Lecture 1795 Dr. ROBERTS, BRIDGPORT 1 Dileverd by Dr Haighton And Taken down by Giles Roberts Lectures on Midwifery Course 1st The pelvis is the first thing that Engages our attention in learning midwifery and there are two Considerations on the pelvis first on the Dry pelvis secondly on the Recint pelvis, there Are many observation on the dry pelvis as here are 14 for Inspection the pelvis is the foundation and support of the Uterus through the knowledge of which you are informed of the passage of the Foetus, and by measuring it in Different direction's you find the length and width. Now the recint pelvis is when it has the teguments ligaments [musclles] muscles &c we are Chiefly to regard the female pelvis which are of Different dimension now that most proper to be taught by is standard pelvis and measure four Inches from pubis to Sacrum & five Inches from Ilium to Ilium 2 Now the medium pelvis is between the largest and the smallest which taken out of a hundred Eighty of which there was best Verry little Difference about the Eight of an Inch Dr loss the pelvis has two parts the upper and Lower or true part as when we say a Child has in Entred the pelvis it is meant in the lower part or in Lower pelvis, In infants the Ossa inamonata is composed of three distinct bones Viz the pubis Ischium & Illium Now in the foetus the pelvis being so formed that the Cartiralages gives way and Renders the Delivery easy, in breech presentations. There are three other parts in which the pelvis in Divided Viz the brim is formed by the lini inomonata, the Cavity & out let or Exes pelvis, the brim of the pelvis is sometimes so Sharp that the Uterus pressing on it becomes painfull the Woman Expresses her pain on the share bone the best method is a bandage to keep up the Abdomen? the Pelvis would be of an Oval if is was not for the portuberance of the basis of the sacrum so if the labour is Natural the long Axis of the Childs head will fall into the Long: Axis of the pelvis but if on the Contrary the 3 Long axis of the Head should fall on the short axis of the pelvis which you may easy turn with your fingers by passing them immediately Under the pubis and when the Head is got in the Cavity it takes or must be assisted in a turn with the face to the Sacrum that being the Largest Cavity and then the Child is Ext under the pubis the whole forming a Curve line B the brim or Enterance of the pelvis when the Childs head Comes Eaven with the pubis the forecepts then Can be made Use of and not before {v the Vagina} 2nd Day A pelvis may be verry small. and be the Cause of Laborious labours or is might be made in Just proportions, - Now a Deformed or Distorted pelvis have three properties, Loss of figure property & Beauty, Deformity - Consists in general, before backwards that is the lower Vertebre lomborium Joining to the basis of the sacrum projecting forwards that makes a small Distance between os sacrium and the pubis or the Deformity may be from side to side the pubis approaching 4 Each other in the form of a Angel or the pubis sometimes is verry flat as it were pushd toward the Sacrum and Renders the passage verry narrow and of Course Dangerous & Difficult Labours, non amongst a number of pelvises some will be deformed and the brim is also deformed non deformity at the brim which will Obstruct the Childs, passage or in other words obstruct the child in passing it is known by the Elongation of the Childs head by being pressed through the Brim it takes sometime for the pressure to moddle the Head by the sutures Colasping or Rideing over each Other. that it might Receive the long or flat form. by the appearances you may Judge it to be a Labourous labour there may be Crooked spine without a Deformed pelvis but when the spine bends in the loins much forward it throws the Virtebre in the pelvis, now the Rickets offer Deform the pelvis by the bones in their youth being verry soft not to walk by Continual Sitting now if you see a woman who throw herself first on one side and then on the other 5 To get forward or waddles along you may be assured she has a Deformed pelvis from Rickets &c there has been Different methods purposed for measureing the pelvis the best is to introduce the middle finger under the pubis to the base of the sacrum and you will feel where the pubis touches the Lower part of the fore finger near the Hich of the Thumb and measure that Distance and that will give you how many Inches it is from the pubis to the sacrum if the pelvis be Deformed in Approaching as an angle you may Judge how much by Introducing your three fingers Under the sympheses pubis and if you find them lay Eaven there is no Angel but if an angle they will Ride Each other that is over one another, if Deformity in the out Let you will observe the process of the Os. Ischium approaching Each other Angel ways Now these Illconveinancys in the pelvis Cause laborious labours but it often happens through strong pressure the Childs Head will much Inlongate and press through a small pelvis Suppriseingly, for at times Nature will perform wonders! 6 3rd Day The Calamities of a deformed and narrow pelvis being treated off we now come to Consequence attending a large or verry large pelvis, sometimes when so Large it has been known that the Child had been Delivered at one pain it has happened that a woman walking across a room and the Child Delivered at once and by tearing away the placenta bad consequences may arise it Happens sometimes a woman has been Deceived by labour pains for an Inclination of going to stool from the Head of the foetus being prest on the Rectum which will excite that. Irratation, this must be Considered for a Child being Delivered in this way in a Nessary has been the Cause of much inquiry and nobody - thinking that it was the Consequence of a large pelvis this terminates verry Unhappily particularly if the woman is not married, because the Child being Dead it may be thought she Did it on purpose now in this Case we suppose the parts Ready for Delivery now in case the parts are not the Uterus maybe forsed Quite out particular if the Child is small from the Uterus not 7 being dilated if you should find the womb bearing Downe in the pains and not sufficiently dilated you must desire the woman not to bear Downe, and you must yourself bear against the Uterus and keep it up Untill it is dilated, supposeing the womb is Dilated the External parts might be verry Rigid and the child comeing Downe with violent forse through the pelvis being large may violently lacerate the perineum. which you must endeavour to prevent, this shows how Necessary it is to go immediately when Calld! the male pelvis is Next to be Considered the Distinction between the male and female pelvis is that the male is larger and massey the bones more Substance and is not Oblong from Illium to Illium, the Acetabulum is Larger and Closer together likewise the sacrum is more Curved but the most particular is the Arch of the pubis being Closer together likewise the sacrum Curved but the most particular is the Arch of the pubis being Closer the pelvis Not Spreading so much in men as in Women, men in general have more bredth 8 At the shoulders, it is Nessary to know how the Body bears in different (Situation) or states of pregnancy now a line through the pelvis will strike the Navel so is appears as pregnancy advances the pelvis goes back and the navel [rises] Drops this situation must be known as you may be mistaken in takeing the Sacrum for the Head of the Child, [illustration] The child Can only pass through the pelvis three ways Viz the Head the feet and the breech there are a variety of different pelvises and the medium termed standard so are the heads of Children of Different dimentions, but with management and knowledge a head Exactly filling the Cavity of the pelvis will go through Easy, In the Explanation of presentations Authors have been verry Complex, Now the Vertex may be presented Centrically in the Cavity, but in many situations which has been Calld all presentations in breech and face case they are subject to many Situations, the most favourable is when the Vertex presents a line with the Occiput an the Chin prest on the brest, as this is the Most favourable Situation! 