IT 4| 
 
 DUKE UNIVERSITY 
 MEDICAL CENTER LIBRARY 
 HISTORY OF MEDICINE COLLECTIONS 
 
 Gift of 
 
 George D. Wilbanks, MD 
 T’53, M'56 
 & 
 
 Evelyn R. Wilbanks, PhD 
 G'56 
 
 r Fi - r 4 1 
 

 I 
 
 
 O 
 
Digitized by the Internet Archive 
 in 2016 
 
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C O L LE G 
 
 O F 
 
 CASES and OBSERVATIONS 
 
 IN 
 
 M I D W I F E R Y. 
 
 By WILLIAM SMELLIE, M.D. 
 
 TO ILLUSTRATE 
 
 His former Treatise, or First Volume, 
 on that Subject. 
 
 LONDON: 
 
 Printed for D. Wilson and T. Durham, at Plato’s 
 Head, in the Strand. 
 
 MDCCLIV. 
 

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[ ii 1 
 
 PREFACE. 
 
 f I ' ^ H E following Colleflions are in- 
 I tended to confirm and illuftrate 
 the method of practice recom- 
 mended in my former treatife or firfi: vo- 
 lume upon Midwifery ; and are placed in 
 the fame order obferved in that perform- 
 ance, to which they have references, as 
 well as to a feries of tables, to the number 
 of thirty-nine, now ready for publication, 
 which I have prepared, with a view to 
 demonftrate and explain what otherwife 
 might not be fo well underfiiood. Thefe 
 will, in fome meafure, fupply the want of 
 proper references in the firfi; volume j tho’ 
 that defedt fhall be more effedtually reme- 
 died in the next edition. 
 
 Between the years 1722, and 1739, 
 while I pradfifed in the country, I took 
 notes of all the remarkable cafes tliat oc- 
 
iv PREFACE. 
 
 currcd in Midwifery ; but in London, fince 
 the year 1740, to the prefent time, I have 
 been more careful and minute in forming 
 a colledfion, with a view to make it public. 
 
 From a great number of inftances, I 
 have fele 61 :ed only the moft material, and 
 fuch as were bed; adapted to the nature 
 of my plan j for, I was unwilimg to tire 
 the reader with a fuccelhon of parallel hif- 
 tories that contain nothing efientially dif- 
 ferent from one another. 
 
 In order to render the performance ffill 
 more com pleat, I have taken from authors 
 of the bed; authority, ^a few extraordinary 
 cafes, which feldom occur, as well as bor- 
 rowed fome medical tranfadtions from the 
 moft approved modern phyfidans. 
 
 From the inftances of natural and tedious 
 labours, the young praditioner will learn 
 how to behave in the like occurrences, and 
 above all things, to beware of being too 
 hafty in offering affiltance, v/hile nature 
 fs of herfelf able to effedtuate the deli- 
 very, 
 
 Among 
 
V 
 
 P Pv E F A C E. 
 
 Among the laborious cafes, he will find 
 a variety of examples, by which he will 
 know when it is abfolutely necelfary to 
 ufe the forceps : in my private practice, I 
 have very feldom occafion for the affill- 
 ance of that or any other infirument ; 
 but I have often been called in by other 
 praffitioners, to cafes in which I have had 
 opportunities to ufe it with fuccefs. 
 
 The forceps and fillet were contrived 
 with a view to fave the child, by helping 
 along the head in extraordinary cafes, 
 when nature was exhaufted, and to pre- 
 vent, as much as pofiible the ufe of fliarp 
 inftruments, when the mother s life was in 
 danger. But if thefe expedients are ufed 
 prematurely, when the nature of the cafe 
 does not abfolutely require fuch affiftance, 
 the mifehief that may enfue will often 
 overbalance the fervice for which they were 
 intended : and this confideration is one of 
 my principal motives for publifhing this 
 fecond volume. 
 
 In my firft, among the improvements 
 and alterations that have been made in the 
 forceps, I mentioned a long pan*, curved 
 
 A3 to 
 
VI 
 
 P Pv E F A C E, 
 
 to one {idc, which I contrived feveral years 
 ago, for taking a firmer hold of the head 
 in the Pelvis, and refting upon the upper 
 part of the Pubis j but, I did not then 
 j ecemmend the ufe of them, becaufe I was 
 afraid of encouraging young pradlitioners 
 to exert too great force, and give their af- 
 lilfance too foon. Of late, however, I 
 have foimd them very ferviceable in help- 
 ing along the child’s head, in preternatural 
 cafes, after the body ,and arms of the 
 Fd'tiis weie brought down, and it could 
 not be delivered without defiroying the 
 child, by overfiraining the neck and jaw. 
 
 On fuch occafions, they are more con- 
 venient than the fliort and ftraight fort, 
 becaufe they take a firmer hold, as will 
 appear in the perufal of Tab. XXXV.- and 
 alfo in Col. XXXIV. of the third volume. 
 They may be like wife ufed in laborious 
 cafes, when the head prefents, though I 
 find the others are more eafily managed 
 m the application (See Tab. XVI. &c.) 
 and, as 1 leklom have recourfe to the for- 
 ceps, except when the head is advanced in 
 the Pelvis, or as the French term it, la 
 8 ’ Fete 
 
PREFACE. vli 
 
 I’ete enclave, I commonly ufed the flioit 
 kind. 
 
 Finding my Colle6lion large enough to 
 compofe two volumes in OSiavo, I deter- 
 mined to publilh one immediately, that 
 comprehends the variety of methods prac- 
 tifed in lingering and laborious cafes, 
 which occur much oftener than the pre- 
 ternatural, and are more apt to puzzle 
 and perplex the young pradtitioner. This 
 Hep I have been induced to take fooner 
 than I at firft intended, by obferving that 
 fuch a fynoplis was very much wanted to 
 refrelh the memory, and diredil the con- 
 du6f of thofe who have attended my lec- 
 tures. 
 
 The unfuccefsful cafes communicated by 
 correlpondents, who delired their names 
 might be concealed, are inferted as fo many 
 beacons to caution others from falling in- 
 to the fame errors and miftakes, in the 
 courfe of pra6lice : and as to the truth of 
 the circumftances which I have related in 
 my own hiftories, the reader muft depend 
 upon my veracity j for, I apprehend, it is 
 equally imprtjper and unneceflary to men- 
 A 4 tion 
 
viii P R E. F A X E.- 
 
 tion the names of the patients, their places 
 of abode, or the exadt time of their deli- 
 very. The other part is almofl compleat- 
 ed, and though I fhould not live to fee it 
 in print, will certainly appear, to fulfil 
 my fcheme and promife to the publick. 
 
 N. B, Since the following cafes were 
 printed, I have feen a French tranflation 
 of my firfl; volume by M. de Preville^ at 
 Parisy who has done great juflice to the 
 work ; and I wifli the author may deferve 
 the charadter which in his preface he gives 
 him, with that politenefs fo peculiar to 
 his nation. He has likewife obliged the 
 world with a print of the inftrument uled 
 by Roonhuifen, as we ufe a fingle blade of 
 the forceps to move along the head in la- 
 borious cafes, according to the direcfions 
 fpecified in my firfl volume. Book III. 
 Chap. III. illufcrated in the XXVIIth and 
 XXVIIIth Colledlions of the fecond. This 
 fecret, he obferves, is faid to have been 
 communicated towards the end of the 
 lafl century, by the Chamberlains from 
 Poiido/iy to Ruyfchy Roc?ihuifen and BoekeU 
 many at Amjlcrdam ; and was lately pur- 
 chafeil by de Vijchcr and Van-de-Paoly phy- 
 
 ficians 
 
 7 
 
P R E F A C E: ix' 
 
 ficians of that city, who have publilhed 
 it for the beneiit of mankind. 
 
 It is a fingle piece of iron near eleven 
 inches long, one inch in breadth, one 
 eighth of an inch thick, and covered with 
 leather; ftraight in the middle for the 
 length of about four inches, and bent at 
 both ends, into a curvature, about three 
 eighths of an inch in depth. 
 
 CON- 
 
 £ 
 

 -4\ "\P '4 
 
 ;.-. ''\y 
 
 isudft'^ ’ ‘ • 
 
 i 3 JL J J 
 
[ xi ] 
 
 CONTENTS. 
 
 COLLECTION I. 
 
 O F the feparatioriy rigidity and dijior-i 
 tion of the bones of the Pelvis. Page i 
 
 COLLECTION II. 
 
 Operations performed upon the external parts » 
 
 lo 
 
 COLLECTION III. 
 
 Of the thicknefs of the Uterus in time of 
 gefiation, 1 9 
 
 COLLECTION IV. 
 
 Of obfruSlions of the Catamenia, the i?nmo- 
 derate flux of the Menfes, and of the 
 . Fluor Albus. 2 1 
 
 COLLECTION. V. 
 
 \ 
 
 Of labour y without any previous fenflble motioii 
 oj the childj and extra-uterine Fcetifes. 53 
 
 COLr 
 
CONTENTS, 
 
 xii 
 
 COLLECTION VI. 
 
 Of Superfcetation, or what was formerly 
 fuppofed to be fo. 8 1 
 
 COLLECTION VII. 
 
 0/ women who exceed the common term of 
 ■ gefiation. 8 9 
 
 COLLECTION VIII. 
 
 Of what is commonly called the falfe concep- 
 tion^ Moles and Hydatides. 92 
 
 COLLECTION IX. 
 
 0 / Polypus^ Schirrofty and Cancer in the 
 Ut°.rus and Vagina. 103 
 
 COLLECTION X. 
 
 Of complaints proceeding from Uterine Gef- 
 tation. t 1 19 
 
 COLLECTION XI. 
 
 Of difeafes that occur at other times as well 
 as in Uterine Geftation. 138 
 
 COLLECTION XII. 
 
 Of mifcarri age ^ or delivery before the full time. 
 
 i;8 
 
 COL- 
 
CONTENTS. xiii 
 
 COLLECTION XIII. 
 
 Of the fit nation of the child during pregnancy, 
 the fgns of conception and premature labour. 
 
 213 
 
 COLLECTION XIV. 
 
 Of natural labours. 228 
 
 COLLECTION XV. 
 
 Cf lingering or tedious labours. 245 
 
 COLLECTION XVI. 
 
 Of lingering and tedious labours. 263 
 
 COLLECTION XVII. 
 
 Of tedious cafes from the rigidity of the Os 
 Internum, Vagina, or Os Externum, as 
 alfo from the wrong pofition of the mouth 
 of the womb. 287 
 
 COLLECTION XVIII. 
 
 ' Of' lingering or dangerous cafes, from weak- 
 nefs, anxiety, frights, floodings, loofenefs, 
 convulfons, feveis, &cc. 296 
 
 COL- 
 
XIV 
 
 CONTENTS. 
 
 COLLECTION XIX. 
 
 Of circumvolutions and knots of the Funis 
 Umbilicalis, contraBions of the Uterus 
 before the fooulders^ &c. 330 
 
 COLLECTION XX. 
 
 Of lingering cafes from the large fize of the 
 cbild^ and the Hydrocephalus. 340 
 
 COLLECTION XXL 
 
 Of lingering cafes from a finally narroWy or 
 diflortedVQhis. ' 35^ 
 
 COLLECTION XXII. 
 
 Of children fuppofed to be dead-born y of the 
 head fqueezed into different forms j of the 
 Funis not Juffciently tiedy broke Jhort or fe- 
 parated in a wrong place. 383 
 
 COLLECTION XXIII. 
 
 Of cafes in which the Placenta was with dif- 
 fcidty delivered, 390 
 
 COLLECTION XXIV. 
 
 Of laborious cafeSy when the Vertex prefentSy 
 and the child s head is low in theVtWis. 404 
 
 COL- 
 
CONTENTS. 
 
 XV 
 
 COLLECTION XXV. 
 
 Of laborious cafes^ when the head of the child 
 is low in the Pelvis, a 72 d delivered with the 
 forceps. 408 
 
 COLLECTION XXVI. 
 
 Of difficult cafes from the rigidity of the parts^ 
 circumvolutions of the Funis, and contrac- 
 tions of the Uterus, in which the forceps 
 were ufed. 43 1 
 
 COLLECTION XXVII. 
 
 Of laborious cafes occafioned by the large fze 
 of the child s heady the narrownefs or dif- 
 tortioji of the Pelvis, wheji the head is low 
 and delivered with the forceps. 444 
 
 COLLECTION XXVIII. 
 
 Laborious cafes, in which the Vertex prefent- 
 ing with the forehead to the Pubis or 
 groin, the patient was delivered with the 
 forceps. 471 
 
 COLLECTION XXIX. 
 
 Laborious cafes of women delivered by the 
 forceps, the Vertex prefenting, the ear 
 
 to 
 
xvi CONTENTS. 
 
 to the Pubis, and the head higher in the 
 Pelvis. 483 
 
 COLLECTION XXX. 
 
 Of laborious cafes from the prejentation of the 
 forehead or Jace^ in which the women were 
 delivered by the forceps, 5055 
 
f ^ / 
 
 
 I 
 
 I ' 
 
ISiSe 13- 
 as* 
 
 a6. 
 
 30 * 
 
 48. 
 
 49 ‘ 
 
 50. 
 
 5 ** 
 
 53* 
 
 56. 
 
 70. 
 
 81. 
 
 S9. 
 
 91. 
 
 103. 
 
 '* JO. 
 
 158. 
 
 *15. 
 
 ai8. 
 
 * 34 * 
 
 » 37 . 
 
 344. 
 
 271. 
 
 *73‘ 
 
 278. 
 
 288. 
 
 a93* 
 
 332 * 
 
 345 * 
 
 349 * 
 
 35S* 
 
 404. 
 
 408. 
 
 444 * 
 
 462. 
 
 466. 
 
 483. 
 
 5 ° 3 * 
 
 E R R A, T A. 
 
 Line penult, xe^i^^ninch and a half in cirtum/treiiUf iB flictr- 
 of an inch and a half longt 
 23. read Curcum pulv, 
 
 4. read Mifce fiat, 
 
 19. read Siuavit vehicuht 
 1$. for fwo read too. 
 
 22i read Boneti, 
 
 6. read during the grtatejl part of ' •which time Jht bad tti 
 flooding.' Two or three days after, &c, 
 
 10. read .rfy. lalt, alexiter Jip.- 
 
 10. read eapiintur q^atuor ter de die, &i, 
 
 5. after -vide read vol. i. lib. 1. tbap. 3. 
 
 21 . for Bhil. Tranf. read from the above. 
 
 after line 5. read Phil, Tranf, N® 150. p. 285. 
 
 4. after vide read vol. i. lih, 1. chap, 3. 
 
 4. after vide read vol. i, lib, 1, chap, 3, 
 
 6. for 144.3 read 1743. 
 
 33, read lib. l. 
 
 4. after vide read vol. i. lib. i, chap, 3. 
 
 20. after out read feemed to be. 
 
 4. after time read vide vol, i. lib, 2. chap, 3* 
 
 7. read for three, 
 
 20. read and might proceed from. 
 
 10. read pupils were to attend, 
 penult, read belly was /welled. 
 
 .8. dele care, read expedition, 
 
 34. read and Jhe had. 
 
 2, read 1 was informed that the, &c, and line 44 read : 
 that the child, 
 
 i 6 . for the chin being leoi •which, 
 
 4. for highly read fttucb. 
 
 16 and 17. read ^operinetum being very thin y andflretched 
 to the extent of five fingers. 
 
 6. for right read left ; and line 8. for left read right. 
 
 3, after crotchet read I then did not know the method of 
 delivering with thf forceps, 
 
 iJt. after world read alive, 
 
 21, after injiruClion read, in particular I -was obliged to 
 Dr. Gordon of Glafgow, and Dr. Ingli/h of Lanark, . 
 in Scotland ; the firft noade me acquainted with the 
 blunt hook ; the other, with the noofe ; and in Lon- 
 don Dr. Nifbet afTifted me in improving the forceps, . 
 and Mr. Hunter, in reforming the wrong praftice of 1 
 delivering the Placenta. 
 
 5. 2f.tex pelvis read and delivered with the fillet, 
 
 6. after vide read vol, i. lib. 3. chap. 2. 
 
 7. after forceps read vol. i. Ub. 3, chap, 3, 
 
 30 . dele as the former was. 
 
 37, comma ahtt fufficient, ahd read and for 1 would,- 
 ^i.ht to tesi towards, 
 
 7, for child read bead. 
 
A 
 
 COLLECTIO,N 
 
 OF 
 
 Cases in MIDWITERY. 
 
 COLLECTION I. 
 
 Of the feparation, rigidity and diftor- 
 tion of the bones of the Pelvis, 
 
 [ Vol. I. Lib. I. Chap. I. ] 
 
 NUMB. I. 
 
 Of the . reparation of the B_ones.. 
 CASE I. 
 
 I N the year 1736, a woman, about 
 the age of thirty-five, being in labour 
 of her firft child, complained of a vio- 
 lent pain at the jundlure of the Ilium 
 with the Sacrum y on the right fide 5 and, in 
 time of the fevereft pains, imagined thefe 
 parts were feparated from one another, 
 with violence. This circumflance was not 
 at that time attended to by the midwife, 
 B who 
 
2 Cases m midwifery. 
 
 who delivered her after a tedious, though 
 r.atural labour ; yet, even after delivery, 
 the pain in this part exceeded all her other 
 complaints. I was called on the fifth day,, 
 when I found the pulfe quick, full and 
 hard, her fkin hot and dry, the Lochia 
 obftrudled, a difficulty in her breathing, 
 a pain and induration in one breaft ; 
 and fhe was totally deprived of reft, by 
 the anguifti in that part of the Pelvis. 
 She immediately loft twelve ounces of 
 blood from the arm, an emollient glyfter 
 was injedted, and a large quantity of har- 
 dened Faces difcharged : in confequence of 
 tliefe evacuations, her back, head, and dif-^ 
 ficulty of breathing were relieved ; but 
 the pain in her hip ftill continuing, warm 
 ftupes were applied to that part, and bot- 
 tles of hot-water to her feet, and I direct- 
 ed her to drink plentifully of warm barley 
 water. By thefe means, ftie was thrown 
 into a profufe fweat, refted well that night, 
 and next m.orning the fever was abated, 
 while the Uterus yielded a copious difcharge, 
 the pain and induration m her breaft were 
 greatly diminifhed, and the milk began to 
 run out at the nipples ; fo that the child, 
 which had before made a fruitlefs attempt, 
 
 now 
 
CASES IN MIDWIFERY. 3 
 
 now fucked with eafe. The only circum- 
 flance that now hindered her from lying 
 quiet and fweating, was, the continuance 
 of that pain in the Pelvis^ which to allay, 
 I prefcribed an embrocation of the ano- 
 dyne balfam, and the following bolus, 
 
 R Piliil. Matth. gr. viii. Sperm. Cet, 9i. 
 de Meconio q-ff- Bolus h. f fumendus. 
 
 This fhe was obliged to repeat every night, 
 and fometimes oftener, in order to procure 
 reft, and maintain the neceffary diaphorefts 5 
 and a glyfter was adminiftred every third 
 day. Ten days elapfed before fhe could 
 be moved out of bed, and twice that time 
 before fhe could lit up in a chair. When 
 her right leg was moved, her fenfation 
 w^as fuch, as if the Ilium and Sacrum of 
 that fide were torn afunder j and with my 
 hand upon the part, I could perceive a fenfi- 
 ble motion in thefe bones. At the end of the 
 month, file was not able to walk or ftand, 
 without being fupported under the right 
 arm, by an alTiftant or a crutch, and con- 
 tinued in that fituation five or fix months ^ 
 after which, fhe found fuch benefit from 
 the cold bath, that fhe could walk with 
 the aftiftance of a cane. She had feveral 
 - • B 2 children 
 
4 CASES IN MIDWIFERY. 
 
 childien afterwards, and her labours were 
 eafy, but they commonly, in fome degree,; 
 affedled that part, which never recovered it^ 
 former ftrength and liability, 
 
 CASE II. 
 
 Communicated by Dr. Smollett, ' 
 
 In the year 1748, a gentlewoman about 
 the age of twenty-feven, of a very llen- 
 der make, thin habit, and lax fibre, was, 
 in the eighth month of her firll pregnan- 
 cy, incommoded in her walking, by a pain 
 and crackling about the Pubes^ which when 
 I examined, I felt a fiirprifing relaxation 
 of the ligament that connedls the jfhare- 
 bones j infomuch, that while .me lay in 
 bed on one fide, I could eafily move them 
 in fuch a manner, that they feemed to ride 
 each other : however, fhe felt no great 
 inconvenience from this preternatural ex- 
 tenfion, which certainly widened the Pel- 
 •vis, for the more commodious pafiage of 
 the child ; and the ligament gradually re- 
 covered its tone : fo that, in two months 
 after her delivery, the OJfa Pubis were as 
 firmly united as ever. 
 
 Although 
 
CASES IN MIDWIFERY. 5 
 
 Although I myfelf have never perceiv- 
 ed fuch reparation in the bones of a living 
 fubjeil, Dr. Lawrence once fhewed me the 
 Pehis of a woman, who died foon^ after 
 delivery, in which all the three bones were 
 feparated almofl: an inch from one another. 
 I likewife faw the fame phenomenon in a 
 ’Pelvis belonging to Mr. Hunter. SpigelhiSy 
 in his Anatomy, Lib. II. cap. 24. fays he 
 has feen fuch a relaxation, which how- 
 ever, he obferves, very rarely occurs. Mr. 
 MonrOy who, in his Ofteology, quotes this 
 author and fome others, owns he had ne- 
 ver met with this kind of feparation, either 
 in the courfe of his pra6lice or dilleftions ; 
 yet has had reafon to fufpedl a relaxation 
 of the ligaments, conne6ling the OJfa in- 
 nominata and facruniy in fome women of a 
 delicate make, who after hard labour com- 
 plained of pain, weaknefs, and a fort of 
 jerking motion in this place j and, though 
 nothing extraordinary was perceivable by 
 the touch, could neither fit nor ftand with- 
 out pain, for the fpace of feveral months j 
 nay, the weaknefs continued for a much 
 longer time, during which they imagined 
 themfelves always finking down between 
 the haunch-bones. 
 
 ' E 3 
 
 NUMB. 
 
6 
 
 CASES IN MIDWIFERY. 
 
 N U M B. II. CASE! 
 
 Of the Os Coccygis oflified and bent inwards. 
 
 I have of late, in a particular manner, 
 examined the Os Coccygis^ efpecially in la- 
 borious cafes, and in women who were 
 turned of thirty before the birth of the 
 hrft child, and have found it actually offi- 
 fied in two patients, the firft turned of 
 forty, and the other about the age of 
 thirty- three : but, in neither of thefe cafes 
 could I perceive, that this rigidity retarded 
 the labour : for, in both, when the head 
 of the child came down to the Os Externum^ 
 it pahed along, and the women were as 
 eahly delivered, as thofe in whom the Coc- 
 cyx is moveable, though both children were 
 of an ordinary fize. The Coccyx and If- 
 chia being much lower than the Pubis^ the 
 back part of the head is commonly pullied 
 out below the laid, by that time the fore- 
 head is prelTed againfi: the Coccyx : For 
 in meafuring from the brim of the Pel- 
 •visy we find that the Pubis, being much 
 fhallower than the other bones, allows 
 an eafy pafiage to the wide part of the 
 
 9 head. 
 
CASES IN MIDWIFERY. 7 
 
 head, when placed from the Sacrum to 
 the fhare-bone. Vide A. II. and IV. 
 
 N U xM B. III. 
 
 Of the narrow and diflorted Pelvis. 
 
 Although cafes of this kind are more 
 naturally inferted among the operations of 
 Midwifery, I fhall mention a few in this 
 place, in order to preferve the regularity 
 of our plan. 
 
 The mod: common diftoition of the 
 Pelvis^ is, from the protrufion or jetting 
 forwards of the lad: Vertebra of the loins, 
 with the Os Sacrum^ and fometimes of 
 two or three of the lowed: vertebral bones. 
 I have been concerned in a few cafes, and, 
 in particular, w'^as called to three Avomen, 
 in wEom the Pelvis was fo narrow, that 
 the diftance between the lower Vertebra 
 and the Pubis, did not exceed two inches 
 and an half. The fird: I delivered four 
 times, but found it impoffible to fave any 
 of the children, except one, xAFich was 
 fmall, and even in that, the dioulder 
 was diflocated. Vide Collet. XXXIV. 
 and the third table of my anatomical 
 prints. 
 
 B 4 
 
 The 
 
8 CASES IN MIDWIFERY. 
 
 The fecond was twice delivered^ by ano- 
 ther gentleman, and three times by myfelf, 
 and only one child was faved by being born 
 in the eighth month, of a very fmall lize. 
 Both thefe patients were fmall in ftature, 
 and diflorted in the fpine. The third, who 
 was a tall woman, but had been ricketty 
 for two or three years in her infancy, I de- 
 livered three times with great fatigue, but 
 could fave none of the children, which 
 were large ; at laft, however, fhe bore a 
 live child in the feventh month. Vide 
 Colledion XXXV. alfo Tab. XXVI, and 
 XXVII. I have been called to feveral 
 others, where the Pelvis appeared, at that 
 part, not to exceed three inches, or 
 three inches and an half : when the 
 children were large, it was impoffible to 
 fave them, either by the forceps or by 
 turning j but when I was called in time, 
 and found thejn fmall, or even of a mid- 
 dle fize, the patient was commonly deli- 
 vered by one of thefe methods, if the la- 
 bour pains were not fufhcient. 
 
