of a Serous
kind generally occurs, this produces a great degree
off irritation, and Debility, and generally ends in Death.
When the Uterus is inverted with the Placenta
attached, it becomes a question whether it will best
to separate it or not before reduction, this last appears
to be most eligable.-
Leaving the expulsion of the Placenta entirely
to Nature, is attended with Danger, as many
Die in consequence of it from its producing a 
high degree of irritation &c. and which my perhaps
by moderated by the use of R a Opii &c and the Discharge
corrected by Antisceptic washes or injections.
Somtimes the Uterus will contract so forcibly
if the Placenta has been left for a length of time, as 
to prevent the introduction of the hand, without 



168
doing more injury by the Violence used, that will
arise from leaving the Placenta, in which case
it must be left, and the Symptoms moderated by 
proper treatment.-
The Navel String is somtimes broken off in 
this case you must pass your hand up into the 
Uterus, and separate the Placenta & bring it away.-
Impediments to the Extraction of the Placenta
somtimes arise from Schirrous adhesion at 
others from irregular contraction of the Uterus.-
Schirrous adhesion does not so often take
place as has been generally supposed, when it has 
done, there must have been some Previous pain 
in the Part, and Chronic inflamation, in consequence 
of which a quantity of Coagulable Lymph is thrown 
out, which forms an adhesion betwext the Maternal
part of the Placenta and the Uterus.
In this case the Child will be expelled and every
thing will appear to be going on well, the Uterus
will contract and form the round Tumor in the 
Abdomen, after waiting a proper time, on attempting
to bring the Placenta away this cant do [illegible] and 
upon introducing the hand, the Placenta will be
found to adhere, if this adhesion is small, a little
force will effect the separation, but if the portion 
Sevri Cartilaginous?



169
which adheres is large it will be very Difficult if 
not impossible to effect the separation. Probably a 
Pair of Forceps might answer a good Purpose in 
assisting the separation, in using them you give no 
pain if only the Placenta is taken hold of.- You
must either by means of these or other means separate as 
much of the Placenta as possible, comparing the different
Portion when extracted.-
If any portion of the Placenta is unaviodably
left, (but none should if possible to extract it) Symptoms
of Fever and very high irritation will come on, and 
the use of various medicines and Remedies will be 
required to alay these as by Opium, Saline Draught
in a state of effervescence, internally, and likwise
antiseptic injections, as an injection of Ag. Hord.
℥vj Vis. Rubr. ℥ij.
When the Difficulty arises from irregular
contraction of the Womb, this may be from untimely
contraction of the Os. Uteri or a preternatural 
contraction at any one part of its Body.
The mode of treatment in both these Cases is 
nearly the same, but is different according on these
is or is not flooding, if there is no flooding you may
wait a little time and possibly the contraction may 



22
170
go off, or a Dose of Tinct. Opii may be given, and 
which in some cases will take off the Spasm.-
In some cases the Spasm only recurs at 
intervals, in this case on passing up your fingers
the part may contract upon them, but by proceeding
gradually you will overcome this, and be 
able to extract the Placenta.-
But when there is flooding, the case is different,
as there is then considerable Danger, this 
flooding somtimes brought on by puling at the 
Chord or perhaps by breaking it off, this could not 
have happened if both Hands had been used, as the 
cause of the Difficulty would than have been discovered.-
In case of flooding you must proceed
more rapidly, yet not so as to use any violence
you must introduce the hand gradually passing
it into the contraction, and by degrees Dilate the 
part 'till you have passed your Hand, and can
take hold of the Placenta, you must then endeavour 
to extract it, if you have only in the first
instance got hold of a small portion you should
endeavour to take hold of a larger, or it may be 
torn off, and which will frequently be the case
removing it by Degrees 'till you have extracted
the Whole, comparing the Different portions and proceed



171
proceed 'till the whole is extracted.- I will not be 
necessary to take the hand out, every time you have
detached a portion, but to slide that part downwards.-
Lingering Labour. This is when the Child
is a greater length of time than common, in expulsion, 
it is not called lingering if over in the course of the 
Day.- The cause of lingering Labour either deficiency
in the expelling Powers, or increased resistance,
or both.-
Defect of Pain, may depend upon Debility,
Plethora, Passions of the Mind, Over distention
of the Uterus, or any thing that may check the general
Exertions of Nature.
Debility requires the use of means that 
can give strength and afterwards to stimulate
the parts to act, such as Cordials of Different Kinds
as Ag. Menth. &c. and occasionally a little wine,
and this in most cases will be sufficient, tho' in
some cases a stimulus will be necessary, such as 
walking about, or by the introduction of the finger
or the Lever, not for the purpose of Delivery, but of 
exciting the Uterus to action.- In some cases when
than is only weak, with giving any assistance towards
the Progress of the Labour, only teazing the Patient and 



172
keeping her awake, a Dose of Ra Opii will afford considerable
Service.- Some have supposed that Debility 
could not be a cause of Lingering Labour, as 
Women have been Delivered when labouring under
Phthisis, and with the greatest Ease, but in this 
case the powers of Resistance are likwise diminished.-
Plethora.- This may be a cause of Lingering
Labour.- You may easily Distinguish this State 
the Countenance and other usual Symptoms, this 
Plethora should be removed by Bloodletting &c. and 
then the Pains will frequently come on sufficiently
if not you may Stimulate the parts to action as 
above.- If you apply this Stimulus before you
have made the evacuations, you run the risque
of some Vessel being ruptured, and this happen
in any part of the Body as the Lungs &c.-
Passions of the Mind. These always divert
the Pain, therefore all causes of Mental Agitation
should be avoided. If any thing of this sort has 
taken place, it may sometimes be necessary to 
take away a little Blood, or to exhibit some Tinct:
Opii.-
Over Distention of the Uterus. This acts 



173
in the same way as an over distention of the Bladder,
if this is from a larger quantity of Water than common,
rupturing the membranes more early than
common will be of Service, this may be slow when
the Os. Uteri is not more Dilated than 1/2 Crown, but
before this is done the case should be will ascertained
for if you evacuate the Waters and they were not 
the cause you do injury.-
Impediments to the general Exertion of Nature.
there may be from different causes, as inflamation
of the Lungs V.S. preventing the action of these parts
in assisting Labour.- Cholicky pains, along
with those of Labour may be another cause in
this case a Purging Carminative Glyster may 
be injected, or Purgatives joined with Carminative
may be given, these will be of Service by procuring
a Discharge of Filatus.- If Opium is given
before the remedies above have been tried it will
do injury, and will be of Service if given after.
Increased Resistance.
Toughness of the membranes may be another 
cause, acting upon the Principle of increased resistance,
when the Mouth of the Womb is sufficiently
Dilated.- Rigidity of Passages, Disproportion
of Parts, and Unfavorable Situation of the Head,
are likwise causes of increased Resistance.-




174
Toughness of the Membranes. This cant impede
the progess of Labour in the early Stage, only
when Labour is somwhat advanced, and the Os. Uteri
considerably dilated, in this case you should Rupture
them, for if this is not done the Whole Ovum
may be expelled together, but this would require
very great Exertion and the Child must be still
born for it becomes drowned in its own Waters in 
consequence of the communication with the
mother being cut off. There is danger too on this
account to the Mother, for the Womb being Distended
for a length of time after the Placenta has been
Detached, a considerable Hemorrhage may be 
the consequence.-
Rigidity of the Passages. This is more frequently
the cause of lingering Labour than any other
and may easily be ascertained.- In a case of this 
sort it will be much better to mention the Delay
that is likely to take place. Under these circumstances,
the objects to be kept in View, are to effect
a relaxation of Parts, to gain time, to guard against
accidents, and to encourage the Patient.
When there is rigidity the loose of some Blooding
possibly be of Service, keeping the Patient still and 



175
and cool, and not alowing much company to 
be in the Room, and keeping the Patient upon a low 
Diet not alowing any thing of Strength to be given.
Whatever will produce relaxation will be of Service
tho' very little can be done by Medicine, it may be right
to give somthing Simple to satisfy the Patients Mind.
Antimonials in nauseating Doses have been recommended,
tho' the continued nausea must be 
very unpleasant. If the Pains are weak and 
only teaze the Patient, a Dose of Ra Opii may be 
of Service by procuring Sleep and that way gaining
time and Strength, and a Glyster may be occasionally
given with advantage.- The Patient may
likwise have warm Fomentations applied to the 
Part, or sit over the Night Chair with some Warm
water in it, these are not of much real Use, tho they
may shew the appearance of Doing somthing.-
A considerable time will elapse before there 
is much Dilatation of the Os. Uteri, perhaps a Day
or more before it has gained the Size of 1/2 Crown.
and the Labour may be 2, 3 or even 4 Days before it 
is terminated.-
If Women of a Rigid Fibre, Blood should be taken
away two or three times during Pregnancy and 
she should live upon rather a low Diet if nothing 
Particular contraindicates.- 



176
During this dilating process, there will sometimes, 
Symptoms come on which are attended
with Danger, as Convulsions, and which is generally
indicated some time before they actually take place
by particular Symptoms, as Pain in the head
Loss of Sight, a Morbid Sensibility of the Eye &c. this 
Pain in the Head is very much different from 
the common Headach, being a violent darting, Shooting
Pain.- When these Symptoms take place
it may be right to inform the Friends of the Patient
what is likely to follow, and there is Plethora
the loss of Blood may be a means of preventing 
this may be taken from a Branch of the Temporal
Artery or Jugular Vein, if there appears a Determination
to the Head.-
Disproportion. This is understood to be 
only slight, and only requires time to alow the Bones
of the head to accommodate themselves to the Passages
this should be ascertained when you examine and 
this should be done not only in one or two points
but entirely round
Unfavorable Situation. This may likewise
be a cause of lingering Labour, as any situation
different from the Natural one is more unfavorable,
and some of these more than others.-

[words crossed out] with its Pearson
23 and [Rem???])

23
177
There are some other Causes which are supposed
to be a cause of lingering Labour, but 
which are somwhat Doubtful, as the Premature
bursting of the Membranes, this may in some 
measure be a cause by reason of their assisting
in the Dilation of the Os. Uteri in the begining
before the head cant to advantage, and the violent
Action of the Parts may force the Womb, down
out of its Place, and if it does not do this, the injury
done may dispose to procidentia Uteri.-
The Cord being round the Neck of the Child has
been supposed by some to be a cause of lingering
Labour, but this cant possibly be the case.-
The Shoulder of the Child hitching upon the 
Pubis, is another cause supposed by some to be
a cause of this kind of Labour, this cant retard the 
Passage of the head, tho' when the Head has passed
the external parts, it may be a cause of preventing
the Body from being expelled, you may remedy
this by pressing with the Finger upon the Neck
of the Child so as to depress the Shoulder, and then
give it the proper turn, and when you can take 
hold of the Shoulder you should pull by them, being
always carefull of applying pressure in the Axilla
on account of the Axillary Plexus of Nerves.



178
Whenever you are called to a Labour which is 
lingering you should always make inquiry, what
this arises from, and whatever that may be, you
must take measures accordingly.-
Laborious Labour. This is when Nature
is not able to expel the Child, tho' the Head presents.
These cause of this is either disproportion between
the Pelvis & Head, Defect of Pain, or a greater
degree of Ossification of the Bones of the Head.-
Disproportion may either be on the Side of the 
head or Pelvis, as the Pelvis being deformed, or the 
head enlarged from any cause as Hydrocephalus
or the extra Ossification preventing the Bones yielding
as they commonly do.- There may in some 
instances be disproportion both on the side of the head
and Pelvis.-
Disproportion varies in its Degrees, the lesser
of which may be relieved by the more gentle means
the greater by more severe treatment.
Nature in all these cases should be alowed
to exert herself to see what can be done without
assistance.-
The milder kinds of Laborious Labour are 



179
manageable by the use of the Lever or Forceps
which do no injury either to the Mother or Child
if properly used,- The more severe kinds require
the Perforator and Crotchet to remove the 
disproportion.- For the milder kinds of Laborious
Labour, [crossed out] Fillet has been recomended
but from the difficulty with which it was applied
the use of it is laid aside.-
An Instrument resembling the Lever was 
invented by a Mr,, Chamberlin, but which had 
very little curve, and on that account would be
applied with very little advantage.- After a time
the Lever, which is more curved was invented, and which
is now very much used and with advantage in the 
milder kinds of Laborious Labour:- The Lever now
in use, is considerably more curved than what was 
formerly used.- The Lever acts with advantage and without
injury if properly used but may do considerable
mischief if applied improperly.-
The Forceps were afterwards invented and which 
act with advantage when the Lever frequently
wont succeed.- The French make use of longer
Forceps than is the Practice in this Country
an apply them under different circumstances
that is when the Head rests [cross out] at the Brim of the 
Pelvis.- The Lever may be be of Service when the 



180
Head rests upon the Brim of the Pelvis, and is out of 
the reach of the common Short Forceps, tho' the long
curved Forceps have been applied with advantage
when the head rested at the Brim in consequence
of some disproportion, and in a case or two when it 
would have been necessary to open the head, only
for the use of these.
The Forceps in common use in this Country are
considerably Shorter, and are only applied when the Head
is low down in the Pelvis.
Dr,, Luke invented Forceps with three Blades
but two are used much more readily and with
greater advantage, as they will alow as much
force to be used as either of Service or consistent
with Utility.- Those Forceps are the best which
will alow the protuberance of the Parietal Bones
to go it into the opening in the Blades, and at 
the same time are bevilled off so as to lay close
to the Head, for the part which gives the Resistance
is that protuberance, and the Forceps cover this
they add to the Back of the Childs Head.-
The intention for using the Forceps are to 
bring the Child away alive, without injury to the 
Mother.
Consideration regarding the Use of the 
Forceps. There comprehend the Propriety of using  



181
them, the Rules to be attended to in all cases, and 
Rules applicable in Particular Cases.-
Various reasons have been assinged for the 
use of this Instrument, but these are not all of 
equal weight.- One very good reason when a 
Woman has been in Labour for a considerable
length of time the head low down in the Pelvis, the
Pains have been Strong but are now going off the 
Patient much exhausted, and Floodings or Convulsions
attending, but the Forceps may be applied
with propriety and advantage in cases much
less urgent.-
Another reason for the use of the Forceps has
been assigned, which is when the Navel String comes
down before the head if the Child, there is no danger
Danger from this circumstance to the Mother
tho' very great to the Child, you may endeavour
to put this to one side when it wont be pressed
upon by the head, but if this cant be done the the 
Forceps may possibly be of Service by bringing the 
Head more quickly this the external parts.-
The Bladder and Rectum should always 
be emptied before the Forceps are introduced.
The Patient may lay on the left side in any 
position of the head with respect to the Pelvis,



