[Illustration]







Lectures
On
Midwifery
By 
Andrew Hiynne M.D. 
Taken by Wm Loyd
In winter corse of 1794
[cross outs]
1795,



Introduction
Folio l
Midwifery should be consider’d in two points
of view, in a limited and a more extinsive one; the former
being the manner In which It was studied by the antients,
which related only to the delivery of the patient, the latter
as now cultivated including with the former, the diseases
Incident to parturition and to children during the 1st
month.
The practice of midwifery was originally confin’d
to females at that time both sexes were Ignorant of
the Theory and on account also of delivery and suppos’d
experience they poses’d as mothers made It be thought that
they were gratifi’d to practice the art, but they were oblig’d
occasionally to call in men, and as such patients were 
generally oblig’d to be deliver’d by Instruments; so midwifery [cross out]   
became the provine of Surgeons; - And the diseaseas incident [cross out]
to pregnant woemen required the aid of medicine which
made Physicians also study It.
In the last century the french made great Improvements
In that science, thire females were the lst who subdued the
prejudice of being attended by men and hence in consequence,
the Science became more generally Studied, yet the french
Institut’d thire Schools mutch later than the English for no
publick lectures were read in [crossed out] France till the year 1740 when
a law was pas’d prohibiting any person practicing midwifery
who had not previously attend'd [crossed out] 3 months at the Hotel Dieu:  



Folio
F
The dutch followed the example of the french and
public Lectures were read in Holland. Dr. Chamberlain was
a celebrated Physician in the last century; but Lectures were
not publickly read till 1730, when Chapman was a practitioner
In the country came to town once a year to deliver Lectures;
but his pupils were only Instructed in Midwifery as he
had no machine; nor were his pupils allowed to attend
real Labours, It’s to Smellie we owe these two Improvements:
after Smellie Dr. Young of Edinborough made some very
considerable Improvements In this art. In 1751 the
King of Prusia establish’d a school at [cross out] Berlin and 
enacted that no woman should practice midwifery 
without having been taught there; and King George 2nd 
establis’d another on the same plan at Gottingberg. 
The progress of midwifery may be divided into four
areas, the 1st includes the practice of the antients; the 2nd is
that which ambrose Pare turn’d the fætus in all
preternaturall cases; the 3rd; the 1st [cross out] Public employment
of the forceps and the fourth, the period In which the science
began to be cultivated by Surgeons & Physicians. 
Hippocrates thought that the diseases of Pregnancy were
occasion’d by Impediments to the a sension of the uterus:
to rilive these complaints, perfumes were hung round



[?]
F
The neck of the patient; he divided labours into naturall
and preternaturall; he thought the latter was owing to
the child lying across, to remedy which he turn’d the
woman Instead of the Child: Altho ambrose Pare practis’d
turning Children so early as 1594, his Books of midwifery
was not publis’d till the middle of last century; he was the
1st who extracted the placenty per funis and who waited
some little time before the extraction, after delivery for
before his time the hand was allways Introduc’d into
the womb as soon as the Child was expel’d, and the
placenta seperated by the fingers. In the reign of Lewis
14th Maurican publis’d on diseases Incident to pregnant
women, but he did not know the use of the forceps, he followed
the practice of Pare and was an enemy to the Cesarrean
Operation, he publish’d observations on his own practice
which are very valuable, but never have apear’d in
English. Chambers at this period went into France with
the forceps as a secret, but It did not answer his purpose;
as no one would purchase his secret; Davanter was the
next who publish’d, he disaproved of the use of that Instruments
he thought that laborious labours were produc’d by the
obliquely of Uterus, he also thought that the placenta
adhear’d Invariously to the fundus Uteri; La. Motte then
publish’d his __ Observations In a Similar manner



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to those of Maurican, this is a very usefull Publication: about
the year 1730 Chapman discoverd that the forceps was ______
Chambers [cross out] great secret, he was succeeded by Gifford
who extended the use of the forceps, he employed them 45 in
256 cases, he followed the practice of the antients In______
detaching the placenta from the fundus Uteri I: E: by
the hand: about this time Sir Fielding Old in Dublin,
[cross out] explain’d the passage of the child’s head through the pelvis,
he thought that the childs head (the long axis) coresponded
with the transverse diameter of the Brim of the Pelvis. _______
Leveret then publish’d where he recommends the forceps
In cases where the head of the child is seperated from the
body: he publish’d on polipi Uteri et Vagina but this
work is of little use. In 1754 Dr. Burton of York publish’d
his Book on Midwifery he gives the best description of the
Pelvis, he advises to turn in all Breach presentations which
was contradicted by the practice of Semllie: he tells us
never to bring down the child by one foot, this was proved
wrong by Gifford who deliver’d 47 out of 49 preternatural [cross out]
presentations In this way; He contrived a kind of crutch
for pushing Up the child In Shoulder presentations, but
the hand In the form of a crutch is better, for the purpose [cross out]
Smellie In his first Volume Is too tedious on Laborious



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6
Labours, and advises the application of the forceps where they are
not necessary or cannot be us’d, his 2nd Volume contains his
own observations and his 3rd teaches more particularly the
diseases of lying in women; Since Smellie Ruderough publish’d
in Latin, but this Is mearly a sylabus of his Lectures; he does not
treat of the diseases of women; upon the whole Smelie’s works
are best adapted for the attention of pupills and Students.
Of the Pelvis.
The Pelvis so call’d from Its similytude to a Bason Is compos’d
of four bones in the adult; viz 2 of a Innominata, Seacrum
and cocysis; In the fœtus It consists of 3, each Innominata
being divided into 3 bones; the Ilium forming the superior & 
laterall portion, the Ischium forming Inferior and
laterall part, and the pelvis the anterior part; tho In the
adult the 3 bones of each Inominatum are compleatly
ossified, yet for the sake of conveniance In describeing the pasage
of the head we presume to draw Immaginary divisions.
Midwifes are unacquainted with the technicall terms
they call the seacrum, the rump bone, the os Cocysis, the
H bone, the Illium, the Haunch the Ischeum, the setting
bone. The Seacrum forms the posterior portion of the
Pelvis In shape of an Irregular Pyramid with It’s base
upwards, It consists of 4 or 5 bones connected by ossification



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these are call’d false vertebræ In opposition to the true which have
Intermediate cartilage, It has 4 or 5 pair of holes on each side
for the transcision of the Saccral nerves, [cross out] the anterior surface
of the Seacrum is concave, the posterior convex and unequal,
through its processes posteriorly It has a canall for the 
continuance of the spinall marrow, Its pasage Is lost
about the 3rd bone of the Seacrum the   is afterwards
defended by a strong Ligament covering it at the superior
part the seacrum Is connected to the last lumbar vertebra
which forms the projection or the great angle of the seacrum:
it’s apex is connected to the Os cocysis laterally Its connected
to the two Illiac: by the seacro Illiac Symphisis.
The os cocysis is continued from the seacrum Its
compos’d of 3 or 4 bones diminishing in size as they aproach
the extremity, its connected to the seacrum by a moveable
articulation, If It should become ossifi’d delivery will be
Impeded but considering the frequent motion of this
part, It’s not likely ossification should take place.
The Illium Is divided Into its Basis surface edges
and Criste, the Inter[cross out]nal part Is concave and has a
ridg extending from the Seacrum to the pubis called Linæ
Inominata, the superior aperture is call’d the Brim of
the pelvis: It’s externall surface is Irregular & convex,



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7
Its Basis is Irregular serving to asist In forming the acetabulum
of the femor, and Ischiatec notch the criste are rounded and
so bent as to represent the figure of an Nalic S.
The Ischium Is divided Into Its Body Tuberosity and
ramus, its body asists in forming the acetabulum and
has spinous proceses to which one of the seacro siatic Ligament
is attached: its tuberosity Is the obtuse point on which one
rests while sitting, and has the other seacro sciatic Ligament
attached to It; its ramus ascends towards the other and
meeting the ramus of the Pubis forms together with It the
foramen Thyoideum & vel Magnum
The Os Pubis is divided into Its body angle and ramus,
Its body helps to form the acetabulum its angle is where
It bends down to form the Symphysis pubis, and Its ramus
Joins that of the Ischium, they form the arch of the pubis
which is wider In females than In males; In females the
distance between the two or anterior and Superior Spinous
processes is one third greater than between the shoulders;
In the males this revers’d In males the knees aproach
each other In order to be in the line of gravity and as the
head of the femor In women Is further a part so the Inclination
of the knee is more perceptible; the bones of pelvis are

Hamilton mentions that the 
bones of Pelvis are incapable
of seperation, or of any
considerable relaxation
During the impulse of labour

F
[?]
Connected by cartilage and ligaments, the [cross out] sacro Illiac
symphisis has two articular surfaces each cover’d with a
seperate cartilage; It has Its capsular ligament surrounding
It, but is not posses’d of motion, as Its firmly connected
by the expansion of the seacro Illiac Ligaments and another
short ligament going from the lumbar vertebræ to the
posterior edge of the criste of the Illium: there are two
Ligaments uniting the Ischium to the Seacrum, call’d
the seacro Illiac Ligament, one going from the spinous proces
the other from the tuberosity: The bones of the Pelvis are conected
by a cartilage and strong ligament, hence the bones of the
Pelvis are not capable of any motion with each other, but
may by diseacs be seperated. The antients thought
that the bones of the Pelvis seperated during labour. 
Gaiobus Invented an Instrument call’d Speculum mastricig
which he Intended to seperate the bones of the Pelvis and to
give an opportunity of serving the progress of labours; others
with the view of relaxing the ligaments recommend fomentations,
Ointments &c &c. Altho the bones do not commonly seperate in labours,
they may be disunited in violent labours this most
generally accompanied with mutcth pain at thire connection,
and the patient feels a kind of action [cross out] or crepitus,

Vide Hunter’s descreption
of the articulation of the
Pubes London Med. observ:
and Inqueres vol ij p 333 

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9
Of these cases there are two Instances one In the memoirs
of the Royall academy at Paris; the other In Smellis 2nd
Volume on midwifery. These bones may however be seperated
without violence; Cows before they calf a littel time, have
thire seacro Illia ligament so relax’d that they walk
lame; and In very delicate women who has had many
children; this sometimes occurs: this is proved by a case
of smollet publish’d by smellie where a woman had
relaxations of the ligament and disunion of the bone
at the 8th month, and a case of Lady in town who had
such a relaxations which occur’d erlier at each succeeding
Pregnancy, these relaxations should be treated (If the 
bones are mutch seperated) by a belt made of soft
Leather worn round the Pelvis. Inflamation some times
affects the capsular ligament of the symphisis pubis,
which sometimes terminates in suppuration, which
is confin’d within the symphisis at other time the matter
may pas along the bone [cross out] under the Peritoneum, and
extends into the acetabulum and there produce
Inflamation and Suppuration; when It goes to this
extent It is Incurable; but when we find a patient
complaining of a pain In this part and there are symtoms



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of Inflamation; we should do all in our power to
remove It; or If It goes on to suppuration a free opening
should be made. Dr. Hunter says, that after delivery
the ligaments of the Pelvis upon disection are allways
more lax, the pelvis is further divided into Its
superior and Inferior apertures and Its excavasation:
the [cross out] superior aperture has been considerd as being
triangular, by some oval, Its divided Into Its transverse
or long and short diamiter, the transverse or long diameter [cross out]
extends from one Illium to another; the short diameter 
from the projection of the Seacrum to the symphisis
Pubis, the long diamiter maesures in the dead subject
from 5 Inches to 5 1/2 the latter measures one Inch shorter;
this is the division of the Pelvis which the English make;
but the french makes two oblique or diagonal diameter
extending from the seacro Illiac Symphysis on one side
to the Body of the Pelvis on the other; this diameter in
the living subject is the greatest wherein the Skeleton
Its nearly of the same length and in the living subject,
the latter is mutch lessen’d by the Psoas and the Illiac
Muscle and the Illiac muscle passing over the brim
of the Pelvis at that part; the inferior aperture has 2
diameters but both measures 4 & 1/4 Inches except where the
Os cocysis is thurst back wards then there is an Inch more



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11.
In that diameter; so that the long diameter of the [cross out] Inferior 
aperture is reverse of the long diameter of the superior one;
the depth of the pelvis is more or less at different parts,
at the seacrum Its 6 Inches and at the sides It’s only 4
Inches deep, and at the symphysis pubis It is only 2
and not quite that; this should be observ’d in examination [cross out]
of woemen during labour for If the head of the child
is retain’d above the brim of the pelvis [cross out] Either by the
[cross out] vitiation [cross out] in the pelvis or a very large head we
shall not be able to fase It in the usuall direction with
the finger directed towards the seacrum we must
therefore In this case feel anteriorly behind the
[cross out] Pubis, where It will be readily found. the
cavity of the Pelvis continues [cross out] cylindricall till
It arises at the spinous process of the Osa Ischii; where
It converges obliquely forwards forming the Inferior
aperture. The head of the child from this particular
formation of the pelvis has mutch difficult in
pasing. If it makes a turn forward with the chin
upon the breast by which [cross out] Its longitudinall
diameter (which measures from 4 & ½ to 5 Inches and
extends from the os pontis to the Occiput) corresponds
with the long diameter of the superior aperture



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12 
which as was mentiond before Is the diagonall aperture.
Sir Fielding Old and Smelie were mutch deceived, In
supposing that It passed In the transverse direction thro,
the cavity of the Pelvis till It arrives to the convergency,
there It makes a semiturn (which It’s capable of to 1/6 of a 
circle) by this means the long diameter of the head corresponds
with the large diameter of the pelvis, (in the Inferior aperture)
and the occiput emerges under the arch of the Pubis.
The fœtal head is compos’d of more number of bones than
the dult, the Os pontis being divided by a continuation
of the Sagitall suture, the sutures are mutch further
apart so that If the pelvis is vitiated or the head very large,
the presure In time of Labour will make the bones
lap over one another, and thus the bulk is considerable
diminish’d. There are two points of the head besides the
sutures uncover’d by bone, these are the posterior & anterior
Fontanilles, the anterior is where the os pontis and Sagitall
sutures meet; the Posterior is where the occiput meets
the Sagitall Suture; these by admitting the approach
of the Bones very mutch assist delivery

Vide vol V of Lond: Med: [cross
outs] observ: and Enquires a
case of Cesarean operation
by Dr. Cooper

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13 
Of The Presentation
By the presentation we mean that part of the child which
corresponds with the pelvis: I mean the center; In an
examination to discover whether the long diameter of 
the head corresponds with the long diameter of the pelvis,
we should attend to the direction of the Sagitall suture;
The knowledg of the diffirent diameter of the Pelvis is
[cross out] necessary, In all operation of the Midwifery, whether
Instrumental or manuall; as they depend upon 
Mechanicall principles; hitherto we have only
consider’d well form’d Pelvises and as all pelvises
differ In some respect from each other; It will be
right to consider them [cross out] further
Of Vitiated Pelves
The pelvis may be deform’d either by the Rickets
Or Mollities ossuim, the former is owing to a want of 
deposition ossified matter, the latter to too great absorption
of It, the former Is incident only to children, the later may
happen to all ages; a vitiated pelvis of the superior aperture
Is more Inconvenient, than one of the Inferior; as In the
former case the application of Instruments Is more
difficult; It’s necessary to discover a vitiation of Pelvis;
otherwise in a tedious laborious parturition a

See the method of examination
by the fingers and hand to
detech narrow pelvis as 
directed by Dr, Wallace
Johnston, System of Midwefery 

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Practitioner may destroy the child.
The [cross outs] Saecrum may be vitiated by exostosis;
It may be too straight or too much, in the former case
the cavity of the pelvis is diminis’d, and In the latter
the convexity of the head is not adapted; but the most
common vitiation hapens from the [cross out] great angle of
Seacrum aproaching the symphises pubis; owing to 
the great in cumbent presure this part sustains and
the softness of the Bones In the diseases above mention’d.
It is an Anchylosis of the coxcyx may happen, If
It should, labour will be Impeded but considering
the motion of this bone every time the fœces is evacuated
It does not seem likely to happen; If a child is put
upon his legs too soon, the basis of the os Ilii will be presed
inwards by the head of the femor and hence the
acetabula will aproach each other too mutch: If the
child is suffer’d to sit to mutch the tuberosity of the
Ischium are bent towards each other by this means
the Brim of the pelvis may be bent towards each other
and the arch lessen’d: In a well form’d pelvis the arch
measures 0 Inches and a vitiated one sometime 
no more than one Inch: The projection of the seacrum
sometimes occasions a pendilous Belly in womin



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who have had many children, It seldom occurs In first
Children for the parietes of the abdomen have not been
accomstom’d to much distention and are therefore
capable of resisting. When the pubis is too proeminent
or too flat It is a pretty certain sighn that there is a
vitiation in the short diameter of the superior aperture,
and when the anterior and superior spinous process
of the Illiac, are too near each other It is a sighn that the
long diameter is vitiated, when the superior aperture
is vitiated a person not accostom’d to It would on examination
be led to suppose that the labour was not farr advanc’d,
the head not having passed the brim and yet as soon 
as the head passes the Brim the patient will be deliver’d,
the externall parts dilete during the effort nature
makes to force the head through the brim, on the other
hand a practitioner Is liable to be deceived, where
the Inferior aperture is vitiated; for the head being very
low down, he will suppose delivery will be speedily affected
and yet It will remain In that state a number of hours,
for long continued pressure of the childs head on this
part, mortification may be produced: as a proof 
of this Dr. Jonston an old practitioner and a man of



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good [cross out] abilities was engag’d to attend Lady Douglas
in Scotland, the labour was very tidious, the pelvis
being vitiated, he desired a consultation, the person
sent to could not Immediately attend and the Dr.
from the danger In which the lady lay, was forced
to deliver without asistance, which he did by
[cross out] opining the head, the patient went on very well
for 15 days when a slough from Inferior part of the 
Urethra seperated and the urine ever after flow’d
through the vagina. We may distinguish a [cross out]
mortification from pressure from a laceration of the
Urethra by the time at which the urine begins to
pass through the vagina, In laceration It takes place
Immidiatly whereas in mortification It does not
happen till the slough seperates which may be 4 or 5
or was the case with lady Douglas even 15 days after
delivery: we cannot form any accurate Idea of
the Pelvis from the figure of the woman, for a woman
may have a distorted spine or extremities and
yet have a good pelvis and vice versa, but we may
form a probable conjecture, from the time the
deformity occured, If It happen’d In Infancy



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The has probably a faulty pelvis and e: Contraris,
If the deformity did not take till after
[cross out] Puberty and Is then confin’d to the lower limbs,
Its probable the pelvis is not affected;
A very capacious pelvis is not Injurous by sometimes
occasioning obliquity; and others a prolapsus and
sometimes a retroversion of the Uterus [cross outs].
If a woman should have a prolapsus Uteri during
labour she should be confin’d to a Horizontal posture
and not suffer to bear down the pains; when these
parts are well form’d the short diameter of the superior
aperture measures 4 1/4 Inches that of the head 3 1/2
[cross out] If therefore (provided the head Is not unusall
large) the short diameter measures only 3 1/2 or 3 1/4 Inches the
woman may be deliver’d of a living child; but If It
measures only 3 Inches there are very few Instances of It.
this Is the case In which forceps may be us’d; If It
measures only 2 ¾ the forceps should not be employ’d,
for by the presure of the forceps necesary to diminish
[cross outs] (the Bulk) of the head sufficient for Its
Extraction, the child must inevidently be destroyed.
the best method therefore Is to open the head with the
Scisars which is mutch easier to the practitioner,



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And safer to the mother, for the head of the child is
only capable of being diminish’d In Its short diameter
by pressure 6 lines or ½ Inch: In france practitioners
are prohibited by laws from opening [cross out] the head of
the child, so that they perform the cesarean operation
If the short diameter of the superior aperture of the
Pelvis measures only 3 Inches; If It is only 2 ½ they
perform It at an early period of Labour.
The English never perform the cæsarean section unless
the diameter Is under 2 ½ Inches, not even then till the
patient becomes quite exhausted: therefore the reason
Is evident why It Is not perform’d more frequently
and with greater success in france than in England.
after the head is open If the superior aperture measures
2 1/2 Inches we should leave It in the Uterus a few hours
before we endeavor to extract It, but If It measures only
2 Inches It should be left 24 or 36 Hours, that the [cross out] bones
may be something soften’d by the putrefaction: when the
seacrum Is to mutch curvid, It is a sighn that the pelvis
Is vitiated posteriorly, at both Its aperturs, and In
such cases we must all ways open the head.