 I have been feveral times befpoke to at- 
 tend women in their firft children, by their 
 friends, who were apprehenfive, that they 
 would have difficult or dangerous labours, 
 
 becaufe 
 
CASES IN MIDWIFERY. 9 
 
 becaufe they were diftorted in their backs. 
 Eight patients in thefe circumftances, did 
 I deliver in the year 1748, and lix of them 
 had eafy natural labours j the other t\w> 
 were more difficult, but that difficulty 
 proceeded from the large fize of the chil- 
 dren, and the fmall make of the mothers. 
 In a few cafes, I have found one or two 
 bones of the Sacrum jetting inwards, to 
 fuch a degree, that the head of the child 
 pafled with great difficulty : in two of 
 thefe, I ufed the forceps, and at one time 
 was obliged to dilate the bones of the Cra- 
 niunii as the lower ends of the OJfa IJchia 
 were fgarce three inches afunder. 
 
 COL- 
 
10 CASES IN MIDWIFERY. 
 
 COLLECTION II. 
 
 Operations performed upon the external 
 Parts. 
 
 \^Vide Vol. I. Lib. I. Cap. IF. Se£l. i.] 
 
 Preternatural Size of the NYMPHiE. 
 CASE I. 
 
 In April 1733, I was called to a young 
 woman, who, by a fall from an hay-loft, 
 upon a poft below, had bruifed the Labia 
 Pudendi : befides an inflammation of the 
 parts, I found one of the Nymphce fo pre- 
 ternaturally large, as to hang down three 
 inches without the Labia. Her mother 
 was furprized to fee fuch an extraordinary 
 excrefcence, which the daughter had con- 
 cealed from her knowledge, and defired 
 me, after the inflammation was removed, 
 to remedy, if pofTible, this inconvenience, 
 as the girl was to be married in a little 
 time. The exciflon was accordingly per- 
 formed with great eafe, as that part next 
 the Labia was very thin. The patient 
 could recolle6l no caufe, to which this ex- 
 crefcence might be owing ; but faid, fhe 
 firfl: perceived it, w'hen flue was fixteen years 
 of age i that it gradually enlarged, and 
 
 fre- 
 
CASES IN MIDWIFERY. ii 
 
 frequently gave her much uneafmefs, by 
 itching, and being fubjedt to pricking 
 pains. The outward edge and extremity, 
 was about an inch thick, extending two 
 inches from the upper to the under part. 
 The caufe did not feem to have been vene- 
 real, but merely a fwelling of the glands. 
 
 CASE II. 
 
 In the year 1722, I was prefent at the 
 extirpation of the Nympha^ which were 
 exceffively large and pendulous in a wo- 
 man, who alleged, that the diforder pro- 
 ceeded from a venefeal taint, of which fhe 
 had been formerly cured. 
 
 Mauri ceau^ in Obfervation 3 1 3 . menti- 
 ons his taking off, by ligature, an elonga- 
 tion of the Carunculce Myrtiformes, 
 
 CASE III. 
 
 Of an obftrufted Hymen. 
 
 In the year 1727, a woman brought her 
 daughter from the country for my advice.^ 
 She had been a year married, and, in her 
 ow*n opinion, was in the eighth month 
 of her pregnancy, although Jfhe was regu- 
 lar in the difcharge of the Catamenia. She 
 afhrmed, fhe had frequently felt the mo- 
 tion of the child, and was grown much 
 
 bigger 
 
12 CASES IN MIDWIFERY. 
 
 bigger than her ordinary fize. I examined 
 the Abdomen^ but could not feel the cir- 
 cumfcribed tumour of the Uterus : indeed 
 file was corpulent, fo that the belly was 
 large, though foft. I then diredled her to 
 lean forwards on the back of a chair, and 
 feating myfelf behind, attempted to exa- 
 mine the Uterus by the Vagina, when I 
 found the entrance obftrudled. 
 
 Through the perfuafion of her mother, flie 
 confented to have the parts infpedled j and 
 being laid fupine upon a couch, I feparated 
 the Labia, when I perceived the Hymen in 
 form of a crefcent, from the middle of 
 which proceeded a kind of ligament, at- 
 tached to the lower part of the Meatus 
 Urinarius, leaving a pafTage on each fide, 
 capable of admitting a probe into the 
 Vagina, and of yielding paffage to the 
 menftrual difcharge, but effedLually ob- 
 hrucling the introdudtion of the Penis. 
 Having fnipt this attachment afimder, I 
 introduced my finger into the Vagina, and 
 felt the Uterus rifing up before it, as in 
 the unimpregnated flate, without any fen- 
 fible weight or ftretching of the part. From 
 tills circumfcance, I concluded, and affured 
 her, Ihe was not with child j then intro- 
 duced 
 
CASES IN MIDWIFERY. 13 
 
 duced a large thick tent, dipped in red 
 wine, and fecured it with a bandage. After 
 this operation, fhe foon became pregnant, 
 and has fince been delivered of feveral 
 children. 
 
 CASE IV. 
 
 In January 1754, a woman brought to 
 me a girl five or fix years old, whofe Hy-^ 
 men was imperforate, though it had been 
 twice opened by a furgeon, but the lips of 
 the incifion had united again. 
 
 I made an opening in the fame place 
 with a biflory, which I gradually dilated, 
 firft, with my little finger, and then with 
 the forefinger, until I could touch the Os 
 Uteri j then, fnipping with a pair of fcif- 
 fars a fmall portion of the Hymen that 
 remained next to the Fremm^ I introduced 
 a large tent, which was kept in the part 
 by compreffes and a proper bandage. 
 
 Hildanus'^ in Centiiria 3. Obferv. 60. gives 
 three examples in which the paffage was 
 fhut up by a membrane. 
 
 The firfl w'^as a girl of fixteen, w^ho was 
 once a month feized with violent pains in 
 her belly, faintings, head-achs, and fome- 
 times epileptic fits ; which, on a copious 
 
 bleeding 
 
14 CASES IN MIDWIFERY. 
 
 bleeding at the nofe, vanifhcd and did not 
 return till the next period. 
 
 She had refufed feveral advantageous 
 matches, in confequence of thefe infirmi- 
 ties, which being communicated to our 
 author, he infpedled the Pudenda, and, 
 finding the Vagina fhut up by a ftrong 
 mem.brane, he diredled an incifion to be 
 made j but the young woman, being terri- 
 fied at the thoughts of the knife, refufed 
 to fubmit to the operation. 
 
 The fecond was a young woman at Pa- 
 ris, who, being married, could not admit 
 the embraces of her hufband ; and he, on 
 that account, fued for a divorce ; but as 
 file fufpedfed herfelf with child, feveral 
 eminent furgeons examined the parts, and 
 found the entrance to the Vagina fhut up 
 by a firong callous membrane, in which 
 were fmall openings, fufficient to allow 
 the menftrual difcharge. 
 
 This membrane being dilated, and pro- 
 per peflaries and applications ufed, to keep 
 the paffages open, the hufband was fatis- 
 fied, and the woman was, in fix months, 
 fafely delivered of a full-grown child. 
 
 Mauriceau likewife, in Obfervation 489, 
 gives an account of a woman’s having 
 
 conceived. 
 
CASES IN MIDWIFERY. 15 
 
 conceived, and been delivered of a child, 
 though the Hymen had not been broke in 
 coition. 
 
 The third cafe of HildanuSi nearly re- 
 fembles the following, communicated by 
 Dr. D. Monro. 
 
 CASE V. 
 
 A girl of fifteen had all the fymptoms 
 of the menftrual difcharge, which conti- 
 nued to feize her regularly every month, 
 though nothing was evacuated from the 
 Uterus. When fhe attained the age of 
 nineteen, her belly was confiderably fwell- 
 ed, and finding a large tumour in her 
 Pudenda, fhe applied for relief to his fa- 
 ther, who immediately perceived it was 
 occafioned by an imperforated Hymen. 
 This he forthwith opened with a lancet, 
 which was inftantly followed by a difcharge 
 of about three pints and an half of blood, 
 of the confluence of butter^milk, and co- 
 lour of grumous blood, though without the 
 leaft fmell or fcetor : about half a pint of 
 the fame fluid was evacuated before morn- 
 ing, and the girl did well. 
 
 CASE 
 
1 6 CASES IN MIDWIFERY, 
 CASE VI. 
 
 Communicated by Dr. George Macaulay^ 
 
 Phyfician to the Lying-in-Hofpital, ini 
 
 Brow7^low-Jlreet . 
 
 About feven years ago, I was defired to 
 vifit a young woman, about nineteen years 
 of age, of a large make, and full-breaft- 
 ed, who was in exquifite pain, and could 
 not make water. Her belly being very 
 much fwelled, her pulfe feverifh, and her 
 pains exa6fly refembling thofe of labour ; 
 I ordered her to be blooded, a glyfter to 
 to be inje6fed, and prefcribed fome other 
 medicines. Next morning, I was inform- 
 ed more circumilantially of her illnefs, by 
 her mother, who faid, fhe had been com- 
 plaining for fome months, though pretty 
 well at intervals ; but now there was fome- 
 thing forcing down at her privy parts. In 
 confequence of this information, I exa- 
 mined her in a curfory manner, becaufe I 
 had called in my way to another patient, 
 to whom I was fent for in a hurry; I 
 found the belly very much diftended, and, 
 endeavouring to pafs one finger into the 
 Vagina^ felt what I then took to be the 
 membranes, with the waters pufhing pretty 
 lovv^ down. 
 
 I 
 
 From 
 
CASES IN MID¥/IFERY. 17 
 
 From this circumftanre I concluded ilie 
 was in labour, and left her for the prefent, 
 after having intimated to the mo^er, that 
 a little time would in all probability de- 
 termine the nature of her daughter’s com- 
 plaint. In my return I call’d again, and found 
 the girl in exquifite agony, though matters 
 were not at all advanced, during, three 
 hours which had elapfed in my abfence. 
 
 Then it was I thought of enquiring, 
 whether or not fhe had ever undergone 
 the menftrual difcharge^ when being an- 
 fwered in the negative, I examined more 
 •carefully, and found what I had miftaken 
 for the membranes, was no other than 
 the imperforated Hymen protruded b.y fome 
 fluid as far as the external Labia. 
 
 Having, upon this difcovery, flgnined the 
 only and certain means of cure to the pa- 
 tient and her mother, and they confenting 
 to the operation, I divided the thick, flrong 
 membrane with a knife, and evacuated, as 
 near as I can giiefs, two quarts of thick, 
 black blood. . As it flov/ed out, and the 
 great prefiure was removed from the neck 
 of the bladder, the urine was difcharged, 
 and the poor girl faid flie found herfelf in 
 heaven. 
 
 C 
 
 She 
 
1 8 CASES IN MIDWIFERY. 
 
 She was afterwards feized with fhiver- 
 ings and faintings, for which I prefcribed 
 cordials and the bark, upon a prefumption 
 that the parts, from the long continued 
 prefiure, might be difpofed to mortification. 
 
 She recovered very fall, and was mar- 
 ried in fix months after the aperture was 
 made. 
 
 Ruyfch^ Tom. i. Obfervat. 22. fays, he 
 was called to a woman in labour, whofe 
 Hymen was entire, and prevented the deli- 
 very of the child, by whofe head it was 
 diftended. An incifion being cautioufly 
 made, he perceived another thick mem- 
 brane farther in the Vaghia^ which being 
 alfo opened, the v/oman was delivered. 
 
 Saviard^ Obferv. 4. relates the cafe of a 
 young lady, whofe Vagma was obftrudled 
 by a membrane, which being cut, two 
 pints of a ftinking matter, of the confiftence 
 «f lees of wine, were difcharged. 
 
 Ele like wife gives an inftance of the en- 
 trance to the Vagina being fo much con- 
 tradled by the indifcreet ufe of aftringents, 
 that a probe could hardly be admitted : 
 but this opening was enlarged upon a di- 
 reftory, fo as to admit a tent an inch and 
 a half long. 
 
 COL- 
 
CASES IN MIDWIFERY, 19 
 
 COLLECTION III. 
 
 Of the thicknefs of the Uterus in time, 
 of Gelfation. 
 
 In the year 1747, and the following, 
 (Vide Vol. III. Coileaion XXXIX. Cafe i 
 and 2.) I had opportunities of opening 
 two women who had arrived at their full 
 time, but died of violent floodings, before 
 any affiftance could be procured to deliver 
 them. The membranes were ftill unbroke, 
 and both Uteri kept at their full extent by 
 a large quantity of water. When I open- 
 ed them, with intent, if poffible, to fave 
 the children, I found each about a quarter 
 of an inch thick. This is iikewife the 
 Hate of an Uterus now in my poliefiion, 
 taken from a woman who died in tire 
 eighth month of her pregnancy, before the 
 membranes were broke. 
 
 I have affifted in opening feveral women 
 who died after delivery, in confequence of 
 exceffive weaknefs and violent floodings ; 
 when the Uterus was not much contradfed, 
 it was not much thicker than that I have 
 defcribed} but, in thofe who died a few 
 days after delivery, from obArucfions of 
 C 2 the 
 
20 CASES IN MIDWIFERY. 
 
 the Lochia and a fever, the Uterus was 
 contradled to a fmall fize, and generally 
 from one to two inches thick : I muft, 
 however, except one cafe of a woman in 
 1752, who feemed to have been feven or 
 eight months gone with child, yet the Ute- 
 rus was contra6ted to a fmall bulk, though 
 when ftretched, it did not exceed the eighth 
 or tenth part of an inch in thicknefs at 
 the Fundus. Vide Dr. Garrow’s Letter, 
 Collea. XIII. No. I. 
 
 \ 
 
 COL- 
 
CASES IN MIDWIFERY. 21 
 
 COLLECTION IV. 
 
 Of Obflru6Hons of the Catamenia, the 
 immoderate flux of the Menses, and of 
 . the Fluor Albus. 
 
 NUMB. I. 
 
 The Catamenia obflrufled. 
 CASE I. 
 
 In the year 1724, a gentlewoman turn- 
 ed of twenty, who had always enjoyed 
 good health and a regular difcharge of the 
 Menfes, happened, during that evacuation, 
 to fall into a river in very cold weather, 
 and was obliged to ride a full mile before 
 fhe reached her home. By this accident the 
 Catajnenia were entirely obftrudted, and I, 
 was called to give my advice and afliflance. 
 When I arrived at the place, flie had been 
 in bed fome hours, and complained of violent 
 pains in her head and back 5 her pulfe 
 was quick, fhe breathed with difliculty, 
 and feemed a little delirious. It was fome 
 time before I knew that the difcharge was 
 upon her when fhe fell into the water, 
 confequently I was ignorant of the obfcruc- 
 tion. She was immediately blooded at the 
 arm, to the quantity of twelve ounces >. 
 
 C 3 butj 
 
22 CASES IN MIDWIFERY, 
 
 but, finding no relief from this evacuation, 
 fhe loft eight ounces more, and fainted 
 away : the pains however, and difficulty 
 of breathing foon abated, and a profufe 
 fweat enfued. This was encouraged by 
 frequent draughts of weak white wine 
 wheyj the pulfe became more calm and re- 
 gular, the delirium gradually ceafed, fhe 
 enjoyed a profound fteep, and next morn- 
 ing feemed to be in perfect health. 
 
 I was then informed of the obflruftion ; 
 and, underftanding fhe was coftive, pre- 
 feribed a glyfter, which had a favourable 
 operation : that fame evening I directed 
 her feet to be bathed in warm water, and 
 defired fhe might fit over the ft earns of it, 
 fo as that the vapour lliould foment her 
 lower parts. 
 
 Next day fhe was gently purged with 
 an infufion of Sena and Manna but the 
 difeharge did not return, although fhe was 
 perfedlly eafy, and free from all complaints, 
 but that of being low-fpirited from the 
 evacuations fhe had undergone. I recom- 
 mended warmth, gentle exercife, and food 
 of eafy digeftion, in hope, that, as fhe was 
 of an healthy conftitution, nature would 
 reftore the regularity of the difeharge. Nor 
 5 ' was 
 
CASES IN MIDWIFERY. 23 
 
 0 
 
 was I difappointed in my expedlation : at 
 the end of four weeks, the menfes appear- 
 ed as ufual, fhe was in a little time mar- 
 ried, and has never hnce had any com- 
 plaint of that nature. 
 
 It would be equally tedious and unne- 
 ceflary, to infert a number of fuch cafes, 
 which have happened in the courfe of my 
 pra6lice. I fhall only obferve, that gentle 
 evacuations, exercife and a low diet, gene-, 
 rally remove thofe obflrudlions in the firfi: 
 four or five months 5 and, unlefs the fluids 
 acquire a wrong turn by fome other kind 
 of irruption, fuch as a difcharge of blood 
 from the haemorrhoidal veins, flomach, 
 lungs, nofe, and fbmetimes, though very 
 feldom, through the hairy fcalp, cuticle of , 
 the legs, and other parts ; I fay, except 
 when diverted by fuch preternatural he- 
 morrhages, the Menfes commonly return, - 
 or eife the patient is afflidted with thofe 
 complaints, which proceed from a weak 
 and languid circulation of the fluids. In 
 this cafe, the method recommended above 
 mufl: be altered, and the obftrudHon re- 
 moved by medicines that quicken the cir- 
 culation of the blood, fuch as gentle 
 emetics, bitter and aromatic infufioisB, pre- 
 , C 4 pa^ations 
 
24 Cases in midwifery. 
 
 parations of fteel, chalybeate waters, rid- 
 ing, and nourifhing diet. In a word, when 
 the obftrucfion is owing to plethora, rigi- 
 dity or tenlion, evacuations are proper i 
 but when it proceeds from a weak and re- 
 laxed habit of body, thofe things that nou- 
 ridi and Rrengthen the conftitution, are 
 moft effedlual. Great attention is there- 
 fore required to confider thefe different 
 circum fiances, and experience to judge of 
 the indication j efpecially, as almoft all 
 the complaints of unmarried women, pro- 
 ceed from the irregularity of this difcharge. 
 
 During my general praclice in the coun- 
 try, when my advice was follicited by fe- 
 male patients, who laboured under, either 
 an obflrudlion, immoderate difcharge, or 
 Lrregularity of the Menfes^ efpecially if the 
 diforder was of long continuance, I fuc- 
 ceeded befl by following the methods re- 
 commended by the late learned Dr. Friend. 
 I fliall therefore infert a fummary of his 
 cafes, with regard to the fymptoms and 
 practice ; and refer the reader to his Fm- 
 menologia for his theory of thefe diflempers. 
 
 CASE 
 
CASES IN MIDWIFERY. 2 ^ 
 C A S E L 
 
 OBoher 26, 1700, a young woman, 
 eighteen years of age, and till that time 
 free from the Menfes, complained of a 
 diarp pain about the loins, knees, and 
 ankles. She alfo laboured under a JDyfp- 
 naa, Naufea, and gripings of the flonaach; 
 upon the leaft ftirring, there was a palpi- 
 tation of the heart. Her countenance was 
 of a florid colour, her pulfe weak and 
 flow. Thefe fymptoms had continued vio- 
 lent for almofl; fix months. He firfl; or- 
 dered the following cathartic. 
 
 R Calomelan. 3i. Refm, Jalap, gr. v. Y artar. 
 Vitriolat. gr. iv. rn. f. pulv. cap. mane in Con-- 
 ferv. Rofar. 
 
 After the operation of the above medi- 
 cine, flie was ordered the following elec- 
 tuary and infufion. 
 
 R Conferv. Abfynth. Roman, Mthiop. Min, 
 %y Chalyh. cum Sulphur, p. p. ^il. Rad. Gen- 
 tian. Curcum. pulf. a yj]. Syr. Gary oph. q^. f. 
 m. f. Ekdi. cap. q. n. m. ter in die, hor. med. 
 fuperhih. Cochl. v. infuf. fey 
 
 R JJmat. Chalyb. §i. fl. infunde in Cerevifine 
 tenuis lb iij. per triduum.^ deinde adde Ra<k 
 Gentian, incif. % 15. Rub. Tindlor. Curcum. d, 
 
 3ij« 
 
CASES IN MIDWIFERY. 
 
 Sij. fumitat. Abfynth. 'Vulgar. Centaur, minor 
 a. m. i. Bac. Junip fern. Cardamom. 
 Min. Cubeh. d 31. mem. fiat, infuf. per diem. 
 In colatura quolibet Haujiu cap. gt. xx. mix-‘, 
 tur. feq. 
 
 Sp. Sal. Armon. EUx. p. p. d 3!]. m. 
 
 He defignedly omitted bleeding, becaufe 
 of the weaknefs of the patient. 
 
 OSloher 28. In the afternoon, fhe com- 
 plained lefs of her Ibomach, the pulfe was 
 ftronger, and her ftrength much increafed; 
 
 OBober 30. The Menfes came down of 
 a laudable colour. The pain at her loins 
 and ankles immediately vaniflied. The 
 flux continued eight days, during which 
 fhe was forbid the ufe of her medicines ; 
 which being however repeated, after ano- 
 ther week, the Menfes flowed regularly 
 again at the next period, and the patient 
 entirely recovered her health. 
 
 C A S E II. 
 
 OBoher 31, 1700, a woman about thirty 
 years of age, had not had the Metifcs for 
 the fpace of two years. Upon the deten- 
 tion of which, fhe was feized with a dry 
 
 cough, 
 
CASES IN MIDWIFERY, 27 
 
 cough, violent dyfpnsea, palpitation of the 
 heart, pain in the head, a vertigo, lofs of 
 appetite, indigeftion and inflation of the 
 jfomach j fometimes a vomiting, decay of 
 Rrength, night fweats, a viciflitifde of heat 
 and cold, and a trembling ; and fometimes 
 the blood broke forth at the noflirils. Tlue 
 pulfe was very weak. 
 
 He fays, the indications of cure feemed 
 to be three. 
 
 I. To reflore a good digeflion in the 
 flomach. 
 
 II. To increafe the impulfe of the blood. 
 
 III. To relax the uterine velTels. 
 
 To relieve the pains and decay of 
 ftrength, he ordered the following Car- 
 diac. 
 
 R Sp. Sal. Armon. Croci. Laud. Liq. a 
 31 m. cap. gt. XXX. fa;pius in quovos vehiculo. 
 
 By the ufe of thefe things, the pains - 
 veiy much abated, and her ftrength was 
 recruited. 
 
 November 2. She took the cathartic pre- 
 fcribed in the former cafe j which purged 
 her fix times, and eafed the Dyfpnsea. 
 
 November 3. She made ufe of the elec- 
 tuary and infufiouj defcribed in the for- 
 mer. 
 
28 CASES IN MIDWIFERY. 
 
 mer cafe ; not negle6ling in the mean 
 time the cardiac mixture. The following 
 emolient fomentation was applied to the. 
 region of the Uterus to relax the velfels. 
 
 R. Rad. Alth^ise. Lil. Alb. d ^ij fcm. Lini, Fe^ . 
 nugrac. d^\\]. Flor. ChamameliyAneth. dp. i. 
 Major an. m. i. Bulliant ex vin. & aq. part, 
 ^q. Liquor fit pro fomentatione bis in die ap- 
 plicand. 
 
 November 8. The pulfe was fomewhat 
 Rronger j but hardly any change in the 
 fymptoms, 
 
 November 15. Nothing new, except that 
 the appetite feemed to return, and the 
 nofturnal fweats vanifhed. 
 
 November 22. A whitilh humor flowed 
 from the Uterus^ which ceafed after five 
 days. He remarks, that there is frequent 
 mention among authors of pallid Menfes. 
 
 December i. The fymptoms, although 
 much milder, were not however yet re- 
 moved. The following purge was pre- 
 feribed. 
 
 R PH. Ruf. 3 B. Reftn. Jalap, gr. iij. 01. Saf- 
 fafr. gt. i. Half. Peruv. q. f. m. f. PH mediocr. 
 
 She likewife returned to the ufe of the 
 eleiTuary, infiifion and mixture j which 
 
 being 
 
CASES IN Midwifery. 29 
 
 being duly taken, the pulfe grew ftronger, 
 and her ftrength was recruited. 
 
 December 19. The. Menfes yvtVQ brought 
 down of a pretty red colour, which con- 
 tinued for three days. Upon their break- 
 ing forth, the fymptoms were fo much 
 abated, that fhe complained only of fome 
 fmall difficulty in her breathing, and pain 
 of her head. But repeating the infulion, 
 her health, at the month’s end, returned 
 with the Catamenia, 
 
 CASE III. 
 
 0 Bober 2, 17^)2, a laundry-maid of a 
 fanguine habit, aged twenty-four years, 
 caught cold, and by walhing her legs, in 
 cold water, in time of the Menfesy they 
 were wholly fuppreffed for the fpace of one 
 year; yet, without any remarkable detri- 
 ment to her health j which he imagined 
 proceeded from her hard labour and exer- 
 cife. But at the year’s end, fhe was attacked 
 with moft of the fymptoms as in the lid 
 cafe; only there arofe a hard tumor on 
 the Tibiay for which he ordered a vein to 
 be opened in the arm. As that did not 
 relieve the tumor, he ordered a cathartic, 
 
 and 
 
30 CASES IN MIDWIFERY. 
 
 and a bittei* chalybeate infufion, with the 
 emollient fomentation. 
 