182
but with the Breech opposed to the Practitioner, and 
very near the edge of the Bed, it will somtimes be
necessary to support the Feet by means of a 
Chair.-
The Forceps should always be used Warm.
The Os. Uteri fully Dilated.-
The Head descended low down.-
The instrument introduced during pain
as both Blades have the same construction
it is immaterial which is introduced first.
The direction of the Blades must be determined
by the Ears of the Child, as the Forceps should
be applied on each side of the Head.- There is 
one exception to this when the head of the Child is 
just entering the Brim of the Pelvis, and this is 
narrower from the Pubis to Sacrum, and the face
of the Child is to either side, the Long Forceps are 
required here and they may be applied to the 
Face and Occiput, this case may somtimes
be relieved by the Forceps tho it will frequently be
necessary to open the Head
If you warm the Forceps and are carefull in 
using them you may somtimes do this without
the Knowledge of the Patient or by Standers, more particularly
if introduced during pain, which should  
a



183
always do, not that you can introduce them with
more ease, but you will give less sensible pain.
You cant often introduce the Forceps unknown
tho' the Lever frequently may.
If you attempt to introduce the Blades before the 
mouth of the Womb is compleatly Dilated, you run
some risque of doing injury by forcing the end of the 
instrument against that portion of the Vagina, which
is joined to the Uterus.- From this cause the Rule
of keeping the point of the instrument close to the 
Head arises.-
When you are about to introduce the Blades
it is immaterial which of them is introduced first
as they are both formed alike, tho' it is best to introduce
that with the left hand first (if you introduce
them sideways) and the right hand Blade over this,
and when you introduce them above and below, it
is best to introduce the lower Blade first.-
When are about to introduce the instrument
you must prepare the way by the introduction of 
the Fingers to separate the Labia &c.- then take one 
of the Blades loosely between the Thumb & fingers, and
introduce the Point under the Fingers, carrying it
gently or with the Point close to the head, 'till you have 
passed it sufficiently high up.- If you meet with 



184
any resistance, you must not use force to overcome
this but gently alter the Direction &c.- When you 
have introduced the first Blade, you must fix this
by means of the third and fourth finger and the Thumb
of our hand, whilst with the first and second you
prepare the way for the other, which you must introduce
in the same gradual manner, always taking
particular care respecting the Locking of the Blades.
If you find you have not got good hold it is not 
necessary to withdraw the Blades, but to move them
gently and by that means fix than properly.-
When you have fixed the forceps properly you
should not immediately begin to draw down, but wait
'till pains come on, and then make extension, having
off when the pains ceases &c.
You must not make the extension in a direct
Line, with in a line to correspond with the Axis of 
the Pelvis, gently moving the instrument from side 
to side as you extend.- Considerable care is necessary
when the head approaches the external parts,
if the Perineum does not Dilate sufficiently, you
must attempt to do this forcibly, but by keeping up
a regular degree of extension, and inclining the 
Handles of the Forceps to the Abdomen.-
Some care is necessary in taking the Forceps



24
185
off more particularly if you have used them without
the Patients knowledge
Application of these Rules, to particular
Cases. No Part except the head is proper for the 
application of the Forceps, tho' they have been applied
to the Breech and might act with considerable force
but the points will press upon the Abdomen, and 
may do considerable injury, in this case the Blunt
Hook acts with much more advantage and safely
but this will be mentioned hereafter.-
The Forceps can only be applied to head in
to two presentations, the Vertex and Face.-
When the Vortex presents, the Face may have
different situation with regard to the Pelvis, the
French have formed six cases from this, but these
may be divided into two namely, the Ears to the 
sides of the Pelvis or opposed to the Pubis and Sacrum. 
When the Ears are to the Sides of the Pelvis with
the face in the Hollow of the Sacrum, the Woman being
laid on the left side with the parts as near the edge  
of the Bed as possible, you must then introduce the 
Blades as directed first [cross out] below than [cross out] above, as by this
means you secure the Locking much more easy.
In some cases you are not able to bring the parts 



186
sufficiently near the edge of the Bed to alow of the introduction
of the Second Blade, you may then pass it sideways
over the face of the Child, for a little way, and 
then turning the Handle downwards, you bring the 
Blade opposite the other, and by carrying it a little 
forwards easily bring them to a Lock.- You must 
then proceed according to the general Rules
When Ears are situated to the Sides of the Pelvis
with the Face to the Pubis. This is attended with 
much more difficulty on account of the parts
not being so well adapted to each other in Shape
In this case if the presentation is ascertained
early before it has entered the Brim of the Pelvis in
any degree, Dr,, Smellie, recommends passing up
the hand to find the feet, and bringing the Child
away by that means.- This may be advisable if the 
case is early ascertained.- When the head has passed 
only a little way within the Pelvis, Dr S. recommends
passing up a long pair of Forceps, and fixing
them on the Head, to raise it up by Degrees 'till he 
can give it the turn with the Face to either side, and 
afterwards when the Head has descended somwhat
lower to turn it with the face to the Sacrum.
In some cases this practice may be adviseable.



187
adviseable.- Objections have been made to this if the
Uterus acts with much force, on account of the 
Vertebra of the Neck being injured, or the Uterus ruptured,
but these depend very much upon the way in 
which the attempt is made.-
In this case the Forceps must be applied on
each side the same as in the last, but the utmost
care will be necessary to prevent a laceration of the 
Perineum, the extension must be made gradually
and the occiput depressed as much as possible to make 
the Axis of the head as Short as Possible.- In speaking
in this way of the application of the Forceps the head
is understood to be low down in the Pelvis. so as tummy
is out of the Question
It will often be a question whether it may not
be better to open the Head of the Child than to use the 
degree of force which would be necessary for the Extraction
of the Head, as the Child will be still born, and a
considerable Degree of injury must be done to the soft
Parts.- When the head is considerably descended, it 
will somtimes be very difficult to ascertain the presentation
and Situation on account of the accumulation
of Scalp, obscuring the Fontanels &c.-
When the Ears are to the Pubis and Sacrum.
The head is considered as low down for they are 
always in this situation, at the time of entering the 



189
Pelvis.- The situation should be clearly ascertained
to form a judgment which way you should give
the Head the Turn, for if you make a mistake
and instead of turning the Face into the hollow
of the Sacrum, should bring it towards the Pubes
you render the case extremely difficult instead
of an easy one.- In some cases when you cant
feel either Sutures or Fontanels from the accumulation
of Scalp, you may determine the situation by
this circumstance, as the accumulation is always
greatest at the Occiput.- The Blades of the Forceps
must be applied towards the Pubis and Sacrum, the 
Blade towards the Pubis first.- When the Blades are 
properly fixed upon the Head, you must gradually
turn the Face into the Hollow of the Sacrum.
The Face Presentation. This is when the 
face presents with the Nose in the Center. In 
this case the Chin may be to any part of the 
Pelvis.- The head wont pass so easily as in 
the Vertex presentation, tho' it will in many
instance pass without any assistance, the Forceps
are sometimes necessary.- To gain a perfect
knowledge of the mode applying them with the 
greatest advantage, it will be necessary to understand
the way in which the head passes without 



190
assistance.- The most simple case is when
the Chin is opposed to the Pubis, as in this the
head passes with the greatest ease. In this case
the Chin is forced forwards and downwards by
the Spine acting upon it, and as it passes takes
exactly the same turn as the Vertex presentation
the Chin gradually emerging under the Pubis.
When the Forceps become necessary you must 
have the above circumstances in view, exactly the 
same as when the Vertex Presents.- The Blades
must Lock over the Mouth of the Child, but you
will not find the so well adapted to the Shape of 
the head as in the other presentation.- When you have
got good hold by the Forceps, you must draw down 
depressing the Chin so as to alow it to pass out under
the Pubis, and then elevate the Handles of the 
Instrument so as to bring them towards the Abdomen
of the Mother 'till you have effected the Passage
of the head, and then proceed as in a Vertex Case.
When the Chin is situated to either side, the 
object is to incline the Chin to the Pubis, and 
proceed as before.- If the head is high up, it may
be necessary to bring it down rather lower, before 
you attempt to give the turn.-

 

191
The Chin is somtimes situated towards the 
Sacrum, here the extraction of the Child alive is
scarcely possible unless the Head be very small.
Fortunately these cases rarely occur.-
On the Use of the Lever.
The management of the Lever supposes a Knowledge 
of the general Rules for using the Forceps,
also the necessity for using it should be well ascertained.-
The cases which render the use of the 
Lever proper, are when nature has done a good
deal but wants some assistance to compleat
the Business.- This instrument is improperly
called a Lever, as this might lead to a wrong mode
of application, it is not to act on the Principles of a 
Lever, but when applied to the head, and its action opposed
by means of 2 fingers, it acts similar to the 
Forceps tho with less advantage.-
It has been recommended to make use of 
the Lever when the head is at the Brim of the Pelvis
but this can seldom be done with advantage, and 
may often do much injury by bringing a Vertex Presentation
to that of an Ear &c.-



192
This instrument can only be applied with advantage 
to two parts of the head, namely the Occiput,
or by passing it along the Side of the Face fix the Fenestra 
of the Blade upon the Chin.-
It is necessary to ascertain the exact Situation
before you apply it, for in case of a Vertex Presentation,
of it was wanted to bring Down the Occiput
and the Instrument by mistake is fixed upon the 
Chin, the case will be changed to a face Presentation.-
When the Head is about to make the Turn
it is better to leave this to Nature, as the Face may 
possibly be turned Forwards, and then you do injury.
The same general Rules are to be observed
as in the introduction of the Forceps.-
You may know when the instrument is fixed
upon the Chin by comparing the Part of the Head
you can feel, with the Blade of the Instrument.
When the instrument is applied you may apply
two or three fingers of the other hand upon the head
of the Child to oppose it, and act in the same way
as with the Forceps, gradually puling down, and at 
the same time makeing use of lateral Motion.
You should be carefull in applying it to the fore
part of the Pelvis in account of the Urethra.-



193
Perforator & Crotchet.
In cases when neither the Lever nor Forceps
can effect the Extraction of the Head, either in consequence
of the Narrowness of the Pelvis, largeness
of the Head, or any other cause, the disagreeable
alternative of opening the head by means of the 
Perforator and Crotchet must be resorted too.-
As the child must in this way be destroyed
the necessity of doing this must be well ascertained,
and if there is the least possibility of bringing 
the Child away (alive) without this, and without
very much endangering the Life of the Woman, this
should be done, this is in case the Child is alive
but if it is already Dead, you may frequently
save the Woman very much by lessening the head
sooner that you would do provided it was alive.
You may often form some Idea of the Business
provided she has had former Labour, and 
thsen have been difficult, tho' this will not amount
to any thing like certainty, for tho' it may
have been necessary to open the head of the Child in
2 or 3 former Labours, yet there may have been 



25
194
some alternation in the Pelvis, or the head of this
child may be small, so that it may pass.
This circumstance may assist the judgment 
and proceed without so much Hesitation.-
If this necessity has only happened once, you
cant reply upon it so much.-
It is much safer to trust to the measurement
of the Pelvis together with accurate observation
respecting the head, and in making 
this measurement and examination you should
do it compleatly in all parts.-
The Necessity of opening the Head may depend
on different causes, but which are resolveable
chiefly into one, namely, Defect of Room.
This may be either from the Pelvis being smaller
or the head larger or more Ossified, so as to prevent
its yielding.-
But it is sometimes admissable to open
the Head where the Disproportion is slight,
this is in case the Child is Dead, but in doing 
this there should not be the least Doubt respecting
the Death of the Child, and the different Signs
of which should be well examined, these any great
Mobility of the Bones of the Cranium, Separation
of the Cuticle, Emphysema, want of Pulsation 





195
in the Cord, Putrid Discharge, want of Motion
in the Child, Discharge of the Meconium &c.-
All these Symptoms are fallacious, tho'
some of much more consequence than others.-
Great mobility of the Bones, this is a vague
term, but by it is meant, a very high Degree
so that the Bones may be formed into any 
Shape, and feels as tho' the Substance of the brain was
destroyed.-
Separation of the Cuticle, this has taken place
without the Child being Dead, tho' is one of the best
single signs.-
Emphysema, this arises from many other
causes, but may assist in forming an Opinion.-
Want of Pulsation in the Cord. If this can
be felt (as Cord), it is a very good sign, for the Child cant
live long after this ceases to beat, tho' it may for 
a Short time.-
Putrid Discharge.- This may arise from 
many other causes.-
Want of Motion in the Child. This is the 
most ambiguous sign of any, for the Child is
frequently not felt for a great length of time
before Delivery and yet may be born alive.-



196
Discharge of the Meconium.- If the breech does not 
present this is one of the Strongest Signs of the Death
of the Child, but somtimes when the Breech presents
this will be forced away tho' the Child is alive, by the
pressure of the Thighs and Knees upon the Abdomen.-
Others Symptoms have been mentioned but 
which are of very little consequence, as want of Pulsation
at the Fontanel, but this can be very seldom
be felt.- Movement of the Child from side to side
this of no consequence.-
But in forming the opinion several of these 
Symptoms should be combined, as they are all liable
to fail singly, and if you cant compleatly make 
up your mind respecting its Death, you must
then proceed on the Supposition that is alive.
Different instruments have been invented
for the purpose of opening and extracting the Head,
but those now in use, are the Perforator, Crotchet,
and Blunt Hook, and in some cases a pair of 
large Forceps with long Teeth.-
When you are about to use these Instruments
the Woman should lay on the left Side, with the 
Breech very near the Edge of the Bed, and you should
be seated opposite the Breech to give as much command



197
command as possible, for the Business will often be attended
with very great Fatigue.-
You must first introduce the left Hand
to find the Sagittal Suture or Fontanel, and then
pass up the Perforator up the Groove made by
the hand, to the Cranium, and then with a motion
the same as when using a boreing instrument,
pass it into the Scull, and before you attempt
to open the Handles, be certain the Point is in 
Cranium, not slided on one Side, you must then
take hold of the Handles, and open them, and then
change the position and open them again, and 
afterwards move them round when open to break 
down the Substance of the Brain, you may then
introduce a Spoon for the purpose of scooping
out part of the Brain.- After this has been done
some have recommended to wait and see if 
nature wont finish the Business, but this should
never be done, but should immediately proceed to 
extract the Child.- If the disproportion was not 
very great very little assistance will effect the 
extraction, but if the Disproportion was very 
considerable, then will be often a great deal of Difficulty.-
When slight, the Blunt hook passed up 



