A* 
v , , ' \ 
S E T T 
, I 4 - ’ . * ' 
OF 
ANATOMICAL TABLES, 
WITH 
EXPLANATIONS, 
AND A N 
ABRIDGMEN T, 
I 
N * \ 
OF THE 
PRACTICE of MIDWIFERY, 
With a View to illuftrate a 
TRE AT I S E 
On that SUBJECT, 
■ .n um 
A ND 
COLLECTION of CASES. 
By WILLIAM S M E L L I K M. D. 
LONDON: 
Printed in the Year MDCCLIV, P R E FACE 
AS in a longcourfe of teaching and practice in Midwifry, I hope I may without vanity fay, that 
I have done fomething towards reducing that Art, into a more fimple and mechanical method 
than has hitherto been done. I have attempted to explain the fame in my Treatife of the Theory 
and PraBice of Midwifry and ColleBion of Cafes, and finding that mofi of the reprefentations 
hitherto given of the parts infervient to Uterine geftation and parturition were in many refpeBs 
deficient, 1 have been induced to undertake the following Tables, with a view to fupply in fome 
meafure the defeBs of others, and at the fame time to illufirate what I have taught and written on 
the SubjeB. How far I have obtained thofe ends, it belongs to others to judge ; / fall only beg 
leave to obferve here by way of Preface, that the greatefi part of the figures were taken from 
SubjeBs prepared on purpofe, to few every thing that might conduce to the improvement of the young 
PraBitioner, avoiding however the extreme Minutiae, and what elfe feemed foreign to the prefent 
dejign ; the fituation of parts, and their refpeBive dimen(ions being more particularly attended 
to, than a minute anotomical invefiigation of their firuBure. 
As thefe Tables may pojfibly fall into the hands of fome who have not feen my former work 1 
have added an abridgment of the PraBice, which though far from being complete, may ferve to il- 
lufirate feveral things which otherwife by a bare reprefentation would be hardly intelligible. 
References are made to Vol. I, II, and 111. by Vol. 1.1 mean that which I firfi publifedin the year 
•1752, and contains a view of the Theory and PraBice of Midwifry, Vol. II. is the ColleBion of 
Cafes mentioned above juft publifioed-, and Vol. III. is a continuation of the fame, and is already 
far advanced. My firfi plan for thefe Tables confined them to the number of Twenty two, which 
Mr. Rymfdyke had finifed above two years ago ; but I foon faw that a further illuflration and 
iConfequently an addition to that number was neceffary. In eleven of thefe Dr. Camper Profeffor of 
Medicine at Franequer in Frielland, greatly afiified me, viz. Table XII, XVI, XVII, XVIII, XIX. 
XXIV, XXVI, XXVII, XXVIII, XXXIV, and XXXVI. The refi were drawn by Mr. Rymfdyke, 
except the thirty feventh and thirty ninth, which were done by another Hand. The whole of the Draw- 
ings are faithfully engraved by Mr Grignion, delicacy and elegance however has not been fo much con- 
futed as to have them done in a Jlrong and diflinB manner, with this view chiefly that from the 
cheapnefs of the work it may be rendered of more general ufe. Tab . I THE 
FIRST TABLE 
t » I 
Reprefents in a Front-View the Bones of a well formed Pelvis. 
A The five Vertebra of the Loins. 
B The Os Sacrum. 
C The Os Coccygis. 
D. The Off a Ilium. , 
E. E The OJfa Ifchium, •. ' 
F The OJfa Pubis. 
G The Foramina Magna. 
H.H The Jcetabula. 
l.I.I.I.T.l The Brim of the Pehis, or that circumference of its cavity, which is defcribed at the 
fides, by the inferior parts of the OJfa Ilium, and at the back and fore-parts, by the fuperior parts 
of the OJfa Pubis and Sacrum. 
In this Table befides the general ftructure and figure of the feveral Bones, the dimenfions of 
the Brim of the Pehis, and the diftance between the under parts of the OJfa Ifchium, are particularly 
to be attended to, from which it will appear that the cavity at the Brim is commonly wider from 
fide to fide, than from the back to the fore-part, but that the fides below are in the contrary pro- 
portion. The Reader, however, ought not from this to conclude, that every Pehis is fimilar in 
figure and dimenfions, fince even well formed ones differ in fbme degree from each other. In 
general, the Brim of the Pehis meafures about five inches and a quarter from fide to fide, and 
four inches and a quarter from the back to the fore-part; there being likewife the fame diftance 
between the inferior parts of the OJfa Ifchium. All thefe meafures, however, muft be underftood as 
taken from the Skeleton, for in the Subjetft, the cavity of the Pehis is confiderably diminifhed by 
its teguments and contents. Correfpondent alfo to this diminution the ufual dimenfions of the 
head of the full grown Foetus are but three inches and a half from ear to ear and four inches and 
a quarter from the fore to the hind-head. 
Vide Tab. XVI. XVII. XVIII. Alfo Vol. I. Chap. I. Se6h 1.2.3, where the form and dimen- 
fions of the Pehis, as well as of the Head of the Foetus, and the manner in which the fame is pro- 
truded in Labour through the Balin, are fully treated of. Confult likewife Vol. II. Col. 1. N° 1. 2. 
where Cafes are given of complaints of the Pehis arifing from difficult Labours. THE 
’ 
SECOND TABLE 
•r' 
Gives a lateral and internal View of the Pelvis, the fame being divided 
longitudinally. 
/ 
A The three lower Vertebra ofithe. Loins. 
B The Os Sacrum. • . 
C The Os Coccygis. ' ’ 
D The left Os Ilium. . 
E The left Os Ifchium. ■ . 
F The Os Pubis of the fame fide. , . 
■ G The Tuberolity of the Os Ifchium. - 
H The Foramen Magnum. 
I.I.I The Brim of the Pelvis. 
* 
This Plate Ihews the diftance from the fuperior part of the Os Sacrum to the OJfa Pubis, as well as 
from the laft mentioned Bones to the Coccyx, which in each amounts to about' four inches and a 
quarter. The depth likewife is Ihewn of the pofterior, lateral and anterior parts of the Pelvis, not 
in the line of the Body,. but in that of the Brim of the former, which is generally three times deeper 
on the pofterior than anterior part, and twice the depth of the laft at the fides. 
Prom this view appears alfo the Angle which is formed by the laft Vertebra of the loins and the fu- 
perior part of the Os Sacrum, as likewife the concavity or hollow fpace in the pofterior internal part of 
the Pelvis, arifing from the curvature of the laft mentioned Bone and Coccyx; the diftance from 
which to the pofterior parts of the OJfa Ifchium is finally here expreft. 
Vide Tab. XVI. XVII. XVIII. XIX. Alfo Vol. I. and II. as referred to in the former Table. TAB. 31. Tab .IE Pages [8]-[9] missing Tab . W. Tab.i T H E 
FIFTH TABLE. 
'FIGURE I. Gives a front View of the Uterus in Situ fufpended in the Vagina ; the anterior 
parts of the Off a Ifchium with the Off a Pubis, Pudenda, Perinaum, and Anus, being removed 
in order to Ihew the internal Parts. 
A The laid Vertebra of the Loins, 
B. The OJja Ilium 
C. The Acetabula. 
D. The inferior and pofterior parts of the OJfa Ifchium. Vide Table XXIX. where the OJfa Pubis and the anterior 
parts of the OJfa Ifchium are reprefented by dotted Lines. 
E The Part covering the Extremity of the Coccyx. 
F The inferior part of the Re&um. 
G. The Vagina cut open longitudinally and ftretched on each fide of the Collum Uteri, to fhew in what manner 
the Uterus is fufpended in the fame. 
H. Part of the Vefica Urinaria ftretched on each fide of the Vagina and inferior part of the Fundus Uteri. 
I The Collum Uteri. 
K The Fundus Uteri. 
L. The Tubes Tallopianee and Fimbricel 
M. The Ovaria. 
N. The Ligament a lata and rotunda* 
O. The fuperior part of the Return. 
FIGURE II. Gives a View of the internal Parts as feen from the right Groin, the Pelvis being 
divided longitudinally. 
' K+ f’*• ' _ . | ' - 
A The loweft Vertebra of the Loins. 
B.C The Os Sacrum and Coccyx. 
D The left Os Ilium. 
E The inferior part of left Os Ifchium. 
/ F The Os Pubis of the fame fide. 
G The Foramen Magnum. 
H The Acetabulum. 
I. The inferior Part of the Re&um and Anus. 
K The Os Externum and Vagina; the Os Uteri lying loofely in the fame. 
L The Vefica Urinaria. 
M.N The Collum and Fundus Uteri, with a View of the cavity of both. The attachment of the Vagina round the 
outfide of the Lips of the Mouth of the Womb is here likewife fhewn, as alfo the fituation of the Uterus, as it is 
preffed downwards and backwards by the Inteftines and Urinary Bladder, into the concave, and inferior part of the 
Os Sacrum. 
O The Ligamenta laca and rotunda of the left fide. 
P. The Fallopian Tube with the Fimbriee; and 
Ovarium of the fame fide. 
R.R The fuperior part of the ReElutn, and inferior part of the Colon. 
FIGURE III. Gives a front View of the Uterus in the beginning of the firft Month of Preg- 
nancy ; the anterior part being removed that the Embryo might appear through the Amnios, 
the Chorion being dilfecled off! 
, 
Yhe "pundus Uteri» 
B The Collum Uteri, with a View of the rugous Canal that leads to the Cavity of the Fundus. 
C The Ox Uteri* 
Vide Vol. I. Lib. I. Chap. 2. Sed. 2, 3. Vol. II. Coll. 3. THE 
SIXTH TABLE. 
FIGURE I. In the fame View and Se&ion of the Parts as in the flrft figure of the former 
Table, lhews the Uterus as it appears in the fecond or third Month of Pregnancy, it’s anterior 
part being here likewife removed. 
F The Anus 
G The Vagina with it’s Plica. 
H.H The pofterior and inferior part of the Urinary Bladder extended on each fide, the anterior and fuperior part be- 
ing removed. 
•1.1 The Mouth and Neck of the Womb, as raifed up when examining the fame by the touch, with one of the fingers 
in the Vagina. 
K.K The Uterus as ftretched in the fecond or third Month, containing the Embryo, with the Placenta adhering to the 
Fundus. 