 05iober 28 . The purge was repeated, and 
 the tumor became milder. 
 
 November 6 . The pulfe encreafed with 
 the ftrength, and, to provoke the MejiJeSj 
 the Saphcena was opened. 
 
 November ii. The Menfes flowed in a 
 fmall quantity. Her florid colour return- 
 ed again, and the tumor with the other 
 fymptoms vanifhed. 
 
 He gives three other cafes, the firfl; two 
 had their complaints from the Menfes be- 
 ing irregular and in two fiaall a quantity ; 
 but the third was that of a married woman 
 about twenty-five years of age ; llie had a de- 
 creafe of the Menfes for almofl: a year, but 
 a total fuppreflion for the three lafl; peri- 
 ods. All thefe he treated according to their 
 different complaints, but brought them 
 regular, principally by the ufe of chaly- 
 beate medicines. 
 
 I have had many patients, who, in ob- 
 jftrucHons of the Menfes ^ if they were at- 
 tacked with difeharges from other parts of 
 the body of different kinds, eitlier periodi- 
 cally or continued, have fruflrated all at- 
 tempts to bring back the Catamenia^ and 
 
 prevented 
 
CASES IN MIDWIFERY. -31 
 
 prevented conception. If the difcharges 
 were from the lungs, ftomach and other 
 vifcera, they frequently proved fatal to the 
 patients : if from the external parts, as 
 haemorrhages from the nofe, hairy fcalp, 
 legs, or iffues in different parts, although 
 they partly prevented the removal of the 
 obftrudtion, yet they kept the patients in 
 a tolerable if ate of health : SckenckiuSi in 
 his Obfervationim Medicinalium^ Lib. 4. I)e 
 Conceptione, pag. 613. gives feveral cafes 
 from different authors, of fome women 
 who conceived before they had the Menfes, 
 others who bore feveral children and never 
 had any fuch difcharge. • 
 
 Mr. Pearce, in ^tBath memoirs. Chap., 
 XIX. from pag. 187, to pag. 190, gives 
 four cafes of girls labouring under the 
 Chlorofn or green-ficknefs, who, after try- 
 ing many medicines in vain, were cured 
 by drinking the Bath waters, and fre- 
 quently bathing in them. 
 
 Vide Hilcfatii, Cent. 5. Obfervat, 41. 
 
 N U M B. 
 
•32 .CASES IN MIDWIFERY. 
 
 NUMB. II. CASE I. 
 
 Immoderate flux of the Catamenia. 
 
 In the year 1732 , 1 was called to a young 
 woman about the age of eighteen, who 
 was very much weakened by an immode- 
 rate difcharge of the Mefzfes. She had 
 been of an healthy conftitution, and re- 
 gular in her monthly evacuations for the 
 Ipace of a whole year j but about flx 
 months before I faw her, fhe was, in time 
 of the difcharge, overheated with dancing, 
 in confequence of which, the Menfes flow- 
 ed to fuch a quantity as threw her into 
 fainting fits, fo that flie was obliged to be 
 carried home and put to bed, where flie 
 was fupported by a nourifliing diet, and 
 in ten days was free of the difcharge. 
 Yet, every three weeks after this period, 
 fhe was attacked in the fame manner, 
 though in a lefs violent degree, and conti- 
 nued ill about the fame fpace of time. By 
 this excefs of evacuation, fhe was reduced 
 from a healthy confdtution and florid 
 complexion, to a weak habit of body and 
 pale vifagej and, when I was called, a6tu- 
 ally lay in a fwoon, occafioned by the great 
 difcharge, and her pulfe, which at any 
 
 time 
 
CASES IN MIDWIFERY. 33 
 
 time was low, I could now hardly feel. 
 As foon as Ihe could fwallow, fhe took a 
 draught of wine and water, in which fiF 
 teen drops of Liquid Laudanum were dilut- 
 ed j then Ihe was put to bed, and in half 
 an hour, the violence of the difcharge was 
 confiderably abated j when I introduced 
 into the Vagina a bit of fpunge, dipt in a 
 folution of alum, wine and watet. Hav^ 
 ing conlidered the cafe during this period, 
 I diredled her to take two fpoonfuls of 
 the following prefcription, as often as the 
 violence of the difcharge Iliould return. 
 
 R Infujion. Rof. rub. §vi. Elix. Vitriol. Laud, 
 liquid, d gut. XV. m. 
 
 I likewife diredlsd the fpunge to be conti- 
 nued, and frequently moiftened with this 
 decodion. 
 
 R Cort. Granat. ^.erc. Flor. Balauft. Ref. rub. 
 d 31] . coquantur in aq.fontan. ad. §vi. in cola^ 
 tura folve alum. 3 et adde Vin. rub. §ij. 
 
 Next day Ihe was much eafier, the dif- 
 charge being diminilhed and of a pale co- 
 lour : for drink, I preferibed chicken broth, 
 in which rice had been boiled, with alTes 
 milk to be taken morning and evenings 
 for diet, veal, chicken, bread-pudding, 
 D . made 
 
34 CASES IN MIDWIFERY. 
 
 made with whites of eggs j and for change 
 of drink, barley-water, in which gum 
 arabic was dilfolved, and water-gruel with 
 eggs, in the manner of egg caudle. Though 
 file recovered her lirength by this method, 
 the difcharge returned at the end of the 
 three weeks, but not in fuch quantity, nor 
 for fuch a length of time. I diredted her 
 to ufe the fame regimen with moderate 
 exercife, and after two or three periodical 
 evacuations of the fame kind, fhe perfedl- 
 ly recovered her health and bloom. 
 
 The fame method I have fuccefsfully 
 ufed with a great number of patients, both 
 married and unmarried, only varying the 
 medicines and the diet, according to the 
 violence of the difeafe and conftitution of 
 the patient ; and . occafionally preferibing 
 the Cort. peruviaii. Pilul. Gummos, SpaWy 
 Bath and Brijiol waters, the two laft kinds 
 elpecially, to be drank at the wells. 
 
 Thofe who are much weakened by flood- 
 ings in mifearriages, or, even in delivery, 
 have fometimes, for two or three periods 
 after, very large difeharges, and are reliev- 
 ed by the means IjDecified above. 
 
 5 Wha^ 
 
CASES IN MIDWIFERY. 
 
 35 
 
 What follows, concerning the immode- 
 rate flux of the Menfes, is copied from 
 Dr. Dale’s Tranflation of Freind. 
 
 CASE I. 
 
 February i. 1702. A certain woman, af- 
 ter a lying-in, was feized with an immo- 
 derate flux of tlie Menfes^ which conti- 
 nued for fix years ; in the lafl: two years, 
 the blood flowed almofl; dailv, concreted 
 fometimes into Grumi of the bignefs of an 
 egg. She laboured under a very great 
 weaknefs and drought, and w^as alfo fome- 
 times feverifli. A violent and continued 
 pain in the Abdomen and region of the 
 Ujteriis. She w'as feized with an anxiety 
 at her heart, and fometimes alfo with a 
 fyncope. The pulfe fcarce perceptible. 
 The intention of the cure feemed to be, 
 after the ftoppage of the flux, to reflore 
 the ftrength, which was extremely much 
 decayed. But in checking the flux, fince 
 I thought proper to abflain from revellents, 
 becaufe their ufe feemed to be forbid, by 
 the ftrength being fo exceffively v/eak, I 
 trufted wholly to aftringents, and them I 
 j ordered as w^ell internally as externally. 
 
 ; D 2 ’ R 
 
36 CASES IN MIDWIFERY. 
 
 R Cortic. Granat. § Rad. T’ ormentill. |i. Flor. 
 Rof. Ruhr. Balauftior. d m. i. Coq. in Aq, 
 Ferrar. Lib. III. ad Confumpt. Lib. I. Cola- 
 tura Jit pro fomentationcy bis in die parti af- 
 febla tepide applicand. 
 
 For her common drink Ihe ufed the 
 Deco6I. Alb. in Lib. II. whereof were 
 boiled Cinnamon gij. 
 
 Internally was applied the F’indl. Antiph- 
 thificdy fo much commended by Ftmullevy 
 drawn from Sacchar. Satur. et Vitriolwn 
 Martisy with Sp. Vini. Of the tincture, 
 Ihe took twenty drops in Aq. Plantag. fe- 
 veral times a day. When her pain or 
 watching was troublefome, die took twenty 
 drops of Laud.liq. Feb. 3. The flux was 
 flayed j and lefl it might poflibly return, 
 the fomentation was repeated daily to Fe- 
 bruary the 6th. But the flux being thus 
 reflrained, the pain and weaknefs feemed 
 now to be regarded. I took therefore from 
 the diastetick medicine, broths, and good 
 nourifliing foods j from the pharmaceutic, 
 the following mixture. 
 
 R Finbl. Croc. Laudan. Liq. Sydenh. d gij. Cham- 
 phor. in Sp. Vini Dijfolut. ji. m. cap. 
 gut. XXX. Sexies in Die in Aqua Cinnam, fort, 
 ft Fiord, d p, a. 
 
 with 
 
CASES IN MIDWIFERY. 37 
 
 with which her ftrength was very much 
 repaired and her pain abated. Feb. 8. A 
 fort of membranous pouch hung down 
 from the Labia Pudendi, which yet ad- 
 hered fo firmly towards the Uterus that it 
 could not be extra6led from the Vagina. 
 It had alfo a very ill fmell j and indeed at 
 firfl fight, the inner coat of the Vagina 
 feemed to be fallen down ; for I the lefs 
 fufpe6led it to be any remains of the Pla- 
 centa.^ becaufe the woman denied that fhe 
 had been brought to bed for fix years. 
 But when, upon confidering the ffink and 
 the pain, I began to entertain fome fufpi- 
 cion of a Placenta.^ I thought it proper to 
 examine into the matter a little more nar- 
 rowly j and therefore enquired of the wo- 
 man, whether fhe had not mifcarried fince 
 that lying in : She confeffed fhe had been 
 with child about two years fince, and that 
 being terribly frightened, as fhe returned 
 home in the night-time through the fireets, 
 fhe had mifcarried by the way 3 but that 
 after fhe was returned home, fhe fent for 
 no midwife to examine, whether any thing 
 was left in the Uterus or not. From that 
 time alfo the pain took its rife. The dif- 
 eafe having been thus enquired into, the 
 D 3 indication 
 
38 Cx^SES IN MIDWIFERY. 
 
 indication feemed to be this ; namely, to 
 reftoj'e the force of the Uterus and abdo- 
 minal mufcles, fo that it might expel any 
 remains of the Placenta j and, becaule 
 the mixture which was ordered her con- 
 duced very much to this end, fhe took 
 forty drops of it feveral times in a day, 
 by which medicine, her fpirits were fo re- 
 cruited, that, Feb. 10. feme part of the 
 Placenta was thrown forth;, not only of a 
 very ftrong fmell, but plainly putrid. 
 Feb. 1 1 . Another portion was alfo thrown 
 forth of the fame ill feent. From that 
 time there were no marks of that mem- 
 branous fubftance within the Vagina : In 
 like manner alfo, was the whole pain im- 
 mediately allayed. Feb. 13. She fo far re- 
 covered her ftrength, as to be able now to 
 fit up for fome hours, after having been 
 confined to her bed almofi; a month. She 
 made no complaint of any thing but her 
 weaknefs and lofs of appetite. She took 
 daily of her mixture, from which fhe found 
 very great relief. Feb. 17. The flux re- 
 turned j which I was unwilling to check, 
 becaufe I found it very moderate, and at- 
 tended with no ill fymptoms j for it ap- 
 peared to be the natural and ordinary 
 
 evacuation 
 
CASES IN MIDWIFERY. 39 
 
 evacuation of the Me?ifes : which was 
 therefore ended on the fourth day. Feb. 
 23. That I might further provide for her 
 ifrength, the following things were pre- 
 fcribed. 
 
 R ‘Tin5i. Cortic. Peruv. in {Vin. alh. Id. i. 15.) 
 
 Fin^. Croci Spec. Biamh. cap. Coch. 
 
 6 ter in die. 
 
 Feb. 25. Her appetite was reftored. No- 
 thing was wanting to complete her health 
 but ftrength ; which however, upon twice 
 repeating the deco6lion, was alfo happily 
 renewed. 
 
 CASE II. 
 
 Sept. 10. 1701. A woman of a full ha- 
 bit, and who had been ufed to have too 
 great a difeharge of the Menfesy fell into 
 an immoderate flux from exceffive exer- 
 cife, fo that the Menfes came dov/n in a 
 large quantity 3 at firfl indeed, for fix days, 
 and afterwards for twelve. 
 
 When fhe had laboured under this in- 
 difpolition the whole fummer, her flrength 
 was very much caft down j fhe was often 
 feized with a Syncope and Spafm 3 her feet 
 fwelled5 her countenance almoft hippo- 
 cratic 3 the blood being very thin, did not 
 D 4 flow 
 
4Q CASES IN MIDWIFERY, 
 flow guttatim^ but, as it were, in a conti-^ 
 nued flream. When I firfl; vifited her, the 
 flux had continued four days, 
 
 The indication, therefore, of the di-^ 
 ftemper required, that the flux fhould be 
 immediately flopped. That this might be 
 effedled, the fame fomentation was applied 
 as is defcribed in the firfl cafe. 
 
 At the hour of rcfl, flie took the fol- 
 lowing hypnotic. 
 
 R T^rochifc. Gordon, gfl. Landan. Lend. gr. ii. 
 Mucilag. Gum. Arab. q. f. m. PH 
 Cap. 3. 
 
 By the ufe of thefe flie flept very quietly. 
 
 Sept. II. Tht Me?ifes flill flowing, this 
 clecluary was prefcribed. 
 
 R Conferv. Rof. Ruhr. §i. Bol. Arm. Croc. 
 Mart, afiring. d 3!. Mafiich. Ler. Japan, d. 
 9 ii. Spec. Liatr. Santal. 9 iv. fyr. e Symphyt. 
 q. f. m. f. Eledi. cap. q. N. M. ^ta quaque 
 hora^ fuperb. Coch. 5. Julap. feq, 
 
 R Aq. fperm. Ranar. Plant agin. Cinnam. Hord. 
 ^Ibh. Syr. e Coral, q f. m. f. Julap. cap. etiam 
 ter in Die Spir. Vitriol. gt. 40. in quovis vehiculo. 
 
 Repet. Foment, et Pillul. pr^Jcript. 
 
 Sept. 13. The flux flill continued, al- 
 though only giittatim j which yet upon her 
 duly taking the medicines, on Sept^ 15, 
 wholly cealed, 
 
 Now 
 
CASES IN MIDWIFERY. 41 
 
 Now therefore, the whole method of 
 cure feemed to turn upon this point, name- 
 ly, to Rrengthen the veffels, and prevent 
 that rarefa6lion of the blood. To anfwer 
 the lirll: intention, the fomentation was 
 every day repeated j the ufe of glutinants 
 and balfamics feemed fufficient for the fe- 
 cond j aftringents being therefore fet afide, 
 the following method was purfued. 
 
 R Deco 5 l. Alb. Ibil. Aq. Cinnamon. Hard. ^ hi. 
 Sacch. Alb. q. f. m. cap. ^iv. quater in die. 
 
 R Balf. Capiv. Polychreft. d 311. cap. gt. xxv. 
 hora decubitus in Conjerv. Rofar. Ruhr, 
 
 Upon the taking of thefe remedies after 
 the interval of almofi; three weeks, Odb. 5, 
 the Menfes returned, and continued fo for 
 lix days. But the laft prefcriptions being 
 repeated, the next period, the flux was 
 terminated the fourth day ; which flop- 
 ping hitherto within the fame fpace of 
 tiriie, the woman was thereupon perfe6Hy 
 recovered, 
 
 CASE III. 
 
 May 21. 1703. a woman thiity-flx years 
 old, after a mifcarriage, had a flux of the 
 Menfes during fourteen days, for three pe- 
 j riods I 
 
42 CASES IN MIDWIFERY. 
 
 riods ; afterwards, for almoft three months 
 they came down daily. By which flux Ihe 
 was fo weakened, that fhe could by no 
 means walk, and but fearce fland. She 
 drew her breath with fo much difficulty, 
 that flie was in danger of being fuflbeated. 
 She was feized fometimes with a Syncope^ 
 and fometimes with a hyfteric fit ; lb that 
 flie lay for an hour or two, as if ffie was 
 dead. The fame pale colour and leannefs 
 as in confumptive perfons : the pulfe weak 
 and intermitting. 
 
 The indication of cure feemed to regard, 
 firft, the ftoppage of the flux, and then 
 the reftoring of the flrength. The fomen- 
 tation was therefore made ufe of, which is 
 deferibed in the firfl: cafe ; which indeed I 
 generally found to be efficacious. Inward- 
 ly fhe took twenty drops of fpirit Sal. dulc^ 
 in DecoEl. T^ormentill. four times a day. 
 May 25. The flux fomething abated, al- 
 though it broke out again every day. 
 The following emulfion was ordered, in the 
 room of her common drink. 
 
 R Amygd. Bulc. excorticat. fern. Iv. frig. 
 ■ - -*• "hus in Mortario contufis affund. 
 
 3ii. fyr. Altha q. f. m. 
 
 ColatuYie add Sal. Prunell. 
 
 May 
 
CASES IN MIDWIFERY. 43 
 
 May 30. The flux was Rayed; however 
 it broke forth again the next day in the 
 evening. But by the continual ufe of the 
 -remedies prefcribed, the flux was fo regu- 
 lated, that from June^t 3 A to the 9th it 
 was wholly flopped ; afterwards, at the 
 •month’s end, it returned at the iifual pe- 
 riods. The flux being therefore reflrained, 
 and the canals fuiflciently clofed up, the 
 other indication was purfued after tliis 
 manner. 
 
 R Conic. Peruv. Rad. Zedoar. ^( 5 . CochinelL 
 3ii. Digerantur cum Vin. Alb. lb ii. tepide per 
 triduum. Liquoris filtrati cap. ter in die |ii. 
 in quolibet haufiu injlillentur Tindi. Serpent. 
 Virg. gt. 20. 
 
 at night, becaufe fhe was often fleeplefs, 
 and fometimes alfo hyfleric ; ftie took the 
 following paregoric pills. 
 
 R Galban. col. 31. fpec. Biambr: Cajlor. Cam- 
 phor. d 9 B. Laudan. Lond. 9 i m. f. Pill. 20, 
 cap. 2. ante decubitum fuperb. ‘Tinbt. pr^efcript. 
 Coch. 4. 
 
 Let her diet confifl of very nourifhing food- 
 
 July 19. Her flomach, which had been 
 hitherto difordered, was much flrengthen- 
 ed ; and her flrength alfo fomewhat con- 
 flrmed. At the beginning of Auguji, the 
 
 woman. 
 
44 CASES IN MIDWIFERY. 
 
 woman, by following the method pre- 
 
 fcribed, was perfe6lly recovered. 
 
 ■ / 
 
 Forejius de Mulierum Morbis, Lib. XXVIII. 
 has nine obfervations on the too great flux 
 of the Menfes. 
 
 Vide Zacut. Lujitan. Tom. I. Lib. III. 
 p. 479. and Tom. 2. Lib. III. p. 487. 
 
 Vide Mr. Stead s cafe in the following 
 number. 
 
 NUMB. III. 
 
 Of the Fluor Albus. 
 
 As Hoffman has treated largely on the 
 Fluor Albiis^ I have inferted an abridg- 
 ment of the following cafes from that part 
 of his works, where he treats De cachexia 
 uterina^ five fluore albo, 
 
 OBSERVATION IL 
 
 In a woman about thirty years of age, 
 of a tender conftitution, living near the 
 fea, a fedentary life, and on a diet of dif- 
 ficult digeftion, as fea fifh, efpecially 
 oyfters, the difcharge of the Menfes had 
 for a year been irregular and in fmall 
 quantities ; flie was much afflidted with 
 the Fluor Albus her countenance began ^ 
 to turn pale, with great laffitude both ol 
 
 body 
 
CASES IN MIDWIFERY. 45 
 
 body and mind. He firft ordered a vomit 
 of Rad. Ipecacuanhce 315 . Tartari Vifrioli 315. 
 to be taken twice a week ; after that to 
 take once a week, a dofe of opening 
 pills, which were compofed of fome bit- 
 ter extracts, gums and rhubarb, and in 
 the intermediate days, three or four ounces 
 every morning of the following Romachick 
 wine. 
 
 R Rad. zedoar. Calami aromat. EnuLe a §15 
 Herb. Abfynth. Rorifmarin. Mariib. alb. men- 
 tha, fahiiS, Centaur, minor, a m.j. Baccar. 
 Junip. §j. infundantur in vini canarienfis 
 menfura una dimidia. Coletur ufus tem- 
 pore & per menfem hac cur a continuetur. 
 
 He advifed her alfo to take frequent 
 and moderate exercife, to eat things of 
 eafy digeftion, and Ihun the contrary. 
 By this method, he cured many, where 
 the difeafe proceeded from a bad digeftion, 
 and not of long Handing, or had not de- 
 generated into a bad habit of body. 
 
 OBSERVATION III. 
 
 A woman paft thirty, of a lean habit, 
 for more than a year after ihe had mil- 
 carried three times, was taken with a trou- - 
 
 blefeme 
 
46 CASES IN MIDWIFERY. 
 
 blefome Fluor Albus^ the Menfes were irre«* 
 giilar, and fometimes in a large quantity. 
 He ordered her fome of his opening bal- 
 famic pills to be taken for three nights, 
 and each morning about three ounces of 
 aperient wine. The fame days he ordered 
 her a bath made with foft water and 
 ftreiigthning herbs, with a bag of the 
 fame herbs, applied over the region of the 
 Gi oins. After the intermiffion of three 
 days, the fame things were again admi- 
 niflred for three more, and repeated in the 
 fame manner a third time, with frelh herbs 
 each time. Then he ordered the Uterus to 
 be fumigated with frankincenfe, maftich 
 and amber 5 and the patient to live regu- 
 lar. By which method, not only the 
 bowels, but alfo the Uterus was purged of 
 a large quantity of humors. 
 
 By the fame ti'eatment, he recovered 
 many others under the fame complaint, 
 as well as the above patient. He further 
 obferves, that it is not only neceffary to 
 purge the body of vicious ferous iluid, 
 but alfo to ftrengthen the relaxed Uterus^ 
 which is too much loaded with vifcid hu- 
 mours, by the ufe of the above baths,, 
 made more efficacious Vvith nervous and 
 
 aromatic 
 
CASES IN MIDWIFERY. 47 
 
 aromatic herbs. And becaufe for the moft 
 part, this diforder is the occafion of bar- 
 rennefs, the above method is the moft pro- 
 bable to remove the fame. 
 
 Vol. III. p. 356, Obf. V. A young wo- 
 man twenty years of age, of a delicate 
 conftitution, and who indulged in a fe- 
 dentary life, after a difficult labour, in 
 which the Placenta was pulled away with 
 a great deal of force, was feized with an 
 acute pain. The Lochia afterwards, did not 
 flow fo freely as they ought. Ever fince 
 fhe laboured under a Fluor Albus, which in- 
 creafed fo much as to weaken her vaftly ; 
 flie was more and more emaciated every 
 day, and her legs began to fwell. He ob- 
 ferves, that he had frequently found in prac- 
 tice fuch violent treatment was the occa- 
 fion of the like complaints. 
 
 She was prefcribed fome balfamic and 
 nitrous medicines, and ordered to drink 
 with her victuals a deco6lion of maftich, 
 with fome cinnamon and wine mixed with 
 it. The parts were likewife fumigated 
 with fandarick, maftich, benzoin and cin- 
 nabar, and fomentations of nervous me- 
 dicines boiled in wine often applied to the 
 inguinal region. This method, with an 
 
 exadt 
 
'48 CASES IN MIDWIFERY. 
 
 exact regimen of diet, had the defii’ed 
 effedt. 
 
 From Mr. Pearce’s Bath memoirs, p. 219. 
 
 A married woman, aged thirty-feven 
 years, having for a long time laboured 
 tinder the Fluor Albus^ which at firft was 
 only white, afterwards yellow, then green- 
 ihi, after that duikilh towards a black, and 
 then interfperfed with red, was cured by 
 fometime bathing in the Bath waters, 
 drinking them, and taking fome gentle 
 balfamic aftringents along with them, 
 while at the fame time, fhe threw up into 
 the Uterus fome of thefe waters with fome 
 Mel rofarum. In this feclion, there are 
 other three cafes of women, cured by 
 drinking thefe waters and bathing. 
 
 Vide Forellum de Mulierum morbisy Lib. 
 XXVIII. where he gives five cafes on the 
 Fluor Albus, 
 
 Vide Bonetui Sepulchretum de jiuore Mu^ 
 liebriy Lib. III. Sect. 36. 
 
 A Cafe from Mr. Steady of Guys Hofpital. 
 