198
so as to fix upon some part of the Cranium, will
affect the extraction, by drawing gently down, and
is best done during pains.- If the Blunt Hook
is not sufficient, you must then have recourse
to the Crotchet, by passing it up and fixing the 
Point on some part within the Cranium, you 
must pull down, but always have your fingers
opposite the Point of the Instrument to prevent 
its injuring the Mother in case it should Slip off
or the Bone give way.- Somtimes different portion
of Bone will give way, and become detached, you 
must be very carefull in effecting the removal 
of these to prevent their injuring the Parts, by
bring them down with some Care, or by Doubling
them between the Thumb and fingers before you attempt
to bring them away.-
The Instrument may somtimes be fixed
with advantage on the ouside of the Cranium
when the rest of the Bones are very much Detached.
If the Pelvis is very narrow it may sometimes
be necessary to bring the Basis of the Cranium
down sideways.-
The large Forceps may be employed with advantage,
by taking hold of the sides of the Scull after the 
Summit has been detached.- After the Child has
been brough away it will be better either to cover the head



199
with a Cloth or unite the parts by means of a Suture,
to render its appearance less disagreeable.-
After opening the Head, some practitioners have
recommended passing up the hand to find the feet
and bring them down, but this should not be done,
for the portions of Bone may injure the internal
Surface of the Uterus very much.-
If the head is enlarged from a collection of 
Water called Hydrocephalus, simply puncturing the 
Head may be sufficient.-
In all cases of this kind it will be much
better to call in another Practitioner, before you attempt
to open the Head.-
If the Resistance is at the Brim of the Pelvis
the long Curved Forceps may possibly bring the 
head down when it otherwise would have required
being opened, they may be used with advantage if
the Disproportion is small, but if it is considerable
the Child will die from the necessary force being
applied therefore it will be better to open the head
as this does less injury to the Mother.-
The Patient living abstemiously during Pregnancy
will somtimes be attended with good effect  



200
It has been proposed and in some instances
practiced with success, to save the Life of the Child
by bringing on premature Birth, in case of Distortion
of the Pelvis.- The Period at which this must 
be done must in some measure depend on the 
degree of Distortion, but cant be done to answer the 
intended purpose, before a certain Period.- Most
of the Children die, that are are born at or before the 
7th,, Month whether accidentally expelled or this excited
by act, therefore seldom should be proposed at that 
period, but will be much more likly to succeed if 
deferred till Pregnancy has continued 7 1/2 or
8 Months, but you cant do this with Propriety
except you know the exact Period of Pregnancy,
and to do this the Woman must be very accurate
in her Reckonings, and this may be done with 
the greatest certainty from the cessation of the 
Menstrual Discharge, if she has been regular
previous to that time.- Quickening is much
more uncertain, but that has been spoken of before.
The mode of bringing on premature Labour
is by evacuating the Waters, this is done by means
of the Stilet or a Catheter, you should pass your
finger up as a guide, and then pass this 2 to let up
the neck of the Womb, which is not yet compleatly 



201
obliterated, and Puncture the Bag of Water, not 
using any force afterwards to bring on Labour, but
this after some time (perhaps 2 or 3 days) will come
on.- You will know when you have punctured
the Bag of Water by its drilling away
Preternatural Labour.
In Preternatural Labour the Head comes away
the last part. These may be divided into two 
Classes, as requiring turning or not.-
The first Class will comprehend the Presentation
of the Feet, Knees or Breech, as the Child can 
pass thro' the Pelvis in that Direction.-
The second, comprehends the presentations of any
other Parts as the Arm Back &c. these requiring
turning before they can pass.-
The Presentation of the Feet being the most Simple,
shall first speak of that.-
In this case the Mouth of the Womb must 
be sufficiently dilated, or you will meet with considerable
Difficulty in compleating the Extraction
therefore never pull down 'till the Os. Uteri & external Parts is compleatly



20
202
compleatly dilated, for if this is not the case, when 
the Breech or Shoulders are at that Part they will
occasion considerable delay, and if it is the Shoulders
or head, the Death of the Child will be the consequence
as it cant Breath, and the communication with 
the mother is cut off.-
The Belly of the Child should be to the Sacrum
to alow it to pass with the greatest case, and if by the 
situation of the Toes you find this not to be the case
you should turn it in this direction in pulling down
by doing this as soon as you have got hold of the 
Thighs, not deferring it longer or you will find much
more difficulty in doing it.-
When the Parts are sufficiently dilated, you
must then take hold of the feet by means of a 
Cloth, and pull down gently, moving the Child from
side to side as you extend, when the Child is come
low down as for instance the Breech near the 
external Parts, you must not then wait for pain
but go on extending; and direct the Woman to hold 
in her Breath and force down, for if you wait
in this stage the Child will be lost from the Pressure
made upon the Navel string.- When you 
have brought the Child so low that the Shoulders



203
are approaching the external parts, you must
then bring the Arms down, one after the other, this 
must be done by passing up your finger and pressing 
upon the Arm at the elbow joint for the purpose
of giving the hand a sweeping direction over the 
face of the Child, when you have got one Arm
down, you must proceed the same with the other
and when both arms are extracted, you must
not then pull down, but pass the forefinger of 
one Hand into the Mouth, and take the Occiput
between two fingers of the other Hand, you have
them compleat command of the head, which
you must give 1/4 of a turn to make the Head
correspond with the long line formed by Cavity
between the Sacrum and Illium, but the Head
wont pass out in this direction, you must therefore
turn it back again, with the Face to the 
Hallow of the Sacrum, then by depressing the 
Chin you are able to bring the Head out without
much difficulty.-
There will be more difficulty attending this 
case if it is the first Child, more particularly
if the Woman is advanced in Years, in this case
you should wait 'till the Parts are more fully 
Dilated



204
Breech Presentation. This is when the presenting
Part is the Breech with the Anus in the Center.-
This should be distinguished from a Hip presentation
which wont pass, but which may be changed
into a Breech case.-
In this presentation the back of the Child
may be situated towards any part of the Woman
tho' the most favorable is when the Back of the 
Child is towards the Belly of the Mother.-
The situation may be know by feeling the 
Notes, and the opening between this; and the Scrotum
which somtimes becomes very much Distended 
by the pressure made upon the Abdomen, forcing
fluid down into the Tunica Vaginalis Testis 
When the Back of the Child is opposed to the 
Belly of the Mother, [and] and Both Child and Pelvis
are standard, if the Pains are sufficiently 
strong, Nature will frequently terminate the 
case without assistance, but when there is either
disproportion or deficiency of Pain, assistance
becomes necessary, and if the Child is near the 
outlet a finger may be introduced into the 
Groin, and gradually pulling Down first on 
one side and then the other; but the Breech is



205
situated higher up, a Blunt Hook may be used
acting first on one side and then or the other 'till
you can act with the Fingers.- You must go on 
in this way 'till you can grasp the Breech, which
you must do as soon as possible, and then go on 
pulling down 'till the Feet drop out and then the
case must be finished as in the Foot case.-
You must not attempt to pull the Thighs
out but kept going on pulling by the Breech,'till
they fall out of themselves.-
In applying the Finger or the Blunt Hook
in the Groin you must not act upon the Thigh
but upon the Pelvis of the Child above the Groin.
When the Pelvis is too narrow to admit of the 
Breech passing, you must pass up the Hand or
find the feet, bringing them down, and endeavour
to extract the Child singly, if this cant be done
the Head must be opened.-
When the sides of the Child are to the Sacrum
and Pubis if it is necessary to make any extension
by the Finger or Blunt Hook in the Groin
you must have the Axis of the Pelvis in view, and pull down
3 times as much in the back as in the forpart 
'till you can grasp the Breech, and then you
must do it and turn the Child with the back to
the Belly of the Mother which brings it to the first case. 



206
When the Back of the Child is to the Sacrum. In 
this case you should endeavour to bring the Child into
the first situation, by taking hold of the Breech as
soon as you are Able, and give it 1/4 of a turn, and 
in the course of a little time longer, another 1/4 turn, and 
which will bring the Back to the Belly of the Mother
and make it the same as the first case.-
In this case it might be adviseable to endeavour
to turn the Child with the Face to the Sacrum
before it has descend much with in the Pelvis, by means
of a Pain of long Forceps fixed on each Hip, and often
the turn was affected to take them off and proceed as 
in the first case.-
When one Foot presents.- This is to be managed
in part like a foot and in part like a Breech
case, by gradually extending &c. 'till the foot Drops
out, and then finish as before mentioned.-
When one or both Knees present. In this 
case you must draw down by the Thighs, 'till the 
Legs drop out, and then proceed according to the 
directions laid down for the foot case.- 



207
Turning.
Turning consists in passing up the hand to find
the Feet, when any other part presents, and is divided
into turning from Necessity and turning from Choice.
When turning from Choice is mentiond it must 
not be understood to be from caprice, but that in this 
case the Child might possibly be born without turn
yet, if the Child is turned, the Danger will be less.-
When neither the Head, Breech nor lower Extremities
present, then turning is required to affect Delivery, this 
is turning from Necessity.- In cases of this sort
it was the Practice of the Ancients, to take the Child
in Pieces, for the purpose of extraction, if they could
not by any means bring down the Head.-
Hypocrates directed the Woman to be shook, under
the Idea of changing the situation of the Child.- 
Ambrose Puree was the first who recommended the 
the turning the Child in cases of this sort by passing 
up the hand to find the Feet, much in the secure way
as now directed.
Tho' the Operation of turning is an improvement
it is not altogether without Danger in itself, more 



208
Particularly if proceeded about in a rough improper 
manner.- The Danger from turing is in proportion
to the Degree of Pain, and the shape of the Uterus
and direction in which the Child lays whether in 
a round or oblong form, for the rounder the Child
lays with the more ease will the the turning be effected.
Turing is somtimes thought proper when
the Head presents, here the concomitant Symptoms
must determine the propriety, these circumstances
usually are, unfavourable Situation of 
the Head. Flooding. Convulsions. want of Pains.
want of Room in the Pelvis.- Oblique situation
of the Uterus.- Prolapse of the Navel String with 
the Head.- These will be each considered separatly.-
In all these cases the head is supposed 
not to have entered the Brim of the Pelvis in any 
Degree, for if it has you must not attempt to 
turns but give assistance in another way, by the 
use of the Lever and Forceps.- You should likewise
have the parts sufficiently dilated before you
attempt to pull down.-
Unfavourable Situation of the Head. This may 
require turning if this cant be rectified, by means
of the Hand or Lever as in case of the Ear presenting
you may sometimes alter the presentation to the 



209
Vertex Case by acting on the Head with the Lever.-
Flooding and Convulsions. The propriety of turning
will be treated of when treating of these particular Subjects.
Want of Pain. This does not require turning if 
there are no unfavorable Symptoms come on, this may
be known by the Pulse and Strength, &c. and if there are
no unfavourable Symptoms you must wait and 
Nature after some time will be able to expel the Child.
With respect to the time you must wait, this depends
very much upon circumstances.- A Patient has 
been in Labour 2 or 3 Days, and during almost the 
whole of this time, the Os. Uteri has been considerably dilated,
but very little pains, these have then come on
and the Labour has soon terminated favourably.-
But if whilst you are waiting any unfavourable
Symptoms come on, and the Patient appears to be 
Sinking, you must then proceed to turn, or in case
the Head has entered the Brim of the Pelvis, the long 
Forceps will then be preferable.-
Want of Room. This is understood to be 
in a slight degree for if disproportion is considerable, 
it will be impossible by any means
to bring the Head away without opening. When 



27
210
the Disproportion is slight, Practioners say in
their Opinions respecting the propriety of turning
at all on that account, very few recommend
it, for the object of turning in this case is to save
the Life of the Child, and it will be a very difficult
matter to bring the head away soon enough to do this 
if you turn on account of Deficiency of Room.
In this case the Lever of Long Forceps would
probably answer better, and save the Life of the 
Child when turning would fail.-
Obliquity of the Uterus. Turning is very
seldom necessary on this account, as this may
generally remedied by changing the Position of the 
Woman so as to alter the bearing of the Womb.
Prolapse of the Navel String. When the 
Navel String comes down before the head of the 
Child, there are different Opinions respecting the 
propriety of turning, some Favour it and others
not.- In cases of this sort if you dont turn 8 in
10 of the Children will be Born Dead, and if you do 
5 in 10, this is understood as a general Rule. In 
certain cases it may be right to turn but if the 
Object is to save the Child, and not on account of 



211
any benefit to the Mother you should never turn
without a probability of Success, and the following
circumstances must be taken into consideration.
Whether the Child is alive this may be known
by the Pulsation of the Chord.-
Whether or not the Head has entered the Pelvis
if the Head has entered the Pelvis turning is out of 
the Question.
Pains Strong or not. If the Pains are Strong there
is an objection to turning, as the degree of force necessary
may injure the Woman, and the Life of 
the Child wont be saved.-
Rigidity of the Passages. If these are in a rigid state
this will prevent the head being extracted time
enough to save the Life of the Child, therefore the 
parts must be in relaxed State to admit of turning,
with any probability of Success.- **
You may sometimes feel the pulsation of the 
Chord before the Membranes are ruptured in this 
case you should endeavour to keep the Bag of Waters
whole 'till the os. Uteri and parts are compleatly
dilated, for whilst Membranes are whole
the Cord is not pressed upon, and it likwise alows
the Child to be much more speedily expelled after they



212
are ruptured.- When the Chord is come down you
should endeavour to put it to some part of the Pelvis
when there is most Room, or to put it entirely
up; if this cant be affected, turning may be then
admissible under certain circumstances before mentioned.-
No Practioner is justified in turning the Child
from any motives of convenience to himself.-
There are certain circumstances which affect
turning rendering more difficult or easy, according
as one or other take place, the Child will be turned
with greater ease according as it lays in a round
form, and more difficult as it form and that of 
the Uterus becomes more oblong.- Another circumstances
to be taken into consideration is want of 
Room in the Uterus, this may depend either upon
Waters having been off a great length of time or upon
the violent action or rigidity of the Uterus.
In these cases if the turning is from Choice
it is much better to be backward in doing it unless
the are pressing Symptoms, but if the turning is 
from necessity, it is then right to do it, but at the 
same time will be adviseable to mention the Danger 
to the Friends.- If the Patient is labouring under
certain Diseases, Phthisis, Fever &c. you should be 



