A text book of midwifery

Front matter

Cornell University Library

The original of tiiis book is in tine Cornell University Library.

There are no known copyright restrictions in the United States on the use of the text.

Preface To The First Editiojn

At the outset of my career as teacher and practitioner, nearly twenty years ago,' I wrote a Compendium of Midwifery which the publishers intended should form one of a series of text books, and which met with a far more cordial reception than I had anticipated. During the next few years however of my clinical activity, I had neither time nor inclination for a more complete and revised treatise, and before long my removal ■ to another sphere of work, which happened more than once, also proved an obstacle.

When later on I found the necessary leisure, the need for a Compendium had passed away. It seemed to me however that a complete treatise of Obstetrical Science, showing what progress had been made both in theoryand practice during the last twenty years, and how greatly the science had been advanced by fresh researches, would be a useful undertaking. Especially did I venture to hope that the wide gap which still separates the Midwifery as taught in our hospitals and medical schools, and that of ordinary practice might be partly bridged over. Such was the origin of this text book. My last object obliged me to treat the subject from a clinical stand-point.

I have endeavoured as far as possible to summarise the accumulated literature of our science ; my own researches have been interspersed with it, for I could not think of exposing them more than could be avoided to the criticism of brother obstetricians. The fact that the first portions of this book have already been in type for two years, will explain why a few of the more recent researches have received somewhat scanty notice.

In arranging my material I have generally followed the established custom, although it is sometimes necessary in a

Viii PREFACE Ta THE FIRST EDITION.

clinical work to bring together sections which have no logical connection.

In the literature appended to each chapter, I have mainly confined myself to recent publications ; the earlier ones are quoted in them and can thus be easily referred to. A complete bibliography would have increased the size of my book without any corresponding advantage.- The distance at which. I was from the publishing office will, I trust, excuse a few typogi-aphical errors ; they are unimportant.

In conclusion I must thank the Publishers for the admirable way in which my text book has been brought out, better perha2)s than the contents deserve.

Spiegelbbeg.

September, 1877.

Preface To The Second Edition

The cordial reception which Spiegelberg's Text Book of Midwifery met with throughout the medical world, soon made' it necessary to allow a new edition of the work to appear. Unfortunately however its completion took longer than was originally anticipated, owing in part to the severe illness of the iiuthor, and in part to the fact that after his death the request to complete the unfinished work found the undersigned totally unprepared to undertake it.

Spiegeljberg did his utmost in the second edition, as he had done in the first, to examine critically the most recent contributions to the literature of the subject, and to giv6 prominence to the latest acquisitions of our science, so that this edition has been enriched in a degree which is by no means inconsiderable, and corresponds to the advance of recent midwifery. But death overtook the indefatigable man in the midst of his ceaseless activity, and robbed him of the joy of seeing his work completed.

Entrusted with the honourable task of completing the remaining portion of the text book of my teacher and friend (including Puerperal Fever and Obstetric. Operations), I have endeavoured, as far as was in my power, to fulfil this task in the spirit of him who has passed away. I, have not ventured to make any important alteration in the contents and arrangement of the previous edition, bearing in mind the many good qualities which have been so generally recognised. Moreover it was desirable to retain the character of the book which it received from its author.

I have therefore sought to incorporate as much as possible the results of the most recent investigations with the work which has already appeared, and have only in a few places used different expressions to those of the earlier edition.

X PEEFACE TO THE SECOND EDITION.

Amongst the papers bequeathed by Spiegelberg, I found a manuscript of his friend Dr. Matthews Duncan of London, containing very valuable criticisms on the first edition. Spiegelberg used this, manuscript with great advantage, and. I have done so also with the special permission of the Author, and I believe I am acting in accordance with Spiegelberg's wish, in here expressing to his friend the grateful acknowledgment which he deserves for the service he has rendered to this Text Book.

Wiener.

Beeslau, May, 1882.

TABLE OF CONTENTS OF VOL. I.

PAGE

Life op Spiegelbekg v

Pkefaoes

Table of Contents ;

List of Illusteattons

XIV

Part I

The Abdominal Cavity, Pelvis and Generative Organs (the Parturient Canal).

1. The abdominal cavity , 3

3. The pelvis with its soft parts — the parturient canal 24

The sezual apparatus , '. 29'

The pelvic peritoneum '. ,. 34

Topography of the pelvic cavity 38

4. The minute structure of the generative organs „ 45

Mammary gland 55

Part II

Phtsiolosy and Hygiene op Pregnancy, Parturition and the Puerperal State.