9 4th Day Presentations has often been Confounded with situations now the general presentations are three as Vertex the face and the Ear yet they have all their situations as the Long axis of the foetus head may Rest on the short Axis of the pelvis and may happen not Directly across but quarter ways which takes the quarter turn for the Head to be in the Right Situation now the long Axis of the head falling into the long Axis of the pelvis and as the Child desends nature gives the head a quarter turn with the face into the Hollow of the sacrum which is the most favourable presentation it must be observed that the long Axis of the pelvis is from side to side in the brim but the outlet or lower part the longest axis is from sacrum to pubis, which from the first Situation wants the quarter turn to place it in the second situation that is the Head, when the face presents it is genarally a long and lingering labour the Head of the foetus and the bones of the pelvis not Agreeing in that situation As some parts of the Head will be much pressd in 9 the Head bearing on different points as then the head in the pelvis looses much Room and renders it along Laborious labour likewise when low Downe the vertex will press and bulge the perinæum and rectum which when the Child is large Endangers a laceration of the perinæum now if you should find and be Certain that the Obstruction is by the Vertex being Detained and you Cannot pass your finger to assist pass the lavor and Draw the vertex Downe and Delivery will be in the Natural way, but you must be well informed and Certain of the presentation and Situation for if you slide the lavor on the Chin you Draw it down & certainly make a face Case of it a child might be born in that posision but requires much time, but if you are certain of the posision you may try to bring the Vertex Downe with your fingers or lavor now to bring the vertex Downe it is said you must Raise the Chin up which is Done by Depressing the Occiput as Drawing the vertex Downe Raises the Chin close on the brest which situation favours the delivery there is a situation Calld a mixt Case when the forehead presents which you will 10 Distinguish by feeling the Eyes and Nose on one side and the great Fontale and Sutures on the other side this presentation mostly turn to a Vertex or face Case if the face is to the mothers belly it must Come under the arch of the pubis you must well inform yourself how to Distinguish what part of the Head presents now the Longest line that Can be Drawn is from the Vertex to the Chin that is through the Childs Head and the shortest is when the Chin is prest on the brest to the Occiput which shows when the Chin is prest on the brest it is the most favourable Situation for Delivery the bones of the Cranum [cross out] in an Infant twelve which shows how much the Cranium will Compress when there is violent forse Likewise attention must be paid to the sutures to Judge what part of the Head presents as the paratalia bones are Joined to the os frontis by the suture Coronalis and the paratalia to one another by the suture Sagittalis and to the Os Occiputs by the lambodalis and to the OssTemporum by the suture squamosæ, the great fontall which likewise is to be. 11 Observed, the frontall Sagittall Coronal sutures all meet which forms the great fontall and is Larger in some Children then in others the small fontall is where the Sagittal Ends, and the lambidoidalis goes across that Joins the Occiput to the parriatalia, by knowing the Exact Situation of the sutures & fontalls will lead you to the Knowledge of the situation and presentation of the head non when there is a Hydrocephalus the whole Length of the suture Sagattalis will be open one or two fingers breadth and you will feel a fluctuation of water which If it should Winder labour then must be a puncture made in the Head it has burst before now by the Cranium being Compressd. in the Vagina [cross out] you must distinguish the Different presentations by feeling and Touching, as when the Vertex presents you will feel the great fontall Cornal & Sagettal sutures if the face the prominant parts as the Eyes nose and particular the mouth if the Back the process vertrbre If the Shoulder is hard pressd in the pelvis it will be hard to Distinguish but you must feel for the arm Now when the Head Enters the pelvis to distinguish 12 the situation you must feel for the Ear the smooth and flat of the Ear will be towards the face the cartilagous or flap of the Ear will be towards the back part of the Head if you Cannot feel the Ear the great fontanell and suture to the little fontanell will inform you which way the face is and how the Vertex is situated now if you should find the great fontanell onone side and the face on the other you may suspect it to be a forhead Case so it will be better for you not to give your Opinion how the labour will be untill you are aquainted with the Situation of the Head 5 Day In the Recent pelvis with its Contents the first thing to be Considered ligaments which Joins the bones together where muscular forse has not been given, the ligaments are generally Elastick and the ligaments of the pelvis are of this sort. the Sympheses pubis is Joined with a Double Cartrilage and there is a space between them and sometimes a Cavity which has himified and pass has formed which has Destroyed Cartrilage and Caused much pain and great lameness and at 13 Last Destroyed the woman we see the formation of one of these tumors in a prepareation it has been supposed that the ligaments of the plvis were move able and gives way in labour, but our professor Dr Heighten Cannot think so as the Consequence of over Stritchd. Ligaments in Labourous Labour has been so great. that the woman has been Confined to her bed for two or three months and a long time before she Could walk it is Cured by bandage with Straps & buckles in the form of a wast band of a pair of breeches & braced Round the Illium for some months, the mussels ajacent to these parts ought to be Considred as their acting as Reciteing power & theirs Muscular forse in Expelling the foetus the Nerves likewise must be Considered the Crural of former Nerve which Come out of the foramen of the Os Sacrum and go to the brim of the pelvis into the thigh the Scatic Nerve Come through the Different foramen and Joins in one large nerve and goes Downe the thigh by the back of The pelvis and when this is prest by the Child it Causes Great pain Downe the thigh & Causes the Cramp or spasm 14 Likewise instruments if not Rightly Used causes the same Complaint as cramp or spasms the Iliac Artrey and Vein pass through here to the thigh and sends - branches to the Uterus & Bladder, now the coats of the veins are thinner then the Coats of the Artries and of Consequence Receive the pressure sooner & the blood is is retarded in the Lower Extremities and prest into the minutest vessells and the lympha is exhald oras it were by fusion prest into the Cellular, membranes of the Lower Extremities & Cause Admatious swellings in the Legs before labour, likewise the lymphatics are obstructed which may at this time cause the piles, the Contents of the Bladder and Rectum obstructed A continuance or Incontinuance of urine by these parts being prest! 6th Day The parts of Generation are next to be Described in the first place they are to be Divided in two parts internal & External the External are those that appear vizible to the Eye that is the mons Veneris labia pudindia Nymphia Clitoris & Hymen Frænum the lowest Extremity and 15 of the labia pudenda and Joins to the periænum the mons veniris is more or less Covered with fat as the Subject is Inclined, these parts are liable to diseases which Call for the Assistance of the practicioner in Midwifery, an Inflamation Deep Internally from ye Mon Veniris with shooting &c Indicates that there May be a Canser, sometimes there is another Disagreeable Complaint, of great Itching with Little Eruptions this is sometimes Symptom of worms and Sometimes from Appearant, the Ung Eerussa Camph, will give relief sometimes arise form the stone Symptomatic, the labia pudenda is subject to Disease and maleformation as Cohesion of the labia which must be seperated & the labia kept from Comeing together as it is will addhere and grow together again, this generally happens to Children, the labia pudenda is subject to Hernia which must be Reduced by bandage sometimes the labia is anasacrious Adametus as said before from the prepuce on the Internal Iliac veins there is seldom any Occasion for puncture for being Supported with tight Bandages and Compress on the labia has been found sufficient untill 16 Labour, these parts are subject to tumors from Exravasated blood from falls and bruises if a puncture is made white the blood is fluid it will Immediately Discharged if the tumor is small and no puncture the absorbents will take it up by the Help of Astringents, but if the Coagulum remains Indurated it Causes Inflamation supperation and so forms an Abscess & then Use poultices & Treat it as such sometimes this Happens from Laborious labour) The Clitoris is composed of the plexus or membranes, retoformus which is blood vessells & the Corpus, cavernosa which Join together and is Cillular as we see by the Desected preparation the Nymphæ is a fold of the ligaments sometimes they are supernaterally - Large, then it is Nessary to Exterpretate it is maybe - Subject to Disease and a tumor, The Urethra is Next to be taken notice off and you must be participle Attentive to its situation that you may know Accurately how to Draw of water with the Catheter a woman with Child Sent for a man midwife to Draw of her water he Introduced the Catheter into the Vagina and broke the membrane of the foetus and 17 Thought it was the Urine, you must know the Situation that you may Introduce a Catheter by feeling and not Expose the woman, for by this you are liable yourself to be Exposed, and some practitioner have Introduced the Catheter into the Vagina for want of knowing the Situation of the metus Urinea! 