213
backward in attempting to turn, except from necessity.-
When it is necessary to turn, you will always
do this to the greatest advantage, immediatly after
the evacuation of the Waters, and from this you will
perceive the necessity of ascertaining the precise
presentation and Situation immediatly after the 
Waters have been evacuated.
Whenever you have reason from any circumstances
to suppose turning will be necessary, you
should never be in haste to break the Bag of Waters,
but alow the parts to be sufficiently dilated before this 
is done.- In cases you may feel a part, which 
will indicate the necessity of turning, before the Bag
of Waters is broken, in this case alow the Waters to remain
'till the parts are sufficiently dilated, and
the membranes a ruptured immediatly pass your
Hand up, and if possible plugg up the Mouth of the 
Womb so as to keep in a Portion of the Waters, this 
will facilitate the Turning.-
When the Waters are evacuated before the Os. Uteri
is sufficiently dilated, and the presenting part
is not well adapted to effect this dilation, as for 
instance in the Back Presentation; you may then
assist the dilating process by passing up your fingers



214
fingers and acting as a Speculum, but this must be 
done with the greatest gentleness
Before attempting to turn the Rectum and Bladder
should be emptied, for if the Bladder is distended
there is Danger of its being ruptured.-
The Patient in all cases may lay on the left
Side, except in some few Instances, and the Parts
should be brought as near the edge of the Bed as possible.-
In some few cases the right Side may be another
more advantageous, this depends upon the Situation
of the Child, but very little benefit can arise
from the Patient being placed in the Hands & Knees 
as some have recommended, and this is in general
a Painfull Situation.-
The Child will seldom require turning before 
the 7th,, Month, but this will depend upon circumstances,
in saying this the Child & Pelvis are supposed 
to be Standard.-
With respect to the Hand most proper to be 
used, that will depend upon the Situation of the Child,
the Back of the Hand should always be opposed to 
the Bones of the Pelvis and the Palm of the Hand to 
the Child.- In passing up the Hand no great degree
off force should be used, but it should be done in a gentle 



215
gradual manner. When you are about to turn, you
should take off your Coat, and do this in way so as to excite
as little alarm as possible to the Patient, and rub
the Back of the Hand (and not the inside) with some oil
or Pomatum, to facilitate its passage.- 
When introducing your hand, this must be done
in a Slow and gradual manner, and if you meet with 
any resistance, you must wait a little to alow the 
Parts to dilate and attempt to overcome this by any
violent degree of force suddenly applied.- There will
generally be a considerable degree of Pain, when the 
Knuckles are about to pass the external parts, and 
when they have passed, somthing less and the wrist will
become grasped, on account of then being more Room
in the Vagina.- In this Stage you should put
your hand in a proper position for finding the 
Feet, the part to which they are situated should have
been well ascertained before, as on this depends the introduction
of the Proper Hand, and in the Proper direction.- 
In passing up the Hand you must 
take care it passes in contact with the Child and 
not on the outside of the Membranes, for these will
prevent you taking hold of the Feet, and will endanger 
the bringing on a Flooding by the Separation of 



216
the Placenta, you may know when your Hand is on 
the outside of the membranes by feeling the interposition
of the membranous Substance between your Hand and 
the Child.- The Uterus should be supported by an Assistant
whilst introducing your Hand, and you should
introduce the hand gently and during the absence of 
Pain, desisting from the attempt during Pain.-
If the Uterus acts frequently and strongly, a Dose 
of R [illegible] Opii may be of Service by lessening the Pain, both
in frequency and Strength, to produce this effect it 
should be given in a full Dose, from 30 to 50 Drops or
more, alowing time for this to produce its effect, perhaps
waiting an hour or an hour & half will be sufficient.
Shd the violence of the pains prevent turning immediately after this [illegible] 
-You should likwise take care to carry the 
hand sufficiently high to find the Feet, and to avoid
mistaking a hand for a Foot, this may be done by 
feeling for the Elbow, or the heel.- Take care likewise
that both feet belong to the same Fetus, this will
be in general the case, as each Fetus is mostly contained
in a separate Bag, tho' is not always the case,
you may ascertain this by passing your hand up
to the Perineum.- If you have only got hold of 
one Foot you should not draw down 'till you have
got the other, and when you have get hold of both 



217
you should draw down in a gradual gentle manner.- 
In some cases when you have got hold of the 
Feet and are attending to bring them down, the head
will descend at the same time, in this case you cant
leave hold of the feet to elevate the Head, but you
may pass a Fillet round one or both Feet, for the 
purpose of keeping them down, and the press upon
the Head so as to elevate it, and alow the Feet to come 
Down.-
In turning, the object to be kept in view is to 
bring the Belly of the Child to the Back of the Mother.
The Difficulties are sometimes such as you cant 
get the better off, so that you wont be able to turn the 
Child and Mutilation will be necessary.-
When you have brought the Feet down, past
the external parts the case must be finished as 
the Foot case.-
Application of the Rules to particular Cases.
The general principles already mentioned being 
perfectly understood, their application to particular
cases will not be attended with much Difficulty.-
As the general principles in all cases are the same
it will not be necessary to mention every individual
variety that may occur.- 



28
218
Back Presentation.
This requires training, and may be distinguished
by feeling the Spinous Processes of the Vertebra in
the middle of the Pelvis, and the Situation may be
determined by the different distances of these at the 
lower and upper part, as this is much greater towards
the Loins & Sacrum.- This in general is not 
a very difficult case.- The Peculiarity in the mode
of turning in this case, consists in conveying the 
Hand up to the Feet by crossing the Back.- In
this case the Back of the Hand should be opposed
to the Sacrum.- The Situation of the Feet must
determine which hand is most proper.-
In the Back Presentation, some have recommeded,
pushing up the Shoulders and alowing
the Breech to come down, but as pushing up
is always attended with Danger, this should never
be done.-



219
Arm Presentation.
If the water have been evacuated for any length
of time, and the Shoulder is wedged into the Pelvis
and at the same time the Pains are Strong, it will
be extremely difficult if not impossible to turn
the Child.- An Arm Presentation seldom requires 
turning before the sixth Month, but is generally necessary
at the Seventh, and somtimes earlier, therefore
particular enquiries should be made respecting the 
Stage of Pregnancy, and if no longer than the Sixth
Month, you may then take hold of the Arm and pull
down and the Head will pass in that Direction.
This is only a general Rule, as in this case the 
Head & Pelvis are supposed to be Standard, and as
there may be deviations on either side, these of course
will affect it, there for you should not rely wholly
upon the Stage but, but take other things into the 
account, as examination &c. make of the Woman
state of the Parts &c.- But in all cases if you
have the least doubt either in respect to the Stage
of Labour or Proportion, you should pass up the Hand
and find the Feet.- Somtimes a hand comes 



290
down with the Head, this is not a true Arm Case.
In this case you must not take hold of the hand
and pull, or you bring it to an Arm presentation,
but you must endeavour to raise the Hand up, and 
keep it up 'till the Head comes down and presents
its returning, perhaps the Lever may be of use here
in bringing the Head down more Speedily.-
If the head is small or the Pelvis large they will
somtimes pass in this direction together.-
But in case the hand becomes jammed in along
with the head and it will neither pass, and your are 
not able to raise it, it will then become necessary
to open the Head.-
A true Arm case is when the Arm alone
descends and when this was the case it was formerly
recommended to push the Hand up, under the 
supposition that some other part would descend, but 
this is bad practice and should never be done, for in all
cases there is danger from pushing up, of rupturing
the Uterus, and in this there is no advantage gained, you
must not likwise pull down by the Arm, except in case
of the Elbow presenting, when you may pull down the 
forearm to make more room to pass up the Hand.
In some case of Arm Presentation, the Child has
spontaneously turned in the Uterus, the Arm going up and 



221
the Breech becoming the presenting part, this is what 
is called Spontaneous Evolution, from this circumstance
Dr,, Denman recommended waiting to see if this would not 
be the case, but from its frequently failing and when
it did succeed the Child was almost always born Dead,
he afterwards restricted this to when the Children were
known to be dead, but this should not be done in any case
except the Child is evidently upon the move, for if you
wait any time the Shoulder of the Child becomes wedged
in the Pelvis so firmly, as to render turning extremely
difficult or impossible.-
In the Arm Presentation where the Shoulder is wedged
in the Pelvis, and the Pains are Strong turning is extremely 
difficult, in this case the Pains may be moderated by
full Doses of Opium, alowing sufficient time for them
to produce their effect, perhaps waiting an hour or an
hour and half, and endeavour to pass up your hand by
gently elevating the Shoulder, and in doing this the greatest
dexterity will frequently be necessary, always using
as little force as possible, in doing this the general Rules
respecting turning must be kept in View, and the Woman
must lay on the right or left side according to the 
situation of the Child, and this must likwise determine
the hand proper to be introduced.- The situation of the Child 



222
may be known by examining the Direction of the palm
of the Hand likwise, the Thumb and Radius, and you 
are not certain from this pass your hand to the bend of 
the Elbow and Axilla.-
In cases when the Difficulty is such as to prevent
your being able turn the Child and bring it away, it then
becomes necessary to mutilate the Child, this is called 
Embryotomy, and may be done by means of the Perforating
Scissors. The mode of doing this is by passing up the 
Scissors guarded by the Hand, and separating the Arm
not at the Shoulder Joint, but by taking of the Scapula
and then making an Opening into the Thorax and Abdomen,
to evacuate their Contents, this will make sufficient
Room to alow of the introduction of the Hand, which you
should do and extract the Child by the feet.
Before you proceed to do this all possible means to 
bring the Child away should be used, consistent with the 
safety of the Mother, if the Child is alive, but in case 
the Child is known to be dead, you may then do it without
so much Hesitation.-
In some instances after the Child has been turned
there will be difficulty in the extraction of the Body
this may be from Air or Water in the Cavity of the Ab



223
this may be relieved by a puncture made into the 
Cavity of the Abdomen.- Sometimes there will be difficulty
in the Extraction of the Shoulders, rendering the 
Blunt Hook necessary, but this should be used with 
great care if the Child is alive, but if dead, so much
caution is not necessary, and if it is great the Arm may
then be separated. 
The greatest difficulty is in the extraction of the 
Head in many cases, and arises either from unfavourable 
position or disproportion, the former of 
these is owing to mismanagement, in not attending
to the Rules laid down for turning, the latter is 
inevitable.- From this it will appear evident
how necessary it is to attend to the Rules.-
If the disproportion is slight, putting the Head
in the position best adapted to the Shape of the Pelvis, will
often effect the extraction, but in case it is in the 
degree so as not to be brought away by this means
some have recommeded long Forceps, but they can 
be of no use as sufficient force may be applied by 
introducing our finger into the Mouth and the 
other hand upon the Shoulder with the Finger on the 
Occiput, this gives you a sufficient command of 
the Head likwise.- If you cant effect the Extraction



224
Extraction of the Head this way it then becomes necessary
to open the Head by means of the Perforator..
If your are able to extract the Head, and there has 
been considerable difficulty, tho' the Child may appear
Dead, yet it may be adviseable to inflate the Lungs
by means of a Proper instrument.-
When it is necessary to open the Head, this must
be done by means of the Perforator, and the part
most convenient for this purpose is the Lambdoidal
Suture, and after the Brain is broke down, you 
may then extract either by extension, or by the introduction
of the Crotchet.- Some have recommended
separating the head from the Body in this case,
but this should never be done.-
In case the Head has been separated from the Body
it has been recommended to trust the expulsion to
Nature, but this cant be done with propriety, more 
particularly if there is Disproportion.-
When a case of this sort occurs, you should make
particular enquiry, whether the Difficulty has arisen
from Malposition or Disproportion, and if from Malposition,
and there is at the same time a Spasmodic affection
relieving that Spasm by means of Opinion, may alow the 
Womb to expel the Head.- Somtimes there will be a Spasmodic
constriction of the Mouth of the Womb, so as to compleatly



225
compleatly in close the Head, it would not be adviseable to 
overcome this Spasm by force, but to give a full
Dose of Tinct. Opii. and wait 'till it produces some 
effect, and then endeavour gradually to Dilate the part.
Different Instruments have been invented for 
the extraction of the Head, but very few of them are 
worth notice, one invented by Gregwaar, to pass into
the Foramen Occipitale, might be of Service when 
there was no disproportion and might assist in 
fixing the Head for the Use of the Perforator and 
Crotchet, which are the only means that will
effect the extraction where there is disproportion,
in using them you must fix the head, either by 
somthing passed into the foramen Occipitale, or by
pressure upon the Abdomen, and the lessen the head
by the Perforator and introduce the Crotchet, for the 
purpose of extraction.- It will somtimes be necessary
to pass the Basis of the Scull sideways if the Disproportion
is great.- You will have much firmer
Hold by the Crotchet, at the Basis, than if it was the 
Summit of the Cranium.- 



29
226
Twins.
Somtimes instead of there being only one Child
there, or 2 or more, have been 3, 4, and in one case
5 Children. When the management of Labour
where there is only one Child is perfectly understood,
that when there is twins &c. cant be difficult
to comprehend, as circumstances are much the 
same.- When there are more than one Child, the
Labour is in general easier, as the Children for the 
most part are less, tho' there have been some exceptions
to this Rule where there were two Children.
If there are 3 or more, the Woman is generally
delivered before the termination of the usual Period
of Pregnancy, as the Womb wont alow of that Distention
necessary for their compleat growth.
The symptoms which indicate the existence of 
Twins during pregnancy are very equivocal, as 
the size of the Abdomen, double quickening &c. as 
this extra enlargment may be from a greater quantity
of Water &c. double quickening not of any consequence
as it may be from the same Child moving
at these different times. There are other Signs mentioned
but which are of no consequence.- 



227
During the time of Labour, and before the Birth of 
the first Child, circumstances sometimes occur which
indicate the existence of Twins, as the presentation
of two Heads, their feet, or Anus &c.-
The time most proper to ascertain whether there
are Twins &c. is often the Birth of the first Child, either
by the Pains, or by laying the Hand on the lower part
of the Abdomen, or by examination internally by the 
Vagina.- It will seldom be necessary to examine internally,
as you may in general determine this by 
laying your hand on the Abdomen, if there is another
Child it will feel full and distended, if not, the Uterus
may be felt contracted in the middle of the Abdomen
in a round hard Body, this way of examination
is preferable.- If you examine internally you
may either feel some part of the second Child, if there 
is another, or the Bag of Waters, but you may possibly
be deceived in this last respect, by a collection of 
Blood &c.-
If you feel a second Bag of Waters you should
immediatly rupture this, as the purpose of alowing 
them to remain that of Dilating the parts, is not 
wanted, and as the parts are relaxed and dilated
by the passage of the first, the second will generally
pass with very little Difficulty, on this account it may 



