Obstetrics: the science and the art

Front matter

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Chapter I. Of The Pelvis

22 Fig. 1. Of the pelvis.

22 Upper and lower pelvis divided by the linea ileo-pectinea or strait.

22 The straits.

23 The excavation. 23 Coxal-bones.

23 Measurement of a pelvis.

24 Fig. 2. A transverse section of pelvis, back view.

24 Fig. 3. A transverse section of pelvis showing the pubal arch.

24 Description of the arch.

25 Form of superior strait, as in Fig. 4.

25 Form of perineal strait, as in Fig. 5.

26 Notices of the pelvic ligaments.

26 Relation of foetus to the straits and excavation.

27 Fig. 6. Showing the flexed state of the foetus in utero.

27 Particular description of sacrum.

28 Fig. 7. The sacrum.

28 The sacral foramina.

29 Case showing the effects of pressure on the sacral nerves.

30 Case of forceps operation for pressure on the sacral nerves.

31 The coccyx described. Fig. 8.

Xll CONTENTS.

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32 The sacro-iliac junction. The sacro-Yertebral angle. Fig. 9.

32 The right os innoniinatum. Fig. 10.

33 Division of the os innominatum at the acetabulum, with Fig. 11.

34 Auricular facette of the innominatum — the pubal facette — sacro-sciatic

notch — plane of the ischium.

35 Os pubis. Fig. 12.

36 Os pubis — or bar-bone. Fig. 13. Symphyseal ligaments.

37 Fig. 14, with account of pelvic ligaments.

38 Opening of the pelvic joints — cases of relaxed symphysis.

39 The whole pelvis — plane of the strait — its inclination.

40 Fig. 15. Inclination of the plane of the strait.

41 "Wigand's figures, 16, 17, of the inclination of the straits.

42 Wigand's figures, 18, 19.

43 Plane of inferior strait. Fig. 20.

44 Diameters of pelvis. Fig. 21.

45 Ten pelves measured. A table.

46 Table of diameters from authors.

46 Axis of pelvis. Fig. 22.

47 Carus's curve, with Fig. 23.

48 The recent pelvis. Fig. 24.

49 Reflections of the pelvic peritoneum — recto-vaginal peritoneal cul de

sac — muscles within the pelvis — blood-vessels, &c.

50 Fig. 25. Contents of pelvis.

CHAPTER n.

MECHANISM OE THE PELVIS — MECHANISM OF LABOR, AS IT DEPENDS UPON THE RELATIONS OF THE PELVIS AND THE FffiTAL HEAD.

51 Flexion, and obliquity of the head. Fig. 26.

52 Dip of the occipito-mental diameter in vertex labor — rotation.

53 Extension illustrated by Fig. 27 — Influence of the perineum in causing

extension of the head — restitution.

54 Rotation of the shoulders to the pubis, in vertex labors — mechanism

of second position. Fig. 28.

55 Mechanism of third position.

56 Fourth position. Fig. 29.

57 Fig. 30. Showing that when the vertex in fourth position cannot

come to the pubis, the occipital extremity of the occipito-frontal diameter must escape first — fifth position. Fig. 31.

58 Sixth position — a case related — an occipito-posterior position, in which

the restitution earned the vertex back to the sacrum.

59 Face presentations. Figs. 32, 33.

60 The doctrine in face cases — bring the chin to the pubis.

CONTENTS. Xlll

Chapter III

OF THE CHILD'S HEAD AND OTHER PRESENTING PARTS. PAGE

61 Fig. 34. Representing a foetal cranium.

62 Figs. 35, 36. The foetal head.

63 Dimensions of the head.

64 Occipito-mental diameter 5.6; occipito-frontal 4.10; bi-parietal 3.11;

fontanels.

65 Presentations — Fig. 37. Illustration of vertex presentations in first

position.

68 Two presentations — cephalic and pelvic. Figs. 38 ; 39.

69 Position of a presentation.

70 Six vertex positions — four pelvic positions — four shoulder positions.

CHAPTER IY.

THE ORGANS OF GENERATION.

72 Pudenda — Vulva — Labia.

73 Labial thrombus — oedema labiorum.

74 Labial abscess.

75 Cohesion of the labia.

76 Differences of the labia — nymphae,

78 Clitoris.

79 Urethra and vestibulum.

80 Hymen.

81 Fourchette — perineum.

83 Laceration of perineum.

84 Vagina — prolapsus uteri is a disease of the vagina,

86 Prolapsus vaginae. Fig. 40.

87 The womb. Fig. 41.

88 The womb. Fig. 41. Structure and power of the womb,

90 Fig. 42. The muscularity of the womb.

91 Action of the womb in labors — duration and number of pains.

CHAPTER Y.