7th Day Rules to find the Urethra some people have thought and made a practice of it that by Introducing the finger or Catheter close under the pubis you would find the orrifice, others have felt for the Orrifice of the Vagina and have Introduced a little above that as the best way to find the metus Urinas between both you meet with Obstructions that renders it Difficult Tedious and painful. Now the best way is to feel for the Clitoris which you may Easy distinguish the pass your finger Downe one Inch below from the Clitoris and you will feel the Orrifice of the Metus Urinus then with the other Hand take hold of the Catheter between your thum and finger and holding it not stiff pass it gently Insinuateing it about and it will slip into the Orifice the situation of which we see in Different preprations 18 Retrention of Urine often Happens to women in pregnancy when Urine is Confined in the bladder two long and the retrention is great the mark of the Irritation will be febrile or feaver, Symptoms and if there is no help and the Accumulation & Distention goes on & the Symptoms Increase, as the bladder Cannot (Increase) or Extend adinfinitum it must of Course burst, (as we see in this prepareation) & although there might be a dribbling away of Urine continually. Remember secreation is going on the same time in the Kidneys and will fill the bladder faster then the Dribbling, . Evacuates, you must be more suspicious of much water Containd in the bladder when the woman tells you that it is Continually Comeing away if you find it nessary Introduce the Catheter and Draw of the water. Supression of Urine often Happen to women in pregnancy and Commonly in the third month as the Uterus is about to Rise out of the pelvis and press on the neck of the bladder, so that it often Happens that women want their Urine Drawn off at this time when the Uterus is Risen out of the pelvis the pressure will be taken off 19 when Suspression comes on through Inflamation which you must Distinguish by symptoms, Use Catharticks bleeding bladder of warm water applied Extended region of the abdomen, in this Case if nessary to Draw of the - water a small Catheter will be best which you must pass in the most gentle manner insinuateing it in by Degrees Holding it slight between your finger & thum feel as before Directed and it will Drop into the Urine Orrfice sometimes Spasms Cause suspression of Urine Bladder of warm water Roppi Clyster with Roppitix Gull &c as Urethrea is not long so the Catheter need not be long and the Curve but slight a number of small holes at the side is better then one at the End when you have Introduced it withdraw the stillet, and the Urine will Run The posission of the woman must next be attended to she must sit on the Edge of the Bed a little Reclined backwards and the thighs Drawn up a little then with your Hand and one finger feel for the Clitoris and that will Direct you to the Orifice and with the other Hand Gently Introduce the Catheter, if the Distention of the Bladder should appear like a Dropsy which have Deceived, 20 Practicioners who have punctured the Bladder takeing the tumor for a Dropsy, Makeing the puncture with the Trochar, some women who would wish to Conceal pregnancy will make it appear to you that they are Dropsical which you may Distinguish by pressing your hand on one side of the Abdomen and checking on the other side you will feel a fluctuation of water. If you find a supposed Dropsy Inquire into the state of the Bladder, sometimes the Loss of the power of Retrenchion is so great that there is a Constant comeing away of water the tone being lost through pressure and Extention of the Bladder & its Neck, sometimes this this incontinuance of Urine through pressure the parts becomes numbd or Dead.. and disposncion to slothing as mortifycation by lost of Substance, when the Tonic powers are much Debilitated, a blister applied to the Sacrum has been of Use R Canth: taken Inwardly to bring on a stranguary as you may see Nessary the Cold bath or any thing of an Astringent quality, Caruncle Myrtiformes supposed to arise from a rupture & Hymen, but Denyed by Barron Haller, but we see 21 them in Diffrent prepareations they may be morbid or Relaxd, the Hymen is frequently found in Children and some times in adults (as wee see in Different preparations) some are Circular other like a half bloon Rose and is a Circular folding of the Inner membrane of the Vagina and in adults Some are semi lunar, sometimes it is so large as to fill up the whole passage of the Ali Interdy and is Called an Improferated Hymen & is not known sometimes Untill the Menses want to Evacuate which you will Observe by the fullness of the brests and Symptoms attending and no menstural Discharge then you may suspect an Improferated Hymen and If you are permitted to Examine you will find it like a little bag of water protruding some times below the labia pudenda and if so it must be punctured, and in general there will be Considerable Quantity of Lymphatic Blood Discharged to the quantity of a Quart or two, 8th Day The Vagina is a long or Rather flattish Canall which Reaches from the pudenda to the Infernal mouth of the womb and is Larger in some women then others situated 22 between the bladder & the Rectum the Internal membranes of some are full of Rugiee or plaits and pirticular in the fore part in some they are fainter and ingestation Obliterated, (as we see in a great number of prepareations of the Internal parts of the Vagina) the princapal use of these Rugee is to allow the ~~~ Vagina to Expand in time of Delivery, it is to be Observed that the Vagina is narrow at Each End and wide in the middle, which shows that in Introduceing a pessary that it should go in tight the Vagina is - Subject to Disease excoriations or shankers in Veneral Complaints which might not be so Large as a Sixpence but when taken in Labour will be as Large as half a Crown which shows what might = happen is there are other sores the Vagina is subject to Inflamation Erysipelas which you may know by the Heat Itching and smarting of the parts, if a full and quick pulse adminster proper laxatives and Cooling Diaphoreticks Fiberfuges &c. if the pulse is Low Bark ~~~ Corrolerants Aramatiks &c. but if full quick and Hard with shooting and Throbbing sensation you may 23 Expect phelegmon then you must Incourage supperation as when the inflamation is past - Resolution, there will be a slothing of the supperated parts and sometimes a mortification Takes place, - but when the parts are Disposed to Heal an - adhesion of the membranes takes place if not timely prevented by Introducing some soft body the figure of the part such as some soft LintRolldup or Rags &c - , the Uterus is Situated between the Bladder and the Rectum, that is the Bladder before and the Rectum behind, the Uterus is subject to many Accidents and the worst of all Disorders the Cansor Likewise the prolapsus Uteri, is when the fundus- Uteri appear below the OsExternum if it protrudes lower it Called procidentia Uteri, the figure of the Uterus by some is Compared to a wine flask flattned before and a little Convix on the Hind part the bladder pressing it before Causes it is to be flat but the pressure of the Rectum Not being so much so that it gains its Convixity on the Hind part the Uterus is Divided into three parts Viz the Mouth the Neck & the fund is 24 or bottom of the womb though this part is upper most the mouth of the womb is Calld by different Names as Os Tincæ Os Uteri Os Internum, Os Exturnam or the mouth of the Vagina or the Enterance of the Vagina to the Os Uteri, it is to be observed that the Os Uteri has not always the same Characters but the most common appearance is a Turberculæ projection like the End of the Glans pennis sometimes the mouth is wide or Oblong at other times have two or three lips as we now see in Different prepareations which shows a great variety in Nature in forming the Os Uteri, this is Subject to Cancers, the woman complains of a burning heavy and forseing pain and no menstrual Discharge, she has a Discharge she Calls the whites which if you Examine may be fætid Sainous or puss you may then suspect a Cancer, If you Examine the Os Uteri you will find it Rough and gaged and the Vagina likewise then the Complaint is in an advanced state, and at this time they Cannot keep their Urine by the parts being Divided and Eatergints one Now the - most that Can be Done is to palliate by Injections ~~~~~~ 25 Sacc Sat. in Barley Water Internally ROppi but this Disorder Baffles all art and nothing Can be done but pallatives to be given as Temporary Relief 9th Day A pollapus ought to be known and Distinguished, this disease Can be better spoken of than a cancer as it will admit of cure this is an Excresence growing from the membrane Internal either from the mouth Neck or body of the Uterus its origin s small but in the Course of time projects through the Os Uteri Like a tongue projecting through the mouth and so Increases to a verry large sise and has the appearance of a Collyflour (as wee see in many preparations) sometimes there arises from the Substance of the womb Turbicles and when they project from the surface of the membrane are Calld. shirrious Turbicles which we see in prepareations the attachment of the pollapus or in Different parts of the Uterus is in the body Neck and mouth those that are attached to the body you Distinguish so as to pass - your finger Round it in the Neck of the Os Meri in general it grows gradually and at other times makes its appearance 26 appearance quick that practicioners have taken it for a Revertion of the womb for sometimes they grow to a large vise in the Uterus that by sudden shocks it has protruded into the~~~ vagina at once, a pollapus has Artries & Veins and they being pressd by the Os Uteri becomes carious and bleed. verry much, which forms Coagulum which is painful in comeing away when the pollapus is attached to