228
in some cases be better to conceal their being a second
Child from the Patient and bystanders, as they may 
suppose there will be the same difficulty attending the
expulsion of this as the first, this you may do, under
the pretense of assisting the expulsion of the Placenta.
Different Opinions have been formed respecting
the management of the second Child, some have advised
immediate Delivery, others to commit the 
expulsion entirely to Nature, and others have advised
are intermediate Course, which is preferable.-
After the birth of the first Child you should immediatly
ascertain the presentation of the second, for 
it is necessary to turn, this can be done at this time
with the greatest ease, and in case of a presentation
which does not require turning and pains come on
the Labour must be conducted as in other cases.
If pains go off, some have recommeded waiting
'till the again come on, but this is not good practice
for the mouth of the womb may again contract, and render
the expulsion more difficult. Dr,, Louden in
all cases, often waiting an hour, tho' the head was the 
presenting part and no unpleasant Symptoms
cause on, always turned.- If unpleasant Symptoms
come on you must attempt Delivery sooner 



229
such cases as require turning in case of 
only one Child require it equally when there
are two or more.-
When all the Children are born, you must
then proceed to the extraction of the Placenta,
as this must not be attempted before, on account
of bringing on flooding &c. and occasioning
other bad effects.- The manner of doing
this is to take hold of the different Chords, together
and proceed as in other cases, taking care
not to invert the Womb.-
Monsters.
There are Fetuses, which differ from the common
form, and do so in different ways.-
The mode of formation is very obscure, and 
the causes which divert Nature from the ordinary
course of evolution are not well understood.-
They are frequently attributed to some effect
which has been produced upon the mind, during 



230
Pregnancy, but this is not at all probable, as
many of these happen when the different parts of the 
Fetus are fully formed, if ever it does it must
be at a very early period.-
A knowledge of the different forms of Monsters
is as full in practice, as they may somtimes
occasion a little embarrassment.- A Brainless
Monster may possible be mistake for one 
whose head has been opened, a mistake of this 
sort occured to a Practitioner, who supposed the 
Head has been Opened
Monsters considered relatively to practice
may be divided into such, as have deficiency
Redundency, Mal Formation and Mal Situation.-
Those that are Deficient can occasion
no difficulty in Labour, except in case of turning
being necessary when the Extremities are
wanting, if there are the lower ones, some embarrassment
will be the consequence, and it may be 
necessary to open the Head.-
When there is redundency, it may be a cause
of Difficulty. It may in this place be right to



231
mention that in case two Children adhere by 
there Chests, that the internal parts are common
to both, this to prevent any thing being done
by way of separation.-
Our circumstance which is favourable, is 
that in [cross out] most cases of monstrosity, there is a disposition
to premature birth.-
Deviations from the common Period of Birth.
Most Labour occur at the end of Nine Callendar
Months or 40 Weeks, and many happen before 
this time, but there are different Opinions, respecting
the possibility of this time bring exceeded.-
From the observation made upon Brutes
it is probable that this may take place in the 
Human subject, but to what extent it is extremly
difficult to determine, this subjects comprehends
a Question of Law relative to the Legitimacy of 
Children, but it is impossible to draw a line of 
Distinction, if the Period is protracted beyond the 



232
45th,, or 46th,, Week, it then admits of a Doubt.-
Premature Birth.
This may take place to any period of Pregnancy,
but as some of these Children live after
Birth, and others not, they are from this Distinguished
into Vital and non Vital, this is likewise frequently
a Question of Law, and on this account
the Line is generally drawn at the 7th,, Month,
but this admits of some Latitude both ways.
Pulsation of the Chord is a sign of Life in a 
Physiological View, but wont be sufficient in 
the other view of the subject.- If the Child cries
it is a certain sign of Life, and if it could be proved
to have breathed that may be sufficient.-
Miscarriages are supposed to occur more 
frequently at some Periods than others, as the 
6th,, Week or third Month, attending to this circumstances
and more particularly if the same Person
has repeatedly miscarried at any certain Period,
may be of some consequence, as by keeping the 
Patient cool and quiet, at that time, miscarriage



233
may frequently be avoided, and at the same 
time giving gentle aperients &c.-
When a Woman has repeatedly miscarried
she will often begin to despair, and there will
be in some reason an assisting cause of this 
taking place, and should by all means be removed
if possibly and for this purpose any thing may
be done to divert this either by way of Medicine
or any other way.-
The immediate cause of Miscarriage is 
the same as that of Labour, which is the contraction
of the Uterus to expel its contents, therefore pains from
Uterine contractions should either be moderated or 
removed.-
Miscarriage may be produced, either by separation
of the Placenta; premature breaking of the 
membranes from any cause, or any thing that only
occasion the Death of the Fetus, tho' abortion does 
not always immediatly follow the Death of the Fetus
as this may take place at a length of time, before 
it is expelled even 4 Months or longer.
Miscarriage from accident will sometimes occasion
a susceptibility to future miscarriages, when 



30
234
this is the case particular care should be paid
in avoiding any of the exciting causes, keeping
the Patient cool and quite and attending to the 
different Symptoms as they may occur.-
A Miscarriage sometimes is not preceded
by any considerable Discharge of Blood, at others it 
is, this is owing to the exciting cause, if it is from 
any thing causing a contraction of the Womb, as 
the rupture of the Membranes &c. there is [cross out] no 
large discharge of Blood, in this case the Uterus proceeds
the same as in Natural Labour; first expelling
the Child then the Membranes, but when miscarriage
proceeds from the Placenta being either partially or 
wholly detached, there is then considerable Hemorrhage
and the case is then much more dangerous than
the Former, and on that account merits particular
attention.-
Miscarriage preceded by a Discharge of Blood.
These are much more dangerous than the other
kind, and this in proportion to the stage of Pregnancy,
as the more advanced, the larger the Vessels
are and consequently the greater Danger.
The cause in this case is the separation of the 



235
Placenta either partially or entirely, when this is only
partial Miscarriage does not always follow, but 
great care in this case is necessary.-
The signs are a Discharge of Blood, taking place
at unexpected Periods, which will coagulate; with 
pain, bearing down &c.-
Some judgment is somtimes necessary to
discriminate between such discharges and the 
menstruations in the early Months of Pregnancy
but this may be done by attending to circumstances,
as whether it occurs at the periods when the 
Menses [wa?] expected, or is accompanied with 
pain or not, or whether the Discharge will coagulate.-
Menstruation very seldom occurs so late 
or later than the third Month, and shews no disposition
to coagulate.- Enquiry may likwise
be made whether the Discharge proceeded from
any accidental cause.-
It is usual to divide these as they occur in 
the early or late Stage of Pregnancy, the time between
the two is generally drawn at the fourth
Month.- Those which occur in the later Periods
of Pregnancy are much more Dangerous, tho' the
others are attended with considerable Danger.-



236
Treatment of Miscarriage in the early Stage.
When there are any Symptoms which indicate 
on approaching Miscarriage, the Patient
should be kept as much as possible in a Horizontal
position, and as cool as possible, the room
should be as cold as conveniently can be, and the 
Bed Cloathing very tight, every thing heating or
Stimulating should be avoided, it is a very common
practice to give Red Wine under the Idea
of its being an Astringent, but this is very wrong
as it acts as a Cordial and of course does injury.
Then somtimes comes on faintness, this should
not be removed by Cordials &c. as it is upon the 
whole a favourable circumstance, alowing the 
formation of a Coagulum, and that way preventing
a return of Hemorrhage except the 
action of the Heart becomes very much affected, and 
the Extremities cold, it may then be necessary to give
some Cordial.-
In some cases instead of immediatly giving
Astringents it may be necessary to take away
Blood from the Arm, but this must be determined
by the State of the Pulse and other circumstances. 



237
Nitre, Mineral Acids, Opium &c. must be given
according to circumstances.- A common remedy
is an Infusion of Roses with Nitre, this does not
appear a very eligable way of giving the Medicine on
the Acid of the Roses may decompose the Nitre, tho' as
it does so only in a small Degree, it may still be 
very serviceable, an Infusion of Roses with the addition
of Natron. Vitriol. is equally well adapted for 
the purpose and is not liable to that inconvenience.
Opium is serviceable only under certain circumstances,
as in case of great irritability, when it answers
best if given in small Doses and repeated frequently or 
2 or 3 Drops every 3 or 4 hours.- If there is no hemorrhage,
at may sometimes do good given in full doses.
Digitalis would appear likely to answer a 
good purpose under certain circumstances, but is
so uncertain in its operation as not to be adviseable.
When the flooding has ceased, the Patient shd,,
be particularly carefull to prevent a return
by attending to the Bowels &c. and by avoiding any
exertion. This mode of treatment in supposed
to be necessary and proper during a state of Strength,
but when the Disease has continued somtimes a



238
different mode of treatment becomes necessary, instead
of giving Nitre &c. Astringents rather of the Tonic
kind become necessary, as the Mineral Acids, or Alum
this last in Doses of from 4 or 5 grains to 8 or 10.-
Preparations of Lead are somtimes given, or Tinct.
Saturn. g tt,, xx. ad g tt, x4, or the Cariess. Acetat. gr, 76 ad
gr. i sal gr,, ii - iii; this in general should be joined with 
small quantities of Opium to prevent its affecting
the Bowels.
Frequent returns of Hemorrhage may 
lead to considerations on the propriety of promoting
Miscarriage, it is better not to do this except
Nature appears to tend that way, except under particular
circumstances, as the Bag of Waters having
been ruptured, or the patient very much reduced
by the discharge, when you may proper examination,
tho' it will be better to avoid this in the early
Stage.- If on examination you feel the Mouth of the 
Womb soft and dilatable, or the Membranes protruding
you may then introduce your finger and act as a speculum,
gradually Dilating the parts &c. but if you
find the Os. Uteri rigid and closed, it will be much
better to leave the case to Nature only making use 



239
of the proper means before mentioned. If on examination
you find the Ovum in the Mouth of the Womb
this is the actual state of Miscarriage, and you should
do nothing for a time except you have reason to suppose
there is an internal bleeding going on, in which case
you may attempt the removal to alow the Uterus
to contract.-
Various instruments have been invented for 
the purpose of Dilating the womb but they are very 
seldom wanted, and may often do injury if used, the 
fingers are in general quite sufficient, and answer
the purpose much the best.-
Some have recommended the application of Styptics 
to the os. Uteri by means of Plugs, this is what 
the French call Tampon these are very objectionable
as they might possibly cause the os. Uteri to close but 
at the same time alow an internal hemorrhage
to go on.- They might be serviceable after the expulsion
of the Contents of the Uterus, when it was not disposed
to contract.- A Patient has considerable Thirst
in general, Cold Water may be alowed, tho' it will
be better if acidulated, as in this case a smaller
quantity will be effectual, and which is adviseable  



240
If on examination you find the Ovum wedged in 
the Mouth of the Womb, and the hemorrhage has continued 
for a length of time, it may be right to endeavour
to bring that away.- It is not in general
necessary to stay with a Patient under these circumstances,
but to see her occasionally.-
You should always carefully examine all discharges
that come away for there will frequently be
Coaguli discharged, and which may be mistaken
for an Ovum.- You should always examine to 
ascertain whether there is a Cavity or a Membranous
substance which may have been the Cavity, if this is 
the case, it is a Miscarriage, but if it is perfectly
Solid, it then is a Coagulum.-
You should likwise examine to know whether
the Placenta is expelled, if not you must not 
attempt the extraction, but leave it to Nature, and 
correct the putrid Discharge which may take 
from time to time by means of antiseptics, as 
Decoct. Hord. in R a,, Myrrh. Decoct. Cort. Inject.
Vis. Rubr. &c.- The Placenta is somtimes expelled
with pains, at others not.-



241
Miscarriages in the latter Months.
The Danger from miscarriage in the latter Months
of Pregnancy, is much greater than that of the 
early Months, on account of the Vessels of the parts
being so much larger.- The Degree of Danger is 
in proportion to the quantity of Blood discharged
and its effects upon the constitution.-
Separation of a Part or the whole of the Placenta
is the cause of this, and which be either from accidental
causes or from the Placenta being attached 
over the Mouth of the Womb, or very near to it.
You may endeavour to ascertain the cause
of this flooding and may do so with a considerable
degree of accuracy by attending to the different circumstances,
as whether it has come on in consequence
of any accidental cause, or whether it has occured without
any such thing, as when perfectly at rest, or
in Bed.- If it arises from separation taking place
owing to its attachment, it will in general come on
about the middle of the 5th,, or 6th,, Month, as the Neck
of the Womb at that time begins to stretch, and not 
much before.- It will likwise be repeated at times
without any evident cause as Neck of the Womb continues



31
242
to Dilate.- If the Discharge is either violent or 
so often repeated, as have considerable effect upon
the constitution, you should examine to ascertain
the state of the Parts, if the mouth of the Womb is any 
ways dilated so as to alow of the introduction of one 
or two fingers, you may then distinguish whether the 
placenta is situated over the mouth of the Womb or 
not, if it is the Placenta that presents, you will
feel a fleshy substance, but if not, you will feel
the Membranes protruding.-
In cases of this sort all the different means 
of stopping the Hemorrhage in the early months
must be had recourse to according to circumstances,
and if the discharge is either checked or stopped
great care should be taken to prevent a return.
If the discharges continue or are so often repeated
as to weaken the Patient very much, it then becomes
a question respecting the propriety of bringing on Delivery,
and which should not be deferred to long or the 
Woman may not have sufficient strength carry her
thro'.- Delivery may be brought on two ways
either by inviting natural Labour, or by the 
more active practice of turning, the violence
of the Hemorrhage, Disposition of Parts, and state 
of pain, will have very great influence in the 



243
determination of the mode most proper.- They 
way to invite natural Labour, is by passing up
the finger to the mouth of the Womb, introducing
one or two of them and making gentle pressure, and 
it the same time acting in a gentle manner as 
a Speculum, this way endeavouring to excite
the Womb to action.- You will somtimes feel
the Bag of Waters protrude, and when this is the 
case you should rupture them, which may be 
done with much propriety sooner than in natural
Labour when there is no hemorrhage, as you now 
want to reduce the size of the Womb, and doing 
this by evacuating the Waters has in some instances
been sufficient.- But in some cases there
is such a Degree of debility as to prevent the 
Womb from be able to expel its contents, in this 
case it becomes necessary to have recourse to 
more active means, that of passing up the hand 
and bringing down the Feet.- When the Hemorrhage
is more violent, as in case the Placenta
is attached over the mouth of the Womb, you must
not then wait for the bringing on natural Labour
but deliver as soon as possible without using violence 

After the Child is extracted, the Placenta must be 
immediately brought away, to slow the Womb to contract
speedily as possible.- 