• . r - ' 
It appears from this and the former Table that at this time nothing can be known, with refpedt to Pregnancy, from the touch 
in the Vagina, as the refiftance of the Uterus is fo iiiconfiderable that it cannot prevent it’s being raifed up before the finger ; 
and even were it kept down, the length of the Neck would prevent the ftretching being perceptible. The Uterus likewife 
not being ftretched above the Pelvis, little change is made as to the figure of the Abdojnen, further than that the Inteftines 
are raifed a little higher; whence poflibly the old Obfervation of the Abdomen being a little flatter at this Period than 
uiual from the Inteftines being prefled more to each fide. Women at this Period mifcarry oftner than at any other: it 
is a great happinefs however in Pra&ice that although they are frequently much weakened by large difcharges, yet they 
rarely fink under the fame, but are fooner or later relieved by Labour coming on, which gradually ftretches the Neck and 
Mouth of the Womb, by the Membranes being forced down with the Waters, and if the Placenta is feparated from the 
internal furface of the Uterus, all it’s contents are difcharged. But if the Placenta ftill adheres, the Membranes break, 
the Waters and Foetus are expelled, and the flooding diminifhes from the Uterus contracting clofe to the Secundines, 
which alfo are ufually difcharged fooner or later. 
From the ftruCture finally of the parts as reprefented in this and the former Table, it may appear that it is much 
fafer to reftrain the Flooding, and fupport the Patient, waiting with patience the efforts of Nature, than to endeavour to 
ftretch the Os Uteri and deliver either with the Hand or Inftruments, which might endanger a laceration and inflammation 
rof the parts. 
Vide C in Table XXXVII. alfo Vol. I. Lib. II. Chap. 2. Se£. 2, 3, 4. Vol II. Coll. 12. N°. 2. 
FIGURE II. Reprefents the Uterus in the fourth or fifth Month of Pregnancy, in the fame View 
and Section of the Parts with the former figure, excepting that in this the anterior part of 
the Collum Uteri is not removed. 
In the natural fltuation the Mouth and Lips of the Womb are covered with the Vagina, and thefe parts are contiguous 
to each other, but here the Vagina G is a little ftretched from the Neck and Lips of the former in order to fhew 
the parts more diftin&ly. , 1 The neck of the Womb, which appears in this figure thicker fhorter and fofter than in the 
former. K The inferior part of the Fundus Uteri, the ftretching of which canfometimes be felt through the Vagina by 
pufhing up a finger on the anterior or lateral part of the fame. 
The Uterus now is fo largely ftretched as to fill all the upper part of the Pelvis and begins alfo to increafe fo much 
as to reft on the Brim, and to be Supported by the fame, the Fundus at the fame time being raifed conftderably above 
the Pubes. From the Abdotnen being now more ftretched the Woman is more fenfible of her growing bigger, and the 
Uterus alfo from the counter-prefiure of the Contents and Parietes of the Abdomen is kept down and the Os Uteri prevented 
from rifing before the finger as formerly. In lean Women the ftretching of the Uterus can fometimes be perceived in 
the Vagina at this period as well as above the Pubes: but nothing certain can be difcovered from the refiftance or feel 
of the Mouth of the Womb or Lips which are commonly the fame in the firft Month’s of Pregnancy as before it. 
The ftze or bulk of the Foetus is finally here to be obferved with the Placenta adhering to the pofterior part of the 
LJterus. 
,Vide the references to Vol. I. and II. in the former Table.. Tab ,YT Tab.W THE 
SEVENTH TABLE 
Reprefents the Abdomen of a Woman opened, in the fixth or feventh 
Month of Pregnancy. 
A.A. A.A The Parietes of the Abdomen opened, and turned back to Ihew. 
B The Uterus. 
C.C.C The lnteflines raifed upwards. 
D The Labia Pudendi, which are fometimes affected in Pregnancy with Oedamatous fwellings, 
occafioned by the preffure of the Uterus upon the returning Veins, and Lymphatics. If the Labia 
are fo tumefied as to obltrucf the Patient’s walking, the complaint is removed by puncturing the 
parts affected. By which means the ferous fluid is difcharged for the prelent; but commonly recurs 
and the fame Operation muff be repeated feveral times perhaps before delivery, after which however, the 
tumefaction entirely fublides. Here it may be obferved that this complaint can feldom or never ob- 
ftruct delivery, as the Labia are fituated at the anterior part of the 0[fa Pubis, and can rarely 
affect the ftretching of the Franum, Perinaum, Fagina and ReBum. From this figure it appears 
that the ftretching of the Uterus can eafily be felt at this period in lean Subjects, through the Parietes 
of the Abdomen; efpecially if the lnteflines do not lie before it. In general indeed as the Uterus 
ftretches, it rifes higher, by which means the lnteflines are likewife raifed higher, and are alfo prefled 
to each fide. Hence the nearer the Woman is to her full time, the ftretching is the more eafily 
felt. 
.Vide Vol. I. Lib. I. Chap. 3. Sect, 3. Lib. III. Chap. 1. SeCt. 2. • and Vol, II. Coll. 12,13. 
- • • \ ' , .. , • , ” ' T H E 
£ I G H T H TABLE. 
In the fame View and Section of the parts as in Table VI. is reprefented 
the Uterus of the former Table, in order to (hew it s contents, and the 
internal parts as they appear in the fixth or feventh Month of Preg- 
nancy. 
A The Uterus ftretched up to the Umbilical Region. 
B B The fuperior part of the OJ[a Ilium. 
< C.C The Acetabula. 
D.D The remaining pofterior parts of the OJfa Ifchium. 
E The Anus. 
F The Vagina. 
G The Bladder of Urine. 
H The neck of the Womb fhorter than in Table VI. and raifed higher by the ftretching of the 
Uterus above the Brim of the Pelvis. 
I The Veflels of the Uterus larger than in the unimpregnated ftate. 
K The Placenta adhereing to the inferior and pofterior part of the Uterus. 
L.L The Membranes that furround the Fetus, the Head of which is here reprefented (as well as 
of thofe in Table VI.) lituated downwards at the inferior part of the Uterus, and which I am apt 
to believe is the ufual fituation of the Foetus, when at reft, and furrounded with a great quantity of 
Waters, as the Head is heavier than any other part. With refpeil to the fituation of the Body 
of the Foetus, tho’ the fore-parts are often turned towards the Tides and pofterior parts of the Ute- 
rus, they are here as well as in the foregoing Table reprefented at the anterior part or forwards, 
in order to.fhew them in a more diftinct, and picturefque manner. 
Vide Vol. I. Lib. I. Chap. 3. Seel. 3, 4. Vol. II. Coll. 13. N° 1. 
f 
From this Table may appear the difficulty of ftretching the Os Uteri in flooding Cafes, even 
at this period, from the length and thicknefs of the neck of the Womb, efpecially in 
a firft Pregnancy: much the fame method however is to be followed here as was directed in Table 
VI. ’till Labour comes on to dilate the Os Uteri. If the Flooding is then confiderable, the Mem- 
branes fliould be broken, that the Uterus may contrail, and thereby leflen the difeharge. The 
labour likewife if it is neceflary, may be aflifted by dilating the Os Uteri in time of the pains, 
which alfo, if wanting, may be provoked by the fame method when the Patient is in danger. If 
this danger is imminent and the Woman feems ready to expire, the Uterus as appears from this Ta- 
ble is at this time fufficiently ftretched to receive the Operator’s hand to extrail the Foetus, if the 
■ Os Internum can be fafely dilated. • 
Laftly, It may obferved that Women are in greater danger at this period and afterwards than in 
the former Months. 
Vide Vol. I. Lib. III. Chap. 4. Seit. 3. N° 1, 2, 3. Vol. II. Coll. 33. N° 2. See alfo in the 
Edinburgh Phylical and Literary Obfervations Art. XVII. The Difleition of a Woman with 
Child, by Dr. Donald Munro, Phyfician at London. tab.w. Tab. IX THE 
NINTH TABLE. 
In the fame View and Se&ion of the parts with the former, represents 
the Uterus in the eighth or ninth Month of Pregnancy. 
A The Uterus as ftretched to near its full extent, with the waters, and containing the Foetus 
intangled in the Funis, the Head prefenting at the upper part of the Pelvis. 
B. B The fuperior part of the OJfa Ilium. 
C. C The Acetabula. 
D. D The remaining pofterior parts of the OJfa Ifchium. 
E The Coccyx. - . 
F The inferior part of the ReBum. 
G.G.G The Fagina ftretched on each fide. 
H The Os Uteri, the lips of which appear larger and fofter than in the foregoing Table, the 
neck of the Womb being likewife ftretched to it’s full extent, or entirely obliterated. 
I.I Part of the Fefica Urinaria. 
K The Placenta at the fuperior and pofterior part of the Uterus. 
L The Membranes. 
M The Funis Umbilicalis. 
This and the foregoing Table lhew in what manner the Uterus ftretches, and how it’s neck grows 
ihorter, in the different periods of Pregnancy; as alfo the magnitude of the Foetus in order more 
fully to explain Yol. I. Lib. i. Chap. 3. Seel. 4, 3. alfo Lib. 3. Chap. 1. Seft. r, 2. likewife Vol. II. 
Coll. 13. N° 1. ' 
Notwithftanding it has been handed down as an invariable Truth, from the earlieft accounts of 
the Art, to the prefent times, that when the Head of the Foetus prefented, the face was turned to 
the pofterior part of the Pelvis, yet from Mr. Oulds Obfervation as well as from Ibme late Diflec- 
tions of the gravid Uterus, and what I myfelf have oblerved in P raft ice, I am led to believe that the 
Head prefents for the moft part as is here delineated, with one Ear to the Pubes, and the other to 
the Os Sacrum; tho’ fometimes this may vary according to the form of the Head, as well as that of 
the Pelvis. 
Confult Mr. Hunter's elegant Plates of the gravid Uterus. THE , 
TENTH TABLE 
Gives a front View of Twins in Utero, in the beginning of Labour, the 
anterior parts being removed as in the preceding Tables. 
> i 
A The Uterus as ftretched with the Membranes and Waters. 
B. The fuperior parts of the Op Ilium 
C. The Acetabula. 
D. The Offa Ifchium 
E The Coccyx. 
F The lower part of the Re Bum. 
G.G The Vagina. 
H The Os Internum ftretched open about a finger’s breadth with the Membranes and Waters in 
time of Labour pains. 
I.I The inferior part of the Uterus ftretched with the Waters which are below the Head of the 
Child that prefents. 
K. The two Placentas adhering to the pofterior part of the Uterus, the two Fatus’s lying be- 
fore them, one with it’s Head in a proper pofition, at the inferior part of the Uterus, and 
the other fituated prseternaturally with the Head to the Fundus: the Bodies of each are here en- 
tangled in their proper Funifes which frequently happens in the natural as well as preter- 
natural pofitions. 
L. The Membranes belong to each Placenta. 
This reprefentation of Twins, according to the Order obferved in myTreatifeof Midwifry, ought 
to have been placed among the laft Tables; but as that was of no confequence, I have placed it 
here in order to fhew the Us Uteri grown much thinner than in the former figure, a little open, 
and ftretched by the Waters and Membranes which are pulhed down before the Head of one 
of the Foetus’s in time of a Labour-pain. With refpecl to the pofition of Twins it is often dif- 
ferent in different Cafes; but was thus, in a late diflecftion of a gravid Uterus by Mr. Mackenzie. 