 A girl of a florid complexion, and ele- 
 ven years of age, about three years and a 
 half ago, had her Menjirua come down in 
 a fmall quantity, of a proper red colour 
 
 anvi 
 
CASES IN MIDWIFERY. 49 
 
 and which continued upon her feveral 
 lucceeding weeks ; then flopped, and re- 
 turned afterwards in a regular manner, once 
 a month, till within thefe three weeks lafl 
 pall, during the greateft part of which 
 time, fhe has had a flooding two or three 
 days. After the firfl flop of the Me?ifeSi it 
 was dlfcovered fhe had the whites, and 
 has been fubjedl thereto ever fince j the co- 
 lour is white, has of late been thin, and 
 fo fliarp, as to excoriate the parts intra 
 Labia. She was fufpecled to be clapp’d j 
 but both fhe and her mother folemnly de- 
 clare, no man had ever touch’d her ; and 
 this was confirmed by the extreme nar- 
 rownefs of the mouth of the Vagina. No 
 particular caufe of this early appearance 
 of the Menfes could be found out unlefs 
 thefe be admitted, that fhe had at that 
 time a violent fit of crying, and might, 
 perhaps, have been weakened, and receiv*- 
 ed a wrench in the loins, by having been 
 compelled to carry large heavy children in 
 her arms. Sometime before, and after 
 her admiflion into the hofpital, fhe had 
 iuch a conflant uneafinefs, fmarting pain, 
 and fenfe of bearing down about the Va- 
 gina and privities, that fhe could not walk 
 E or 
 
 
50 CASES IN MIDWIFERY. 
 
 or lie in bed, except crofs-legged, which 
 pofition of the parts was tolerably eafy to 
 her. She complains of great weaknefs 
 acrofs the loins, and has an almoft unex- 
 tinguilhable third:, and is regular in ftools. 
 In thefe circumftances the phyfician di- 
 redted as follows. 
 
 R Gum. Olihan. 3d mellis q. f. folut. adde aq, 
 La£i. AleK. Mirabil. Syr. Balf. d sij/. 
 Haufi. omni noble et mane fumend. et R De- 
 cobl. e Cort. Peruv. §ij. Elix. Vitriol gr. xx. 
 f. Haujl. quotidie Hora xma Matutina et wta 
 ‘vefpertina capiend. 
 
 After the ufe of which, between two 
 and three weeks, fhe being rather coftive, 
 a gentle purge was judged necelfary j as 
 
 R InfuJ. Sen. §id Mann. 3vi. aq. Mirah. 5!]. 
 f. Haujt. pro re nata ajfumendus. 
 
 Thefe agreed perfedtly well with her, 
 the Menfiiim prqfluvium was foon ftopt by 
 the aflringents, and the external forenefs 
 removed by fomenting the parts night and 
 morning with warm milk, and afterwards 
 gently anointing them with fome of this 
 liniment. 
 
 R Oh Almygd. dulc. fperm, Ceti^S Cera alh, 
 |d. m. f. Linimentum. 
 
CASES IN MIDWIFERY. 51 
 
 Little or no check was however given 
 to the whites by two months ule of the 
 internals, and thereupon they w^ere at that 
 time left off for thefe pills, 
 
 R Pil. ex duohus gr, xii. Calomel ppt. gr. iv. 
 f. pil. ij. bis in feptimana cum levi regimine 
 capiend. 
 
 R Terebinth. Venet. 3!] Pulv. Glycyrrh. q. f. f. 
 Pil. mediocr. quarum^ capiantur ter de die in 
 quovis vehiculo. 
 
 The purging pills operated moderately, 
 and together with the others, were per- 
 fifted in about eight weeks, the flux gra- 
 dually abating thereby, except for the lafl: 
 three weeks, during which it feemed to 
 be at a fland, and was fo conflderable as 
 to induce the phyflcian to endeavour to 
 put a total flop to it ; which he attempted 
 and fucceeded in by five weeks repetition 
 of the olibanum draught as dire6led above, 
 and file was accordingly prefented out well. 
 
 It would be unnecelfary to infert more 
 cafes of this complaint ; though it may 
 be ufeful to make fome general remarks 
 on the methods which I have found fuc- 
 cefsful in pra6Iice. 
 
 I have found this difcharge beneficial to 
 tbofe who were obftrufled or irregular in 
 E 2 their 
 
52 CASES IN MIDWIFERY. 
 
 their Me?ifes j but this benefit was more or 
 lefs, according to the quantity of the eva- 
 cuation : and the Fluor Albus is diminifh- 
 ed by all thofe methods that are ufed in 
 removing obftrudtions. 
 
 Indeed, where this complaint was owing 
 to a weak and lax habit of body, I have 
 found it relieved by the method of cure 
 recommended in the immoderate flux of 
 the Catamenia j and although I have gene- 
 rally fucceeded in both cafes, I have met 
 with fome patients, who from the long 
 continuance of the difeafe, could not be 
 radically cured. 
 
 I have had feveral patients where this 
 difeharge diminifhed, on the ceffation of 
 the Mciifes about the age of 45 or 50, and 
 in a few years afterwards, entirely ftopt 
 of itfelf. Some of them who could not for 
 ten, fifteen or twenty years, from the tume- 
 faction, excoriation and forenefs of the 
 parts, were now able, after the above cef- 
 lation, to conveffe with their hufbands. 
 Vide Vol. I. Book I. Ch. III. SeCt. i. 
 
 C 01 
 
CASES IN MIDWIFERY. 53 
 
 COLLECTION V. 
 
 Of labour, without any previous fenfible 
 motion of the child, and extra-uterine 
 Foetufcs. Vide Se6l. 2. and 3. 
 
 NUMB. I. 
 
 Labour without the motion of the Foetus. 
 
 In the year 1728, a woman turned of 
 thirty, after having bore three children, 
 inclining to be corpulent, found the Menfes 
 obftrudled ; but, far from afcribing this 
 obftrudtion to the true caufe, imagined it 
 was the confequence of her growing fat, 
 efpecially as fhe had never felt any thing 
 like the motion of a child. In this way 
 file continued till the feventh month, when 
 I was confulted about removing the ob- 
 flru6Hon, though fhe would not allow me 
 to examine in the proper manner. Find- 
 ing her in good health, though fully per- 
 fuaded that her bignefs was either owing 
 to corpulency or a dropfy, and bent upon 
 having the obftrudtion removed, I pre- 
 icribed Ibme gentle opening medicines, as 
 l,ie was naturally coftive. I was again 
 V E 3 con- 
 
54 CASES IN MIDWIFERY. 
 
 confulted in the eighth or ninth month, 
 when fhe ftill declared that fhe felt no mo- 
 tion ; and obftinately adhered to her for- 
 mer opinion. At lafl, however, I was 
 called to relieve her in a fuppofed fit of 
 the cholic, and reached the place of her 
 abode, juft time enough to receive the 
 child, though fhe would not be perfuad- 
 ed of her real fituation, until ftie a6iually 
 heard it cry, becaufe fhe had never felt it 
 ftir, either before, or in time of the labour 
 pains. I have delivered many women of 
 ftrong and lively children, after they were 
 fully prepofleffed with a notion that they 
 were dead, becaufe they had felt no mo- 
 tion in time of labour. 
 
 In fome cafes, I have imagined the la- 
 bour was brought on by fuch motion ; but 
 have generally found, that the pains did 
 not follow this motion j and after the chil- 
 dren, were certainly known to be dead, I 
 have delivered a number of women with 
 as much eafe, as when the children are 
 alive. The only obftacles I ever found in 
 the delivery of dead children, were the 
 tumefa6lion of the belly, from the rare- 
 fa6Hon of the contained air, that rendered 
 the labour a little tedious, and a large 
 
 head 
 
CASES IN MIDWIFERY. 55 
 
 head or narrow Fehis, which would have 
 been attended with the fame difficulty, had 
 the children been alive, or the body not 
 tumefied. 
 
 NUMB. II. 
 
 Of extra-uterine Foetuses. 
 
 In the philofophical tranfa 61 :ions; No. 
 323. p. 426. there are accounts of fome 
 extra-uterine Foetufes^ both of the human 
 and brute fpecies by Mr. Tounge j with 
 regard to the human, he fays, Extra-ute- 
 rme Embrios have been fometimes found 
 in women j but not publickly taken no- 
 tice of till the beginning of the laft cen- 
 tury. The younger Riolan fpeaking of the 
 falopian tubes, fays, they appear of the 
 fame nature and fabftance as the womb, 
 ^ia carnofa eji in qua, quod eji mirabile, 
 foetuni huma^iim concipi, fuit obfervatum. 
 Then gives an account of four fuch ftrange 
 conceptions which occurred to his know- 
 ledge. 
 
 He likewife obferves, fince that time, 
 more ftrange ones have happened in that 
 country ; one was found at Paris in Ja- 
 nuary 1669, by Mr. B. Vefalius in the tube 
 of a woman. It was four months old, 
 E 4 and 
 
56 CASES IN MIDWIFERY. 
 
 and fo grown, and the tube fo diftended, 
 as made him miftake it for another womb, 
 and accordingly to call the account he 
 publifhed thereof, Demonjiration dune dou- 
 ble matrice. Mr. Oldenhurgh inferted an 
 extra< 5 l of it in the philofophical tranf- 
 adtions. No. 48. and the German Acade- 
 my, Vol. I. Obf. no. did the likej but 
 neither feem’d to underftand the myftery, 
 till De Graaf took it right, and made ufe 
 of this very obfervation, to illulfrate and 
 confirm tlie hypothefis of Kerkringius. 
 About ten years afterwards, a more , won- 
 derful and incredible one happened there. 
 It comes very well attefled by Dr. Bayle^ 
 who fhfl publifhed a hiftory of it in the 
 'Journal des Sgavans, A.D. 1678. and af- 
 ter Mr. Oldenhurgh put an extradt of it in- 
 to the Phil. Pranfa^. No. 139. p. 979. 
 This cafe is taken from Phil. PranfaB^ 
 and not from Mr. Tounge. 
 
 Margaret Mathew., wife of John Puget, 
 fhearman, at or near Pouloufe, being with 
 child, 1652. perceived about the end of 
 the ninth month of her bearing, fuch pains 
 as women ufually have when about to fall 
 in labour. Her water alfo broke, but no 
 child followed. For the fpace of twenty 
 
 year? 
 
CASES IN MIDWIFERY. 57 
 
 years Ihe had perceived this child to ftir ; 
 with many troublefome fymptoms accom- 
 panying: but for the laft fix years, Ihe 
 perceived not the child to move. She 
 died “Jan. 18, 1678. and the next day be- 
 ing opened, a dead child was found in 
 her belly out of the womb, no way joined 
 or fallened to it j the head downward } 
 the buttocks hanging toward the left fide. 
 All the back part of this child was covered 
 with the Omentumy which was about two 
 fingers thick, and Ruck hard to divers 
 parts of the body, fo as not to be fepa- 
 rated without a knife ; which being done, 
 very little blood ilTued. This infant 
 weighed eight pounds, averdupoize ^ the 
 Ikull was broke into feveral pieces 5 the 
 brain of the colour and conliftence of 
 ointment of rofes. The flefh red, where 
 the Omentum Iluck, other parts whitidi, 
 yellowifh, and fomewhat livid, except the 
 tongue, which had the natural foftnefs 
 and colour. All the inward parts were 
 difcoloured with a blackilhnefs, except the 
 heart, which was red, and without any 
 ilTuing blood. The forehead, ears, eyes, 
 and nofe were covered with a callous fub- 
 ftance, as thick as the breadth of a finger. 
 
 The 
 
58 CASES IN MIDWIFERY. 
 
 The gums being cut, the teeth appeared 
 in the adultnefs of thofe in grown perfons. 
 The body had no bad fmell, though kept 
 three days out of the mother’s belly. The 
 length of the body, from the buttocks to 
 the top of the head about eleven inches. 
 The mother died about the 64th year of 
 her age. 
 
 Mr. Tounge goes on and fays, that be- 
 fore either of thefe appeared in France ^ there 
 happened one in Holland to H. Rhoonhuys. 
 A woman with child at hejl> full time, was 
 four days in labour, and, although fhe 
 had many midwives, could not be deliver- 
 ed ; our author was called December 1658, 
 found the Internum Uteri Ofculum clofe 
 fhut ; without flowings, or any fore-run- 
 ners of the delivery. He, finding the com- 
 mon paflage fo clofely fhut up, and a very 
 painful tumour above the navel, propofed 
 the Ccefarian fedlion. The woman having 
 feen that operation made at Paris, ear- 
 neflly defired him to perform it on her ; 
 but he, to obferve fome unnecelfary forms 
 delayed it till the woman died ; who, he 
 believes, with the child, might have been 
 preferved, if the operation had been done 
 when he firfl: faw her. Opening the belly, 
 
 he 
 
CASES IN MIDWIFERY. 59 
 
 he found a child among the intrails, and 
 the Placenta fallen ed to the Colon ^ and part 
 to the Fundus Uteri, and that there was a 
 breach in the womb, capacious enough 
 for the infant to pafs through into the bel- 
 ly. F. B'artholi?ms, the year after Rhoon- 
 huyfe's exploration, met with fuch an ex- 
 traneous Fcetus lapt up in a Mpla, which 
 he found in the belly of a woman, and 
 conje6lures. Non pojfum aliud divmare, qiiam 
 quod foetus hie primo in tubis uteri concep- 
 tus. He imparted this firll to G. Horfius, 
 Ep. 58. Vol. IV. afterwards in the pad 
 Obfervation of his lixth century. 
 
 Ann. Dom. 166,2, In the city of Aurange, 
 D . Baldwin and Mr. Delafort found Puel- 
 luni egregimn optinie formatum extra Uterum. 
 The report, of this difeovery is made pub- 
 lick by Sachs with remarks. Mifcell. Cur. 
 Vol. I, Obferv. 110. which he concludes 
 with one more llupendous than all I have 
 cited, which he had from the Silefa chro- 
 nicle, written long fince by N. Polinus, and 
 thus relates it. 
 
 A woman, who had born ten children 
 in fifteen years matrimony, conceived 
 again j and, at the full time, was delivered 
 through an abfeefs of the left Hypocondria. 
 
 ■ Ex 
 
6o CASES IN MIDWIFERY. 
 
 Ex qua infans honi habitus exfraBus, qui bap-^ 
 tizatus fuity et annutn unum cum dimidio fu- 
 pervixit j mater ‘vero^ fummis in doloribus 
 tertio die obiit. He alfo, at the beginning, 
 gives an account of a gentleman’s fervant, 
 having killed a ewe which was thought 
 fat, and having taken out the bowels, 
 found a very unufual and monftrous lump 
 of fat, proceeding like a wen from the 
 middle of the Omentum^ and when open- 
 ed, a lamb was found in the fame. He 
 likewife relates, that thirty years fince, he 
 had been fhewn the like found in a bitch. 
 He was alfo told by a gentleman hunter, 
 that he lately found in the paunch of a 
 hare two full grown young ones amongft 
 the bowels, but almoft rotten, and three 
 immature embrios in the Uterus. 
 
 There is alfo in the Philofophical 'Pranf- 
 adiionsj one cafe that feems to be publilhed 
 by two different perfons of near the fame 
 date at Paris j the firft is by Mr. Saviard, 
 No. 222. p. 314. The fecond is by Dr. 
 Fern, No. 251. p. 121. which laft I have 
 copied, as being the fulleft. 
 
 A goldfmith’s wife, near nine months 
 gone with her fifth child, was received into 
 the Hotel Dieu, Sept. 20, 16^6. She- was 
 
CASES IN MIDWIFERY. 6i 
 
 then about thirty four years of age, of a 
 tender conftitution, had had four children 
 before, all which had done very well ; but 
 with the prefent, fhe had been very ill, 
 and endured a great deal of mifery. The 
 midwife, who examined her body, found 
 a confiderable riling on the right fide near 
 the navel, which very much refembled a 
 child’s head ; her belly below* that place 
 bearing no proportion to that above, or to 
 the time of her pregnancy i on the left 
 fide, there was nothing lingular. The 
 midwife thought Ihe felt through the Fa^ 
 gina^ a thick membrane filled and diftend- 
 ed with water, and in it the heel of a 
 child bent toward the thigh ; but Ihe 
 could not be allured whether this was 
 within the womb or not, by reafon the in- 
 ner orifice was drawn fo high under the Os 
 Fubis^ Ihe could not without fome difficulty 
 touch it with the extremity of her finger. 
 Upon trying fome time after, Ihe could 
 not difcern any thing like the Foetus Ihe 
 had felt before. The patient told her, 
 that for the firfl: fix weeks after her being 
 with child, Ihe had great and continual 
 pains, which Ihot toward the navel, and 
 terminated there i and thefe lalled till the ■ 
 
 third 
 
62 CASES IN MIDWIFERY. 
 
 third month ; that from thence to the 
 fifth, file had frequent convuliions, apo- 
 ple6lic fits, and terrible Sincopes^ fo that 
 thofe about her defpaired of her life ; that 
 from the fixth to the eighth month, fhe 
 had enjoyed much better health, which in 
 fome meafure had flrengthened her and 
 her infant j that the pains fhe had endured 
 fince that time, feemed to be fo many al- 
 ternate throes, probably proceeding from 
 the repeated flrrokes of the child’s head in 
 that place, where the teguments were fo 
 thin, by reafon of their great extenfioir, 
 that the hardnefs of the Cranium could 
 plainly be difcerned through them. In 
 this condition was this miferable woman 
 when fhe was received, into that hofpital, 
 till her affliftion increafing, fhe could not 
 lie on her fides or back, being forced to 
 fit in a chair, or kneel in her bed, with 
 her head refting on her breaft. Thefe 
 flrange and unaccountable fymptoms ob- 
 liged the midwife to confult with the phy- 
 fician and mafter-furgeon of the houfe j 
 who thought it was befl: to leave the work 
 to nature, and prepare the woman for la- 
 bour by opening a vein in her foot. The 
 evacuation was ordered to be fmall, in 
 6 w'^hh 
 
CASES IN MIDWIFERY. 65 
 
 which regard was had to the weaknefs 
 of the patient, and the delicacy of her 
 conftitution. However, after this time, 
 the child made no efforts, and the tumor 
 fubfided ; there remaining only a hydro- 
 pic indifpofition, which might be perceiv- 
 ed by the flu6luation j and a great quan- 
 tity of water came away, for feveral days, 
 from the orifice of the vein; infomuch, 
 that fhe, who feemed to have her lower 
 belly and thighs exti'emely diflended, was 
 very much emaciated before her death. 
 
 After her deceafe, her body was opened 
 by M. Jovey ; and upon the firfl incifion 
 through the teguments, there came away 
 two or three pints Tans meafure, of wa- 
 ter and blood, and there appeared the 
 head of a child naked ; and when the 
 parts were all laid open, there was found 
 an entire female Foetus^ contained in a co- 
 ver or bag, which at once ferved it both 
 for a womb and membranes. yi.^Jovey 
 took the child and umbilical firing out of 
 the mother’s belly, tracing the firing to 
 the Placentaj into which it was inferted. 
 This lafl appeared like a great round lump 
 of flefh, and adhered fo firmly to the Me^ 
 fentery and Colon on the left fide, that it 
 
 could 
 
64 . CASES IN MIDWIFERY. 
 
 could not be feparated from them without 
 fome trouble. On one fide of this lump 
 was a leffer, about the fize of a kidneyi 
 which principally adhered to the Mefentery^ 
 and received feveral branches of the firing 
 into it. The larger lump was round, and 
 the greateft part of it adhered to the bag 
 or cafe, which contained the child. This 
 cafe or bag was corrupted and mortified 
 in part, which probably might proceed 
 from the frequent ftrokes of the infant’s 
 head. It fprung from the edges of the 
 ^ube or Fimbria of the right Ovary, which 
 W'as more entire than the left, and pro* 
 ceeded obliquely to the left fide, terminat- 
 at the bottom of the Pelvis. In its 
 defcent, it fent out a fmall portion between 
 the womb and the ReSium. This bag, by 
 comprefling the neighbouring parts, had 
 gained a confiderable fpace in the above* 
 mentioned cavity ; in fuch a mannerj that 
 a great part of the child’s body was lodg- 
 ed at the bottom of it, in a bended pof- 
 ture, with the head pro]e6ting forwards, 
 which formed the prominence near the 
 navel. This bag feemed to be nothing 
 elfe but an elongation and diftention of 
 the tube, and an expanfion or produdion 
 
 of 
 
CASES IN MIDWIFERY. 65 
 
 of the broad ligament on the right fide, 
 which was evident from its continuity to 
 thefe parts, and the diftribiition of the 
 fpermatic veffels, which were larger than 
 ufual, and paffed from the extremity of 
 the tube to the larger lump. The womb 
 was entire, and in its natural Rate, except 
 that it was fomething larger than ordinary, 
 being about the fize of that of a woman 
 ten or twelve days after delivery, and no 
 marks that the child had been lodged in 
 it. 
 
 M. Jovey having obferved this, thought 
 proper to defift, till feveral eminent phyli- 
 cians and furgeons were called 3 and then 
 the womb being carefully diflefted, it was 
 nnanimoufly agreed, that the Foetus had 
 never been in it, it being, as it was noted 
 above, in the fame Rate as' in women who 
 are not with child, except the fmall dila- 
 tation of its bulk, which might arife from 
 a compreffion of the veffels, and intercep- 
 tion of the refluent blood, by the unna- 
 tural pofition of the Foetus. In thrufting a 
 long and Render probe through the right 
 horn of the womb, it eaRly palled into 
 the tube on the fame fide for three fingers 
 jbrcadth in length, but it could not be 
 F thruR 
 
66 CASES IN MIDWIFERY. 
 
 thruft farther, by reafon of the conftric- 
 tion of the tube in that part. The capa- 
 city of the tube could not be diftinguifhed. 
 The Farietes of it, by their coalition with 
 the Chorioji and Amnios of the child, form- 
 ing the bag in which the child was in- 
 clofed, which eiitended from the tube on 
 the right fide to that on the left, and was 
 agglutinated to the Vifcera of the lower 
 belly, the Redlum^ and to the back part of 
 the womb, as appeared by fome fragments 
 remaining on thofe parts after the fepa- 
 ration. 
 
 A Fcetus in the right horn of the Uterus^ 
 by Dr. FernCy No. 251. p. 125. 
 
 In dilTecting the body of a woman, who 
 fuppofed herfelf to be tliree months gone 
 with child, I found the womb very fmall, , 
 not larger than in virgins, and a hard 
 fubhance in the right horn, which being 
 opened, appeared to be the fkeleton of an 
 infant, witli the navel-ftring fmeared round 
 with a white matter not unlike plaifter. 
 
 Ill 
 
CASES IN MIDWIFERY. 67 
 
 In the Phil. Pranf, No. 378. p. 387. An 
 extra-uterine Fcefus that had continued 
 five years and an half in the body, by 
 Robert Hoiiljion^ M. D. 
 
 I was fent for in Augnjl 1717. to a w^o- 
 man near Newport-?narkct^ who had been 
 married eighteen years to a native of the 
 EaJi-I?jdies, by whom fhe had eight chil- 
 dren, befides two mifearriages. At my 
 vifiting her, fhe was wdth child in a fe~ 
 cond marriage, and her huiband a vigo- 
 rous young man. She was near her full 
 time, and had felt pain for feveral days, 
 which returning by intervals, fhe conclud- 
 ed would, as ufual, bring on her delivery. 
 Her mother and her midwife apprehend- 
 ing no difficulty, affiured thofe about them, 
 that only time was wanting. But I found, 
 on examination, that her womb was of 
 no bulk to contain a child near its time ; 
 and that its neck, which was of an uncom- 
 mon hardnefs, was alfo clofed fo ftraitly as 
 to refufe the admiffion even of a fmall probe 
 or knitting needle. I declared upon this that 
 her delivery was impoffible, becaufe the 
 child was not within the womb, but be- 
 tween the womb and the guts ; but that it 
 F 2 might 
 
68 CASES IN MIDV/IFERY 
 
 might be removed by a pafiage to be made 
 for it, without any great pain, and with 
 fafety to the mother. I offered to under- 
 take it, and affured them that this was the 
 only opportunity, and that if fhe negledled 
 it, it would be out of the power of art 
 hereafter to give her any relief, for fhe 
 muff languiffi till death, unlefs favoured 
 by fome unlikely and extraordinary acci- 
 dent. However confidently I affirmed it, 
 they liffened with a mixture of difbelief 
 and amazement, and reje6led my affiff- 
 ance. At that time, in probability it 
 would have been fuccefsful j for flie was 
 a flender well-ffiaped woman, in good ha- 
 bit of body, and of a fprightly difpofition. 
 
 It was a year after this when I was de- 
 lired again to vifit her. I found her much 
 difordered by a growing impofthumation in 
 her belly. I ordered her fome cordial ffo- 
 machics, CaJJia^ and fuch gentle lenitives ; 
 and they met with fuccefs beyond my ex- 
 pectation j fo that by aid of a regular diet, 
 and the watchful exaftnefs of a very ten- 
 der mother, (a nurfe of about thirty years 
 experience about this city) I reffored her 
 to filch ftrength, that fhe went chearfully 
 abroad, and applied herfelf to bufmefs. 
 
 About 
 
CASES IN MIDWIFERY. 69 
 
 About fifteen months after the time 
 when I vifited her firfl, her mother came 
 from her to intreat my affiffance : fhe 
 complained of great pain in the lower 
 part of her Abdomen \ and I found a tu- 
 mor of a conic form, projefting about an 
 inch beneath the Umbilicus 3 its inflamma- 
 tion, with tenfion, and a feverifhnefs at- 
 tending it, fo plainly indicated fuppura- 
 tives, that I was not furprized to hear, 'in 
 a few days, that it had broke as I wifhed. 
 I propofed to lay it open, both to give a 
 free emiflion, and prevent its becom- 
 ing fiflulous j but flie was apprehenfivc, 
 that I would, as flie call’d it, cut open 
 her belly : fo that not being able to pre- 
 vail with her, I ordered her a pot of un- 
 guent and fome plaiflers. The ulcer foon 
 grew fiflulous, and fo continued till flie 
 died, which was on the 23d of Aprils 1723. 
 in the 4ifl year of her age. 
 
