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A SET OF

ANATOMICAL TABLES,

, WITH ^^Al

EXPLANATION SSm'Bi:

AND AN ABRIDGMENT OF THE

PRACTICE OF MIDWIFERY,

WITH A VIEW TO ILLUSTRATE

A TREATISE ON that SUBJECT, and
COLLECTION of CASES.

BY WILLIAM SMELLIE, m. d.

l'^-€4^<a oil
TO WHICH ARE ADDED,

NOTES AND ILLUSTRATIONS,

Adapted to the prefent Improved Method of Practice,

BY A. HAMILTON, m.d. f.r.s. Edinburgh,
and Profeflbr of Midwifery in the Univerfity of Edinburgh.

7^

FIRST WORCESTER EDITION,

With an entire New Set of Plates, carefully Corrected and Revised.

PRINTED at WORCESTER, Massachusetts,
BY ISAIAH THOMAS.

Sold at his Bookllore in Worcester ; by faid Thomas, and Andrews,
Fauft's Statue, Newbury Street, Boston; and by laid Tkomas, and
Carlisle, in Walpole, Newhampfhire,

MDCCXCill.

ni

PREFACE.

y^S, in a long courfe of teaching and
pradiice in Midwifery^ I hope I may without van-
ity fay, that I have done fomething towards re-
ducing that Art into a morejimpie and mechan-
ical method than has hitherto been done ; I have
attempted to explain the fame in my Treat ife on
the Theory and PraBice of Midwifery and Col-
leBion of Cafes ; and finding that mofl of the
reprefentations hitherto given of the parts fub^
fervient to Uterine Geflation and Parturition
were in many ref peels deficient^ I have been in-
duced to undertake the following Tables, with a.
view to fupply in fome meafure the defedis of
others, and at the fame time to illujlrate what I
have taught and written on the fubjeB, How
far I have obtained thofe e?ids, it belongs to oth-
ers to judge, Ifhall only beg leave to obferve here
by way of Preface, that the great eji part of the
figures were taken from fubjeBs prepared on
purpofe, tojhow every thing that might conduce
to the improvement of the young Practitioner :
Avoiding, however, the extreme Mi nut ice, and
what elfe fcemed foreign to the prcfcnt defign ;
thefituation of parts, and their refpeBive dimen-
fions, being more particularly attended to, than a
minute anatomical inveftigation of their fir uBure,
As thefe Tables may pojfibly fill into the hands
of fome who have not jccn my former work, I

have

have added an abridgment of the Pra£lice ; which ^
though far from being complete, may ferve to il^
luflrate feveral things which otherwife by a bare
reprefentation would he hardly intelligible.

References are rnade to Vol, /, //, and III. By
Vol. I, I mean that which I firfl publifhed in the
year 1752, and contains a view of the Theory
and PraBice of Midwifery ; Vol. 11, and III,
contain the ColleBion of Cafes mentioned above.
My firfi plan for thefe Tables confined them to
the 7mmber of twenty two, which Mr. Rymf-
dyke had fin{fhed above two years ago ; but I
foonfaw that a farther illujlration, and confe^
quently an addition to that number, was necef
fary. In eleven of thefe. Dr. Camper, yirw^r-
ly ProfefTor of Medicine^/ Franequer in Frief-
land, nozv Profeffor of Anatomy ^;2i Botany ^/
Amilerdam, greatly afjifiedme, viz. Table XII ^
XVI, XVII, XVIII, XIX, XXIV, XXVI,
XXVII, XXVIII, XXXIV, and XXXVL
The refwere drawn by Mr. Rymfdyke j except
the thirty feventh and thirty ?ji?7th, which were
done by another hand. The whole of the draw^
, ings are faithfully engraved: In which, hoW"
ever, delicacy and elegance have not beenfo much
co7\f lilted, as to have them done in a Jlrong and
diflinB ma7iner ; with this view chiefly, that
from the cheapnefs of the work it may be render^
ad of more general ufe.

EXPLANATIONS

or A SET OF

ANATOMICAL TABLES,

With an ABRIDGMENT of the

PRACTICE OF MIDWIFERY.
FIRST TABLE

Represents, in a front view, th^

bones of a well formed Pelvis,

A. The five Yertehrce of the loins*

B. The Os Sacrum*

C. The Os Coccygis*

D. D. The OJfa Ilium,

E. E. The OJfa Ifchium.

F. The OJfa Pubis.

G. The Foramina Magnus^
H. H. The Ace tabula,

1. 1. 1. 1. LI. The brim of the Pelvis, or that
circumference of its cavity, which is defcribed at
the fideS; by the inferior parts of the OJfa Iliim,
A and

6 ANATOMICAL TABLES,

and at the back and fore parts, by the fuperior
parts of the OJfa Pubis and Sacrum,

In this table, befides the general ftru6lure and
figure of the feveral bones, the dimenlions of the
brim of the Pelvis^ and the diftance between the
under parts of the OJfa IJchiiim, are particularly
to be attended to, from which it will appear that
the cavity of the brim is commonly wider from
fide to fide, than from the back to the fore part,
but that the fides below are in the contrary pro-
portion. The reader, however, ought not from
this to conclude, that every Pelvis is fimilar in
figure and dimenfions, lince even well formed
ones differ in fome degree from each other. In
general, the brim of the Pelvis meafures about five
inches and a quarter from fide to fide, and four
inches and a quarter from the back to the fore
•part ; there being likewife the fame diftance be-
tween the inferior parts of the OJfa Ifchium, All
thefe meafures, however, muft be underftood as
taken from the fkeleton, for in the fubjedl, the
cavity of the Pelvis is confiderably diminiftied
by its teguments and contents. Correfpondent
alfo to this diminution, the ufual dimenfions of
the head of the full grown Fcetus are but three
inches and a half from ear to ear, and four
inches and a quarter from the fore to the
hind head. '■.

Vide Tab. XVI, XVII, XVIII. Alfo, Vol. I.
Chap. 1. Setl. i, 2, 3. Where the form and di-
menfions of the Pelvis, as well as of the head of
the Fxtus^ and the manner in which the fame is

protruded

/i/r II .

WITH EXPLANATIONS, 8cc. /

protruded in labour through the bafon, are fully
treated of. Confult likewife Vol, II. Coll, i. No.
1,2. where cafes are given of complaints of the
Pelvis arifmg from difficult labours*

SECOND TAB L E

Gives a lateral and internal view of the Ptlvis^
the fame being divided longitudinally,

A. The three lower Vertebrce of the loins,

B. The Osfacrum,

C. The Os Coccygis,

D. The left Os Ilium.

E. The left Os Ifchiim,

F. The Os Pubis of the fame fide.

G. The acute procefs of the Os Ifchium,
H. The Foramen Magnum,

I.I.I. The brim of the Pelvis.

This plate fhows the diftanee from the fuperi-
our part of the Os Sacrum to the OJfa Pubis, di^
well as from the lad mentioned bones to the
Coccyx, which in each amounts to about four
inches and a quarter. The depth likewife is
fliown of the poflerior, lateral, and anterior parts
of the Pelvis, not in the line of the body, but in
that of the Ptlvis from its brim downward, which

A 2 is

a. ANATOMICAL TABLES,

is generally three times deeper on the pofterior
than anterior part, and twice the depth of theiafl
at the fides.

From this view appears alfo the angle which
is formed by the la ft Vertebra of the loins and
the fuperior part of the Os Sacrum, as likewife
the concavity or hollow fpace in the pofterior in-
ternal part of the Pelvis, arifing from the curva-
ture of the laft mentioned bone and Coccyx ; fi-
nally, the diftance from which to the pofterior
parts of the OJfa Ijchium is here expreffed.

Vide Tab. XVI, XVII, XVIIT, XIX, Alfo, VoL
I, and II, as referred to in the former table.

THIRD TABLE

Exhibits a front view of a diftorted Pelvis,

A. The five Vertebrce of the loins,

B. The Os Sacrum,

C. The Os Coccygis.

. D. D. The OJfa iMin,

E. £. The OJfa Ijchium,

F. The Offa Pubis,

G. G. The Foramina Magna,
H. H. The Acetabxda,

From this plate may appear the great danger
incident to both mother and child when the Pel*

1

e

, J /aie. m

WITH EXPLANATIONS, S^c. ^

vis is diftorted in this manner ; it being only two
inches and an half at the brim from the poflerior
to the anterior part, and the fame diftance be-
tween the inferior parts of each Os Ifchiilm* Vide
Tab. XXVII, where the Pelvis is one quarter of
an inch narrower at the brim than this, but fuffi-
ciently wide below. Various are the forms of
diflorted bafons, but the lafl mentioned is the
moft common. It is a great happinefs, however,
in pradice, that they are feldom fo narrow,
though there are inftances where they have been
much more fo. The danger in all fuch cafes
muft increafe or diminifh, according to the de-
gree of diftortion of the Pelvis ^ and iize of the
child's head.

Vide Vol. I. Book i. Chap. I. Se61;. 4, 5. And
Vol. II. Coll. 1. No. 3, 4, 5. Alfo, Coll. 21,
27, and 2^,

FOURTH TABLE.

Shows the external female parts of generation.

A. The lower part of the Abdomen,

B. B. The Labia Piidendi feparated.
C The Clitoris and PrcepiUium*

D. D. The Nymph(v.

E. The Fojfa Magna, or Os Externum.

A 3 F, The

JO ANATOMICAL TABLES,

F. The Meatus Urinarius.

G. The Frcenum Labiorum.
H. The Perinceum,

I. The Anus.

K. The part that covers the extremity of the

L. L. The parts that cover the tuberofities of

the Ojfa Ijchuim.

As it is of great confequence to every pra6li-
tioner in midwifery, to know exaftly the fitua*
tion of the parts concerned in parturition, and
which have not been accurately defcribed by
former Anatomifts, with a view to this particular
branch, I have given this draught from one of
the preferved fubjeQ;s which I keep by me, in or-
der to demonftrate thefe parts in the ordinary
courfe of my le6lures. From a view then of the
fituation of the parts, it appears that the Os
"Externum is not placed in the middle of the
inferior part of the Pelvis^ but at the anterior
and inferior part of the Puhes, and that the
Labia cover likewife the anteriour part of thefe
bones.

Secondly, It may be obferved, that as the JV^-
num Labiorum, which is nearly adjoining to the
inferior part of the OJfa Pubis, is only about an
inch from the Anus, between which and the Coccyx
there is about three inches diftance, it follows,
that the Anus is nearer to the firft mentioned
bones than to the latter*

Thirdly,

WITH EXPLANATIONS, &c, n

Thirdly, The view of this and the following
table will furnifli proper hints, with refpe6l to
the method of touching or examining the Os
Uteri, without hurting or inflaming the parts, as
it appears that the Os Externum is placed for-
wards towards the Pubes, and the Os Uteri back-
wards towards the ReEium and Coccyx^ By this
wife mechanifm of nature many inconveniences
are often prevented, which mull happen if thefe
parts were oppofite to each other, and fituated in
the middle of the inferior part of the Pelvis, par-
ticularly a Prolapfus of the Vagina and Uterus,
cither in the unimpregnated ftate, or in any of
the firft four months of pregnancy ; as alfo too
fudden deliveries in any of the laft months.

Fourthly, From a view of the lituation of the
parts, it will appear, that in labour, when the Os
Uteri is fufficiently opened to allow a palfage for
the head of the Foetus, the fame is protruded to
the lower part of the Vagina, hy which the exter-
nal parts are pufhed out in form of ^ large tu-
mor, as in Table XV.

Lajlly, It may be obferved, that when it is nec-
eflary to dilate the Os Externum, the principal
force ought to be applied downwards and to-
wards the ReBum, to prevent the Urethra and
neck of the bladder from being hurt or inflamed.

Vide Vol. I. Book I, Chap. 2. Sea. i. Vol. II.

Coll, 2.

A 4 FIFTH

i« ANATOMICAL TABLES,

FIFTH TABLE.

Figure I. Gives a front view of the Uterus in
Situ fufpended in the Vagina; the anterior
parts of the Ojfa Ifchium with the OJfa Pubis^
Pudenda, Perinceum, and Anus, being removed
in order to fhew the internal parts.

A. The lafl Vertebra of the loins.

B. B. The OJfa Ilium,

C. C. The Acetabula.

D. D. The inferior and pofterior parts of
the OJfa Ifchium, Vide Tab. XXIX, where the
OJfa Pubis and the anterior parts of the OJfa
Ifchium are reprefented by dotted lines.

E. The part covering the extremity of the Coccyx.

F. The inferior part of the ReEum,

G. G. The Vagina cut open longitudinally,
and flretched on each fide of the Collum Uteri, to
ftiew in what manner the Uterus is fufpended in
the fame.

H. H. Part of the Vefica Urinaria ft retched
on each fide of the Vagina and inferior part of
the Fundus Uteri.

I. The Collum Uteri.

K. The Fundus Uteri,

L. L. The Tubc^ Fallopiancc and Fimbria,

M. M. The Ovaria,

N. N.

'^^B

WITH EXPLANATIONS, &c. i§

N. N. The Ligamenta Lata and Rotunda.
O, O. The fuperior part of the Rectum.

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

A. The loweft Va'tchra of the loins.

B. C. The Os Sacrum and Coccyx, with the
Integuments.

D. The left Os Ilimn.

E. The inferior part of the left Os Ifchium*

F. The Os Pubis of the fame lide.

G. The Foramen Magnum.
H. The Acetabulum.

I.I.I. The inferiour part of the ReEium and
Anus.