the mouth of the womb you cannot Distinguish the middle or small neck of it from the Neck of the Uteri as by its weight it has Drawn the Neck of the womb to the External part through the Vagina, to distinguish between a procedenta Uteris and a pollapus, the prolapsed Uterus is Larger at the End & & a pollapus is smaller you must be Certain that it is a prollapsus that you do not take any part of the Uterus up in the Ligature Dr. Hunter passed a ligature over a pollapus and Inclosed some past of the Uterus by the weight of this Excresence Draging Downe the mouth which gave the woman great pain and she Died, which gave Dr Hunter great Concern and from that time he advises Never to make a ligature without finding the mouth of the os Uteri the Cure is easy when you know the situation of the pollapus 27 [illustration] [illustration] by passing a ligature over it and Drawing it tighter every Day untill it Drops off, there are Different Instruments for this purpose of makeing the Ligature ones is two pipes made of Silver and Joined together (as in the margin) with a silver-wire passing through it which must be anealed and so Draw the wire Tight and hoist Every Day another Instrument for this purpose and which Dr Heighton Recommends in preferance to the tubes (which see in the margin) the internal cavity of the Uterus is Triangular and in the neck a kind of valve or rugee Called arbor Vite some have thought this to be the seat of the flour Alba the Internal membrane of the womb is smooth and in the Virgin state Hardly any cavity to be perceived except a small Longitudinal one that Just admits of a brissle as we see in prepareation Dr Hunter & Lowder both say that they. Could never Distinguish a flour alba from a gonerrea only by the woman moral Character there is a Disorder Calld Tympanetus of the womb which seldom happens it is wind in the Uterus A Reversion of the womb seldom happens but Immediately After Delivery, and when it Does Happen it must be Returned, 28 10th Day The Uterus being the sent of Menstruation has been disputed by some Physiologists as they Immagined that the Menstrual discharge was from the Vagina but - experiments on this Head has Confirmed that the discharge is from the Uterus, there is likewise a great Diffrence between the Natural blood and menstural Discharge for the Natural blood when Left to Cool will Coagulate but with the menstrual it is Visa, Versa as it appears to be Nothing but serum with Red particles in it and = Coagulum lympha but in Uterine Hæmorrhage it is blood now when the time Accretion Draws to a period & there being more blood in the Vessells then Nature requires the artries and vains of the Uteri being Distended, Now where there is a great Deal of blood there is always much action which Cause a pressure on the Vessels and Extracting Artries and the Effusion take place but whether it is the artries or veins is not Determined the Branches Hipogastric Vein which arises from the Internal Illic and spermatic Vessels and when the Illia Leaves the Abdomen it sends out the Epogastric 29 which gives vessels to the pudenda then it is Called Curalis, the apendages to the Uterus are the fallopian tubes Ovaria broad and Round Ligament, the fallopian Tubes are situated on each side of the womb and have a - communication with the womb which will but admit a Hogs brissle to pass into it, and they have muscular motion to Expell the gellatinous humour, those tubes are subject to the Dropsey, the Ovaria have a number of Irregular surfaces in their Body supposeing to Remain from Different Conseptions but there are the same in Girls they Contain a fluid of a gellatenous nature which is accumilated and prest from the Ovaria in Coltiue by a stimulateing - power and leaves a small hole or vacuum after it which looks yellow as we see in preprations of all these parts, the Ovaria - is subject to absess and Dropsey. and in some of them there is Hair and in others teeth and there has been found a foetal Jawbone a Circumstance that has happened that the Ovaria has been Ossified which has been a subject of much speculation if in the place of these solid substances there should be a Dropsey you must attempt a Cure by Tapping, But you must Remember that the water 30 Is contained in Cellulars or sacks which have no communication with one another (a woman in shore Ditch that Laboured under this Complaint, & which ovarum Contained thirty Galls of water, Now when the Ovaria is not so much Inlarged it may get into the pelvis and be of the utmost consequence in Delivery as it may present before the Head of the Child and stop up the passage, [illustration] the Round ligaments passes through the ring of the groin and is lost in the tugments of the mons Veneris. 11 Day It is to be observed that the ligaments of the Uterus is a continuation and Duplicateure of the Peritoneum which Extends and Reflects a covering in part to the Uterus bladder and Rectum the broad ligaments form as if it were two Chambers Calld. the posterior & the anterior or back Chamber the posterior Chamber desends so low that the peritoneum covers the Uterus to the Joyning of the Vagina to the Uterus and in an acute angel Reflects & Runs up covering the Rectum and anterior cavity of the pelvis sometimes the small intestines will Lodge in this Cavity, which Cause great pain & Dissagreeable senseation, the posterior chamber Desends not so low as the 31 neck of the bladder, part of the Uterus and Rectum are not covered with the peritonæum, but it Reflects back again and lines the anterior Cavity of the abdomenical mussels opposite the pelvis now the peritonæum not Covering the Neck of the bladder in great suppression of Urine a trocar may with safety be Introduced over the Os pubis without any Danger of wounding the peritonæum or filling the Chamber with Urine, by leaving the Cannulæ for some time, and the parts will closely adhear to one another without danger and then the canulæ might be with drawn We next proseed's to Impregnation sexonal Intercourse or Coltu, the minutes of which being without the sphere of human Comperhension all that we know is by Observation of the Effect in consequence of which a great number theories have been Erected by different Authors particularly De Graff but it is Certain that an Ovarium in Ovria must be impregnated when it forms a Turbicle projecting like a nipple but smaller and then this bursts and Enters the fallopian tube † in its passage to the terus, and the Cavity that is left is Calld corpus-lutiam it is thought by some that the fallopian tubes Could not † By the Compression of the Fimbria 32 act on contrary principles such as to admit and Remit but it is well known that it Has a preperistaltic motion to admit and Remit as may be seen by Experimental ~ Observations, when this something Escapes the Ovarium and the fimbre Neglects it office in Compressing the Ovarium this something fall from the outer Orrifice of the lube into the abdomen and produces what is Calld a Ventricle Case and the foetus how Remained in the Abdomen a Considerable time, at other times being Detained in the fallopian tubes for want of motion or By accident is there forms a foetus {as we see in prepareations} so that it is Clear that this something is impregnated the minutiae of of the principles of the first for formation, being beyond the Sphere of Human Comperhension we Can only look and wonder at Divine Wisdom and with the Psalmest say How wonderfull are they work OGod of host and in wisdom hast thou made them all { this something collects in the tubes and bursts then Escapes through the fallopian ~~~~ tubes into the Uterus where it attaches and goes through diffrent Revolutions in the formation of a foetus as we see from a speck to the full sise, this is Natures general plan We see inpreparation. 33 The Navel string is next to be considred as to its length its Common length is 2 feet if longer you will frequently find a turn or two or more Round the Childs Neck and if the Navel string should be two short as there have been some not above six inches, there in Danger of a premature seperation of the placenta or a Reverted Uterus by being so suddenly drawn away, or prehaps flooding, the Cord in general is Composed of three blood Vessels a Vein and two Artries. which pass in spiral lines and sometimes in half spirial lines from the foetus to the placenta sometimes you will find a not in the Cord. from Diffrent Evolutions, which is keept from being tight by air in the Cellular membrane. the Cord is Covred by the two membranes the Chorion and Amonion but they adhere so Close together that they Cannot be seperated from the - Cellular membrane composeing the Cord. it is to observed that there are no Nerves Entering the Composition of the Cord, the Immagineation and Longing of women as it is Called it is not to be Acct. for as it is beyond all human Conception. 