Vide Vol. I. Lib. 3. Chap. 1. Se6t. 4. and Chap. 3. Sect. 1. and Vol. II. Coll. 14. and Vol. III. 
Coll. 37. Tab.X rLu> .XI THE 
ELEVENTH TABLE 
Exhibits another front View of the gravid Uterus in the beginning of La- 
bour; the anterior parts being removed, as in the former Table; but 
in this the Membranes, not being broken, form a large bag containing 
the Waters and: Foetus. - * 
• 1 . t. s V .1- # 4 
o * - * f • f » * * • . ' 
* " * ' / * ’ r * * * . , 
• * - • • ‘ ' "* * - - >- * - . ■ . . .* _ i . . 
• • - • - ' ’• £ .. . . / „ . , ‘ , 
A The fubftance of the Uterus. 
B.B.C.C.D.D The Bones of the Pelvis. 
E The Coccyx. ■ - . • 
F The inferior part of the Rectum. 
G The Vagina. 
H,H The Mouth of the Womb largely ftretched in time of a pain, with I the Membranes and 
Waters. This Circumftance makes it ufually certain that Labour is begun, whereas from the 
degree of dilatation re prefented in the former Table there is little to be afcertained, unlefs the 
pains are regular and ftrong, the Os Uteri being often found more open feveral days and even 
weeks before Labour commences. 
K The Chorion. ■ . 
L The fame diflecled off at the inferior part of the Uterus, in order to fhew the Head of the 
Foetus through the Amnios. N. B. This Hint is taken from one of Dr. Albinufes Tables 
of the gravid Uterus. 
M The Placenta, the external convex furface of which divided into a number of Lobes, is here 
reprefented, it’s concave internal part being covered by the Chorion. 
;■ - ♦ * * * v r 
. . . .• * ' . ' v ' 'v’“ ‘ 
The Placenta has been found adhereing to all the different parts of the internal furface of the 
Uterus, and fometimes even over the inlide of the Os Uteri; this laft manner of adhelion however 
always occafions Floodings as foon as the fame begins to dilate. 
Tables VI. VIII. IX. X. fhew the internal furface of the Placenta towards the Foetus, with the 
Veffels compofing it’s fubftance proceeding from the Funis which is inferted, in different Placentas, 
into all the different parts of the fame, as well as in the middle. 
The Thirtieth and Thirty third Tables fhew the infertion of the Funis into the Abdomen of the 
Foetus. 
With refpect to the expulfion of the Placenta, when the Membranes break, the Uterus contradls 
as the Waters are evacuated ’till it comes in contrail with the Body of the Foetus: The fame 
being delivered, the Uterus grows much thicker and contrails clofely to the Placenta and Mem- 
branes by which they are gradually feparated, and forced into the Vagina. This fliews that we 
ought to follow the method wrhich nature teaches, waiting with patience, and allowing it to fepa- 
rate in a flow manner, which is much fafer praitice, efpecially when the Patient is weak; as the 
difcharge is neither fo great or fudden as when the Placenta is hurried down in the too com- 
mon method. But then we muff: not run into the other extreme, but aflift, when nature is not 
fuffxcient to expel the fame. 
Vide Vol. I. Lib. III. Chap. i. Seit. 4. Chap. 2: Seit. 2, 5* VoL II. Coll. 14, 23. THE 
TWELFTH TABLE 
Shews (in a lateral View and longitudinal Divilion of the Parts) the gravid 
■ Uterus, when Labour is fomewhat advanced. 
A The loweft Vertebra of the Back. 
B The Scrobiculus Cordis, the diftance from which to the laft mentioned Vertebra is here lhewn 
by dotted lines; as alfo part of the Region below the Diaphragm. 
C. The ufual thicknefs and figure of the Uterus when extended with the Waters at the latter 
end of Pregnancy. 
D. T hefame contracted and grown thicker after the Waters are evacuated. 
E. The figure of the Uterus when Pendulous. In this Cafe if the Membranes break when the 
Patient is in an erect pofition, the Head of the Foetus runs a risk of Hiding over and above 
the 0(fa Pubis, whence the Shoulders will be pufhed into the Pehis. 
E.F The figure of the Uterus when ftretched higher than ufual, which generally occafions 
Vomitings and Difficulty of Breathing. Confult on this Subject Mr. Levret fur le Mecha- 
nifme de differentes Grofiefles. 
G The Os Pubis of the left Side. 
H.H The Os Internum. 
I The Vagina. 
K The left Nympha. 
L The Fabium Pudendi of the fame fide. 
M The remaining portion of the Bladder. 
N The Anus. 
O.P The left hip and thigh. 
In this Period of Labour the Os Uteri being more and more ftretched by the Membranes pulhing 
down, and beginning to extend the Vagina, a great quantity of Waters is forced down at the lame 
time, and (if the Membranes break) are difcharged ; whence the Uterus contrails itfelf nearer to 
the body of the Foetus, which is here reprefented in a natural pofition with the Vertex refting at 
the fuperior part of the OJfa Pubis and the forehead towards the right Os Ilium. As foon as the 
Uterus is in contact with the body of the Foetus, the Head of the lame is forced backwards to- 
wards the Os Sacrum from the line of the Abdomen B.G into that of the Pehis, viz. from the 
uppermoft F to the near end of the Coccyx, and is gradually pulhed lower as in the following Table. 
If the Membranes do not break immediately upon their being pulhed into the Vagina, they 
Ihould be allowed to protrude Hill further in order to dilate the Os Externum. 
Vide Vol. I. Lib I. Chap. 2. Seif. 2. Chap. 3. Seif. 3. Lib. III. Chap. 1. Seif. 1, 2, 4. 
Chap. 2. Seif. 3. Chap. 3. Seif. 4. N°. 3. Vol. II. Coll. 10. N°. 4. Cafe 3, 4. Coll. 14. Vol. III. 
Coll. 34. N°. 2. Cafe 4. Tab. Ill Tab.JIIL THE 
THIRTEENTH TABLE. 
In the fame View and Section of the parts as in Table VI. (hews the na- 
tural pofition of the Head of the Foetus when funk down into the 
middle of the Pelvis after the Os Internum is fully opened, a large 
quantity of the Waters being protruded with the Membranes through 
the Os Externum, but prevented from being all difcharged, from the Heads 
filling up the Vagina. 
A The Uterus a little contra&ed, and thicker from fome of the Waters being funk down before 
the Child or difcharged. 
B.B The fuperior parts of the Off a Ilium. 
C The inferior part of the Re Hum. 
D. The Vagina largely ftretched with the Head of the Foetus. 
E. The Os Internum fully opened. 
F A portion of the Placenta. 
G. The Membranes. 
H. The Ligamenta lata. 
I I The Ligamenta rotunda. Both thefe laft ftretched upwards with the Uterus. 
The Fertex of the Foetus being now down at the inferior part of the right Os Ifchium, and the 
wide part of Head at the narrow and inferior part of the Pehis, the forehead by the force of the 
pains is gradually moved backwards, and as it advances lower, the Fertex and Occiput turn out be- 
low the Pubes, as in the next Table. Hence may be learnt of what confequence it is to know, 
that it is wider from lide to fide at the Brim of the Pehis, than from the back to the forepart, and 
that it is wider from the fore to the hind Head of the Child, than from Ear to Ear. 
Fide Vol. I. Lib. I. Chap. i. Se6t. 3, 3. alfo Lib. III. Chap. 3. Seel. 3,4. N° 3. Vol. 2. Coll. 14. THE 
FOURTEENTH TABLE. 
In a fimilar View and Section of the Parts with Table XII. ftiews the forehead of the Foetus 
turned, in it’s progreflion downwards, from it’s pofition in the former Table, backwards to the 
Os Sacrum, and, the Occiput below the Pubes, by which means the narrow part of the Head is 
to the narrow part of the Pehis, that is, between the inferior parts of the OJfa Ifchium. Hence 
it may be obferved, that though the diftance between the inferior parts of the laft mentioned Bones 
is much the fame, as between the Coccyx and Pubes, yet as the Cavity of the Pehis is much fhal- 
lower at the anterior than lateral part, the Occiput of the Foetus, when come down to the inferior 
part of either Os lfchii, turns out below the Pubes; this anfwers the fame end as if the Pehis 
itfelf had been wider from the pofterior part than from fide to fide; the Head likewife enlarging the 
Cavity by forcing back the Coccyx, and pulhing out the external parts in form of a large Tumor, as 
is more fully defcribed in the following Table. 
Vide Vol. I, II. as referred to in the preceding Table. 
» 
A The Uterus contra&ed clofely to the Foetus after the Waters are evacuated* 
B.C.D The Vertebra of the Loins, Os Sacrum and Coccyx. 
E The Anus. 
F The left Hip. 
G The Perinaum. 
H The Os Externum beginning to dilate. 
I The Or Pubis of the left fide. 
K The remaining portion of the Bladder. 
L The pofterior part of the Os Uteri. TabUT. Tab.XV. THE 
v 
FIFTEENTH TABLE 
\ g ■ • 
Is intended principally to (hew in what manner the Perinceum, and exter- 
nal parts are ftretched by the Head of the Foetus, in a firft pregnancy, 
towards the end of Labour. 
A The Abdomen. 
B The Labia Pudendi. 
C The Clitoris, and its Praputium. 
D The hairy fcalp of the Foetus fwelled at the Vertex, in a laborious cafe, and protruded to 
the Os Externum. 
E.F The Perinaum and Anus pufhed out by the head of the Foetus in form of a large Tumor. 
G.G The parts that cover the Tuberojities of the OJfa Ischium. 
H The part that covers the Os Coccygis. 
The Perineum in this figure is ftretched two inches, or double its length in the natural ftate ; 
but when the Os Externum is fo much dilated by the head of the Foetus as to allow the delivery of 
the fame, the Perinceum is generally ftretched to the length of three and fometimes four inches. 
The Anus is likewife lengthened an inch, the parts alfo between it and the Coccyx being much dif- 
tended. All this ought to caution the young Practitioner never to precipitate the delivery at this 
time, but to wait, and allow the parts to dilate in a flow manner, as from the violence of the La- 
bour-pains the fudden delivery of the head of the Foetus might endanger the laceration of the parts. 
The palm of the Operator’s hand ought therefore to be prefled againft the Perinceum, that the 
head may be prevented from palling till the Os Externum is fufficiently dilated, to allow its de- 
livery without tearing the Frenum, and parts betwixt that and the Anus, which are at this time 
very thin. 
Vide Vol. I. Lib. III. Chap. 2. Se£t. 2. Chap. 3. Se£t 4, N°i, and Lib. 4. Chap. 1. Seel. 1. 
alfo Vol. II. Coll, 14, 24, Vol. Ill Coll. 4a THE 
SIXTEENTH TABLE 
And the three following Ihew in what Manner the Head of the Foetus is helped along with the For- 
ceps as artificial Hands, when it is neceflary to aflift with the fame for the fafety of either Mother 
or Child. In this Table the Head is reprefented as forced down into the Pelvis by the Labour- 
pains, from it’s former Polition in Table XII. 