K. The Os Externum and Vagina; the Os Uteri
lying loofely in the fame.

L. The Vejica Urinaria.

M. N. The Collum and Fundus Uteri, with a
view of the cavity of both. The attachment of
the Vagina round the outfide of the lips of the
mouth of the Womb is here likewife fhown, as alfo
the fituation of the Uterus, as it is prelTed down-
wards and backwards by the Intejimes and Urina-
ry Bladder, into the concave, and inferiour part
of the Os Sacrum.

O. The Ligamenta Lata and Rotunda of the
left fide.

P. P. The Fallopian tube, with the Fmbrics.

Q. The Ovarium of the fame fide.

R. R.

14 ANATOMICAL TABLES,

R. R. The fuperior part of the ReElum, and
inferior part of the Colon,

Figure III. Gives a front view of the Uterus in
the beginning of the firft month of pregnancy ;
the anterior part being removed, that the Em*
^r^'o might appear through the Amnois, the
Chorion being diire6led oflp.

A. The Fundus Uteri.

B. The Collum Uteri, with a view of the rugous
canal that leads to the cavity of the Fundus^

C. The Os Uteri.

Vide Vol. I. Book I. Chap. 2. Seft. 2, 3. VoL
II. Coll. 3^.

SIXTH TABLE,

Figure I. In the fame view and feftion of the
parts as in the firll figure of the former table,
fhows the Uterus as it appears in the fecond or
.third month of pregnancy, its anterior part
being here likewife removed.

F. The Anus.

G. The Vagina with its Plica: .

H. H. The pollerior and inferior part of the

Urinary

WITH EXPLANATIONS, 8cc. t^

Urinary Bladder extended on each fide, the anteri*
or and fuperior part being removed.

I. I. The mouth and neck of the Womb, 2^
raifed up when examining the fame by the touch,
with on^ of the fingers in the Vagina,
J K. K. The Uterus as ftretched in the fecond or
third nhonth, containing the Embryo with the
Phcenta adhering to the Fundus,

It appears from this and the former table, that
at this time nothing can be known, with refpe6k
to pregnancy, from the touch in the Vagina, as
the refiftance of the Uterus is fo inconfiderable
that it cannot prevent its being raifed up before
the finger ; and even were it kept down, the
length of the neck would prevent the flretching
being perceptible. The Uterus likewife not be-
ing ftretched above the Pelvis^ little change i$
made as to the figure of the Abdomen, further than
that the Intejlines are raifed a little higher ; whence
poffibly the old obfervation of the Abdomen being
a little flatter at this period than ufual from the
Intejlines being prefTed more to each fide. Wom-
en at this period mifcarry oftener than at any
other : It is a great happinefs, however, in prac-
tice, that although they are frequently much
weakened by large difcharges, yet they rarely fink
under the fame, but are fooner or later relieved
by labour coming on, which gradually fi:retchcs
the neck and mouth of the Womb, by the Mem-^
hranes being forced down with the waters, and if
the Placenta is feparated from the internal furface

of

i6 ANATOMICAL TABLES,

of the Uterus, all its contents are difcharged.
But if the Placenta ftill adheres, the Membranes
break, the waters and Foetus are expelled, and the
flooding diminifhes from the Uterus contradling
clofe to the Secundines, which alfo are ufually dif-
charged fooner or later.

From the ftru6lure finally of the parts, as rep-
refented in this and the former table, it may ap^
pear that it is much fafer to reflrain the flooding,
and fupport the patient, waiting with patience the
eflports of nature, than to endeavour to ftretch the
Os Uteri, and deliver either with the hand or in-
ftruments, which might endanger a laceration and
inflammation of the parts.

Vide C. in Table XXXVIL Alfo, Vol. I. Book
IL Chap. 2. Seel. 2, 3, 4. Vol. IL Coll. 12. No. 2.

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

In Ihe natural fituation, the mouth and lips of
the Wo7nb are covered with the Vagina, and thefe
parts are contiguous to each other, but here the
Vagina G. is a little ftretched from the neck and
lips of the former, in order to fliovv the parts more
diftmaiy. I. The neck of the Wo7nb, which ap^
pears in this figure thicker, fliorter, and lofter
than in the former. K. The inferiour part of
the Fmdits Uteri, the ftretching of which can

fometimes

WITH EXPLANATIONS, Scc^ if

fometimes be felt through the Vagina, by pufhing
up a finger on the anterior or lateral part of
the fame.

The Uterus now is fo largely ftretched as to
fill all the upper part of the Pelvis, and begins
alfo'to increafe fo much as to reft on the brim,
and to be fupported by the fame, the Fandus at
the fame time being raifed confiderably above the
Puhes. From the Abdomen being now more
ftretched, the woman is more fenfible of her grow-
ing bigger, and the Uterus alfo, from the counter-
prefTure of the contents and parietes of the Ah-
do7nen, is kept down, and the Os Uteri prevented
from rifmg before the finger as formerly. In
lean women, the ftretching of the Uterus can fome-
times be perceived in the Vagina at this period as
well as above the Pubes : But nothing certain
can be difcovered from the refiftance or feel of
the mouth of the Womb or Lips, which are com-
monly the fame in the firft months of pregnancy
as before it.

The fize or bulk of the Foetus is finally here to
be obferved, with the Placenta adhering to the
pofterior part of the Uterus,

Vide the references to Vol. I, and II, in the
former table.

SEVENTH

i8 ANATOMICAL TABLES.

SEVENTH TABLE

Reprefents the Abdomen of a woman opened in
the fixth or feventh month of pregnancy^

A. A. A. A. The parietes of the Abdomen open-
ed, and turned back to (how

B. The Uterus,

C. C. C. The Intejlines raifed upwards.

D. The Labia Pudendi, which are fometimes af-
fected in pregnancy with 0 edematous (weUings, oc-
cafioned by the preffure of the Uterus upon the
returning veins, and .Lymphatics, If the Labia
are fo tumefied as to obflru6l the patient's walk-
ing, the complaint is removed by pundluring the
parts affedled. By which means the ferous fluid
is difcharged for the prefent, but commonly re-
curs ; and the fame operation muft be repeated
feveral times, perhaps, before delivery, after
which, however, the tumefa6lion entirely fub-
fides. Here it may be obferved, that this com-
plaint can feldom or never obflruCl delivery, as
the Labia are fituated at the anterior part of the

, OJa Pubis, and can rarely affe£l the ftretching of
the Frcenum, Perina^um, Vagina, and ReBum.
From this figure it appears that the ftretching of
the Uterus can eafily be felt at this period in lean
fubje6ts, through the parietes of the Abdomen ;
efpecially if the Intejlines do not lie before it.
In general, indeed, as the Uterus ftretches, it rifes

higher.

WITH EXPLANATIONS, &c. 19

higher, by which means the Intejlines are likewifc
raifed higher, and are alto preffed to each fide.
Hence the nearer the woman is to her full time,
the ftretching is the more eafily felt.

N, B, Oedematous fwellings, fymptomatick of
pregnancy, afFefting the labia, have in few, if
any inftances, been obferved to interrupt the prog*
refs of labour ; therefore the difcharge of the fe-
rous fluid by pun61ure is feldom requifite ; and
repeated punHure in advanced geftation might be
attended with difagreeable confequences.

Vide Vol. I. Bookl. Chap. 3. Seft. 3. BookllL
Ghap. 1. Se£l, 2. and Vol. II. Coll. 12, 13*

EIGHTH TABLE,

In the fame view and fe6lion of the parts as in
Table VI. is reprefented the Uterus oi the form-
er table, in order to (hew its contents, and the
internal parts as they appear in the fixth or
feventh month of pregnancy.

A. The Uterus flretched up to the Umbilical
region,

B. B. The fuperior part of the OJfa Ilium*

C. C. The Acetahula,

D.D. The remaining pofterior parts of the
OJfa Ijchium,
E. The Ams.

F, The

2Q ANATOMICAL TABLES,

F. The Vagina.

;G. The bladder of Urine.

H. The neck of the Womb fhorter than in Table
VI, and raifed higher by the ftretching of the
Uterus above the brim of the Pelvis.

I, The yelfels of the Uterus larger than in the
unimpregnated flate.

K. K. The Placenta adhering to the inferior
and pofterior part of the Uterus.

L. L. The Membranes that furround the Foetus,
the head of which is here reprefented, as well as
of thofe in Table VI, iituated downwards at the
inferiour part of the Uterus, and which I am apt
to believe is the ufual fituation of the Foetus, when
at reft, and furrounded with a great quantity of
waters, as the head is heavier than any other part.
With refpe6i: to the fituation of the body of the
Foetus, though the fore parts are often turned to-
wards the fides and pofterior parts of the Uterus,
they are here as well as in the foregoing table
reprefented at the anterior part or forwards, in
order to fliow them in a more diftin61: and pic-
turefque manner.

Vide Vol. I. Book I. Chap. 3. Sed. 3, 4. Vol.
11. Coll. 13. No. 1.

From this table may appear the difficulty of
ftretching the Os Uteri in flooding cafes, even at
this period, from the length and thicknefs of the
neck of the Womb, efpecially in a firft pregnancy :
Much the fame method, however, is to be follow-
ed here as was diredled in table VI, until labour

comes

WITH EXPLANATIONS, Sec, 21

comes on to dilate the Os Uteri. If the flooding
is then confiderable, the Me7nhrams fhould be
broken, that the Uterus may contrad, and thereby
leflbn the difcharge. The labour iikewife, if it.
is neceffary, may be affifted by dilating the Os
Uteri in time of the pains ; which alfo, if
wanting, may be provoked by the fame method
when the patient is in danger. If this danger is
imminent, and the woman feems ready to expire,
the Uterus, as appears from this table, is at this
time fufliciently flretched to receive the opera-
tor's hand to extra6f the Foetus, if the Os Liter--
num can be fafely dilatedi

Lajlly, It may be obferved that w^omen are in
greater danger at this period, and afterwards, than
in the fornrer months.

Vide Vol.1. Book III. Ghap. 4. Sed. 3. No. 1,
!2, 3. Vol. IIIo ColL 33. No. 2. See alfo in the
Edinburgh Phyfical and Literary Obfervations^
Art. XVII, the dilTeftion of a woman with child,
by Dr. Donald Miinro, phyfician at London.

See, DireQions for the management in cafes of
flooding, Dr. Hamilton s Outlines of Midn^ifery,
page 401*

NINTH TABLii,

In the fame view and fe6lion of the parts with
the former, reprefents the Uterus in the eip-hth
or ninth month of pregnancy,

B A. The

22 ANATOMICAL TABLES,

A. The Uterus as ftretched to near its full ex-
tent, with the waters, and containing the Fxtus
entangled in the Funis, the head prefenting at the
upper part of the Pelvis.

B. B. The fuperior part of the OJfa Ilium,

C. C. The Acetabula,

D. D, The remaining poflerior parts of the Of-
fa Ifchium,

E. The Coccyx.

F. The inferior part of the ReBum.

G. G. G. The Vagina ftretched on each fide.
H. The Os Uteri, the lips of which appear

larger and fofter than in the foregoing table, the
neck of the Womb being likewife ftretched to its
full extent, or entirely obliterated,

LI. Part of the Vejica Urinaria.

K. K. The Placenta at the fuperior and pof-
terior part of the Uterus.

L. L. The Membranes.

M. The Fimis Umhilicalis.

This and the foregoing table fhow in what
manner t\i€ Uterus ftretches, and how its neck
grows fhorter, in the different periods of preg-
nancy ; as alfo the magnitude of the Foetus, in
order more fully to explain Vol. L Book I. Chap.
3; Sed. 4, 5. Alfo Book III. Chap. 1. Se6t. 1, 2.
Likewife Vol. 11. Coll. 13. No. 1.

Notwithftanding it has been handed down as
an invariable truth, from the earlieft accounts of
the art, to the prefent times, that when the head
of the Foetus prefented, the face was turned to the

pofterior

^

S^u^

k:.

WITH EXPLANATIONS, &c. ^^

pofterior part of the Pelvis, yet from Mr. Quid's
obfervation, as well as from fome late difleclions
of the gravid Uterus, and what 1 myfelf have ob-
fervfed in praftife^ I am led to believe that the
head prefents for the moft part as is here delin-
eated, with one ear to the Pubes, and the other td
the Os Sacrum ; though fometimes this may vary,
according to the form of the head, as wi;il as that
of the Pelvis.

Confialt Dr. Hunter s elegant plates of the grav-
id Uterus,

TENTH TABLE

Gives a front view of Twins in Utei'Oj in the be-
ginning of labour, the anterior parts being
removed, as in the preceding tables.

A. The Uterus, as ftretched with the Membranes
and waters.

B. B. The fuperior parts of the OJfa Ilium.
G. C. The Acetabula,

* D. D. The OJa IJchium.