34 12th Day The placenta Comes Next to be Considred by some Authors it is called the womb Cake the seccondine the after burden, but in our present practice we shall Confine ourselves throughout the whole Course of Lectures to the term placenta and is that part or substance which forms Communication between the mother and the Child, and is found in most animals but not in the Oviparous kind such as birds &c, as their nutriment is absorbed from the yolk by a cord from the abdomen of the Chick, but what is Remarkable the Bad being oviparous has a placenta? Now in twins or triplets or four they have each a placenta Distinct in general, but it sometimes happens that there is but one general placenta with two sets of vessells which communicates from fetus to fetus whch shows the necessity of two ligatures not in fear of Utrine Hemorages but of the other childs bleeding to Death (the placenta is subject to Different shape as well as figure) The placenta of a Rabbit is all round the Chorion, and that of a 35 Guinea pig is in form of a button and that in a mare is like a number of vessels and Ramefications and is a thin membrane which nature has so ordered hat it might not be easy torn away by ye violent motion this Animal undergoes when it trots or gallops, The human placenta has two surfaces the external which is attached to the Uterus and the fetal surface where the Cord is inserted the internal surface that is the parts that are attached to the Uterus have Concave surface and fisures in many parts that it may adhere close to the uterus the external is convix and Rather globular, and branches of the umbilical vessels are spread through all its substance, the placenta is attached to diffrent parts of the uterus but most commonly to the fundis uteri, the Ovium being received in this part, the placenta is about six inches diameter and one Inch or Inch and half think and is a Little thinner towards the circumference, the final cause of the placenta being attache'd to the fundies uteri is because the Iterus is continually increaseing in sise and expantion 36 in its body so that it does not effect the fundis, but when attached to the side of the Uterus and the extention is great of Consequence it must render the placenta and open the mouth of the vessels and a voilent and Coangerous Hemorrage insue this about the third or fifth month the veins are situated internally and the artries externally in the placenta, the structure of the placenta has been but Lately understood, for Baren Haller knew not its structure, there appear a number of small fibres or a mass of fibres which are a number of Cellular processes with Ramnificatios of Artries & veins which will show by Injection it has been thought by some that the placenta is glandular, the placenta Consists of two parts one belonging to the mother and other other to the foetus. the foetus's part is vascular processes shooting into the maternal part which is Cillular, (as we see in a great number of prepareations) and are distinct belonging to each other and their veins and Artries have no communication to each other for if you inject the maternal part it will not 37 communicate with the foetal part. & so vice versa it appears that there must be a double Circulation between the mother & the maternal part & the foetus's parts the veins and artries are divided into a number of small Branches the Veinus part which Unite in one large tube Called the Umbilical Vein which brings Back the blood to the Child & proferates the Child at the Navel and from thence passes into the Liver where it Communicates with the Vena Cava & portarum the two artries arises from the internal. Iliacs of the Child and upon each side of the bladder and perforates the belly where the Umbilical vein enters then proceed to the placenta in a Spinal line round the vein in conjunction with them and the Cellular membrane which form the funis Umbilicus there artries together with the umbilical vein do the same office in the placenta which is afterwards performed in the lung by the plumanary artrie & vein until the Child is delivered and begins to breath for if you bring away the placenta with the Child you will find the Circulation goeing on between 38 the placenta & the Child and no blood will escape from the Exterior part of the placenta, if the mother Expires from voilent flooding and the placenta is not tore the Child will be alive and Vigrous, the Internal membrane of the womb is full of Celluæ which contain a mucus & when press'd lubricates the passage of the Merus or Cavity of the womb the foetal part mixes with the Maternal part and absorbs what is necessary for its Nurishment and to make blood the foetus's - vascullar procss's Joining the maternal Cellular part from whence the absorbent vessels Draw what is necessary for nurishment as young trees draws their nurishment from the Earth by their absorbent Vessels 13 Day  40   Andre Duglas M.D., his Observation on that species of hemorrhage which is occasioned by an Attachment of the Placenta to the Cervix Uteri. A Discharge of blood from the Uterus during pregnancy which is always an alarming Complaint becomes Dangerous when it Occurs in the latter months; and is particularly so when Occasioned by an attachment of the placenta over the Cervix Uteri, this attachment which has been Over-looked by the Earlier writers in midwifery is a cause of hemorrhage seems to be first taken Notice of Levret, I shall Confine the few observations I have to offer to the Case allready specified. Viz, the placenta attached over the Curvix Uteri, till of late it was the received = Opinion that the Cervix Uteri began to dilate about the third month and Continued gradually to stritch and becomes Shorter till the Term of gestation was Compleated. the Late Dr Hunter has Enabled us to form more Clear & Correct Ideas on this subject His Dissections and accurate Observations Establish as a fact that the Curvix Uteri Remains Contracted taken from the Medical communications volume the first published in 1784 Communications may be addressed to Dr Gray Brit Museum contracted through its whole length to the seventh Eighth or even Ninth Month in none of these Cases where I have found the placenta presenting Could the appearance of flooding be Dated earlier then the seventh month in some it Did not commence till near the full term at whatever period the dilatation begins, it will destroy the perfect Urine between the [illegible] will necessarily flow from the Vessels when Communications are Broken. This, accumulating within the Uterus and Separating more & more of the placenta will at Last be sufficient to overcome the resistance of the Os Uteri & A great Discharge of blood will Declare the dangerous Situation of the patient Not that the Danger is always Immedate for the Hæmorrhage seldom Kills by a single attack, but it abates & Returns and Every return brings Increase of Danger there is no Case in which it is of so much Consequence that the practitioner should take his Measures Speedily or in which he is Less at liberty to trust to doubtful remedies whenever we are satisfied that the flooding is in Consequence of an attachment of the placenta over the Cervix Uteri Delivery should be Attempted immediately, for Could we suppose a case in which notwithstanding the Loss of blood the powers of the Uterus were undiminished these powers could not be directed to any good purpose, the placenta adhering by its whole circumference becomes a band which strongly resists the Dilation of the Curvix and at the same time acting as a Cushion Interposed between the Child and the Os Uteri prevents their ever comeing into immediate contact Hence the wombs is deprived of that Stimulus which in other Cases is excited by the pressure of the membranes and Child at the os Uteri, and were the labour pains sufficiently strong to overcome such an Obstacle the danger to the patient would not be Diminished by the placenta being first Expelled, The principal objections to delivering early in uterine Hemorrhages are founded on the Rigid and Contracted State of the os Uteri and the danger of Injuring by efforts to Dilate it, I should wish this fear to opperate so far as to prevent the Nasty application of Great forse but not to Delay or Check the Intention to Deliver when Regulated by gentleness and prudence, In floodings near the full term rigidity of the Os Uteri may not, eaven at the commencement of the attack prove any Obstacle to the Introduction of the Hand but I have not seen one Instance of recovery where in the seventh or Eight month there was no Resistance to my first Endeavour to Dilate this verry yielding state of the Os Uteri is to me always an Alarming symptom, it Cannot be Considred as the Effect of Utrine action which in the case if it takes place at all is feeble an Unavailing we have every Reason to fear that it is in consequence of a diminution of vital power from blood all Ready lost it therefore becomes of infinite moment to Discourage every Idea of waiting hill the Os Uteri is soft and easy Dilatable, since it is event that very seldom occurs till our endeavours Can be of no use if Delivery is long delayed the womb deprived of its energy by the greatness and continuance of the Hæmorrhage will not have power to Contract itself when Empty and the vessels opening on the Internal surface haveing their Diameter undiminished will Continue to pour out blood till the woman is quiet exhausted, another Argument in favour of speedy Delivery is the uncertainty of the manner in which different constitutions may be affected by loss of blood while one survives the effusion of a quantity almost incredible another sinks under a discharge by which we are scarcely alarmed from the wisdom with which our organs are adapted to perform their various functions; from my own experiance and the Experiance of others and minute observations I am Inclined to think that the Os Uteri cannot be so susceptible