A.A.B.C The Vertebra of the Loins, Os Sacrum and Coccyx. 
D The Os Pubis of the left fide. 
E The remaining part of the Bladder. 
F. The Inteftinum ReBunu 
G. The Uterus. 
i-HThe Mons Veneris. 
I The Clitoris with the left Nympha* * 
X The Corpus Cavernofum. 
V.The Meatus Urinarius. 
K The left Labium Pudendi. 
L The Anus. 
N The Perinceum. * 
P The left Hip and Thigh. , 
QJR. The Skin and mufcular part of the Loins. # 
,The Patient in this Cafe may be as in this Table on her Side with her Breech a little over the fide or foot of the Bed, her 
Knees being likewife pulled up to her Belly, and a Pillow placed between them, care being taken at the fame time that the parts 
are by a proper covering defended from the external air. If the hairy Scalp of the Foetus is fo fwelled that the fituation 
of the Head cannot be diftinguifhed by the Sutures as in Table XXI, or if by introducing a finger at the Pubes or Groinsy 
the Ear or back part of the neck cannot be felt, the Os Externum muft be gradually dilated in the time of the pains 
with the Operators fingers (previoufly lubricated with hogslard) till the whole hand can be introduced into the Vagina 
and flipped up in a flattifti form between the pofterior part of the Pelvis and Child’s Head. This laft is then to be railed 
up as high as is poflible to allow room for the fingers to reach the Ear and pofterior part of the neck. When the po- 
fition of the Head is known, the Operator muft withdraw his Hand, and wait to fee if the ftretching of the parts will 
renew or increafe the Labour-pains, and allow more fpace for the advancement of the Head in the Pelvis. If this how- 
ever proves of no effect, the fingers are again to be introduced as before, and one of the Blades of the Forceps (lubri- 
cated with lard) is then to be applied along the infide of the hand or fingers, and left Ear of the Child as reprefented in 
the Table. But if the Pelvis is diftorted, and projects forward at the fuperior part of the Os Sacrum, and the forehead 
therefore cannot be moved a little backwards in order to turn the Ear from that part of the Pelvis which prevents the 
End of the Forceps to pafs the fame, in that cafe I fay, the Blade muft be introduced along the pofterior part of the Ear 
at the fide of the diftorted bone. The hand that was introduced is then to be withdrawn and the Handle of the intro- 
duced Blade held with it as far back as the Perinceum will allow, whilft the fingers of the other hand are introduced 
to the Os Uteri, at the Pubes or right Groiny and the other Blade placed exactly oppofite to the former. This done the 
Handles being taken hold of and joined together, the Head is to be pulled lower and lower every pain till the Vertex, 
as in this Table, is brought down to the inferior part of the right IJchiumy or below the fame. The wide part of the 
Head being now advanced to the narrow part of the Pelvis betwixt the Tuberofities of the OJfa Ifchium it is to be turned 
from the left Ifchium out below the Pubes, and the forehead backwards to the concave part of the Os Sacrum and Coccyx, as 
in Table XVII. and afterwards the Head brought along and delivered as in Table XVIII. and XIX. But if it is found 
that the delivery will require a confiderable degree of force from the Head’s being large or the Pelvis narrow, the handles 
of the Forceps are to be tied together with a Fillet as reprefented in this Table, to prevent their pofition being changed, 
whilft the Woman is turned on her back as in Table XXIV. which is then more convenient for delivering the Head than 
when lying on the fide. 
This Table fhews that the handles of the Forceps ought to be held as far back as the Os Externum will allow, that the 
Blades may be in an imaginary line between that and the middle fpace between the Umbilicus and the Scrobiculus Cordis. 
When the Forceps are applied along the Ears and Sides of the Head, they are nearer to one another, have a better hold, 
and mark lefs than when over the Occiputal and Frontal Bones. 
Vide Vol. I. Lib, III. Chap. 3. from Sed. 1. to 6. and Vol. II, Coll, 25, 26, 27, and 29. Tab XVI Tab.IM THE 
SEVENTEENTH TABLE. 
In the fame View with the former reprefents in out lines the Head of the 
Foetusbrought lower with the Forceps, and turned from the pofition in 
the former Table, in imitation of the natural progreffion by the Labour- 
pains, which may likewife be fuppofed to have made this turn, before 
it was neceflary to affift with the Forceps, this neceffity at laft arifing 
from many of the caufes mentioned in Vol. I. 
: , • \ 
* v 
In this View the pofition of the Forceps, along the Ears and narrow part of the Head, is more 
particularly exprefled. It appears alfo that when the Vertex is turned from the left Os Ifchium, 
where it was clofely confined, it is difengaged by coming out below the Pubes, and the forehead 
that was prelfed againft the middle of the right Os Ifchium, is turned into the concavity of the Os 
Sacrum and Coccyx. By this means the narrow part of the Head is now between the Offa Ifchium, 
or narrow part of the Pelvis, and as the Occiput comes out below the Pubes, the Head pafles Hill 
eafier along. When the Head is advanced fo low in the Pelvis, if the pofition cannot be diftin- 
guilhed by the Sutures, it may for the moll part be known by feeling for the back part of the neck 
of the Foetus, with a finger introduced betwixt the Occiput and Pubes, or towards one of the Groins. 
If the Head is fqueezed into a longilh form as in Table XXI. and has been detained many hours in 
this pofition, the pains not being fufficient to compleat the delivery, the afliftance of the Forceps 
mull be taken to fave the Child tho’ the Woman may be in no danger. But if the Head is high up 
in the Pelvis, as in the former Table, the Forceps ought not to be ufed except in the moll urgent 
neceffity. 
This Table alfo Ihews that the handles of the Forceps are ftill to be kept back to the Perinaum, 
and when in this pofition are in a line with the upper part of the Sacrum, and if held more backwards, 
when the Head is a little higher, would be in a line' with the Scrobiculus Cordis. If the Forceps 
are applied when the Head is in this pofition, they are more eafily introduced when the Patient is in a 
fupine pofition, as in Table XXIV. Neither is it neceflary to tie the handles, which is only done 
to prevent their alteration when turning the Woman from her fide to her back. 
As I have had feveral Cafes where a longer fort of Forceps that are curved upwards are of great 
ufe to help along the Head, when the Body is delivered firft as in Table XXXV. the lame are re- 
prefented here by dotted lines. They may be ufed in laborious Cafes as well as the others, but 
are not managed with the fame eafe. 
Moll of the parts of this Table being marked with the lame letters as the former, the defcriptions 
there given will anfwer in this, except the following. 
L. The Anus. 
M. The Perineum. 
O The common Intiguments of the Abdomen. 
R The Ihort Forceps. , T , 
S The long curved Forceps, the firft of thefe is a eleven Inches long, and the lalt twelve Inches 
and a half, which I have after feveral alterations found fufficient, but this need not confine 
others who may choofe to alter them from this llandard. Vide Table XXXVII. THE 
' - t . \k , ' ■. ‘ 1 • ‘ \ 
El GHTEENTH TABLE 
/ 
In the fame View and Section of the parts, Ihews the Head of the Foetus 
in the fame pofition; but brought lower down with the Forceps than in 
the former Table, for in this the Os Exteruum is more open, the Occi- 
put come lower down from below the Pubes, and the forehead paft the 
Coccyx, by which both the Anus and Perinawn are ftretched out in form 
of a large Tumor as in Table XV. , 
When the Head is fo far advanced, the Operator ought to extract with great Caution, left the 
parts fhould be torn. If the Labour-pains are fufticient, the forehead may be kept down, and helped 
along in a flow manner by prefling againft it with the fingers on the external parts below the Coccyx: 
at the lame time the Forceps being taken off, the Head may be allowed to ftretch the Os Externum 
more and more in a gradual manner, from the force of the Labour-pains, as well as afliftance of the 
fingers. But if the former are weak and infufficient the afliftance of the Forceps muft be conti- 
nued. Vide the defcription of the parts in Table XVI. S.T in this reprefent the left fide of the Os 
Uteri. The dotted lines demonftrate the fituation of the Bones of the Pelvis on the right fide, and 
may ferve as an Example for all the lateral Views of the fame. 
Vide Vol. I. Lib. III. Chap. a. Vol.II. Collett «, T,A3.jm Tab. XIX THE 
NINETEENTH TABLE. 
In the fame View and Section of the Pelvis, is intended by out lines to 
(hew that as the external parts are ftretched, and the Os Externum is di 
lated, the Occiput of the Foetus rifes up with a femicircular turn from out 
below the Pubes, the under part of which bones are as an Axis or Fulorum, 
on which the back part of the neck turns, whilft at the fame time, the 
Forehead and Face in their turn upwards, diftend largely the parts be- 
tween the Coccyx, and Os Externum. This is the method obferved by Na- 
ture in ftretching thefe parts in Labour, and as nature is always to be imi- 
tated, the fame method ought to be followed, when it is neceflary to 
help along the Head with the Forceps. 
Vide the three former Tables for the Defcriptions, and References. THE 
TWENTIETH TABLE. 
# 
„ * " . > 
In the fame Section of the parts, but with a View of the right fide; (hews 
the Head of the Foetus in the contrary pofition to the three laft figures, 
the Vertex being here in the Concavity of the Sacrum, and the Forehead 
turned to the Pubes. 
. ... { 
A.B The Vertebra of the Loins, Os Sacrum and Coccyx. 
C The Os Pubis of the right lide. 1 - ' 
D The Anus. 
E The Os Externum not yet begun to ftretch. 
F The Nympha. . 
G The Eabium Pudendi of the right fide. 
H The Hip and Thigh. 
I.I The Uterus contracted the Waters being all difcharged. 
When the Head is fmall, and the Pelvis large, the Parietal boms and forehead will, in this Cafe, 
as they are forced downwards by the Labour-pains, gradually dilate the Os Externum, and ftretch 
the parts between that and the Coccyx in form of a large Tumor, as in Table XV. till the Face comes 
down below the Pubes, when the Head will be fafely delivered. But if the fame be large and the 
Pelvis narrow, the difficulty will be greater, and the Child in danger; as in the following Table. 