 For above five months before her death, 
 fhe voided her excrements by this vent ; 
 and all the foft parts of the Foetus, with 
 fome fmall bbnes of its fingers. But the 
 refl of the fkeleton remaining entire, I 
 took it out of her body, together with 
 the Vagina, Uterus, ReSium, &c. v/herein 
 F 3 it 
 
70 CASES IN MIDWIFERY. 
 
 it had involved itfelf, as may be been more 
 particularly in the figure annexed. 
 
 A FiVtus formed in the Ovarium^ by M, de 
 S, Maurice. 
 
 A woman, after being fafely delivered 
 of eight children, and continuing five 
 years afterwards without having any 
 more, about three months before her 
 death, fufpedted herfelf to be fallen into 
 that condition again ; becaufe fhe never be- 
 fore failed of being very regular, and had 
 not found herfelf fo for more than a month. 
 After this, fhe had a little fliov/, which 
 fcarce left off wholly, during the laft two 
 months of her life, and which fhe paff, 
 neverthelefs, without much trouble j fo 
 that file thought herfelf to be fecure, as to 
 the point of her being with child. But 
 April 22, 1682. after fhe was up in the 
 morning, in very good health, fhe fell in- 
 to faintings, had violent pain like a cho- 
 lic, in the region of the right groin, which 
 terminated at the reins, a little after eight 
 in the evening. She felt all the Prcdu- 
 dia of an imminent travail ; fhe called her 
 chirurgeon, and died in his arms, faying, 
 I am delivering, I am delivering ; ” 
 
CASES IN MIDWIFERY. 71 
 
 there appearing outwardly neither di fil- 
 iation nor flooding, nor any mark of this 
 diforder. 
 
 On opening the integuments of the 
 beUy, all the entrails in the epigajfric re- 
 gion, were feen floating in blood, which was 
 taken out with a fpoon, to the quantity 
 of two pounds. To avoid changing the 
 fltuation of the parts, a large quantity, 
 which was coagulated, fhill remained in 
 the right flank, and in trying to take this 
 out with the hand, a little Foetus was found 
 in the firfl: clots, about the bignefs of a 
 man’s thumb, and a third lefs in length, 
 all very diftindtly formed, and in which 
 was manifeftly difcovered the fex of a 
 boy, but naked and without covering. 
 The right cornu of the womb v/as found 
 near this place ] the teflicle, or ovary, was 
 torn longways, and through the middle 
 on the flde, that it did not touch the 
 Fuba. This teflicle was near the bignefs 
 of a hen’s egg, and feemed to be the 
 place where the Fcefus was contained, and 
 which had burfl through the fame, for 
 the left teflicle was no bigger than a lit- 
 tle chefnut : the tube was not dilated, nei- 
 ther was there any rent of the Uterus^ 
 F 4 which 
 
72 CASES IN MIDWIFERY. 
 
 which appeared to be in its natural ftatc, 
 and was, as Dr. Harvey has defcribed it, in 
 the firft month of pregnancy ; but when 
 it was opened, he found not the leaft fign 
 of conception j the veflels of the interior^ 
 membrane feemed full of blood, and vari- 
 cous, which might be the caufe of that 
 little fliow of blood, as before-mentioned. 
 
 He remarks, that although authors fpeak 
 of Fcetiifes found in the tubes and belly, 
 he does not know of any that mention 
 there being in the tefticle or ovarium, as 
 this feems to have been. 
 
 In the Phil. Franf. No. 367, p. 126. a 
 Foetus that continued 46 years in the 
 mother’s body, communicated by Dr, 
 Steigertahl. 
 
 Anna Mulleen^ of the village of Lein- 
 near Gemund in Suabia^ of a dry and 
 lean conftitution, but otherwife healthful 
 and robuft, died at the age of ninety-four, 
 after fhe had lived a widow forty years. 
 Forty-fix years before her death, fhe de- 
 clared herfelf to be with child, and had 
 all the ufual tokens of pregnancy. At the 
 end of reckoning the waters came away, 
 and fhe was taken with the pains of la- 
 bour, 
 
CASES IN MIDWIFERY. 73 
 
 hour, which continued upon her about 
 feven weeks, and then went off, upon the 
 ufe of fome medicines given her by a fur^ 
 geon. Some time after this, file recovered 
 her perfect health, except only, that her 
 belly continued fwell’d, and that now and 
 then, upon any exercife, fhe felt a little 
 pain in the lower part of it. She was af- 
 ter this twice brought to bed ; the firff 
 time of a fon, who is now a huntfman 
 at Bifchoffjldehty and afterwards of a daugh- 
 ter, who is married to a foldier. Butnotrr 
 withftanding this, fhe was firmly perfaad- 
 ed, that fhe was not yet delivered of what 
 fhe firfl: went with, and defired Dr, Wohn- 
 lixe the phyfician of Gemund^ and one 
 Knaiiffcn a furgeon at Heubach, to open 
 her body after her death. Accordingly, 
 after her death, which happened on the 
 nth of March ^ 1720, after four days ill- 
 nefs, her body was opened by the furgeon, 
 the phyfician afore-mentioned being dead. 
 He found within her a hard mafs of the 
 form and fize of a large nine-pin bowl, 
 but had not the precaution to obferve, 
 whether it lay in the Uterus or without it, 
 and for want of better inftruments broke 
 it open with a blow of a hatchet. This 
 
 ball, 
 
74 CASES IN MIDV/IFERY; 
 
 ball, and the contents of it are explained 
 in the figures of the T^ranfaSHonSy and ac- 
 cording to the defcription and appearance, 
 feems to have been fo flrongly prefl’ed, 
 that the parts "were confolidated to one 
 another, and the integuments in a man- 
 ner ofiified. Tlie nofe was turned up and 
 flattened, and the eye clofed : but the ear, 
 the arms, of which the right is the largefl, 
 and the two joints of the thumb, ^c, are 
 plainly diflinguifhable. 
 
 An account of a child taken out of the 
 Abdomeriy after having lain there upwards 
 of fixteen years, during which time, 
 the woman had four children, all born 
 alive. By Starkey Middletoriy M. D. 
 
 Gentlemen, 
 
 The records of your fociety furniflt us 
 with feveral cafes of extra-uterine concep- 
 tions, one of which I communicated to 
 you, March 28. 1745. neverthelefs, I could 
 not help flattering myfelf, that this cafe 
 alfo might be worthy your notice. — In 
 April 1731, Mrs. Ball without BiJl:opfgafey 
 perceived by the ufual fymptoms that flie 
 was pregnant j and, in OBober following, 
 being then in the fixth month of her preg- 
 nancy. 
 
CASES IN MIDWIFERY. 75 
 
 nancy, fhe had a child died in her lap of 
 convulfions ; the furprize of which, caufed 
 a great fluttering within her, attended 
 with a fenfible motion of the child, which 
 motion continued, though gradually weaker 
 and weaker, for about flx or feven days, 
 after which, flhe did not perceive it move 
 any morej but from this time fhe had 
 conftant pains attending her, which ap- 
 peared like labour pains. Her midwife 
 for feveral days expedted a mifcarriage; 
 but, finding herfelf difappointed, advifed 
 her to apply to Dr. Batnber, whofe known 
 abilities in the feveral branches of phyfic, 
 joined to his great experience and judg- 
 ment in midwifery, made him unqueition- 
 ably the mofl: proper perfon to be confult- 
 ed, as the cafe appeared fo very uncom- 
 mon in its circumfliances ; at the fame 
 time, that his great humanity always gave 
 the mofl: free accefs to the poor in their 
 diflrefTes. The do6lor, after a proper 
 examination, finding fufficient indications 
 of a dead child, ordered her fome forcing 
 medicines upon taking which about three 
 times, fhe difeharged fomething, which 
 the women fuppofed to be part of the 
 after-birth, accompanied with a fmall 
 5 quan- 
 
76 CASES IN MIDWIFERY. 
 
 quantity of water. In confequence of 
 this difcharge, her pains ceafed, but with- 
 out any diminution of her belly. After 
 fome time, hie again applied herfelf to 
 the doftor, who thought it mofc advife- 
 able to diicontinue her medicines, and 
 leave the affair intirely to nature. In this 
 Rate, fne continued for about twenty 
 months, viz. to yiiiy 1733. which was 
 two years and two months from her firft 
 reckoning ; Ihe then again applied to Dr. 
 Bcmher., acquainting him, that die was 
 not yet delivered of the child die fo long 
 fince came to confult him about, and that 
 her pains were lately returned, and daily 
 increafed without any intermiffion. Upon 
 the doctor’s examining her, he thought it 
 proper to fend her home, immediately di- 
 redling her to promote her pain, by fre- 
 quently dipping fome warm caudle, 
 by the ufe of which, her pains became 
 more regular i and the next day the doc- 
 tor made her a vifit, and was informed 
 die had difcharged two waters, but nothing 
 more: he then carefully examined her 
 again, and plainly felt a child through the 
 integuments of the Abdomen, but could 
 pot give her any adiftance. 
 
 It 
 
CASES IN MIDWIFERY. 77 
 
 It was about this time Dr. Bamber firfr 
 acquainted me with the cafe, defiring me to 
 attend her as often as occafion might require; 
 and that I would acquaint him, if any 
 thing like labour, or other remarkable al- 
 teration, fhould offer. Accordingly, I made 
 her a vifit, and after a proper examination, 
 was convinced of the certainty of the doc- 
 tor’s aflertion. Her pains now began to 
 abate, and fhe grew tolerably eafy ; but 
 about the latter end of 'January 1733-4, 
 jfhe conceived again with child, and was 
 delivered the 28th of OBober following by 
 Dr. Bamber j who fent for me to attend 
 him in her labour : the dodlor foon deli- 
 vered her of a fine boy, and after hav- 
 ' ing brought away the Blacenta^ he fearch- 
 ed for the other child, which he had be- 
 fore felt through the integuments of the 
 Abdomen^ but found it lodged in the cavity 
 of the Abdomen^ and beyond the reach of 
 human art to relieve her. This fail every . 
 one then prefent was made fenfible of. 
 
 OBober 22, 1735. I was fent for to her in 
 her labour, but before my arrival, flie was 
 delivered of a boy; however, I brought away 
 the Placenfay which gave me an oppor- 
 tunity of examining for the other child, 
 
 4 and 
 
78 CASES IN MIDWIFERY, 
 
 and found it in the fame fituation as for- 
 merly. 
 
 OBoher 9. 1738. I was again fent for to 
 her, when in labour, but Ihe was deliver- 
 ed of a boy before I arrived. Upon exa- 
 mining the womb, and the Hate of the 
 Abdomen^ the child appeared juft as before, 
 without any alteration. 
 
 "Jime 17, 1741. I was again fent for in 
 her labour, but found her juft delivered 
 of a girl ; and, upon examining the parts, 
 every thing appeared as before. 
 
 OB. 14. 1747. Being greatly emaciated 
 by conftant pains, &c. fhe was admitted 
 a patient in Guy s-Hofpitaly where Ihe died 
 the 7th of November following, after hav- 
 ing laboured under the diftreifes and un- 
 eafinefs of carrying a dead clrild wdthin 
 her, in a manner loofe in the Abdotnen up- 
 wards of ftxteen years. The day after her 
 death, I opened her in the prefence of 
 doctors Nepit^ Nicholls and Laurence., when 
 the UteruSy and the feveral other contents 
 of the AbdomeUy appeared nearly in their 
 natural ftate ; but on the right fide, with- 
 in the Oi lliumy a child prefeiited itfelf, 
 which was attached to the Ilium and neiirh- 
 
 O 
 
 bouring membranes, by a portion of the 
 
 F critonceumy 
 
CASES IN MIDWIFERY. 79 
 
 Teritonceum^ in which the Fimbria and part 
 of the right Fallopian Fube feemed to lofe 
 itfelf. The child feemed no ways putrid ; 
 but the integuments were become fo cal- 
 lous, and changed from their natural Hate, 
 that the whole feemed to refemble a carti- 
 laginous mafs, without form or diftinc- 
 tion ; the legs, indeed, were diftinguifhable, 
 though they were much wafted and dif* 
 torted. Upon opening the callous integu- 
 ments of the head and face of the child, 
 the bones appeared perfe6lly formed, with 
 a few fpots of tophous concretions on them. 
 This account may ferve to convince thofe 
 who are of opinion, that boys are con- 
 ceived on the right fide, and girls on the 
 left, as this woman had three boys, and 
 one girl after the Fallopian Fube on the 
 right fide had loft its a( 5 fion. 
 
 TourSy 
 
 Middleton. 
 
 In the memoirs of the Academy of ScF 
 ences at Parisy M. 1702. p. 234, &c. we 
 read of a Foetus extra£l:ed by the Anus-^ 
 and in H. 1722. p. 20. of one found in the 
 Fallopian Fube, the German Ephemerides, an. 
 
 pri?n. 
 
8o CASES IN MIDWIFERY. 
 
 L. III. Obferv. no. mentions a 
 lying betwixt the Uterus and ReBum : and 
 Tom. III. Obfer'vat, ii. defcribes another 
 found in the Abdomen of a woman, where 
 it had lain above fixteen years. 
 
 In the Med. EJ'ays of Edinburgh^ Vol. V. 
 Art. 38. is the hiftory of one child ex- 
 tracted by an opening in Xh^AbdomeUy and 
 part of another palTed by ftool ; by Dr. 
 Gabriel Kingy phylician at Armaghy Ire^ 
 land. 
 
 COL- 
 
CASES IN MIDWIFERY. 8i 
 
 COLLECTION VL 
 
 Of SuPERFOETATioN, OE what was for- 
 merly fuppoFed to be fo. Vide Sedl. 6. 
 
 CASE I. 
 
 In the year 1728. I was called to a wo- 
 man in the country, who was feized with 
 a violent flooding in the fourth month of 
 her pregnancy, and before I reached her 
 houfe, which was about four miles diflant 
 from the place of my habitation, fhe had 
 mifcarried of a fmall Foetus and the Secun- 
 dines. The difcharge was abated j yet as 
 fhe had been before delivered of twins, 
 at three different times, I examined the 
 Vagina^ and found the Os intei'num fo much 
 contradled, that I could hardly introduce 
 the top of my finger. The neck of the 
 womb feemed to be about half an inch 
 long j and above that, I felt a pretty large 
 ftretching of fhe Uterus on the lides and 
 anterior part. As fhe had refted little the 
 preceding night, I prefcribed a paregoric 
 mixture, with thirty drops of liquid Lau- 
 danum^ two fpoonfuls of which fhe took 
 every two hours, until fome flight pains, 
 that hill remained, were removed, and fhe 
 
 G fell 
 
82 CASES IN MIDWIFERY. 
 
 fell alleep. In two days fhe was perfe6Ily 
 cafy, and in about three months after tliis 
 period, her hufband brought her to my 
 houfe, where fhe told me flie had been ir- 
 regular in the difcharge of the Menfes, 
 fince her mifcarriage, and was grown 
 very big j a circumftance fhe imputed 
 to a dropfy, or rather a tympany j for 
 flic found frequent motions from wind. 
 By examiniiig the Abdomen and Vagina^ I 
 plainly perceived fhe was in the eighth 
 month of pregnancy, and affured her, the 
 wind fhe felt, was no other than the mo- 
 tion of a child j obferving that fhe had 
 probably conceived two children as for- 
 merly, and though fhe had mifearried of 
 one, the other had remained, and would 
 continue to the full time. My prognoftic 
 was verified in about nine weeks, when 
 fhe was delivered of a fall-grown female 
 child. 
 
 CASE II. 
 
 About three years after this tranfadlion, 
 my affiftance was demanded to a woman, 
 who, in the fixth month of her pregnan- 
 cy, was alfo taken with a flooding, though 
 in a fmall quantity, which continued ten 
 days before I was call’d j fome water was 
 
 likewife 
 
CASES IN MIDWIFERY. 83 
 
 llkewife difcliarged without pain, and 
 yielded a mortified fmell. I underilood, 
 that the day before I was confulted, flie 
 had felt fome flight pains, and a few fmali 
 bones had been difcharged from the Vagi- 
 na ; and thefe, upon examination, proved 
 to be the bones of the legs and arms be- 
 longing to a Fcstii^. I could fcarce intro- 
 duce the tip of my finger into the Or in- 
 ternum, though the neck feemed larger 
 than ufual, and above that, the Uterus v/as 
 pretty large. The cloths that were moif- 
 tened with a ferous difcharge, exhibited 
 a brownidi colour and had a putrid fmell. 
 The woman was much alarmed, her fpi- 
 rits were funk, die had for fome time en- 
 joyed little or no reft, and was coflive. I 
 ordered an aperient glyfter to be imme- 
 diately injeOed, after the operation of 
 which, I direOed her to take ten grains of 
 the Pil. Matth. and next day four fpoon- 
 fuls of the following mixture, every fix 
 hours. 
 
 R Pukg. ^vi. Eryon. Comp. §i. Cajlor. 
 gutt, c. Spt. C. C.guU. lx. Syr, Caryoph. Ji. A/- 
 
 riikewife dir^dled the glyfler to he re- 
 peated every afternoon, and the pills 
 every night, if there fhould be occafion, 
 G 2 and 
 
^4 CASES ix\ MIDWIFERY. 
 
 and found her perfedlly eafy and free from 
 all complaints, and was told Ihe had the 
 preceding night difeharged the reft of the 
 bones and Sccimdines of a child. I infifted 
 upon her keeping her chamber and bed for 
 fome days, and preferibed a cordial mix- 
 ture, with fome dofes of Sperma Ceti^ at the 
 requeft of her female acquaintance. 
 
 About two months after this diforder, 
 I received another call, when fhe told me 
 her ftomach was puffed up with wind, 
 that fhe was taken with a violent cholick, 
 and had been three days without paffage 
 in her belly. When I felt the Abdomen^ as 
 fhe v/as a thin woman, I could plainly 
 perceive a ftretching of the Uterus^ extend- 
 ing above the navel ; and, upon examin- 
 ing by the touch, in the Vagina^ felt the 
 Os intermmi largely opened, the membranes 
 with the waters puflied down, and through 
 thefe, the arms, fhoulder, and navel-ftring 
 of the Feetus. She was agreeably furpriz’d, 
 when I told her flie was in labour of a 
 child, though in the feventh or eighth 
 month j then being put to bed, and the fe- 
 male friends affembled, fhe was, to her great 
 joy, delivered of a live male child, which, 
 though fmall, was reared by fucking ano- 
 ther 
 
CASES IN MIDWIFERY. 85 
 
 ther woman at firfl, and afterwards the 
 mother, who had formerly loft two clhl- 
 dren. 
 
 CASE III. 
 
 Communicated by Mr, Campbell, in a 
 letter, dated from Poole, April 25. 1750. 
 
 Sir, 
 
 The following being a very uncommon 
 cafe, I am willing to communicate the 
 fame, to have your fentiments on tlie 
 fubjecl. 
 
 A woman in this neighbourhood, was 
 delivered of her firft cliild, and the deli- 
 very followed by fevere after-pains ; and 
 five days after, fhe mifcarried of a Feet us, 
 which could be no more than four or 
 five months in growth. There wms no 
 fign of putrefadfion about it, though il 
 was ftili-born ] there was no hair, nor 
 other fign of its being longer conceived. 
 How to reconcile this with the prefent 
 dodlrine of conception, will, I believe, be 
 found difficult. I fiiould b^ glad, if at 
 the fame time, you would be pleafed to 
 acquaint me how to diftinguifn betwixt 
 an obftrudlion, and the total difappeaiv 
 ai^ce of the Menfes in women. 
 
 G 3 My 
 
S6 CASES IN MIDWIFERY 
 
 My anfvver was to this efFe6l. 
 
 Sir, 
 
 What you have writ me, fcems to fa- 
 vour the notion of fuperfcetation, more 
 than any thing I have met with in pi'ac- 
 tice. But there are inftances of extra- 
 uterine Fcefiifes. which have lain whole 
 years in the Abdomen without being putri- 
 jfied. However, we fee from time to time 
 things happen, that we cannot account 
 for, and thefe deftroy all our fine theories. 
 
 The Menfes commonly difappear in wo- 
 men, between the age of forty-five and 
 fifty fometimes they leave them fooner, 
 if the woman chances to grow fat, if the 
 Catamenia appeared early in life, or if fhe 
 hath bore many children : but, whether 
 the diforder proceeds from obftrudlions, or 
 the total difappearance of the Menfes^ the 
 intention of cure in both cafes, is, to re- 
 peat venaefedHon and gentle purgatives. 
 
 Schenckius^ Lib. IV. De Superfcetatiotiey 
 p. 617. has colledled feveral obfcrvations 
 of fuperfcetations. 
 
 Others, of late, to prove tlie pofTibility 
 of fuch things, have advanced an attefted 
 
 cafe 
 
CASES IN MIDWIFERY. 87 
 
 cafe from America^ of a black woman, 
 who, by converling with her hufband, of 
 her own complexion, and immediately af- 
 ter with a white overfeer, was delivered 
 of twins, one a mulatta, and the other a 
 black child : alfo another, of a woman of 
 CharlesAtowTiy South-Car olmay about the 
 year 1714. and mentioned by Dr. ParfonSy 
 in a ledfure read before the Royal Society 
 of London, OBober 1745. who was brought 
 to bed of twins, one a mulatta, and the 
 other a white child ; fhe confeft, that im- 
 mediately after her hufband had left her, 
 a negro fervant came to her, and forced 
 her to comply with his defires, by threat- 
 ning her life if fhe refufed. 
 
 In the memoirs of the Academy of Sci- 
 ences at Paris, H. 1702. p. 30, &c. we 
 read of the delivery of a boy, in whofe 
 Placenta was found a fort of bladder, 
 which contained a female Fcetus, reckon- 
 ed to be four or five months. And H. 1729. 
 p. 12. of two children delivered at a day's 
 diflance, one aged forty days, the other 
 at the full time. 
 
 Ruyfch, in Tom. I. Obferv. 14. gives an 
 account, of a furgeon’s wife at Amjierdam, 
 G 4 in 
 
8S CASES IN MIDWIFERY. 
 
 in 1686, who was delivered of a ftrong 
 live child, and in fix hours after, of a 
 fmall embryo, the Funis of which was full 
 of Hydatides^ and the Placenta as large and 
 thick, as in one of three months. He 
 exhibits a figure of this phaenomenon. 
 
 Mauriceau^ in the firfi: of his additional 
 Obfervations at the end of the book, men- 
 tions his having feen a young woman, 
 who had been delivered at the ufual time 
 of twins, one of which was alive and of 
 the ordinary fize, the other was dead, 
 and feemed to be only of three or four 
 months. He accounts for this circum- 
 ftance, by fuppofing the death of the child 
 at the term of four months, but that its 
 waters remained micorrupted, from the 
 air not being admitted, &c. 
 
 CO hr- 
 
CASES IN MIDWIFERY. 89 
 
 COLLECTION VIL 
 
 Of women who exceed the common term 
 of Geflation. Vide Se6f, 7. 
 
 C A S E I. 
 
 I was befpoke in the year 1443, to lay 
 a young woman of her firft child. She 
 was taller than the middle lize, and had 
 been healthy from her infancy. She was 
 married in September^ about a week after 
 the menftrual difcharge, which, not re- 
 turning at the Rated time, fhe was feifed 
 with the ufual complaints of ficknefs and 
 reaching, which her mother fuppofed to 
 be certain ligns of pregnancy j and though 
 Ihe reckoned only to the beginning of 
 June^ fhe was not delivered till the end of 
 Augujl. Before marriage, the Menfes had 
 flowed regularly every four weeks, and 
 though Ihe, perhaps, did not conceive im- 
 mediately after wedlock, it was reafonable 
 to fuppofe, fhe adfually exceeded the ufual 
 term of geflation, by four or five weeks 
 at leafl. Her labour was very tedious, 
 though the Pelvis was of a large fize j but 
 the child was very lufly, and the head 
 fqueezed jnto a longitudinal form. Two 
 
 years 
 
90 CASES IN MIDWIFERY. 
 
 years after, I delivered her of a fecond 
 child, w^hich was alfo very large ; yet, the 
 labour was fhort, and happened accord- 
 ing to the common time of reckoning : 
 nor was the head of this lad: fqueezed 
 into a longifh form, like that of the firft, 
 which was indeed the larged child I ever 
 brought into the world. 
 
 CASE II. 
 
 In the year 1735, I was called by a mid- 
 wife to a woman in childbed, and found 
 the breech of the F^^fus prefenting at the 
 brim of the Pelvis, where it had duck for 
 fome time, without advancing, although 
 the mother had been long in labour, and 
 the membranes had been broken eighteen 
 hours before I came. I with great diffi- 
 culty pulhed up the breech, and brought 
 down the legs j and, after much fatigue, 
 delivered her of a live child. According 
 to this woman’s reckoning, die had ex- 
 ceeded the ufual time of gedation by eight 
 weeks ; for, die affirmed, and her mother 
 confirmed the adertion, that die had but 
 one difcharge of the Me?ifes after die was 
 married, -and in the middle of the month 
 was feized with the common fymptoms of 
 
 preg- 
 
CASES IN MIDWIFERY. 91 
 
 pregnancy, from which they concluded Ihe 
 had conceived foon after the evacuation. 
 