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With respect to the discovery of these circumstance If on 
examination we feel the projection of the seacrum with
the finger, the Pelvis Is vitiated at the superior aperture,
If we feel the coccysis forwards, If the spinos process
of the Ischium are too long or too close, If the tubercles
are too near each other, or If the arch of the pubis has
not Its usuall bredth the superior aperture Is
deform’d but we cannot discover by the signs. The
vitiation of the superior aperture: If the small of the
back is too mutch hollowed the pubis flattend or the
head retain’d above the [cross out] Brim of the pelvis when
the 1st stage is over of the labour; It is very probable the superior
aperture is deform’d. [cross out] however the head may be retain’d
by a Hydrocephulus, which may be known by the feel of
the head which is round large and a fluctuation
discoverable, another way of discovering the vitiation
of the superior aperture is by the distance of the
betwen the anterior and superior spinous process
of the Ilia, which in a well form’d pelvis is 9 Inches.
If It measures only 7 Inches It’s vitiated laterly,
another method of discovering It is by measureing



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the distance from the spinous process of the last lumbar
vertebra to the mons veneris. It ought to be betwen 7 and
8 Inches allowing 3 Inches for the thickness of the bone
which Is nearly the same In all pelvis. The [cross out] french
are very expert at this, as It is the custom In france that
deform’d woemen undergo and externall mensuration
of the pubis previous to thire marriage, If the debth of the
pelvis be altered It will be vitiated, If the Ilia are of
equall    the Pubis neither to proeminent or to flat
and the small of the back straight the pelvis in generall
Is well form’d, for the mensuration the woman may
be placed on her side or what is still a better posture
on her hands and knees: the axis of the Pelvis is different
to the axis of the body, this is a wise provision of nature
to prevent miscariage, as It takes off the effect of
gravity: the axis of the Belly, is perpendicular in a line
to the Horizon, the axis of the superior aperture is in a 
line drawn from the umbelicus, to the last bone of the
seacrum. In Quadrupeds as the fœtus is supported
by the parietes of the abdomen, this peculiar structure
of the pelvis Is not necesary, the head of a human
fœtus is larger In proportion than any other animall

Dr. Leak favours the
operation of [cross out] Dividing
the Symphisis pubis
very mutch and
condemns the cæsarean
operation

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Therefore It cannot pass but by Its long diameter
corresponding with the long diameter of the pelvis: in 
Brutes the head is so small as to be capable of pasing
In any direction. The soft parts in animals are more
flaby than in the human subject; and therefore mutch
easier dilated: and as the axis of the Pelvis corresponds
with the axis of the trunk, the uterus has not so many
difficults to subdue: It is therefore thinner and
labour Is effected with mutch less pain than In
women; Brutes never require asistance, as In them
distorted Pelvises never ocurr, we do never hear of 
rickets or mollities ossium ever affect them, and
even If [cross out] they were; as the pelvis supports very little
weight It probably would not be vitiated.
(Section of the Symphisis Pubis)
This operation was Invented by Monsr. Singault.
It is probably an elargement of the Idea
of the antients who endeavoured to distend the cavity
of the pelvis by Instruments, which they invented for the purpose
but singualt was the 1st, who thought of dividing the __
Symphisis pubis: to gain this point, his Idea was
laid before the royall accadamy at paris, who
disaproved of It. This Idea lay dormant till
Singualt took his degree, when he soon had an opportunity

Hamilton recomends
that It should not be
perform’d in no cases
whatever
The world is mutch 
Indepted to Dr. Osborns
for his accurate investigation
of this subject to [cross out] which we
with pleasure refer and to which
we think it necessary to add any 
remarks as his sentiments on that
occasion coincide with our own / Hamelton
see osborn on Laborious parturition

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Performing It with success, this operation made a
great noise at the time and many people went to see
the women’s child [cross out], but upon examination It
was found that nature alone would have effected
the delivery, for the Pelvis, was but slightly vitiated;
and the child but small. Bondejal was the most
succesfull oponent of Singault, he proves that the 
operation Is not sufficient for the Enlargement of the
cavity of the pelvis. singault himself confeses he
could not seperate the bones of the Pelvis more than
one Inch and half, the operation was now perform’d
on all patients who died at the Hotel Diu and they 
found that If the bones could be seperated to two and
half Inches which was the greatest space that they could
seperate, a considerable degree of violence must be us’d,
and that the seacro Illiac symphysis were disunited
and yet even by this the short diameter of the superior
aperture of the pelvis was not widened more than
two lines (1/3 of an Inch) Singault and monsier
Le roi who was a friend of Singault, says these experiments
are false ones for they say probably as the Pelvis is



F
22
vitiated will the enlargement be greater, and that in the
living subject the seacro Illiac symphysis will not be
seperated, the latter assertion in a very short time proved
false but with respect to the former, It certainly is
true, but yet the operation will not succeed for suppose,
the short diameter of the pelvis & meusureing 1 ½ or
2 Inches, the head in the short diameter measureing
3 1/2 Inches It’s clear It cannot pass the aperture.
tho It should be increas’d 8 or 10 lines for the head
cannot be lesen’d more than 6 lines without destroying
the child; when the os pubis are seperated the hand
is to be introduc’d and the child brought down by
the feet; some few years since Singault performd
the operation; 5 times out of which he lost 4 children
and one woman; It has been perform’d in Holland
and In Germany. In the latter country, the very
man who Introduc’d It became Its oponent.
there are Instances of women who after having
It perform’d, became again pregnant and 
were delivered without asistance: one of these
occured to Singault himself who attened a
patient on whom he had before performed



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23
The operation, he again propos’d It but the woman
refusing he left her abruptly and she was 
soon afterwards deliver’d by nature none but
a female practitioner attending her; the
objections to this operation are, that the Bladder
and Urethra are liable to be wounded, that we do 
not gain space where It is requr’d that there is
danger in exposing the cavity of the Pelvis and
lastly that It is Inefficatious.
(On the female organs of Generation)
The female organs of generation are [cross out] divided
into Internall and Externall, the externall are
those which may be seen without dissection, the
Internall are the Uterus, and It’s appendages,
authors have disputed which of these should
be 1st, some asertain we should begin with the [cross out]
Uterus, as other parts are dependat on It: others
Judg that the external parts are less complex, and
therefore more easily understood, this mode we
shall adopt; The externall organs are divided
into mons veneris, Labia magna, Clitores, labia
minora vel Nymph, vel Labæ interna, meatus
Urinarius, franum, Labiorum, et Perinœum; 

See Med: Facts & observ: Vol [cross out] ∙iij∙ Page 50
A case of an enlarg’d Nympha
Vide Med: Facts and observations Vol 4 Page 26 
a case of a fungus enlargement of Extremity
of the female Urethræ [cross out]

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24
In the naturall state the labia are closed but upon
thire being seperated the Clitoris, Nympha, and
Meatus urinarius appear, the mons veneris is
situated orver the symphisis pubis, It’s compos’d
of common Integuments with fat underneath; at 
Puberty this part is cover’d by hairs, from the mons
veneris are continued Labia magna, these bind the
fisure and terminate in the perineum, forming the
frenum labiorum, behind which Is a depresion calld
fosa Navicularis. The Clitoris arise by two crura
from the tuberosity of either of the os Ischii these [cross out] unite
under the symphisis pubis and form the glans 
clitoris, the crure of the clitoris resemble in Structure
the corpa cavernosa penis, they are capable of
Erection and are then distened with blood, the
Glans Clitoris is cover’d by a reflexion of the cutis
call’d Its prepuce, this prepuce extends over the
superior and lateral parts of the glands, but not
over the Inferior part from the prepuce are continued
the nymph, which are two folds of thin skin
continued in the corse of the Lubia megna.
The meatus Urinarius is the termination
of the cunall leading to the blader, It’s thicker, 



F
25
Larger and shorter than in males, not bing 1 ½ or 
2 Inches in length. the vagina Is the caneal leading
from the os externum to the uterus, Its diferent according
to the situation of the uterus, we are told by authors
that it’s 5 or 6 inches in length, It is compos’d of three
tunics Its internall is villous and has a number
of      chiefly situated at its superior and laterall
parts these be come straight in time of labour a number
of ducts open Into It, which power forth a quantity of 
mucus for Its lubrication; Its middle coat is suppos’d 
to be muscular, Its externall one membranous:
The Hymen is a membrane which closes the os externum,
Its semilunar having two cornea or projection 
[cross out] extending on each side having a semilunar
opening through which the menses pass: The [cross out] perineum
Is that portion of Integuments having Its fibres
across betwen the frenum labiorum and anus.
Diseases of the external Organs and 
method of cure 
The Lubia magna or glans clitoris may be ulcerated
from a veneriall affection or from violence during
labour, If the latter is the case It may cur’d by 



F
26



F
27
cleanyness as by repeatedly washing the parts with
warm milk and water; If Its veneriall recourse
must be had to mercury, but in this case we should not 
acquaint the patients friends of the nature of the [cross out]
case, thes external parts are subject to schirious 
and fungous [cross out] humors, these are generally suffer’d
to proceed to a considerable length or bulk, before
we are consulted, when we attempt a cure we should
consider the cause; If it depends upon the o constitution
the habit at large is to be attened too, but let them
arise from whatever cause they will If they are
very painfull we should use emollient Cataplasms
to ally Irritability; the humors may sometimes be
removed by caustic but If they are large thire remveal
will be better effected by [cross out] the knife, which is
the most expeditious method, and as there are naturally
no large vesels, we shall not have any hemorage of
consequence unliss the tumor is very large, and then
the vesels increase in size, the labia magna are sometimes
œdomatous, If this ocurs during pregnancy It is owing 
to the presure of the gravid Uterus but If the patient
is not pregnant It’s anesarcous the mode of relief
is [cross out] by fomentations and Scarifycations,



F
28
which act hower only as palliatives for If caus’d
by the presure of the uterus they will return severall
times and the same means mut be repeatedly
employed they are so very Inocent that they may be had
recourse to during labour If necesary If they arise
from an anasarcous [cross out] habit the disease must 
be first removed before the swelling of the labia can
be radically cured, In warm climates the labia
is apt to adheare but this is not a common occurance
here, when It happens, It is owing to want of cleanlynes,
during long continued putrid fevers, or small pox.
In adults, these adhesions may be seperated with 
the knife and by some recomnen’d even in childern,
but It is improper, as we may divide more than is
necesary: and as the parts may be readily seperated
by the fingers; After the parts are seperated we should
insinuate betwen them a cloth diped in the Aqua: Vigito
Minerall: or Vitriol: Solution to prevent reunion, [cross out] which 
would otherwise happen: the labia magna are subject 
to Itching during pregnancy all we can do to allivate
this troublesome complaint is to use sedatives to
take off the Iritability. These parts are liable likewise
to Inflamation and suppuration, we should allway
endeavor suppuration to prevent: but If we cannot 



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29
succeed in doing this, some authors recommend Of the 
pain is violent to make early opening but we think
this Improper as Inscisions In this part fistula
are apt to form the better practice will be therefore
to give opiates use Cataplasms and leave the
opening of the abces to nature, The perineum is
liable to be [cross out] lacerated in quick labours particularly,
with 1st Children and where It’s short: its usually
about an Inch and ½ in length, but in time of labour
[cross outs] It’s some times stretch’d to 6 Inches in
length; If this laceration extends to the anus we call 
it entire, when not so farr Its call’d partiall, the
latter is not of so mutch consequence, It is often
Induc’d by the use of warm cordialls by the patient
forcing down her pain during the 1st stage of labour,
by which means the child comes down before the
external parts are dilated; and by Its sudden
expulsion the perineum is torn through: It may in
generall be prevented by a proper support If
therefore the membranes are broke and the Head
seeming drawn before the externall parts are fully
dilated and the pains are strong as soon as we



F
30



F
31
Perceive a tumor forming In perinæs we should
during every pain support the perineum with a
cloth folded double in the left hand and by means
of the right hand extened over the pudendum.
prevent the head from pasing too suddenly out.
If the perines is lacerated the woman complains
soon of acute pain after delivery, but this will
sometimes happens without a laceration here we
should form our diagnosis from the continuance
of the pain, particularly at the time of voiding 
the urine If It is a laceration the pain will
continue for four or 5 days, and the patient will
feel a great deal of pain every time she makes
water: If It’s not a laceration this symtom will
be absent and the pain will go off in 5 or 6 hours.
Our assistance may be required in respect to the 
Hymen in two ways, It may be so rigid so as to
prevent the consumation of marriage or It may 
be imperforated by which means menstruation
will be prevented. this membrane is peculiar
to the humane species. Dr. Donald monro mentions
a case of a woman 15 years of age who could not
menstruate till the Hymen was divided:

*Vide Edinburg Med
Commen Vol 4 part 2 Seut 2
Case iv
The falopian tubes [cross out] have
one extremity fixed to the 
fundus Uteri where the 
perforation is so small It
will hardly admit of a hogs 
bristle but the diameter
gradually enlarges becoming 
wider and wider like a
trumpet till It terminates 
in a loose floating extremity 
call'd morsus diaboli.
Hamilton
Dr Hamilton says that the :Uterus
is generally no more than 
3 inches long

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32
Mr. Cline relates a case of a girl at the age of [cross out] 19
not menstruating on account of a Imperforated
Hymen. Dr. M: Cauley mentions a case in smellies
2nd Volume, where he mistook a case of this kind
for the protrusion of the membranes, the girl being
in pain but upon a more attentive examination
he discoverd his mistake and by *perforating the
Hymen 2 Quarts of Blood Issued out:
A calculus may be form’d [cross out] in the female [cross outs]
Bladder, but on account of width and sharpness 
of the Urethra, It does not often happen
(Of the Uterus and It’s Appendages)
The form of the uterus Is that of a pear, with its
anterior and posterior surfaces a little flattened,
It is situated betwen the bladder and rectum,
during [cross out] pregnancy Its surface becomes a little
convex, and Its figure then is ovall; It is divided
Into Its body, fundus and cervex: the uterus is a
compact surface its thicker at Its cervex [cross out]
than at its fundus, Its bredth is about 3 Inches,
at the fundus and one at the cervex: some authors
assert that during Pregnancy that the uterus



F
33
Becomes thiner as If streached, in the same manner
as the Bladder when distended with urine: others
say that It becomes Thicker: but the truth is that It remains
nearly of the same thickness; tho Its fibres are farther
asunder this may be accounted for from the
Increasing of the veins and Lymphatics the orifice
of the veins being as large as a [cross out] quill: for this
reason flooding in the last months of pregnancy
are more dangerous than in the early months,
for the danger in the HemHorge is in proportion to the 
quantity of Blood lost in a given time: In the naturall
state the cavity of the uterus is usually small very 
Indeed and of a triangular shape from the fundus
at each corner of the fallopian tubes go off: the uterus
has an Internall villous coat, like the vaginæ.
Its cervical portion has like wise a Rugd continued
into It, these rugd are denominated penniform
and betwen the folds are a number of small
glands which secreat the mucus [cross out] – and which
stops up the uterus during pregnancy. It's compos’d
of blood vessels, Lymphatic Nerves and muscular
fibres, tho the existance of the latter have been
doubted the arteries of the uterus arise from

The falopian tubes are liable
to disease. water is some times
colleted in them and either 
floats through the whole cavity
of the tube or each end
coalesces in consequence
of some Inflamation and
the waters appears to be
containd in a cyst It is
difficult to distinguish
from the diseas’d ovaria
with [cross outs] which It is
often complicated and
requires a similar method 
of treatment
Hamilton

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34
the spermatic and Hypogastric the spermatic
arise like those In the males; the hypogastric arise
from the Internall Illiac and are divided into
3 branches, the 1st retaining the name of the
Hypogastric go to the uterus, Bladder &c the 2nd,
is the Pudica Interna, It supplies the vagina;
and the 3rd, Sciatic passes out at the Ischiatic
notch: the veins preserve the same name and
correspond with the arteries. The nerves come from
the mesocolic flexus and from some of the seacrall
nerves, but the sympathy betwen the uterus and
stomach, is not owing to these, but by branches
from the Intercostall nerves which send nerves
to all parts of the viscera. The canals of the Fallopian [cross out]
tubes terminate In Fimbris thire cavity is mutch
smaller towards the uterus. The ovariæ as well
as the fallopian tubes are suspended [cross out] by the
ligamentum latum thire situation is about
one Inch behind, and little below, the fallopian
tubes, some authors say that they secreat a
fluid similar to the male semen others say



F
35 
that they contain a glaizsy fluid, but thire
real use and action is not well understood;
When women are Impregnanted there appears
in the ovarie little oblong glundular bodies
call’d corpora Luteas, yeilding a fluid which
by the Micrescope appeared to have animacule
floating In It similar to those Lewinhock
discoverd in the male semen. Hamilton says
In this appearance the microscope desiaves
for that a similar appearance may be observed
In all the fluids of the body. The Ligamenta
rotundæ go off from the uterus a little below the
Ligamenta lata, covered by a duplicature of
the peritonium after passing through the
abdominall rings, They are lost in the mons
veneris hence It is that the Inguinall glands
are often effected during pregnancy, & In diseases
of the uterus.
(Diseases of the Internall organs
and method of cure)
The vagina is sometimes very short and narrow,
this will not be discovered till marriage the
consumution of which is prevented, it is to be

M: La: Motte mentions
his having deliver’d 3 woemen 
who had not the smallest vestige
of an orifice through the vagina
to the uterus
Dr. Harvey relates a case
where the whole vagina was grown
together with cicatrices nature
after a tedious labour made the 
dilatation and a large child
was born

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36
remedied by sponge tents: for this purpose 
a piece of sponge is to be fill’d with water and
compressed as close as possible, and dried in this
form it is afterwards to be cut into proper
pieces, these when Introduc’d should be covered
with fine linnen, otherwise sponge will Insinuate
into the villi of the vagina and disagreeable
circumstance will ensue from It’s adhesion: the
linnen however should be cut sufficiently large
to admit of the dilatation of the sponge the
tents at 1st should [cross out] be very small gradually
Increasing the size of them: sometimes in these cases
the efforts of the husband will excite Inflamation,
which will bring on a discharge similar in
appearance to a gonorrhæ; [cross out] we should be guarded
in our prognostics in these cases. In every lingering
labours or by the rude use of Instruments the
vagina may [cross out] be inflam’d, and slough: If this 
is partial, [cross out] adhesion may take place,
but sometimes allmost the whole internall surface
may coalasce; If It should be near the os externum,
It may be [cross out] reliev’d by the knife, but If Its farr
back, It will be safer to use the sponge tents.
Sometimes the vagina has [cross out] longitudinall
or transverse Septa, the latter of which prevent

See Med Facts and observations Vol 3 Page 71
A case of double Uterus

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37
Conception: If they are near the os externum
they may be divided by the knife, and If farr
back, sponge tents will generally succeed sometimes [cross out]
when there is a longitudinall septum, there is
a double uterus; an Instance of which of a woman [cross out]
who was deliverd at Hraborough who was deliverd
in april of a full grown child and In the september
following of another: this woman was afterwards
disected and a longitudinall sinus was found
in the vagina and a double uterus and thus
the superfœtation was accounted for.
(Of a Prolapsies and Procidentia Utteri)
A descent of the uterus has two names, according
to the degree, when It is fallen down so low as to be
Insinuated betwen the labia magna, it is [cross out]
calld Procidentia, if it is only in the vagina
It is call’d prolapsus, Uteri; nurses call these
Indiscriminately a bearing down of the womb.
this disease may be mistaken for polypi or
inversion of the womb: but If we carefully
examine a prolapsus or procidentia we shall
be able to feel [cross out] the os tincæ and this circumstance
will destinguish the disease.

of 7 cases of inverted
Uterus (*from a rude
extraction of the placenta)
where I have been call’d
within several years the
consequence of ignorance
or temerity of the practitioner 
in one single instance
only the woman survivid
the shocking accident
Hamilton.