E. The Coccyx,

F. The lower part of the ReBim.

G. G. The Vagina,

H. The Os Internum ftretched open about a.
finger's breadth with the Membranes aftd water$
in time of labour pains.

Bia I.LThs

24 ANATOMICAL TABLES,

L L The inferior part of the Uterus ftretched
with the waters which are below the head of
the child that prefents.

K.K. The tw^o Placentas adhering to the pof-
terior part of the Uterus, the two Fxtufes lying
before them, one with its head in a proper pofi-
tion, at the inferior part of the Uterus, and the
other fituated preternaturally, with the head to
the Fundus : The bodies of each are here en-
tangled in th^ir proper Funis, which frequently
happens in the natural as well as preternatural
pofitions.

L. L. L. The Meinbranes belonging to each
Placenta,

This reprefentation of twins, according to the
ot-der obferved in my Treatife of Midwifery,
ought to have been placed among the lafl tables ;
but as that was of no confequence, I have placed
it here in order to Ihow the Os Uteri grown much
thinner than in the former figure, a little open,
and ilretched by the waters and Membranes which
are pufhed down before the head of one of the
Fxtujes in time of a labour pain. With refpe6i
to the pofition of twins, it is often different in dif-
ferent cafes ; but was thus, in a late difre6i;ion of
a gravid Uterus by Dr. Mackenzie,

Vide Vol. L Book IIL Chap. i. Sed. 4. and
Chap. 5. Seel. 1. and Vol. II. Coll. 14. and Vol.
IIL Coil. 37.

For the improved management in cafes of plu-
rality of children, fee Dr. Hamilton's Outlines of
Midwifery, page 412,

ELEVENTH

1^-

■9itff'X.

1

t

wixx^ EXPLANATIONS, 8cc.
ELEVENTH TABLE

Exhibits another front view of tht gravid Uterus
in the beginning of labour ; the anterior parts
being removed, as in the former table ; but in
this the Membranes, not being broken, form a
large bag containing the waters and Fcetus,

A. The fubftance of the Uterus,

B. B. C. C. D. D. The bones of the Pelvis.

E. The Coccyx,

F. The inferior part of the ReBiim.

G. G. G. G. The Vagina,

H. H. The mouth of the wowHargely ftretched
in time of a pain, with I. the Membranes and wa-
ters. This circumftance makes it ufually certain
that labour is begun, whereas from the degree of
dilatation reprefented in the former table, there is
little to be afcertained, unlefs the pains are reg-
ular and ftrong, the Os Uteri being often found
more open feveral days, and even weeks, before
labour commences.

K. The Chorion,

L. The fame dilTe&d off at the inferior part
of the Uterus, in order to fhow the head of the
Foetus through the Amnois, N. B. This hint is
taken from one of Dr. Albmus's tables of the ^rav^
id Uterus.

B 3 M. The

^6 ANATOMICAL TABLF^.

M. The Placenta, the ex^el^al convex furface
of which, divided into ^ nurpbe]^ of Loh^s^, is here
reprefented, its concave internal parts being cov-
ered hy the Chorion,

The Placenta hdiS been fo.und adhering to all
the different parts of the internal furface of the
Uierus^ and {ometiraes even over the infide of the
Os Uteri ; this laft; manner of adhefion, however,
r^lways occaiion3 floodings as foon as the fame
begins to dilate.

Tables VI, VIII, IX, X, fh<»\r th&^internal fur.
face of the Placenta towards the Fxtus, with the
velTels compofmg its fubifance proceeding froni
the Funis which is inferted, ixi different Placentas,
into ail the different parts of the fame, as well as
in the middle.

The thirtieth and thirty third tables ihew the
infer tion of the Fimis\xxt,othQ.Abdoi^enoit]iQ Fcetus^

With refpe6t to the expullion of the Placenta^
"whai i\iQ Membra^ics break, the Uterus conirdidk^
83 the waters are evacuated until it comes in con^
ta6f with the body of the Foetus : The fame being
delivered, the Uterus grows much thicker, and
contrafts clofely to the Placenta and Membranes,
by which means they are gradually feparated,
and forced into the Vagijia. This Ihews that we
ought to follow the method which nature teaches,
waiting with patience, and allowing it to feparate
in a flow manner, which is much fafer pra6lice,
efpecially when the patient is weak ; as the dif-
charge is neither fo great or fudden as when the

Placenta

WITH explanations; ^c. if

placenta is hurried down in the too commori
method. But then we mufl not run into the
other extreme, but alii ft, when nature is not fuf-
ficient to expel the fame.

Vide Vol.1. Book III. Chap. i. SeQ:, 4. Chap.
2. $€6^. 2. 5. Vol. II. Coll. 14. 23. Alfo Dr.
Hamilton s Outlines of Midwifery, p. 211, et feq*

TWELFTH TABLE

Shows, in a lateral view and longitudinal divifion
of the parts, the gravid Uterus, when labour is
fomewhat advanced.

A. The lowed Vertebra of the back.

B. The Scrobicuhs Cordis, the diftance from
which to the laft mentioned Vertebra is here fhown
by dotted lines ; as alfo part of the region below
the Diaphragm,

C. C. The ufual thicknefs and jfigure of the
Uterus when extended with the waters at the lat-
ter end of pregnancy.

D. The fame contra61:ed and grown thicker af-
ter the waters are evacuated.

E. E. The figure of the Uterus when pendulous.
In this cafe, if the Membranes break when the pa-
tient is in an ered pofition, the head of the Fxtits
runs a rifk of flidmg over and above the OJfa Pu^

B 4 bis,

28 ANATOMICAL TABLES,

bis, whence the fhoulders will be pufhed into thei
Pelvis,

F. F. The figure of the Uterus when flretched
higher than ufual, which generally occafions.
vomitings and difRculty of breathing. Confult
on this fubjeQ Mr. Levret fur le mechanifm©.
de difFerentes groirefles.

G. The Os Pubis of the left fide,
H. K. The Os Internum,

I. The Vagina,

K. The left Nympha,

L. The Labium Pudendi of the fame fide.

M. The remaining portioh of the bladder.

N. The Anus,

O, P. The left hip and thigh.

In this period of labour, the Os Uteri being
more and more ftretched by the Membranes pufh-
ing down, and beginning to e^ctend the Vagina, a
great quantity of waters is forced down at the
fame time, and, if the Membranes break, is dif-
charo^ed ; whence the Uterus contra61;s itfelf near-
er to the body of the Foetus, which is here repre-
fented in a natural pofition, with the Vertex reft-
ino- at the fuperior part of the OJfa Pubis, and the
forehead towards the right Os Ilium. As foon as
the Uterus is in conta6l with the body of the Foetus,
the head of the fame is forced backward towards
the Os Sacrum from the line of the Abdomen B, G.
into that of the Pelvis, viz. from the uppermofl
F. to near the end of the Coccyx, and is gradually
pufhed lower, as in the following Table.

If

ryr^^/^im.

WITH EXPLANATIONS, &c. 29

If the Membranes do not break immediately
upon their being puftied into the Vagina, they
fhould be allowed to protrude flill further in or-
der to dilate the Os Externum.

Vide Vol. I. Book I. Chap. 2. Sed. 2. Chap. 3.
Se61;3. Book III. Chap. 1. Se6t. 1, 2. 4. Chap. 2,
Sed. 3. Chap. 3. Sed. 4. No. 5. Vol. II. Coll.
10. No. 4. Cafe 3, 4. Coll. 14. Vol. III. Coll,
§4. No. 2. Cafe 4.

THIRTEENTH TABLE,

in the fame view and fe6lion of the parts as in
Table VI, fiiows the natural pofition of the
head of the Foetus when funk down into the
middle of the Pelvis after the Os Internum is
fully opened, a large quantity of the waters
being protruded with the M^m^r^w^fs. through
the Os Externum, but prevented from being all
difcharged, by the head's filling up the Vagina.

A. The Uterus a little contra 6led, and thicker,
from fome of the waters being funk down before
the child, or difcharged.

B. B. The fuperior parts of the OJJa Ilium.

C. The inferior part of the Recfum,

D. D. The Vagina largely ftretched with the
bead of the Foetus.

E. E. The

go ANATOMICAL TABLES,

E. E. The Os Internum fully opened.

F. A portion of the Placenta,

G. G. The Membranes,

H. H. The Ligamenta Lata.
I. L The Ligamenta Rotunda, Bath thefe lafl
firetched upwards with the Uterus,

The Vertex of the Fcetus being now down at
the inferior part of the right Os Ijchium, and the
wide part of the head at the narrow and inferior
part of the Pelms, the forehead by the force of
the pains is gradually moved backwards, and as
it advances lower, the Vertex and Occifut turn out
below the Fubes, as in the next Table. Hence
may be learnt of what confequence it is to know,
that it is wider from fide to fide at the brim of
the Pelvis, than from the back to the forepart, and
that it is wid«r from the fore to the hind head of
the child, than from ear to ear.

Vide Vol. 1, Book L Chap. i. Sed. 3. 5. Alfo
Book IIL Chap. 3. Seft. 3, 4. No. 3. Vol. II,
ColL 14.

FOURTEENTH TABLE,

In a fimilar view and fe6lion of the parts with
Table XII, fhows the forehead of the Foetus turn-
ed [in its progreffion downwards, from its pofi-

tion

<y^,

-«'iv*

Z)y

'■^'^

WITH EXPLANATIONS, Sec. ^t

lion in the former Table] backwards to the Os
Sacrum, and the Occiput below the Pubes, by which
means the narrow part of the head is to the nar-
row part of the Pelvis, that is, between the infe-
rior parts of the Offa Ifchium, Hence it may be
obferved, that though the diftance between the
inferior parts of the la ft mentioned bones is much
the fame, as between the Coccyx and Piibes, yet as
the cavity of the Pelvis is much fhallower at the
anterior than lateral part, the Qcciput of the Foetus,
when come down to the inferior part of either
Os Ifchium, turns out below the Pubes ; this an-
fwers the fame end a& if the Pelvis itfelf had been
wider from the pofterior part than from fide to
fide ; the head likewife enlarging the cavity by
forcing back the Coccyx, and pulhing out the ex-
ternal parts in form of a large tumor, as is more
fully defcribed in the following Table.

Vide VoL 1 5. II, as referred to in the preceding
Table,

A. The Uterus con traded clofely to the Fxtus
after the waters are evacuated.

B. C. D. The Vertebrae of the loins, Os Sacrum
jind Coccyx,

E. The Anns,

F. The left hip.

G. The Permceum^

H. The Os Externum beginning to dilate.
I. The Os Pubis of the left fide.
K. The remaming portion of the bladder.
L. The pofterior part of the Os Uteri,

KB.

32 ANATOMICAL TABLES,

i\^. B. Although for the moil part, at or before
this peiiod, the waters are evacuated, yet it often
happens, that rriore or lefs will be retained, and
not all difcharged, until after the delivery of
the child ; occafioned from the prefenting part
of the Fa:tus coming into clofe contaft with the
lower or under part of the Uterus, Vagina, or Os
Externum, immediately, or foon after the Mem-
branes break.

*^»>»-®>»<£0^aQ>g 4-® «<i<f**s^'>

FIFTEExNTH TABLE

Is intended principally to fhow in what manner
the Perinceum and external parts are ftretched
hy the head of the Foetus, in a firfl pregnancyy
towards the end of labour.

A. The Abdomen,

B. The Labia Pudendi.

JC. The Clitoris, and its Prceputium.

D. The hairy fcalp of the Foetus fwelled at the
Vertex, in a laborious cafe, and protruded to the
Os Externum.

E. F. The Perinceum and Anus pufhed out by
the head of the Fxtus in form of a large Tumor,

G. G. The parts that cover the Tuherofities of
the OJfa Jjchiiim.

H. The part that covers the Os Coccygis.

The

Mrfe

jy

^IHp^

WITH EXPLANATIONS, Sec. 33

The Perinceum in this figure is flretched two inch-
es, or nearly double its length in the natural flate ;
but when the Os Extermm is fo much dilated by
the head of the Fxtus as to allow the delivery of
the fame, the Perinceum is generally flretched to
the length of three, and fometimes four inches.

The Anus is likewife lengthened an inch, the
parts alfo between it and the Coccyx being much
didended. All this ought to caution the young
pra6litioner never to precipitate the delivery at
this time, but to wait, and allow the parts to dilate
in a flow manner, as from the violence of the
labour pains, the fudden delivery of the head of
the Fxtus might endanger the laceration of the
parts. The palm of the operator's hand ought
therefore to be preiTed againft the Perinceum, that
the head may be prevented from pafling until the
Os Externum is fufficiently dilated, to allow its
delivery without tearing the Frcenum, and parts
betwixt that and the Anus, which are at this time
very thin.

Vide Vol. I. Book III. Chap. 2. Seft. 2. Chap.
4. Se6l. 4. No. 1. and Book IV. Chap. 1. Se6l. 1.
Alfo, Vol. II. Coll. 14. 24. Vol. III. Coll. 40.
Alfo, direftions for the management of natural
labour in Dr. Hamilton's Outlines of Midwifery,
page 207, and feq. and the Judicious Obferva-
tions and directions of Charles White, Efq;
F. R. S. Manchefler, third edition of his Treatife
on the Management of Pregnant and Lying in
Women, Chap. 5. page 82 to 113.