THE OVARIES DESCRIBED,

94 Stroma of ovaries. Graafian cells.

95 Fig. 44. Magnified ovulum. Membrana granulosa. Macula germi-

nativa.

96 De Graaf.

XIV CONTENTS.

PAGE

97 Purkinje's account of the vesicle. Figs. 45, 46, 47.

98 Yon Baer's Epistle de Ovi Manimalinni, &c.

100 M. Coste. — Hist. Gen. et Partic. du Developpenient, &c. Wharton Jones and Wagner.

102 Coste's dissection of ovary. Fig. 48.

103 Wagner's human ovule. Fig. 49.

104 M. Burdach and M. Huschke cited.

105 Corpus luteuni. Fig. 50.

Part II. The Physiology Oe Reproduction

CHAPTER VL

MENSTRUATION.

119 Analyses of menstrua.

121 View of the ovaries in menstruation. Fig. 51.

125 Express doctrine of menstruation.

126 Menstruation is ovulation.

129 Time in which fecundation is possible.

chapter vn.

CAUSES AND TREATMENT OF AMENORRHEA.

140 Emansio mensium.

141 The endangium or blood-membrane.

143 Anaemia of emansio. Drugs.

144 Iron. Yallet's mass.

145 Blaud's pill. Quevenne's iron.

CHAPTER Yin.

PREGNANCY.

148 Definition of pregnancy.

149 Fecundation.

150 Conception.

154 Decidua. Figs. 52, 53.

156 M. Coste's views of the decidua. Fig. 54.

158 Decidua of Didelphis. Figs. 56, 7.

CONTENTS. XV

PAGE

162^ Gradual development of gravid womb — its effects.

167 Quickening.

171 Placenta. Hunter, Velpeau, Flourens, Owen. Human placenta. Figs. 57, 58.

176 Placentules of the ruminants.

177 Appearances seen on detaching placenta in the subject.

179 Blastoderm.

180 Allantois.

181 Umbilical vesicle.

182 Omphalo-mesenteric vessels and cord. Fig. 60. 184 Circulation of foetus.

188 Faulty developments. Teratology. Figs. 61, 62, 63, 64, 65.

193 Duration of pregnancy. Tables of.

199 Computation of term.

200 Changes in the nature of the womb. Fig. 66. 202 Uterine muscles. Fig. 67.

204 Obliquity. Pressure on the vessels.

207 Anaemia Gravidi. Hydatids.

210 Moles. Physometra. Hydrometra.

211 Abortion.

215 Dewees' placenta hook. Bond's forceps.

216 Tampon.

219 Prolapsus.

220 Betroversion. Fig. 70. 236 Extra-uterine pregnancy. 238 Signs of pregnancy.

Part III. The Therapeutics And Surgery Oe Midwifery

CHAPTEB IX.

LABOR.

246 John Ocularius and Al-Mamun.

247 Citation from Wigand, G-eburt des Menschen.

248 M. Quetelet's statistics of labor.

249 Definition of labor.

250 Cause of labor.

251 Subsidence of the womb.

252 Labor pains.

XVI CONTENTS.

PAGE

256 State of cervix uteri dilated. Fig. 71. Constitutional effects of the

pains.

257 Outward signs of labor.

258 Touching. 260 False-pains.

263 Periodicity of labor-pains.

264 Progress of the contraction in the whole womb.

266 Extrusion of the placenta.

267 State of the foetus, in labor. Outward thrust of the spinal arch under

the pains.

268 Positions. Fig. 72.

270 Madame Boivin's table of positions.

271 Dr. Nsegele's Lehrbuch der G-eburtshiilfe.

272 Observations on the mechanism of the labor, 274 State of the patient soon after delivery. 276 Lochia.

CHAPTER X.

CONDUCT OF A LABOR.

279 Table of duration of labors.

281 Cautions relative to the circulation during labor,

284 Alvus.

285 Decubitus.

287 To assist the flexion and rotation.

288 To correct obliquity.

289 Vaginal vesicocele; case of, in a labor.

291 Management of the cervix and os uteri, Effects of a bad sacrum,

292 Influence of a badly shaped pubis.

293 The perineum.

295 Cord around the neck. The shoulders.

296 How to treat the child,

297 The placenta.

298 Retained placenta.

299 Hour-glass contraction,

302 Womb after delivery,

303 After-pains.

304 Hemorrhage.

307 Sitting up too soon.

309 Tampon never, in labors,

310 Turn out the clot. Binder

312 Diet.

313 Suckling. Medicine.

314 Lochia. Sitting up.

CONTENTS. XV11

PAGE

315 Etherization.

319 Professor Simpson's Letter.

322 Reply to Professor Simpson's Letter.

CHAPTER XI.

FACE PRESENTATION. Fig. 73.

338 Fig. 78. Chin to sacrum in face-case.

CHAPTER XH.