Vide Vol. L Chap. 2. Lib.III. Sed. 3. Vol. II. Coll i<5. N° 2. Tab. XX Tab..XXI THE 
TWENTY-FIRST TABLE 
t 
• i - - • f - ’ • * k 
Shews the Head of the Foetus in the fame pofition as in the former Table, but being much larger, it 
is by ftrong Labour-pains fqueezed into a longilh form with a Tumor on the Vertex, from the long 
compreflion of the Head in the Pelvis. If the Child cannot be delivered with the Labour-pains, 
or turned and brought footling, the Forceps are to be applied on the Head as defcribed in this fi- 
gure, and brought along as it prefents; but if that cannot be done without running the rifque of 
tearing the Perinaeum, and even the Vagina and Re Bum of the Woman, the Forehead mull be 
turned backwards to the Sacrum. To do this more effectually the Operator mull grafp firmly 
with both Hands the handles of the Forceps, and at the fame time pulhing upwards raife the 
Head as high as poflible, in order to turn the Forehead to one fide, by which it is brought 
into the natural pofition; this done the Head may be brought down and delivered as in Table 
XVI. &c. 
Vide Vol. I. Lib. III. Chap. 3. SeCt. 4. N° 2. and Vol. II. Coll. 28. alfo the former Table for 
the Defcription of the parts except 
K The Tumor on the Vertex. The fame compreflion and elongation of the Head as well as the 
Tumor on the Vertex, may be fuppofed to happen in a greater or lefs degree in the XVI. 
XVII. XVIII. XIX. Tables as well as in this, where the Difficulty proceeds from the Head be- 
ing large or the Pelvis narrow. Vide Table XXVII. and XXVIII. 
L The Forceps. Sometimes the Forehead maybe moved to the natural pofition by the afifi- 
tance of the Fingers or only one Blade of the Forceps. The Forceps may either be the 
ftraight kind, or fuch as are curved to one fide, when it is neceffary to ufe one or both 
Blades. ' 
M The Vefica Urinaria much diftended with a large quantity of Urine from the long preffure of 
the Head againft the Urethra which fhews that the Urine ought to be drawn off with a 
Catheter in fuch extraordinary Cafes before you apply the Forceps, or in preternatural Cafes, 
where the Child is brought footling. 
N The under part of the Uterus. 
0.0 The Os Uteri. THE 
I "* 
l 
TWENTY-SECOND TABLE 
i 
' #" 
Shews in a front View of the parts, the Forehead of the Firms presenting 
at the Brim of the Pelvis, the Face being turned to one fide, the Fonta- 
nel le to the other, and the Feet and Breech ftretched towards the Fundus 
Uteri 
S' • ' . ' . % 
A.A The fuperior part of the OJfa Ilium. 
B The Anus. 
C The Perinaum. 
D The Os Externum, the thicknefs of the pofterior part before it is ftretched with the Head of 
the Child. 
E.E.E The Vagina. 
F The Os Uteri not yet fully dilated. 
G.G.G The Uterus. 
H The Membrana Adipofa. , 
If the Face is not forced down, the Head will fometimes come along in this Manner, in which 
Cafe the Vertex will be flattened, and the Forehead railed in a conical form, and when the Head 
comes down to the lower part of the Pehis, the Face or Occiput will be turned from the fide, 
and come out below the Pubes. But if the Head is large and cannot be delivered by the pains, 
or if the wrong pofition cannot be altered, the Child mult, if poflible, be brought footling, or de- 
livered with the Forceps. 
Vide Vol. I. Lib. III. Chap. 2. Se6t. 3. Chap. 3. Se& 4. N°. 3. Vol. II. Coll. id. N°. 4. Coll. 28. Tab.XXII Tab.IXUE THE 
T W E N T Y-T HIRD TABLE 
Shews in a lateral View the Face of the Child prefenting, and forced 
down into the lower part of the Pelvis, the Chin being below the Pu- 
bes, and the Vertex in the Concavity of the Os Sacrum: the Waters like- 
wife being all difcharged, the Uterus appears clofely joined to the Body 
of the Child, round the Neck of which is one circumvolution of the 
Funis. 
A.B The Vertebra of the Loins, Os Sacrum, and Coccyx. 
C The Os Pubis of the left fide. 
D The inferior part of the Reffium. 
E The Perinaum. ' 
F The left Labium Pudendi. 
G.G.G The Uterus. 
When the Pelvis is large, the Head, if fmall, will come along in this pofition, and the Child 
be faved: for as the Head advances lower, the Face and Forehead will ilretch the parts between 
the Franum Labiorum and Coccyx in form of a large Tumor. As the Os Externum likewife is di- 
lated, the Face will be forced through it, the under part of the Chin will rife upwards over the an- 
terior part of the Pubes, and the Forehead, Vertex, and Occiput turn up from the parts below. If 
the Head however is large, it will be detained either when higher or in this polition. In this cafe, 
if the pofition cannot be altered to the natural, the Child ought to be turned, and delivered foot- 
ling. If the Pelvis however is narrow, and the Waters not all gone, the Vertex, Ihould, if poffi- 
ble, be brought to prefent; but if the Uterus is fo clofely contracted, that this cannot be effected, 
on account of the ftrong prelfure of the fame, and Ilipperinels of the Child’s Head, in this cafe the 
Method directed in the following Table is to be taken. THE 
TWENTY-FOURTH TABLE 
Reprefents in the lateral View, the Head of the Foetus, in the fame porti- 
on as in the former Table; but the delivery is fuppofed to be retarded 
from the largenefs of the Head, or a narrow Pelvis. 
,i 
In this cafe, if the Head cannot be raifed, and puflied up into the Uterus, it ought to be deliver- 
ed with the Forceps, in order to fave the Child. This pofition of the Chin to the Pubes is one of 
the fafeft cafes, where the Face prefents, and is moft eafily delivered with the Forceps, the manner 
of introducing of which over the Ears is lhewn in this Table. The Patient muft lie on her Back 
with her Breech a little over the Bed, her Legs and Thighs being fupported by an afliftant fitting 
on each fide. After the parts have been flowly dilated with the Hand of the Operator, and the 
Forceps introduced, and properly fixed along the Ears of the Child, the Head is to be brought down 
by degrees, that the parts below the Os Externum may be gradually ftretched: The Chin then is to 
be raifed up over the Pubes, whilft the Forehead, Fontanelle, and Occiput are brought out flowly 
from the Perinoeum and Fundament to prevent the fame from being hurt, or lacerated. But if the 
Foetus can neither be turned, nor extracted with the Forceps, the delivery muft be left to the La- 
bour-pains, as long as the. Patient is in no danger, but if danger is apparent, the Head muft be 
delivered with the curved Crotchets. Vide Table XXXIX. 
When the Face prefents, and the Chin is to the fide of the Pelvis, the Patient muft lie on her 
fide, and after the Forceps is fixed along the Ears, the Chin is to be brought down to the lower 
part of the Os Ifcbium, and then turned out below the Pubes, and delivered in a flow manner as 
above. 
Vide Vol. II. Coll 16. N°. 6. as alfo Table XVI. XVII. XVIII. and XIX. for the Defcription of 
the parts. Tab.XXIF Tab.XXV. THE 
TWENTY-FIFTH TABLE 
' * i '. 
Shews in a lateral View of the right fide, the Face of the Foetus, prefent- 
ing as in Table XXIII. but in the contrary pofition, that is, with the 
Chin to the Os Sacrum, and the Bregma to the Pubes, the Waters evacu- 
ated, and the Uterus contracted. 
A The Os Externum not yet begun to ftretch. 
B The Anus. Vide Table XX. for the further Defcription of the parts. 
In fuch cafes as well as in thofe of the laft mentioned Table, if the Child is fmall, the Head will 
be pufhed lower with the Labour-pains, and gradually ftretch the lower part of the Vagina, and 
the external parts, by which means, the Os Externum will be more and more dilated, ’till the Ver- 
tex comes out below the Pubes,zxA rifes up on the outfide; in which cafe the delivery is then the fame, 
as in natural Labours. But if the Head is large, it will pals along with great Difficulty, whence the 
Brain, and veflels of the Neck will be fo much comprefled and obftru&ed, as to deftroy the Child. 
To prevent which, if called in time, before the Head is far advanced in the Pelvis, the Child 
ought to be turned and brought footling. If the Head however is low down, and cannot be turned, 
the delivery is then to be performed with the Forceps, either by-bringing along the Head as it pre- 
lents, or as in the following Table. See the References in the preceeding Table. THE 
TWENTY-SIXTH TABLE 
Reprefents by outlines in a lateral View of the left fide of the Subject, 
the Foetus in the fame fituation as in the former Table. 
The Head here is fqueezed into a very oblong form, and though forced down fo as fully to di- 
late the Os Externum, yet the Vertex and Occiput cannot be brought fo far down, as to turn out 
from below the Pubes, (as in the foregoing Table) without tearing the Perineum, and Anus as 
well as the Vagina and Reffum. 
The belt method in this cafe, after either the lhort, or long curved Forceps have been applied a- 
long the Ears (as reprefented in the Table) is to pulh the Head as high up in the Pehis as is pof- 
fible, after which the Chin is to be turned from the Os Sacrum to either Os Ifchium, and after- 
wards brought down to the inferior part of the laft mentioned Bone. This done the Operator 
muft pull the Forceps with one Hand, whilft two fingers of the other are fixed on the lower part 
of the Chin or Under-jaw, to keep the Face in the middle, and prevent the Chin from being de- 
tained at the Os IJchium, as it comes along, and in this manner move the Chin round with the 
Forceps, and the above fingers, ’till brought under the Pubes, which done the Head will be ealily 
extracted as in Table XXIV. 
If before afliftance has been called, the Head is fo fqueezed down into the Pehis, that it is im- 
poflible to move the Chin from the Sacrum to either Os Ifchium, (o as to deliver with the Forceps 
for the fafety of the Child, the Operator muft wait with patience, as long as the Woman is not in 
danger, or there is no certainty of the death of the Foetus: But if the patient runs the leaft rifque, 
the Head muft be delivered with the Crotchet. 
In general with refpecl to the pofture of the Woman in the application of the Forceps, when 
the Ears are to the fides of the Pehis, the Forceps as was obferved in Table XXIV. are moft ea- 
fily introduced when the Patient lies upon her Back, and her Breech over the fide of the Bed; 
but when the Ear is to the Pubes or Groin, they are better applied when the Patient lies on her 
fide, as was obferved in the cafes where the V?rtex prefented. 
Vide Table XXIV. for the Defcription of the parts and the References, alfo Table XXXIX. 
for the manner of uling the Crotchet. Tab .XXVI. Tab .XXVII. THE 
TWENTY-SEVENTH TABLE 
Gives a lateral internal View of a diftorted Pelvis, divided longitudinally, 
with the Head of a Foetus of the feventh Month palling the fame. Vide 
the explanation of Table III. 
A.B.C The Os Sacrum and Coccyx. 
D The Os Pubis of the left fide. 
E The Tuberojity of the Os Ifchium, of the fame fide. 
The Head of the Foetus here though fmall, is with Difficulty fqueezed down into the Pehis, and 
changed from a round to an oblong form, before it can pals, there being only the fpace of two 
Inches and one quarter between the projection of the fuperior part of the Sacrum, and the OJfa Pu- 
bis. If the Head is foon delivered, the Child may be born alive: but if it continues in this manner 
many Hours, it is in danger of being loft, on account of the long Preflure on the Brain. To pre- 
vent which if the Labour-pains are not fufficiently ftrong, the Head may be helped along with the 
Forceps, as directed in Table XVI. 