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38
The causes of this disease are a relaxation of
the ligaments of the uterus and also of the vagina,
for a relaxation of the ligaments of the uterus alone
could not produce It as that body could not
pass into the vagina unless that canall was 
sufficiently relax to admit of It. this disease
happen more frequently in large than small
pelvises and in women who are accustomed to
hard labour and stand in an errect posture,
such as washer woemen. the complaint is aggravated
by coughing sneezing and costiveness by a rude
extraction of the placenta and therefore women affected
with this disease these things should be guarded
against as much as possible or they should be
kept in a horizontal posture during, as well as
a longer time than is usuall after delivery.
not being suffered to take any pains standing.
White of manchester has a good Book on
Midwifery & he suffers his patients to sit up the
second day, in Bed [cross out] and gets them up mutch
sooner than is usually done and has not experianc’d
any Inconveniance from It. in the country this
may be the case, but in London the woemen are so



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39 
mutch relax’d that it would not answer.
Woemen who have had many children or for a long 
time the fluor albus are more subject to a 
prolapsus uteri; than those of a contra description.
This disease is greatly aggrevated during the early
months of Pregnancy, for the uterus then being
within the cavity of the Pelvis, gravitates by Its
weight towards the os externum, but the effect in
later month is different for about or rather before
the 4th month the uterus emerging from the cavity
of the Pelvis is supported by its brim and the effect
of [cross out] gravity the remainder 4 months is prevented.
the 1st symtoms of this disease is an encrease fullness [cross out]
and weight of the part, If the uterus is low down
there may be a suppression of urine. our Indication
of cure in the disease are two, first to reduce the
uterus to Its proper situation and Second to retain
It there If there should be any great degree of
Inflamation in the parts, as there sometimes is
from the friction of the patients linnen &c
It will be imprudent to attemp the reduction,
In this case we should first moderate the
Inflamation: a slight one Is not so mutch to be



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40
regarded, as It will generally supide after the
reduction of the part: ulcers are not objection to
the uterus being replaced they will heal better
afterwards, tho, It will be proper to use emollient
Injections, some authors recommend a diffirent
practice, but It is a bad one: the second
Indication of cure has been attemped by astringent
Injections, pessaries and sponge tents: astringent
Injections are all ways proper after the uterus
is reduced that the vagina may recover Its
tone, provided there is no Inflamation nor
ulceration. we recommend sponge tents to
pessaries, as the latter are painful of Introduction [cross out]
difficult of extraction [cross out] induce suppresion of
Urine and costiveness from thire pressure upon 
the urethra and vagina and by thire over
streching the vagina they prevent a radicall
cure, [cross out] however in [cross out] poor people who are
obliged to stand mutch we are oblig’d to use
them. Dr. Thynne show’d a new Invented Instrument
for the purpose of supporting the uterus, It is 
shaped like a pear and very easy of Introduction
one end of It by means of a wire is fastened to a



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41
Belt wore round the waist the wire being so
bent as to suffer It’s Introduction into the vagina,
the woman takes out and Introduces it at
pleasure. pesaries of various kind have
been employed as some practitioner recommend
globular ones other circularr, orthers oval. a pesary
ought to be made of light materialls and
such as will not expand by absorbing moisture,
they should not prevent coition, nor press on
the Urethra or rectum: a circular pessary If
made of proper wood will answer all these
requesites and is therefore preferable to all
except the [cross out] new one above mentioned,
the size of the pessary should be attended to,
If to small it will be useless If too large the
vagina will be too mutch distended and
unecesary pain produced: the diameter 
should correspond with the diameter of the
tumor; the introduction of the pesary is very 
painfull and requires attention and
persivereance. The circumferance of the pessary
should be passed through the os externum
perpendicularly with respect to the body, this
should be done cautiously and by twining 

Stoney concretions and 
even worms it is said 
have been found sometimes 
within the uterus

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42
It round so that the os exterum may be
gradually dilated, It then is to be turned transversely 
so that the superior edge supports
the os tincæ, and In Its inferior edge supported
by the Perinium, by this means pressure upon
the urethra or Rectum is avoided;
(Of a Polypus of the Organs
of Generation)
A Polipies of the uterus or vagina is not an
unfrequent disease they are generally of a
pyramidall figure, with thire Basis towards the
os externum: and thire attachment is generaly
by a small pedicle, tho sometimes they have a
broad base with thire open towards the os externum:
they may arise from any part of the internal
surface of the [cross out] uterus or vagina,
but they are generally atached to the edges of the
os uteri: If they arise from the Internal surface
of the uterus, they are incurable as they are out
of reach of our asistance; polipi are of diffirent
texture some being spongy, and others more 
compact; If small they do not prevent 
conception or delivery, the symtoms they
occasion are uterine iritation a sense of



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43
pain in the vagina or Uterus the menses may
not be suppressed but are sometimes lessened in
Quantity; there will be Irregularites in the function
of the Bladder and Intestines, these symtoms
are succeeded by a discharge, which is at 1st
mucous, but becomes afterwards sanguinous
and serous, sometimes these is alwas a
continuall draining of pure blood, by which 
and the great pain the patient suffers, they
become very mutch exhausted, nurses and
midwifees suppose the accident to come by
labour, but It oftner happens to old maids
then married women. The only disease this can
be mistaken for a prolapsus et Invesics Uteri
with regard to the former the os Tincæ being in
that case felt will distinguish the disease,
but we must be cautious to distinguish the
latter as Dr. Hunter once employ’d a ligature
in an inverted uterus which he mistook for
a polypus, the case terminated fatally
to distinguish it from an Inversion we should
attend to the compact substance of the 
uterus which is different from the most



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44
firm species of polypus to the extream Iratability
of the womb; if it an inverseon to the time of the
commencement of the disease as an enversion
can only happen soon after delivery, should any
doubt remain. It may be remov’d by Introducing
the finger per anum, for If It is an Inversion a
void space will [cross out] be pericived betwen
the rectum and Bludder. The only cure of this 
complaint is extirpation; for this purpose
some authors recommend the knife but the
Ligature is certainly preferable the more
distant the polipi from the os externum the
more difficult to apply the ligature, Luveret
has invented 3 Instruments for this purposes
but the fingers are mutch preferable providing [cross out]
they will reach and In general they will 
as the weight of the tumor bring the tumor down
low; great care ought to be taken in fixing the
ligature, that no part of the uterus or vagina
are Included; the ligature is to be tighten’d every
day till the tumor falls off; which is usually 
in 4 or 6 days this operation is only to be attemped
only where the tumore adheres to the os tince by a



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45
pedicle and that pedicle is distinctly felt,
after the operation opiates and glysters will be
necessasry
(Of the Fluor Albus)
The fluor albus (by women call’d the whites or
weakness) is a discharge of serous fluid from 
the genitals: some authors asert, it is wholly from
the lawnall glands of the vagina, others that
It arises from an affection of the menstruall
arteries; It generally attacks women of relax’d
habits, these who are irregular, or profuse in
menstruation; those subject to miscariage
and those who have had lingering labours; It
often comes on at the age of puberty, tho It may
come on at an earlier period at the 8 or 9 year,
this discharge is of different consistance
and colour, as this disease has been taken for
gonorhea. sometimes [cross out] fluor albus is periodical [cross out]
but then It is not of much inconveniance and
has been suppos’d to supply the place of the 
menstruall discharge: by a long continuance
of this disease the constitution becomes affected
occasioning pain and weakness in the small



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46
of the back, pale countenance debility particularly
affecting the stomach, in some the menses are obstructed
in others profuse the discharge is increas’d about
the menstruall period the urine is [cross out] turbid and
slimy. this disease may be distinguished from
ulcers in the womb and vagina from these ulcers
being proceeded by the Inflamation suppuration,
and by the discharge from the ulcers being
smaller in quantity fœtid and attended with
pain: [cross out] We distinguish It from the veneriall
disease, by the latter being attened, with
Inflamation pain In makeing water and sometimes
chancres this discharge is 1st thin and virulent
gradually becomeing milder. In the fluor alb:
the discharge is thick from the 1st, not becomeing
thin till the patient is mutch reduc’d. in the
gonorhea the discharge is from the neighborhood
of the clitoris; in the fluor albus It is from the
vagina. A relax’d habit generally proceeds
this disease, hence Its most frequent in
moist climates, as holland. this disease is
never fatal, but it sometimes in those that
are,



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47
as [cross out] Dropsies; where the constitution is much
affected the prognostic is unfavourable, in this
case we must endeavor to emend the
constitution in general, but If the complaint is 
merely local, local applications may affect a 
cure It will be proper in the 1st place to give
3 g of R: [cross out] rhae: [cross out] every second or third
night; unless the patient is very weak, great
benefit has been dirived from Emetics. The Bath
and spa waters may be of service but particular
of Bristol, our topicall application may be
cold water or an Infusion of green tea for an
Injection at 1st gradually using more astringent
applications as Alumen, Vitriol alb: If the
vagina should be ulcerated, an Injection may
be us’d of the Mel. rosar with T: Myrrh; these
should be us’d after in small quantites.
bee migations of Myrrh, mastic and oliban
may be us’d after the Injection. cold bathing 
is particularly servicable in this disease;
but the woman are averse to It, in which
partiall cold bathing should be employd;
the most nutritious food is the most

Dr. Simpson cut through
a colosity of an os uteri which
was ½ an Inch thick
Edenborough Med Essasys Vol iij
Upon the whole tumors in the
vagina or about the orificum
Uteri may be safely extirpated
without danger of Hemorrhage
or other fatal Symtoms
Hamelton
Giulemeau dilated and La Motte
extirpated callositus in the vaginæ
and os Tinceæ where the children were
Successfully expel’d by the force of 
nutural Labour

F
48
Proper for the nourishment of woemen who have this
complaint, but they should be very temperate
the best drinks, are Lime water, and port Wine
Bath, Bristol, and spa waters, the driest air is 
the best.
(Of a schirrus and cancer of the Uterus)
A schirrus is a hard, tumor, gradually form’d
It is difficult (when it affects the uterus) to
discover it in Its early stage; It begins with
symtoms of Uterine Iritation, pain and sense
of the part falling down, particularly when the
patient is errect, when the disease has proceeded
so farr as this, It may be discovered by applying 
the lance on the abdomen; when an hardness
and an Irregularity will be felt, but [cross out] we
should examine per vagina, If the uterus is
schirrous, the os Tinceæ will be disfigured, its
edges thick, and painfull to the touch,
If we should be still in doubt, we may
easily satisfy ourselves, by the Introduction
of the finger per anum, when we shall exactly
know the progress of disease this disease  
may be confounded with a mole or Dropsy
of the uterus: in a mole the abdomen



F
49
Is usually enlarg’d; in a schirrous Its Irregular,
and the health is impaired; in mole It is not
so mutch; in a mole there is a suppression and a
Irregularity of the menses, in a schirrous tho they
are less copious than is naturall, they are allways
regular, In a mole the breasts enlarge and often
continue a fluid like milk, in the schirrous
the breasts dimisish; In a dropsy the abdomen
is equal and a fluctuation evident. there is 
very little hopes of a true schirrous terminating
fauvorable, particularly where the generall
health is mutch affected with hopes of
radically cureing the disease, we advise
the use of Mercury; antein: saponacious Medi
Alkaline salts, Chalybeat, sea air and
water; these medicenes should be given in
very small doses, otherwise by thire stymilating
effect, they will do mutch mischief, small
and frequent Bleeding and laxative
medicines, will be proper during thire use,
particularly If there is pain or fullness
of the pulse; this method should not be
followed in every case attened with pain,



F
50
deep seated; In these cases, we can only recommend
palliatives small and repeated bleeding and 
gentle laxatives; we should be very cautious in giving
the patient or friends our opinion respecting this
complaint; for If we say It is a cancer and will
destroy the patient, It renders every body unhappy
and posible the patient may remain in that
state a considerable time before It terminates
or it may end in death; in a very short time.
the food should be light and the drink a
Decot : Liquor in process of time ulceration
takes place and there is a fœtid discharge
and increased pain, which can only be relived,
by opium; this disease generally makes a
most horrid devastation before the patient
dies; practitioners have long sought a specific
for this disease, arsnic has been tried, and
Storck of Vienna thought he had discovered
a specefic in the Scicutta but this, as will as every
other medicene in a very little time lost its good
affect, and the diseases in spite of all our efforts
allways proves mortal. all healing things should
be carefully aivedid, and palliative method adopted.



F
51
(Of the Dropsy of the Uterus)
The Uterus is subject to hydatids, these by some are
thought to be occasion’d by clotted blood, by others
to portion of the placenta retained and by others
are thought to be productions from the uterus.
The diseas commences with symtons of Uterine
Iritation; hence the disease has been taken for
pregnancy particularly If the abdomen is
sweled: at the expiration of [cross out] 9 months the
uterus makes an effort instinctively to
expel Its contents; this is attended with pain
and is suppos’d to be in labour, and nature
will sometimes relive [cross out] herself. wee should
be very cautious in asisting least we should Injure
the uterus; this disease is diffiultly distinguish’d
from pregnancy. the abdomen is more unequall
and sometimes an [cross out] obscure fluctuation is
perceived: Sometimes a dropsy of the uterus
occus, some authors think it is produced by 
cause is, which produce ascites, others say that it is one
large [cross out] Hydatid, for that the os Tincæ [cross out] is never
so farr clos’d as to prevent the access of the water,
In this disease as in Hydatids, the action of the  

Dr. Hamelton recommends
tonics after the evacuation
of the water, to do wich he
recommends the use of the
[cross out] catheter or finger
by the os Uteri 

F
52
Uterus takes place at the expiration of 9 months
and expels the waters: this is a very unfrequent case,
when it occurs we should attempt the cure by tonics.
A Dropsy of the ovarias is not so unfrequent a
disease, It usually atacks old maids about the
sesation of the menses, [cross out] It is of the encysted kind,
the water allways being, collected in one or more cysts
there is in general an evident fluctuation, and the
abdomen Is Irregular; this diseas commences with
pain in the lower part of the abdomen, and there is
a small hard circumscrib’d tumor in the groin;
the extremity of the affected side is [cross out] numb’d or
rather enlarged, the tumor continues to encreas till
the abdomen is enormously large, sometimes In the
early stage of the disease, the diffirence betwen It
and ascites is evident, but in the latter stage, It
is difficult to distinguish them, as the abdomen
becomes more equal, but the quantity of Urine
is not so mutch diminish’d, as In the ascites, the
health in general not so mutch affected, the
greatest inconviniance is the weight of the tumor,
It is sometimes severall years collicting.

Fœtuses or bones of fœtuses
are sometimes found in
tubes or ovariæ but they
seldom make considerable
progress and ought never
to be cut upon and
extracted unless when they
points outwardly or form
abcesses 
which are out of the reach of art /Hamelton
Vide Medi: Facts 
and observations Vol 1st Page 73
an account of extra Uterene
conception 

F
53
In the begining of the disease, Opium and fomentations
may be employed for the attendant pain,
Diuretics and Cathartics so use full is as ascites
are here improper, they do not effect any good
purpose, as the complaint seems to be out of the
reach of [cross out] circulation and they tend only
to debilitate; the operation of the paracentesis
is the only means of relief in this complaint, and
It must be repeated as often as occasion requires, if
the water is contained in more thane one cyst we
shall only gain a partiall relief, the friends of the
patient should therefore be informed of the uncertainty [cross out]
of the operation; and we should be carefull to
know that the woman is not with child, at the time.
as great mischiefe might ensue: It is not
necessary to perform the operation, till [cross out] the size of
the tumor requires It; for a cure will not be obtaind
Instances [cross outs] occur of [cross out] patients having this
disease 50 years, hair and bones have been found in the
diseas’d ovariæ, these were formerly thought to be
extra uterine fœtuses but now thought otherwise the
ovariæ, may be effected with cancer and schirrous,



F
54
Of Touching
The touch is divided into internal and external; by the
latter is meant the application of the hand on the
abdomen, the former, consist in introducing one or
more fingers [cross out] into the vagina; If a woman has symtoms
of Uterine Irritation and about the fourth month,
[cross out] from the commencement of the symtoms a circumscrib’d
tumor Is felt in the Hypogastric region, Just [cross out] above
the brim of the pelvis, we may conclude the woman to
be with child, we should not be too hasty in giving
our opinion, as we are liable to be deceived by the
fatness of the woman, If Its from pregnancy the
tumor is oblong and Inclined to the right side of
the abdomen, on account of the Segmoid flexion
of the [cross out] colon; the tumor occasion’d by
fat is universally over the abdomen and the woman
do not feel pain on Its being presed, which she
does If It is a gravid uterus, about or rather
before the 4th month the uterus emerges from the
cavity of the pelvis, about the 5th the fundus uteri
is half way betwen the pelvis and umbelicus,
about the 6th It is as high as the umbelicus, about
the 6 7 month It is half way betwen the umbelicus
and semi form cartilage, at the 8th It corresponds with



F
55
It corresponds with it from the 8th and during
the 9th month It gradually subsides this is an Indication
that the uterus is in a situation to act properly.
Women give to the internall touch, the term of
trying a pain and a practitioner would be thought
undelicate was he to make a use of any other,
It is employ’d in ascertaining pregnancy,
the progress of labour and presentation and to
discover the situation of the pelvis the 1st time
when we examine a patient we should do It on
her left side; afterwards If it is necessary she
will submit to any position the practitioner may
think proper: The Index is the most proper
finger we can examine with; as we can Introduce
It farther than any other, we should accustom
ourselves to the use of Either Index; as sometimes 
one will answer better than the other, some 
authors recommend the Introduction of two fingers,
but sometimes even one will give considerable
pain, pregnancy cannot be well ascertain’d
till the uterus emerges [cross out] from the pelvis;
for till that time the neck of the uterus undergoes

1.6
3
½  
1
___
2.1 7.
2
___
2.3.7.
Vide Med: Facts and
observations: Vol 1st Page 108
remark on Menstruation
By Dr. Denmar
At the same time the 
semen begins to form
itself in the male
Hamilton

F
56
no change: therefore If we are consulted early
whether a woman is or [cross out] is not pregnant, we should
by some excuse or other defer giving our opinion; for 
If wrong our character will be materially Injur’d.
defer [cross out] It as long as we can: an externall [cross out]
examination will be of great service to us, as
sometimes we can feel the motion of the child.
some say we can discover pregnancy before the
uterus [cross out] emerges from the pelvis by Its
encreasing weight and Thickness of the os Tincae, but
the opinion is eronious as these [crossout] signs may
be caus’d by schirrous. 
Of Menstruation
When a healthy female arrives at the age
of puberty she has a discharge of Blood from the
vagina, It is periodical returning at interval
of about 28 days, this discharge is termed
menses or catamania. In this country it usually
commenses at the age of 14 or 15, and [cross out]
[cross outs] continues from that time
to the 45th or 48th year, before It ceases: this discharge
does not take place while the women is pregnant



F
57
or in generall whilst she gives suck; tho Instances
have accurd to the contrary: there may sometimes
be a triffling discharge of Blood during pregnancy,
from the vagina but the menses never appear
during That period and That all discharges of
blood at [cross out] this time are morbid: the menstruall
discharge proceeds from the vesels of the uterus
all ways; this was clearly seen in a patient of
Dr. Hunters, who had a prolapsus uteri; no woman
can conceive till after the menses have appear’d,
they therefore shew when the woman Is fit for
generating her species; this discharge varies
in Its commencement and cesation in different
climates In very hot climates it comes on about
the 9 or 10 year and ceases about the 30th when the
woemen are considerd as old: very probably as
[cross outs] woemen in such climates are treated
like Slaves, for thire capable of procreation at a
time when thire understanding is not arrived at
its [cross out] and they are not consider’d as rationall
beings, In very cold climates the menses to not
appear till the 20th year and then only in the [cross out]
summer months.