244
pass up the hand and turn.- The center of the 
Placenta is not always immediately attached
over the Mouth of the Womb, somtimes only a small
portion, in this case the Danger is not so great, but 
when the middle of the Placenta is attached, it is 
then an extremely dangerous case, when this is 
the case you must not attempt to separate the 
Placenta from the Womb, for the Purpose of alowing
the introduction of the Hand, [illegible] that would be multiplying
the number of Bleeding Orifices; and under
the case of the Woman more dangerous but you
must pass your hand thro' the Substance of the 
Placenta to the Feet.- In these last cases the 
Child must necessarily be destroyed by the loss 
of Blood.- Manual assistance may somtimes
be necessary before the Uterus is of a sufficient size
to alow of the introduction of the Hand, as at the 3d,,
or 4th,, Month, in this case you may puncture the 
Bag of Waters by the use of the Stiletto or a Catheter, and
Labour will in general come on in the course of from
one to three or four Days.- It will be necessary to 
alay the irritability which will be produced, by
means of opiates occasionally, but there wont be 
than degree of irritability produced in the early as in 



245
latter periods of Pregnancy.-
Flooding after Delivery.- This is often the 
consequence of an inert condition of the Uterus, and
cannot in many cases be trusted to Nature with 
safety, if upon laying your hand upon the Abdomen
you dont find the Uterus contracted, you may in
many instances excite this gentle pressure upon
the Abdomen, or you may apply Clothes wetted in 
cold Water to the Abdomen.- The common mode of 
applying Clothes moistened in Vinegar and Water
to the external parts is injudicious and often does
injury by causing excoriation, and as the action
of this is not from any astringent property independant
of its coldness, cold water will answer way
purpose and that applied to the Abdomen, as near
the part affected.- It very violent cases it has 
been recommended to throw cold Water into the 
Cavity of the Uterus by means of a proper Syringe
in want of which a long Glyster pipe might answer
the purpose.- You may likwise endeavour to 
rouse the Womb to action by passing your finger
the the Os. Uteri and making pressure, or by passing
passing your hand into the Cavity and recovering it round
[cross out] 



246
[cross out]
[cross out]
[cross out]
[cross out]
[cross out]
Flooding does not always come on immediately
after Delivery, but in some cases occurs 3 or 4 Days
or even a Week or two after Delivery, if this is not owing
to some accidental cause, there is great reason to 
suppose the Uterus is in a Diseased state.-
In flooding after Delivery the usual remedies as 
in other cases must be had recourse to according 
to circumstances, as Infus. Rosa. Carcess. Acetat.
Alum in &c.- It is somtimes the case to give the 
Infusion of Roses, joined with Carcess Acetat, under
the Idea of their assisting each other, but this is not 
the case, as the render is each other less usefull by their 
combination.- A degree of faintness frequently
comes on, and which should not be obviated except
when in an alarming degree, as it is upon the whole
rather a favourable circumstance, alowing the Vessels
to form a Coagulaum &c.- If in a very alarming degree,
a small quantity of some Cordial may be 
given and repeated according to circumstances.-



247
The plugg or Tampons has been recommended
in these cases, but does not appear to be well adapted
as it may act as an Astringent to the Neck of the 
Womb causing it to contract, and alowing an internal
bleeding to go on.- The way it may be 
applied is by means of a piece of Spong, and which 
may be moistened in any astringent Liquid.-
Pain of the Head connected with Flooding.
This is the effect of [ina??ition] and usually continues
'till that state is removed, consequently any 
medicine for its Cure will be of little Service, but 
the best mode of attempting its removal is by 
giving nourishing food, and in small quantities
and frequently repeating it, according as the Stomach
will bear it.- Leeches to the Temples do have, tho'
a Blister may afford some relief.-
Excessive Restlessness. This is another consequence
of violent flooding, and is extremely Dangerous, 
some few have recovered when this has 
been only in a slight degree, tho' it is generally
a Symptom of approaching Death, it marks a very 
high Degree of Depletion.- In cases of great loss 



248
of Blood, transfusion might be of very great Service,
if not for prejudice, as the Blood should be 
Arterial, it cant be taken from the Human Subject, 
but might from a Sheep, by laying bare the
Carotid Artery, and introducing one end of a Tube
and the other into the Saphena Vein, and in 
this way a portion of Blood might be introduced.
In great loss of Blood upon other occasions
the practice might be serviceable.-
Fevers connected with Parturition.-
Any fever which is Dangerous when occuring at
other times is more particularly so now, those
attended with the least danger are intermittants,
tho' there are some few exceptions to this, as in case
there is a considerable degree of Stupefaction &c. showing 
a considerable determination to the Head, this
often proves fatal, at the 3d,, or 4th,, attack, in this
case, actives means must be employed and then
early.- The Distinct kind of small pox as 
having but little Fever, is not exceeding Dangerous,
tho' the confluent is attended with considerable 
Danger.- In all Fevers the danger is agravated
by parturition, for if the Fever is of the low Typhus 



32
249
kind, the loss of Blood would do injury, and there
is generally a considerable Discharge attending Delivery.-
If the Fever is of the inflamatory kind
the violent exertions increase the inflamatory
affection.-
Delivery is not consequently rendered more
difficult by the presence of Fever, some think it 
either rather more easy.-
When there is Delirium, the progress of the Labour
should be diligently attended to, for when there 
has been Delirium, the Child has been expelled, without
the knowledge of the Bystanders, therefore particular
attention should be paid.- After Delivery
has been effected during the presence of Delirium, this 
will frequently subside, and the patient appear
better, but in many cases this is only transient,
and the patient very soon begins to sink, and 
Death follows. Speedily
The general treatment of Fevers will be the 
same as under other circumstances.-
Convulsions. These are particularly
Dangerous during Pregnancy.- They exist under
to different forms, Acute and Chronic.- Convulsions
must be distinguished from Hysteria.- The cause 



250
Convulsions has been referred to two opposite
conditions of the Body, namely Plethora and Inanition,
but there dont appear sufficient without a
certain degree of irritation.-
When Plethora is the cause Bleeding &c. will be of 
Service, if the Plethora is general, but it somtimes is
local, consisting in a determination to some particular
part as the Head, in this case the application
of Leeches, Cupping &c. will be of Service, and this
by way of preventative, a perature is an indication
of their approach by Vertigo, &c.
If the cause is from inanition, it is then 
much more dangerous, as this is much more difficult
to remedy, it must be attempted by means
the most nourishing kinds of food given in small
quantities or as the Stomach will bare it, and frequently
repeated.-
If Convulsions arise from irritation, the 
cause of that should be removed if possible, but the 
seat of that irritation must be first attended to, if 
the seat of irritation is in the Primæ Viæ, the 
exhibition of an Emetic, and afterwards clearing the 
Bowels, by a gentle Purgative or a Glyster may be of 
Service, afterwards giving Tinct Opii. Assa Fœtid.
or different kinds of Antispasmodics may be of Service



251
or Some of them as Opinion or Assa Fœtida may be 
given in the form of Enema.- The warm bath may
occasionally be of Service, and as this takes some time
in preparing it will be always right to have this 
in readiness early.- If the seat of the irritation is 
in any other part that must be attended to, if from 
Distention of the Bladder, the Water must be drawn off.
If the Uterus is the seat of irritation, it may in
right in some cases to bring on delivery, as in 
case this is much danger apprehended to the Life 
the Mother, from former Labours &c.- If on examination,
you find the Os. Uteri relaxed, and a Disposition
to Labour, this may be improved, but should
be done by the gentlest means possible, for there is 
frequently great injury done by using to much
force.- Even if there is no Disposition to 
Labour if you have ascertained the necessity or propriety
of bringing on premature Labour, making 
gentle and persevering attempts will generally succeed,
at the same time assisting the relaxation of 
Parts by different means as warm glysters throw 
into the Rectum.- Advantage will be gained by 
the early Rupture of the membranes.- During the 
convulsions it will be right to interpose some substance
between the Teeth to prevent the Tongue being injured.



251
Convulsions during pregnancy are very
frequently fatal, the Danger is in proportion
to their frequency of recurrence and Degree of 
Violence.-
When Convulsions are so violent & frequent 
as not to alow of any lucid interval, there is great
reason to suppose a Determination to the Brain
to be present, in this case you should endeavour
to make a Derivation, by purging &c. only opening
the Jugular Vein.-
Extra Uterine Cases.
These do not terminate by the common Passages
as other kinds do, but somtimes from an Abscess being 
formed in the Abdomen from which a Putrid Fœtus or its 
Bones are discharged; eithr by Nature or Art at other times these Bones escape
by the Rectum, from this being ulcerated Through.
Extra Uterine cases are of three kinds, namely
in the Fallopian Tubes, Ovariae, and Ventral case.
The way the Ovarian is formed, is by the Stimulus
of impregnation being given to one of the Vesicles of 
De Graaf, but which does not escape from the Ovarium
but goes on evolving itself.- When the Vesicle of impregnation



253
impregnation escapes from the Ovarium, but instead of 
being embraced by the fimbriated extremity of the Fallopian
Tube escapes into the Cavity of the Abdomen, it attaches
itself to any part it comes in contact with, the Vessels
of the Maternal part of the Placenta, in osculate with
the Vessels of that part, and evolution goes on.- 
When the Fallopian tube is the seat, it arises from 
the ovum being detained in that part, and evolution
takes place as before.
Mun 4th, kind
Evolution goes on in their cases 'till about the 
usual period at which time pain and the usual
Symptoms of Labour come on, but this does not advance,
these recur at times, but after some time, they 
entirely cease, the enlargement still continuing.
When the Child is contained in the Uterus, when the 
Symptoms of Labour come on at the usual Period
of the Child on any account cant be expelled, or attached &c such
Symptoms come on as inevitably end in the Death
of the Woman, therefore whenever even the Symptoms of 
Labour come on, and then after a time subside, and 
go off entirely, it must then be an extra Uterine case.
Somtimes during Labour, the Child will escape
thro' the Uterus or Vagina into the Cavity of the Abdomen,
a case of this sort occured, and when the Child afterwards



254
afterwards remained afterwards for upwards of 40 Years,
on examination after Death the Child was found in 
an Ossified State.- If a case of this sort was to occur
it would be right to pass up the hand after the Child, and 
endeavour to bring the Child away by the Feet, tho' the 
Woman most probably would Die.-
A Woman may live with an extra Uterine Case
for Years, and it afterwards be discharged either by the
ways before mentioned, or by an Operation which consists
in cutting into the Cavity containing the Child, and 
extracting it, afterwards closing the Wound by Sutures.
The Child does not continue to increase in size
after the 9th,, Month, at which time it becomes Dead.-
In cases of this sort you should never attempt to 
extract the Child by an incision 'till Nature appears
to point that way, by the formation of an Abscess as then
the Cavity is circumscribed, and Air is not admitted
into the Cavity of the Abdomen.- This Operation has 
been called the Cesarian Operation but improperly-  



255
Cesarian Operation.
The true Cesarian Operation always supposes one 
incission made into the Uterus, and may in some cases
be necessary both in the living and Dead Subject.
When the Woman is dead, if the Operation is 
performed it should be done immediatly, or the Child
will likwise be dead.- It is useless to perform the 
Operation in this case before the 7th,, Month of Pregnancy.-
In some cases where the Woman has died
suddenly undelivered, the hand has been passed up the Vagina
and the Child extracted by the Feet, if this is done it 
should likwise be done immediatly.-
In the living subject the Chances of compleat
success are very few, and therefore it should never be 
proposed, where delivery by the Natural Passages is possible.-
Different causes have been assigned for the frequent
failures of this Operation, as the admission
of Air &c. this cant be the case, as air is not found
to produce so much injury, when admitted into any
Cavity as has formerly been supposed.- As Death
in general take place in the course of 24 hours, it as



256
to be owing either to loss of Blood or to the Shock which
is given to the System and from extravasation into the 
Cavity of the Abdomen &c. 
Different Parts have been recommended for the 
incission, as towards one side, but the Epigastric 
Artery would be divided.- The best part for the incission
is in the course of the Linea Alba.
The incission should be begun at or rather above the Navel, and 
extended downwards 6 In. the external incission may 
be rather more, but that thro' the Uterus should be 
only 6 In. in length.- It is rather unfortunate when 
the Placenta is attached to the anterior part, of the 
Uterus, if there is a considerable portion attached
it may be better to make the incission directly thro'
it, but if only a small portion, it may be adviseable
to separate it.- When the Uterus is laid bare
you may possibly find somthing which may indicate
the attachment of the Placenta when before in 
this case making the incission rather to one side 
may be adviseable.-
The Bladder should be emptied before the incission
is made.- When the incission is made the hand 
must be passed, and the Feet takes hold off.- There 
will somtimes be difficulty in extracting the Shoulders.



33
257
the Head must be placed in the most favourable Position
and Head, on this account no time should be 
alowed for the Uterus to contract.- After the 
Child is extracted, the Hand must be again introduced,
for the extraction of the Placenta.-
The external Wound should be then closed by means
of the Quilled Suture, but the Ligatures should by no 
means be passed either thro' the Uterus or Peritoneum.-
A Very slight Bandage must be used.-
After the Operation an Opiate must be given, and 
which should be repeated from time to time, joined
with other remedies to allay the irritation, and occasionally
Laxatives, Glysters, fomentations &c.-
Section of the Symphisis Pubis.
This has been proposed as a Substitute for the 
Cesarian Operation but is only an imperfect one 
and is now fallen into neglect. 
In case any advantage was gained in respect 
to Room, the soft parts were so much injured,
as to almost certainly destroy the Patient.