 I have feledled thefe two cafes, from a 
 great number of lefs certainty, to fhew, 
 that women may, probably, go with child 
 beyond the nine months : though this is a 
 circumftance that rarely happens. Indeed, 
 I have known many women exceed that 
 period by their own reckoning ; but I 
 have generally fuppofed, they committed 
 fome error in keeping the account. 
 
 Vide Ijamotte, Liv. i. ch. 27. and 28. 
 where we read of women, who have 
 been delivered a conhderable time before 
 and after the term of reckoning. I my- 
 felf very often find my patients go two 
 or three weeks beyond the nine months, 
 reckoning from the laft difcharge of the 
 Menfes, 
 
 COL- 
 
92 CASE 3 IN MIDWIFERY. 
 
 COLLECTION VIII. 
 
 Of what is commonly called the falfe con- 
 ception, Moles and Hydatides. 
 
 N U M B. I. C A S E I. 
 
 Of False Conception. 
 
 Being called to a gentlewoman in the 
 year 1722, I wa§ told by the women who 
 Were about her, that fhe had mifcarried of 
 a falfe conception in the third month ; 
 and that the fame misfortune had hap- 
 pened to her feveral times before this ac- 
 cident. The midwife pretended that thefe 
 falfe conceptions proceeded from a foul- 
 nefs of the Uterus^ and had prefcribed, 
 from time to time, deco 61 :ions of Sabine^ 
 Artemijla^ and other herbs, to be taken 
 by the mouth, and injedled by the Fagina. 
 
 This being the firft cafe of the kind, 
 which I had feen, I carefully examined the 
 fubliance, which was bigger than a goofe 
 egg, and found it no other than a coagu- 
 lum of blood, of which llie had loft a large 
 quantity, formed round the Secundines^ by 
 the preifure of the Vagina^ where it had 
 lain for many days. I plainly difcovered 
 the cavity which had contained the embryo, 
 
 and 
 
CASES IN MIDWIFERY. 93 
 
 and affured them it was a real conception, 
 though the embryo had been forced through 
 the , membranes and loft. 
 
 Since that time, I have been concerned 
 in a great number of cafes of the fame 
 kind : fometimes, I have found the em- 
 bryo partly diflblved, and fometimes per- 
 feft, commonly of the fize and figure of 
 a fmall horfe-bean, when the mifcarriage 
 happened in the ninth or tenth week of 
 pregnancy ; but when no embryo was 
 found, it was always termed a falfe con- 
 ception by the good women. 
 
 When the membranes broke before the 
 Secundines were difcharged, I have known 
 the embryo pafs off unobferved with the 
 coagula of blood, and be loft among the 
 cloaths; and at other times, when the 
 membranes were not broke, I have found 
 it diflblved in the waters. 
 
 In one cafe where I was concerned, the 
 Chorion had broke, and the Amnios was 
 difcharged whole, with the embryo fwim- 
 ing in about ten times its own bulk of 
 water, as clear as cryftal. Though it 
 was not bigger than a fmall bean, I could 
 diftinguifti the legs and arms pretty well 
 formed j but as I had not leifure to im- 
 
 merfe 
 
94 CASES IN MIDWIFERY, 
 merfe it in fpirits immediately, it lay in a 
 cup for the fpace of twelve hours, at the 
 expiration of v/hich, I found the waters 
 muddy ; and when I opened the Amnios^ in 
 order to evacuate the corrupted fluid, and 
 fupply its place with fpirits for the prefer- 
 vation of the embryo, I perceived the legs, 
 arms, and greatefl: part of the body, were 
 quite diflblved. 
 
 CASE II. 
 
 In the year 1723, I attended a patient, 
 who mifcarried in the fifth month, the 
 Foetus and membranes having been dif- 
 charged together. About five days after 
 the mifcarriage, I was called to examine a 
 fubftance, which had been pafled with a 
 great deal of pain, and which the mid- 
 wife termed a real falfe conception. This 
 was about the fize of an hen egg, fur- 
 rounded with what appeared to be a ftrong, 
 thick membrane, which when I opened, I 
 perceived the whole was no other than a 
 coagulum of blood, which had been 
 flrongly prefl'ed in the Uterus or Vagina, 
 fo that the ferous part having been fqueez- 
 - ed out, the furface, in confequence of the 
 preflure. Had afilimed the form and ap- 
 pearance 
 
CASES IN MIDWIFERY. 95 
 
 peartmce of a membrane. I have feen a 
 great number of fuch fubftances, which 
 have been always miftaken for falfe 
 conceptions, by midwives, nurfes, and 
 even gentlemen of the profeffion. Indeed, 
 
 I myfelf had at firft a confufed notion 
 of thefe things, until I underftood that 
 coagula of blood would aiilime fuch ap- 
 pearance from preffure in any cavity. 
 Thefe I have feen difcharged, both before 
 and after mifcarriages and deliveries, at 
 all times of pregnancy, though generally 
 in the hrft five months, and more frequent- 
 ly in the third, than in a more advanced 
 ftate of uterine geftation. 
 
 N U M B. II. CASE I. 
 
 Of Molas. 
 
 In the month of December 1742, a wi- 
 dow gentlewoman, about the age of fifty, 
 was fuddenly feized with violent, pains, 
 like thofe of labour, and a difcharge of 
 blood from the Uterus. Two years had 
 elapfed fince her Menfes difappeared j but 
 having received a fall down flairs, fhe had, 
 from the time of that accident, been fub- 
 , jecl to pains in the lower part of the Ab- 
 domen and back, with a flow draining of 
 5 blood 
 
96 CASES IN MIDWIFERY. 
 
 blood from the Ute?-us. Thefe complaints 
 continued fix months before die was taken 
 with the violent pains, in confequence of 
 which I was called to her affiftance. I 
 felt the Or Internum a little open, and 
 fomething prefenting, like, the edge of a 
 'Placenta^ or a round flefliy fubflance. 
 She was for feveral days, kept tolerably 
 eafy, by taking five or ten grains of PiL 
 Matth. or draughts with Liquid Lauda- 
 num^ from fifteen to thirty drops, repeat- 
 ed occafionally as the pains returned. 
 Laxative and emollient glyffers were fre- 
 quently injected by way of fomentation, 
 as well as to evacuate the inteftines. The 
 Or Internum was gradually dilated, the dif- 
 charge and pains fuddenly returned, a 
 large oblong flefh-like fubflance was thrufl 
 down into the Vagina^ and by gently 
 openinghhe Or Externum^ at length extradl- 
 ed, when the pains and flooding abated. 
 This fubflance being examined, appeared 
 to be nothing elfe than the fibrous part 
 of the blood, ilrongly fqueezed together, 
 nearly as large as the head of a child, in 
 the flxth or feventh month. A bloody 
 ferum continued to drain from the parts, 
 for feveral days, when the red colour va- 
 
 niflied. 
 
Cases in midwifery. 97 
 
 lilfhe.l, and it began to yield a Ilrong foetid 
 fmeil. She v/as ibized with violent pungent 
 pains in the HypogafiricitgLon, the lips of the 
 Os Internum fwelied, and became unequally 
 indurated, the pains anddifcharge increafed, 
 with all the direful fy mptoms of a confirmed 
 cancer in Utero. Yet no other fiefh-like fub- 
 ftance was evacuated, though every now 
 and then Ihe was attacked with violent 
 floodings: at length fhe became hedlic, 
 and died in about three months. 
 
 [ VUe Col. IX. No. II. Cafe III. ] 
 
 NUMB. II. CASE II. 
 
 Mr. Watkins, Surgeon at Colejhill in JVar-^ 
 wickjhire, in a letter dated Auguji 24, 
 1746, writes to this effedl:. 
 
 Give me leave to trouble you with one 
 cafe, as a confirmation of your dodlrine, 
 that the Mola is, for the mofl: part, an 
 excrefcence or coagulated blood, and not 
 a falfe produdlion from generation. 
 
 I was called to a married woman full 
 fixty years of age, who flooded profufely, 
 in confequence of a falling down of the 
 womb, as I was informed by the mid- 
 wives ; for fhe w’as attended by two who 
 had attempted the redu6tion. Finding an 
 imperforated fubflance prefenting, I con- 
 i'! eluded 
 
93 CASES IN MIDWIFERY. 
 
 eluded it was not the Uterus : then placing 
 her in a proper pofture, I introduced my 
 hand, and delivered her of a mufcular,. 
 or rather tendinous-lihe fubftance^ as big 
 as a large calves heart, exa6Hy refembling 
 the auricles, and conical point, which had 
 prefented at different times, for feven years 
 iaft pad:, with vail flooding and excruci- 
 ating pains. The lofs of blood was now 
 exceflive, but by the help of incraffating 
 medicines and acids, fhe is happily reco- 
 vered and hearty. 
 
 Vid. Bomtus SepulcJjret. Lib. III. Se6f. 
 37. Ruyfeh. Tom. I. Obferv. 28, and 29. 
 Forejlus de Morbis MuUerurn, Lib. XX VIII, 
 Wldafius Centur. 2. Obfervat. 52, 
 
 NUMB. III. CASE I. 
 Hydatides difeharged from the Uterus, 
 
 In the year 1752, one of my pupils at- 
 tended a poor woman, who, in the fourth 
 month of her pregnancy, was taken with 
 a violent flooding, which was reflrained 
 by opiates ^ but, in three days, returned 
 with greater violence, accompanied v/ith 
 Ifrong pains and frequent draining, like 
 a Fenefmus. At length fhe difeharged a 
 pot full of coagulated blood and Hydatides^ 
 
 adhering 
 
CASES IN MIDWIFERY. 99 
 
 adhering to a membranous fubftance, or 
 to one another, like a bunch of grapes of 
 different fizes, from the bignefs of a nut- 
 meg to the fmallnefs of hempfeed. The 
 patient was reduced to fuch a degree, that 
 we thought fhe could not pofiibly live ; ne- 
 verthelefs, fhe gradually recovered, contra- 
 ry to our expedlation. 
 
 CASE II. 
 
 Communicated by Mr. Crawford of Lotu^ 
 don., in the year 1753. 
 
 I was called to a woman about the age 
 of twenty- feven, who thought herfelf fe- 
 ven months gone with child. When J 
 entered the room, fhe flood leaning on 
 the back of a chair, with an earthen pot 
 betwixt her legs : fhe had voided near a pint 
 and an half of blood into this receiver, be- 
 fore I came, and at times evacuated the fame 
 quantity for near three months. Her 
 flooding was then much abated j but fhe 
 was very weak and low, though almofl 
 intirely free from pain. When I examin- 
 ed the Matrix, I found the Os Tinas open 
 to fcarce the breadth of half a crown, 
 but nothing like the appearance of a child. 
 Though her flooding was now but fmall, 
 H 2 in 
 
loo CASES IN MIDWIFERY. 
 
 in coniideration of her having enjoyed n'o 
 reft for three nights before, fhe was, by 
 my dire6lion, put to bed, and took a com- 
 pofing draught, which made her fleep 
 about two hours j but flie waked with 
 feemingly ftrong pains. I examined her 
 again, and introducing my fore and mid- 
 dle fingers into the Vagina^ felt fomething 
 which I miftook for clotted blood. It 
 filled both my hands when I brought it 
 away, and appeared to be a large bundle 
 of Hydatidcs connected one with another 
 by an infinite number of fmall, flender 
 filaments. Thefe bladders contained a 
 clear lymph, and were of different fizes, 
 Ibme as large as my thumb, and others as 
 fmall as a pin’s head ; and her pains con- 
 tinuing, ftie evacuated as many as filled 
 a two quart bafon : thus delivered, fhe 
 was freed from her pains, her flooding 
 ceafed, and the womb contracted to the 
 fize of my fift. Neverthelefs, fhe was ftill 
 ftrongly polfeiTed with the notion that 
 there was a child remaining, and earneftly 
 begged that I would bring it into the world. 
 I aifured her, that flie was already deliver- 
 ed of what flie liad miftaken for a child, 
 and having prefcribed what was neceffary, 
 
 left 
 
CASES IN MIDWIFERY. loi 
 
 left her very well fatisfied and compofed. 
 Next day I found her eafy 5 fhe continued 
 to do very well, and at the writing of this 
 cafe, was in the fifth or fixth month of 
 pregnancy. 
 
 N.B. She had been delivered of two 
 
 children, before fhe was troubled with the 
 
 Hvdatides. 
 
 ✓ 
 
 Mr. Lamotfe^ in his XVIth Obfervation, 
 gives an account of a woman that ima- 
 gined herfelf gone with child above 
 five months, who was delivered of a 
 mole, or fomething of that nature, as 
 big as two fifts, compofed of an infinite 
 number of veficles, tied to one another 
 by membranes, and which held toge- 
 ther like the fpawn of frogs 5 after being 
 cxceffively weakened with a continual lofs 
 of blood for eighteen days, which was 
 flight at firff, but became very violent be- 
 fore delivery, and flopt immediately after. 
 
 In Obfervat. XVII. he gives an account 
 of a woman that imagined herfelf gone feven 
 or eight months, who paft a great quan- 
 tity of waters, which, he thinks, was a 
 real dropfy of the Uterus, 
 
 H 3 
 
 In 
 
IC2 CASES IN MIDWIFERY. 
 
 In Ohfervation XVIIL he gives a cafe 
 where the Abdomen increafed to a great 
 bignefs, to the eighth or ninth month ; 
 and, although the woman had her MenfeSy 
 fhe imagined fhe was fo long gone with 
 child, having miffed one period at the be- 
 ginning of her reckoning ; but inftead of 
 being delivered of a child, Ihe, for feveral 
 days together, paffed an incredible quantity 
 of wind, making the fame noife as when 
 it vents itfelf at the Anusy but involunta- 
 rily. Vid. Ruyfch, I’om. I. Obferv. 28. 
 
 In Phil. P’ranf. No. 309. p. 2387. there 
 is a paper by Mr. J. Toungy giving an ac- 
 count of balls of hair, with bones in the 
 middle, fome like teeth, others refembling 
 the mandible, with a few fockets and teeth 
 in them, contained in different parts, as 
 the Uterus and OvartUy &c. 
 
 There are alfo accounts of the fame 
 kind, by Dr. Edward Pyfony No. 2. p. ii, 
 and by Dr. Sampforiy No, 2. p. 49. 
 
 COL- 
 
CAsES in midwifery. 103 
 
 COLLECTION IX. 
 
 Of Polypus, Schirrofity and Cancer in the 
 Uterus and Vagina. Fide 
 
 NUMB. I. CASE I. “ ' 
 
 Of the Polypus. - 
 
 A woman turned of thirty, who never 
 had bore children, confulted me in the 
 year 1726, about a very extraordinary 
 diftemper. One of the febaceous glands, 
 on the right fide of the Os externum^ and 
 clofe to the Carunculce Myrtiformes^ had in- 
 fenfibly increafed and fwelled to fuch a 
 degree, that I found it as large as a mid- 
 dling pear, hanging from the part by a 
 long neck as thick as my little finger, and 
 about half a yard long, fo that the tumor 
 reached down to her knees. I perceived 
 the lower end, which was the largeft, ex- 
 coriated, and appearing like an Herpes^ 
 though fhe felt no pain j and from this 
 part, a fmall quantity of blood was dif- 
 charged, during every menflrual evacua- 
 tion. A ligature being applied to the neck 
 of the tumor, clofe to its origin, it was 
 H 4 ampu- 
 
104 CASES IN MIDWIFERY, 
 amputated, and the wound cured without 
 any difficulty, 
 
 CASE II. 
 
 In the year 1742, a midwife being call- 
 ed to a woman in labour, about the age 
 of tv/enty-fix, felt not only the child’s 
 head pufliing down through the Os inter- 
 num into the Vagina^ but, at the fame time, 
 another large, firm, round fubflance at 
 the fide of the head, protruding in the 
 fame manner. A male pi'adlitioner being 
 confulted, could not difccver the nature of 
 this tumour, and left the patient, telling 
 hei' it was fiirgeon’s work. Neverthelefs, 
 the head was, with great difficulty, forced 
 beyond the fi^velling, and the child deli- 
 vered, though the midwife was unjuftly 
 accufed by the neighbours, of having pull- 
 ed down the Uterus. Some months after her 
 delivery, the tumour infiamed, and mat- 
 ter being formed below its furface, was 
 difcharged to fuch a quantity, as emiaciated 
 and enfeebled the patient, A gentleman 
 being called to her affifiiance, defired my 
 advice j but when we confulted together,- 
 no right judgment could be formed, be- 
 
 caiife 
 
CASES IN MIDWIFERY. 105 
 
 caufe the tumor filled up the yN\\o\t Vagina^ 
 and the Oi internum could not be felt. We 
 recommended a milk diet, and fome time 
 after the confultation, we were called 
 again, when we found the fweiling forced 
 down without the external parts, and could 
 plainly feel the Os inter?iu?n, to the fide of 
 w'hich the tumor adhered by a very fhort 
 neck, about an inch thick, and of a livid 
 colour towards the lower part. The Os 
 internum was pulled down, in fuch a man- 
 ner, that the lips were perceivable, toge- 
 ther with the upper part of the tumor, 
 which had not as yet changed colour. 
 Round this, a firm ligature being made, 
 the tumor was amputated, when we found 
 the lower parts of its neck already livid. 
 Before this feparation, the patient had 
 been tormented with violent pains, from 
 the pulling down of the Uterus^, and the 
 draining of the ligaments ; and, at the 
 time of the operation, was very much ex- 
 haufted ; fo that fhe died in two or three 
 days after the excifion. 
 
 The body being opened, the under fide 
 of the Uterus was found mortified, and the 
 right fide adhering to the neighbouring 
 
 parts. 
 
io6 CASES IN MIDWIFERY. 
 
 parts, by which the Ovarium and Falhpim 
 T^ube of that fide were covered and con- 
 cealed. The tumor, being cut open, ap- 
 peared to be a folid, firm, glandular fub- 
 fiance. 
 
 CASE III. 
 
 Communicated in a letter from Mr. Holy- 
 oakcy dated Jan. 29, 1750. 
 
 The child prefented with the back, and 
 was extra6led footling; and after delivery, 
 the Placenta came away with little or no 
 affiflance : but the Uterus flill continuing 
 remarkably large, Mr. Holyoake fufpe6led 
 that there was contained in it, a great 
 quantity of coagulated blood, ■ or another 
 child. He accordingly introduced his hand 
 into the womb, and felt a large flefhy fub- 
 flance, adhering to the left fide of the 
 Fundus^ with fmall excrefcences hanging 
 from it like teats. At firfl, he was afraid 
 of extra6ling it, left it fhould be followed 
 by a mortal haemorrhage ; but confidering 
 that a dangerous flooding might enfue 
 from the Uterus being kept thus diftended, 
 he refolved to feparate this fubftance, 
 which did not come away without confi- 
 
 derable 
 
CASES IN MIDWIFERY. 1.07 
 
 derable force, and weighed near two 
 pounds, being of the texture of a Polypus. 
 
 As he dehred my opinion of this af- 
 fair, I obferved in my anfwer, that glan- 
 dular excrefcences or Polypufes are com- 
 monly attached by veffels, and could not 
 have been feparated with the fingers : the 
 Placenta^ when left, and long retained in 
 the Uterus^ is comprefled into a fchirrous 
 hardnefs ; that the nature of Molas is not 
 yet afcertained; and though, fometimes, 
 unaccountable appearances occur, this fub- ' 
 fitance feems to have been a large coagu- 
 lum, which had acquired fuch firmnefs by 
 prefiiire, in a flooding which might have 
 happened before he arrived. 
 
 I myfelf had extra6led as large coagula 
 after delivery, though of a loofer texture ; 
 but thofe formed in repeated floodings, 
 before delivery, are more folid, and afliimc 
 the appearance of a flefhy fubftance. 
 
 CASE IV. 
 
 In the year i753> I was called to a wo- 
 man by Mr. Pinkjiane, who informed me, 
 that flie had been much weakened with 
 large difcharges from the Uterus, at firfl: 
 fanguineous, and afterwards of a brownifh 
 
 colour, 
 
io8 CASES IN MIDWIFERY. | 
 
 colour, and foetid fmell : on examining in 
 the Vagina^ I felt the Uterus largely ftretch- ^ 
 ed with little or no neck, and a little above j 
 the Fubisj the Abdomen felt like one in the 
 lixth month of pregnancy. The Os Uteri 
 Vv^as thin, and fo much open, as to receive 
 the end of my finger ; and I found a fmall 
 fubftance like a Polypus lying loofe within it. 
 Two days after, being again called, the above 
 gentleman told me, that the woman had 
 fomething like pains ; that the Os Uteri 
 was more open, and he could feel the 
 fubfoance adhering to the Uterus by a fmall 
 neck. This was really the cafe^ but when 
 he prefied on the Abdomen to keep down 
 the Uterus^ I felt a contradlion higher, as 
 if the neck of the Polypus adhered to ano- 
 ther round, hard fubftance, much larger 
 and higher in the Uterus. In two or three 
 days more, I was again called, and in- 
 formed, he had hooked down the Polypus 
 with his finger, through the Os Uten\ in- 
 to the Vagina. I then found it more fen- 
 fible, adhering to a larger fubftance ; yet, 
 at no time did I perceive any difcharge on 
 my finger. She was aged thirty-eight years, 
 had been married about a year ; and al- 
 though regular in the menftrual difcharge, 
 
 her 
 
CASES IN MIDWIFERY. 109 
 
 her bignefs gave fome fufpicion, that fhe 
 might be with child. She had been taken 
 with frequent ficknelTes and reachings 5 
 which, about fix weeks before I was call- 
 ed, had increafed, and fhe was every now 
 and then attacked with violent pains j 
 then folio w'ed the large difcharges, which 
 weakened her fo much, as frequently to 
 throw her into dangerous faintings. Every 
 thing necefiary was ordered, as to diet and 
 medicine, to fupport and keep up her 
 firength j but the difcharge was fo great, 
 that fhe at laft funk under it and died. 
 When the Abdomen was opened, a large 
 quantity of brownifh, foetid fluid was dif- 
 charged, and a tumor appeared at the 
 lower part, larger than a child’s head, 
 which we took firfl: for the Uterus ; and 
 from which we, with great difficulty, fc- 
 parated the Peritonceum^ Omentum and In- 
 tejiines ; all thefe adhering fo firmly to 
 one another, that we could fcarce diflin- 
 guifli, and feparate them, without tearing 
 the parts. Finding we could not be in- 
 formed properly, as the Uterus lay in the 
 Abdomen^ all was carefully difledfed ; and, 
 when taken out, we /ound this large tu- 
 mor was not the w^'ornb. We then endea- 
 voured 
 
no CASES IN MIDWIFERY. 
 
 voured to find the Ovaria, and Fallopian 
 Fitbes^ but all the neighbouring parts ad- 
 hered all round fo ftrongly, that there was 
 no fuch thing to be difcovered. Having 
 dilated the fore-part of the Vagina^ we 
 difcovered the little Polypus lying in it, 
 about the bignefs of a kidney-bean, with 
 a flender neck about an inch long ; and, 
 opening the Os Uteris we perceived a little 
 cavity in the neck, that had been ftretch- 
 ed by the Polypus^ which it contained. 
 Tracing farther, we found the cavity of 
 the Fundus Uteri^ to our great furprize, 
 no larger than in an unimpregnated Rate, 
 and the neck of the Polypus adhering, as 
 we thought, to a round hard tumor, that 
 was contained in the fubftance of the Ute- 
 rus, on the left fide of the neck. This 
 being difledted out, one of the glands in- 
 creafed to the fize of a fmall pullet’s egg, 
 covered with the internal membrane of 
 the Uterus, and the Polypus adhered only 
 to the infide membrane, and not to the 
 . gland. It was alfo covered by the. Perito- 
 naeum on the left fide, and when cut opei^ 
 was of a whitifh folid fubftance. The 
 Polypus, when cut, was fofter, and, in co- 
 lour and confiftence, like a kidney. We 
 
 then 
 
CASES IN MIDWIFERY. iii 
 
 then examined the large tumor at firft ta- 
 ken for the UteriiSy which was of a livid 
 colour, and full of the fame foetid brown- 
 ifh fluid, that was found in the Abdomen. 
 We obferved a fmall opening at the back 
 part, ' by which this had been gradually 
 difcharged into the Abdomen^ and another 
 opening lower down through the ReBumy 
 which was livid. This circumftance 
 fliewed, that the fluid trickled from the 
 tumor into the Abdomen, and from thence, 
 through the ReBum and Fundament', and 
 not from the Uterus through the Vagina, 
 as had been imagined. This tumor ap- 
 peared to proceed from the Fundus Uteri, 
 and, in examining more narrowly the fub- 
 flance of the Uterus, which was white, 
 folid, and a little thicker than common, 
 we found another gland near as big as 
 the firft, and a little above, on the left 
 fide of the Fundus, and contained alfo in 
 the fubftance of the Uterus -, but when we 
 cut open this gland, it was grown livid on 
 the infide. We then concluded, that i^, 
 was more than probable, the large tumor 
 was originally one of thefe glands, that 
 had increafed gradually as the others j that 
 it had turn’d cancerous on the inflde, and 
 
 had 
 
 2 
 
ill -- CASES IN MIDWIFERY. 
 
 had been gradually Rretch’d more and more, 
 with the cancerous fluid, that had burll 
 through ; and was difcharged, as was be- 
 fore obferved. The infide of the tumor 
 was full of little hard knots, of the bignefs 
 of hempfeed, and the coats about one 
 eighth of an inch thick. The pain Vvas, 
 much of the fame kind as a burning heat, 
 and tearing, attended v/ith a hedlic fever, 
 fmcopes, a low, quick, and fometimes 
 an intermitting pulfe. Thefe fymptoms, 
 before I examined the Os Uteri, made me 
 imagine, there was a cancer in the Uterus •, 
 but, Ending the Os Uteri foft, and not 
 fchirrous, and in large, hard bumps, as 
 in other cafes, when cancerous, I was at 
 a lofs what judgment to form ; though I 
 imagined, it was more probably a gland, 
 or Polypus, increafed to a large bignefs in 
 the Uterus, and turned cancerous, and 
 that the fmall Polypus was an appendix 
 from that; and, as fhe had fomething, 
 every now and then, like labour-pains, 
 the large Polypus, if it adhered to the 
 Uterus with a fmall neck, might be at 
 laft forced down into the Uterus, and ta- 
 ken off by a ligature, 
 
 Bonetus 
 
CASES IN MIDWIFERY^ 113 
 
 Bonetus^ in his Sepulchretum, ' Eib.' III. 
 Se6l^. 32. Ohferv. 6, 8 , gives feveral 
 inftances of fareomatous ^ and glandular 
 tumors, which were miftaken for the Ute~ 
 j'us, until the contrary appeared upon dif- 
 fe6fion. 
 