PRESENTATION OF PELVIC EXTREMITY OF THE CHILD.

345 Causes of pelvic presentations.

348 Fatalities in breech cases. Diagnosis of them.

350 Not to bring down the feet.

352 Fig. 79. Fig. 80. Illustrations of pelvic presentations. First position.

354 Second position. Third position of breech.

356 Fourth position.

CHAPTER XIII.

PRETERNATURAL LABORS — CAUSES.

362 Madame Lachapelle's statistical table of labors.

363 Shoulder presentations.

365 Two shoulder presentations for each shoulder. Fig. 82. Diagnosis.

366 Turning in shoulder cases.

374 Spontaneous evolution of the foetus.

375 Fig. 83. Of double-headed child and of anencephalous child. Fig.

84, to illustrate spontaneous evolution. 377 Hemorrhagic labors. 382 Placenta praevia.

389 Concealed hemorrhage.

390 Post-partum hemorrhage. 392 Hour-glass contraction .

394 Hemorrhage after delivery of the placenta.

397 Mauriceau's account of his sister's case.

401 Convulsions.

412 Cramp. Prolapse of the cord.

414 Fainting. Hernia. Anaemia.

421 Exhaustion.

426 Engagement of bowel in front of womb. 1

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PAGE

427 Carcinoma Uteri. Illustrated by Figs. 85, 86, 87.

431 Variola as cause of preternatural labor.

432 Vaccination of the gravid woman dangerous. 434 Twins and triplets. Fig. 88.

439 Management of preternatural labor. Fig. 89.

440 Turning. See Figs. 90 to 100.

CHAPTER XIV.

DEFORMED PELVIS.

454 Deformed pelvis. Figs, of, 101 to 106.

459 Mensuration of the pelvis. Figs. 107, 108.

462 Fig. 109, illustrative of descent of bladder in labor.

464 Laceration of womb and vagina.

CHAPTER XV.

THE FORCEPS.

468 History of tbe discovery and progress of the forceps.

471 Mauriceau's relation of Hugh Chamberlen's operation.

473 Chamberlen's preface.

477 The Chamberlen instruments. Figs, of, 110 to 114.

480 Smellie and Levret. Manni's criticism.

481 Pean's and Baudelocque's forceps.

482 Professor Davis" forceps.

484 Professor Huston's forceps. Fig. 115.

485 Davis' forceps applied to head. Fig. 116.

486 Appropriation of obstetrical instruments — as mother's or child's. 417 to 560 Directions as to use of forceps.

CHAPTER XVI.

EMBRYOTOMY.

516 Mrs. R.'s case.

526 Author's embryotomy forceps. Figs. 118, 119, 120.

531 A case of Cesarean operation.

CHAPTER XvH.

INDUCTION OF PREMATURE LABOR.

CONTENTS. XIX

CHAPTER XVni.

INVERSION OE THE WOMB.

PAGE

552 Dr. Hatch's letter to author, describing a case of inversion. 556 Notice of Mr. Crosse's work on Inversion.

CHAPTER XIX.

PUERPERAL FEVER.

CHAPTER XX.

OP ATRESIA VAGINA.

583 Case of atresia after labor, in which the uterus was punctured from the

rectum. 586 Case of atresia vaginae.

CHAPTER XXI.

ON ERGOT.

CHAPTER XXII.

OF MILK-FEVER.

599 Inflammation of the breast — sore nipples.

603 Weed.

605 Gathered breast.

Part I V. The History And Diseases Of The Young Child

CHAPTER XXIII.

611 Viability of the child — establishment of the respiratory life.

612 Non-viable child.

613 Tying the navel string.

614 Washing the child.

615 Dressing the navel — dress for the child. 618 Food of the neonatus.

624 Fall of the navel string, and formation of umbilicus.

625 The meconium.

XX CONTESTS.

PAGE

626 Alrine dejections.

629 The gum.

630 Sore-mouth.

632 Jaundice— Coryza, or snuffles.

CHAPTER XXIV.

CYANOSIS NEONATORUM.

CHAPTER XXV.

667 Supplementary.

669 Bond's instrument for retroversion.

OBSTETRICS

PRELIMINARY OBSERVATIONS.

Midwifery is the art of assisting women in labor.

Obstetricy comprises the sciences of anatomy, physiology and pathology, as relative to the reproductive organs, and the arts of therapeutics and surgery, as applied to sexual affections in women.

Midwifery is an Art.

Obstetricy is a Science.

A Midwife or Accoucheur is one who assumes the conduct of cases of labor.

An Obstetrician is a physician, who, in addition to a general knowledge of physic and surgery, adds the special information that is necessary for one having the peculiar charge of all sexual affections, whether in the department of Midwifery proper, or in other complaints of the sex.