258
Treatment of Women after Delivery.
When the Woman is delivered, that is when the Child
and Placenta are expelled, all moisture should be 
removed by means of Cloths, and a Cloth wrung
out of Warm Water applied to the Perineum, and 
another under the Breech.- The woman should
lay some little time perhaps 1/2 an hour, but this 
must depend upon circumstances, if there is flooding
she must remain a greater length of time, before
she is put to Bed.-
It is right to examine the different portions
of Placenta, is this has come away in detached
portions, comparing the to Satisfy the Nurse and 
attendants.- It has been usual to pass a Bandage 
round the Abdomen, but this should only be 
a Simple Napkin.-
The Room &c. should be kept moderately cool
not so hot as was formerly done.-
The Diet should be Simple, nothing either in 
form of food or Drink that is Strong should be alowed
for the first few Days.-
If either from any irregularity or from other 
causes, any unpleasant Symptoms come on 
purging will generally be found preferable to 



259
Bleeding. Always determine the necessity of the Bleeding
befor you attempt to do it.- The Bowels should
always be kept moderatly open by means of some 
gentle Laxative.- Opium will occasionally be 
Serviceable to alay irritability, but will generally require
either to be joined with Aperients, or those to be 
occasionally given.-
After Pains.
These arise from the contraction of the Womb, and 
continue to take place 'till that is compleatly
affected.. After pains should distinguished from 
Pains arising from other causes, as from internal
inflamations of Different parts, namely Enteritis, Inflamation
of the Uterus, Puerperal Fever &c. and this 
may done by attending to the Different Symptoms
after Pains, recur at intervals, [cross out] the Pain arising
from inflamation is constant, and the Pulse are affected.
In Pain from costiveness the Pulse may not be affected
yet the pain is more constant.-
Women who have had several Children have the 
after pains more violent.- The usually continue about
2 or 3 Days.- The treatment is generally by Opium 



260
but which is better joined with Aperients, more particularly
if there is costiveness.-
Symptoms of flatulent Cholic sometimes
attend, in this case Carminatives and Aperients
or Carminative Glysters may be Serviceable, and 
afterwards Opium
Lochia.
This is a Discharge which takes place from the 
Uterus after Delivery, and arises from the Vessels
of the Uterus which communicated with the Maternal
part of the Placenta.-
The Qauantity and duration of this Discharge
is very variable, in general it continues about 10
or 12 Days, but you must judge whether the Discharge
is too excessive or continues too long by its affect upon 
the constitution.- If the quantity is such as to produce
some unpleasant affect upon the Constitution
you must must then endeavour to check it either by
astringents, or if it arise from any other cause as 
Cough, that cause must be attended to, and the 
treatment must be the same as in flooding after
Delivery.- In some cases flooding will come on 



261
several Days after Delivery, when this is the case there
is great reason to suppose a Diseased State of the Uterus
to be the Cause.-
Women are Somtimes alarmed if the Lochia, become
suddenly suppressed, but if this does not arise
from any particular cause, as inflamation &c. [??ed]
is not followed by unpleasant Symptoms, it is of 
no consequence, but if it is caused by or is accompanied
with Symptoms of inflamation, those must be 
attended to.- Before you proceed to take away Blood
it will be generally right to give a Purge, and that 
alone will often be sufficient.- 
Somtimes the Lochia will only be suppressed
for a short time by a Clotter of Blood stopping up the 
mouth of the Womb, the Uterus be be excited to act for the 
expulsion of this, and the Lochia will then again flow.
In some cases of Stoppage of the Lochia, a discharge
of another kind will take place, which supplies its place.
The Discharge is at first composed of Blood, but it 
gradually changes, and after sometime only tinges the
Linen of a Pale Red, and afterwards of a Greenish Colour
and it then very soon ceases altogether  



262
Inflammation of the Uterus
The Symptoms of this are pain below the Navel
taking place the second or third Day after Delivery
and which has no intermissions.- If Pressure is 
applied, it gives considerable pain, and there is a 
considerable Degree of Fever and this of the Acute kind
attended with a Suppression of the Lochia.-
It may arise either from violent Labour or 
improper management, perhaps in the use of Instruments.-
A gradual Diminution of Pain, and return
of the Lochia, are favourable Signs
The Treatment in this complaint must be of 
the active kind kind and early employed, or Death
will take place.-
Bloodletting must be had recourse to early
and occasionally repeated according to the Constitution
of the Patient, not alowing to long intervals between
each evacuation, also Leeches may be applied to 
the Abdomen, and a Blister will somtimes be adviseable,
also fomentations &c. The Bowels must be 
kept freely open, and the Patient kept upon the strict
antiphlogistic Plan.- Before you proceed to this 



263
active mode of Treatment, you must be certain of 
this being the Disease, and that it is not from irritation.-
If you have any Doubt it may be better to 
give a Purge, and take away a small Quantity of Blood,
and from this you may be enabled to form a judgment
with more certainty.-
Puerperal Fever.
This term, if literally employed, might comprehend
any fever happening in the Puerperal State,
but is is used to denote one particular form of fever
which only occurs at that time.
This Fever is attended attended with, Pain in
the Head, and intense Pain in the Abdomen, and is 
contagious.-
The Abdominal pain should be distinguished
from arising from other complaints, as Distention
of the Bladder, Cholic, After Pains, Enteritis, Inflamed 
Uterus &c.-
You may know whether the pain arise from 
distention of the Bladder by the introduction of the 
Catheter or by other circumstances, and likwise from
Cholic by attending to circumstances.- After pains  



264
intermit at times, which is not the case with pain
in Puerperal Fever, tho' it suffers slight remissions.
After pains may be accompanied by accidental 
Fever.-
In Enteritis there always considerable Difficulty
in procuring Stools which is not the case, in Puerperal
Fever, as there is often a Degree of Purging.
It is more Difficult to distinguish between this complaint
and Inflamation of the Uterus, but by attending
to all the circumstances you may generally distinguish
between the two, in the Puerperal Fever
the Lochia are not suppressed, which is the case 
in inflamation of the Uterus.- The mode of attack
in the two complaints is different.- The Pain is often
in a different part, as in Puerperal Fever the Pain
may be in any situation which is not the cas in 
Inflamation of the Uterus.-
From many facts it is proved that this Disease
is contagious, and sometimes very actively so, no 
Women except those in Puerperal State, are liable
to be affected by it.-
The attack is by a Rigor followed by a Degree
of feverish heat, and pain in the Abdomen.
The Disease is not always equally contagious
often depends upon the mode of Life, Situation &c.



34
265
In many instances when a Practitioner has 
been attending a Patient Labouring under Puerperal
Fever, and is immediatly called to a Woman in Labour,
the complaint has been communicated.-
The commencement of this Disease from the 
time of Labour is various, generally on the second
or third Day, sometimes as late as the fifth, and
has been observed much later, even a late as a Month.
The attack is by a Rigor attended with Pain
in the Abdomen, the Rigor after some time goes off 
and is succeeded by pain in the Head and feverish
Heat.- 
The Duration is very indefinite, it has terminated
fatally in 36 hours after the attack, and 
as late as the 9th,, or 10th,, Day, in generall if it continues
'till the 6th,, or 7th,, Day the Patients recover.
The Peritoneum is the seat of inflamation, and 
has been found in all the Different Stages, as that 
of adhesion, in one part in others, effusion, and Suppuration,
and the seat of the Pain will be various
according to the seat and stage of the inflamation.
Different Writers have described the Pain to be in
different situation, they may have all been right, as 



266
the situation will vary according to the situation
and stage of the inflamation.
Prognosis.- This is always unfavorable, but
not at all times equally so.- A Very quick Pulse
with much tension of the Abdomen indicate extreme
Danger.- What in other fevers would be considered
a quick Pulse is in this rather slow, as 120
in this Disease the Pulse are of often 140 or 160, or even
so quick as not to be numbered distinctly.-
In this complaint the Pulse assist more in 
forming a judgment than in most others, if the 
Pain abates it is not of much consequence except
there is an alteration of the Pulse likewise. A sudden
cessation of Pain that has before been violent, unless
attended with a favourable Pulse, should be regarded
with Distrust.- It is a favourable sign when
quickness of Pulse and degree of Pain, gradually abate.-
Delirium very seldom attends this complaint
tho' there is such great quickness of the Pulse, the 
mind being generally tranquil.
Treatment. Different and opposite modes of 
Treatment have been recommended in this som 



269
complaint, some strongly recommending Bleeding
others condemning it.- In cases where active Inflamation
exists, with a degree of strength in the constitution,
Bloodletting is proper and should be taken in
rather a large quantity and in the early Stage, but 
if there is a Degree of weakness and the complaint is
more advanced, it will then be injurious, but this 
must entirely depend on the nature and Stage of the 
Complaint and the Patients constitution.-
Dr. Gordon of Edenburgh says that in all cases
when the Patient was bled to the quantity of 20 oz.
early, they recovered, and another respectable Practitioner
says that in all cases when bleeding was 
employed the Patients Died.- It will be right to 
take away a small quantity and this will assist
in determining the Propriety of Bleeding more freely.-
Local bleedings either by Leeches or cupping
may be had recourse to with advantage, but 
as the inflamation is only a consequence not
a cause of the Fever, it must be attended to only 
secondarily.-
Vomiting is strongly recommed by the French
Practitioners, and certainly always affords relief, it 



268
always be employed early, and is best given in
repeated Doses so as to produce the full effect,
Ipecacuanha answers the Purpose best.-
Somtimes a spontaneous vomiting of a Dark
grumous Matter comes on, when this is the case
the Patients generally Die.-
Purging has been strongly recommended
and may frequently be given with advantage
the purging should be kept up by giving the 
Medicine in repeated Doses so as to procure
5 or 6 Stools Daily, a good purge a a Solution of 
Natron. Vitriol. in Aq. Mentha. A good Rule
for the exhibition of Purges may be to give so 
long as the Patient is relived and not weakened.
Somtimes a Spontaneous Diarrhea comes 
on which relieves very much, on which account
you should never be in parts to check any thing
of that sort which takes place, except it weakens
the Patient, then you may moderate or Check it.
Blisters to the Abdomen may be of Service
and should not be to small, and should be 
applied early.-
If the disease changes from the inflamatory
kind, and puts on Symptoms of Typhus, the 



269
mode of treatment must be changed, Medicines
of the Cordial Diaphoretic kind may be had recourse
to as Camphor &c. or Wine, and Bark, somtimes
rather freely, in the advanced Stages of the complaint.
Attention must likwise be paid to the 
Palliation of Urgent Symptoms, as Pain, by
Fomentations, Anodyne Liniments, Rubefacients
&c. a Liniment composed of Ol. Olivar. ℥i Camphor.
ʒij R a,, Opii ʒij M. will often relieve.- The Warm
Bath is not adviseable on account of its disturbing 
the Patient so much.-
Sickness and Vomiting may be relieved by 
Opium, or the Saline Draughts in the State of 
effervescence 
Milk Fever.
This comes on about the second or third Day 
after Delivery, with Rigors and other Febrile Symptoms,
attended with a Painfull Sensation of the 
Breasts, all which are abated by a Discharge of the 
Milk, hence the remedy is Obvious, and the Child
should be put to the Breast, as the first Discharge of 
Milk is proper and Serviceable to the Child.-  



270
If during the cold Stage any thing hot or Stimulating
is given, a considerable Degree of Fever will
be excited, and will render the exhibition of Purge
necessary.-
Many Women dont wish to give the Child the 
Breast but want this Milk repelling, this is sometimes
effected with care and safety, at other times
not. When this is wanted to be effected, you shd,,
act moderately upon the Bowels, procuring 4 or 5
Stools daily, and ordering a low Diet, and the application
of some simple Plaster to the Breast.-
It will sometimes be necessary to take small
quantities of Milk away by means of proper
Glasses &c. or the Thinner parts being absorbed, will
leave a portion inspissated, this causing irritation
will bring on a Milk Abcess.- When Inflamation
takes place a few Leeches may be applied &
the Saturnine washes.-
Somtimes inflamation will put a stop
to the Secretion of Milk.-
When by the application of Leeches, Saturnine application,
Purging &c. you cant subdue the inflamation,



271
inflamation, you must have recourse to poultices, to 
forward Suppuration, and evacuate the Matter
by means of an Opening when formed.-
This Disease very seldom terminates in Cancer.-
Soreness of the Nipples. This is relieved or 
cured by washing them with Brandy or a Weak
Solution of Alum.- wearing Leads &c-
Swelling of the lower Limbs
This is an œdamatous swelling of the lower Limbs
which comes on after Delivery, which begins at the 
Groins and extends downwards to the Feet.
The complaint may attack either one or both
sides.
The time of its commencement from delivery 
is variable, may come on in the course of a Week, or 
two, and has been as late as 6 or even 9 Weeks.-
The Limb in the beginning is œdamatous, but 
after the Disease has remained some time it looses
its softness, and becomes considerably more hard.
The cause of this Disease is inflamation and 



272
obstruction of the Lymphatic Glands about the Groin
and Poupart's Ligament, probably owing to some portions
of Blood remaining in the Uterus, which becoming
Acrid, Stimulate the absorbents, causing irritation, and 
inflamation of the Glands situated about the Groin.
The Disease has been distinguished into mild
and violent according to the Symptoms.-
The Hardness which takes place after a time
is owing to a quantity of coagulable Lymph, which 
is thrown out becoming inspissated.-
Success in the treatment of this Complaint, depends
on the early resolution of the inflamation, rendering
them pervious to the Passage of the Lymph
and afterwards to invigorate them by means of 
Tonics and Stimulants.
In the early Stage Leeches applied to the Part
and other means of reducing the inflamation
may be applied.- Purges may be frequently administered
with advantage.- Emetics likwise from 
the goods effects in other cases of a Similar Nature,
as Hernia Humoralis, may be employed with advantage, 
and should be given in full Doses.-
When the Disease is more advanced and a Degree
of Hardness has taken place, you must then have recourse
to a different mode of treatment. Ungt Hydroy.



