Practical observations in midwifery : with a selection of cases

I . With

A SELECTION OF CASES.

By JOHN RAMSBOTHAM, M. D.

Lecturer on Midwifery at the London Hospital, and one of the Physician- Accouchears to the Lying-in Charity for delivering Poor Married Women at theip own Habitations.

WITH NOTES,

BY WILLMMP. BEWEES, M.B.

Lecturer on Midwifery, Member of the American Philosophical Society, Member of the Philadelphia Medical Society, Member of the Academy of Medicine, &c.

PHILADELPHIA :

PUBLISHED BY H. C. CAREY AND I. lEA, No. 126, Chesnut Street.

ADVERTISEMENT OF THE AMERICAN EDITOR.

The Editor was so much pleased with Dr. Ranisbotham's work on Midwifery, that he thought he would be doing an acceptable office to the Medical Community in this country, should he cause it to be repubHshed. He believes he does not say too much, when he declares it to be, in his opinion, one of the best practical works (so far as it goes) extant. It is from a sincere wish to be useful to his more distant brethren, that he has undertaken the office of an editor, as very few copies of the work were imported, and they bore a high price; a sufficient number therefore could not be procured, did not the cost itself deter; and he ventures to declare that any man's library will be enriched by the possession of the work. He is happy to find, from the declaration of the Author, (and on this ventures to congratulate the Profession) that he will give at a vi future period the result of his experience upon other subjects of obstetrical practice.

The Editor has ventured to add a few notes to the text of his Author ; for this he shall make no apology, for if they are found of any importance, they will need none, and if they are not, it will in no way supply the defect.

TO

mmm mm^^ m^m^

Sir,

If the warmest feelings of personal friendship had not proved a sufficient inducement to me to inscribe the following pages to you, the acknowledged superiority of your professional acquirements, added to the peculiar consideration of your holding the office of Consulting Physician-Accoucheur to the Lying-in Charity for Delivering Poor Married Women at their Own Habitations, would at once have pointed out you as the most proper person to whom I could offer a dedicatory address. But, Sir, allow me to say that the influence of the former motives has had its due weight in imposing upon me this grateful task.

Having had the honor of being associated with you, for many years past, as one of the Physician- Accoucheurs to the above-mentioned Charit)-, I can duly appreciate your valuable services. You have, vili indeed, for an unusual, nay, almost unprecedented length of time, discharged the arduous duties of your situation, with the first-rate credit to yourself, as well as with the greatest advantages to the Institution, and to Its objects. You have my best wishes, that you may long enjoy such a state of health, as will enable you to continue your professional usefulness. Your associates have merely to tread in your steps to ensure to themselves public confidence and esteem.

The fact, perhaps, is not generally known, that more than five thousand women are annually delivered by the midwives of this extensive Charity, in the several districts of this large Metropolis. Of the whole number, about one-half is relieved in the district of which I have the official charge. A wide range of actual experience is thus offered to its medical officers, from which they can scarcely fail to derive an useful stock of practical knowledge.

Under your auspices, I beg leave to tender to the Profession the first fruits of those observations, which have been derived from this extended source, this fertile field; as well as from a considerable share of private practice ; and, I trust, they will be generally received with that candour, in which they are written. In the relation of the several cases, I have confined my remarks to a brief and simple detail of

I ix facts ; and I have, at the same time, carefully refrained from the mention of names in praise or censure. But I have occasionally noticed the melancholy consequences of ignorance and mal-practice, as salutary beacons, to warn the rash and inexperienced practitioner of hidden danger, and to furnish such cautions, as may prevent him rushing headlong into similar mischief.

Be pleased, Sir, to accept the sincere assurances of the highest respect and esteem from

The author.

Broad Street BuiiDiNtes, 1st January, 1821 .

Preface

The following pages have not to boast of any nosological arrangement, nor of novelty in practice or theory. They will be found simply to contain what the title announces, Practical Observations in Midwifery ; viz. on subjects connected with Labour, and its consequences ; which have been derived from clinical experience. I have merely stated such facts as I have seen ; such, indeed, as have occurred in my own practice : I may have omitted many remarks which ought to have been inserted, but I have not availed myself of the writings of others ; I have, in the present instance, declined that advantage.

The introductory remarks, in themselves of little value, became necessary to the completion of my plan, that I might the more perfectly contrast the situation of a woman at the full period of pregnancy, with that immediately after the conclusion of the act of labour, in xii order to determine the importance of those changes which are brought about by natural agencies under the act, and to draw the reader's attention to them. For I am sorry to think, that it has been too much the custom in practical midwifery, to consider mechanical expulsion of the uterine contents, or their extraction, as the principal, nay, almost the sole object of professional duty, to the neglect, if not to the exclusion, of attention to the changes above hinted at, and which are of far more importance to the security of the patient.

The remarks on Natural Labour are short and concise ; noticing rather the general occurrences under the process, than offering rules of management. But, on the several states under which the Placenta may be found, my observations have been more extended, and, I confidently hope, not to the disadvantage of the suffering sex. I have endeavoured to call the watchful attention of my brethren to a case, which is by no means uncommon, and which, if overlooked, may, in a short time, be productive of the most fatal consequences, viz. the relaxation of the Uterus under flooding, especially under internal flooding, either before or after the extraction of the Placenta ; and I feel persuaded, that the mere mention of xiii

the fact will be sufficient to excite that attention.

My observations on the different cases of Protracted Labour, under a natural presentation, are confined to practical points : I have scarcely ventured to offer an opinion on contested questions, being desirous of avoiding professional controversy : nor have I thought it necessary to explain the mode of application of the several instruments, since that is more properly the duty of a teaching professor, than .of a writer, and since practice alone can make any one adroit at their use. I have certainly introduced a great number of cases on several of the subjects, but my apology must be found in the interest of the subject : I have selected such as seemed to me to bear more particularly on the principal points of the text, or such as possessed some striking singularity. The cases on the Rupture of the Uterus, will evince the fallacy of the too generally received opinion, that there is no danger in a common natural labour, except from flooding ; they also shew that a parturient woman may be endangered by a cause which no human efforts can counteract.

If the following observations tend but in the xiv slightest degree to the ultimate improvement of our useful profession ; if they draw the attention of the accoucheur to points which are occasionally overlooked ; and if they thereby prove useful to any parturient woman, I shall not regret the time and trouble the publication has taken up. Should the present attempt be favorably received, I may be induced, at some future time, to continue and extend Practical Observation to other cases of difficulty and danger in the act of Child-birth.

Contents

Advebtkement.