This figure may ferve as an example of the extreme degree of diftortion of the Pehis, between 
which and the well formed one, are many intermediate degrees, according to which the Difficulty 
of Delivery muff: increale, or diminilh, as well as from the Difproportion of the Pehis and Head 
of the Foetus; all which cafes require the greateft Caution, both as to the management, and fafety 
of the Mother and Child. 
Vide Vol. I. Lib. III. Seel. 3. N°. 5. Chap. 3. Sed. 4. N°. 3. Vol. 2. Coll. 21. N°. 1. and Coll. 
29. THE 
— • . , • 
TWENTY-EIGHTH TABLE 
- - * * . W" * / * *. 
Gives a fide View of a diftorted Pelvis, as in the former Table, with the 
Head of a full grown Foetus, fqueezed into the Brim, the Parietal Bones 
decuflating each other, and comprefled into a conical form, 
A B C The Os Sacrum and Coccyx. 
D The Os Pubis of the left fide. 
E The Tuberojity of the Os Ifchium. 
F The Procejfus Acutus. 
G The Foramen Magnum. 
This Table lbews the impollibility in fuch a cafe to lave the Child, unlefs by the Cafarian Opera- 
tion, which however ought never to be performed excepting when it is impracticable to deliver at all 
by any other method. Even in this cafe, after the upper part of the Head is diminilhed in bulk, 
and the Bones are extracted, the greateft force mult be applied in order to extradl the Bones of the 
Face, and Balls of the Skull, as well as the Body of the Foetus. 
Vide Vol. I. Lib. III. Chap. 3. Se6t. 7. Chap. 5. Se£t. 5. and Vol. III. Coll. 31, 39. TAB.XXVIII Tab .XXIX THE 
T W E N T Y-N I N T H TABLE 
Reprefents in a front View of the Pelvis, as in Table XXII. the Breech 
of the Foetus prefenting, and dilating the Os Internum, the Membranes be- 
ing too foon broke. The fore-parts of the Child are to the pofterior 
part of the Uterus, and the Funis with a knot upon it furrounds the 
Neck, Arm, and Body. 
N. B. In this Cafe the Child if not very large or the Pelvis narrow, may be often delivered alive 
by the Labour-pains; but if long detained at the inferior part of the Pelvis, the long preffure of the 
Funis may obPn'uet the circulation. In moft cafes where the Breech prefents, the effect of the La- 
bour- pains ought to be waited for, ’till at leaft they have fully dilated the Os Internum and Vagina, 
if the fame have not been ftretched before with the Waters and Membranes. In the mean time 
whilft the Breech advances, the Os Externum may be dilated gently during every pain, to allow 
room for introducing a finger or two of each Hand to the outfide of each Groin of the Foetus, in 
order to aflift the delivery when the Nates are advanced to the lower part of the Vagina. But if 
the Foetus is larger than ufual, or the Pelvis narrow, and after a long time, and many repeated pains 
the Breech is not forced down into the Pelvis, the Patient’s ftrength at the fame time failing, the 
Operator mull: in a gradurl manner open the parts, and having introduced a Hand into the Vagina, 
raife or pulh up the Breech of the Foetus and bring down the Legs and Thighs. If the Uterus is fo 
ftrongly contracted that the Legs cannot be got down, the largeft end of the blunt Hook is to be 
introduced, as directed in Table XXXVII. As foon as the Breech or Legs are brought down, the 
Body, and Head are to be delivered as defcribed in the next Table, only there is no neceflity here 
to alter the pofition of the Child’s Body. 
Vide Vol. I. Lib. III. Chap. 4. Sea. 1, 2. Vol. III. Coll. 32. 
The defcription of the parts in this, and the following Table, is the fame as in Table XXII. 
only the dotted lines in this defcribe the place of the Offa Pubis and anterior parts of the OJfa If 
chium which are removed, and may ferve in this refpeA as an example for all the other front Views, 
where, without disfiguring the Table, they could not be fo well put in. THE. 
• * 
THIRTIETH TABLE 
Shews in the fame View, and with the fame References as the former, the Breech of the Foetus 
prefenting, with this difference however, that the fore-parts of the Child are to the fore-part of the 
Uterus. In this cafe when the Breech coming double as it prefents is brought down to the Hams, the 
Legs muft be extracted, a Cloth wrapped round them, and the fore-parts of the Child turned to the 
back-parts of the Woman. If a pain fhould in the mean time force down the Body of the Child, 
it ought to be puflied up again in turning, as it turns eafier when the Belly is in the Pelvis, than 
when the Breaft and Shoulders are engaged, and as fometimes the Face and Forehead are rather to- 
wards one of the Groins, a quarter turn more brings thefe parts to the fide of the Pelvis, and a 
little backwards, after which the Body is to be brought down. If the Child is not large the Arms 
need not be brought down, and the Head may be delivered by prefling back the Shoulders, and 
Body of the Child to the Perineum, and whilft the Chin and Face are within the Vagina, to bring 
the Occiput out from below the Pubes, according to Daventef s method. Or the Operator may in- 
troduce a linger or two into the Mouth or on each fide of the Nofe, and fupporting the Body on the 
fame Arm, fix two fingers of the other Hand over the Shoulders, on each lide of the Child’s Neck, 
and in this manner raife the Body over the Pubes, and bring the Face and Forehead out with a femi- 
circular turn upwards, from the under-part of the Os Externum. All this may be eafily done when 
the Woman lies on her fide; but if the Child is large, and the Pelvis narrow, it is better to turn 
the Patient on her back, as defcribed in Table XXIV. and after the Legs and Body are extracted 
as far as the Shoulders, the Arms are to be cautioufly brought down, and the Head delivered. If 
the Child cannot be brought double, the Breech muft be pufhed up, and if the refiftance of the 
Uterus is fo great, as to prevent the extraction of the Legs, the Patient ought to be turned on 
her Knees and Elbows. When the Legs are thus brought down, the Woman is to be again turned 
to her Back, to allow more freedom to deliver the Body, and Head as before defcribed. If the 
Head after feveral trials cannot be delivered, without endangering the Child, from overftraining 
the Neck, the long curved Forceps ought to be applied as in Table XXXV. If thefe fail, fome 
time may be allowed for the effect of the Labour-pains, which likewife proving infufficient. the 
Crotchet muft be ufed as in Table XXXIX. TAB.XXX Tab.XXXI THE 
THIRTY-FIRST TABLE 
4 
Reprefents, in a front View of the Pelvis, the Foetus comprefled by the 
Contraction of the Uterus into a round form, the fore-parts of the for- 
mer being towards the inferior part of the latter, and one Foot and 
Hand fallen down into the Vagina. In this figure the anterior part of 
the Pelvis is removed by a longitudinal Section through the middle of 
the Foramen Magnum. 
f v » *. : « . i ■ > -■* - •' >J* t v.I ; i. 
A. The fuperior parts of the OJfa Ilium. 
B. The Uterus. 
C The Mouth of the Womb, ftretched and appearing in 
O.O.O.O The Vagina. y C 
D The inferior and pofterior part of the Os Externum. 
E. The remaining parts of the OJfa Pubis, and Ifchium. 
F. The Membrana Mdipofa. 
• * ' > „ r ■“ ' f r * 9 
This and the three following Tables reprefenting four different preternatural pofitions of the Foe- 
tus in Utero, may ferve as examples for the manner of delivery in thefe as well as in all other pre- 
ternatural Cafes. 
In all preternatural Cafes, the Foetus may be eafilv turned and delivered by the Feet, if known 
before the Membranes are broke, and the Waters difcharged ; or if the Pelvis is narrow, and the 
Patient is ftrong, the Head, if large, may be brought down fo as to prefent in the natural Way ; 
but if all the Waters are difcharged, and the Uterus is ftrongly contracted to the Body of the Foe- 
tus, this laft method can feldom take place, on account of the ftrong preflure of the Uterus, and 
flipperinefs of the Child’s Head. 
In the prefent Cafe, the Woman may either be laid on her Back or Side, as defcribed in Table 
XVI. and XXIV. and the Operator having llowly dilated the Os Externum with his fingers, muff in- 
troduce the fame into the Vagina, and pufh up into the Uterus the parts of the Foetus that prefent; 
or if there is fpace for it, his Hand may pafs in order to dilate the Os Internum if not fufticiently 
ftretched previoufly by the Membranes, and Waters. This done he muft advance his Hand into 
the Uterus, to know the polition of the Foetus, and as the Breech is rather lower than the Head, 
fearch for the other Leg, and bring down both Feet without the Os Externum. A Cloth muft then 
be wrapped round them, and having grafped them with one Hand he is to introduce the other into 
the Uterus, in order to raife the Head of the Foetus, whilft the Legs and Thighs are pulled down 
by the Hand that holds the Feet. When the Head is raifed, and does not fall down again, the Hand 
of the Operator may be withdrawn from the Uterus, and the delivery completed, as directed in the 
two former Tables. By the artlefs method of taking hold and pulling one or both Feet, the Breech 
may come down and the Head rife to the Fundus, but if this fhould not happen, there will be great dan- 
ger of overftraining the Foetus, which is prevented by the former method. If the Membranes are 
broken, before the Os Uteri is largely opened, and the Hand of the Operator cannot be introduced, 
which fometimes happens in a firft Pregnancy, the parts of the Foetus lhould be allowed to protrude 
ftill further, by which means the rigidity of the Os Internum will in time be leflened. THE 
THIRTY-SECOND TABLE 
Reprefents in the fame View with the former, the Fcetus in the contrary 
pofition; the Breech and Fore-parts being towards the Fundus Uteri, th e 
left Arm in the Vagina, and fore Arm without the Os Externum, the 
Shoulder being likewife forced into the Os Uteri. 
The Operator in this Cafe muft introduce his fingers between the back part of the Vagina and 
Arm of the Foetus, in order to raife the Shoulder and make room for palling his Hand into the Ute- 
rus to diftinguilh the pofition. This being known, he ought to pulh up the Shoulder to that part 
of the Uterus, where the Head is lodged, in order to raife the fame to the Fundus, If the Body of 
the Fcetus does not move round, and thereby lie in a more convenient pofition for bringing down 
the Legs, the Hand of the Operator ought to be pulhed up ftill higher to fearch for, and take hold 
of the Feet, which are to be brought down as far as is poflible. If this lhould not change the pofi- 
tion, the Shoulder is to be pulhed up, and the Legs pulled down alternately, ’till they are 
brought down into the Vagina, or without the Os Externum, after which the delivery may be com- 
pleted as in the former Cafe. 