F
58
Menstruation generally comes on with pain
in the back and genitals, head ach restlessness, 
It continues for 2 or 3 days and does not for 1st
time return regular periods: yet in some women
It is regular in Its return from the 1st and [cross out] is
not attended with any pain or Inconveniance
when It is establish’d and the woman in health
It generally returns to the day nay sometimes to the 
hours; In weakly constitutions the discharge
continues for 9 or ten days. The quantity of the 
menstruall discharge has been estimated
from ℥ij to ℥ ft in different climates but it
is imposible to estimate with accuracy, Its
generaly suppos’d to be in this climate from 
℥iv to ℥ij : It was formerly suppos’d that
this discharge was of a malignant quality
It was therefore allways buried and the 
woemen did not go into company during the
time of menstruation; but this prejudice
Is now laid aside. In proportion as the menses
appear earlier or later in life in proportion will
they disapear; In England they generally



F
59
ceased from the 45th to the 50th and they observe
the same irregularity at thire onset; both in respect
to the Intervals and the quality of the discharge,
sometimes the intervals are 7 or 8 weeks and the
discharge excessive; various opinions have been
form’d respecting the cause of the menstruation,
some have attributed It to the Influence of the
moon, others to general and topicall Plethory,
and others to fermentation, some authors suppose
It proceeds from arteries and others from veins;
and others again from sinuses in the uterus;
If the moon had any Influence [cross out] over the
discharge all woemen would menstruate at
the same time, and Its probably that every
female of every animal would have a discharge
simular to menstrual: It is very well known
that neither of these circumstance takes place
for there are some [cross outs] woemen menstruate
[cross out] every day and no animal except
woman and those of the monkey kind have
any discharge of the kind. The Idea of fermentation
is now laid aside as rediculous



F
60 
[cross out] great pains was taken to support the
doctrine of menstruation being occasion’d by
plethory, It was aledg’d that from the [cross out]
Indolence and weakness of the sex, they were more
disposd to plethory and that this cause and
produce regular menstruation to relive that
plethory, but this is not the case; for strong
laborious woemen, menstruate more regularly
as the discharge is of a better quality than in
those of a contrary habit; for In them tho the
discharge is in greater abundance It is impoverish’d, 
having fewer of the red particles.
As true thought that the menses flowed
from sinuses in the uterus; which he thought
were gradually fill’d by dipositions of blood
during the month, but no such sinuses are
to be found in an unpregnated uterus; this
Idea of his arose from his drawing conclusions
from the apearance of the gravid Uterus,
In which the veins are as [cross out] large as the
little finger and these, he mistook for sinuses
some asert that this discharge is nothing,



F
61
diffirent from conmon Blood and others asert
that it is a discharge Lui Veneris but whether 
It is or Is not: It is certain It will not coagulate
when in a state of rest as common Blood
will; the most generall [cross out] opinion at present is that this
discharge is from topicall plethory, this opinion
was 1st broached by Dr. Cullen, he thinks that
the growth of the body is affected by the fluids
being propel’d against the vessels and distending
them and as the vessels increase in densty they
Increasin’ size and as the uterus is [cross out] later
evolved than all other parts of the body, the blood
about the age of Puberty meets with [cross out] greater
resistance in every part of the body than the
Uterus, consequently It is determined to
that organ and an hemorage takes place,
Cullen attributes the [cross out] periodicall
return of the menses to the effect of Habit
but If this [cross out] was the case they would not be inclind
to cease at the time they do, the constitution
having been habituated to this discharge so
many years, It must be a power inherited
to the uterus, which we are not able to discover



F
62
The intention of this discharge [cross out] have been
thought, to render the uterus fit for conception
and to afford nourishment to the fœtus, we
know that woemen who don not menstruate [cross out]
regularly are not in a state for conception;
but this Idea of the menstrual Blood affording [cross out]
nourishment to the [cross out] fœtus is not so well
founded, for If this was the case It would not
seem probably that those animals who do not
menstruate could not nourish thire fœtus
proper and also If that opinion was Just
the menses would not totally disapear
as soon as conception had taken place;
but would diminish gradually, as the fœtus
would increase in size. It is observable
in animals who have not menses, that they
are capable of procreation only at certain periods
and at such times they [cross out] have allways
a secretion of mucus from the genitals,
now woemen Imagine that they suffer mutch
more than males at the commence and
cessation of menstruation, but this Idea is



F
63
In some degree eronious as these periods are
Climateric even males; some persons asert instances
of males menstruating, but this mistake must
[cross out] arrise from males having discharges from
the genitals, which have become periodicall in
consequence of habit, and effects of disease
and not of habit as the menses are; If this
discharge is supressed there is disease in the 
constitution; The symtoms of Chlorosis or obstructed 
menstruation are pain, in the back, loins, and
head: restlessness and nothing will alliviate
this disease, till the uterus has attain’d Its
growth, hower It may be alleviated by increasing
the momentum, of the blood, and for this purpose
exercise is the most expedient, particularly
riding on [cross out] horse back, but the timidyty in
this disease will often prevent it being
practised, the most solid and nutrive food
is the most proper for patients in this disease
and as for cordials are proper we should recommend
red wine before Spirits as the patients are apt



F
64
to indulge to an exces of any drink which is
advis’d them; Woemen are more [cross out] delicate and
Irretable during menstruation than at any other
time thefore they require food which is easy
of digestion at this period, but they are averse
to fish and milk but these prejudices should not be
compated; obstructed menses, may be divided
into two Species which require a very different
method of cure, in pale woemen of a Leucophlegmatic
habit we should 1st cleans the primæ viæ and 
administer tonics as the diseas, in such arise
from debility, Chalybiates are very powerfull
remedies in these cases, as is cold and sea [cross out]
bathing, by these means the health will be
ammended before the menses begin to flow,
and here calomel have been very successfully
given, Elictricity like wise has been of service
at this time. If the patient [cross out] has a florid complexion
and hectic habit, there will be a quick pulse,
Cough and other febrile symtoms: here we
should employ bleeding and cooling medicines,
spare diet &c, the T: Heleb : Njr : may here be
servisable but probably any other laxative may

menses.

F
65
answer as well, should the obstruction be causd
by an acute disease, that disease is to be 
attended to, and the obstruction will be remov’d
when that disease is cur’d; sometimes the menstruall
discharge in too great abundance or returns
oftner than the usuall period it is to be remov’d [cross out]
by an attention to every thing that tends to
restore the [cross out] strength both of the body and mind;
but If It should be attened by a febrile daiathesis 
we should 1st employ a mild antiphlogistic
plan till that is relived and then strengthen
the [cross out] habit; Painfull menstruation may
be [cross out] reliv’d by Bleeding and gentle laxatives,
the pediluvium, opium and sitting over warm
water woemen thinks that at the final cessation
of the menses they are liable to disease they
therefore at these periods use frequent Aleotec
medicines, but these are improper as the disease
should never be forced at this time; we should use
small bleeding light diet moderate exercise,
and the body should be kept open; toncis may
be occasionally employ’d. cancers of the uterus
always proceed very rapidly after the finall cesation of the mences.

Vide Hunter’s plates of the
Gravid Uterus 

F
67
(Of the contents of the Gravid Uterus)
The fœtus during the 1st days of pregnancy is 
term’d embryo which name It retains, till the
form of the animal is delineated; the ovum when
It pases the fulopian tubes, is so small as not
to be visible to the naked eye; about the 7 or 8 day
we can distinguish two small vesicles the largest
is to form the head, the smallest the trunk of
the fœtus, about the 12 day, four very small 
protuberance may be discovered upon the smaller
vesicles, [cross out] which are the rudiments of the extremities
the upper of which are larger and are developed
sooner than the lower ones: the face begins then
to be delinated by very small spots making
the eyes, nose, ears and mouth; but the face
is not compleatly delineated before the 15 day.
the funis begins now to be form’d It appears
like a very fine thread but the placenta cannot
be accurately discoverd before the 18th day.
the placenta is at this time are Corless as the 
red particles of the Blood do not pass through,
If the Embryo [cross out] take the name of fœtus 

A fœtus of 4 weeks is
about the size of a common
fly and 6 that of a bee
at 12 weeks it is nearly
3 Inches and Its formation
very distinct*/Hamilton
*Vide Dr. Hunters plates 
of the gravid Uterus

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68
at the expiration of the 1st month, the former
being all that time delineated and Its length
about one Inch, at the end of six weeks the form
is more compleate, at this time the K head bears
a larger portion to the [cross out] rest of the Body, than at any
othir period of pregnancy at the end of the 2nd
month the fœtus measures 2 inches and ½ at
end of 3 months 3 ½ the 4th and 5th It is usually
about 5 inches and at the time of Birth 20 or
22 Inches but its length and wait varies very
considerably. The fœtus in Utero in order to
correspond with the womb: is doubl’d into an
ovall form, It’s chin is [crossed out] press’d down upon Its
breast, It’s knees drawn up towards the chin,
and the heels, apply to the buttocks and Its
arms are clasped round the knees; It was formerly
thought that the head [cross out] of the fœtus in Utera,
was applied to the fundus utero, untill Just
before the actack of labour, when the fœtus turned
with the head towards the os tincæ, but this
Idea is eronious for the head is towards the 
os Uteri the whole time of pregnancy: the fœtus
differs from the adult in many particulars;



F 
69
the head is a larger to the size of the body
the head of the adult is firmly united by sutures,
consequently its Bulk cannot be diminish’d
by pressure, but the sutures in the fetall head
are so farr asunder as to permit Its being
lesen’d to a great degree even so mutch as ½ Inch
without destroying the child. In the Brute
creation thire younge are generally borne blind.
In the humane species, it is not so, but vision
is imperfect in a new borne babe, this is most
probably owing to the great degree of the dilatation
of the Pupil at this time for during [cross outs]
the time the child is in utero, the child not
having expos’d to light, the Iris has not received
that stimulans from light, which afterwards
causes It to contract and which It cannot do
probably till It has been sometimes accostom’d
to It, vision is the 1st sense which is perfect, and
then hearing and other senses. In the fetal Eye
there is a membrane call’d Pupill eris; extending
from the extreamity of the Iris filling up the
Pupil, this was 1st observ’d by the Haller and

See Med: Facts observati: Vol: 5 Page 92
An account of a child without organs 
of generation

F
70
since noticed by Dr. Hunter they both
thought they Injected It: by some anatomist
it has been suppos’d to prevent the rays of light
affecting the child when 1st born; but this can
never be the case as It is never found in a 
fœtus, more than 7 months old, Its [cross out] use therefore
is unknown. the thorax in the fœtus is narow
and flatter than In the dult, the lungs of a 
fetus in utero, are specificly heavier than
water, but after Birth when once they have
been expanded with aire, are specificly lighter,
hence arose the Idea of putting a piece of the 
Lungs of a child suppos’d to be murdered in 
a pail of water, but this experiment is 
fallacious and never ought to be admitted
in a court of Judicature, for Instance putrefaction
may in some degree have taken place and
there the air which is seperated will render
the lungs  the child may have breath’d once or 
twice and then expire naturally, besides
maternall feeling is so naturall that we
should [cross out] Judg on the fauvorable side

The fœtus have an ovall hole
open betwen the two auricles
of the heart call’d foramen 
ovale and a large communicating 
canall call’d
canalis arteriosa [cross out]
going betwen the pulmonary
artery and aorta which two
pasages allow [cross out] the rest of
this circulating fluid that 
returns by the cava superior
to be transmitted to the aorta 
without pasing through the
lungs
It has a gland situated
in the fore part of the chest
betwen the lamence of the 
mediastin call’d the 
Thymus / Hamilton

F
71
The woman has already shown hersef
influenc’d by her amorous passion and
why should we doubt her maternal feeling,
It is certainly equally great.
The fetal heart differs from the adult
by the communication of the two auricle by 
means of the foramen ovale: in the fœtus
the internall Illiac arteries are larger
than the externall in consequence of the
two umbelicall arteries, which arise from
the latter and this is the reason why the superior
extremities increase faster than the lower
one before birth, but after birth the umbelicall
artery dry up, the externall Illiacs receive
a greater quantity of Blood, are larger [cross out]
than the Internall, and then the lower
extremeties increase faster than the
superior: the testes of the fœtus are 
within the abdomen lying upon the
psoas muscle just under the kidneys
confined by a duplication of the



F
72
Peritoneum, they have been supos’d to be
plac’d there as being more secure than in the scrotum
least they should receive Injury during labour;
but this is not the case, as they generally decend
into the scrotum about the 7th month of the pregnancy.
A Child may be born with a hernia owing
to the tunica vaginalis not closing properly
round the spermatic chord: the urinary Bladder
in fœtuses is oblong, in adults it is pyramidall 
at it’s top, In the fœtus is a membrane
calld the urachus, this in a calf is a canall
leading to a membrane call’d Alantois.
Rudder imagined he Injected this in the 
human subject and some have thought
it to [cross out] be suspensory ligament to the Blader;
The funis Umbeliculis passes from the navel
of the child to the placenta, It consists in 
the human subject of 2 arteries and one
vein, but in Brutes there are two arteries
and two veins, these vessels are connected
together by celular membrane the
Interspaces of which are fill’d with a



F
73
gelatinous [cross out] matter, which serves
to take off the effect if any accidental pressure
which would otherwise Intercept the circulation.
a portion of the amnios, is reflected over the
funis, giving It an external coat: the blood is
convaied to the child from the placenta by the
Umbelical vein and from the child to the 
placenta by the umbelical arteries: the funis
is very variable in Its length, being sometimes
not more than 9 or 10 Inches at others 3 or 4 feet
It varies likewise in thickness, this depinds
upon the greater or less quantity of gelatinous
matter, but in general the thickness of the 
funis and size of the placenta, is a adapted
to the size of child; there are very often little
protuberances on the funis and the women
Imagine that the mother’s to have many 
children, as there is knobs. the Embryo in
the 1st Instance adheres to the placenta,
from which the funis gradually elongated.
If the arteries of the funis ramify mutch

Dr. Hamelton mentions
7 cases of enverted Uterus
from the rude extraction
of the placenta out of which 
only one did well

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74
Before they enter the placenta is very
tender and in such [cross out] cases should be [cross out] cautiously
extracted.
The placenta is a circular cake measureing
about 6 Inches across, It is about one Inch in
thickness at the funis becomeing gradually 
thinner; towards the edges this cake is the 
medium of communication betwen the mother
and child, in almost every species of animal
there is some difference in respect to the placenta,
In some multifirous animals there are as
many placentas as fœtuses and in others
as In the sow there is only one placenta
notwithstanding the number of her young.
the placenta may adhere to every part
of the uterus but it very seldom adheres
to the same [cross outs] spot
in succeeding pregnancies, It is compos’d of
arteries, veins and celular substance,
the most celular part of the placenta is
next the uterus, It is term’d the maternal

Thus there are three
cerculations belonging to
the fœtus viz one between
the uterus and placenta
by absorption one betwen
the fœtus & placenta by a
continuation of vessels
through the cord and one 
within the fœtus Itself

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75 
Portion: while that side next the fetus
which is most vascular is call’d the fœtal
portion; there is no communication of vesels
betwen these two portions, for Injections will
not pass from one to the other, Its therefore
suppos’d that the maternal blood is effus’d
into the celular portion, and that the veins
which open into It, In this Instance perform
the office of the absorbents, and convey the blood
to the child: this has been suppos’d to be a 
wise provision of nature, [cross out] to prevent the
constitutionall disease of the mother being
communicated to the child, others suppose that
the blood effus’d in the cells of the placenta
underwent some chainge which was necessary,
previous to It’s entering the body of the fœtus.
In the human subject, the number of placenta
generally correspond with the [cross out] number of futus,
[cross out] tho the placenta adhere together. when
there are twins they are Inclos’d in seperate
[cross out] membranes and water, & there are two
funises so that the disease of one Child, is not 

The true waters is containd within
the [cross out] amnion
waters are sometimes collected
betwen the chorion and amnion 
these are call’d false waters
and without detriment
to the woman may flow
at any time of pregnancy

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Necesarily convay’d to the other, for the placenta
to they adhere yet it is there [cross out] they do not communicate,
as one cannot be Injected from the vessels of the others,
The membranes arise from the edges of the placenta,
they are In general very delicate but they never
rupture till labour commences becaus during
pregnanacy, the os Tincæ being compleatly clos’d, the
Uterus in every part affords them firm support,
but when the os Uteri, dilates in labour the support
is taken away at that part, and the waters being
pressed down by the contraction of the Uterus,
the membranes are bursted at that part, Dr. Hunter
diffines 4 membranes the amnios, the chorion, 
the spongy chorion or Tunicæ decidua Uterina
yet tunicæ decidua reflexce; the amnios is that
tunicæ [cross out] next the fœtus and the rest are in the  
abouve order, the true chorion is the smothest tunicæ:
tho not the most transparent, the fluid containd
withing these [cross outs] tunces is calld Liquor ramnia or
waters, this is diffrent in colour and consistance,
being sometimes milky and at others yellow,  



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It is greater in quantity during the early month,
and when the fœtus is dead, It [cross out] Affords an asylum
for the child and dilates the soft parts in labour
(Of the signs and Diseases of Pregnancy)
Conception is suceed’d by various effects, which 
during the early months has been call’d the signs
and during the latter months the diseases of pregnancy
and Quickening is the line of distinction betwen
them. A part may have the property of receiveing
a degree of Irritation without inconvenianc to the 
patient, when this actuating cause is increas’d
the part is then said to be Irritable as In consequence
of this encreas’d action, It becomes excited by a
less stimulans than before; this stimulans is
call’d Irritation and is divided into two species
simple or direct and Irritation by sympathy 
or consent: the 1st implies when the stimulis is
applied immediately to the part so Irritated,
and the second is when a part distant from the
primarily affected, by means of a connection by
nerves with It. The diseases of the early months



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of pregnancy are caused by uterine Irritation,
while those of the latter are caus’d by [cross outs]
[cross out] pressure of the gravid Uterus: these
persons who are mutch trouble’d with diseases
of the early months are generally relived after
quickening and are seldom affected again till
the 8th month, but those who suffer Inconvenience
[cross out] during the early [cross outs] months are
generally till the whole of the period after quickening.
woemen affected with the disease of early months
[cross out] are [cross out] generally better off (providing they
are not very violent,) than those who suffer
no inconvenience they do not so often miscary.
The signs which usually succeed conception
are nausia, aversion to food the patient was
formerly fond of, lasitude and symtoms of 
generall increas’d Irratability: there are [cross out]
shooting pains and an enlargement of the 
breast, this is one of the 1st symtoms sometimes
occuring before the cessation of the menses, which
is the 1st sign the woman herself Judges by, then the



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79
around the basis of the Nipples become of
a darcker colour, this depends on the enlargement
of the breasts; nausia an vomiting If not before, now
come on, the countenance now alter’d, the Eyes become
more [cross out] sprightly and the mind becomes sincerely
affected; at this period the menses ceases to flow;
some asert that woemen may menstruate during
[cross out] pregnancy, this is a mistake for the menstruall
discharge comes from the arteries of the uterus and
the ovum during pregnancy adhears to the uterus and
blocks up those vesels If therefore a women did
menstruate during the pregnancy, the ovum must
be detached every month and again adhere;
It is most probable that those who asert this opinion,
must have been deceived by a discharge of Blood
from the vagina and not the true menstruall
discharge from the Uteres; But the women [cross out]
during the 1st months of pregnancy become thinner
they take less nourishment and consequently
form less chyle; there is [cross out] more Inclination than
usual in consequence of the pressure of the utures
on the Bladder; we should know the progeress of the



F
80
of the symtoms of pregnancy as we have
occasion woemen who want to deceive as, as [cross out] criminals
who are under sentence of deth and woemen who
are kept by old men who want to deceive them
for [cross out] a lacrative purpose, they know the signs
of pregnancy as well we do, but are not so
well acquainted with the order; The habit may
generall be affected by uterine Irritation tho
not that part may be particularly affected
and the uterus may be brought in to action and
or absorption produc’d by the effections of parts
sympathiseing with the uterus as obstinate
costiveness affections of the stomach &c &c &c.
When the the uterus has increas’d in size as mutch [cross out]
as the cavity of the pelvis will allow, It emerges
from the pelvis and is supported by Its brim
about this period the woman quickens which
is usually from the 14th to the 18th week this circumstance
sometimes comes on suddenly and sometimes 
a small discharge of the blood and frequent from
the fright the woman has hysteric symtoms.