SIXTEENTH

g4 ANATOMICAL TABLES,

SIXTEENTH TABLE,

And the three following, fhow in what manner
the head of the Fottus is helped along with the
forceps, as artificial hands, when it is neceffary
to afTifl with the fame for the fafety of either
mother or child. In this Table the head is
reprefented as forced down into the Pelvis by
the labour pains, from its former pofition in
Table XII.

A. A. B. C. The Vertehrce of the loins, Os Sa^

£rum and Coccyx,

D. The Os Pubis of the left fide.

E. The remaining part of the bladder.
F* F. The Intejlinum Re^im^

G. G. G. The Uterus.
H. The Mons Veneris,
1. The Clitoris with the left Nympha.
X. The Corpus Cavernofum Clitoridis.
V. The Meatus Urinarius.
K. The left Labium Pudtndi.
L. The Anus,
N. The Perinceum.
O. P. The kft hip and thigh.
R, The ikin and mufcular part of the loins.

The

/

WITH EXPLANATIONS, &c. 35

The patient in this cafe maybe, as in this Ta-»
ble, on her iide, with her breech a little over the
fide or foot of the bed, her knees being likewife
pulled up to her belly, and a pillow placed be-
tween them, care being taken at the fame time
that the parts are by a proper covering defended
from the external air. If the hairy fcalp of the
Fostus is fo fwelled that the fituation of the head
cannot be diftinguilhed by the Sutures as in Ta-
ble XXI, or if by introducing a finger between
the head of the child and the Pubes, or Groin,
the ear or back part of the neck cannot be felt,
the Os Externum muil be gradually dilated in the
time of the pains with the operator's fingers
(previoufly lubricated with hog's lard) until the
whole hand can be introduced into the Vagina,
and flipped up in a flattifh form between the
pofterior part of the Pelvis and child's head.
This laft is then to be raifed up as high as is
poflible, to allow room for the fingers to reach
the ear and pofterior part of the neck. When
the pofition of the head is known, the operator
muft withdraw his hand, and wait to fee if the
ftretching of the parts will renew or increafe the
labour pains, and allow more fpace for the ad-
vancement of the head in the Pelvis, If this,
however, proves of no efFe6t, the fingers are again
to be introduced as before, and one of the blades of
the forceps (lubricated with lard) is then to be ap-
plied along the infide of the hand or fingers, and
left ear of the child, as reprefented in the table.
But if the Pelvis is diftorted, and projeds for-
ward

36 ANATOMICAL TABLES,

ward at the fuperior part of the Os Sacrurfi, and
the forehead therefore cannot be moved a little
backwards, in order to turn the ear from that
part of the Pelvis which prevents the end of the
forceps to pafs the fame ; in that cafe, I fay, the
blade muft be introduced along the pofterior
part of the ear at the fide of the diflorted bone.
The hand that was introduced is then to be with-
drawn, and the handle of the introduced blade
held with it as far back as the Perinceu7?i will al-
low, whilft the fingers of the other hand are in-
troduced to the Os Uteri, at the Pubes or right
Groin, and the other blade placed exaftly oppo-
fite to the former. This done, the handles being
taken hold of and joined together, the head is to
be pulled lower and lower, every pain, until the
V^ertex, as in this table, is brought down to the:
inferior part of the left Ifchium, or below the
fame. The wide part of the head being now ad-
vanced to the narrow part of the Pelvis betwixt
the Tuberofities of the OJfa Ifchium, is to be turn-
ed from the left Ifchium out below the Pubes, and
the forehead backwards to the concave part of
the Os Sacrum and Coccyx, as in Table XVII,-
and afterwards the head brought along and de-
livered, as in Table XVIII, and XIX. But
if it is found that the delivery will require
a confiderable degree of force from the head's
being large, or the Pelvis narrow, the handles
of the forceps are to be tied together with a
fillet, as reprefented in this Table, to prevent
their pofition being changed, whilft the woni^

an

/

WITH EXPLANATIONS, &c. 37

an is turned oil her back as in Table XXIV,
which is then more convenient for delivering the
head than when lying on the fide.

N. B, When the head is wedded in the Pelvis^
and the balis not yet protruded below the brim^
the forceps can neither be employed with advan-
tage nor fafety ; and to attempt the mechanical
turns recommended here would be difficult and
hazardous.

This Table fhows that the handles of the for-
ceps ought to be held as far back as the Os Ex^
termtm will allow, that che blades may be in an
imaginary line between that and the middle fpace
between the Umbilicus and the Scrobiculus Cordis,,
When the forceps are applied along the ears and
lides of the head, they are nearer to one another,
have a better hold, and mark lefs than when oveir'
the Occipital and Frontal bones.

Vide Vol. I. Book. III. Chap. 3. from Se3:. 1.
to 6. and Vol. II. Coll. 25, 26, 27, and 29.

SEVENTEENTH TABLE,

In the fame view with the former, reprefents, in
outlines, the head of the Fcctus brought lo v^er
with the forceps, and turned from the pofition
in the former Table, in imitation of the natur-
al progreflion hy the labour pains, which may
C likewife

88 ANATOMICAL TABLES,

likewife be fuppofed to have made this turn,
before it was neceflary to aiTiil; with the for-
ceps, this GeccfTity at laft arifmg from many
of the caufes mentioned in VoL L

In this view the pofition of the forceps, along
the ears and narrow part of the head, is more
particularly exprelTed. It appears alfo that when
the Ve7''tex is turned from the left Os Jfcliimi,
where it was clofely confined, it is difengagedby
coming out below the Pubes, and the forehead
that was prelfed agaiarft the middle of the right
Os Ifchium is turned into the concavity of the Os
Sacrum and Coccyx. By this means .the narrow
part of the head is now between the OJfa Ifchium,
or narrow part of the Pelvis, and as the Occiput
comes out below the Pubes, the head paffes fliil
eafier along. When the head is advanced fo low
in the Pelvis, if the pofition cannot be diflinguifh-
ed by the futures, it may for the mod part be
known by feeling for the back part of the neck
of the Foetus, with a finger, introduced betwixt
the Occiput' and Pubes, or towards one of the
Groins. If the head is fqueezed into a longifli
form, as in Table XXI, and has been detained
many hours in this pofition, the pains not being
fiifficient to complete the delivery ; the afliilance
of the forceps muft be taken to fuve the child,
though the woman may be in no danger.

The ajfiftance of the forceps mufl be taken to favt
the child., though the woman be in no danger. This
may require a little explanation. The exact di-

menfions

WITH EXPLANATIONS, &c. 39

menfions of a child's head cannot eafilybe afcer-
tained before delivery ; nor can it be known
how long a labour may be protracted, without any
material injury to the mother. The changes the
head of the Foetus fufFers both in its figure and
diminution of bulk, by compreilion, render it
capable of paffing in fome cafes where we would
little expe.6t it. On the contrary, when the head
is but little advanced, and wedged in the Pelvis,
the forceps are applied under obvious difadvan-
tages; lince it is well known to practitioners,
that women fufFer the natural bruifes with more
fafety than thofe occafioned by the bell con-
flru6led modern inftruments, in the hands of
the moll Ikiiful pra6litioners. The forceps^
therefore, in general, Ihould not be ufed, efpeci-
ally in the early part of a man's pra6lice, except
only on the moH urgent occajions. And if the
head is detained at the brim of the Pelvis, as in
the former Table, the cafe is unfavourable for the
forceps.

See this important precaution further enforced,
page 37, line 4.

This Table alfo fhows that the handles of the
forceps are ftill to be kept back to the Perinceum,
and when in this pofition are in a line with the
upper part of the Sacrum^ and if held more back-
wards, when the head is a little higher, would be
in |i line with the Scrobiculus Cordis, If the for-
ceps are applied when the head is in this pofi-
tion, they are more eafily introduced when the
patifent is in a fupipe pofition, as in Table XXIV,

C 2 Neither

40 ANATOMICAL TABLES,

Neither is it necefTary to tie the handles, which
is only done to prevent their alteration when
turning the woman from her fide to her back.

As I have had feveral cafes where a longer
fort of forceps that are curved upwards are of
great ufe to help along the head, when the body
is delivered firft, as in Table XXXV, the fame
are reprefented here by dotted lines. They may
be ufed in laborious cafes as well as the others,
but are not managed with the fame eafe.

Moil of the parts of this Table being marked
with the fame letters as the former, the defcrip-
tions there given will anfwer in this, except the
following.

L. M. The Anns.

M. N. The Perinceum,

O. The common Integuments of the Abdomen,

R. The fhort forceps.

S. The long curved forceps, the firft of thefe
is eleven inches long, and the laft twelve inches
and a half, which I have after feveral alterations
found fufficient, but this need not confine others
who may choofe to alter them from this flandard.

Vide Table XXXVII.

EIGHTEENTH

WITH EXPLANATIONS, Sec. a

EIGHTEENTH TABLE,

In the fame View and Se6lion of the parts, fhows
the head of the Foetus in the fame pofition, but
brought lower down with the forceps than in
the former Table ; for in this the Os Externum
is more open, the Occiput comes lower down
from below the Piibes, and the forehead pafl
the Coccyxy by which both the Anus and Peri^
ncpimi are ftretched out in form of a large
tumor, as in Table XV.

When the head is fo far advanced, the opera-
tor ought to extraft with great caution, left the
parts fhould be torn. If the labour pains are
fufficient, the forehead may be kept down, and
helped along in a flow manner by preifmg againft
it with the fingers on the external parts below
the Coccyx : At the fame time the forceps being
taken ofiF, the head may be allowed to ftretch the
Os Externum more and more in a gradual man-
ner, from the force of the labour pains, as well
as afTiftanceof the fingers. But if the former are
weak and infufficient, the afliftanceof the forceps
muft be continued. Vide the defcription of the
parts in Table XVI. S. T. in this reprefent tho
left fide of the Os Uteri, The dotted lines dem-
onftrate the fituation of the bones of the Pelvis

C 3 on

i^ ANATOMICAL TABLES,

on the right fide, and may ferve as an example
for all the lateral views of the fame.

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

Vide Vol. I. Book IIL Chap. 5. Seft. 3. VoL
II. Coll. 25.

NINETEENTH TABLE.

In the fame view and Section of the Pelvis^ is
intended by out lines to fhow, that as the extern-
al parts are flretched, and the Os Externum is
dilated, the Occiput of the Fxtus rifes up with a
femicircular turn from out below the Pubes, the
under part of which bones are as an axis, or ful-
crum, on which the back part of the neck turns,
whilft at the fame time the forehead and face in
their turn upwards, diftend largely the parts be-
tween the Coccyx, and Os Externum. This is the
method obferved by nature in ftretching thefe
parts in labour, and as nature is always to be
imitated, the fame method ought to be followed,
when it is neceifary to help along the head with
the forceps.

Vide

'^^:xiK.

/i^/^^xx:"

WITH EXPLANATIONS, Sec. 43

Vide the three former Tables for the defcrip-
tions and references.

TWENTIETH T A B L E,

In the fame Seclion of the parts, but with a view
of the rischt fide, {hows the head of the Fxtus
in the contrary pofition to the three laft fig-
ures, the Vertex being here in the concavity of
the Sacrum, and the forehead turned to the
Pubes,

A. B. The Vertebrce of the loins, Os Sacrum and
Coccyx,

C. The Os Pubis of the right fide.

D. The Anus,

E. The Os Externum not yet begun to ilretch.

F. The Nympha,

G. The Labium Piidendi of the right fide.
H. The hip and thigh.

I.I. The . £//erMS contraQed, the waters being
ail difcharored.

o

When the head is fmalL and the Pelvis larore,
the Parietal bones and the forehead will, in this
cafe, as they are forced downwards by the labour
pains, gradually dilate the Os Externum, and
flretch the parts between that and the Coccyx in
form of a large tumor, as in Table XV, until the

C 4 face

41 ANATOMICAL TABLES,

face comes down below the Pub es, when the head
will be fafeiy delivered. But if the fame be
large, and the Pelvis narrow, the difficulty will be
greater, and the child in danger; as in the fol-
lowing Table.

F7^^ Vol. L Book IIL Chap. 3. Sed. 4. No,
3. Vol. IL" Coil. 16. No. 2.

TWENTY FIRST TABLE

SSows the head of the Pectus in the fame poiition
as in the former Table, but being much larger,
it is by llrong labour pains fqueezed into a
longilh form with a tumor on the Vertex, from
the long compreffion of the head in the Pelvis,
If the child cannot be delivered with the labour
pains, or turned and brought footling*, the
forceps are to be applied on the head as de»
fcribed in <;his figure, and brought along as it
prefents ; but if that cannot be done without
running the rifque of tearing the Perinceum,
and even the Vagina and ReBum of the woman,
the forehead mud be turned backwards to the
Sacrum, To do this niore effe6lually, thq

operator

*Turnivg, when the head is fo far advanced in the Pelvis, and of ^
more than ufual fize, i? a dreadful praftice, and fhould never be
attempted*

0.

