A System of Midwifery

Chapter I. Signs of Pregnancy.

Difficulty and importance of the subject.--Diagnosis in the early months.--Auscultation.--Changes in the vascular and nervous systems.--Morning sickness.--Changes in the appearance of the skin.--Cessation of the menses.--Areola.--Sensation of the child's movements.--"Quickening."--Auscultation.--Uterine souffle.--Sound of the foetal heart.--Funic souffle.--Sound produced by the movements of the foetus.--Ballottement.--State of the urine.--Violet appearance of the mucous membrane of the vagina.--Cases of doubtful pregnancy.--Diagnosis of twin pregnancy, 80

Chapter Ii. Treatment of Pregnancy.

Sympathetic affections of the stomach during pregnancy.-- Morning sickness.--Constipation.--Flatulence.--Colicky pains.--Headach.--Spasmodic cough.--Palpitation.--Toothach.-- Diarrhoea.--Pruritus pupendi.--Salivation, 101

Chapter Iii. Signs of the Death of the Foetus.

Difficulty of the subject.--Signs before labour.--Motion of the foetus.--Sound of the foetal heart.--Uterine souffle.-- Signs during labour where the head presents--where the face, the nates, the arm, or the cord, present.--Fetid liquor amnii.--Discharge of meconium, 107

Chapter Iv. Mole Pregnancy.

Nature and origin.--Varieties.--Diagnostic symptoms.-- Treatment, 112

CHAPTER V. EXTRA-UTERINE PREGNANCY.

Tubarian, ovarian, and ventral pregnancy.--Pregnancy in the substance of the uterus, 117

CHAPTER VI. RETROVERSION OF THE UTERUS.

History.--Causes.--Symptoms.--Diagnosis.--Treatment.-- Spontaneous terminations, 126

CHAPTER VII. DURATION OF PREGNANCY, 136

CHAPTER VIII. PREMATURE EXPULSION OF THE FOETUS.

Abortion.--Miscarriage.--Premature labour.--Causes.-- Symptoms.--Prophylactic measures.--Effects of repeated abortion.--Treatment, 141

Part Iii. Eutocia, or Natural Parturition.

CHAPTER I. STAGES OF LABOUR.

Preparatory stage.--Precursory symptoms.--First contractions.--Action of the pains.--Auscultation during the pains.--Effect of the pains upon the pulse.--Symptoms to be observed during and between the pains.--Character of a true pain.--Formation of the bag of liquor amnii.--Rigour at the end of the first stage.--Show.--Duration of the first stage.-- Description of the second stage.--Straining pains.--Dilatation of the perineum.--Expulsion of the child.--Third stage.-- Expulsion of the placenta.--Twins, 156

Chapter Ii. Treatment of Natural Labour.

State of the bowels.--Form and size of the uterus.--True and spurious pains.--Treatment of spurious pains.--Management of the first stage.--Examination.--Position of the patient during labour.--Prognosis as to the duration of labour.--Diet during labour.--Supporting the perineum.--Treatment of perineal laceration.--Cord round the child's neck.--Birth of the child, and ligature of the cord.--Importance of ascertaining that the uterus is contracted after labour.--Management of the placenta.--Twins.--Treatment after labour.--Lactation.--Milk fever and abscess.--Excoriated nipples.--Diet during lactation.--Management of lochia.--After-pains, 169

Chapter Iii. Mechanism of Parturition.

Cranial presentations--first and second position.--Face presentations--first and second positions.--Nates presentations, 199

Part Iv. Midwifery Operations.

CHAPTER I. THE FORCEPS.

Description of the straight and curved forceps.--Mode of action.--Indications.--Rules for applying the forceps.-- History of the forceps, 216

Chapter Ii. Turning.

Turning.--Indications.--Circumstances most favourable for this operation.--Rules for finding the feet.--Extraction with the feet foremost.--Turning with the nates foremost.--Turning with the head foremost.--History of turning, 230

Chapter Iii. Cæsarean Operation.

Indications,--Different modes of performing the operation.-- History of the Cæsarean operation, 243

CHAPTER IV. ARTIFICIAL PREMATURE LABOUR.

History of the operation.--Period of pregnancy most favourable for performing it.--Description of the operation, 250

Chapter V. Perforation.

Variety of perforators.--Indications.--Mode of operating.-- Extraction.--Crotchet.--Embryulcia, 256

PART V. DYSTOCIA, OR ABNORMAL PARTURITION.

CHAPTER I. FIRST SPECIES OF DYSTOCIA.