Notwithstanding obstetricy is constituted of several different branches or sorts of knowledge, it claims to be considered as a distinct science.

This claim it could not set forth nor maintain, until, in a modern age, a method or classification of the items of which it consists, has been with some success attempted.

The writings of the ancients, whether the Greeks, Romans, or Arabians, upon obstetrics, deserve not to be held as scientific works; nor do the productions of Pare, Guillemeau, Lamotte, Mauriceau or Deventer, merit so high a rank.

Of the English writers, neither Thomas Rainald, Chapman, Giffard, nor Burton, rise to the elevation of scientific authors; whereas, Smellie, Denman, David D. Davis, Collins, Dewees, Robert Lee, Churchill, and many others, have produced works whose scientific pretensions cannot be denied. It is, perhaps, unnecessary in this conjuncture to name the names of Levret, Baudelocque, Gardien, Velpeau, Wigand, Nsegele, Jdrg, Stein, Carus, Lowenstein, and many 2

18 PRELIMINARY OBSERVATIONS OBSTETRICS A SCIENCE.

other French and German philosophers who have treated of our subject with an order, precision, clearness and dignity, that place its claims to be regarded as a science beyond cavil.

While I contend for the claim of obstetricy to be regarded as one of the sciences, I admit the difficulty of discovering a perfect method or classification of the items of knowledge that compose the sum of it; and, perhaps, it may be contended that a method is essential to the nature of a science. It may be that it is not a science, but only a collection of items of disjointed sciences. The difficulty consists in the distinctness and absolute isolation of many of the facts or integers of the science, and the want of any natural order or series in them ; its items being rather fitted to be gathered together in a set of collections or fascicles, than in a regular sequence of books or chapters. What methodical connection is there, in fact, between a chapter on retroversion of the womb and one on the history and application of the forceps ; or what alliance betwixt the sacro-sciatic ligaments, and a crural phlebitis, or a mammary abscess?

In zoology there is a scale or gradation of the integral items of the science, resting on the constitution of the nervous mass of the different classes as well as the species. In mathematics, or the science of numbers, there is also a gradation, a scale, or regular series, all the integers of w T hich have a relation to each other.

There is, however, in obstetricy, a Method of the several subjects of contemplation that may serve to indicate to the learner or student the place in which he ought to find the special object of his search.

I am fully persuaded that we have, in our branch, no natural method ; and, therefore, without seeking for novel divisions and classifications to be used in this work, I propose the following course or order of studies.

I shall treat of —

I. The anatomy of the parts concerned in the acts of reproduction, with remarks on their pathology and therapeutics.

II. The physiology of reproduction.

III. The therapeutics and surgery of midwifery, or the obstetric art.

IV. The history and diseases of the neonatus, or young child. Here it seems are four divisions, classes, or branches of obstetricy;

each one of which is susceptible of being treated in a separate book, or volume. But, in order to the greater convenience of the reader, I shall prefer to transpose, according to my own pleasure or my own views of what may most conduce to the easy and rapid progress of the student, the various facts, precepts and doctrines, from one depart-

PRELIMINARY OBSERVATIONS METHOD IN OBSTETRICS. 19

ment to another, without rigorous reference to an order or method. The above arrangement shows that our obstetricy is a science, in so far as a method is necessary to that title ; for it is clear that by dividing the subjects of this volume in the manner now mentioned, we have it in our power to reduce to classes, genera and species, the various topics or facts to be exposed — and thus, with proper painstaking, to make of this book a kind of ledger, in which shall be found posted up, at page and line, all the particulars that we may deem it proper to enter on the pages.

M. G. Cuvier, in the Introduction to the Regne Animal, says, " There can be only one perfect method, and that is a natural method. This is the title given to an arrangement, in which, beings of the same genus are placed nearer to each other than to beings of any other genera, those of the same order nearer together than to those of other orders, and so throughout the arrangement. This is the ideal method to which everything in natural history should tend; for, it is evident, if it could be attained, we should be in possession of an exact and complete expression of all nature. In a word, a natural method would be the whole science; and every step towards it carries the science nearer to perfection."

Experience teaches that even in Natural history, an exact and perfect method has not yet been attained. Nevertheless, so great have been the improvements in method, that naturalists have little embarrassment in mastering the multitudinous items of which their science consists, in comparison with our difficulty of arriving at certain conclusions in a branch of knowledge or science in which is mixed up with a pure natural history, an unspeakable vastness of psychological and metaphysical cognitions.

Inasmuch as all the particular items of obstetrical knowledge must have an ultimate reference to the anatomical structures concerned in reproduction, I shall, following the custom of the moderns, commence with the osteological part of our anatomy, and proceed at once to describe the obstetric pelvis — or the female pelvis.

PART I.

ANATOMY OF THE PARTS CONCERNED IN THE ACTS OF REPRODUCTION.