^ejoa,

WITH EXPLANATIONS, Sec. 45

operator muft grafp firmly with both hands
the handles of the forceps, and at the fame
time puftiing upwards, raife the head as high
as poffible, in order to turn the forehead to
one fide, by which it is brought into the nat-
ural pofition ; this done, the head may be
brought down • and delivered as in Table
XVI. &c.

Vide Vol.1. Booklll. Chap. 3. Sea. 4. No. 2.
and Vol. II. Coll. 28. Alfo the former Table for
the defcription of the parts, except

K. The tumor on the Vertex, The fame com-
preffion and elongation of the head, as well as
the tumor on the Vertex, may be fuppofed to hap-
pen in a greater or lefs. degree in the XVl, XVII,
XVIII, XIX Tables, as well as in this, where the
difficulty proceeds from the head being large, or
the Pelvis narrow. Vide Tables XXVII, and
XXVIII.

L. The forceps. Sometimes the forehead may
be moved to the natural pofition by the afli (lance
of the fingers, or only one blade of the forceps.

N. B. Though the ufe of a fingle blade of
the forceps, or the fimple lever, is ftill retained
in practice, and in a few particular cafes may be
employed in preference to the double lever, the
application is more difficult, more flight and pro-
feffional judgment are neceffary in the manage-
ment, and the two bladcd forceps can be em-
ployed with more fafety and equal fuccefs, in
general, by young praQitioners. The forceps

^ may

46 ANATOMICAL TABLES,

may either be the ftraight kind, or fuch as are
curved to one fide, when it is neceffary to ufe
one or both blades.

M. The Vejica Urinaria much diflended with a
large quantity of Urine, from the long preffure of
the head againfl the Urethra, which fhows that
the Urine ought to be drawn off with a Caiheier,
in fuch extraordinary cafes, before you apply the
forceps, or in preternatural cafes, where the child
is brought footling.

N, . The under part of the Uterus, .

O. O. The Os Uteri.

TWENTY SECOND TABLE

Shows, in a front view of the parts, the forehead
of the Fostus prefenting at the brim of the Pel-
vis, the face being turned to one fide, the Fon-
tanelle to the other, and the feet and breech
ftretched tov/ards the Fundus Uteri,

A. A. The fuperior part of the OJ[a Ilium.

B. The Anus.

C. The Perincsum.

D. The Os Externum ; the thicknefs of the

poflerior part before it is llretched with the head

of the child.

E. E. E. The

d)

2S^:xs.

^^^s;-

Mr A,

xxm.

WITH EXPLANATIONS, &c. 47

E. E. E. The Vagina,

F. The Os Uteri not yet fully dilated.
G.G.G. The Uterus.

H. The Membrana Adifofa, , // i

//

If the face is not forced down, the head will
fometimes come along in this manner ; in which
cafe the Vertex will be flattened, and the forehead
raifed in a conical form ; and when the head
comes down to the lower part of the Pelvis, the
face or Occiput will be turned from the fide, and
come out below the Fubes, But if the head is
large, and cannot be delivered by the pains, or
if the wrong pofition cannot be altered, the child
muft be delivered with the forceps. If they
fhould fail, recourfe mull be had to Embryulcia,

Vide Vol. I. Book HI. Chap. 2. Sed. 3. Chap.
3. Sea.4. No. 3. VoL II. Coll. 16. No. 4. Coll. 28.

TWENTY THIRD TABLE

Shows, in a lateral view, the face of the child
prefenting, and forced down into the lower
part of the Pelvis, the chin being below the
Pubes, and the Vertex in the concavity of the
Os Sacrum ; the waters likewife being all dif-
charged, the Uterus appears ciofcly joined to

the

48 ANATOMICAL TABLES,

the body of the child, round the neck af which
is one drcumvolution of the Funis.

A,^B. The Vertebrce of the loins, Os SacryM^
and Coccyx.

C. Th€ Os Pubis of the left fide.

D. The inferior part of the Redum^

E. The Perincewn.

F. The left Labium Pudendi.
G.. G;. G. The Uterus,

When the Pelvis is large, the head, if fmall,
will come along in this pohtion, and the child be
faved : For, as the head advances lower, the face
and forehead will ilretch the parts between the
Fr^cnum I^abiorum dLXid. Coccyx in form of a large
tumor. As the Os Externum likewife is dilated,
the face will be forced through it ; the under
part of the chin will rife upwards over the an-
terior part of the Pubes j and the forehead, Ver^
tex, and Occiput, turn up from the parts below.
If the head, however, is large, it will be detained
either when higher or in this pofition. In this
cafe, if the pofition cannot be altered to the nat-
ural, the child ought to be turned, and delivered
footling.

See N. B: at the end of explanation of Table
XXV. page 51.

If the Pelvis, however, is narrow, and the wa-
ters not all gone, the Vertex ihould, if poffible,
be brought to prefent ; but if the Uterus is fo

clofely

tJ^/<r/f^XXX\'

WITH EXPLANATIONS, &c. 49

clofely contra6led that this cannot be efFeQed, on
account of the ftrong prelTure of the fame, and
llipperinefs of the child's head, in this cafe the
method dire6led in the follov/ing table is to be
taken,

TWENTY FOURTH TABLE

Reprefents, in the lateral view, the head of the
Fcstus in the fame pofition as in the former
Table ; but the delivery is fuppofed to be re-
tarded from the largenefs of the head, or a
narrow Pelvis*

In this cafe, if the head cannot be raifed, and
pufhed up into the Uterus, it ought to be deliv-
ered with the forceps, in order to fave the child.
This pofition of the chin to the Pubes is one of
the fafefl cafes where the face prefents, and is
mod ealily delivered with the forceps ; the man-
ner of introducing of which over the ears is fhown
in this Table. The patient mufl lie on her back,
with her breech a little over the bed, her legs and
thighs being fupported by an affiftant fitting on
each fide. After the parts have been flowly di-
lated with the hand of the operator, and the for-
ceps introduced, and properly fixed along the
ears of the child, the head is to be brought down

by

§0 ANATOMICAL TABLES,

by degrees, that the parts below the Os Externim
may be gradually llretched : The chin then is
to be raifed up over the Piibes, whilfl the fore-
head, Fontanelle, and Occiput, are brought out
llowly from the Perinccum and Fundament to pre-
vent the fame from being hurt or lacerated.
But if the Fxtus cannot be extra6led with the
forceps, the delivery mull be left to the labour
pains, as long as the patient is in no danger ; but
if the danger is apparent, the head muft be de-
livered with the curved crotchets. Vide Table
XXXIX.

When the face prefents, and the chin is to the

lide of the Pelvis, the patient muft lie on her fide ;

and after the forceps are fixed along the ears, the

. chin is to be brought down to the lower part of

the Os IJchiitm, and then turned out below the

Pubes, and delivered in a flow manner as above.
Vide Yol, II. Coll. 16. No. 6. As alfo Tables

XVI, XVII, XVIII, andXIX,forthedefcription

of the parts.

TWENTY FIFTH TABLE

Shows, in a lateral view of the right fide, the
face of the Foetus prefenting, as in Table XXIII,
but in the contrary pofition ; that is, with the

chin

wr^isssr.

#

WITH EXPLANATIONS, Sec. 51

chin to the Os Sacrum, and the Bregma to xhz
Puhes, the waters evacuated, and the Uterus
contra6led.

A. The Os Externum not yet begun to flretch,

B, The Anus, Vide Table XX, for the further
defcription of the parts.

In fuch cafes, as well as in thofe of the laft
mentioned Table, if the child is fmall, the head
will be pufhed lo^\rer with the labour pains, and
gradually ftretch the lower part of the Vagina
and the external parts ; by which means the Os
Externum will be more and more dilated, until
the Vertex comes out below the Pubes, and rifes
up on the outfide ; in which cafe the delivery is
then the fame as in natural labours. But if the
head is large, it will pafs along with great dif-
ficulty ; whence the brain, and velTels of the
neck, will be fo much compreffed and obllruded,
as to deftroy the child. To prevent which, if
called in time, before the head is far advanced in
the Pelvis, the child ought to be turned, and
brought footling. If the head, however, is low
down, and cannot be turned, the delivery is then
to be performed with the forceps, either by bring-
ing along the head as it prefents, or as in the fol-
lowing Table. See the references in the pre-
ceding Table.

TV. B. Alarming floodings only excepted, it ifi
bad pradice to turn the child when the head pre-
Jaiis J a^id in cafes of relative dijproportion be-
tween

52 ANATOMICAL TABLES,

twetn it and the Pelvis, we can never propofe to
fave the child by turning.

See note, Table XXI, page 45.

TWENTY SIXTH TABLE

Reprefents, by outlines, in a lateral view of the
left fide of the fubje61:, the Fcstus in the fame
fituation as in the fornier Table.

The head here is fqueezed* into a very oblong
form ; and though forced down fo as fully to
dilate the Os Externum, yet the Vertex and Occiput
cannot be brought fo far down, as to turn out
from below the Puhes,2is in the foi'egoing Table,
without tearing the Perinceiirn and Anus, as well
as the Vagina and ReBum,

The beft method in this cafe, after either the
fhort or long curved forceps have been applied
along the ears, as reprefented in the Table, is to
pufli the head as high up in the Pelvis as is pof-
fible ; after which the chin is to be turned from
the Gs Sacrum to either Os Ifchium, and after-
wards brought down to the inferior part of the
lad mentioned bone. This done, the operator
mull pull the forceps with one hand, whilll two
fingers of the other are fixed on the lower part
of the chin or under jaw, to keep the face in the

middla

//juz^YSsn,

WITH EXPLANATIONS, &c. 53

middle, and prevent the chin from being detain*
ed at the Os Ifchium, as it comes along, and in
this manner move the chin round with the for-
ceps, and the above fingers, until brought under
the Pubes, which done, the head will be eafily
extrafted, as in Table XXIV.

If, before afiiftance has htG.n called, the head
is fo fqueezed down into the Pelvis, that it is im-
poffible to move the chin from the Sacrum to ei-
ther Os Ijchium, fo as to deliver with the Forceps
for the fafety of the child, the operator mull
wait with patience, as long as the woman is not
in danger, or there is no certainty of the death
of the Fxtiis : but if the patient runs the lea ft
rilk, the head muft be delivered with the crotchet.

In general, with refpeft to the pofture of the
woman iri the application of the forceps, when
the ears are to the lides of the Pelvis, the forceps,
as was obferved in Table XXIV, are moft ealily
introduced when the patient lies upon her back,
with her breech over the fide of the bed ; but
when the ear is to the Puhes or Groin, they are
better applied when the patient lies on her fide^
as was obferved in the cafes where the Verte:/Q
prefented.

Vide Table XXIV, for the defcription of the
parts, and the references. Alfo Table XXXIX,
for the manner of ufing the crotchet. See alfo
general rules for ufing the forceps in Dr. HamiU
tons Outlines of Midwifery, page 269, and feq.
and Dr. Denman's Aphorifms on laborious and
preternatural prefentation.

D TWENTY

54 ANATOMICAL TABLES,

TWENTY SEVENTH TABLE

Gives a lateral internal view of a diftorted Pelvis^
divided longitudinallyj with the head of a Foe-
tus of the feventh month pafling the fame*
Vide the explanation of Table IIL

A. B. C. The Os Sacrum and Coccyx.

D. The Os Pubis of the left fide.

E. The Tuberofity of the Os IJchiumi of the fam^
fide.

The head of the Fcetus here, though fmall, is
with difficulty fqueezed down into the Pelvis, and
changed from a round to an oblong form before
it can pafs, there being only the fpace of two
inches and one quarter between the proje6lion of
the fuperior part of the Sacrum and the OJfa Pubis,
If the head is foon delivered, the child may be
born alive : But if it continues in this manner
many hours, it is in danger of being lofl, on ac-
count of the long preffure on the brain. To pre-
vent which, if the labour pains are notfufficient-
ly ftrong, the head may be helped along with the
forceps, as dire6led in Table XVI.

Dr. Ofburn has endeavoured to prove, " thafc
the faetal head, at full maturity, cannot bear com-
preffion to a volume much fmaller than three
inches, from one parietal bone to the other, con-,
fiftently with fafety to the child's life." He

therefore

XXMI.

^z^xxvm.

J

^viTH EXPLANATIONS, &c, 55

therefore concludes : " Through a Pelvis which
has its cavity fo contra 6led, that the bones ap-
proach nearer to each other than three inches, it
is utterly impoflible for a living child, at full
maturity, by any means to pafs/*

See Dr. Ofburn's EfTay on Laborious Parturi--
tion, page 28. et feq.

This figure may ferve as ah example of the
extreme degree of diflortion of the Pelvis^ between
which and the well formed orie are many inter-
mediate degrees, according to which the difficulty
of delivery muft increafe bi* dimihifh, as well as
from the difproportion of the Pelvis and head of
the Foetus ; all which cafes require the great^Jl
taution, both as to the manageiiieiit arid fafety
bf the mother and child.

Vide Vol. I. BookllL Chap. 2. Sea. 3* No. 5.
Chap. 3. Se6l. 4, No. 3. Vol. IL Coll. 21. No. i«
and Coll. 29*

MS' 9jy.