35
273
Fort. rubbed in upon the lower extremities will be of 
service, and this may be done with great freedom
without producing any effect on the constitution, on account
of the impervious state of the Vessels.- If the
Mercury does affect the Mouth it is upon the whole a 
favourable sign, shewing that the Vessels are not entirely 
obstructed.- In this stage of the complaint, Pulv.
Ipecac. Comp. may sometimes be given with advantage.-
This Disease very seldom terminates in Suppuration
tho' it does somtimes, this should be prevented if 
possible, for if an Abcess bursts, it is extremely difficult
to Heal, and there are many abcesses generally form, and
this repeatedly for a length of time.-
Laceration of the Perineum.
This is much less disposed to Heal than an incised
Wound in the Same part, yet the attempt should
be made.- You must keep the parts in contact as 
much as possible, by passing a Roller round the 
Thighs, as neither Sutures not adhesions can be 
made use of with propriety, or advantage.
Some gentle stimulant application may be made 



274
use of to promote the growth of Granulations, as
Tinct. Myrrh. Simpl. &c.
When the laceration extends to the Rectum
the loss of power to retain the Feces is the consequence.-
In case the Head of the Child is so large as to 
render it very probable that the Perineum may 
be lacerated, it may be a Question whether making 
a slight incision would not be more adviseable
than alowing the parts to be lacerated.-
Excoriation of the Labia.
When the Labour has been Difficult, and the Head
has rested a considerable time upon the external
parts, they are frequently Excoriated, and sometimes
Ulcerate, and if the constitution is irritable will put
on a flabby unhealthy aspect, and have frequently
been mistaken for Venereal, on this account you
should always take particular care to Distinguish
between the two, for if you employ Mercury in a case 
of this kind, you will do very great injury.-
The mode of treatment must by by any means
that will alay irritation locally an constitutionally, as
fomentations of Poppy heads, Opium, Cicuta &c. or occasionally 



275
occasionally Bark and Wine, sometimes very freely.
When Simply an excoriation, a little simple Ointment,
or Saturnine wash may be employed.-
Diseases of Children.
The Diseases mentioned are to be confined to those
which prevail in early infancy.- Some of these
are Surgical cases, and others belong to the Physician.
Some of the Surgical Cases, arises from the 
Birth, others existed while in Utero, and others appear
after Birth.- 
Of the first kind are the different effects of Pressure
on the Scalp, producing Inflamation, Abcess & Gangrene,
the are to be treated according to the common Rules
of Surgery.-
When the Shape of the Head has been altered, forming
what are called a mole shot, or Horseshoe head,
it has been recommended to press on the head in 
the opposite direction, but this very wrong and shd,,
never be done.-
Others have recommended apply a cupping
Glass over the part, or a Piece of Adhesive Plaster, or 



276
or wet Leather, with a String to the Center, to alow
of extension being made, this may sometimes be 
Serviceable.-
Paralysis of the Arm somtimes takes place from
pressure made on the Axillary Plexus of Nerves, more 
particularly if the Blunt Hook has been used, the
way to avoid this is make the Pressure on the back
Part of the Arm.- What [illegible] produced? [illegible] slight Galvanic [illegible]
Fractures sometimes take place during birth
more particularly of the Humerus or Femur, in 
Breech, or Feet presentations, these must be treated
like other fractures.-
It will be adviseable to examine the Child, immediately 
after birth, or the Nurse may break any
Bone &c. and say it occurred during Labour.-
Fractures are most liable to occur when the 
Blunt Hook is used.- 



277
Diseases existing before Birth.
Swellings of the Head containing a Fluid. These
are often seated on the Parietal Bones, and contain
a Gainy fluid.- These Tumors must be Distinguished
from Hernia Cerebri.-
Some have supposed these Tumors to arise
from some injury received during birth
but this is not the case.- The Bone is not 
necessarily affected, tho' is somtimes, but appears
to be in a secondary way, from pressure.
These Tumors will in general be cured by the 
use of Astringent Embrocations, as a strong Solution
of Alum.- If the Tumor does not give
way to this, it may be adviseable to evacuate
the fluid by a Small opening, to prevent the 
affects of Pressure upon the Bone.-
Cohesion of the Genitals. If this is of the 
Labia Pudenda you should examine to ascertain
whether the internal parts are perfect, and 
the external parts only adhering, if this is the 



278
case you may divide the Parts by means of the 
Knife, afterwards dressing the Parts to prevent
them again adhereing.- If you have any doubt
you had better wait 'till the Age of Puberty, and
these Symptoms may occur which may direct
your Judgement, for if it is only the Hymen being
imperforated the Menses will be found collected
behind it.- 
Cohesion of the Eye-Lids. If these are in 
other respects well formed, this adhesion may
be divided by means or a Small Bistory, or a 
Direction, avoiding wounding the Puncta Lachrymalia
&c.
Tongue Tied. This should always be remedied
early, or the Tongue will grow in the curved
position, and prevent the Childs speaking.-
This is remedied by dividing the Frenum by
means of a proper pair of Scissors, taking care
to avoid the Sublingual Vessels, and Ducts of the 
Maxillary Glands. Women often suppose the Child 



279
is Tonge tied when it is not, and it may be better
to draw Blood to satisfy these.- The Child is not 
Tongue tied if it can elevate the tip to the Roof of
the Mouth, or put it over the lower Lip.-
Hair Lip. The proper time for curing this
is only to be considered here, namely whether before 
putting the Child to the Breast or after it is weaned.
If there is a fissure in the Palate and the Child
is not able to suck it will be adviseable to perform
it early, that is before it takes the breast at all, but
in a general way it will be better to defer it 'till the 
Child is weaned.-
Umbilical Hernia. Children are often born
with small protrusion at or near the Umbilicus,
and sometimes with larger ones if there are small
a cure may generally affected by a constant and 
regular pressure made upon the part either by 
adhesive Plaster, and sheet Lead, or by means of 
a well constructed Truss.- No Circular Bandage
can be used with advantage, as it would
tend to increase the Tumor by its pressure on 
the sides of the Abdomen.- When these Tumors are 



280
larger they generally prove fatal, as there is likewise
a Defect of the Parietes of the Abdomen.- 
Spina bifida. It receives this name
from the spine in the part when the Tumor is 
situated being split into two portions.
This Disease may be distinguished by passing 
the Finger along the Spine, if it is Spina Bifida,
you will perceive the Defect in the Bone.-
It is most commonly seated in the Loins.
The appearance is sometimes a small Tumor
at others, the Skin is flat and shrivelled, this is 
owing to the Tumor being burst During births
when this is the case Children are generally born Dead.
This Disease is somtimes combined with Hydrocephalus.-
This Disease is formed by a 
quantity of Water distending the Membranous, covering
of the Spinal Marrow.-
The sensation of the lower Limbs is generally
impaired.- The Tumor should be kept from 
bursting as long as possible, for when this takes
place Death in general soon follows, this maybe
attempted by astringents and Bandage.- 



36
281
Malformation of the Urinary Passages.
These are of different kinds. When the Pressure 
is imporated, a small portion of the end 
may be taken of by a Scalpel.- When is elongated
or constricted a small part may be taken off
or it may be slit up the same as in the 
Operation for Phymosis.
When the Glands Penis are imperforated,
different modes of treatment may be necessary
according as there is a preternatural opening
or not, but the success off any operation is very
uncertain.- If there is not any opening it will
be extremely Difficult to affect one by art, and 
if there is a preternatural one, endeavouring 
to make one in the proper part will be extremely
Difficult or impossible, for tho' an opening
might be made, yet it will almost to a certainly
close again, as as Membranous Living cant be given.
Sometimes there will be a retention of Urine
without any malformation, in this cas a bent
Probe or small Catheter will be useful, if a Male 



282
or if a female, washing the Parts with a Spong
and Warm Water, to cleanse away any sebaceous
matter, may be of use.-
Imperforate Anus. When this is the case 
the Child will not have the usual Discharges, and 
on examination, (if the imperforation is only at the 
Anus) the Meconium, may be felt fluctuating
behind the part, in this case a puncture may
be made or a small crucial incission, keeping 
the parts from again adhereing.-
If the Stricture is situated higher up, relief
is less certain, and that in proportion as the seat
is higher.- Somtimes the Anus terminates
in the Bladder or Vagina, if in the Bladder Death
may soon takes place, but if in the Vagina, the
Patient may live, but will be in a Distressing
state, and not remediable.-
Lues Venera. This Symptoms of this complaint
are in general less evident in this state than
in the adult, as there is not that regular pain



283
of Symptoms.- When these are dubious Symptoms,
which dont yield to the common modes of 
treatment, it will be right to give Mercury a
trial.
The best way of giving Mercury to Children is 
by giving a grain of Calomel every night or again
of Quicksilver rubbed down with any common Substance,
or what may perhaps be still better, giving
a little Calomel, which has been washed with Aq:
Calcis to divert it of its Acid.-
It may not in all cases be prudent to betray
suspicion.
Different opinions have been formed respecting
the way in which a Child can receive the 
Disease from the Mother, one Opinion is that 
there must be actual contact of Matter, and that 
this takes place during its passage thro' the Vagina.
John Hunter is of this Opinion, but there are 
facts which tend to prove than this is not absolutly
necessary, but that sucking the Breast of 
a Diseased Woman is sufficient.-
Swallowing the Tongue. This is owing to the 
Frenum being to short, alowing the end to be turned



284
back towards the Throat, and bringing on evident
coughing, with a sense of Suffocation.- This is 
relieved by bring the Tongue forwards by means
of the Finger or the Handle of a Teaspoon. 
Elongation of the Uvula. This often brings on 
similar Symptoms, and is owing to a relaxed State.
Anstringent washes, composed of a Solution of Alum
or a powder with a portion of Alum will be of Service.
Purulent Eye. This complaint is most common
among indigent people, and those who are 
filthy.- The first Symptom are a degree of fullness
and redness of the Eyelids, which takes place a
few Days after birth, soon after this the Eyelids adhere
together, and on separating them, a quantity
of Purulent Matter will be discharged, if the Disease
is alowed to go on, the Eyelids become tumid, and 
inverted so that they cant be closed, opacity of the 
Cornea follows, and incurable blindness.-
This is owing to a larger quantity of fluids
being determined to the Conjunctiva, from their
being in a relaxed state.-
In the begining astringents in the form of Lotion.



285
or Tinct. Opii. will be of Service, a Solution of Alum
or vitriolated Zinc. in the proportion of 4 or 5 Grains to an
Ounce will answer very well, this should be applied
as is very common to the side of the Face, but should
be dropped between the Eyelids.- When there is much
Tumefaction it may be necessary to divide some of 
the Vessels to take off the Distention.-
When there opacity of the Cornea a Solution
of Hydrary. Muriat in the proportion of gr. ss and gr. in,,
to ℥j.
Purulent Discharge from the Ears.
This somtimes arises from behind the Ears, and
at others from the Meatus Auditorius.-
When from behind the Ear, the discharge may 
be stopped by Astringent washes or Calomel Ointment.
When the Discharge proceeds from [cross out] within the
Ear, it probably originates from behind the Typanum,
and as a portion of this with probably some of the 
Bones will be destroyed, it may be of very great
consequence.- The cure may be attempted by
means of Astringent injections.-



286
Diseases of Infants requiring Medical Treatment
Much uncertainty often attends this part of Medical
Practice, from the uncertain of Diagnosis, on account
of Children not being able to express themselves except 
by the signs of Nature.-
The state of the Pulse in Children is but an uncertain
Criterion of Disease.- In Infancy the Pulse
are in the natural state, about 120 or rather more 
and this corresponding with 72 in the Adult, but to
she any remarkable degree of increase of quickness
they must be 200, or much more, and which can not 
be counted.-
The Degree of fever in Children, is much better ascertained
by the Degree of heat, Thirst and frequency
of respiration.-
Children are much more irritable than Adults
this in consequence of the Brain and Nerves, bearing
so much greater proportion to the rest of the Body
than in the Adult.-
Diseases of early infancy depend principally
upon these causes, namely irritability, Acid Acrimony
in the Primæ Viæ, and over feeding.



287
Irritability, as depending in part upon the 
cause before mentioned, cannot be compleatly removed,
but it may frequently be much moderated,
by removing any irritating cause, or by the 
action of certain remedies, as antispasmodics &c.
according to circumstances.-
Acidity in the Primæ Viæ, this existence of this 
is evident from many Symptoms, as from the smell
&c. and indicates the use of Antacids, in giving these
it may not be necessary to entirely subdue the Acidity
but only to moderate it.- As alway will coagulate
Over feeding is a very common cause of Disease
in Children and often takes place of the Child being
fed to quieten it, when it is uneasy from other causes,
in this case Nature will frequently relieve herself
by Vomiting. The Cure is obvious.-
Red Gum, this is a Disease of very little consequence,
except to distinguish it from Measles,
which the eruption somewhat resembles, only is not 
attended with the usual Symptoms, as Cough, Fever
&c. the eruption making its appearance without
any previous Symptoms.-



288
Apthæ, may be suspected, when pain is expressed
during sucking, and there is soreness of the Nipples,
it is easily determined on examination, by white Specks
on the Tongue, Fauces &c.
This Disease is distinguished into mild and 
Malignant, these are distinguished by the Colour
of the Specks. &c. if they are of a White colour and unattended
with Fever, this kind is curable by local
applications, as honey Borax &c. tho' it may be 
sometimes necessary to give a Purge, or some 
Cretaceous Medicine with R [illegible],, Opii in small
Doses.-
When the Pustules are of a Brown dusky colour,
attended with fever, irritation and a considerable
degree of Debility, besides cleansing the Mouth,
attention must be paid to the Fever.- The 
Primæ Viæ must be cleaned by Emetics or Purgatives, 
and afterwards, Bark, Wine and Opium
may be had recourse to.- The Bark may be 
rendered more pleasant by the addition of a bitter
Liquorice, to the Decoction, and it should be given Warm.



289
Convulsions may be distinguished into the Acute
and Chronic.- In the acute form of the Disease
the Child often dies on the first attack, therefore active
treatment becomes necessary.-
Children are very much disposed to Convulsions
from their excessive irritability, consequently
all irritating causes should be avoided or removed.
The irritating causes may be either seated
in the Primæ Viæ or in the constitution at 
large.- When the Stomach is the seat Vomiting
or Purging may frequently effect the removal
and it may somtimes be necessary to excite the
action of Vomiting sooner than can be done by
Medicine, that is by irritating the Fauces.-
Stools may be procured by Suppositories as
a Piece of Soap in a Conical Shape &c.-
General irritation will cause convulsions
as is the case in fever, Small Pox &c. you must
then endeavour to alay it by different means, as 
the Warm Bath, Opium, Musk, Assafœtida, or 
by Glysters of some of the Articles before mentioned 



290
in which you may in general give about 3 times
the quantity you would give by the Mouth.
Sometimes the milk disagrees with the Stomach
when this is the case it is evident what must be 
done.-
Convulsions succeeding an Acute Disease in 
the advanced State, are generally fatal.-
In the Chronic form of the Disease, several
of the remedies before mentioned may be had recourse
to, and external applications as Volatile
Liniments may be used. These frequently end in
Idiotism.-
Icterus. Children are after born with this Disease
but which in general disappear in a few Days by 
the Discharge of the Meconium.- Somtimes are 
Emetic, or a little Rhubarb may be of Service.-
Vir. Aloctic. Alkalin. has been recommended.
There is a Species of this Disease attended with
Emaciation, wrinkled face, and Shrill Voice, which
is fatal.-
Watery Gripes. This is often a consequence
of a deprivation of proper breast milk.- The 



291
remedy therefore is obvious.- The Testaceous powder
with Aromatics and Opium are sometimes
usefull.- This Disease is more easily prevented
than cured.- If these things dont do proper milk
must be had.
Erysipelas Infantilis.- When the Navel
string comes off there will somtimes be a slight
Erysipelatous Affection, but which is of no consequence
and is generally cured by the Nurse with singed Rags.
But there is another Disease of much more consequence,
and attack, either the parts about the 
Navel, or the Genitals, spreading to the Back and 
Belly and which puts on a putrid appearance,
it attacks different constitutions, and its progress
is very rapid, frequently ending in Mortification.
Bark and wine may be given internally, and 
Camphorated Spirit applied locally
Periodical Cholic. This often takes place at 
the time the Nurse menstruates. (which they sometimes
do) May be moderated by gentle opiates 



297
You will frequently be asked to recommend a 
Wet Nurse, but which should if possible be declined
and when asked respecting the health of any one you
should be extremely guarded, and only speak in general
Terms, as you cant always possitively say, whether
or not the Woman as free from Disease.-