Malposition of the child.--Arm or shoulder the only faulty position of a full-grown living foetus.--Causes of malposition.--Diagnosis before and during labour.--Results where no assistance is rendered.--Spontaneous expulsion.-- Malposition complicated with deformed pelvis or spasmodically contracted uterus.--Embryulcia.--The prolapsed arm not to be put back or amputated.--Presentation of the arm and head.-- Presentation of the hand and feet.--Presentation of the head and feet.--Rupture of the uterus.--Usual seat of laceration.-- Causes.--Premonitory symptoms.--Symptoms.--Treatment.-- Gastrotomy.--Rupture in the early months of pregnancy, 264

Chapter Ii. Second Species of Dystocia.

Size and form of the child.--Hydrocephalus.--Cerebral tumours.--Accumulation of fluid and tumours in the chest or abdomen.--Monsters.--Anchylosis of the joints of the foetus, 281

Chapter Iii. Third Species of Dystocia.

Difficult labour from faulty condition of the parts which belong to the child.--The membranes.--Premature rupture of the membranes.--Liquor amnii.--Umbilical cord.--Knots upon the cord.--Placenta, 286

Chapter Iv. Fourth Species of Dystocia.

Abnormal state of the pelvis.--Equally contracted pelvis.-- Unequally contracted pelvis.--Rickets.--Malacosteon, or mollities ossium.--Symptoms of deformed pelvis.--Funnel-shaped pelvis.--Obliquely distorted pelvis.--Exostosis.--Diagnosis of contracted pelvis.--Effects of difficult labour from deformed pelvis.--Fracture of the parietal bone.--Treatment.--Prognosis, 292

Chapter V. Fifth Species of Dystocia.

Obstructed Labour from a Faulty Condition of the Soft Passages.

Pendulous abdomen.--Rigidity of the os uteri.--Belladonna.-- Edges of the os uteri adherent.--Cicatrices and callosities.-- Agglutination of the os uteri.--Contracted vagina.--Rigidity from age.--Cicatrices in the vagina.--Hymen.--Fibrous bands.-- Perineum.--Varicose and oedematous swellings of the labia and nymphæ.--Tumours.--Distended or prolapsed bladder.--Stone in the bladder, 308

Chapter Vi. Sixth Species of Dystocia.

Faulty Labour from a Faulty Condition of the expelling Powers.

I. Where the uterine activity is at fault--functionally or mechanically--from debility--derangement of the digestive organs--mental affections--the age and temperament of the patient--plethora--rheumatism of the uterus--inflammation of the uterus--stricture of the uterus.--Treatment. II. Where the action of the abdominal and other muscles is at fault.--Faulty state of the expelling powers after the birth of the child.-- Hæmorrhage.--Treatment, 324

Chapter Vii. Inversion of the Uterus.

Partial and complete.--Causes.--Diagnosis and symptoms.-- Treatment.--Chronic inversion.--Extirpation of the uterus, 345

Chapter Viii. Encysted Placenta.

Situation in the uterus.--Adherent placenta.--Prognosis and treatment.--Placenta left in the uterus.--Absorption of retained placenta, 354

Chapter Ix. Precipitate Labour.

Violent uterine action.--Causes.--Deficient resistance.-- Effects of precipitate labour.--Rupture of the cord.-- Treatment.--Connexion of precipitate labour with mania, 361

Chapter X. Prolapsus of the Umbilical Cord.

Diagnosis.--Causes.--Treatment.--Reposition of the cord, 368

CHAPTER XI. PUERPERAL CONVULSIONS.

Epileptic convulsions with cerebral congestion.--Causes.-- Symptoms.--Tetanic species.--Diagnosis of labour during convulsions.--Prophylactic treatment.--Treatment--Bleeding.-- Purgatives.--Apoplectic species.--Anæmic convulsions.-- Symptoms.--Treatment.--Hysterical convulsions.--Symptoms, 376

Chapter Xii. Placental Presentation, or Placenta Prævia.

History.--Dr. Rigby's division of hæmorrhages before labour into accidental and unavoidable.--Causes.--Symptoms.-- Treatment.--Plug.--Turning.--Partial presentation of the placenta.--Treatment, 393

Chapter Xiii. Puerperal Fevers.

Nature and varieties of puerperal fever.--Vitiation of the blood.--Different species of puerperal fever.--Puerperal peritonitis.--Symptoms.--Appearances after death.-- Treatment.--Uterine phlebitis.--Symptoms.--Appearances after death.--Treatment.--Indications.--False peritonitis.-- Treatment.--Gastro-bilious puerperal fevers.--Symptoms.-- Appearances after death.--Treatment.--Contagious or adynamic puerperal fevers.--Symptoms.--Appearances after death.-- Treatment, 415

Chapter Xiv. Phlegmatia Dolens.