F
81 
some authors say that the menstrual 
discharge being retaind causes all the [cross out]
[cross out] diseases of early month, of pregnancy
but that about the quickening the fœtus
consumes all the discharge and the symtons
disapear; but the cessation of the [cross out] menses at the
time of quickening is better accounted for [cross out]
[cross outs] upon Mechanical principles
for the uterus during Its [cross out] enlagement in the
early months is confin’d to the cavity of the pelvis
and is pressed upon by the surrounding parts
and It’s weight is not well supported the uterine
In Irritation is [cross out] consequently Increas’d, but at 
the time It emerges from the pelvis It is free from 
any kind of pressure and Its weight is supported
by the brim of the pelvis, hence a great cause of the
Irritation [cross out] Is at this time remov’d and the 
patient remains well till about the 8th month.
when the uterus has acquir’d so considerable a
a size as to prees on the stomach and produce
nausia and vomiting and by Its pressure on the



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Illiac veins the lower extreamities become
adomatous and sometimes the [cross out] thighs aree
num’d from the pressure on the nerves and 
sometimes even the arteries are compressed hence
a greater determination of blood to the head and
superior parts which has by some [cross outs] been
thought [cross out] to be a cause of convulsions.
Pregnant women have usually a febrile
diathesis; as blood drawn at that period is observed
to have a Buff upon it something similar
to the true Inflamatory crust this gave rise to
the bleeding of pregnant woemen which is to 
generally adopted; It may be employ’d in the
country to advantage in robust woemen, but
It seldom does any good in a large town ore
[cross out] dibilytated woemen. The diet proper
for [cross out] pregnant woemen depends on thire
former habit of liveing, In generall they seek
for vegetables [cross outs] of cooling aperient
nature and these are proper for such patients
nervos woemen who [cross outs] are liable to
Miscariage have been confin’d to a horizontal



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Posture during the greater part of pregnancy
without any good affect, It is a custom in London
to prevail on woemen to keep in an Indolent state
during the early months, and to use considerable
exercise during the latter months, this is highly
improper for mutch exercise should be taken
during the early months only. The sickness most
incident to pregnancy is troublesome in the
morning when the woman first begins to move,
It is compared a to be very like in sensation to sea
sickness It seems in general to be of service,
so that If it’s not very violint no attemp should
be made to restrain It, if Its exceeding violent
we should 1st administer laxatvis, then we
may give [cross out] saline Draughts, in a state of
efervesence, æther and opium are recommened
but ‘nothing will have so good an affect as the
horizontal position, columbo root after the 
sickness abates has very good affect in
restoring the tone of the stomach, and will be
found moste usefull medicine,



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The nausia which [cross out] some times is troublesome
may be relived by gentle Emetics. the heart burn
may be occasion’d by sympathy or ancidity in
the stomach, the former may be relived by the
Saline Draughts, the latter by alkalis and 
absorbents: magnesia is a very usefull
medicene in this case. Pregnant woemen are
sometimes troubl’d with costivness, this is very
Injurious and should be guarded against
by gentle laxatives, as Ol: Recini; by long
continued costiveness the fœces become
undurated and this exists nothing will tend
the expulsion of Liquid stools: purgative do Leave
no good nor are glysters allways of service; If they
do not: all we can do, is to introduce the finger into
the vagina, and endeavor to break down the
column of harden’d fœces in the rectum: pregnant
woemen are liable to Hemorhoides ariseing
entirely from the presure of the uterus and
not from any thing in habit as the woemen
suppose, Emollient laxatives will be proper.
and If the Hemorhoids are very painfull



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Leechis may be applied to the part, or they may
be pricked with a lancet aqua Vegito minerall
is of service in general, as an application; greasy
ointments do no good. Some woemen are liable
to Blotches in the face during pregnancy these are
not dangerous and not require attention, they
go off spontaniously after delivery; Pregnant
woemen are very lyable to be troubled with
affections of the bowells, and these arise from
an Inert rather from an Irritable state
of them, If the former is the case and the patients
plethoric, bleeding will be proper, and If the 
stomach is loaded an Emetic will be proper
after which we should give mild laxatives:
If the bowells are Irritable and fabril diathesis
bleeding will be proper, after which we may
give Rhubarb and small doses of Ipecucuan:
cum opii, starch and mutton broth Glysters are
proper, If there is a tenesmus. Pregnant woemen
are liable to strangury and supresion of urine,
If this is in the early month It may be caus’d



[cross out]
87
By uterine Irritation from consent of parts 
If it is not remov’d It may occasion a retroversion
of the Uterus, from the over distention of the bladder
If it occurs in the latter months It is owing to the
pressure on the neck of the bladder; Incontinence
of Urine is occasion’d sometimes in the latter
months, by the large Uterus pressing on the fundus
of the bladder, this circumstance is an indication [cross out]
that the head of the child presents, woemen
are often very restless in the night during the
latter months; nothing relive them so mutch
as cold air and water, this chiefly occurs
to weakly woemen, very great fear comes on
woemen towards the latter end of pregnancy,
that they shall not survive parturition,
accompanied with uneasy sensations
and generally fabrile symtoms vertigo,
Hemiphlegia &c. If the habit is plethoric we
must endeavor to give relief by bleeding and the
antiphlogistic plan should be pursued.
woemen may be affected with the veneriall
disease during pregnancy and we are



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Advis’d by authors never to attempt cureing
after the 5 month but only to endeavor to mittigate
the symtoms till after delivery; If a woman should
have a gonorhæ only, we [cross out] may attempt to cure It
in every period of the pregnancy, as early as possible;
[cross out] even at all periods tho the woman should
have a confirm’d lues, we may attempt a cure by
the exibition of mercury, providid we do not raise
a salivation. There has been [cross out] much dispute [cross out] whether
the lues veneria [cross out] can be communicated from the
Mother to the child in Utero: Dr. Thynne never
saw a child born with the marks of Lues, but
he has seen children born with the small pox
and If one disease may be communicated, why
not the other
(Of a Retroversion of the Uterus)
A retroversion of the uterus is where the fundus
uteri, is thrown back ward, between the vagina and
rectum and os tincæ, instead of being in a line
with the axis of the Inferior aperture of the pelvis
is under the symphisis pubis, this disease
comonly happen during the 3rd and 4th month of 

Vide Dr. Hunters plates
of the gravid Uterus Pl:
†† in Lond Med: Observ:
and Enquires
The [cross out] cure should
be attemped by Bleeding 
warm bath fomentations &c
previous to the [cross out] 
reduction of the parts
to allay the Inflamation
/Hamilton
Vide Med: Facts and
observations Vol 1st page 96
a case of a catheter left in
the bladder in drawing of
the urine

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Pregnancy; It is caus’d from an over distention
of the bladder from a Supression of Urine, this
disease is more frequent in England then in france
this is to be attribute’d to the too great delicacy
of the English females, who retain thire urine too
long a time, the symtoms of this disease, are
a supression of urine, costivenes and, violent
pain. when these symtoms take place, in the
3rd or 4th we are authoris’d to request an examination,
If this be the disease we feel the fundus and
posterior part of the uterus, through the posterior
part of the vagina, betwen that canall and
the rectum we shall find the os Tincæ behind
the symphisis pubis; this disease is so frequent
that it must have occur’d during the time of the 
antients, but they were Ignorant of It, for
It was not known till the year 1754 when Dr.
Hunter 1st discover’d It by disection, In order
to cure It we should draw of the water by means
of a catheter [cross out] we should Inject Oily Glysters
into the rectum, and some times the uterus
will be replac’d spontaniously we need not 
therefore be in haste to replace the Uterus,

It has been proposed to
puncture the blader in
case the urine cannot be
be evacuated sufficiently
If that will not succeed to
thurst a trocar into the 
Uterus to cause abhortion
or to enlarge the pelvis by incision
at Symphisis pubis in order to
accomplish the reduction of the 
Uterus. /Hamilton
The impregnated ovum
or rudements of the fœtus
is not all ways received from
the ovaria from the tuba
Follapiana, to be thence
convey’d into the cavity
of the Uterus. For there are
Instances where the fœtus
some times remains in the
ovarium and sometimes
even in the tube or where It drops
out of ovaria misses the tube
falls into the cavity of the abdomen
takes root in the neighbouring 
parts and is there by nourish’d
But they are all ways less than
the uterine fœtuses they either
do not receive so mutch
nourishment as In the succulent
uterus or they generally come
to thire full growth long before
thire common term
/ Some of these burst in the
abdomen others form
abcesses and are there by
discharg’d othirs shrivel
appear bony and are
retain’d during life or
dischargd by stool
abcesses &c
/ Hamilton

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But continue to draw [cross out] off the urine occasionally
every [cross out] 2nd or 3rd day and If the uterus does not then
return It should then be [cross out] replace’d and this is
easily done by elevating the fundus and body of
the uterus by means of the Index of the left hand
Introduced per anum and the Index of the right
in the vagina, the flat catheter is the most proper
for drawing off the Urine in this case
(Of the Changes occuring during
Pregnancy)
Conception having taken place and the Ovum being
come into the Uterus, the uterus begins gradually 
to enlarge and as It becomes heavier It falls lower
Into the pelvis the os Tincæ becomeing nearer to the os
externum, the uterus keeps gradually increasing
and about the 4th month It emerges from the pelvis
and is the remaining part supported by the brim
of the pelvis, about this time quickening takes
place and the symtoms incident to Uterine
Irritation ceasis and the woman remains easy
till about the 8th month. The uteres does not



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become thinner as the bladder does by It’s enlargement
but in general retains It’s naturall thickness;
the reason of which is, that It receives a greater
quantity of blood during pregnancy which distends
Its vessels and thus maintains It’s thickness.
The os tincæ after [cross out] the uterus ascends from
the pelvis continues about the same distance from
the os externum, It then gradually receds further
in proportion as the cervix of the uterus is obliterated
which is wholly about 8 months after which time
the uterus gradually subsides and the os tincæ,
again aproaches the os externum. In 1st pregnanies
the uterus generally ascends perpendicularly, 
as the abdomenal muscles, not being accustom’d
to the kind of presure, afford a considerable
resistance and prevent what is terminated
Pendilous belly. If the uterus subsides during the
9th month, It is an Indication, that It is dispos’d
to act [cross out] properly: If It does not subside, the woman
will have a perpetual vometing, tight respiration
and other symtoms of presure and the labour



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In general will prove troublesome; thise symtoms
are to be relived by an errect posture, which is
contrary to that requird In the diseases of early 
months. At the period of 9 months, the uterus contracts
in order to expel Its contents and this action is
not peculiar to the uterus alone, It occurs in every
othir part of the body and probably It is only an
action produced by the effect of a certain degree of
Irritation In the same manner [cross out] the ventricles
of the heart contract upon receiving a certain
quantity of Blood, adequte to [cross out] produce such a
stimulus as will induce thire contraction.
No action which we are acquainted with can be
continued long If It is violent and therefore the
pain of labour is periodical, for nature could
not support a continuance of It without intermision.
The pain of labour is produc’d by the resistanc
which given to the contraction of the uterus, [cross out] woemen
In the different stage of a labour, express thire pain
in a different manner, in the 1st stage that is while
the os Tincæ and soft parts are dilated, she creis

See Midi Facts and observations Vol 5 Page 96
A case of a apoplexy in a pregnant woman
with observations

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out in an acute tone of voice, but after the
parts are fully dilated, her tone of voice is more
grave, and she retains her breath, endeavor to
bear down the contents of the uterus as mutch
as posible, a woman who has true labour pains
has not the power of moderating them.
they will have thire full effect,
(Convulsions)
Woemen during the latter months of pregnancy,
are liable to be seiz’d with convulsions, these have 
been [cross out] suppos’d by some to arrise from the uterus
presing on the Illiac arteries and so causing [cross out]
a greater determination of blood to the upper
parts, but If this [cross out] was the only cause, they
would oftner happen than they do; conulsion occuring
to pregnant woemen are very dangerous symtoms
and frequently fatall [cross outs]
[cross outs] If they happen at the 
full period of pregnancy and are accompanied
with true labour paines, the prognosis is more
fauvorable than If It [cross out] was otherwise.



F
94



F
95
As It is [cross out] in the Intervals [cross outs] betwen
the fits are long and that the patient does not
remain senseless long after the cessation of the 
paroxism: If they occur about the 8th month and
are not accompanied with labour pains: If the 
Intervals are short and the woman remains
a long time comatose after the cessation of the fits,
the prognosis is very unfavrable; the convelsions
are not removed by dilivery always, and our
prognosis in this case must be guided by frequency of the return
compared with those before, If any force is us’d to
deliver woemen Who have convulsions, shuch woemen
constantly die; preternatural presentations are 
therefore fatal to them and in some woemen who
are subject to convulsions, there is such an
extreame degree of Irratability that If the os tincæ
is only touch’d they are Instantly throun into
convulsions, and therefore in such, tho the pains 
do not expel the child after the parts are fully
dilated we cannot use the forceps, but we must
lessen the bulk of the head withe the scissars as by
that means the parts are not so mutch Is Irritated,



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96
and in general the child is dead, In these cases.
woemen who are attact’d with convulsion, always
peviously complain of pain in the head unusually
at the Pit of the stomach, so that these symtoms
may be consider’d as charictaristic of the disease,
The only remedy we can rely on In this complaint
is copious bleeding and the nearer this is done
to the head the better, as in the temporal arteriy
or Jugular vein we should employ cathartics
and afterwards opium which is better given in
small repeated doses, frequent throughing cold
water in the face suddenly, will sometimes prevent
the fit, It aught to be done [cross out] Just as the fit is
comeing on, as will any other sudden fright.
Emetics have been recommended, but there seems
danger least in the act of vomiting, some of the
blood vessels of the cranium should be burst,
[cross out] howevyr If there is nausia they may possible
have good effect. When we are call’d to a 
pregnant woman in convulsions we should 
allways enquire If the membranes are brocken
If they are not we should probable get a 



F
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Mitigations of the convulsions by rupturing
them; woemen are most liable to this complaint
in 1st pregnancies.
[cross out] (Of Uterine Hemorrhages)
Uterine Hemorages require the greatest
skill, and attention in thire treatment as the
los of time here is of the utmot consequence.
every discharge of blood from the uterus has
not the name of Hemorage, It will be proper to
divide them into 4 classes, 1st into those of the 
early months, 2nd unto those of the latter, 3rd into
Hemorage occuring after the delivery of the fœtus:
these three as they never occur In a state of
health aught to be considerd as hemorge tho,
the discharge is ever so triffling, 4th into Hemirge
after the extraction of the placenta or excessive
Lochia, this is not term’d an hemorge unless
the quantity is very considerable as there is
allways some discharge at this period; all these
Hemorages that [cross out] happen after Six months are
term’d Hemora In the early months of pregnancy
and those [cross outs] which happen after the



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commencement of the 7th month are said to be
Hemorehages of the latter months this distinction
is very [cross out] necessary; because in the latter months
we are authoris’d to Introduce the hand into the
Uterus to deliver the child which cannot be done
before the termination of the 6th month, Hemorrhages
of the early months, are less dangerous than those 
of the latter months, because in the former case,
the vesels of the uterus [cross out] are not so mutch
enlarg’d and the danger of the Hemorrhges, depend
upon the quantity of blood lost in a given time,
Yet If It happens at the full period [cross outs]
[cross out] of Pregnancy and is not attended with labour 
pains the danger is not [cross out] so great because
the delivery will be readily effected.
Rich people are more liable to miscary than
poor people, owing to thire Indolence and delicasy
of structure, poor people, seldom miscary except
from violence: abhortions are Induc’d by every
thing quickening the circulation, as violent 
exercise pasions of the mind, particularly
terror; which acts by determining a greater quantity 
of blood to the internal parts in such the



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1st symtom is generally a discharge of the blood
from the uterus; the woemen generally attributes
her abhortion to the act she was employ’d in.
when her 1st symtoms came on: miscarriage has
been attributed to general [cross out] or partiall debility
the former does not seem to be the case, for
consumtive patients seldom miscary, tho they
experiance the utmost effect of generall debility
It rather seems to be occasion’d by a debility in
the uterus and Its appendages combined with
are productive of general [cross out] Irritability
some attribute It to the extream [cross out] lubricity of
the uterus, by which means say they It cannot
retain the ovum, but let It slip from Its cavity
but If this was the case abhortion would be
attended with little pain, but [cross out] sometimes
there is as mutch as there is in a [cross out] labour,
some woemen have in 5 or 6 succssive Pregnancies,
abhorted regularly at the same period, this has
been accounted for, Supposing that in such the
Uterus could not bear a further degree of
enlargement, which [cross out] is at that period received.
It is posible for woemen to conceive when the



F
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Ovaria are sound tho the cervex of the uterus
is diseas’d the fœtus may acquire perfection,
but If the fundus Uteri is depres’d; abhortion
in all [cross out] probability will take place, whether
we attempt to prevent abhortion before or
after the symtoms we seldom succeed: If we
mean to prevent It before the symtoms comes
on, we must attend to the generall heath of
the patient and particularly to the state of
the alimentary canal and Bladder If the
woemen should be plethoric she should be
bled and a spare diet enjoin’d with evacuant
Glysters are the most proper for keeping the
Bowels open, or If any thing is given by the
mouth, castor oil is the best medicine, If the
patient is of a weak delicate habit we should endeavour
to invigorate It, the cold bath is excelent for this
purpose; but we should find a considerable
difficulty to persuade a pregnant woman
to get into It, unless we accustom her to It before
she proves with child, and in such woemen, an



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Horizontal posture as mutch as can be
comply’d with will be of service, tho It would be
hurtfull in a plethoric woman. there are some
woemen in whom we cannot prevent miscarriage
and others who take the most powerfull medicines
will not effect it, sometimes the membranes
rupture spontaniously and then abhortion of 
corse takes place yet some woemen will tell you that
the waters came away at that time and yet that
they went thire full time, but in this they must
have been deceived; the symtoms of abhortion
are different, they 1st complain of pain in the
abdomen, Back, and Extremities, frequent
inclination to make water, but abouve all
a discharge of blood from the vagina; If this
last symtom is profuse, the woman allways
miscaries, but If Its slight [cross out] tho she has the
other symtoms Its posible she may recover,
and go her full time, some woemen miscary
with great pain, whilst others abhort during
thire sleep, or while they are at thire meals
without the least previous notice when an



F
102
Abhortion takes place in the early months
tho oum comes away compleat, but in latter months
the membranes rupture and the [cross out] aqua is
expel’d as in Labour: The ancients thought that in 
preternaturall labours that the placenta
adheard so firmly to the uterus that it could
not be seperated by the hand, they compare It
to fruit which when full ripe, readily fall off,
but which when green adhears firmly, some
of them have contriv’d Instruments for extracting
It whilst others recommend Introduceing the hand
into the uterus but these cases we should leave to
nature, there will most probably no bad
consequence arise, tho It should remain till
Its putrid, Dr. Thynne has severall times seen
this case. Uterine Hemorrhages are to be treated
as other Hemorrhages and by lessening the
contents of the woomb: for thus It is duced to
contract by which means the orifice of the
Bleeding vesels are stopped: Fainting is a
desirable circumstance in uterine Hemorrahges

Mr. Blizard and Abynether recomend Emetics in 
these cases

F
103
for thus time is given for formation of coaguld,
and the Uterus is not deprived of the power of
contracting during that time, for woemen often
abhort, or are deliver’d during a fainting [cross out]
fit. The necesity for not useing stimuli [cross out] in
these cases is obvious astringents have been
recommended, but they are improper, as they
tend to Increase the circulation which should
be retarded as mutch as possible, If the patient
is plethoric we should bleed, It will be proper to
give Niter and minerall acids, these have been
objected to because they are apt to make the
patient vomit, but this is a circumstance which
is of service rather [cross out] than otherwise.
Astringent Injections have been recommen’ded,
but they do not answer, for If used while the
Blood is gushing from the uterus, they do not
come in contact with the vesels and If us’d
when the flooding abate, they may wash off
[cross out] coaguld from the vessels and induce
fresh [cross out] Hemorhage. cloths diped in cold water
and apply’d to the loins will be proper,



F
104
but they should be removed as often as they
become warm, Glysters of cold water are proper
rest should be join’d and the woman kept as
coole as posible in all wether tho she shakes
with cold, In the early months If the discharge
is profuse we should endeavor to rupture the
membranes, tho thise case can seldom be
done, and in the latter months we should 
always try the effect of this before we proceed
to delivery in these cases, the woman is never
safe untill she is deliverd for tho the
flooding should cease in consequence of a
coagula they are very liable to return upon
the removal of these coagula; and If the
practitioner should not be present, the
woman may die before he can arrive. an
Instance of this [cross out] hapend to a Gentleman
in London, we ought therefore in floodings of 
the latter months never to leave the patient, 
If they are violent till she is deliverd,
[cross out] Dr. Thynne never know’d an Instance [cross out] an
Instance where hemorrhage of the early month



F
105
months was primarely, the cause of the womans
death, they are therefore only dangerous by leaving
the woman in a debilated [cross out] state at which time
they are very liable and yet unable to withstand
the effect of a [cross out] fever; Maracue relates 78
cases of Hemorrhages of the early months, 4 of
which prov’d fatal, but he attributes thire
death to the rude extraction of the placenta:
all hemorrhages are occason’d by a seperation
of some part of the placenta from the uterus
by which some of the mouths of some of the
uterine vessels are expos’d: the placenta is
sometimes attach’d over the os Tincæ, and thus
produce a hemorrhage peculiar to the later
months; It does not take place till a chainge
begins to take place in the neck of the womb,
which is generally about the 7th month these
hemorrages [cross out] are more dangerous than those arising
from the seperation of the placenta we should
not attend to the quantity of blood lost in an
hemorrhage but to the effect produced upon
the constitution for in the 1st place you cannot
asscertain the quantity exactly, and some



F
106
Woemen will bear to [cross out] loose more than
others. the
greatest danger is indicated by the pulse
being quick and allmost imperceptible;
the countenance pale, the extremities cold
and If these should be high respirations
and convulsions, after the loss of mutch blood
Dr. Thynne says the case is all ways mortal.
vomiting often occurs, but this is not so dangerous
an Indication as has been generally supposd;
If there is labour pains the danger is not so
great for the uterus contracts so close round the
body of the child that the vessels are In [cross out]part
clos’d we should alway remember this in our
prognosis for the / nearer the women is to her
full time the greater the [cross out] is danger in generall
yet If a woman is seized with a flooding and 
has labour pains (being her full time) the
danger is less than If It was at the 7th month.
In all hemorages [cross out] of the latter months our 1st
object is to acertain whether the placenta is
attached over the os Tincæ or not and this is 
often very [cross out] difficult, for the



F
107
Os Tincæ is frequently cover’d with a clot 
of Blood, which we can scarce distinguish
from the placenta by the feel, Rigby advises	
In all cases where we are dubious to Introduce
the hand and effect premature delivery,
as he thinks It is the least risk, for If It should
be so the danger is great, at the commencement
of the labour; as the gradual dilalation of the 
os uteri must afford a very large surface
of bleeding vessels, for a considerable time,
as soon as ever we can discover the placenta
is attached over the os Tincæ (art being our [cross out]
only rescorce) we should proceed to deliver
the patient, as by waiting for a return of
the discharge the vessels will be more
enlag’d and the Hemorhage proportionable
larger, in case of seperation of the placenta,
from any other part of the uterus; If the
discharge is moderate and the woman not
much exhausted in consequence we should
not deliver [cross out] at the 1st or second discharge,



F
108
But wait in hopes of the woman supporting
them till the full period of pregnancy when
nature may effect the delivery and life
both of the mother and child be preserved,
but the woman may be in such a state as she
cannot bear the further loss of Blood and
here we should deliver immediatly, otherwise
the patient will be lost. In flooding cases the os Tincæ is in 
such a state as to be easily dilated, In placenta
cases we are advised to perforate [cross out] It with one
finger, and there to enlarge that opening so
as too introduce the hand, and to deliver the
child through It, but the best way is to introduce 
the hand gradually betwen the uterus and
placenta to seperate the placenta from the
os Tincæ, we must then turn the child and
there will be a cesation or moderation of the
discharge: we should proceed in extrctiing
the child very cautiously and slowly in
order that the uterus may contract as the 
child is expeled.