Chap. I.— Pregnancy

Puberty, menstruation, corpus luteum, impregnation, duration of pregnancy 59 a. In the generative organs and their vicinity 67

J. In the organism as a whole , , 83 a. The development of the ovum ; 90

i. The foetal appendages ' 95

(1.) In the different months of pregnancy 115

(2.) The maturefcetus 121

(3.) Attitude, lie and position of the foetus in the uterus 127

(4.) Nutrition and circulation of the foetus. , 132

Xll ■ CONTENTS.

PAGE

3. The diagnosis of pregnancy l**^

u,. The obstetrical examination (uterine souffle, foetal pulse and

umbilical souffle) ■ I'lO

b. Diagnostic value of the various signs of pregnancy 1^2

(1.) The various signs of pregnancy ' l-*^'^

(2.) The diagnosis of the period of pregnancy, the calculation

of the date of delivery •■•■• 168

(3.) The diagnosis between a first and a subsequent pregnancy 162

(4.) The diagnosis betiycen a living and a dead fcetns. 164

The diagnosis of sex .'., 165

4, The hygiene of pregnancy 167

CHAP. II.— FAETUEITION. Determining cause of labour, nerve centres for the uterus 171

1. The clinical progress of parturition (" pains ", action of abdominal muscles,

stages of labour, constitutional symptoms, duration of labour) 17-1

», The mechanism in general (expulsive forces, canalisation of the cervix uteri, of the perinteum j' bag of membranes, rotations of the

foetus, influence of "pains" on the distribution of blood) 183

b. Special mechanisms — presentations of the foetus 204

(1.) Vertex presentations '. 20y

(2.) Face presentations ; 220

(3.) Brow presentations '. ■. 231

(4.) Presentations of the pelvic extremity 23.'i

The use of chloroform in labour ; 266

Multiple pregnancies and births (superfcetation add dystocia) 270

CHAP. III.— THE PUEEPERAL STATE. (Processes accompanying it.)

a. Involution 2H8

b. The secretion of milk 301

c. The diagnosis of the puerperal state 305

2. The new-born child : 3l)(j a. Care of the' lying-in woman ; gjg

6. Care of the new-bom child ; "-in

PAKT III.

PaTHOLOOY and THERAPEUTios OF PkeMAUCY, PaRTDRHION AND THE

_ Puerperal State (Definition .of Obstetrical Operations). CHAP. I.-THB PATHOLOGY 6f PREGNANCY.

1. Disorders caused by a morbid intensity of'physiological phenomena.

(Alterations of bWod, anomalies of the circulation and of digestion-' urine, skin, neuroses.) ' & >

2. Complications due to intercurrent diseases

(Acute infectious diseases, malaria, ioterusr'i'seases'of" the'heajt" diseases of the respiratory passages, syphilis, operations.) Death during pregnancy

CONTENTS. Xlll

PAOB

3. Anomalies of the sexnal organs '. 371

o. FaUnresin development .-. 372

b. Displacements 377

(1.) Prolapse of theu'erua and vagina 377

(2.) Hemise of the uterus 381

(3.) Anteversiou of the uterus 383

(4.) Betroflezion and retroversion of the uterus 386

li. New formations 398

(1.) Fibro-myoma of the uterus ., ; 398

(2.) Cancer of the cervix uteri 402

(3.) Ovarian tumours 403

d. Inflammatory conditions (metritis, endometritis decidualis

chronica et catarrhalis, lencorrhoea, abnormal softening and

mobility of the pelvic articulations) 408

e. Injury and rupture 415

4. Diseases of the ovum 418

a. Pregnancy outside the uterine cavity — extra-uterine pregnancy ... 418

b. Anomalies of the decidua (atrophy, aborted ovum and fleshy mole) ' 447

c. Anomalies of the chorion, myxoma of the chorionic villi, vesicular

mole 451

d. Anomalies of the amnion , 459

e. Anomalies of the liquor amnii — hydramnios 460 g. Anomalies of the umbilical cord ;.,.., 476

Hernia of the cord 482

h. Anomalies of the fcetus 483

Intra-uterine death (habitual death, maceration and mummification of the ovum, retained ovum, missed labour) 496

5. Hsemorrhage from the uterus— premature termination of pregnancy 605

Menstruation during pregnancy 507

a. Haemorrhage during the first 28 weeks, abortion •. 508

6. Hasmorrhage after the 28th week. .' 528

(1.) Haemorrhage due to detachment of the normally inserted

placenta 529

(2.) Haemorrhage due to insertion of the placenta at the lower

segment of the uterus — placenta prasvia 534

Prolapse of the placenta 660

ILLUSTIUTIONS OF VOL. I.