Nature of the disease.--Definition of phlegmatia dolens.-- Symptoms.--Duration of the disease.--Connexion with crural phlebitis.--Causes.--Connexion between the phlegmatia dolens of lying-in women and puerperal fever.--Anatomical characters.--Treatment.--Phlegmatia dolens in the unimpregnated state, 463

Chapter Xv. Puerperal Mania.

Inflammatory or phrenitic form.--Treatment.--Gastro-enteric form.--Treatment.--Adynamic form.--Causes and symptoms.-- Treatment, 473

INDEX, 483

A SYSTEM OF MIDWIFERY.

INTRODUCTION.

By the term Midwifery is understood the knowledge and art of treating a woman and her child during her pregnancy, labour, and the puerperal state. We employ it in this extended sense, because most systematic writers of later times have adopted this arrangement. The terms, Art des Accouchemens of the French, the Ostetricia, and Arte della Parteria, of the Italians and Spaniards, and the Geburtshülfe of the Germans, are restricted to the process of parturition, although they have been and continue to be, used in the same extended sense as that in which we propose to use the term Midwifery.

Although pregnancy and parturition, strictly speaking, are perfectly natural functions, yet they involve such a complication and variety of other processes, and also changes of such extent, that the whole system is rendered more or less subservient to them during the periods of their existence: hence, therefore, their number and variety must ever render them more or less liable to deviations and irregularities of action, which will necessarily be aggravated by the effects of civilized life, and in many instances are productive of derangement in the general economy of the system. Under such circumstances the irritability of the system increases at the expense of its strength and vigour, and not only increases its liability to these derangements, but diminishes its power of resisting their effects.

In order that we may render the nature and treatment of the changes and phenomena, which take place in the human system during the periods above alluded to, more intelligible, we shall take a short anatomico-physiological view of the structure, form, arrangement, and function of the parts and organs which are more or less directly concerned in these important processes. This will embrace the subject of embryology, a department of physiological knowledge, which, though it has lately been much enriched by valuable discoveries, still affords a rich field of investigation and research.

The diagnosis and course of healthy pregnancy, and its various diseases, terminating with the subject of healthy parturition and its treatment will form the subject of the succeeding part.

Parturition properly speaking, will come under two separate heads eutocia and dystocia; the one signifying natural or favourable labour, the other, unnatural, faulty, or unfavourable labour.

The concluding part will contain a short account of some of the more important diseases which occur to the female during the first month after parturition.

PART I.. The Anatomy and Physiology of Utero-Gestation.

THE ANATOMY AND PHYSIOLOGY OF UTERO-GESTATION.

CHAPTER I.

THE PELVIS.

Ossa innominata.--Sacrum.--Coccyx.--Distinction between the male and female pelvis.--Diameters of the pelvis.--Pelvis before puberty.-- Axes.--Inclination.

The Pelvis, as the frame-work which, in great measure, contains, supports, and protects, the complicated apparatus of the generative organs, first claims our attention; since an accurate knowledge of the form, size, and uses, of its different parts is indispensably necessary, not only to understand the situation of the viscera it contains, but also to form a correct view of the mechanism upon which the process of parturition depends.

This osseous canal or circular archway, consists essentially of three bones, the right and left os innominatum, which form the sides of the arch, with the sacrum between them, acting as a keystone, and supporting the whole weight of the trunk above.

Ossa innominata. The ossa innominata in early life consists of three distinct bones, the iliac or hip bones at the sides, the ischia or lower portion upon which we sit, and the ossa pubis which meet each other anteriorly to form the front part of the pelvis. In the adult these are consolidated into one bone, merely leaving irregular lines and ridges here and there to mark their previous existence.

These bones present several striking points of resemblance with those which belong to the upper extremities, viz. the scapula and clavicle; and in the early stages of development, this similarity is much more distinctly seen: it is remarkable, that although the ischia and ossa pubis are formed later than the ilia, yet they unite with each other much sooner than with the ilia, so that the two consolidated bones bear the same relation to the ilium which is separated from them, that the clavicle does to the scapula: many other points of resemblance between the bones of the shoulder and pelvis might be noticed if necessary. (Meckel, Anat. vol. ii. p. 239.) The ossa innominata meet each other in front, forming the symphysis pubis, having layers of fibro-cartilage interposed between their extremities, and bound together by ligamentous fibres constituting the ligamentum arcuatum, or annulare ossium pubis, and by which a more rounded appearance is given to the pubic arch. They are united to the sacrum posteriorly, one on each side of it, forming the right and left sacro-iliac symphysis or synchondrosis; this differs in many respects from the symphysis pubis, the cartilaginous coverings of the opposing bones being much thinner, especially those of the ossa innominata; the surfaces are extremely uneven from the deep indentations which each bone presents at this part, locking, as it were, into each other, and thus contributing greatly to increase the firmness of the joint, which is also still farther strengthened by the support of powerful ligaments.

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