of Injury as has been supposed in many cases of abrotion and premature Labour when thick Riged and Contracted it sustains for many Hours, without any bad Consequences the action of the most forseable pain, this Species of action must be as great a violence to Nature, as dilation slowly and gently performed by a prudent and Cautious opperator, and the Circumstance of its being about in the one Case by the hard bones of a Childs Head Acting on the Os Uteri from within or in the other by the Hand acting without cannot make any Essential Diffrence in its effect upon the parts the Cases which I have seen Justify me in thinking that we ought, on no account, to be Deterred from attempting to Deliver where the Danger is so imminent and certain and the Ill consequences apprehended so remote and Doubtfull Mauriceau La Motte Deventer and others have not expressed much fear of injuring the Os Uteri even by Introduceing the Hand in the more Early months of pregnancy Le Roux a Respectable modern Author says the Os Uteri is sometimes torn with little inconvenience I was myself Called C In After Delivery to a poor woman who had Evidently suffred this Accident yet she Recovered without Hæmorrhage fever or Inflamation and afterwards bore several Children In short I have seen enough to convince me of that Pens, Predictions of certain Death to the patient from useing forse to Dilate the Os Uteri is Ill founded that Ruptureing the membranes Stimulateing the os Uteri & trusting to the labour pains to Deliver as recommended by Levert & Puzos, cannot be Depended on, in cases where the placenta is attached over the Curvix but that where Species of attachment is certain speedy Delivery Affords Almost the only Chance of Life to the patient to effect this our efforts to Dilate the Os Uteri should be persued with gentleness and perseverance and the Delivery finished by extracting the Child footing as soon as the Hand of the opperator can pass this will happen sooner or Later in Different Cases even when the Circumstances appear in all Respects similar for although the continual Application of some dilateing powers may greatly dispose the Os Uteri to relax yet that relaxation does not seem alltogether to depend on a mere Machanical cause however Applied, on the contrary even at the full term when the Natural process has not been precipitated the Os Uteri will often for a Long time resist the strongest action of the Labour pains and at last yeild almost instantaneously, In Abrotion and premature labour the same is to be preceived in a still greater Degree and in cases of flooding or convulsions when the Practitioner have perseverd even for Hours in his endeavours to dilate with little sensible Effects it frequently happens that the os Uteri suddenly Losses its Rigidity becomes soft & Readyly admits of the Necessary dilitation this is prehaps to be accounted for from the stimulus of the labour pains or the opperators efforts when Urged to a Certain Degree, exciting some action of the Uterus of which this Relaxation is an Effect and whether this is ye Consequence of mechanical or sympathatical Stimulus it is sufficient to Encourage Us to continue our attention that we may be ready to avail ourselves of the first favorable moment. When the Os Uteri will admit the hand Delivery being then in our power it may be finished Directly or in a gradual way a wish to save the Child's life is the only inducement to follow the method but the saftey of the mother is more Certainly promoted by slowly Ext the Foetus, I generally endeavour to bring away the placenta as soon as possible that I may with more Effect Introduce some low or Rag moistned with vinigar so as to fill the vagina this is what Le Roux calls tampon and has hitherto Answred my expectations in every care in which I have used it after Delivery Thus have I ventured to give my Opinion in favour of an Old practice if it has often failed to answer the purpose for which it hath been Recomended many of the Failures may justly be ascribed to the means haveing been two long Delayed no one can be more adverse to Interfere in natures opperations or to substitute my own Efforts for those of the Constitution but that species of hæmorrhage which arises from this Unfavourable Attachment of the placenta Does not encourage the smallest hope that the constitutional powers will ever be able to act with any good Effect that so Hazardous an opperation as forseable Delivery should be undertaken with Reluctance is not supriseing the Idea will convey the most alarming senseation to the Patient, & her friends and the sucess must ever be doubtfull, yet the Opperator will always be considered prticularaly answerable for the Consequences, but when the Life of a fellow Creature is at stake when little hopes is from Nature when the powers of medicine would Dissapoint us and Endanger our patient by Delay No fear of Censure nor any consideration excepting that of her safety ought to engage our attention for a moment   The Cause of [cross out] scrophulous Tumours is from a peculiar Acidity of the serum in the Blood whenever it fixes upon the Glands muscles or [mem???] Coagulated and Hardens then and when it mixed with [the man??] always disolves it, & Consumes the Bone If this acid humor be simple, the Disease is a simple struma; but If Joined with a malignity it makes a mixt tumor - of the Oedematous kind &c- . Now by Coagulation [Forean] something is meant distinct from concretion, which is incident to all other tumors and to the Serum itself [upon many other] from [abaucty?] of Causes, The whole blood being fibrous may admit of many concretions and thickenings; but they differ from this Coagulation [as much as] just [lay] the same way as the boiling of milk to a thickness or thickning [of milk] it with flour &c differs from making a curd with Ronnect I shall rather assume this instance in milk because of the near kindred between it and blood and also for the near resemblance that many Scrophulous tumors have to [the] its Curd. It is very Common to see the *Conglobate Glans [to] grows Large and full [with] of a white Curd so exactly Like that of Milk that it is Hard to Distinguish them; when they differ from this it is from some other mixture in the blood which [makes] it causes it [cross out] which may [cross out] spurs [illegible] Cause * the small Glans of the Neck- but whether [cross out] it arises from the [illegible] they [Coagulatia?] or of the matter itself when Coagulated is less as contained by [illegible]: the former may [cross out] from an Acidity [cross out] and [??times] as sharp as to approach near to the [acrimo???] of Aqua Fortis; in which cases the Patient feels - violent Corrosions and Excruciating pains &c the tumor [cross out] itself [being] is apt to Degenerate into a Cancer - or it may have [an other mixture] a with it so as to make it of a Vitrolique or Aluminous Nature; - all which acidities though they generally agree [cross out] producing of Coagulation [an] yet [they] this make [coagulation] then a very - unlike each other; the Difference also may be in the matter Coagulated - the varieties of which been infinite are Hard to be recited only I must take Notice that from this latter Cause it is that I was forced to put as well the property of Dissolution as of Coagulation into the Dissection of this Disease for though the Acidity be the same which Cometh into a bone with that which goeth into the flesh Glands &c - yet the Matter it works Upon being Different that is Narrow (which Differs from all other Juices of the Body) it Doth Disolve &c Rot is and also the fibres of the bone it self - Let no man Wonder at the Contrary effect of the same Cause who observeth the different operations of fire, upon wax and Clay where it is visible that the Contrariety of Accidents Happens from the Matter & not the Efficient The like Instance maybe made in Vinegar which when it is mixed with milk. it [?????lates] it into a [Curd?]; if put upon an egg, it [illegible] Disolves the [white] shell but also attend [illegible] white Contained in it into a Limpid Water; which [white] notwithstanding we observe to be a body much more liable after to concrete and Grow thick than milk itself. this similitude will hold good of our ye strumous Acidity, which when [it] mixed with the serum of the blood [it] Coagulates it, and when it enters into the marrow, though that be of a more Compact texture than the serum yet the mixture of this acidity is so far from promoting that Hardness that it disolves the Consistency it allready possesses [hath] The immediate cause of the Kings Evil. I have observed already Viz to be the acidity of the serum but the Remote Causes [that is the causes] of this Acidity (to which the struma owe their origin) are somewhat difficult hard to be enumerated; the Head to which I shall Refer them are these Air, Dict, Exercise, Natural Complexion Hereditary Affections, ye Veneral Disease Improprieties of Treatment and the Itch Not perfectly Cured &c [strong as it may] [seem] those porous may beget a schropholous offspring, [weakness] [of the solid] &c &c Those Children who are born of strumous parents are Usually Subject to this Disease. [so] They will also acquit it from [from] a Nurse [cross out] afllicted from whose Brest they Reserve their Nourishment 3 Those who Live in an air Excessive thin & sharp or very thick and foggy, are [b??] Liable to this