 Saviard, Obferv. XXXVI. mentions a 
 woman, who imagined herfelf eleven 
 months gone with child. The Os internum 
 being dilated to the bignefs of a crown, 
 they endeavoured to extra6t the extraneous 
 body, but unfuccefsfully. Since her ima- 
 gining herfelf with child, fhe had every 
 month, a very confiderable difcharge of 
 blood, which weakened her fo much, that 
 fhe died. On opening her body, there 
 was found, adhering to the Fundus Uteri., 
 a flefhy mafs of the bignefs of an ox’s 
 heart, covered with a membrane, that 
 feemed a continuation of that of the Ute- 
 rus, to which it adhered by a longifh neck, 
 fmaller than the tumor. There was a 
 cqnfiderable cavity found in it, that ex- 
 tended from its bafe to its point, into 
 which the veins emptied themfelves, and 
 from whence the monthly haemorrhage 
 flowed. The fubftance of it was glandu- 
 
 I lar 
 
1 14 CASES IN MIDWIFERY. 
 
 lar and fchirrous, and its point gangrenous 
 from the violence in the extraction. 
 
 Vide M. Le-isret's Objervations fur la cure 
 ‘radicale de plufieurs Polypes de la Matrice^ 
 
 &c. Paris 1749. 
 
 In the Philofoph. Pranfadl. No. 481, 
 p. 285. is a letter from Peter P’empleman, 
 
 M. D. to JVillia?n Battle^ M. D. Fellow of 
 the Royal College of Phyficians, London, 
 and F. R. S. concerning a Polypus at the 
 heart, and a fchirrous tumor in the Uterus, 
 
 N U M B. n. C A S E L 
 Of the ScHiRRus and Cancer in the 
 Uterus and Vagina. 
 
 In the year 1722, I aflifted in opening 
 the body of a woman turned of feventy, 
 who for a long time before fhe died, had 
 been very big in the Abdomen, and fubjeCt 
 to reachings and cholic pains : the firft 
 diforder was fuppofed to proceed from wa- 
 ter contained in ciftufes, and the other 
 complaints from a diftemperature in the 
 Ipleen or kidneys. 
 
 The adipofe membrane and Omentum 
 were of an extraordinary thicknefs. The 
 Uterus was almoft as big as a child’s head, 
 and feemed very foiid to the touch : when | 
 
 IM 
 
CASES IN MIDWIFERY. 115 
 
 laid open, we could not perceive the leaft 
 appearance of a cavity, which, in all pro- 
 bability, was filled up by the increafe and 
 preflure of the glands. The gall-bladder 
 contained about twenty ftones of different 
 fizes } while the Ovaria were fmall and 
 fhrunk. 
 
 CASE II. 
 
 Sometime about the year 1734, an old 
 female fervant belonging to a lady in the 
 country, died in a very emaciated condi- 
 tion 3 her belly having been increafed to 
 an enormous fize. The Abdomen had be- 
 gun to fweil foon after the Catamenia ceaf- 
 ed to flow, and as it increafed to a confi- 
 derable bulk, fhe was affli6led with a dif- 
 ficulty in breathing, in making water, and 
 going to ftool. Thefe complaints increaf- 
 ed, in proportion to the augmentation of 
 the belly, particularly the difficulty in 
 breathing, which would not allow her to 
 lie in bed, except when fupported by pil- 
 lows : though fhe was eafier when up, ef- 
 pecially when fufpended by the armpits. 
 A great number of deobftruent medicines 
 were adminiftred, as weU as hydragogues, 
 far lyhe cafe was fuppofed to be dropficals 
 I z but 
 
ii6 CASES IN MIDWIFERY. 
 
 but every thing proved inelFedlual : and 
 when fhe was opened, v/e were not a lit^ 
 tie furprized to find the fwelling proceed- 
 ed intirely from the UUrus, which when 
 taken out, weighed about twelve pounds. 
 It was altogether folid, without any per- 
 ceivable cavity, of a white colour, and 
 firm glandular confidence, and had preffed 
 upon the inteftines in fuch a manner, that 
 about four inches of the Ilium were mor- 
 tified. The Ovaria were likewife much 
 emaciated. 
 
 CASE III, 
 
 When I opened the Abdomen of the wo- 
 man mentioned No. II. Cafe I. of the 
 V'lIIth Colledtion, I found the 'Uterus 
 nearly as large as that defcribed in the 
 firfl cafe of this number, but the furface, 
 inflead of being fmooth, was /rendered 
 unequal by large indurations as hard as a 
 cartilage : the Ovaria were affedfed in the 
 fame manner, and feveral fchirrofities ap- 
 peared upon the Omentum. The cavity of 
 the Uterus was irregular, in confequence 
 of thofe indurated fwellings, the interflices 
 of which were deeply ulcerated ; the Os 
 Uteri was large, unequal, and dudded 
 
CASES IN MIDWIFERY. ny 
 
 with tumors as large as pigeon’s eggs j and 
 the was full of little ulcers with cal- 
 lous lips. . ' 
 
 CASE IV. 
 
 I was lately called to a woman about 
 the age of forty-five, who had never bore 
 children : but, for ten years had been ir- 
 regular in the menftrual difcharge, and 
 always in great pains before its appear- 
 ance ; file had likewife been afflicted with 
 the Fluor Albus in great quantity. I felt 
 a large, hard tumor filling up ail the back- 
 part of the Vagina, to which it clofely ad- 
 hered by a large bafis ; and it was with 
 difficulty I could feel the Os Uteri cafi: for- 
 wards towards the Pubes, and lludded 
 with large indurated fwellings, from which 
 fhe had been for feveral months fubje6l to 
 excruciating pains, fo as to be obliged to 
 receive a glyfter every evening, with an 
 opiate after its operation. She has like- 
 wife, from time to time, large evacuations 
 of blood, as well as the other difcharge in 
 great ''quantity, often of a brov/nifh co- 
 lour and very fcetid fmell. 
 
 I have known a great number of fuch 
 cafes, which commonly b^in at the time 
 I 3 when 
 
Vi8 CASES IN MIDWIFERY. 
 
 when the menftrual difcharge ceafes, be- 
 ing occafioned by different accidents and 
 irregularities j and generally prefcribe ve- 
 n8efe6fion once a month, and fome gentle 
 laxative once or twice a week, by which 
 means the Uterus^ though fchirrous, is 
 kept in a Rate of indolence, without in- 
 flammation or degenerating into a con- 
 firmed cancer. 
 
 N. B. The above patient died fince the 
 cafe was fent to the prefs. 
 
CASES IN MIDWIFERY. 119 
 
 COLLECTION X. 
 
 Of complaints proceeding from Uterine 
 Gestation^ 
 
 N U M B. I. CASE! 
 
 Of Nausea, Vomitings and Longings. 
 
 VideNo \. I. Lib. 2, Chap. i. 
 
 In the year 1746, I was called to a wo- 
 man, who having been attacked in the 
 fecond month of her firft pregnancy, with 
 violent reachings and vomitings, was per- 
 fuaded by fome of her acquaintance to 
 take a vomit, which, they fuppofed, would 
 remove the complaint. She accordingly 
 took twenty-five grains of Ipecacuandy 
 which operated upwards and downwards 
 with fuch violence, as threw her into con- 
 vulfions and floodings, and when I came 
 to her afliftance, fhe was extremely low 
 and faint. She immediately fwailowed 
 fifteen drops of Liquid Laudanum in a tea- 
 cup full of mint-water j and 1 prefcribed 
 the following mixture to be taken occa- 
 fionally. 
 
 R Lin5i. Rofar. rub. Latid. l^iquid. gutt. 
 
 XV. conf. Fracaft. 31] . M. 
 
 and between whiles a little burnt claret. 
 The evacuations foon ceafed, and fhe en- 
 I 4 joyed 
 
120 CASES IN MIDWIFERY, 
 
 joyed tolerable reft that night, but the dif- 
 charge of blood returned next morning, 
 and pains coming on, ftre mifcarried the 
 following evening. 
 
 CASE II. 
 
 In about four months after this acci- 
 dent, the fame woman became pregnant, 
 and being again attacked with ftcknefs at 
 her ftomach and reachings, in the begin- 
 ing of the fecond month, I was called to 
 her relief. Finding ftie had exceeded the 
 iifual period of her Catamenia^ about a 
 week, I ordered eight ounces of blood to 
 be taken from her arm, and ftie was im- 
 mediately relieved. In four weeks after 
 this evacuation, the reaching began to re- 
 turn with more violence, the venaefeclion 
 was repeated, and the complaint abated : 
 fhe was twice afterwards blooded at the 
 interval of four weeks, vdth the fame fuc- 
 cefs, and happily went on to her full 
 time : neverthelefs, though thefe evacua- 
 tions greatly diminifhed the complaint, it 
 in a finall degree recurred every morning, 
 till the middle of the fifth month. 
 
 CASE III. 
 
 A woman fubjedt to nervous complaints, 
 waS) in the fecond montli of her fecond 
 
 preg- 
 
CASES IN MIDWIFERY. 12 1 
 
 pregnancy, attacked with violent Teach- 
 ings, for which Ihe underwent gentle eva- 
 cuations, and took draughts with the neu- 
 tral lalts, to no purpofe. The complaint, 
 however, abated, in confequence of her 
 going into the country, and drinking affes 
 milk for the fpace of fix weeks : but when 
 fhe returned to town, the vomiting re- 
 curred with greater violence, and die mif- 
 carried in the fourth month. 
 
 CASE IV. 
 
 In the year 1730 , 1 was called to a wo- 
 man, who had been fuddenly feized with 
 a violent cholic, and frequent draining, 
 like that of a 'T’enefmus, She being codive, 
 
 I ordered a glyder, which operated feve- 
 ral times j but the draining dill continu- 
 ing, I gave her twenty drops of liquid' 
 haudaniim^ in a little white-wine whey. 
 In the mean time, her fider, in putting 
 her to bed, obferved that fhe had under- 
 gone a large difcharge of blood, and de- 
 fired me to examine. I was not a little 
 furprized to find the head of a Fostus forc- 
 ed down in the Vagma j however, I help- 
 ed it along, and the Placenta followed. 
 This might be in the fifth month of preg- 
 
 nancy^ 
 
t 22 cases in midwifery. 
 
 nancy. I found her next day, in a fair 
 way of recovery, and was then informed, 
 that Ihe had been privately married, and 
 the preceding nightj in order to conceal 
 this ftep, had eaten heartily of a difh, 
 which was known to have been her fa- 
 vourite, notwithftanding a Naufea^ which 
 threw her into thofe fevere cholic pains, 
 and ftrainings that occafioned the mifcar- 
 riage. 
 
 CASE V, 
 
 A woman who had bore children, been 
 uncommonly healthy during pregnancy, 
 and ufed to banter her female compani^ 
 ons, on .account of their antipathies and 
 longings, was, herfelf, in the year 1753, 
 when four months gone with child, one 
 evening, unaccountably feized with a long^ 
 ing for an artichoak, when flie heard them 
 cried in the flreet; but as they at that 
 time fold at an high price, flie refolved to 
 check her defire, as a piece of foolifh ex- 
 travagance, and went to bed, without 
 having indulged her appetite. She could 
 not deep, however, but became refllefs 
 and anxious, felt a craving and uneafy fen- 
 fation at her ftomach, and could think of 
 nothing, but the pleafing arid relifliing 
 
 difh 
 
CASES IN MIDWIFERY. 123 
 
 difh of which fhe had baulked her own 
 inclination. Towards morning, file was 
 attacked by violent fpafmodic contradlions 
 in her bowels, and I was juft called in 
 time, to receive the little Fcetus : but there 
 was no difcharge from the Uterus,', fo that 
 • I knew the Placenta ftill adhered, and re- 
 folved to wait with patience, until it ftiould 
 be difengaged and come away of itfelf. 
 Being coftive, fhe received a glyfter, after 
 the operation of which, fhe fwallowed the 
 following draught, to be repeated every 
 four hours, for three or four times. 
 
 R Confe^l. Damocrat. 9ij. Aq. Cinnamom. Simp. 
 
 - Spirit. Syr. Croci a 3 ij. M. 
 
 By thefe means, fhe obtained reft and a 
 plentiful fweat j and next night there was 
 a fmall difcharge from the Uterus, fucceed- 
 ed by after pains, which difcharged the Se- 
 cundines. Vide Lamotte, Obferv. 43, and 44. 
 
 N U M B. II. C A S E I. 
 
 Of obftrudled Urine and Costiveness. 
 
 Being called to a woman, who in her 
 firft child, had a total obftrudlion of urine 
 about the end of the fourth month, I 
 found her in great pain from the diften- 
 
 fion 
 
124 CASES IN MIDWIFERY. 
 
 fion of the bladder ; for the fuppreflioa 
 had continued full thirty hours, and im^ 
 mediately gave her eafe, by drawing off 
 the urine with the catheter. For feveral 
 days file had made water with fome diffi- 
 culty, and but a very little at a time, and 
 when I examined, I felt the Uterus lower 
 down than ufual. After having evacuated 
 the bladder, I ordered her to be blooded, 
 and a glyfter to be adminiflred, as fhe was 
 coftive. Next morning I found her in the 
 fame condition as before, fhe having paff- 
 ed no urine lince the catheter was ufed : 
 
 I again examined the Rate of the Uterus^ 
 and felt it forced ftill lower down by the 
 preffiire of the over-charged bladder : indeed 
 it was lb low, that I could feel the length 
 of the neck and the firetching of the Fim- 
 diis^ which feemed to fill up the whole 
 Pehis : I likewife examined by the ReBum, ' 
 when finding it prefs flrongly againfl the 
 Sacrum as well as the Pubes ; and feeling ■ 
 it uncommonly hot, I concluded that its ; 
 whole body was inflamed. When I prefled | 
 my Anger againfl: the Os Uteri, fo as to * 
 raife it up, fome of the urine was dif- 
 charged, but this being in fmall quantity, 
 
 I was fain to have recourfe to the catheter. 
 
CASES IN MIDWIFERY. 125 
 
 by which fhe was again relieved of the 
 pain above the Pubes, though Ihe Rill con- 
 tinued to complain of great pain lower 
 down in the Pehis. She had a quick 
 pulfe, accompanied with other feverifli- 
 fymptoms, for which blooding was re- 
 peated to the quantity of ten ounces, and 
 as the glyfter had not operated according 
 to expedtation, I prefcribed a folution of 
 Mann. ^i. Sal. Glauber, ^ij. in aq. fontan. 
 and diredted that the glyfter fliould be re- 
 peated, in cafe this Haujlus fhould not be- 
 gin to operate in two hours. Next day, 
 I was called again to . evacuate the urine, 
 and found that the draught had operated 
 feveral times j but the pains in the Va-> 
 gina hill continued, together with the 
 fever, though not fo high as the preced- 
 ing day. I then advifed her to be cupp’d 
 and bath’d, by which means her com- 
 plaints abated i yet I was obliged to draw 
 off the urine once in twenty-four hours, 
 for eleven days, before Ihe could pafs it in 
 the natural way ; and then Ihe went on 
 to her fu]l time. She began to be trou- 
 bled with this fupprellion about the fame 
 time in her. next pregnancy 5 but by blood- 
 ing and keeping her body open, it was 
 
 fame 
 
126 CASES IN MIDWIFERY. 
 
 prevented from being total. I have had 
 two other patients troubled with the fame 
 complaint, about the fame period of gef- 
 tation, which continued fourteen days, 
 and was overcome by the fame method ; 
 namely, by repeated bloodings and gly- 
 fters, together with the affi fiance of the 
 catheter. I have frequently known a dif- 
 ficulty in making water, happen at the 
 end of the fourth, and vanifh about the 
 middle of the fifth month, 
 
 C A S E ll. 
 
 I was lately called to a v^oman in the 
 fifth month j and felt the Fundus Uteri 
 forced down backwards, to the lower part 
 of the Vagina^ the Os Uteri being forward 
 and above the infide of the left groin, 
 The neck and under part of the bladder 
 were fo preffed, that the patient had not 
 urined for feveral days : the Vejica was 
 ftretched up to the Scrobiculus Cordis, and 
 a fludluation was felt as in an Afcites. 
 The male catheter was ufed, becaufe the 
 other was too fhort, and emptied a great 
 quantity of urine fo that the diftenfion of 
 the Abdomen confiderably diminiflied, 
 
 Next day, after the fame operation, fhe' 
 mifcarriedj confequently the obflrudlioii 
 
 was 
 
CASES IN MIDWIFERY. 127 
 
 v/as removed : but, being greatly emaciated 
 by want of nourilhment, Ihe was in two 
 or three days carried off by a Diarrhcea. 
 
 CASE III. 
 
 In the year 1 746, being called to a wo-* 
 man who was feized with labour-pains, 
 and a fmall degree of flooding in the third 
 month, occafioned by a violent ‘TenefmuSj 
 I ordered fix ounces of blood to be taken 
 from her arm, and prefcribed an anodyne 
 draught, which relieved her for feveral 
 hours ; but the pains returning, flie foon 
 mifcarried, The fame accident had hap- 
 pened to her twice before, from the fame 
 caufe ; for fhe was naturally very coftive. 
 She no fooner fufpecled herfelf of being 
 with child again, than my advice was de- 
 manded ; and fhe being of a full habit, I 
 prefcribed venaefe6fion to eight ounces, and 
 a laxative glyfter to be injected immedi- 
 ately. Then I direfted her to take about 
 three drachms of the EleB. Lenitiv. every 
 other night, to live chiefly on broths and 
 boiled meats, with boiled roots and greens, 
 and as it was then fummer, to eat ripe 
 fruits. By this regimen, her body was 
 kept open, and fhe went on to the full 
 time. Vide Lamotte, Ohferv. LI. et feq. 
 
 NUMB, 
 
128 CASES IN MIDWIFERY. 
 
 NUMB. III. CASE I. 
 
 Of fwellings of the Haemorrhoids, Legs* 
 Thighs and Pudenda. 
 
 In the year 1744, I vihted a woman in 
 the fourth month of her pregnancy, who 
 was very much afflifted with coftivenefs 
 and haemorrhoidal complaints, to which 
 fhe was naturally fubjecl ; at this time, 
 however, they had increafed to a great de- 
 gree, and the pain was fo fevere, that Ihe 
 had enjoyed little or no reft for feveral 
 nights. I prefcribed venaefedtion ta the 
 quantity of ten ounces, and as fhe was ' 
 averfe to a glyfter, ordered a bolus confift- 
 ing of 
 
 R Flor. Sulph. 9 i, Pulv. e chel. cancror. Simp. 
 
 3b. Ele5i. Lenitiv. §i. Syr. Rof Solut. q. f. 
 
 to be taken at bed-time, in fome water- 
 gruel made with frefli butter. If this 
 fhould not operate plentifully next morn- j 
 ing, I directed it to be reinforced with 
 Snl. Glauber, sij. Mannee §i. dillblved in 
 water. She accordingly took both pre- 
 feriptions, in confequence of which fhe j 
 had three motions. The SphinSier Ani 
 was fo fwelled, inflamed and painful, that I 
 thought it neceflary to foment the parts with 
 the fleams of an emollient decodtion,inwhich 
 
 fome 
 
CASES IN MIDWIFERY. 129 
 
 fome SalAmfnowac was diilbl'/ed, with a mix- 
 ture of Ipirit of wine and vinegar. Notwith- 
 ftanding thefe applications, the pain, fwell- 
 ing and fever increafed, and being afraid 
 of ufing fcarifications or leeches to a wo- 
 man in her condition, without farther ad- 
 vice, I delired a phyfician might be called, 
 and he ordered a repetition of venaefedlion, 
 and opening medicines, by which the fever 
 was allayed ; but as the haemorrhoidal 
 fwellings did not fublide, we ventured to 
 apply leeches to the parts, about five ounces 
 of blood were difcharged, and the fwelling 
 immediately fubfiding, die proceeded hap- 
 pily to the full time. 
 
 CASE II. 
 
 In the year 1744. I attended a woman, 
 whofe legs had begun to fwell in the fe- 
 venth month of pregnancy, and this fwell- 
 ing, which was of the leucophlegmatic or 
 anafarcous kind, continued without giving 
 her much difturbance, till the middle of 
 the ninth month, when being obliged to 
 walk a confiderable way, upon fome par- 
 ticular bufinefs, flie, on her return to her 
 own home, found her left leg and thigh 
 excelfively fwelled and painful. Indeed, 
 K when 
 
1 30 CASES IN MIDWIFERY. 
 
 when I was called, I began to fear a mor- 
 tification would enfue, for the fkih ap- 
 peared of a livid hue. The vv^oman being 
 otherwife of a ftrong and healthy confti- 
 tution, I immediately ordered twelve 
 ounces ‘of blood to be taken from her 
 arm j and as (lie was cofHve, prefcribed a 
 purgative glyfter, which operated three 
 times. Her leg and thigh were fomented 
 with a decodlion of the fame nature as 
 that defcribed in the preceding cafe ; and 
 as the pain continued, an emollient cata- 
 plafm was applied over all the parts af- 
 fedled. She enjoyed little reft that night, 
 
 • and finding her fever, pain and reftleflhefs 
 remaining next morning, I ordered her to | 
 be blooded again to the quantity of ten 
 ounces, diredled her to take draughts with 
 the neutral falts, to drink plentifully of 
 an emulfion with nitre, and continue the 
 ufe of the fomentation and poultice. Next > 
 
 day, the pain and tenfion were a little 
 abated, but her pulfe being ftill quick, fhe ^ 
 was again blooded to the quantity of eight 
 ounces, and the internal medicines, with ( 
 the external applications, continued; by 
 which means the inflammation was car- i 
 ried off in a few days, and in a little i: 
 4 time- ! 
 
CASES IN MIDWIFERY. 13 1 
 
 time fhe fell into labour, and was fafely 
 delivered. 
 
 CASE III. 
 
 In the year 1750, a woman of a lax 
 habit of body, during her firft pregnancy, 
 ran into the extreme of being too abfle- 
 mious, and drank nothing but water. In 
 the fourth month her legs began to fv/ell, 
 and when I was called in the feventh, I 
 found not only her legs and thighs oede- 
 matous, but alfo the Labia Pudendi fo 
 much fwelled, that fhe could not walk. 
 This fwelling, however, fubfided, in con- 
 fequence of a few punflures with the 
 point of a lancet. I then prefcribed re- 
 peated dofes of the Confediio Cardiaca, and 
 direfled her to drink ilrong beer or wine, 
 infiiead of fmali beer or water : by thefe 
 means, fhe recovered a little from the lan- 
 guifhing condition in vrhich fhe was, 
 though the fwellings of the legs fciU con- 
 tinued ; and when that of the Labia re- 
 turned, fo as to prevent her taking a little 
 exercife, it was reduced as before by the 
 punflures. 
 
 In this manner fhe went on in her preg- 
 nancy, to the end of the eighth month, 
 K 2 wnhen 
 
132 CASES IN MIDWIFERY. 
 
 when file was taken in labour ; and though 
 her weaknefs rendered the cafe tedious, 
 file was fafely delivered of a very fmall 
 child, that lived fome weeks. She reco- 
 vered tolerably well of her lying-in, for the 
 hrft twenty days, and the oedematous 
 fwellings fubfided : but her conftitution 
 having been fo much weakened and im- 
 paired, the whole furface of her body be- 
 gan to be puffed up with an anafarca. 
 This cafe being without the fphere of 
 pradlice to which I had confined myfelf, 
 I defired that other advice might be ufed, 
 notwithftanding which, the difeafe ftill 
 increafed, and carried her off in about fix 
 weeks after her delivery. Vide Lamotte, 
 Objerv. 45, 46, 47. 
 
 N U M B. IV. C A S E I. 
 
 Of pains in the back, belly, fides, toge- 
 ther with vomitings and difficulty in 
 breathing towards the end of preg- 
 nancy. 
 