FIG. PAGE

1. The pelyU : 8

2. Anterior half of pelvis (seen from behind) 10

3. Lateral Tiew of pelvis (seen from within) 10

4. Ditto (without ligaments) 10

5. Pelvis from below 1!

6. Pelvis (horizontal section) ; 12

7. Outline of pelvic inlet 14

8. Outline of pelvic dilatation -. 14

9. Outline of pelvic strait 14

10. Outline of pelvic outlet .' 14

11. Showing inclination and axis of pelvis ....; 16

12. Posterior half of pelvis ; .,.. 19

13. Uro-genital and anal regions 27

14. The parturient canal 28

15. Vertical and transverse section of female generative organs 30

16. Median section through female pelvis 35

17. Posterior view of the genital tract and its sarroimdings 42

18. Venous plexus of the genital canal' 44

19. Sagittal section through a parturient woman 72

20. Portio vaginalis directed backwards , 76

21. Portio vaginalis directed forwards 76

22. Ovum showing the yolk-sack and the amnion in process of development 91

23. Ovum showing the amniotic folds about to coalesce and the allantois at an

early stage 92

24. Ovum showing the subzonal membrane covered with villi, and the allantois

which has undergone further development 92

■25. Ovum in which the vascular layer of the allantois has come into contact

with the subzonal membrane , oi

26. Membranes of a human embryo in site qg

2g" 1 Ovum becoming embedded in the deoidua, and reflexa in process of

„„■ / development „„

30. Section through an incapsuled ovum 97

31. Section through the placental and uterine wall .!!!!!!!!..!! 105

32. Section through the placental and uterine wall '"' jor

33. Wreath of capillaries at the margin of the skin and umbilicalcord ....". 112

34. Human ovum 12 — 13 days old '"

35. Human ovum at the end of the third or the beginning of the fourth week "!. IIC

36. Human embryo in situ within its membranes 4 weeks old • " 1 1 r

37. The embryo from fig.. 36 magnified \.'

38. Human embryo of the 6th— 7th week magnified 2 diameters .."...!.. 1 1-

S9. Foetal head seen from the side '

40. Fcetal head seen from above

ILLUSTRATIONS. XV

Fid. PAGE

41. Foetal circulation 136

42. Bxpnlaiou of the placenta (according to Sohultze) 184

43. Expulsion of the placenta (according to Matthews Duncan) 185

44. Section through the frozen body of a woman dying during the period of

expulsion 194

45. The uterus and parturient canal of fig. 44, without foetus 195

46. Foetal skull ; 210

47. Shape of the head in vertex presentations (ocoipito-anterior position), with

. a well marked caput succedaneum 213

48. Foetal head bom in the second vertex position (moderate pelvic con-

traction) '. 215

49. Shape of head with an anterior parietal presentation 217

50. Face passing through the pelvic outlet and vulva ,.... 225

51. Face, presentation with chin directed posteriorly 226

52. Shape of the head in face presentations 227

63. Head entering the brim as a brow presentation 231

o4. Caput saccedaneum of. brow presentation... 234

55. Shape of the head in a brow presentation 235

56. The lateral flexure of the trunk acoonipanying delivery in a breech

presentation : , 239

57. Interlocking twins 283

58. Foetal circulation 309

59. Circulation in the new-bom child 309

60. Circulation in an adult ; 309

61. Utems displaced backwards 387

62. Retroflexion of the gravid uterus, showing the distended bladder with the

mucous membrane and a portion of the mnscularis detached and in a state

of gangrene • 390

63. Diagram of an incomplete retroflexion , 397

64. Tubal pregnancy of the left side " 422

65. Pregnancy in a left rudimentary hom 424

66. Interstitial pregnancy *26

67. Interstitial pregnancy ;•■• 427

68. Ovum with an imperfectly developed decidua; extemal surface of the

vera '^^^

69. Blood-mole with extravasations and blood-cysts on the foetal sttrface 450

70. Vesicular mole in the uterus 452

71. Portion of the uterine wall from fig. 70, showing the way in which the

degenerated villi involve the muscular tissue 454

72. Torsion of the cord • ^^^

73. Torsion at the foetal end • 479

74. Amputation of the left fore-arm with radimentary formation of fingers 487

76. Utems with the nucleus of a fibrinous polypus after abortion ■. 516