disease. Diet of salt [so???] and Slimy meats [one likewise causes of this disease] and wantof Exercise is a great Cause of the bloods growing acid and Slimy External accidents are often the Occasional Cause of the Kings Evil, but they always suppose a predisposition of the body to it in which Case we often see a blow Compression bruise wrench of the Hip Knee ancle or other Joint Produce an Inchylosisor what is vulgarly Called a White swelling which [cross out] [cross out] [cross out] [cross out]* If not properly Treated will soon produce a Spina-Ventosa* ][I cannot help observing that the application of Blisters or any other stimulant to those Kind of Tumor is Like Pouring Oil into the fire To [cross out] Extinguish it I should not have made this Remark were it not that [cross out] many of those who have applied to me wher deemd incurable from Different Hospital &- Practitioner; have been Treated as above, that is, the knee the Elbow ancle or whatever Joint [that] is affected with the White swelling the first application is a Blaster * A Caries or Rollennes of the Bone from sharp tumors 4 or some other Stimulant nay so [that have] have Informed me that they have gone so far as to have fourteen of those Plaster's applied as fast as it was possible; As soon as one was Healed another was applied Immedately . [Now I will leave any] [Practicioner to Judge if in the above case] which was the Case with one Now under my Care and after all was Turned out of [cross out] an Hospital Incurable; and I will venture to affirm that all Those stimulating applications Whethe Planters ointments Oils or what not of this Class, are administered with as little propriety as success; many having been ruined by it and as many sent to the Grave. 5 3rd. which is soon follow by visible symptoms [which are] alike the most of the Evil 3 [that is] that is glandulous tumors of the Neck &c in so much that author generally have Confirmed it to the [cross out] Neck alike for [in general] this part is the most commonly affected When Ever the Patient is strumous, and if the outward and more visible glands Remain whole yet generally speaking the inward ones, those Especially of the Mesentery, are Obstructed and swell'd Of this I have seen Divers Examples Especially in Children - Dr Sydenham in my opinion seems not to have had a Clear notion of this when he aserts that the swellings in Rickety Children are Occasioned by Repeated Cathartic's, for I make no Doubt if he had Examined accurately the Concatenated Glands in the neck [but] he would Have found those tumors [cross out] before any Cathartic had been Given; but [cross out] facts which must also determine this [cross out] any other original Effect will soon take from attachment to cause the theories - Conditions for Curing all Kinds of scropholous tumors on the Joints commonly called - White swellings - by G Roberts Apothecary & Man-midwife Bruport -- Although it cannot be denied that this Class of tumors have baffled the skill of the most Learned Physician ever since the days of Galen, Mr Roberts is Happy to say that He is able to Cure this Dreadfull disease in all its stages and as a proof the following Cures are inserted - It has been remarked by most medicinal writers [of] both ancient & modern that this Class of Tumors [have] baffled the Skill of the most renowned physicians [cross out] from Galen to the present time X Mr. Roberts has the satisfaction to say that (after an intense Application the Study of Pyhsic, he has at last found [cross out] out, how to cure this dreadful disorder in all its Stages [cross out] vulgar that the ignorant may not misguided vulgarts these Tumours are [generally] vulgarly termed [by the] while Swellings The TERMS of attending St. THOMAS's - HOSPITAL l. s. Dresser for a Year - 50 : 0 Ditto -for Half a Year - 31 : 10 Pupil - for a Year -25 : 4 Ditto - for Half a Year - 18 : 18 Fees - 1 : 2 The Physicians of St. Thomas's-Hospital have taken into Consideration the Necessity of the Surgeons Pupils being instructed in Medicine, as well as in Surgery, the Practice of most of them when they come into the Business being principally in Medicine, they have therefore been induced to come to a Resolution of admitting them into the Prescribing Rooms, so they mat be able to see and understand the Physicians Practice. The Terms are Five Guineas & half during their Attendance as Surgeons Pupils to St. Thomas's-Hospital [Turn over Giles Roberts - ℥ - 1 g 42 1 2 .. 10 Journyt Linds} &x Grenea } 4..0 49 " 11 rimam ---9 £ 50 - 0 The TERMS of attending the ANATOMICAL LECTURES For the First Course - 4 Guineas - the Second - 3 Guineas - the Third - 3 Guineas - the Fourth - 2 Guineas Each Gentleman who has attended four Course becomes a perpetual Pupil, without any additional Expence: Or, for seven Guineas paid at once the Subscriber becomes a perpetual Pupil, having the Right of attending the Lectures as long as he pleases. The TERMS of learning the Art of DISSECTING, INJECTING, and making ANATOMICAL PREPARATIONS. For a single Course - 3 Guineas For two Courses - 5 Guineas Perpetual Pupil - 13 Guineas For 12 Guineas paid at once the Subscriber becomes a perpetual Pupil to the Lectures, and a dissecting Pupil for four Courses. These belong to Dr. Roberts 1 the Use of the lever by Rob Bland M,D. taken from the Medicinal Communications Vol seccon published 1790 as it must necessarily happen that cases, out of the Reach of the forcepts must Occur where it would be Dangerous to Delay the delivery and where it would be barberous to have Recourse to the Crochet to assist in these Cases it is that an Instrument was wanted Easy in its application and powerfull in its Effect, such a one is the Lever which may be used with Equal safety and advantage when ever the Head in within its sphere of action; because the lever pressing upon the head of the Child in one point only on or near the basis of the Occipitis allows it to Extend itself in every other Direction so as to fill Equally and Intirely the cavity of the pelvis which when embraced by the two blades of the Forceps it is prohibited from Doing The cases in which the Lever may be advantageously employed have so near an affinity with those in which we are under the Necessity of Using the perforator and Crochet being often only shades or Degrees of the same Obstacle that it is frequently impossible to Determine with Certainty in the commencement of labour which Instrument it may be necessary to mark use of it therefore seems proper to consider the general progress of a Labour in that Class which is usually denominated laborious that is where the Child presenting with its head in protruded so slowly and with so much Difficulty that its own life as well as that of the Mother are imminant 2 imminant Danger and to prescribe a general method of conduction women through such difficult Labours A woman in labour is to be treated as if suffering pains so long as the os Uteri Either Remains thick rigid & close or after being a little open Does not go on to Dilateing, if she is hot and the vessells are full she must be blooded the bowels must be emptied by glysters small Doses of salts Castor Oil or some other fit aperient and at night a sufficient Dose of R Oppi should be given to procure sleep - and Rest, the Diet - in the mean time must be regulated and the air of the Room keept Cool and the woman must be admonished not to strain Dureing the pains but Leave them to Exert their natural forse and this process must be continued untill the Os Uteri and os externum are so relaxed as to admit Easily the passing of two or three fingers or the Hand if Necessary into the Vagina to Examine the situation of the Head of the Child and to explore the Capasity of [the head of the pelvis] the pelvis if the Head of the Child is found still Resting above the brim of the pelvis a portion of the scalp - only - or a verry small part of the bony casque, being thrust Down through that straight which is found to be preternaturally narrow the Os Sacrum projecting and approaching to Near the pubis there can be little hopes of a Child passing through - Alive under such Circumstances and through such a pelvis the soft parts of the woman are now prepared and the sooner we begin to Deliver by - opening the Head of the Child and Extracting it with the Crotchet with the greater sucess and advantage to the woman (whose safety is now alone to be Consulted with the Opperation be terminated 3 But if half or the major part of the skull has been forced through the brim of the pelvis and notwithstanding the continuance of the labor pains Remains wedged there making no progress, or only an almost insensible one for the space of four or five hours, in whatever position it may offer we meet proceed to Deliver with the Liver best by longer wasting the pains should flag cease, they strength of the woman be Exausted the Discharges from the Vagina should become putrid and acrid, and in fine Inflamation or fever takes place which afterwards it will be out of our power to Remove or prevent the Effects of but if we should begin to opperate before the periods I have Described, there would be danger of lacerating the perinæum and of bruising os Injuring the Vagina or the Uterus itself particularly if it be the first Child and this Danger will be greater when Useing the Force In then the [laver] lever but it may be asked are we in all Cases to proseed