TWENTY EIGHTH TABLE

Gives a fide view of a diftorted Pelvis, as in the
former Table, with the head of a full grown
Foetus fqueezed into the brim, the Parietal bones
decuffating each other, and comprefFed into a.
conical form.

D ^ A. B. C,

S6 ANATOMICAL TABLES,

A. B. C. The Os Sacrum and Coccyx^

D. The Os Pubis of the left fide.

E. The Tuberofity of the Os Jfchium,

F. The Procejfus Acutus.

G. The Foramen Magnum,

This Table fhows the impoffibility in fuch a
cafe to fave the child, unlefs by the Ccejarian op-
eration ; which, however, ought never to be per-
formed, excepting when it is impra6ti cable to de-
liver at all by any other method. Even in this
cafe, after the upper part of the head is dimin-
ifhed in bulk, and the bones are extra6led, the
greateft force mufl be applied in order to extra61:
the bones of the face and bafis of the fkull, as
well as the body of the Fcetus,

Vide Vol. I. Book IIL Chap. 3. Se6l. 7. Chap.
5. SeQ:. 3. and Vol. IIL Coll. 31. 39.

N. B. In oppofition to the opinion of Dr,
Smellie, and fentiments of former authors, Dr.
Oiborn has proved, from the cafe of Elizabeth
Sherwood, that '•' a child at full maturity may
be extracted by the crotchet through a Pelvis
whofe aperture does not exceed one inch and a
half from Pubes to Sacrum, with tolerable facility
to the operator, and perfeft fafety to the mother ;
dimenfions much lefs than what have been fup-
pofed to require the Cccfarian operation, even in
the latell and bell books." Elfay on Laborious
Parturition, page 64, — 251, &:c.

TWENTY

yxxsx.

WITH EXPLANATIONS, ^c. gf

TWENTY NINTH T A B L E

Reprefents, in a front view of the Pelvis, as in
' Table XXII, the breech of the Foetus prefent*
ing, and dilating the Os Internum, the Mem-
branes being too foon broke. The fore parts
of the child are to the poflerior part of the
Uterus ; and the Funis with a knot upon it,,
furrounds the neck, arm, and body.

Some time after this and the following Tables
were engraved, Dr. Kelly fliowed me a fubje6l he
had opened, where the breech prefented itfelf,
and lay much in the fame pofition with its body-
as in the ninth Table, fuppoling the breech in
that figure turned down to the Pelvis, and the
head up to the Fundus Uteri,

I have fometimes felt, in thefe cafes []wheii
labour was begun, and before the breech was
advanced into the Pelvis~\ one hip at the Sacrum,
the other refting above the Os Pubis, and the
private parts to one fide : But before they could ad-
vance lower, the Nates were turned to the fides.
and wide part of the brim, of the Pelvis, with the
private parts to the Sacrum, as in this Table ;.
though fometimes to the Piibes, as in the follow-
ing Table. As foon as the breech advances to the
lower part of the bafm, the hips again return to
their former pofition, viz, one hip turned out
D 3 below

g^ ANATOMICAL TABLES,

below the Os Pubis, and the other at the back
parts of the Os Externum,

N. B. In this cafe the child, if not very large,
or the Pelms narrow, may be often delivered alive
hy the labour pains ; but if long detained at the
inferior part of the Pelvis, the long prefTure of the
Funis may obftru61: the circulation. In mofl
cafes where the breech prefents, the efFeffc of the
labour pains ought tp be waited for, until at leafl
they have fully dilated the Os Internum and Vag-
ina,, if the fame have not been flretched before
with the waters and Membranes, In the mean
time, whilfl the breech advances, the Os Externum
jpay be dilated gently during every pain, to al-
low room for introducing a finger or (wo of each
hand to the outfide of each groin of the Foetus,
in order to alii ft the delivery when the Nates
are advanced to the lower part of the Vagina.
But if the Foetus is larger than ufual, or the Pelvis
narrow, an4 after a long time and many repeated
pains the breech is not forced down into the Pel-
vis, the patient's ftrength at the fame time failing,
the operator muft in a gradual manner open the
part?, and, having introduced a hand into the Vag-
ina, raife or pulh up the breech of the Foetus, and
bring down the legs and thighs. If the Uterus is
fo ftrongly coritrafted that the legs cannot begot
down, the largeft end of the blunt hook is to be
introduced, as direfted in Table XXXVII. As
foon as the breech or legs are brought down, the
body and head are to be delivered as defcribed ii^

the

WITH EXPLANATIONS, See, §9,

the next Table, only there is notifecei here to
alter the pofition of the child's body.

Vide Vol. I. BooklH. Chap. 4. Se6l 1,2. Vol.

HI. CoiL 32.

The defcription of the parts in this, and the
following Table, is the fame as in Table XXII,.
only the dotted lines in this defcribe the place of
the OJfa Pubis, and anterior parts of the OJfa If-
chium which are removed, and may ferve in this
refpe6l as an example for all the other front views,
where, without disfiguring the Table, they could
not be fo well put in.

N, B, The ufe of the blunt hook, in breech
cafes, is a hazardous expedient ; and manual af-
liftance of every kind fhouldbe avoided, the mod
urgent cafes only excepted.

See Dr. Hamilton s Outlines of Midwifery, page
37Q, et; feq.

THIRTIETH TABLE

Shows, in the fame view, and with the fame
references as the former, the breech of the Fatus
prefenting ; with this difference, however, that
the fore parts of the child are to the fore part of
the Uterus. In this cafe, when the breech com-
ing double, as it prefents, is brought down to the
hams, the legs muft be extra61ed, a cloth wrap^.

D 4 pcd

§o ANATOMICAL TABLES,

ped round them, and the fore parts of the child
turned to the back parts of the woman. If a
pain fhould iri the mean time force down the
body of the child, it ought to be pufhed up again
in turning, as. it turns eafier when the beliy is in
the Pelvis, than when the breaft and ftioulders
gre engaged ; and as fometimes the face and fore-
head are rather towards one of the groins, a quar-
ter turn more brings thefe parts to the fide of the
Pelvis^ and a little backwards, after which the
body is to be brought down. If the child is not
large, the arms need not be brought down, and
the head may be delivered by preffing back the
fhoulders and body of the child to the Perinxum,
and whilft the chin and face are within the Vag^
ina, to bring the Occiput out from below the Pubes,
according to D^venters method. Or the opera-
tor may introduce a finger or two into the mouth,
or on each fide of the nofe, and, fupporting the
body on the fame arm, fix two fingers of the
other hand over the fhoulders, on each fide
of the child's neck, and in this manner raife
the body oyer the Pubes, and bring the face and(
forehead out with a femicircular turn upwards,
from the under part of the Os Externum;. All
this may be eafily done when the woman lies on,
her fide ; but if the child is large, and the Pelvis
narrow, it is better to turn the patient on her
back, as defcribed in Table XXIV; and after the
legs and body are extra6led as far as the fhoul-
ders, the arms are to be cautioufly brought down,
and the head delivered. If the woman has flrong

pains,

WITH EXPLANATIONS, Sec. 6^1

pains, and when by the felt pulfation of the vef-
fels of the Funis Umbilicalis, or the flruggling mo-
tions of the Fxtus, it is certain that the child is
ftill alive, wait with patience for the alliftance of
the labour : But if that and the hand are infuf-
ficient, and the pulfation of the Funis turns weak-,
er, and if the child cannot be brought double,
the breech muft be pufhed up ; and if the re-
liftance of the Uterus is fo great as to prevent the
extraction of the legs, the patient ought to be
turned on her knees and elbows. When the legs
are thus brought down, the woman, if needful,
is to be again turned to her back, to allow more
freedom to deliver the body and head, as before
defcribed. If the head, after feveral trials, can-
not be delivered, without endangering the child,
f/om overftraining the neck, the long curved for-
ceps ought to be applied, as in Table XXXV,
If thefe fail, and the patient is not in danger,
fome time may be allowed for the effed: of the
labour pains ; which likewife proving infufHcient,
the crotchet muft be ufed as in Table XXXIX,
and when it is certain that the child is dead, cr
|:hat there is no poffibility of faving it.

N. B. Under proper management, if there is
no confiderable relative difproportion between
the head and the Pelvis, the hand of the operator
will be fufficient to relieve the head, when re-
tained after the delivery of the body, in breech,
and other preternatural prefentations. See Dr.
Hamilton s Outlines of Midwifery, p. 366 to 368.

THIRTY

6$ ANATOMICAL TABLES,

THIRTY FIRST TABLE

Reprefents, in a front view of the Pelvis, the Fce^
tus comprell'ed hy the eontraftion of the UUriis.
into a round form, the fore parts of the former
being towards the inferior part of the latter,
and one foot and hand fallen down into the
Vagina. In this figure the anterior part of the
Pelvis is removed by a longitudinal fe6lioa
through the niiddle of the Foramen Magnum*

A. A, The fuperior parts of the QJfa Ilium*.

B. B. The UUrus.

C. The mouth of the Womb ft retched, and ap*
pearing in

O. O. O. O. The Vagina,

D. The inferior and poflerior part of the Os^
Externum.

E. E. E. E. The remaining part of the OJfa Pih
his and Jfchimn.

F. F. F. F. The Memhrana Adipofa.

This and the three following Tables, repre-
fenting four diflperent preternatural pofitions of
the Foetus in utero, may ferve as examples for the
manner of delivery in thefe as well as in all oth^
cr preternatural cafes.

In all preternatural cafes, the Foetus may be
eafily turned and delivered by the feet, if known

before

fclai

^:xxxi.

WITH EXPLANATIONS, Sec. 63

before the Membranes are broke, and the waters
difcharged ; or if the Pelvis is narrow, and the
patient is flrong, the head, if large, may be
brought down fo as to prefent in the natural way :
But if all the waters are difcharged, and the Ute-
rus is flrongly contra 6led to the body of the Fcs'
tus, this lafl method can feldom take place, on
account of the ftrong preifure of the Uterus^ and
flipperinefs of the child's head.

In the prefent cafe, the woman may either be
laid on her back or fide, as defcribed in Tables
XVI, and XXIV ; and the operator, having flow^
ly dilated the Os Externum with his fingers, muft
introduce the fame into the Vagina, and pufh up
into the Uterus the parts of the Fcetus that pre*
fent ; or if there is fpace for it, his hand may
pafs in order to dilate the Os Internum if not fuf-
ficiently ftretched previoufly by the Membranes
and waters. This done, he muft advance his
hand into the Uterus^ to know the pofition of the
Foetus ; and, as the breech is rather lower than
the head, fearch for the other leg, and bring down
both feet without the Os Externum, A cloth muft
Ithen be wrapped round them ; and, having grafp-
jed them with one hand, he is to introduce the
Other into the Ute7-us, in order to raife the head
of the Fxtus, whilft the legs and thighs are pulled
down by the hand that holds the feet. When
the head is raifed, and does not fall down again,
the hand of the operator may be withdrawn from
the Ute7'us, and the delivery completed as dire6l-
ed in the two former Tables, By the artlefs

method

64 ANATOMICAL TABLES,

method of taking hold and pulling one or both
feet, the breech may come down and the head
rife to the Fundus ; but if this fhould not hap-
pen, there will be great danger of overllraining
the Foetus, which is prevented by the former
inethod. If the Membranes are broken before the
Os Uteri is largely opened, and the hand of th^
operator cannot be introduced, which fometimes
happens in a firft pregnancy, the parts of the Foe^
tics ihould be allowed to protrude ftill further,
by which means the rigidity of the Os Internum.
will in time be leffened.

Viie Vol. I. and III. on preternatural labours.

See alfo directions for the management of pre-
ternatural labours in Dr. Hamilton s Outlines of
Midwifery, page 357, et feq. and Dr. Denman\
Aphorifms refpeding the Diftindion and Man-
agement of preternatural prefentation,

THIRTY SECOND TABLE,

Reprefents, in the fame view with the former, the-

Fixtus in the contrary pofition ; the breech and'

fore parts being towards the Fundus Uteri, the

left arm in the Vagina, and fore arm withaub

the Os Externum, the ftioulder being likewife

forced into the Os Uteri.

The

,^

'2/aUy2QSL.

WITH EXPLANATIONS, &c. 65

The operator in this cafe muft introduce his
fingers between the back part of the Vagina and
the arm of the Forties, in order to raife the fboul-
der and make room for paffing his hand into the
Uterus to diftinguilh the pofition. This being
known, he ought to pufti up the Ihoulder to that
part of the Uterus, where the head is lodged, in
order to raife the fame to the Fundus. If the
body of the Fxtus does not move round, and
thereby lie in a more convenient pofition for
bringing down the legs, the hand of the operator
ought to be puftied up Hill higher to fearch for,
and take hold of the feet, which are to be brought
down as far as is poflible. If this fiiould not
change the pofition, the fhoulder is to be pufhed
up, and the legs pulled down alternately, until
they are brought down into the Vagina, or with-
out the Os Externum, after which the delivery
may be completed as in the former cafe.