If the Feet cannot be brought down lower than into the Vagina, a Noofe may be introduced over 
both Ankles, by which the Legs are brought lower by pulling the Noofe with one Hand, whilft the 
other previoully introduced into the Uterus, pufhes up the Shoulders and Head. By this double force 
the pofition of the Foetus is to be altered and the delivery effected. In thefe Cafes as the Shoulder is 
raifed to the Fundus, the Arm commonly returns into the Uterus; but if the Arm is fo fwelled as to pre- 
vent the introduction of the the Operator’s Hand, and cannot be folded up or returned into the 
Uterus, it muft be taken oft' at the Shoulder or Elbow in order to deliver and fave the Woman. 
If both Arms come down, when the Breaft prefents, the Methods above defcribed are to be ufed. 
Vide the Explanations and References of the foregoing Table to illuftrate this and the fol- 
lowing. TabIXXU TAB.xmc THE 
/ . / 
T H I R T Y-T HIRD TABLE 
' V ‘ ' #. * \ 
I 
Exhibits in the fame View likewife of the Pelvis with the former, a third por- 
tion of the Foetus when compreffed into the round form, the Belly, viz. or 
Umbilical Region prefenting at the Os Internum, and the Funis falle ndown. 
into the Vagina, and appearing at the Os Externum. 
The delivery in this Cafe is to be effedled as in the former Table, by pufhihg.up the Bread:, and 
bringing down the Legs. When the Belly prefents, it is ealier corning at the Legs, than when the 
Bread: prefents, becaufe in the former Cafe the Head is nearer to the Fundus Uteri, and the Legs 
and Thighs lower. If the Belly or Bread: is forced down into the lower part of the Pelvis, the Child 
will be in danger from the bending of the Vertebrae, and predure of the fpinal marrow, fo great 
force is alfo required to raife thefe parts up into the Uterus, in order to come at the Feet, that it 
will fometimes be necedary to turn the Woman to her Knees and Elbows, to diminidi the refillance of 
the Abdominal Mufcles. When the Funis comes down without the Os Externum, if there is a pul- 
fation felt, it mud: immediately be replaced, and kept warm in the Vagina, to preferve the circulation 
and prevent a ftagnation from it’s being expofed to the cold Air. If the Funis comes down when 
the Head prefents, the Child is in danger if not fpeedily delivered with the pains, or brought foot- 
ling. 
See the two former Tables for the Explanations, and References. THE 
• * 
THIRTY-FOURTH TABLE 
Shews, in a lateral View of the Pelvis, one of the moft difficult preterna- 
tural Cafes. The left Shoulder Breaft and Neck of the Pectus prefenting, 
the Head reflected over the Pubes to the right Shoulder and Back, and 
the Feet and Breech ftretched up to the Fundus, the Uterus contracted at 
the fame time, in form of a long Sheath, round the Body of the Foetus. 
A.B.C The Os Sacrum and Coccyx. 
D The Os Pubis of the left Side. 
E Part of the Urinary Bladder. 
F The ReBum. 
M The Anus. 
M.N The Perineum. , 
V The Meatus Urinarius. 
O The Os Uteri not yet opened, and fituated backwards towards the ReBum and Coccyx. 
R.S The fame reprefented in dotted lines, as open when the Labour is begun. 
T.W The fame more fully dilated, but nearer the pofterior than anterior part of the Pelvis. 
W.P The fame not fully ftretched at the fore-part, tho’ intirely obliterated at the back-part, the 
Uterus and Vagina being there only fometimes one continued Surface. 
Hence it appears why the anterior part of the Os Uteri is frequently protruded before the Head 
of the Foetus at the Pubes, which, if it retards delivery, is removed by Hiding it up with a finger 
or two between the Plead and laft mentioned Part. Vide Table IX. X. XI. XII. XIII. 
The manner of delivery in the polition of the Foetus, as reprefented in this Table, is to en- 
deavour with the Hand to force up the part prefenting in order to raife the Head to the Fun- 
dus. If this is impoffible from the ftrong contraction of the Uterus, the Operator muft pulh up 
his Hand in a flow and cautious manner along the Breaft and Belly of the Child, in order to come 
at the Legs and Feet, which are to be taken hold of, and brought down as far as the polition 
of the Foetus will admit of. The Body is then to be moved round by pulhing up the lower parts 
and pulling down the upper, till the Feet are brought without the Os Externum, and the delivery 
completed as in Table XXXI. But if the Feet cannot be got down, fo as to be taken hold of 
without the Os Externum, a Noofe muft be fixed over the Ankles as in Table XXXII. 
Vide Vol. I. and III. as direded in Table XXXI. TAB.XXXK. Tab.XXXV THE 
T H I R T Y-F IFTH TABLE 
\ 
Shews in a lateral View of the Pelvis the method of affifting the delivery 
of the Head of the Foetus, with the long curved Forceps in preter- 
natural Cafes, when it cannot be done with the Hands as defcribed in 
Table XXIX. 
A The three loweft Vertebra of the Loins with the Os Sacrum and Coccyx. 
B' The Os Pubis of the left Side. 
C.C The Perinaum and Anus prefled backwards with the Forceps. 
D The Inteflines. 
E. The Parietcs of the Abdomen. 
F. The Uterus. 
G The pofterior part of the Os Uteri. . 
H The ReBum. ; 
I The Vagina. 
After the Body and Arms of the Child are delivered, and the different methods ufed to bring 
down the Head with the hands, as directed in the above Table, and more fully defcribed in Yol. I 
and III. the following method is to be tried in order to fave the Child, which muff: otherwife be loft 
by overftraining the Neck and fpinal Marrow. .-The Woman being in the fupine polition as in Ta- 
ble XXIV. one of the afliftants ought to hold the Body and Arms of the Child up towards the Ab- 
domen of the Woman, to give more room to the Operator, who having introduced one hand up 
to the Child’s Face, and moved it from the Side a little backwards, for the eafier application of the 
Forceps along the lides of the Head, muft then turn his Hand to one of the Ears, and introduce 
one of the Blades, with the other hand between the fame and the Head, with the curved lide to- 
wards the Pubes as in this Table. This done the hand is to be brought down, to hold the handle of 
the Blade of the Forceps, ’till the other hand is introduced to the other lide of the Head, by which means 
the fame is prefled againft the Blade that is up, and which is thus prevented from flipping, whilft the 
other hand introduces the fecond Blade on the oppofite lide. The Blades being thus introduced care 
muft be taken that in joining them no part of the Vigina is locked in. After the Forceps are firmly 
fixed along the fides of the Head, the Face and Forehead muft be turned again to the fide of the 
Brim of the Pelvis, by which means the wide part of the Head is to the wide part of the Brim. 
This done the Head is to be brought lower, and the force gradually increafed, according to the re- 
fiftance from the largenefs of the Head or narrownefs of the Pelvis. The Forehead when brought 
low enough down, is then to be turned into the Concavity of the Os Sacrum and Coccyx, the han- 
dles of the Forceps raifed upwards, and the lame caution ufed in bringing the Head through the 
Os Externum, as defcribed in Table XIX. and XXX. By this method the Head will be delivered, 
the Child frequently faved, and the ufe of the Crotchet prevented, except in thofe Balms that are 
fo narrow, that it is impofiible to deliver without diminilhing the bulk of the Head. 
Vide Table XXXIX. alfoVol.1. Lib. III. Chap. 4. Sect. 5. Yol. Ill, Coll. 34, 35. THE 
T H I R T Y-S I X T H TABLE 
Reprefents in a lateral View of the Pelvis the method of extrading with 
the afliftance of a curved Crotchet, the Head of the Foetus when left 
in the Uterus, after the Body is delivered and feparated from it; either 
by it’s being too large or the Pelvis too narrow. 
A.B.C The Os Sacrum and Coccyx. 
D The Os Pubis of the left Side. 
E.E The Uterus. 
F The locking part of the Crotchet. 
g.h.i The point of the Crotchet on the inlide of the Cranium. 
If this Cafe happens from the Forehead’s being towards the Pubes, or the Child long dead, and 
fo mortified that both the Body and Under-jaw are feparated unexpectedly, the long Forceps that 
are curved upwards will be fufficient to extrait the Head; but if the fame is large, and the 
Pehis narrow, and the delivery cannot be effected by the above method, then the Head muft 
be opened, that it’s bulk may diminifh, as it is extracted. The Patient being placed either on her 
Back, or Side, as in the Explanation of Table XVI. and XXIV. the left Hand of the Operator 
is to be introduced into the Uterus, and the Forehead of the Foetus turned to the right Side of 
the Brim of the Pehis. and a little backwards, the Chin being downwai'ds; after which the Palm 
of the hand and fingers are to be advanced as high as the Fontanelle, and the Head grafped with the 
thumb and little finger on each fide, as firm as is polfible, whilft an affiftant prefl'es on each fide of the 
Abdomen with both Hands, to keep the Uterus firm in the middle and lower part'of the fame. This 
done the Operator having with his right hand introduced and applied the Crotchet to the Head (the 
point being turned towards the Forehead and the convex part towards the Sacrum) he mull go up 
along the infide of the left hand as high as the Fontanelle, and there, or near it, fix the point of 
the Crotchet, keeping ftill the left hand in the former polition, ’till with the other he pierces the 
Cranium with the point of the Inftrument, and tears a large opening in it to I after this, keeping 
the Crotchet fteady, he may Hide down his left hand in a cautious manner left the former polition 
fhould be altered, and the Head will fink lower down by the ailiftants prefling on the Abdomen. 
The two fore fingers of the left hand are then to be introduced into the mouth and the thumb below 
the Under-jaw, the hand being above the Blade of the Crotchet. When this firm hold is taken, the 
Operator may begin and pull llowly with both Hands, and as the Brain difeharges through the per- 
foration, the Head will diminilh, and come along. If this method fhould fail from the ftipperinefs 
of the Head or it’s being fo much ofified that a fufficient opening cannot be made, the Vertex muft 
be turned down to the Brim of the Pehis, the Fontanelle backwards, and each Blade of the long 
Forceps introduced along the lides of the Head, with the curved fide towards the Pubes. After 
they are joined and locked, the handles are to be tied together with a fillet to keep them firm on the 
Head, an affiftant is to keep the handles backwards ’till the Cranium is largely opened with the long 
Sciflars ffiewn in Table XXXIX. This done the Head is to be extracted in a flow manner, firft turn- 
ing the Forehead to the fide of the Brim, and as the Brain evacuates, and the Head comes lower 
down, again turning the Forehead into the concavity of the Sacrum, and completing the delivery as 
in Table XVI. 
This Table may alfo ferve for an example, to fhew the method of fixing the Crotchet on the 
Head, when altho’ the Body is not feparated from it yet it cannot be delivered with the Operator’s 
Hands or the long Forceps as in Table XXIX. and XXXV. 