F
109
Of Labours
Labours are divided into 4 classes, Naturall,
Laborious, preternatural and complicated.
A Labour is term’d natural from nature
being sufficient to effect the delivery, it is defin’d
to be where the head presents and the labour
is terminated four and twenty hours from the
commencement of labour If It protracted beond
that time, tho the powers of the constitution
may be [cross out] sufficient to over come difficulty
It is call’d a Laborious, Tidious, difficult
labour, preternatural labours are those in
[cross out] which any part except the head presents
and where the asistance of art, is most
frequently required; If any labour is combin’d 
with flooding or any other circumstance
wich requires the asistance of art 
It is call’d a complicated or [cross out]                                         
anomalous labour; Nurses make many
distinctions If there should be vomiting, they
call It a sick labour, If drowsiniss, appears
they term It a sleepy labour, If there is a



F
110
If there is a great quatity of mucus they call
it a wet labour; these circumstancs are of
service, as by Intervals of sleep woman [cross out] are refresh’d
by the great secretion of mucus [cross out] the parts more
readily dilate and the act of vomiting facilitates
the expulsion of the child [cross outs] If there is but
little mucus the nurse says It is dry labour,
and these in generall are tedious and the parts 
in general take a great while to dilate [cross out] the action
of the uterus and labour pains, have been employ’d
as synonimous terms, but they differ [cross out] in
signification for the labour pains are caus’d
by the resistance made to the action of the uterus,
and the action of the uterus is the power overcoming
that resistance. the obliquity of the uterus
has been suppos’d a cause of tedious labours
and in some country it is customary to take of
that effect by the position of the patient, in 
England we allways deliver woemen on thire
left side and in [cross out] nine cases out of ten, the
obliquity will be found on the right, owing



F
111
to the sigmoid flxion of the colon on the left,
but If the belly is pendilous, the patient should
be on her back the whole of the labour and If the 
uterus is on the left side, she should be on the right,
In france woemen are deliver’d in the same
position as we place patients for the operation
for [cross out] the stone but this is indelicate and painful,
In germany they are deliver’d on a stool, but this
is [cross out] improper, as the woemen cannot have the 
benefit of sleep, during the intervals of pain;
In Ireland they are deliver’d while setting on 
the knees of another, and in america, they [cross out]
think so little of the matter, that woemen often [cross out] 
deliver themselves, against a tree in the field,
and carry the child home themselves. in England
the delicacy of the females is such that they will
not admit the practitioner to come near them
till the pain is violent, we [cross out] therefore
should allways enquire of the nurse the state
of the bowells, the Bladder &c how long the patient
has been in labour whether the pains are violent
an quick and If the waters are discharg’d,



F
112X
If the patient has been long in labour we
should frequently retire into another room to give
the patient an opportunity of voiding her urine.
which in such cases, she has a frequent inclination
to do; In natural presentations the most
common is where the occiput is inclin’d to the
left cotyloid cavity and the face to the right
sacroilliac symphysis: the french say the head
may come in six different ways or directions
rather, they advise you If you find It comeing
[cross out] unfaurable to endeavor to altert it, but
This is often impracticable and always
unecessary, as nature is sufficient to
effect the delivery If the proportions of the 
parts are proper; if the face presents with one or
both arms: they constitute varieties in nuturall
labour but a longer time is necessary for
the completition of the delivery: labor generally
comes on with a degree of despondency and this
is not peculiar to the females In the human
species as It is observable in Brutes.
[cross out] particularly in 1st pregnancy

For a minute detail of the
bed dress of the patient
and other particulars
relating to the management
of natural labours see
tretise of midwifery for the 
use of female [cross out] practioners

F
113
It may be occasiond by sympathy. from the
1st change made on the os Uteri and this is
increas’d on a naturall timidity. during the 1st
pains the os Tincæ begins to dilate and this is
the most distresing period of the Labour. as the 
woman then being mutch distressed by anxiety
fear &c. labours most commonly comes on with
a shiverring fit, but instead of this shivering,
there should be a full and distinct rigour,
similar to that which is observ’d at the begining
of fevers, or should a rigour come on in the midle.
It indicates a future attack of puerpurall
fever, or some impending mischief to the mother
or fœtus; In natural presentations (and In
those only) there is sometimes a suppresion of
Urine, this is occasion’d by the presure of the 
head of the child on the neck of the bladder
or Urethra, [cross out] we therefore in all lingering
labours, should attend to the state of the bladder,
and this should be done by applying the 
hand on the os pubis, for If we depend on the 
woman’s account we are liable to be deceived



F
114
for If the membrane break before the os uteri
is mutch dilated, the water will triffle away
and the woman will Imagine it’s her urine, and
the Bladder by being distended is liable to be
ruptur’d and a circumstance which has
actually occur’d in two or three cases: to relive
this suppression of urine, we must introduce
a finger into the vagina and push the head
back and a little upwards and then posible
the woman may make water, If this method
does not suceed [cross out] we must have recourse to
the catheter and in these cases we should
always use the flat one, when we examine to
feel If the Bladder is distended, over the 
pelvis we should [cross out] feel If It is [cross out] a flat
circumscrib’d tumor which is painfull to
the touch in such cases we should draw
off the water as soon as posible; woemen in labr,
who have natural presentations, are also
often’d troubl’d with an oposite disease this
is an incontinuance of urine, [cross out] occasion’d 



F
115
By the presure of the head of the child upon
the fundus of the bladder; Its increas’d by
patients sneezing, and coughing or standing
upright, It is of no further consequence than that
of making the patient well and aught not to
be attended to, Tenesmus or costiveness
are frequent occurences during labour;
from the pressure upon the rectum, the latter
(particularly in tedious labours) should be
removed by glysters, as It impedes delivery,
by diminishing the cavity of the pelvis; Deorhee
[cross out] sometimes occurs and is generally of service 
by removing the fabrile diathesis, and
preventing an accumelation of fæces in the 
rectum. One or both Labia magna frequently
swel to a [cross out] considirable degree during
labour and put on a gangreaneous appearance,
this circumstance has given mutch alarm [cross out]
to the patient and practitioner, but the fear
is groundless It is extravasated blood
and a point of a lancet is all that is
necessary.



F
116
The vagina becomes smear’d with a roassy
mucus which is at 1st ting’d with blood and
is then call’d the shew It is a proof that the 
os Tincæ is in some degree dilated and It serves
to lubricate and relax [cross out] the part disposing
to dilatation for the passage of the child,
this often appears before tho sometimes
not till after the Labour pains commence.
Labour pains have been divided into true
and spurious and a distinction is necesary
in practice for If [cross out] spurious, they may be
relived and will be proper to them otherwise
by thire continuance they may exicte the true
action of the uterus, even at a primature period
we [cross out] should therefore be carefull to distinguish
them, true labour pains generally begin
in the loins extend round the abdomen
and terminate at the pelvis tho they sometimes 
commence in some particular part, they
are often troubled with vomiting and



F
117
Sometimes with violent pain at the pit of 
the stomach and in the head, the two last
simtoms indicate convulsions before the termination
of the labour and therefore whenever these symtoms
occur we should acquaint the friends of the patient,
that we expect such an attack during labour,
true labour pains are periodical, and slight
at the begining, but as the labour advances they
return more strong and frequent, woemen
generally recover more perfectly after lingering
than rapid labours, and It is observ’d these woemen
who are seiz’d with the puerpural fever are those
generally who have had quick labours,
Whilst the soft parts are dilating, the woeman
exprses her pain in an accute tone of vaice,
like one wounded by a cutting instrument,
but as the labour advancs when the soft parts 
are sufficiently dilated and the uterus begins
to expel It’s contents, the woman complains in
a more grave tone, Instinctively retains her
breath in order to force down the contents of the 



F
118
Womb as mutch as posible, therefore If
we attend to these circumstance, we shall be
able in some degree to judge the progress of labour,
by the expresions of the woman and thus we avoid
the inconveniance of frequent examination to
assertain the state of the labour there is [cross out] great
Impropriety in giving heeting or forceing things
or desireing the patient to bear down before the
os Uteri is dilat’d; If we do the patient is sure
to be Injur’d by It, indeed Its seldom necessary
afterwards tho in some cases under proper
restrictions, It may tend to expediate the
delivery; When the pains are slow and full
which by the woemen are calld grinding pains
we should not follow the practice of nurses and
midwifes, who tell the wonan the pains are of
service that she must experiance mutch
stronger before she can be deliver’d, as that
very mutch discoureges and adds to thire
inefficasy of the pains, on the contrary we should
make use of all encouroging soothing language
in our power.

case of emphysema brought on by severe labour
pains Vide Med: Facts: [cross out] observations Vol 2 page 45.

F
119
False pains may be produc’d by the flatulincy,
costiveness, fatigue, febrile diathesis an Irritable
habit by the regular motions of the child. these
are to be [cross out] relived by attention to thire causes,
If they arrise from fatigue, or flatulences glysters
[cross outs] succe’d by opium will be of service
as Indeed in all spurious [cross out] pains: if they
arrise from febrile diathesis; small bleeding
and the antiphlogistec plan will be proper and
venesection will be of servic in all spurious pains:
in 1st children and full habit. If they arise
from an irritable state of the patient, opium
is the most usefull remedies, after the exibetion
of Glysters, spurious pains are often periodicull
and equally strong with true pains, false
pains more frequently occur in an Evening
they are more [cross out] Irregular than true pain,
and are not accompanied with slimy mucus,
but this is not sufficient for as to form
prognostics, some advise to lay your hand
on the abdomen and If we feel a hard globular
body,



F
120
In motion we are certain It is the uterus in
action, this is certainly a good method but in
this stage no woman will permit it, the only
certain method we can distinguish true from
false pains is the introduction of the finger into
the vagina, and If they are true pains the 
os tincæ will be found almost as thin as brown 
paper, and little dilated, and we should find
the uterus bearing down during a pain.
Woemen are often so impatient during labour
as to insist upon asistance in thire cases, If the
parts are dilated we should only sit by them,
or [cross out] keep a finger / In the vagina during a pain, 
by which they will be satisfied we should in
all cases to endeavor to deliver them as quick as
posible. Labours are divided into 3 [cross out]
stages, the 1st consists in the dilatation of the
os uteri: and rupture of the membranes:
The 2nd, the delivery of the child, and the 3rd, that
of the extraction of the placenta, & membranes,
the os Tincæ at the begining of the labour is of various
thickness size and distance from the external



F
121
parts. The 1st stage of labour is effected 
very slow, particular in the begining and the
1st labour, It is perform’d by a contraction of the
uterus forcing out a portion of the membranes
and waters through, which being a soft accomedating
body is insinuated during a pain to every part
of It and acts like a wedge; when there is a pendilous
belly we do not discover the os Tincæ, in the axis of
the inferior aperture of the pelvis, but It is push’d
towards the seacrum. A labour advances, the
intervals of care become shorter and the woman
becomes anxious for the event but we must be
very cautious in not giving a dicesive answer
to any question that may be asked respecting
the duration of the labour; as we cannot say how
long the os Tincæ may be dilating or how long 
the pains may continue strong: the longer the
os Uteri is indilating the more in proportion 
will the woman be affected with nausia and
vomiting and If we examine during the time
the woman is [cross out] vomiting we shall find that
the uterus bears down as mutch as during a



F
122
Pain. labours sometime instead of increasing
Irritability will lessen it and the patient will
sleep during the intervals of ease, If pain returns
often, and If the os uteri is thin and bears down
during a pain and particularly If the woman
has had children before she should not be
left when the os tinceæ is a little dilated the
membranes will be [cross out] felt protruding and very
turgid similar to a blown Badder during a
pain and sometimes has been mistaken for
the head of the child, [cross out] It may be
distinguished by there being [cross out] no sutures to be flt
we should be very careful in an examination,
for during pain the membranes are [cross out] easily
broke and If we should do this at [cross outs] so early
a period we render naturall labour a tedious
one, for the head of the child Is not near so
well [cross out] adapted to dilate the parts as the
membranes are; we should break the
membranes till the os Tincæ is fully dilated
and Indeed in natural labours, It is very



F
123
Seldom necessary to break them at all; but when
It is, It may be readily done by scratching them
gently with the nail of the Index finger during
the height of pain; [cross out] we must not attemp
examining a woman the 1st time but during a
pain; but in france where the delicacy of the sex
is not so great as It is here, practitioners examine
In the absence of a pain and they are certainly then
The best Judges of the situation of the parts, the 1st
stage of the labour being now over, the uterus
In consequence of Its contents being lessen’d by the 
evacuation of the waters; is excited to more [cross out]
vigerous acction and contracts close by round the
body of the child. we should never leave any
woman after the evacuation of the waters, but
more particularly those who have had children
before, for they are frequently deliver’d in
the next or a very few pains afterwards.
It may be necesary to repeat the motions the 
head makes in its pasage through the pelvis:
It 1st makes a flexion [cross outs]
forwards, the chin resting upon the breast



F
124
This is continued without alteration till It
arrives at the spinous process of the os Ichchic:
when It makes 6th or an 8th part of a turn, by which
means the long diameter of the head corresponds
[cross out] with the long diameter of the inferior aperture
of the pelvis and as the head pases through
the externum the occiput emerges from under
the arch of the pubis, and the waters are evacuad
and the parts dilated, the head preses on the
perineum and here our attention is require’d
least a laceration should take place;
Quadrupeds and woemen who are deliver’d
without assistance, seldom have laceration
of Perineum, the principal cause of this accident,
is too quik an expulsion of the head and the
perineum being preternaturally rigid, as
soon as [cross out] ever we perceive [cross out] the head forming
a tumor in perines, our attention must be
directed to support that part and this is done
by a finc et cloth in the left hand and the
palm of the right should be apply’d over the



F
124
Os externum to prevent the too suden expulsion
of the child, in some cases It will be necessary to
support the perineum while the shoulders and
hips pass. It often hapens that the head of a child
will recede in the absence of a pain, tho push’d
lower during a pain, but this is of no consequence 
particularly If we are affraid of a laceration
of the perineum, and It may In some degree
tend to prevent It after the head is deliver’d
we should not attempt to extract the body, If
we do, we generally do some Injury and nature
will compleat the delivery in one or two pains
more, for If we pull the body without getting
the shoulders into the long diameter of the pelvis,
we Increase the difficulty; Mr. White of manchester
observes that by allowing nature to complete
the delivery we prevent afterpains and Injuries
to the external parts and he says that the
extraction of the placenta will be more [cross out]
easy for If we extract the body in the absence
of pain the uterus is more liable to contractions.



F
125
[cross out] Spasmodic. as soon as the head is deliver’d 
the mouth should be turned from the os externum,
least a sudden gust of waters might suffocate
the child If the child, is weakly and the breathing
not perfect we may destroy it by tying the funis
too soon, the ancients did not tie the funis till 
after the placenta was deliver’d but this is
inconvenient, however we aught not till after
the child has cried, as this is the criterion by
which we can Judge of the [cross out] breath life
having taken place there have been many
opinions respecting the tying of the funis, some
thought one Ligature next the child was sufficient,
others think that two are proper and the funis
is to be divided betwin them, we generally advise
two and our principal reason is cleanliness,
and besedes If there is twins It is posible that
the placenta may communicate and If so the
child in the Utero must perish and some practitioners
say that when the placenta is [cross out] turgid with 
blood It is most easily seperated and by having
two ligature we cam more readily discover



F
126
Whither there is any flooding after delivery
of the fœtus, the funis should be divided about 
4 or 5 fingers breadth from the abdomen of the
child, It should be tied with a peice of tape
or thread 10 or 12 times double: we should be carefull
that nothing but the funis is betwen the blades
of our scissars, as thire is an Instanc of an
eminent practitioner, cutting of a portion of a
child’s [cross out] penis; to avoid this, we should
take the funis betwen the middle and ring
finger of the left hand; by which means we
exclude every thing else; after laying the funis
we should apply a flannel cap over the head of 
the child, particularly If is in the winter time.
otherwise If the child should have sore Eyes, which
is a common occurance, the nurse will attribute
to this neglect; after we have given the child to
the attendant we should apply our hand to the 
[cross out] abdomen of the mother this will be permitted
at this time; tho in the begining of labour the
patient will not suffer It, If we find that
the abdomen is large and

delivery ---------

F
127
Hard most probably thire is another child,
particularly If there should be a continuance
of pain, If we are In any doubt respecting this,
we should introduce a finger into the vagina
and with the other hand on the abdomen
we should press the abdomen downwards
by this means, we shall be able to decide.
the extraction of the placenta should never
be attempted immediately after delivery
and if there should be twins It should not be till after the 
of the 2nd child; Hypocrates advises medicated
substances to be introduced to excite the
contraction of the uterus, and celsus recommends
the introduction of the hand immediately after
delivery in order to remove coagula of blood,
and extract the placenta; this practice was
universally adapted for many years but
was at last rejected by Ryusch and 
ambrose parry; yet smelie Inculcated this
doctrine and It is practic’d by some at the 
pesent day. Dr. Hunter advanc’d a doctrine
the reverse of this, he observ’d that in all



F
128
Animalls the placenta is deliver’d by the efforts
of nature he therefore propos’d never to extract the
Placenta at all, but this method of practice
proved fatal to several and we find It right
to preservere a medium betwen the [cross out] practice of
Celsus and Hunter for If we extract the placenta
immediatly after delivery we expose the
orifices of a great number of vessels, which
may power out a great quantity of Blood,
before the uterus has time to contract on the
other hand by leaving It to nature we render
the mind of the patient uneasy It causes pain
and produces putrid diseases; In general the
poper time to waite before the extraction of the
placenta is from 10 to 20 [cross out] minutes
tho this is uncertain; as It depends entirely
on the state of the uterus; we must wait till
It is in a disposition to contract; for then the
extraction of the placenta is less difficult
and the orifices of the vesels all close; as the
placenta is seperated. As soon as we percieve
the uterus to contract we



F
129
Should take hold of the funis with a cloth in one 
hand and Introduce the other into the vagina, the
two fingers and draw the funis over the top of these
fingers as over a pully the funis will recede
during inspiration and the efforts we use
should be just sufficient to prevent this
recission, we [cross out] ought to pull gradually and
gently and not by intervals; as the placenta 
is comeing througe the vagina, we should turn
round by which means we can extract the
membranes also, If the uterus does not contract
soon after delivery we should prescrib cordials 
and the abdomen should be rub’d with a
warm flannel by which means the action
of the womb: will be excited: If after delivery
an hemorrhage a comes on, providing the
action of the uterus takes place; there is [cross out]
no danger but If it’ s accompanied with [cross out] a
flooding of the uterus which is generally the case, we
should not extract [cross out] the placenta, by the funis
but by introduceing the hand into the uterus.
and dilating with the fingers by which
Irritation the action of the uterus will be excited.