If the feet cannot be brought down lower than
into the Vagina, a noofe may be introduced over
both ankles, by which the legs are brought lower
by pulling the noofe with one hand, whilll: the
other, previoufly introduced into the Uterus^
pulhes up the fhoulders and head, l^y this dou-
ble force the pofition of the Fcetus is to be altered,
and the delivery efFe6led. In thefe cafes, as the
fhoulder is raifed to the Fundus, the arm com-
monly returns into the Uterus ; but if the arm is
fo fwelled as to prevent the introdudion of the
operator's hand, and cannot be folded up or re-
turned into the Uterus, it muft be taken off at the

fhoulder,

66 ANATOMICAL TABLES,

fhoulder, or elbow, in order to deliver and favd
the woman*. If both arms come down, when
the breaft prefents, the methods above defcribed
are to be ufed.

Vide the explanations and references of ih6
foregoing Table to illuftrate this and the follow-*
ing.

Thirty third table

Exhibits , in the fame view like wife of the Pelvis
with the former, a third polition of the Foetus
when comprejQTed into the round form, the
belly, viz. or Umbilical region, prefenting at
the Os Intermm, and the Funis fallen dowil
into the Vagina^ and appearing at the Os Ex*
ternimi.

The delivery in this cafe is> to be efFe6led as ill
the former Table, by pulhing up the breaft, and
bringing down the legs. When the belly pre-
fents, it is eafier coming at the legs, than when
the breaft prefents, becaufe in the former cafe the
head is nearer to the Fundus Uteri, and the legs and

thighs

♦ The protruding arm of the child does not impede the Introduftion o£
the operator's hand in turning ; and the horrid expedient of amputation
recommended here^ andby former praftitioners, is feldom neceffary, cvea
in cafes of confiderable narrownefs of the Pelvis from diftortion.

See Df, Hamilton's Outlines of Midwifery, page 59?, ctftq.

^^xxxm.

%

WITH EXPLANATIONS, &c. ej

thighs lower. If the belly or breaft is forced
down into the lower part of the Pelvis, the child
will be in danger from the bending of the Ver-*
iehrce, and the preffure of the fpinal marrow, fo
great force is alfo required to raife thefe parts up
into the Uterus, in order to come at the feet, that
it will fometimes be neceifary to turn the wom-
an to her knees and elbows, to diminifh the re-
fillance of the Abdominal mufcles. V/hen the
Funis comes down without the Os Externum, if
there is a pulfation felt, it muft immediately be
replaced, and kept warm in the Vagina, to pre-
ferve the circulation, and prevent a ftagnation,
from its being expofed to cold air. If the Funis
comes down when the head prefents, the child is
in danger, if not fpeedily delivered with the pains,
or brought footling.

N, £, For an ingenious method of reducing
the prolapfed cord, See London Medical Journal^
Vol. VII. 1786, page 38.

See the two former Tables for the explanations
and references.

THIRTY FOU'RTH TABLE

Shows, in a lateral view of the Pelvis, one of the
moft difficult preternatural cafes. The left
Ihoulder, breaft, and neck of the Fcetus pra-

fen ting,

68 ANATOMICAL TABLES,

fenting, the head reflefted over the Pubes to
the right ftloulder and back, and the feet and
breech ftretched up to the Fundus, the Uterus
contra6led at the fame time, in form of a lonsr
flieath round the body of the Fxtus^

A. B. C. The Os Sacrum and Coccyx^

D. The Os Pubis of the left fide.

E. Part of the Urinary bladder.

F. The ReBum*

H. L K. The private parts,

M. ThtAnus'.

M. N. The Perinceim.

V. The Meatus Urinarius,

O. The Os Uteri not yet opened, and fituated
backwards towards the ReBum and Coccyx.

R. S. The fame reprefented in dotted lines, as
Opened when the labour is begun.

T. U. The fame more fully dilated, but nearer
to the pollerior than anterior part of the Pelvis,

W. P. The fame not fully ftretched at the fore
part, though intirely obliterated at the back part^
the Uterus and Vagina being there only fometimes
one continued furface*

Henge it appears why the anterior part of the
05 Uteri is frequently protruded before the head
of the Fcetus at the Pubes, which, if it retards de-
livery, is removed by Hiding it up with a finger
or two between the head andlaft mentioned part.
The pra6lice recommended here is attended with
confiderabie hazard ; and in a favourable pre^

fentation

7^/a/eJS^

WITH EXPLANATIONS, &c. eg

fentatf on of the Fxtus the dilatation may be fafely
ti-ufled to nature. Vide Tables IX, X, XI,XII,XIII.

The manner of delivery, in the pofition of the
Foetus, as reprefented in this Table, is to endeav-
our with the hand to force up the part prefent-
ing, in order to raife the head to the Fundus » If
this is impoffible from the flrong contra6tion of
the Uterus, the operator muft pufh up his hand
in a flow and cautious manner along the bread
and belly of the child, in order to come at the
legs and feet, which are to be taken hold of, and
brought down as far as the polition of the Fxtus
will admit of. The body is then to be moved
round by pufhing up the lower parts, and pull-
ing down the upper, until the feet are brought
without the Os Externum, and the delivery com-
pleted, as in Table XXXI. But if the feet cannot
be got down, fo as to be taken hold of without
the Os Externum, a noofe muft be fixed over the.
ankles, as in Table XXXII.

Vide Vol. I, and III, as dire6led in Table XXXL

THIRTY FIFTH TABLE

Shows, in a lateral view of the Pelvis, the method
of afTifting the delivery of the head of the Foetus
with the long curved forceps, in praeternatural
cafes, when it cannot be done with the hands,
asdcfcribed in Tables XXIX, and XXX.

A. The three lowefl Vcrtcbrce oi tlit loins, with
the Os Sacrum and Coccyx^

E JB The

fO ANATOMICAL TABLES,

B. The Os Pubis of the left fide.

C. C. The Perincemn and Anus prelTed back-
wards with the forceps.

D. The Intejlines,

E. E. The Parietes of the Abdomen*

F. F. F. The Uterus,

G. The pofterior part of the Os Uteri,
H. The Retlum,

L The Vagina,

After the body and arms of the child are de-
livered, and the different methods ufed to bring
down the head with the hands, as direfled in the
above Table, and more fully defcribed in Vol. I,
and III, the following method is to be tried in
order to fave the child, which mull otherwife be
loft by overftraining the neck andfpinal marrow.
The woman being in the fupine polition, as in
Tc^le XXIV, one of the afliftants ought to hold
the body and arms of the child up towards the
Abdomen of the woman, to give more room to the
operator, who having introduced one hand up to
the child's face, and moved it from the fide a
little backvvrards, for the eafier application of the
forceps along the fides of the head, muft then
turn his hand to one of the ears, and introduce
one of the blades with the other hand between
the fame and the head, with the cured fide to-
wards the Pubes, as in this Table. This done,
the hand is to be brought down to hold the han-
dle of the blade of the forceps, until the other
hand is introduced to the other fide of the head,
t)y which naeans the fame is preffed againft the

WITH explanations; &c. 71

blade that is up, and which is thus prevented
from (lipping, whilft the other hand introduces
the fecond blade on the .oppofite fide. The
blades being thus introduced, care muft be taken,
that in joining them no part of the Vagina is
locked in. After the forceps are firmly fixed along
the fides of the head, the face and forehead mufl
be turned again to the fide of the brim of the
Pelvis, by which means the wide part of the
head is to the wide part of the brim. This done,
the head is to be brought lower, and the force grad-
ually increafed, according to therefiftance from the
largenefs of the head, or narrownefs of the Pelvis.
The forehead, when brought low enough down, is
then to be turned into the concavity of the Os Sa-
crum and Coccyx, the handles of the forceps raifed
upwards, and the fame caution ufed in bringing the
head through the Os Externum, as defcribed in Ta*
ble XIX, and XXX. By this method the head will
be delivered, the child frequently faved, and theufe
of the crotchet prevented, except in thofe bafons
that are fo narrow, that it is impoffible to deliver
without diminifhing the bulk of the head.

Vide Table XXXIX. Alfo, Vol. I. Book III.
Chap. 4. Se6l. 5. Vol. III. Coll. 34, 35.

N. jB. In preternatural labours, if the head can*
not be relieved by the hands of the operator, the
childcanfeldombefaved by mechanical expedients.
In difficult cafes the long citrved forceps may, how-
ever, be attempted to be applied. Thofe of Dr.
Leak, in thofe circumflances, are preferable to any
Others. See note after explanation of Table XXX,
£ 2 THIRTY

72 ANATOMICAL TABLES,

THIRTY SIXTH TABLE

Reprefents, in a lateral view of the Pelvis^ tfee
method of extrading, with the affiftance of a
curved crotchet, the head of the Fcetus, when
left in the Uterus, after the body is delivered
and feparated from it, either by its being too
large, or the Pelvis too narrow.

A. B. C. The Os Sacrum and Coccyx,

D. The Os Pubis of the left fide.

E. E. The Uterus,

F. The locking part of the crotchet.

g, h. i. The point of the crotchet on the infide
of the Cranium,

If this cafe happens from the forehead's being
towards the Pubes, or the child long dead, and fo
mortified that both the body and under jaw are
feparated unexpeftedly, the long forceps that are
curved upwards will be fufficient to extra8: the
head ; but if the fame is large, and the Pelvis
narrow, and the delivery cannot be effedled by
the above method, then the head niuft be open-
ed, that its bulk may diminifh, as it is extrafted.
The patient being placed either on her back, or
lide, as in the explanation of Table XVI, and
XXIV, the left hand of the operator is to be in-
troduced into the Uterus, and the forehead of the
Foetus turned to the right fide of the brim of the
i^clviSf and a little backwards, the chin being

downwards ^

^/^XXXVX

WITH EXPLANATIONS, Sec. 73

downwards ; after which the palm of the hand
and fingers are to be advanced as high as the
Fontanelle, and the head grafped with the thumb
and little finger on each fide, as firm as is poffi-
ble, whilft an affiftant preffes on each fide of the
Abdomen with both hands, to keep the Uterus firm
in the middle and lower part of the fame. This
done, the operator having with his right hand in-
troduced and applied the crotchet to the head
(the point being turned towards the forehead, and
the convex part towards the Sacrum) he muft go
up along the infide of the left hand as high as
the Fontanelle, and there, or near it, fix the point
of the crotchet, keeping flill the left hand in the
former pofition, until with the other he pierces'
the Cranium with the point of the inftrument, and
tears a large opening in it from K to I ; after
this, keeping the crotchet Heady, he may Aide
down his left hand in a cautious manner, left
the former pofition Ihould be altered, and the
head will fink lower down by the affiftant's preiT^
ing on the Abdomen. The two fore fingers of
the left hand are then to be introduced into the
mouth, and the thumb below the under jaw, the
hand being above the blade of the crotchet.
When this firm hold is taken, the operator may
begin and pull flowly with both hands, and as
the brain difcharges through the perforation, the
head will diminifh, and come along. If this
method fhould fail from the flipperinefs of the
head, or its being fo much offified that a fuffi-
cient opening cannot be made, the Vcrlex raufl

F. 3 be

74 ANATOMICAL TABLES, ^

be turned down to the brim of the Pelvis, the
Fontanelle backwards, and each blade of the long
forceps introduced along the fides of the head^
with the curved fide towards the Puhes. After
they are joined and locked, the handles are to
be tied together with a fillet, to keep them firm
on the head, an affiftant is to keep the handles
backwards until the Cranium is largely opened
with the long fcilTars ihown in Table XXXIX.
This done, the head is to be extra6led in a flow
manner, firil turning the forehead to the fide of
the brim, and as the brain evacuates, and the
head comes lower down, again turning the fore-
head into the concavity of the Sacrum^ and com-
pleting the delivery, as in Table XVI.

This Table may alfo ferve for an example, to
fhow the method of fixing the crotchet on the
head, when although the body is not feparated
from it, yet it cannot be delivered with the ope-
rator's hands, or the long forceps, as iij Table
XXIX, and XXXV.

Vide Vol. I. Book III. Chap. 3. Sed. 7. Chap.
4. Sea. 5. Alfo, Vol. III. Coll. 31, 36.

N. B. It is the fafeft praftice, where the re fi fi-
ance is confiderable from relative difproportion,
to diminifh the volume of the child's head pre-
vious to the extra6tion with the hook.

THIRTY

'y%r^:KxxsTL.

WITH EXPLANATIONS, &c. 75

T HI RTY SEVENTH TABLE-

And the two following, reprefent feveral kinds of
inflrumentsufeful in laborious and difficult cafes.

A. The ftraightfliort forceps, in the exad pro«
portion as to the width between the blades, and
length from the points to the locking part : The
lirll being two and the fecond fix inches, which
with five inches and a half (the length of the
handles) makes in all eleven inches and a half.
The length of the handles may be altered at
pleafure. I find, however, in praftice, that this
ftandard is the moil convenient, and with lefs
difficulty introduced, than when longer, having
alfo fufficient force to deliver in moll cafes,
where their affiftance is necefTary. The handles
and lowell part of the blades may as here be
covered with any durable leather, but the blades
ought to be wrapped round with fomething of a
thinner kind, w^hich may be eafily renewed when
there is the lead fufpicion of veneral infe6lion in
a former cafe ; by being thus covered, the for-
ceps have a better hold, and mark lefs the head
of the child. For their eafier introdu6lion, the
blades ought likewife to begreafed with hog's lard.