Vide VoL I. Lib HI. Chap. 3. Se6t. 7. Chap. 4. Se£t. 3. alfo Vol. III. Coll. 31,36. Tab.xxxvl TAB.XXSM THE 
THIRTY-SEVENTH TABLE 
With the two following reprefents feveral kinds of Inftruments ufeful in 
laborious and difficult Cafes. 
A The ftreight lhort Forceps, in the exaCt proportion as to the width between the Blades, and 
length from the points to the locking part: the firft being two and the fecond fix Inches, which 
with five Inches and a half (the length of the handles) makes in all eleven Inches and a half The 
length of the handles may be altered at pleafure. I find however in Practice that this ftandard is 
the molt convenient, and with lels difficulty introduced, than when longer, having alfo fufficient 
force to deliver in molt Cafes, where their afliftance is neceffary. The handles and loweft part of 
the Blades may as here be covered with any durable leather, but the Blades ought to be wrapped 
round with fomething of a thinner kind, which may be ealily renewed when there is the lead fufpi- 
cion of veneral 1 nfeClion in a former Cafe: by being thus covered, the Forceps have a better hold, 
and mark led the Head of the Child. For their ealier Introduction the Blades ought iikewife to be 
grealed with Hogs-lard. 
B Reprefents the pofterior part of a fingle Blade in order to fhew the width and length of the 
open part of the fame, and the form and dimenfions of the whole. The handles however as here 
reprefented are rather too large. 
Vide Table XXL for the figure and dimenfions of the long Forceps, that are curved upwards, and 
covered in the lame manner as the former. 
The Forceps were at firft contrived to fave the Foetus, and prevent, as much as pofilble, the ufe 
of lharp Inftruments; but even to this falutary method recourfe ought not to be had but in Cafes 
where the degree of force requiiite to extract will not endanger by it’s confequences the life of the 
mother. For by the imprudent ufe of the Forceps much more harm may be done than good. 
See the Explanation of Table XVI, alfo the Preface to Vol. II. with the cafes in the Collection 
on that SubjeCt. 
C The Blunt Hook which is ufed for three purpofes. 
Firjl, To affift the extraction of the Head after the Cranium is opened with the Sciffars, by in- 
troducing the finall end along the Ear on the outfide of the Head to above the Under-jaw, where 
the point is to be fixed; the other extremity of the Hook being held with one hand, whiUl two 
fingers of the other are to be introduced into the forefaid opening, by which holds the Head is to be 
gradually extracted. 
Secondly, The fmall end is ufeful in abortions in any of the firft four or five Months to hook down 
the Secunaines, when lying loofe in the Uterus, when the Patient is much weakened by Floodings 
from the too long retention of the fame, the pains alfo being unable to expel them, and when they 
cannot be extracted with the fingers. But if the Placenta ftill adheres it is dangerous to ufe this 
or any other Inftrument to extraCl the fame, as it ought to be left ’till it feparates naturally. If a 
fmall part of the Secundines is protruded through the Os Uteri and pulled away from what ftill ad- 
heres in the Uterus, the mouth of the Womb contraCls, and that irritation is thereby removed which 
would have continued the pains, and have feparated and difeharged the whole. 
Thirdly, The large Hook at the other end is ufeful to affift the extraction of the Body, when the 
Breech prefents, but Ihould be ufed with great caution, to avoid the diflocation or fraClure of the 
Thigh. 
Vide Table XXIX. alfo Vol. I. Lib. II. Chap. 3. Lib. III. Chap. 3. SeCl 7. and Chap. 4. SeCt. 2. 
Vol. II. Coll. 12. Vol. III. Coll. 31, 32. THE 
T H I R T Y-E IGHTH TABLE. 
* 
A Reprefents the Whale-bone Fillet which may be fometimes uleful in laborious Cafes, when the 
Operator is not provided with the Forceps in fudden and unexpected exigencies. 
When the Vertex of the Foetus prefents, and the Head is forced down into the lower part of the 
Pelvis, the Woman weak and the pains not fufficient to deliver it, the double of the Fillet is to be in- 
troduced along the Forepart of the Parietal Bones to the Face, and if poflible above the Under-jaw, 
which done the Whale-bone may be either left in or pulled down out of the Sheath and every weak 
pain a {lifted by pulling gently at the Fillet. If the Head can be raifed to the upper part of the 
Pelvis, the Fillet will be more eafily got over the Chin, which is a fafer and better hold, than on 
the Face. If the Face or Forehead prefents, the Fillet is to be introduced over the Occiput. Vide 
Vol. I. Lib. III. Chap. 3. Sed. 2. Vol. II. Coll. 24. 
In fuch Cafes likewife the Whale-bone may be fupplied by a Twig of any tough Wood, mounted 
with a limber Garter or Fillet fewed in form of a long Sheath. 
B.B Gives two Views of a new kind of PelTary for the Prolapfus Uteri, being taken from the 
French and Dutch kind. After the Uterus is reduced, the large end of the PelTary is to be 
introduced into the and the Os Uteri retained in the concave part, where there are three 
holes to prevent the ftagnation of any moifture. The fmall end without the Os Externum has two 
tapes drawn through the two holes, which are tied to four other tapes, that hang down from a belt 
that furrounds the Woman’s Body, and by this means keep up the Peflary. This fort may be taken 
out by the Patient when lhe goes to bed, and introduced again in the morning; but as this fometimes 
rubs the Os Externum, fo as to make it’s ufe uneafy, the round kind marked C. are of more general 
ufe. They are made of Wood, Ivory, or Cork, (the laft covered with Cloth and dipt in Wax): 
the Peflary is to be lubricated with Pomatum, the edge forced through the paflage into the Vagina, 
and a finger introduced in the hole in the middle lays it acrofs within the Os Externum. They ought to 
be larger or fmaller, according to the widenefs or narrovvnels of the paflage, to prevent their being forced 
out by any extraordinary {Training. Vide Vol. I. Lib. IV. Chap. 1. Sect. 7. Vol. III. Coll. 24. 
D.D Gives two Views of a Female Catheter to Ihew it’s degree of curvature and different parts. 
Thofe for common ufe may be made much lhorter for conveniency of carrying in the pocket; but fome- 
times, when the Head or Body of the Child prefles on the Bladder above the Pubes, it requires one 
of this length; and in fome extraordinary Cafes I have been obliged to ufe a Male Catheter. 
Vide Vol. I. Lib. II. Chap. 1. Sed. 1, 2. Vol. II. Coll. 10. N°. 2. Tab.AXXvA Tab JQQOX. THE 
T H I R T Y-N INTH TABLE. 
I 
a Reprefents a pair of curved Crotchets locked together in the fame manner as the Forceps: It 
is very rare that the ufe of both is necefl’ary, excepting when the Face prefents with the Chin turned 
to the Sacrum and when it is impoffible to move the Head to bring the Child footling or deliver with 
the Forceps. In that cafe, if one Crotchet is not fufticient the other is to be introduced, and when 
joined together will a£t both as Crotchets, in opening the Cranium, and, as the Head advances, will 
likewife a cl as Forceps in moving and turning the Head more conveniently for the delivery of the 
fame. They may alfo be ufeful to affift when the Head is left in the Uterus, and one Blade is not 
fufficient. There is feldom occafion however for the fharp Crotchet, when the Head prefents, the 
blunt Hook in Table XXVII. being commonly fufficient, or even the Forceps to extract the fame, 
after it is opened with the ScilTars. Great care ought to be taken when the ffiarp Crotchet is intro- 
duced, to keep the point towards the Foetus, efpecially in Cafes where the fingers cannot be got up to 
guide the fame. The dotted lines along the infide of one of the Blades reprefent a Sheath that is con- 
trived to guard the point ’till it is introduced high enough; the ligature at the handles marked with 
the two dotted lines is then to be untied, the fheath withdrawn, and the point being uncovered is fixed 
as directed in Table XXXVI. 
The point guarded with this Sheath may alfo be ufed inftead of the blunt Hook. 
b Gives a View of the back part of one of the Crotchets which is twelve Inches long. 
c Gives a front View of the point to lhew it’s length and breadth, which ought to be rather 
longer and narrower than here reprefented. 
d Reprefents the Sciflars proper for perforating the Cranium in very narrow and diftorted Pel- 
vis's. They ought to be made very ftrong, and nine Inches at leaft in length, with Hops or refts 
in the middle of the Blades, by which a large dilatation is more ealily made. 
The above Inftruments ought only to be ufed in the moft extraordinary Cafes, where it is not pof- 
iible to fave the Woman without their affiftance. 
Vide Vol. I. Lib. III. Chap. 3. Se6l. 4 Chap. N°. 1. Vol. III. Coll. 31. 35. 
ERRATA. 
Title Page, line 2. read Set. 
Preface line 2. read Midwifery. 
4. a Comma after done. 
14, read anatomical. 
1 cf. read Midwifery. 
Table line 
II. 2. for Tuberofity read acute 
Procefs. 
17. for Brim of the former 
read Axis of the for- 
mer from it's Brim 
downwards. 
21. read finally the difiance• 
22. dele finally. 
III. 20. read Lib. I. Chap. 1. 
V. 27. read of the left. 
38. read lata. 
VI. 45. read Months. 
46. read Finally the fize. 
VII. 8. read 0edematous. 
VIII. 17. K.K read adhering. 
36. read may be obferved. 
38. forVol.ILreadVol.III. 
Table line 
VIII. ult. read Monro. 
IX. 2. no point after Table. 
16. read K. K and line 17 
L.L 
X. 19. read Funes. 
21. read belonging. 
XI. n. read G.G.G.G 
19. read Albinufs. 
23. read adhering. 
32. read contact. 
34. read by which means. 
XII. 32. read to near the end. 
XIII. 2. no point after Table, 
dele the fame in Ta- 
ble XIV. XVII. XIX. 
XX. 
20. read of the Head. 
XIV. 4. all between, turned and 
backward to be in 
parenthefis. 
10. read Os Ifchium. 
XV. 23. read Frcenum. 
XVI. 14. read Corpus Cavernofum 
Clitoridis. 
Table line 
XVI. 19. read QTMine 20. dele 
cu 
24. for finger at read finger 
between the Head of 
the Child and 
40. for right read left. 
penult, read Occipital. 
XVII. 37. read Integuments. 
XVIII. 5. read Externum. 
ult. read Collett. 25. 
XIX. 6. read Fulcrum. 
XX. ult. read Lib. III. Chap. 3. 
Sett. 4. N°. 3. 
XXL 20. read ajfifiance. 
XXIV. 20. read are fixed. 
XXVII. penult, read Lib.lII.Chap. 2. 
XXVIII. ult. read Chap. 5. Sett. 3. 
XXIX. 18. read gradual. 
XXXII. 7. read Vagina and the 
XXXV. 6. read 29. and 30. 
XXXVI. 27. read in it from k to i. 
34. a Comma after Head\ 
read offified. 
XXXVII. 13. read venereal.