a morbid retention is
difficult and dangerous
If the placenta remains
and nature fails to expel It the woman generally 
dies from uterine Inflamation [cross out] and
gangarine. [cross outs] 
It must left to nature as long as posibl If that fails
the hand must be introduced very cautiously
Hamilton

F
130
But we must continue our hand in the uterus
till this is excited or effected If we are call’d
in late to a violent flooding case and the
patient very mutch exhausted It will be
imprudent to extract the placenta immediately
for there is allways some blood lost upon the
seperation of the placenta and the patient
so farr reduced, as not to be capable of sustaining
[cross out] such a loss: in cases of hemorhages, woemen
are very mutch terrifi’d which makes them
appear more exhausted than they really
are, sometimes the placenta is [cross out] retain’d
from a spasmodic contraction of the uterus
which throws It into a variety of forms,
we must persevere stedily in our attempt
to introduce your hand into the uterus in
these cases, we must bleed and be free in the
use of opium at the same time applying
warm fomentations to the abdomen, great
benefit has been derived from Emet: Tarter given
in small doses repeated, often sometimes there
are morbid adhesions of the placenta to the 
uterus In these cases we can never seperate

from the retention to long
malignant putrid miliary
fevers and fatal fllooding
have often been occasion’d
of which I have known several
Instances /Hamilton
Vide Whete's treatise
direction for [crossed out]
[crossed out] manageing the
placenta cases 11th-12th 13th
14th & 15th. Kirklands
treatise of child bed fever
page 158 & 164

F
131
The whole we must introduce our hand and
detach as mutch as we can, In extracting the
placenta by the funis we must, be careful
not to exert so mutch force as to seperate the
funis, which is easily done If the vesels
ramify mutch, before they enter the placenta.
(Of Laborious or Tedious Labours)
These [cross out] frequently require our
assistance, they are defin’d to be where the head
head presents, but from some impediment,
the labour protracted beyond the space of [cross out]
24 [cross out] hours, these are not peculiar to
[cross out] deform’d woemen but often happen
to those who have a    Pelvis, the uterus varies
in form in different animals also in thicknes
It is thicker in the Human, than in any other
species which gives It a great power to overcome
that resistance, which is peculiar to the human
subject, woemen are affected by the pasions
of the mind, It is therefore evident that it 
is wrong to communicate Inteligence to woemen
in labour; The complexion of the patient has



F
132
been suppos’d to have some Influence over
labour, but this is only applicable to very fair
or very dark woemen as such are more liable
to the affections of the mind and body whilst
these woemen of Intermediat shades generally 
posses a more equitable disposition and better
health. The size of a woman has been suppos’d 
as an occasional cause of difficult labours, This
so far just that these woemen are generally inactive
and cannot undergo mutch fatigue and very
small woemen have frequent distorted pelvises
but which circumstance are generally avoided
in woemen of a midling stature, the state of the
mind has also been thought to have some effect
as these woemen of a chearful disposition are
said to undergo parturition the best. the climate
and heat of the weather may likewise have some
effect, as woemen in general quicker in hot
than in cold countries; there is allmost an endless
scarcity of the species of labourious labours,
and these [cross out] in general are owing to a combination
of causes. they may consequently be divided
into 4 clases.



F
133
First those occasiond by the Inertio of the uterus.
2nd by a [cross out] rigidity of the soft parts. 3rd those occasion’d 
by a disproportion betwen the head and pelvis,
and fourthly from diseases in the soft parts;
the causes of the 1st class may be too great distention
of the uterus this never in so great a degree as to
deprive It of all power of action tho It may be
mutch diminish’d from this cause as we
observe in twins for in these cases the 1st stage of
labour is perform’d very slow the pains being
very feeble, In these cases we should break
the membranes for by this means, the
contents of the uterus is lessen’d and It acquires
power, yet we should be cautious as we are
to recollect, that the child is more liable to
Injury after the waters are evacuated.
It was formerly a practice to confine a patient
to her bed as soon as labour commenc’d but this
practice is not proper in general, for by this
means we counteract the effects of the gravity
of the uterus and retard the labour in cases
[cross out] where the patient has had a very quik [cross out]
labours it …ay



F
134
be Right. If the uterus does not subside at a
proper period of the pregnancy, there is apt to be
a sickniss and a spasm of the uterus when
labour commences; when this happens the patient
is of a weak, Irritable habit and in such It will
be proper to mitigate the constitution by exiersise
during pregnancy, the patient is often in these
cases feverish [cross out] then bleed, cooling medicines, are
proper opium aperients. &c &c & but in young
plethoric woemen we should not give opium
till after we have evacuated freely as It is apt
to disturb the order of labour. the rigidity of the 
membranes, has been consider’d as a caus of
difficult labour, but in general the cause of
thire not Breaking is owing to the inefficasy of
the labour pains, for we find in premature
labours where the membranes are always stronger
than at the full time they break spontaneously.
Sometimes the funis is very short or It might 
be twisted round the child this is said to be a cause
of difficult labour but nature will effect
delivery.



F
135
If the head of the child is deliverd and the 
funis twisted round Its neck, we are directed
to bring the funis over the head of the child, If [cross]
this is easyly [crossed out] practicable It may be done, but
If we cannot do It easily we should examine
the pulsation, in funis, If It is strong, we
should leave It to nature but If feeble the child
is dying and we should deliver It as soon as
posible by Introducing the finger into the
arm pits or passing a Handkerchief over the
head or we should tye and divide the funis
as If the child was deliverd and rely upon
the breathing life. The abdomen of the child
may be dropsicall and impede delivery a case
of this kind happend to Dr. Young of Edinborough.
Debilitated woemen have often very quick
labours, but then they are generaly a long time
before they recover and are liable to be atack’d
by every predominant contagion; woemen of a 
full habit, are more liable to lingering labours,
but that they recover more speedily:



F
136
When the mind is depres’d, an the labor tidious
all we can do here is to [cross out] encourage the patient.
the rigidity of the soft parts is a particular
attendant upon 1st labours and this very [cross out] much
increas’d If the patient is advanc’d in years
before she proves with child a or may be caus’d by
Inflamation so that we ought be very cautious
in giveing healing medicines at the begining of
labour. bleeding is not necessary in every labour
but where the patient is young plethoric or If thire
is fever or topical Inflamation it is proper as
are cooling glysters &c &c and in rigidity and 
Inflamation of the soft parts, the patient should
[cross out] sit over the steams of hot water. A pendilous
belly may be a cause of tedious labour for In
this case the uterus endeavors to expel its contents
in a direction contrary to the axis of the pelvis
this and every other obliquity is to be counteracted
by the position of the Uterus. the rigidity of the
os Uteri, may exist without the externall
organs being affected and vice versa.



F
137
A disproportion betwen the head and the pelvis
may happen from a vitiation of the latter,
If this is not very great nature will accomplish
the delivery, but If it’s very considerable we must
have recourse to Instrumental delivery, another
cause of this disproportion may be a complicete
osification of the head of the child which
deprives It of the power of lessening. sometimes
there are tumors on the head of the child which
impedes It’s pasage when this is assertain’d
It should be open’d; a Hydrocephalus may happen
to a fœtus in Utero; but this cannot be known
till the 1st stage of labour is over and then there
will be a fluctuation evident and the sutures
are very farr apart as soon as this is discover’d
It will be proper to open the head as It is not alive.
If the face presents or is turned towards the
pubis It’s productive of a tedious labour,
sometimes we are able to discover this early,
while the face is yet above the brim and then
we may posible be able to change [cross out] the 
presentation If we do It must be for the better,
It cannot be for the worse, If the parts of

[cross out] -- 1 6
[cross out] -- 3 7 3
[cross out] –- 1
[cross out] –- 7

F
138
generation are in a regid state this cannot
be done, sometimes one or both arms come
down with the head If we can return them
we ought to do It; otherwise we must leave the
case to nature but then the labour will be
render’d tedious, The distention of the rectum
or bladder may produc a tedious labour,
by occupying too great a part of the cavity of
the pelvis, we should therefore in all lingering
labours, attend to the state of the rectum and 
bladder with respect to the bladder we should
apply our hand on the lower part of the abdomen,
for the woman may mistake on the evacuation
of the Liquor [cross out] amnia for a discharge of urine;
In general we may relievie a true distention of
the bladder by presing the head of the child
back with the finger; but If this cannot
be done [cross out] we must have recourse to the flat
catheter, a woman may conceive who has a 
stone in the Bladder and this by coming before 
the head of the child may impede Its passage
should such a case occur It will be proper
to [cross out] cut upon the stone and extract it.
Excresenses and serherri of the os Uteri



F
139
May be a cause of tedious labour they may 
protract [cross out] It, The os Tincæ in These cases, will
dilate very slowly; It is posible a woman
after conception [cross out] may form an Inflamation
or other causes have an adhesion of the sides
of the vagina, this will certainly very mutch
impede delivery, If they near the os externum
they may be taken for unruptured Hymen
and hence probably arose the conjecture of a
woman conceiving with a perfect Hymen
this difficult we remove by dividing them
tho If left to nature, the delivery will be in
time accomplish’d, Tumors are another
impediment, these If large must be remov’d.
It’s said that a labour has been protracted by
the dropsy of the ovaræ and [cross out] relived by the
trocar. A rupture of the uterus has been
allways [cross out] consider’d as very uncommon, but
Dr. Thynne is of opinion that it is not an 
unfrequent case, he has known several and
he thinks it is very probably that this happens
in general where woemen die suddenly during
labour without appearant cause; It is alwas
mortal.



F
140
(Of Preternatural Labours)
A preternatural labour, is that in
[cross outs] 
[cross out] which any part of the fœtus [cross out] except the
head presents, every woman is liable to them,
a number of uncertain symtoms have been
enumerated by which we are to judg during
[cross out] pregnancies of a probability of a
preternaturall labour but they are eronious
and If they were certain, they would be of no use
In practice; woemen who have such labours
have often an Irregularity [cross out] of the abdomen
during pregnancies and feel an unusuall
sensation upon lying down and in these the
uterus seldom subside the 9th month, as
It generally does, in naturall cases. in these
the lst stage of labour is very lingering and
the membranes Instead of forming a round   
body usually form a long one, like the finger
of a glove. If upon examination, after the
dilatation of the part we cannot feel any
part of the child, it’s a strong [cross out] presumtion
that the presentation is preternatural

Vide Medical Facts and observations
Vol 1 Page 76 Spontaneous Evolution of
the fœtus


F
141
and we are authois’d in this case to introduce
the hand into the uterus to asertain the
presentation, and here it may be necessary to
premise that whenever we introduce the
hand, It should be carried through the
externel organs during the height of pain,
as then the patient will not asertain the pain
we give them, but should be introduced through
the os Tincae in the absence of pain. the back of the
hand should be smeard over [cross out] with a strong
lather of soap, over which we must spread oil
to prevent alkali from stimulating [cross out] the parts:
the head of the fetus can only be distinguish’d
from the other parts by the sutures and Ears,
from the breach or shoulder may be [cross out]
so Jammed in the pelvis so as too feel as solid as
the head. the presentation of the shoulder is
to be ascertain’d by carrying the finger along
the side of the neck and Ear [cross out] der
and the right shoulder is distinguish’d from it
by the direction of the ears. the arm is distinguish’d
from the foot, by the fingers, which are
longer than the toes and the thumb being at a distance.

See Med: Facts and observations Vol 5 Page 96
A Breech case and footling

F
142
The back may be known by the spinous process
of the vertebra, the [cross out] abdomen or [cross out] breast by feeling
the Insertion of the funis; the Breech [cross out] is known
by a discharge of meconium by the cleft in the
buttocks and by the genitals, [cross out] however the
discharge of meconium sometimes happens in
a naturall presentation but then it is a
certain Indication of a dead child: the inferior
extremity is known by the [cross out] heel, and the
shortness of the toes: preternatural Labours
may be divided into two classes the 1st including
presentations of the breech and lower extreameties
and the second including presentations of the 
superior extreamities. Dr. Thynne never met
with any others: after the [cross out] membranes are
broken and we find that the Breech presents
double some authors recommend us bringing
the feet down directly, others recommend us
to lave It to nature and the later is certainly
the best practice, for the child may all ways
come double and by this means the parts are
so mutch dilated that the head may be [cross out]
easily brought away and there is a greater
Probabilyty [cross out] of



F
143
Saveing the child, If the funis preceds the
breech or the woman mutch exhausted or a
flooding comes on, we must endeavour to
expediate the delivery. and this we do by
Introducing our finger into the groins of the
child and extracting gently from side to 
side or we may pass a Handkerchief over
one or both groins these methods are mutch 
preferable to the blunt hook for by the use
of this Instrument we are liable to break
or luxate the thigh or Injure the genitals
In these cases the child is usually born dead
particular If It is larger than common, of the 1st
labour. in all preternatural presentations
If the os Tincæ [cross out] is [cross out] not fully dilated and
the membranes are entire we should be careful
in our examinateon, least we rupture them
If the membranes are ruptur’d and the os tincæ
not fully dilated we should in all presentations
(except those of the upper extremites with the shoulder)
wait patiently and not attempt artificial
dilation except some dangerous occur.
in this case except we must use artificial
dilatation as It is necessary to turn the child.



F
144
As soon as the breach is expel’d we should
attend to the direction of the child and if It is 
not already we should turn it that the occiput
may nearly correspond with the pubis of the 
mother; but we must be carefull to do the
hips are expeld otherwise the head will be locked
in the pelvis having done this we should
extract gently from side to side and as soon 
as we are come almost to the shoulders, we
should extract the arms, for this [cross out]
purpose support the body of the child on one
arm bringing it as much as possible to
one side then we should pass [cross out] along the
arme one or two fingers of the opposite side
of the child as high as the elbow, and then
we must depress the childs arm the same
method must be observ’d in respect to the other
arm, but we must use some caution or we 
shall break the arm, we are now to support
the brest of the child in our left arm and
then to put the Index of our left hand into
the childs mouth while the finger of the 
right [cross out] hand are employ’d across the back of
the neck we therefore extract from side to side,



F
145
we are to extract in the contrary direction
in all these cases we must proceed in a very
gradual manner, In case of a Back or belly
presentation which are very scarce we must
reduce them to a footling case, If the shoulder [cross out]
or any portion of the arm without the head the
child must be turn’d If the os Tincæ is fully
dilated and the membranes entire in a
shoulder presentation we ought to endeaovur to
turn the child, before the waters are evacuated
as It is then mutch easier upon account of the 
waters preventing the uterus closely embracing
the child, If the external parts are rigid tho
the os Tincæ is dilated we should endeavour
to dilate them artificially and this should be
done during a pain. If the membranes are
broke, the os tincæ rigid and an upper extremity
presenting, we must have recours to artificiall
dilatation and that during the abscence of
a pain If we do not proceed to this method
the shoulder is still further wedg’d in the
pelvis, and the case becomes still more



F
146
Difficult; The uterus may be said to have
3 actions, viz, Its elasticity It’s contraction
in time of labour and spasm in case of the
latter we cannot attempt to turn the child
but must use opium, bleed, open the bowells
&c. we should never attempt turning a child
during a pain as we are in great danger of
Injureing, the uterus and whenever we perceive
a pain comeing on, we ought to flatten our hand
to prevent the unequaleteis of our knuckles
from Injureing the womb: when a superior
extremity presents we should examine whther
the arm be twisted and ascertain which
hand It is and [cross out] which way the palm
of the hand is directed for we must introduce
our right or left according as the right or
left presents of the child’s, and the feel are
usually found on that side to which the
palm of the hand is directed, when we have
occasion to turn a child; we should endeavor
[cross out] o to do it while the woman is upon her
side, That we might not alarm her, but
If this does not suceed we must place her 
on [cross out] her back.



F
147
or even her [cross out] knees and elbows, If we can lay
hold of both feet, so mutch the better but we can
turn by means of one, we should bring down
the foot very gradually for If we are in a hurry
we not only run a risk of Injureing the patient but
the foot will slip from us, If the shoulder be
Jammed at the superior aperture of the pelvis,
so as to prevent the Introduction of the Hand
we must endeavour to return It and for this
purpose Dr. Burton of york Invented an Instrument
in the form of a crutch but the hand introducd
in that form is certainly mutch preferable.
If the shoulder is so farr Jam’d, as We posible
cannot turn It, we must rely on nature, It has
happen’d that by the [cross out] forcible
contraction of the uterus the body of the
child has revolv’d round its own axis
and the feet pushed down but we never
should rely upon this as It requeres many
adventitious circumstance as a large pelvis,
small child strong pains &c &c. necessety
alone should induce us to leave the
labour; It is a circumsance which has
happen’d and may [cross out] again, therefore



F
148
We mention it: If a distorted pelvis is
combined with a [cross outs] preternatural Presentation the difficult
is increas’d and we have a great deal of
trouble in bringing the head away. If after
the body is expel’d, we finde by the funis
that the child is alive; we should compleat
the delivery as soon as we can but we must
[cross out] get It througe the pelvis in the most
fauvorable manner, the forceps well here be
usefull but If we find that the child’s dead;
we should leave It to nature for some hours
at least; or If the friends of the patient should
be importunate we should open the head
but we must be carefull not to dvide the
muscles or Ligaments which connect the
head to the vertebræ otherwise whem we
attemp to extract the head which well be
seperated and left in the uterus If such
case should happen some have advesed it
to be left to nature, tho recommend the
forceps. It being a [cross out] moveable body we shall
find some difficuly in applying them unles
the head can be fix’d by an asestunt presing the [cross out] 
abdomen.