B. Reprefents the poflerior part of a fingle
blade, in order to fhow the width and length of
the open part of the fame, and the form and pro-
portions of the whole. The handles, however, as
here reprefented; are rather too large. ,

E 4 Vide

7^ ANATOMICAL TABLES,

Vid(i Table XXI, for the figure and proportions
of the long forceps, that are curved upwards,
and covered in the fame manner as the former.

The forceps were at fiiH contrived to fave the
Foetus, and prevent, as much as pofFible, the ufe
of Iharp inftruments ; but even to this falutary
jnethod recouirfe ought not to be had but in cafes
where the degree of force requilite to extra^ will
not endanger, by its confequences, the life of the
mother. For, by the imprudent ufe of the for-
ceps, much more harm may be done than good.

See the explanation of Table XVI, alfo the
Preface to Vol. II, with the cafes in the collecr-
tion on that fubje6l.

C. The blunt hook, which is ufed for thi-ee
purpoCes.

Firfij To affift the estraftion of the head after
the Cranium is opened with the fciifars, by in-
troducing the fmall end along the ear on the out-
fide of the head to above the under jaw, where
the point is to be fixed ; the other extremity of the
hook being held with one hand, w^hilfl two fin-
gers of the other are to be introduced into the
forefaid opening, by which holds the head is to
be gradually ex traced.

Secondly, The fmall end is ufeful in abortions
in any of the firft four or five months, to hook
down the Secundines, when lying loofe in the
Uterus, v/hen the patient is much weakened by
floodings from the too long retention of the fame,
the pains alfo being unable to expel them, and
when they cannot be extra6i:ed with the fingers.

But

y/m/eys^^\SL

WITH EXPLANATIONS, 8cc. ^f

jBut if the Placenta ftill adheres, it is dangerous
to ufe this or any other inllrument to extra6l the
fame, as it ought to be left until it feparates nat-
urally. If a fmall part of the Secundines is pro*
truded through the Os Uteri, and pulled away
from what ftill adheres in the Uterus, the mouth
of the Womb contrafts, and that irritation is there-
by removed which would have continued the pains,
4nd have feparated and difeharged the whole.
Thirdly, The large hook at the other end is ufe-
ful to ailift the extraction of the body, when the
breech prefents, but fhould be ufed with great
caution, to avoid the diflocation or fra6lur€ of
the thigh.

N, B, The fmall extremity of the hook can nev-
er be employed without danger to the mother in
the former cafe ; nor the large hook without haz-
aid of deftroying the child, or occalioning violent
jnjury to the mother in the latter.

ra^ Table XXIX. Alfo, Vol. I. Book 11. Chap.
3. Book. III. Chap. 3. Se6l. 7. and Chap. 4.
Sea. 2. Vol. II. Coll. 12. Vol. III. Coll. 31, 32.

THIRTY EIGHTH TABLE.

A, Reprefents the whalebone fillet, which may
fometimes be ufeful in laborious cafes, when the
operator is not provided with the forceps in fud-
den and unexpected exigencies.

When

jre ANATOMICAL TABLES,

When the Vertex of the J^toprefents, andthe
head is forced down into the lower part of the
Fefvis, the woman weak, and the pains not fuf-
ficient to deliver it, the double of the fillet is to .
be introduced along the fore part of the Parietal
bones to the face, and if poflible above the under
jaw ; which done, the whale bone may be either
left in or pulled down out of the fheath, and ev-
ery weak pain aflifted by pulling gently at the
fillet. ; If the head can be raifed to the upper part
of the Pelvis, the fillet will be more eafily got
over the chin, which is a fafer and better holU
than on the face. If the face or forehead pre-
fents, the fillet is to be introduced over the Occiput.
Vide YohLBook in. Chap. 3, Sed. 2. VoL
II. ColL 24.

In fueh cafes, likewife, the whale bone may be fup-
pliedby a twigof any tough wood, mounted with a
limber garter or filletfowedin form of a long fheath^
. N. jB. Fillets, of whatever conftru61;ion, being
difficult of application, trifling in their powers,
liable to cut or gall the child's head, though a
fecure hold Ihould be obtained, and in other
refpeds inferior to the forceps, are now with juf-
tice reje6led from pra6lice.

B. B. Gives two views of a new kind of pefTary
for the Prolapfus Uteri, being taken from the
French and Dutch kind. After the Uterus is re-
duced, the large end of the pcffary is to be in-
troduced into the Vagina, and the Os Uteri retain-
ed in the concave part, where there are three holes
to prevent the fl agnation of any moifture. The

fmall

WITH EXPLANATIONS, &c. 79

fmall end without the Os Externum has two tapes
drawn through the two holes, which are tied to
font other tapes, that hang down from a belt that
furrounds the woman's body, and by this means
keep up the pefTary. This fort may be taken out
hy the patient when fhe goes to bed, and intro-
duced again in the morning ; but as this fome-
times rubs the Os Ext&rnum, fo as to make its ufe
uneafy, the round kind marked C are of more
general ufe. They are made of wood, ivory, or
cork (the laft covered with cloth and dipt in wax :)
the peifary is to be lubricated with pomatum, the
edge forced through the palJage into the Vagina,
and a finger introduced into the hole in the mid-
dle lays it acrofs within the Os Externum, They
ought to be larger or fmailer, according to the
widenefs or narrownefs of the, palfage, to prevent
their being forced out by any extraordinary
flraining. Vide Vol. I. Book IV. Chap. 1. Se6l.
7. Vol, III. Coll. 24.

See a defcription of a globe pelTary, recom-
mended by Dr. Denman, London Medical Jour-
nal, Vol. VII, for 1786, page 56.

D. D. Gives two views of a female catheter, to
fliow its degree of curvature and different parts.
Thofe for common ufe may be made much fhort-
er for conveniency of carrying in the pocket ;
but fometimes when the head or body of the child
prelfes on the bladder above the Pubes, it requires
one of this length ; and in fome extraordinary
cafes I have been obliged to ufe a male catheter.

Vide Vol. L Book 11. Chap. 1. Seft. 1, 2. Vol.
II, Coll. 10. No. 2. THIRTY

$a ANATOMICAL TABLES,

THIRTY NINTH TABLE.

a Reprefents a pair of curved crotchets locked
together in the fame manner as the forceps. . It
is very rare that the ufe of both is neceffary, ex-
cepting when the face prefents with the chin
turned to the Sacrum, and when it is impofTible
to move the head to bring the child footling, or
deliver with the forceps. In that cafe, if one
crotchet is not fufficient, the other is to be intro-
duced, and when joined together will a6l both as
crotchets, in opening the Cranium, and as the head
advances, will likewife a6l as forceps in moving
and turning the head more conveniently for the
delivery of the fame. They may alfo be ufeful
to affift when the head is left in the Uterus, and
one blade is not fufficient. There is feldom oc-
cafion, however, for the fharp crotchet, when the
head prefents, the blunt hook in Table XXVII,
being commonly fufficient, or even the forceps to
extract the fame, after it is opened with the fcif-
fars. Great care ought to be taken when the
fharp crotchet is introduced, to keep the point
towards the Foetus, efpecially in cafes where the
fingers cannot be got up to guide the fame. The
dotted lines along the infide of one of the blades,
reprefent a ffieath that is contrived to guard the
point until it is introduced high enough ; the
ligature at the hafidles marked with the two dot-
ted lines is then to be untied, the fheath with-
drawn,

l/a/e:SSSSi.

#

WITH EXPLANATIONS, &c. 8i

drawn, and tlue point, being uncovered, is fixed
as dn-eded in Table XXXVL

The point guarded, with this fheath, may alfo
be ufed inftead of the blunt hook.

h Gives a view of the back part of one of the
crotchets, which is twelve inches long.

c Gives a front view of the point, to fhow its
length and breadth, which ought to be rather
longer and narrower than here reprefented.

N, B, In the lefs improved (late of the 'art,
when mechanical exertions were chiefly trulled
to accomplifh delivery, in cafes of narrownefs
from diltortion of the bones, two blades of the
crotchet were recommended by Dr. Smellie*
That pra6lice is now rejedled ; for both blades
can never be employed at once with advantage,
and feldom with fafety.

See Dr. Hamilton's Outlines of Midwifery,
page 285 to 302 ; alfo Appendix, 420 ; and Dr.
Olburne's Effay on Laborious Parturition.

d Reprefents the fcilfars proper for perforating
the Cranium in very narrow and diilorted Pelvifes,
They ought to be made very ftrong, and nine
inches at leail in length, with ftops or refts in
the middle of the blades, by which a large dila-
tation is more eafily made.

The above inftruments ought only to be ufed
in the moil extraordinary cafes, where it is not
pofTible to fave the woman without their affiilance.

Vide Vol. I. Book IIL Chap. 3. Sed. 5. Chap.
5. No. 1. Vol. IIL Coll. 31, 35.

ADDITIONAL

82 ANATOMICAL TABLES,

ADDITIONAL TABLE.

Number XL.

By the late t)r. Thomas Young, with improvements by Dr.
Hamilton, both Profeflbrs of Midwifery at Edinburgh,

Among the few improvements which have been
made in the obftetrical apparatus fmce the days
of Qr. Smellie, the mod important are the alter-
ations in the fo7'cepSf by which the inconveniences
formerly attending the ufe of that inftrument are
obviated, and the operation is rendered more fafe
and eafy.

In contriving thefe alterations, the intentions
were, i . That the large curves fhould correfpond
as nearly as poflible with that of the Pelvis, 2. That
their points Ihould be thrown forwards and made
round, to prevent their hitching, or even prefTing
uneafily againfl any part of the Pelvis ; and
likewife to maintain their hold of the head,
whilfl it is to be brought forwards in that curv-
ed line of diredion which nature obferves.
3. That an inverted curve fhould be made towards
the joints, whereby the Perinceum may be faved
from injury, the extrafting force rightly conduc-
ed, and the handles at the fame time kept from
prefhng uneafily on the inferior and anterior parts
of the Puhes. 4. That their fub fiance ftiould be
reduced as much as poffible, fo that they are not
made flexible, or fo thin at the edges as to hurt
the part. 5. That their clams be made to prefs

equally

•^^XL.

B

A

y.3.

'.'B f

WITH EXPLANATIONS, Sec. 83

equally on the child's head, and fpread gradually
from the joint, fo as not to dilate the Os Vagina:
too fuddenly. 6. That the clams be of a due
breadth, with the outer furface a little convex,
and extremely fmooth, that they may not prefs
uneafily or hurt the woman. 7 . That their length
be fuch as can be applied fafely and commo-
dioufly within the Pelvis, and at the fame time fuit
the different fizes of the head as much as pollible.

The inftrument, executed according to thefe
intentions, is called the Short Curved Forceps, It
confifls of two blades, or parts ; each of which
is diftinguiftied into the handle A, the joint B O^
and the clams D E. See fig. 1 . which reprefents
one of the blades before it is bent into its perfect
ftate : a a a are three holes for admitting fcrews
to fix the wooden handle. — Fig. 2. fliows the in-
ftrument finifhed and locked, in which ftate it
meafures about 11 inches ; and, when properly
made, weighs about 11 ounces troy. The clams
muft be covered with the beft Morocco leather,
ftiaved thin, moiftened with water, and fewed on
with waxed filk.

N, B, Several inconveniences, both in the intro-
dudion and confequences, having been found to
attend the ufe of the forceps with the clams cov-
ered, praftitioners at prefent very generally pre-
fer thofe of poliftied fteel.

Fig. 3. A catheter, with a fmall curve towards

the point, which is better adapted to the female

Urethra than the ftraight. It may be perforated

with 8, 12; or 16 holes in rows, as here reprefent-

» ed,

84 ANATOMICAL TABLES,

cd, and terminated by a flight, very fmooth,
rounded, or oblong knob. The length fliould be
nearly fix inches, and the diameter not trifling.

Fig. 4. The perforators of Dr. Denman, now-
employed by many praditioners, in preference
to thofe of Dr. Sraellie, with the angular rejli ren^
dered fmoothcr and more rounded. If the long fcif-
fars of Dr. Smellie fliould be ftill retained in
pratlice, the fliarp edges orfght to be removed ;
they Ihould have, like thofe of Dr. Denman, a
degree of curve towards the points, and be pro-
vided with blunt knobs, inftead of the angular
refl:s, which expofe the patient to the hazard of
having the parts wounded or lacerated.

See Dr. Hamilton's Outlines of Midwifery,
page 290.

N. B, With a view to fave the child when the
mother is in danger, but the head too high for
the common Jhort forceps, and alfo to obviate an
inconvenience complained of by many pra6li-
tioners, of their locking within the Vagina, the
long forceps of Mr. Leveret of Paris, Do6iors
Smellie and Leak of London, and of Mr. Pugh
of Chelmsford in EiTex, have been invented.
The lig-htnefs and neatnefs of confl:ru6i:ion of Dr.
Leak's, with juftice, entitle them to the preference.

Fig. 5. The blunt hook, as prefently ufed, with
a fwell in the middle, by which a more fecure
hold: can be taken, and the extra6lion accom-
pliflied with more fafety and fuccefs, than with
the ftraight hook.

FINIS.

L