to Deliver with Instruments as soon as the parts of the woman are so far Relaxed as to afford a - passage to the Head of the Child how Long we may wait after this period, before there is Danger of Inflamation or some Dreadfull mischief, it is impossible by any first Rule to Determine as that will be verry different in Different Constitutions some women will bear the continuance of violent pain several Days without material mischief whilst others will be hurried into feavers, or convulsions at the end of a few hours only in generous with the first Children are soonest Injured and when the Head of the Child is pressed into the pelvis as to Deny egress to the Urine the Danger is Imminent, but will be sufficient to have pointed out when the Lever may be used or at what period it may be used with saftey 4 the practicioner will Determine in Each particular Case from his Knowledge of the Constitution of the patient & from the Circumstances before him, the Head of the Child being sufficiently to afford a reasonable hope of success with the Lever the woman is to be placed on her Left side as in a natural Labour when one or two fingers of the Right Hand must be Introduced between the pubis and the Head of the Child where ever there is most Room (which will be generally on one side of the symphysis of the pubic) with the Back of the finger to the pubis when the End of the Lever anointed with Lard must be Gradually insinuated between the Head of the Child and the [pubis] fingers with which also the Instrument must be guided untill it has passed the Os internum, then the fingers must be with Drawn and the Instrument will readily pass along untill it finds apart to rest upon which will generally be near or upon the mastoid process of the temporal bone or on the basis of the Os Occipitis, and according as the Head of the Child is more or less Obliquly situated in the pelvis or in other words, as the Occipites of the Child is nearer to, or farther from the pubes the stem of the Liver will Rest either against the pubes or the Ischium taking now the Handle of the Liver in his Right hand the Accoucheur must Dureing a pain Raise it gradually over the pubes and abdomen of the woman his left hand at the same time pressing Downe the middle of the Liver to which it affords a fulcrum thus preserving the parts immediately under the pubes from Injury on the pains ceasing he must Rest and renew his efforts [every succe] with each returning pain (which if tardy he may Excite by a slight motion of the Instrument while he finds 5 the head of the Child pushing out the perinæum which must be guarded and supported with the Left hand, now no longer wanted to press down the Center of the Lever Continuing to Rise the handle of the Lever with his Right hand untill the Head has so far - Entred the [pubis] the external passage that he is sure every obsticle to the Birth is removed when the Lever may be slowly withdrawn these directions must however be varied to suit the different positions in which the Head of the Child may might offer for when the Head of the Child presents Transversely one ear being the pubis and the other to the sacrum the Liver must be Introduced obliguely across the pubes passing it from that side of the pelvis to which the face is Directed to the opposite side, so that the point of the Lever may be made to Rest behind the Ear or upon the Occiput of the Child when the face of the Child presents, if the Chin points to the sacrum the Lever must be introduced in the manner already Directed either Immediately under the symphsis of the pubes or a Little to the Right or Left of it according as the face inclines Either way if the chin is turned to the pubes which is I believe most unusual position in face presentation or if the face is turned to the pubes the liver must be introduced along the sacrum in this position I should prefer the Liver with a large Curve, although in this case also I have succeeded with my common [cross out] Lever other positions in which the Head of the Child may present might be Described, but as they would require only a trifiling deviation from the Rules have laid Downe it seems not Necessary to mention them those who Desire a more particular Acct of them will be abundantly compensated by Cunsulting M. Herbiniaux's book on the subject, 6 from the above I think I am authorised to Conclude that the knowledge of the manner of employing the Liver may be acquired with greater Ease then that of the forceps and if the action of these two Instruments be Compared the pre-eminence of the Liver will be found to be still more Considerable and Obvious for the Liver touching the Head of the Child in one point only, neither alters its shape not offers any impediment to its making that turn which we always find it taking in a natural Labour the forceps on the Contrary by pressing the Meadow Each side and Diminishing it bulk in one Direction Increases it in the opposite and by being moved from blade to blade the only motion they admit without slipping. [cross out] Necessarilly alter the Route the Head should take when the Liver is used the perinaeum is pushed out in form of a tumor before the Os Externum is in the Least stretched as in a Natural Labour with the forceps the os Exturnum is stretched by the Junction of the two blades as soon as the Head begins to Descend and before it Enters the Hallow of the sacrum and enlarges the [pericanum] perinæum consequently much more skill and address is required in managing the forceps, to avoid Injuring the perinæum then in Useing the Lever I Could pursue the parallel farther but I think the above is sufficient to prove what I professed to show that considerable advantage will accrue from introduceing the Liver into general practice instead of the forceps.   Eau pour fortifier la vue - On fait dissoudre dans un demi litre d'eau de riviere ʒo centiq du sulfate de zinc (couperare blanche) et 1 gram ʒq centiq. De racine d'iris de florence en poudre On bouche la boutuile que l'on met dam un endroit frais. La preparation se trouve achinie apres, 24 heures; on la passe a travers de la saie; on l'emplaie en oineant l'ail dam un petit bassin dit ailleri rempli de cute eau Autre dite Eau de bluet. Cette eau est dit on tettemone favorable a la vue qu'on l'a surmonnie' casse lunetti Fleur de bluet avec leur calui 60 gram. On les broii et on les fait macere pendant 24 heures. Dans un litre d'eau, puis on fait distiller a un feu Desable maseri L'eau de bluet est regardie comme un excellent remede contre l'inflammation des paupieri, elle y joint la prapuité de fortifier la vue et d'emtallier le teint On l'emploii comme l'eau de zinc a'dessuer Matters of Propriety in attending labour when you are sent for to a labour go imeaditly and not wait to gain time. you got go into the room immediately be wait till you see the Nurse who will tell you wether the woman has stool or not or voided urine. discharge of water, &c tools with a Servicable and plecil [illegible] give home, examine the roin if there is a water close [illegible] eager withdraw to [illegible] her an apperenenity to [illegible] water dent be in a hurry in your examining yet will find pace will find they will set a [illegible], Leun Towel &c [illegible] is a kind to examine be caution how you give your opinion. satisfies yourself poat the [illegible] are true & what progress the state of laborer is in [illegible] of the Os Uterus now as the [illegible] advances the membranes protrude now when is it necessary for the membrance to break if when the [???] orifice is open about the size if half crown, if the membrane a tough they must be broken when the water is broken and the water discharged other a [illegible] first stage 2 Sage Stage, [Chi] expulun if the child after the water is broken the women will fall asleep for [the] four meants you your find the child natural a preternal Presentutun. [chound] Pent Examine uses distmas they will think the labour is very forward and not put them in the bed too soon now then [illegible] urine in a Natural labour that year can given [illegible] which is [illegible] the Periences. if the part the not must relax'd [illegible] back for a Laceration will [pred???] [y???] pust back the [me] [per???] never the fauce and that will [illegible] when the head is cut draw it gently cut, and apply a warm cloats. separate the Navel string but wait till it crip. [illegible] Catheter into the practice just under the root of the tongue and blow in to the trachies London Lon nd M then wall give you a cup the 2d stage of Naturals tubes Occurring of the Placenta observe th is not turns feel the [illegible] and using fever invert it a women died of bis force inverted Uterus pocket iiner ud if you find symptom hemorrhage &c the [illegible] [illegible] wind and attemp to medicalls to [re???] as the internal part of the Uterus to the seat of minuts ahis there is [illegible] aren from pasten the [delv????] gtt the Placenta Lond [illustration] [illustration]  Take two parts of mercury, one of zinc and one of tin: the zinc and the tin are to be fused and mixed together with the mercury; and the mixture agitated in a wooden box, internally rubbed with chalk. The mass is then to be reduced to a fine powder, and employed in that state, or mixed with grease; the effect of this amalgam is surprising; for by this means the power of electrical machines is inconceivably augmented.