F
149
Anomalous Labours.
These are where some accident happens
during labour which is dangerous to the life
of the mother or child as the funis comeing before
the head, floodings, convulsions &c. If the funis
comes down before the head and we perceive a
pulsation in It, we ought to deliver the woman
speedily or the child will be destroy’d in 1st labours
If we cannot reduce the funis and keep It up we
should turn the child or If the head is low down,
use the forceps or lever, the same practeic is 
requesite If the funis precieds the Breech; [cross out] one
thing is to be [cross out] rememberd that as soon as you
have retaind one part of the funis another falls
down; Dr. MacKenzie to prevent this, inclos’d the
[cross out] protruded funis in a piece of cloth and return’d
It, which had a good effect; In all violent flooding
cases The woemen must be deliverd Immediately,
to deliver the woemen there have been a variety
of Instruments invented the one in prencipal
use is the forceps; the best hold which we can
obtain is to have the hollow of the blades over



F :
150
The ears and the point towards the chin they
are never proper in breech cases; as here we [cross out] can
use the fillet, Blunt hook &c the forceps are very
use full in wedg’d cases of the head, that is where
It’s long diameter is forced into the narrow diameter
of the pelvis, they are usefull likewise in slight
vitiation of the pelvis but If the pelvis, is more
than six lines too narrow the child will be
destroy’d by the presure of the forceps: the 1st
stage of labour should be compleated before
we attempt to use the forceps they should
be warm’d before they are us’d; we should
make It a rule, never to use the forceps, till we
feel the ears as we are to guided by them in
the application of the forceps: the lever is
used with the same intention as the forceps,
it is an Instrument very mutch in use at
present and prefer’d to the forceps as It’s
application is more easy safe, yet we can 
exert more force with the forceps. sometimes
in labour there is cesation of the pains



F [cross out]
151
without any apperent cause this may
be either temporary or final and thes we
are to judg of by the symtoms of the patient
If it’s only temporary the pulse will not
sink the [cross out] countenance will remain
unalterd and the spirits good in this case
we should use cordials frictions to the
abdomen &c &c. [cross out] but if the countenance
alters, the pulse [cross out] sinks we must not only
give cordials, [cross out] but deliver the; in general we can
apply the forceps while the woman is on her
left side conveniantly but If the head is very
low [cross out] down, the patient should lie on her back.
we must be very careful in introducing the
blades of the forceps, the best method is 1st to 
introduce one or two fingers of the right hand
over the ear and introduce the left hand
blade of the forceps betwen the fingers and
head, we then pas two fingers of the left hand
over the other ear and introduce the other blade,
we then lock the forceps and extract slowly
from side to side during a pain, we must not attempt
to turn the head, as nature will spontaniously



F
152
do that as we extract mutch better than we
can, when the head is pasing through the os
externum, we should elevete the handlue of the
forceps and at the time support the perineum
with the other hand when we use the lever; we must
make our hand the fulcrum as mutch as
posible upon the ramus of the Ischium and not
upon the pubis as was formerly done. the head
cannot by weg’d only from long contined pains
it cannot hapen in a well form’d pelvis
or If [cross out] it is much vitiated where a pelvis is
much vitiated the child must be born dead
and as the use of use of the forceps and lever is
pregudicial to the mother: it will be better
practice to open the head immediately as this
an operation perfectly consistant with the safty
of the mother, the symtoms of a dead [cross out] child
are extreamly uncertain the most certain is
a putrid discharge from the vagina, could we
ascertain it we might relive the patient sooner
by opening the head of the child, the best
instrument for this purpose is the long
Scissars;

≡ For when the capacity of the pelvis is so straight as not to
permit any part of the childs head to be protruded through
the superior aperture nor to admit two fingers [cross out]
of the accoucheur’s hand at the bottom to conduct proper
Instruments with safety to open and diminish the
fœtus’s head and secure a firm hold to procure the
extraction the cæserian Section has there been practised
or the unfortunate woman become [cross out] the victim of the 
imperfection of the art
Hamilton 
Sir Fielding ould call’s It a
detestable barbarous and
Illegal piece of inhumanity
and [cross out] endeavours to prove
the improbabilyty and even
imposebilyty of Its suciss
on the contrary If we could rely on
the testimony of authors since the 1st
accounts of the caesarian operation
Successfully practised by a sow 
Gelder on his own wife in the 16th 
century † many well attesed
histories apear’d on record In which 
It is said to have been sucessfully
perform’d
† Vide Bauhins Appendix to
Rousets Treatise ----
When the narrow diameter at the brim or bottom of the 
Pelvis does not exceed one or 2 Inches that this operation
Is Justified by modern practitioners
in consequence of distortion ≡

F
15 [cross out] 3
Which we pass through one of the fontanels
if we can or through a suture, you then open
the scissars in every direction to enlarge the opening
and Introduce an Instrument to destroy the
texture of the brain (a common spoon is as
usefull an Instrument for this purpose as
any) after the brain is evacuated we extract
the head by a blunt hook introduced through
the opening If the vetiation is very considerable
we should leave the head to be softend by 
putrefaction. 
Of the Caesarean operation
This is an opening made into the uterus, in
order to extract the child; It has been employed
where woemen have died suddenly during labour;
In order to preserve the life of the child: it may
be perform’d in those cases where the uterus
ruptures during labour and the child escapes
into the cavity of the abdomen; whenever the
head of the child can be examined per vagina
It should always be extracted through, that
[cross out] canal: in a rupture of the uterus *

The case of Elizabeth Sherwood
on whom Dr. Osborn operated [cross out] is extraordinary
[cross outs]. Her Pelvis in the short diameter
measur’d (9.8 from the Seacrum to pubis) ¾ tho of Inch 
on the left side quite to the Illium which was about
2 ½ Inches in length the space was certainly not wider
It was even thought to be narrower: on the right side the
apperture was rather more than two Inches in length
from the protuberance to the Illium It was at the 
atmost about 1 ¾ Inches from the hind to the fore part
but It became gradually narrower both towards
the Illeum and towards the projection yet after the 
child’s head had been opend 36 hours the child 
was deliverd; and on the 7th day the patient was as
well as at any former period of her life
Osborn Vide page 75
* Vide the last page of [crossed out] this Book

F
154
the life of the woman is not to be attended as she
allways dies, but surely we should endeavour
to save the child; in france this operation is
oftener necessary than in England, as thire laws
prohibite the opening the head of the child, upon 
a calculation 9 out of 10 woemen die who have
It perform’d and as we are allowed to open the
head in this country, the [cross out] cerarean operation
will never be found necessary.
Of the treatment of Lying in Woemen 
As soon as the placenta is extracted we should 
chainge the position of the patient by putting
the legs on the street as this very mutch refreshes [cross out]
them, we should then remove the wet cloth
from the pudendum, and apply a warm dry
one, the practitioner by the little circumstanc
shows attention to his patient and ingratiates
himself in her favour: the woman should then
take some light cordial as a little warm wine
the french usually give spermaceti and
Oily mixtures at this time but they are apt
to produce nausia however [cross outs]



F
155
If the patient has been accustom’d to this 
[cross out] method we should pursue It, or she will not
think well of us: we should attend to the heat 
of the room nurses are too fond of keeping thire
patients too warm. In [cross out] general poor woemen
recover from a lying in better than rich; this has
been attributed to difference of constitution, to
which may be added a difference in the after
treatment; woemen are fond of being deliver’d
on the bed, but weakly woemen should be deliver’d
in By [cross out] that means they avoid the fatigue of being
removed afterwards however they should 
not be put to Bed, till the labour is pretty farr
advanced, otherwise they become anxious [cross out] and
the labour is retarded; with respect to the
food of the pateint, we should be guided by
her accustom’d habit she may have toast,
and Tea, Beef tea, whtimeat, fish &c &c.
in [cross outs] hysteric woemen the food should 
be more of a cordial nature and taken oftner,
vegetables seldom agree well (after delivery)
with woem and are therefore improper,



F
156
the woman should be shifted in about 
16 or 18 [cross out] according to the stringth she
has required, the patient should be chaing’d 
every day about the 2nd or 3rd day. she should
sit up right in bed; to prepare her for the
fatigue of getting out of bed and compleatly
shifted the 4th or 5th day this is generally done
towards evening that the fatigue may
procure her sleep in the night, about the 3rd
day or sooner If there should be any
inflamatory diathesis or pain in the abdomen,
the boowels should be emtied and this is 
best done by cooling glysters, but [cross out] If the
patient is averse to this, we [cross out] may give
castor oil, magnisia or any other mild
purgative we should not purge before the
3rd day unless there should be necessity as
It disturbs the secretion of milk: the 9th day
is reckon’d, creticall as the patient [cross out]
[cross out] is seldom attach’d (after this day)
with puerpural [cross out] fever, and we always
find that nurses wish to confene thiree



F
157
Patients to bed on that day. the disease which 
happen after delivery are mutch improv’d in the
method of treatment since men have studied
midwifery as a profesion: they are divided
into 3 clases the 1st from the delivery of the patient
till the termination of the 3rd day: the 2nd from
the 3rd till the termination of the 6th, and the
3rd class from that period till the termination
of the 9th day: those complaints that occur
during the 1st three days are faintings, after
and spasmodic pains, excesive discharge
of lochia and diseases of the external parts
there are two distinctions to be made to these
faintings [cross out] which lying in woemen are
subject, the one arise merely from the sudden removeal
of the [cross out] presure, of the uterus, and is not
dangerous, in this the pulse is readily felt
and there is a warmth in the body in the other
species the body: seems cold the pulse is hardly
perceptible, the countenance is very mutch
allerted and the respiration is high, this is a
mortal symptom and in general [cross out] preceds
unintended Hemorage once a rupture of the



F
158
Uterus; In the former case affording
presure to the abdomen by a Bandage giveing
mild cordials coole air &c is [cross out] in [cross out] generall
sufficient but in the later case besides these
we should use the most powerful stimulants
for exciting the action of the uterus. we must
distinguish spasmodic, from after pains
the former generally comes on after delivery
very soon; and attack persons who have had
children before, are periodicall are confn’d
to the region of the uterus and usually go off
in 24 hours, tho sometimes not till the
second or third day spasmodic pains usually
come on after delivery, attack woemen in 1st
labours, after pains are occasiond by the
efforts the uterus makes to extract coagula
of blood &c. Dr. Burton recommened the introduction
of the hand for the removall of them but this
gives pain and they will collect [cross out] again
and nature will expel them, we may give
Spermaceti or Camphor with opium in spasmodic
pains we should use glysters, opium:
Camphorated Embrocation fomentations to the 
abdomen.



F
159
The Lochia is a discharge of Blood which
takes place as soon as the placenta is seperated,
this is a natural discharge and not to be attended
to by the practitioner; unless It should be excesive; 
which is known from the effects it produces,
this discharge in heathy women usually 
[cross out] continues red for 4 or 5 days It then
becomes more limpid and is call’d by [cross out] the
nurses the green waters this in healthy
woemen continues for 10 or 12 days but in
weak habits sometimes a [cross out] month,
the pasions of the mind may increase this
discharge as many laborious labours
warm drink, twins, and the rude extraction
of the placenta. If a [cross out] portion of which is
left behind, it will cause an immoderate
and fœtid flow 4 or 5 days after delivery
there is not an instance upon record of It’s
proving mortal, If It does not take place
till 12 hours after delivery; to relive the
disease we should endeavour to excite the
action of the uterus by cordials, cloths dipped



[cross out]
160
In vinegar and water and apply’d cold
to the abdomen and remov’d as often as they
acquire the temperature of the body; by making
moderate presure on the abdomen by introducing
lint (dipped into vinegar and water) into the 
vagina we should expose the patient to the 
cold air att all seasons. [cross out] confine her to an
horizontal posture &c our prognostics in this
case [cross out] as well as all other Hemorrhages,
should be jugded [cross out] by the effects produced upon
the constitution and not to the quantity of blood
lost. the external organs are subject to
Inflamation and contusion, which may be 
remov’d by evacuations and topicall
applycations; a laceration of the Perineum
sometimes occur, some authos recomend but
they will not answer, as the urine being
insinuated into the wound prevents It’s 
healing by 1st Intention; we should keep the
[cross out] parts clean and the knees laid
together, the bowels [cross out] kept open,
a compleat laceration proves very troublesome



F
161
But a partial one is easily cured when this is
the case, there is a violent smarting after
delivery, which continues and is increas’d
upon the patient voiding her urine.
The urethra many be lacerated during labour
or from the long presure of the head of the 
child, It may slouth afterwards, in this
case the urine comes through the wound,
and when we introduce the catheter we shall
discover the wound, If it happens to be a
laceration; It will be discoverd soon after
delivery; If it’s from a slouth, I will not be
known for several days; If its a large
portion it is generall [cross out] incurable.
the flowing of the milk is generally 
preceded by slight [cross out] rigours if the
Brest is no suckeld the milk may be
absorb’d into the constitution and produce
fever or It is not absorb’d it will produce
abcess in the [cross out] breast; it is a provision
of nature that the milk just secreated
has a [cross out] purgative quality



F
162
Admirable calculated to cleans the bowels
of the child; woemen who do not suckle thire 1st
child in general have very little milk in
succeeding labours and that is readily absorb’d,
and vice versa, those woemen who mean to 
suckle thire childeren should have them applyed,
in 12 or 24 hours after delivery except the
woman should be very weak an then we may
defer It a little while longer; woemen suffer
more from thire milk than any animals; owing
to the peculiar sensibility and structure of the 
breast; in Brutes the ducts are not so numerous
as the human subject. where the child dies,
or the woman does not mean to suckle the child,
she [cross out] ought to have her brests drawn; and
the body should be kept open; there are many
contrivances of the breast glases &c for drawing off
the milk; but the mouth of a person is the
best method; If Inflamation comes on, a lotion
of crude sal ammon : in venegar will be proper
If we finde suppuration likely to commence
we should encourage It, by poultices, but tho



F
163
But tho we can distinguish a fluctuation,
it will not be proper to open the breast with
the lancet &c. as those wounds are apt to become
fistilous; as there they are broke superficial
dresings will be all thats requisite.
If we find them slow in suppurating we may
add a little strained galbamem to each poltice.
The nipples are liable to ulceration; of two
kinds If it’s at the basis of the [cross outs] nipples
It most [cross out] probably is venerial and if so the
only cure is mercury: but there is often an
ulceration of [cross out] nipples themselves which
may be remov’d by frequent washing with
brandy and water or weak solutions of 
Vitriol alba. (vide contra)



F
164
Puerperal Fever
This fever has been attributed to violence in
delivery but it most frequently happens to those
woemen who have good labours, this disease
seldom occur’d formerly, but since the erection of
Hospitals and the increase of towns, It has been
more frequently observ’d the 1st account we have of
this disease was in 1604 when it happen’d at the
hotel deu at Paris, and they attribute it, to the
lying in ward being near that [cross out] for the reception
of wounded and they observ’d the number of 
persons attack’d with this diseas, varied in
proportion to the number of wounded persons in
the ward below, the next we have of It was in 1746
It usually attack’d the woemen about the 3rd or 4th day
after delivery with tension and pain in
the abdomen, flacidity of the mamæ and if 
[cross outs] the milk was secreated it
was generally absorb’d; it most generally attack
those woemen who neglect cleanliness.
Parry who wrote on this disease suppos’d



F
166
It to be owing to a metastosis of the milk
P    who also wrote upon It said It often came
on so late as the 2nd or 3rd week and recommends
Camphor as a very powerful medicine, but
however in a subsequent publicetion he 
acknowledg’d it’s inefficacy: this [cross outs]
disease occur’d in dublin 1768 but not in England
till 1770 and this acconted by lying in hospitals
not being in England so soon as in france.
this disease comes on with a [cross out] rigour, and
a rejection of everything that is taken within
the stomach, pain and tension of the abdomen,
the bowels are sometimes costive and others lax,
the latter state is generally the most fauvorable
the pulse at 1st full but becomes weak,
the respiration is difficult It usually 
[cross outs] terminates fatally betwen the 4th and 
7th day the prognosis is always unfauvorable,
the principle distinguishing symtom, is the 
violent tension and pain in the abdomen,
very contrary practice in respect to bleeding



F
167
have been employ’d, but with any success
Emetics are sometimes found servsable, [cross out]
but a great deal depends upon thire being
administerd soon after the attack of the 
complaint, in plethoric habits, sometimes
bleeding will be of service, but we mus be very
cautious, particularly in Hospitals and large
towns, this fever is seldom communicated
except one women being near another who is 
contaminated, It never effects any person
[cross out] but woemen who have been brought to bed.
It may be distinguesh’d from Inflamatory
fevers, by not comeing on immediatly after
delivery and from its attaiking woemen
who have had very good Labours.
(vide contra)



F
168
The Miliary Fever
Sometimes attacks lying in woemen, its of
two kinds the red and white, the former is the
least dangerous, thire in this an eruption of
small red pimples the white kind which is
most dangerous, has small white [cross out]
transparent [cross out] vesicles, containing
a fluid, the red kind generally commences
about the 3rd day after delivery with fever,
no milk is secreted, there is a pain in the back
and loins, nausia and vomiting itching in
the breast and neck, where the [cross out] pimples 1st
apear: in the white kind the symtoms are
the same but more violent, this disease
is generally the effect of improper treatment,
as giving the patient heating things &c.
It usually happens in the summer and
after tedious labours &c. the danger of this
complaint is in some degree to be estimated
by the number.

Dr. Leak’s practical
observations on the child
bed fever. 5th.. Edition page 255

F
169
Of Eruptions: If the fever [cross out] diminishes
on the apearance of the eruption ther is less
danger, but If the fver does not give way, or
there should be cold fits after the eruption,
If the eruption should appear and disapear
alternatly, or If there is a stupor; the prognosis 
[cross out] unfavourable, The treatment of this
diseas is similar to the small pox.
The proper time for weaning children
is from the 9th to the 12th month. The pulse in
young children is usually at 140. In the
mild Thrush Borax and Honey is very good
application, in the more putrid kind
The Bark and cordials are proper.



Index



Index       
Folio
Axis of the Pelvis 19
Adhesions of the Labia 28
_________Vagina 36
Attachment of the Placenta over the 105 os Tincæ
Anomalous Labours 149
After Pains 160
Abcess Milk of 163
Abhortions 98
Breasts abcesses of 163
Bearing down of the Uterus 37
Belly pendulous 111
Blunt Hook 150
Coccyx os 6
Calculus 31
Cancer of the Uterus 48
Chlorosis 64
Contents of the Gravid Uterus 67
Changes occuring during Pregnancy 90
Convulsions 93



7-Cæsarean operation 153
Child dead signs 142
Description of the Pelvis 5
Diameter 10
Diseases of the [cross out] external organs 25
________Hymen 31
________Uterus & its apendges 31
Dropsy of the Uterus 51
_________Ovaria 52
Diseases of Pregnancy 77
Diseases of the internal organs 35
Extraction of the Placenta 74
Female [cross out] Organs of the Generation 23
Fluor Albus 45
Fœtus peculiarities of 70 71
Funis tying of 125
Fainting of after Delivery
Fever Milk 162
_______Puerperal 164
       Miliary 168
Forceps use of 151 149
Fillet 150
Funis preccedd, the Brecch 143




Gonorrhæ 46
Gravid Uterus contents of 67
Hymen diseases of 31
Hemorhages Uterine 97
of the early months 98
of the latter 98
Cure of 103 A 110
Head opening of 152
Hook blunt 150
Handkerchief of when useful 143
Ilium os 6
Ischium os 7
Itching of the female organs 28
Inflammation 28
Ligaments relaxation of 8 &c
Lecture introductory 1
Labia maga, ædematous swelling of 27
Labia Adhesions of 28
Inflamation of 28



Labia itching of 28
Laceration of the Perineum 29 A 160
Labours of 109
First and 2nd stage 121
Tedious 131
Preternatural 140
Anomalous 149
Lochia of 159
Lever 152
Menstruation of 56
Miscarriage of 98 99
Milk of the 164
Milk fever 162
Miliary fever 168
Membranes description of 76
Ovaria Dropsy of 52
Opening of the Head 152
Os Sacrum 5
Pleum 6
Ischeum 7
Pubis 7



Pelvis Description of 5
Pubis 7
Pelvis diameter of 10
Axis of 19
Presentations of 13
Pelvis vitiated 13
Perineum laceration of 29
Prolapsus Uteri 37
Procidentia 37
Polypi of 42
Peculiarities of the fœtus 70 71
Placenta of the extraction of 74
Attach’d over the os Tincæ 105
Presentations of the Head 141
Breech 142
Belly 145 . 142
Shoulder 145 . 141
Arm 141 145 26
Pain Spasmodic 146
Puerperal fever 164
Presentasions of the Back 142 : 145
Inferior extremeties 142



Relaxation of the Ligamens, of the pelvis 8 &c
Retroversion of the Uterus 88
Section of the Symphysis Pubis 20
Schirrus of the Uterus 48
Signs of Pregnancy 77
Spasmodic pains 146
Scesars use of 16
Touching 54
Tying the funis 125
Turning the child 146 A 7
Treatment of Lying in woemen 154
Uterus Double 37
Uterus rupure of the 153
Prolapsus of 37
Procidentia 37
Dropsy of 51
Schirrus of 48
Cancer 48
Retroversion of 88
Ulcers of the vagina 46
Uterus 46
Uterine Hemorrhage 97



Vitiated Pelvis         13
Vagina diseases of  36
Finis





































== [cross out] he gave an opiate and took his leave of the 
patient, not expecting to have seen her [cross out] alive
[cross out] again; she slept well that night,
complain’d for a few days of an uneasy
sensation like after pains; on the 5th day
matter in a large quantity appear’d on
the cloths at the pudendum, but without
much pain, The discharge gradually 
lessen’d, and her recovery otherwise
was nearly as good as If no
Extraordinary accident had 
happen’d.
Hamiltons
Midwifery
Vide page 153 [cross outs] of his book
the last line and word

About four years ago in a case where the shoulder 
of the child had presented in an oblique direction
at the brim of the pelvis, the labour had been permitted 
to go on from the morning till the afternoon the midwife
had mistaken the presenting part [cross out] for the breech; and 
the pains, after a few hours, became so strong and
forcing, that she expected the child to be expel’d with
every through, The patient soon after became restless
tossing and Delirium ensued.
In this situation Dr. Hamilton was call’d in.
When the patient was properly secur’d by assistants,
he [cross out] pas’d up [cross out] his hand with difficulty, and discover’d 
a considerable rent in the uterus, towards the
superior and latter part of the cervix, through which
the shoulder and arm of the child [cross out] had escaped into the 
cavity of the abdomen. Every attempt to Insinuate the hand
so high as to reach [cross out] one or both feet, with a view to bring 
them down and deliver, brought on an impetuous
gush of blood. I was therefore obliged to deliver with
the crotchet; and more readily adopted this [cross out]
method, as there was little reason to expect from 
the history of the case, That The child was alive.
It appear’d to have died the day before; After the
feet and body were extracted, the 1st arm was readily 
relived; but in bringing down the other, tho every 
precaution was employd, the wound in the uterus
was increas’d downwards to the very edge of the
os Tincæ; the placenta was remov’d by the 
Introduction of the hand into the uterus on account
of flooding; and some portion of Intestine reduced,
which had been forced through the wound of the 
uterus, and protruded at the vagina almost
as far as the os externum. This gave me an opportunity 
of examining the rupture which I found
already amazingly dimish’d by the contraction of the
Uterus==