 In the year 1 744, I was called to a wo- 
 man of a weak and lax habit of body, in 
 the third month of her pregnancy, who 
 was feized with violent pains in her back, 
 and a difcharge of blood from the Uterus 
 
 but 
 
CASES IN MIDWIFERY. 133 
 
 but before I arrived fhe had mifcarried. I 
 then underftood fhe had formerly fuifered 
 a great deal from violent floodings in her 
 fecond pregnancy, when at her full time, 
 by which her health was weakened and 
 impaired j fmce that misfortune, fhe had 
 four times mifcarried in the third month, 
 notwithffanding her having been blooded 
 by way of precaution, which, indeed, fhe 
 imagined had haftened the mifcarriage, by 
 throwing her into fainting fits, accompa- 
 nied with pains in the back, which were 
 always the fore-runners of flooding. I 
 advifed her to go to Bath, and drink the 
 waters, in order to flrengthen her confti- 
 tution before her next pregnancy : and this 
 expedient had the defired effect 5 for foon 
 after . her return, fhe became pregnant, 
 and went on to the full time. 
 
 I have had feveral inftances of w'^omen 
 of a lax habit, who could not bear eva- 
 cuations, but mifcarried in confequence of 
 them. 
 
 CASE II. 
 
 A wmman of a ftrong and healthy eon- 
 flitiition, was attacked, in the fourth 
 month of her fecond pregnancy, wdth a 
 K 3 violent 
 
134 CASES IN MIDWIFERY. 
 
 violent pain in her back, for which I or- 
 dered ten ounces of blood to be taken from 
 her arm, and aslhe was conftipated, a lax- 
 ative glyfter to be injedled. By thefe 
 means, the violence of the complaint was 
 abated : but, next day, her pulfe continu- 
 ing quick and full, the venaefedfion was 
 repeated to the quantity of eight ounces, 
 and a ftrengthening plafter applied to the 
 back. Thele precautions being taken, fhe 
 proceeded tolerably well, till the eighth 
 month, when file was feized with ftretch- 
 ing pains in the Abdomen and fide. I 
 again preferibed phlebotomy to the amount 
 of eight ounces, and diredted the parts 
 affedted to be frequently anointed with po- 
 matum. By which means, her complaints 
 were relieved, and fhe went on to the full 
 time. 
 
 She had mifearried in the third month 
 of her firft pregnancy, negledling the pre- 
 caution of being blooded, when fhe was 
 feized with pains in her back, and other 
 plethoric complaints. I have been con- 
 fulted in many fuch cafes, and always 
 find, that women of a full habit are re- 
 lieved by venaefedtion at any time of preg- 
 nancy. 
 
 CASE 
 
CASES IN MIDWIFERY. 135 
 CASE III. 
 
 In the year 1 747, a woman was, towards 
 the end of the eighth month of pregnan- 
 cy, attacked with vomitings, and a diffi- 
 culty in breathing, wffiich increafed to fuch 
 a degree, that fhe could not lie in bed, 
 but was fupported by pillows, in a pofture 
 between lying and fittings nor could fhe 
 retain either folids or fluids on her flo- 
 mach. I was called about the middle of 
 the ninth month, when I found the Ute~ 
 rus ffretching higher up than is ufual, in 
 the Abdomen. I was informed that fhe 
 had nearly the fame complaints, though 
 not to fuch a degree, in two former preg- 
 nancies s that file feldom went abroad, 
 took little or no exercife, but frequently 
 lay on the bed, and that her drefs had 
 been always loofe. In confequence of 
 thefe hints and obfervations, I fuppofed 
 that her complaints proceeded from the 
 preffure of the Uterus^ and ordered fix 
 ounces of blood to be taken from her 
 arm. I likewife prefcribed draughts with 
 the neutral falts ; but thefe being rejedled 
 by the ftomach, I directed about half a 
 pint of ftrong beef broth to be injedfed 
 K 4 by 
 
136 CASES IN MIDWIFERY. 
 
 by way of glyfter, four or five times a 
 day, to fiipply the want of nourifhment 
 by the mouth 5 and this fuccedaneum had 
 the defired effedl. Indeed, I diiTolved four 
 grains of opium in the two firfl that were 
 adminiftred, in order to prevent their be- 
 ing difcharged j but when the inteftines 
 were emptied, they remained without the 
 opium, and were taken up by the abfor- 
 bent vefiels. 
 
 By thefe glyfiers fhe was effe6fually nou- 
 riflied, and the dyfpncea relieved by fre- 
 quently taking the air in a coach, till fiie 
 arrived at the full time, when fhe was de- 
 livered of a fmall weakly child, and a 
 great quantity of water. 
 
 In her next pregnancy, fhe laced tighter 
 at firfi, flackening by degrees, as fhe en- 
 creafed in bulk, and took a good deal of 
 cxercife, by which precautions, her for- 
 mer complaints were prevented from re- 
 tunjing. 
 
 CASE IV. 
 
 In the year 1746, I attended a patient 
 in her firft labour, who was of a leuco- 
 phlegmatic habit, lived in an indolent 
 manner, and had tire fame complaints that 
 
CASES IN MIDWIFERY. 137 
 
 are defcribed in the preceding cafe^ though 
 not to fuch a violent degree. I was not 
 called until fhe was in labour, which prov- 
 ed very tedious from her weaknefs : and 
 I advifed her to take more exercife if ever 
 fhe fhould be pregnant again. About two 
 years after this period, I was fummoned 
 again j but fhe was delivered fome hours 
 before I reached the place of her abode. 
 Far from having followed my advice, I 
 underftood fhe had afted in diametrical 
 oppofition to it, drefled in a loofe, floven- 
 ly manner, without even walking in her 
 room, but rather chofe, towards the end 
 of pregnancy, to be always in bed, fup- 
 ported with pillows : the dyfpncea and 
 teachings had begun fooner than in her 
 firfl pregnancy ; and fhe feemed to be in 
 a very weak and dangerous condition : for 
 after delivery her complaints did not abate. 
 I advifed thofe who were prefent, to fend 
 immediately for the phyfician of the fa- 
 mily, and left her to his care : but the 
 Vis Vita was fo much exhauiled, that fhe 
 died in two days. As for the child, it 
 had been dead for feveral days before deli- 
 yery. Vide Lamotte, Obferv. 50. 
 
 COL- 
 
138 CASES IN MIDWIFERY. 
 
 COLLECTION XL 
 
 Of difeafes that occur at other times as 
 wdl as in Uterine Gestation. 
 
 Vide Lib. 2. Ch. 2. 
 
 N U M B. I. C A S E I. 
 
 Of Stones or Gravel in the Kidneys 
 or Bladder. 
 
 In the year 1 747, I was called to a wo- 
 man in the feventh month of her fecond 
 pregnancy, v/ho had been feveral years 
 fubjedt to violent gravel pains in the kid- 
 neys, from which divers fmall hones had 
 pafied into the bladder, and were dif- 
 charged with the urine. When I arrived, 
 Ihe was in great torture from a hone, 
 ■w'hich file imagined, had ftopt in the right 
 ureter ; fhe was leized with violent vomit- 
 ings and drainings, and her urine being 
 high-coloured, I was afraid of a mifear- 
 riage. In this apprehenfion, I ordered 
 ten ounces of blood to be taken from her 
 arm, a glyher to be adminihered, and af- 
 ter its operation, preferibed ten grains of 
 Til. MatthcBi^ by which means, the vio- 
 lence of the pain was allayed, and in a 
 little time, the hone pahed into the blad- 
 der. She was afterwards, from time to 
 
 time, 
 
CA.SES IN MIDWIFERY. 139 
 
 time, fubjeft to pains from the paffage of 
 gravel, but not to fuch a violent degree ; 
 though it was much more fevere and re- 
 turned more frequently during pregnancy, 
 than at other times, 
 
 CASE II. 
 
 Communicated by Mr. Archdeacon, Sur- 
 geon at St. Neots, in a letter dated Sept. 
 19, 1747. 
 
 One Gibbs, the wife of a coal-porter in 
 this place, had long complained of violent 
 pain in the bladder, with other fymptoms 
 of a Hone ; but met with little compaf- 
 fion, becaufe fufpedted of idlenefs, rather 
 than of having any real diforder. She af- 
 terwards proved with child, and endured 
 great torment all the time of geftation, 
 till fhe fell in labour, when the midwife 
 being called, was furprized to find a hard 
 body prefenting before the head of the 
 child. She did not know how to a6l up- 
 on this occafion, but the patient’s circum- 
 ftances not permitting her to employ a 
 male practitioner, patience was the only 
 remedy fhe had to fuppoit her through a 
 long and painful labour. At lall the 
 midwife felt fomething come away, 
 
 and 
 
140 CASES IN MIDWIFERY. 
 
 and upon examination, found it was a 
 ftone of the fliape and fize of a goofe’s 
 gizzard, weighing five or fix ounces, which 
 fire afterwards gave to do6Ior Waller of 
 Cambridge. The child followed immedi- 
 ately after it was difcharged, and proved 
 to be a boy, who is now a Blackfmith in 
 London^ about twenty-eight or thirty years 
 of age. The woman recovered very well, 
 but was troubled with an involuntary 
 emiffion of urine ; ihe afterwards bore a 
 daughter and lived fever al years, until fhe 
 was fhot by accident, at a gentleman’s 
 houfe in this town. 
 
 In FhiL “Franf. No. 202. p. 817, there 
 is a paper by Dr. F horn as MoUneux, giving 
 three cafes of young girls of fix, ten and 
 eleven years of age, from whom ftones 
 were extracted by dilating the Urethra with- 
 out cutting, although in the lafi, the 
 ftone was of a large fize. And another 
 paper in p. 818. of a woman, who void- 
 ed a firone that weighed above two ounces 
 and a quarter. A fione about the fame 
 magnitude was voided by another woman 
 of fixty-three years of age, as attefted by 
 Dr. Richard Beard, No. 178. Vol. V. 
 
 There 
 
CASES IN MIDWIFERY. 141 
 
 There is alfo a paper from V)i\Bealey 
 No. 18. p. 320. defcribing a Rone taken 
 out of the womb of a woman, by inci- 
 fion, that weighed near four ounces. 
 
 CASE III. 
 
 Bonetus^ in his Sepulchretiprij Book III. 
 Se6t. 38. Obferv. i. relates a cafe of a wo- 
 man, who was for many years afliidled 
 with a mold violent pain in the left kid- 
 ney, and though fourteen times with child, 
 was always delivered before her full time, 
 in the eighth or beginning of the ninth 
 month. When fhe died, he opened her, 
 and found the left kidney quite wafted, 
 the right kidney was very much dwelled, 
 and contained a very large Rone. 
 
 The thirteenth cafe, was that of a 
 woman, who was for many years fubje6l 
 to convulfive diforders of the hyReric 
 kind, which were more violent when Ihc 
 was with child ^ and fhe commonly mid- 
 carried at the end of the third month, 
 and at laR died of an apoplexy. When 
 Rie was opened, contrary to his expecta- 
 tion, the womb appeared to be perfectly 
 found, and he could find nothing about 
 thofe parts, that could occafion the difor- 
 
 der j 
 
142 CASES IN MIDWIFERY. . 
 
 der; but, in opening the head, he found 
 a large quantity of water lodged in the 
 cavities of the brain, which he alledges 
 v/as the occahon of thofe fpafmodic pains 
 and diforders, and of the abortions that 
 foil owed. 
 
 He has feveral other cafes of abortions, 
 occahoncd by feveral other caufes. Vide 
 Coiled;. XII. of this book. 
 
 NUMB. II. CASE r! 
 
 ' Of Hernias. 
 
 In the year 1746, I was befpoke to at- 
 tend a patient in labour, who from her 
 infancy had been troubled with a fmall 
 Hernia in her left groin ; which, however, 
 difappeared in the fifth month of her 
 pregnancy. As it flill continued up when 
 labour came on, I directed an affiftant to 
 prefs her fingers on the part, during every 
 pain, to prevent it from being over-flrain- 
 ed, and fhe was fafely delivered. I ex- 
 pected the Hernia would return as foon 
 as file fhould be recovered and walk about, 
 . becaufe this was the cafe of another wo- 
 man nearly in the fame fituation, though 
 the Her?iia was larger and on the left fide, 
 I vras, however, agreeably difappointed, 
 
 for 
 
CASES IN MIDWIFERY. ^3 
 
 for It has not yet re-appeared, although I 
 have delivered her twice fmce that period. 
 
 C A S E II. 
 
 I delivered a woman in the year 1727, 
 who had been afflifted with a rupture in 
 the left groin, during the whole time of 
 uterine gefbation. Though fhe could re- 
 duce the Hernia^ it was fo.;ced down by 
 every pain, and gave her great uneahnefs. 
 The labour being pretty far advanced 
 when I arrived, I took the opportunity of 
 reducing the Hernia upon the ceffation of 
 the pain, preffing my fingers upon the 
 part, and diredling her to lie on her left 
 fide, with her thigh clofe up to the Abdo~ 
 meuy a pofition, which favoured its keep- 
 ing up, and prevented the anguifh which 
 retarded the labour. She was accordingly 
 fafely delivered, and when fhe recovered of 
 her lying-in, I recommended a trufs, by 
 which the diforder was palliated. 
 
 CASE III. 
 
 I attended a patient, who after a for- 
 mer, labour, was afflifled with an Exom- 
 phalosy which difappeared in the eighth 
 month of uterine geftation, but returned 
 after delivery. 
 
 CASE 
 
144 CASES IN MIDWIFERY. 
 
 CASE IV. 
 
 In the year 1731, I was called to a wo- 
 man, who had felt a fwelling gradually 
 increafe at the left fide of the Anus ; and 
 this tumor difappeared when fhe was 
 in bed, but always returned in the day 
 while fire was a-foot. This Hernia conti- 
 nued down all the time of her firft labour, 
 upon which, an inflammation and flrran- 
 gulation of the inteftine enfued, fo that it 
 could not be reduced as ufual. But, as 
 fhe had a large difcharge of blood after 
 delivery, and the parts were fomented with 
 difcutient fomentations, reinforced with 
 warm and emollient cataplafms, the flric- 
 ture was overcome, and the Hernia re- 
 duced. In her next labour, the inteftine 
 was forced down by the pains, which had 
 alfo puflied down the membranes with the 
 waters, and confiderably opened the Os in- 
 ternum. The Hernia., however, was re- 
 duced by opening the Os externum, intro- 
 ducing my hand into the Vagina, and 
 pufhing the inteftine above the Os Sacrum. 
 By this operation the membranes were 
 broke, the waters difcharged, and the 
 head being forced down into the Pelvis, 
 
 kept 
 
 O 
 
CASES IN MIDWIFERY. 145 
 
 kept up the intelline j then fhe was fafely 
 delivered without undergoiag the fame 
 rifque die had run before. 
 
 CASE V. 
 
 In the year 1746, I had occafion to ex- 
 amine an Her 7 iia of the fame kind, in a 
 woman, who about two years before I 
 faw her, and a month after fhe was deli- 
 vered of her firft child, had felt a fwell- 
 ing on the left fide of the Perinceum and 
 Anus^ which fhe imputed to the violence 
 ufed by the midwife in delivering her. 
 The fwelling increafed confiderably, hang- 
 ing down in the day, though while fhe 
 was in bed, fhe could gradually thrufl it 
 up into the Pelvis, between the Vagina and 
 ReBum, by introducing two fingers into 
 the Vagina, and pufhing it up, until fhe 
 found it returned into the Abdomen ; but 
 when fhe arofe, it always relapfed. About 
 three quarters of a year after this tumof 
 firft appeared, fhe conceived, and was 
 feized with a violent cough, which forced 
 down the intefline in fuch a manner, as 
 to increafe the fwelling to the fize of a 
 man’s -fift. As fhe augmented in bulk, 
 fhe found greater difficulty in reducing 
 L the 
 
146 - CASES IN MIDWIFERY. 
 
 the Hernia, though the redu6lion became 
 more neceffary, from the pain occafioned 
 by the preffure of the Uterus ; infomuch, 
 'that fhe was frequently obliged to lie down 
 on purpofe to effedl it. About five weeks 
 before fhe fell in labour, the tumor in- 
 creafed to fuch a degree, that fire could 
 not reduce it at all ; and thus fhe conti- 
 nued for feveral days in great pain. As 
 fhe had been an out-patient of St. George’s 
 Hofpital, Dr. Rofs fent her hufband with 
 a melfage to me, defiring, that I would 
 fend one of my pupils to her afiiftance. 
 It was late when I received this intimation, 
 and the place of her abode being at a di- 
 Ilance, I defired Mr. T’omkins to vifit her, 
 but fhe would not allow him to examine 
 the tumor. Next morning, I accompa- 
 nied him to the place, and found her in 
 great agony : the part was livid, and all 
 round the edge of the fwelling, of a fiery 
 red colour : fhe lay on her fide, and when 
 turned upon her back, for the convenience of 
 examining the tumor, it broke in the middle 
 where the fkin was thin, and where there 
 was a fmall fludfuation underneath ; from 
 the opening which was fmall, ifilied about 
 a fpoonful of pus mixed with blood, and 
 
 imme- 
 
CASES IN MIDWIFERY. 147 
 
 Immediately after this difcharge, a thin 
 fluid of a greyifh colour, to tiie quantity 
 of half a pint. This rupture no fooner 
 happened, than the patient exclaimed, that 
 the inteftine was gone up, and that fhe 
 was perfectly free from the pain, which 
 the moment before had been fo violent. 
 We v/ere very much alarmed at what had 
 happened, becaufe this fluid which .flill 
 continued to flow in a fmall quantity, ap- 
 peared to be the contents of the Ileon^, part 
 of which, we concluded, mufl; be morti- 
 fied. She being coftive, the Colon was 
 emptied by a glyfler, a pledget applied to 
 the aperture, and fhe was ordered to take 
 no other fuftenance but foup, made of 
 lean mutton or beef. She recovered, con- 
 trary to our expedlation, went on to the 
 full time, was delivered by Mr. I’omkins, 
 and fome months after her delivery called 
 upon me, when 1 found the Hernia had 
 kept up, and the part appeared firm, 
 though a little ichor continued to ouze 
 from the fmall orifice: fo that, I ima- 
 gined the inflamed inteftine had adhered 
 to the neighbouring Vifcera^ after the 
 mortified flouehs had been cafl: off. She 
 was frequently troubled with violent 
 L 2 pains. 
 
248 CASES IN MIDWIFERY. 
 
 pains, and great weaknefs in that fide of 
 the belly, as if the gut was become nar- 
 row and contradled, fo as to hinder the 
 eafy paffage of the Ingejia. In about five 
 months after this cure, the rupture re- 
 appeared, in confequence of her over- 
 ftraining at a walh-tub, and fhe being 
 again pregnant, it was feveral times re- 
 duced by one of my pupils, by whom fhe 
 was likewife fafely delivered. 
 
 She afterwards fickened of the fmall- 
 pox, and died. 
 
 CASE VI. 
 
 Communicated in a letter from Mr. Stubbs^ 
 of Bedfordjldire^ dated Feb. 2. 1752. 
 
 He was called to a woman near forty 
 years of age, in labour of her firft child, 
 and underftood a midwife had been in 
 waiting ten hours, and that the mem- 
 branes were broke. The Vagina and Pel- 
 vis were filled up by a tumor, which at 
 firfi: touch, he mifiiook for the head or 
 Nates of the child j for he had fcarce room 
 to introduce one or two fingers betwixt it 
 and the Pubes : but opening the Os exter- 
 num^ and pufliing up this tumor, he felt 
 the Os Uteri largely dilated, and the child’s 
 head refting againft the Pubes, 
 
 He 
 
CASES IN MIDWIFERY. 149 
 
 He withdrew his hand, which was very 
 much cramped and prefled, and having 
 refled a little, and confldered the nature 
 of the tumor, which probably proceeded 
 from the inteftines pufhed down at the 
 back-part of the Vagma, he again inflnu- 
 ated his hand, and prelTing flirongly upon 
 the tumor, it was reduced, and the head 
 immediately defcended into the Pelvis : 
 then it was delivered by the forceps, be- 
 caufe the woman was weak, and both mo- 
 ther and child did well. 
 
 NUMB. III. CASE I. 
 
 Of an Ascites during Pregnancy. 
 
 In the year 1 747, I was called to a wo- 
 man immediately after her delivery, who 
 from the bignefs that remained, imagined 
 there was another child in the Uterus. 
 Upon examining in the Vagina, I could 
 find nothing to jufiify this notion 5 but in 
 the Abdomen, which was very large, I 
 plainly felt a fiucfuation of water : this 
 increafed confiderably after Ihe recovered 
 of her lying in, when I advifed her to 
 confult her phyfician and furgeon, who, 
 in order to relieve her of the anguifh pro- 
 L 3 ceeding 
 
150 CASES IN MIDWIFERY, 
 
 ceeding from the diftention of the parts, 
 tapped her leveral times before fhe died,- 
 
 CASE II. 
 
 It will be unnecdfary to defcribe parti- 
 cular cafes of the Anafarca, I fliall there- 
 fore, once for all, obf'erve, that I have 
 been called to feveral patients of a weak 
 and lax habit, and found the cellular 
 membranes fwelled over the whole furface 
 of the body. By the method prefcribed 
 in Colledi:. X. No. 3. Cafe 3. all of them 
 were relieved and ftrengthened before deli- 
 very, except one woman, who after deli- 
 very, was, from exceffive weaknefs, car- 
 ried off by an univerfal anafarca. Vide 
 Mauriceau, Obferv. 81. and Medical Efr 
 fays of Edinburgh. Vol. V, Page 642. 
 
 An account of an Hydrops Ovarii^ by Dr, 
 y. Douglas, No. 308. p. 2317. of the Pbih 
 P’ranf. A woman, not long after fire had lain- 
 in of her firft child, received a violent blow 
 upon the left fide of her belly j the pain abat- 
 ed in two or three days, but returned in tv/o 
 months, when fhe obferved that fide gra- 
 dually turn bigger than the other, and 
 the pains increafed ; but in three months 
 after fhe was frlf afiided with them, they 
 went off, when fie turn’d pregnant, and had 
 
 no 
 
CASES IN MIDWIFERY. 151 
 
 no other Tymptom than what is common 
 in that Rate, only fhe was much bigger than 
 ordinary ; after dehvery, the fwelling abat- 
 ed but little. In about a year after, fhe 
 again conceived, went on to her full time, 
 was delivered of a live child, but was fo 
 weak, that fhe died on the third day. 
 On the dodlor’s opening the Abdomen., there 
 iffued out a vaft quantity of flimy vifcid 
 water, in colour and confiftence very much 
 refembhng a bro'wn, thick and ropy fyrup, 
 ±0 above fixteen or feventeen gallons, which 
 he imagined, was contained in a duplica- 
 ture of the Peritoneum, as the inteffines 
 did not appear : but after examining more 
 narrowly, he found that the thick mem- 
 brane, including the waters, could be fe- 
 parated from the Vifcera and Peritoneum, 
 This bag reached from the Pubis to the 
 Midriff -, and from the left region of the 
 loins to the right, and filled up the whole 
 ■cavity of the Abdomen, diftending her belly 
 fo far, that a plate could eafily lie on it, 
 when fhe was alive. After he had freed 
 it from ail the neighbouring parts, he 
 found it adhered infeparably to the left 
 Fallopian Fube and that it was nothing 
 but the membrane of the Ovarium thicken- 
 L 4 ed, 
 
152 CASES IN MIDWIFERY. 
 
 ed, and diflendgd by the colle6lion of 
 the abovemention ed humor. All the other 
 Vifcera in the Abdomen were found, and in 
 their natural ftate. 
 
 There are feveral other papers of thefe 
 cafes in Fhil. Tdranf. viz. No. 140. p. looc. 
 in a woman opened by Dr. Henry Sampfon, 
 the left Ovarium was increafed to fuch a 
 bignefs, that it, and the fluid contained, 
 weighed with the Uterus that was but light 
 137 pounds. Vide'^o, 348. p. 452. by Dr. 
 Hollings. And another in No. 3 8 1 . p. 8. of 
 a dropfy in the left Ovarium^ of a woman 
 of fifty eight yeai's of age, cured by a 
 large incifion made in the fide of the Ab~ 
 domen^ by Dr. Robert Houjioun^ who relates 
 the following particulars. 
 
 A woman near Glafgow, in her lafl: lying 
 in, at forty-five years of age, fuffered much 
 from her midwife’s feparating and pulling 
 away the Placenta with two great vio- 
 lence, and was fo fenfibly affecled with a 
 pain which then feized her left fide, be- 
 tween the navel and the groin, that ever 
 after fhe had fcarce been free from it, but 
 had it more or lefs for thirteen years to- 
 gether. That part of the Abdomen in- 
 ereafed, and gradually ftretched to a great 
 
 bulkj 
 
CASES IN MIDWIFERY. 153 
 
 bulk, and at laft drew to a point, when 
 the do6lor made by degrees a large open- 
 ing, from which was firft difcharged a 
 gelatinous fubflance, and then about nine 
 quarts of fuch matter as is obferved in 
 fteatomatous and atheromatous tumors, 
 with feveral hydatides of various fizes, 
 containing a yellowifh ferum, and feveral 
 pieces of membranes which feemed to be 
 parts of the dilfended Ovarium after this, 
 he Hitched up the wound with three 
 Hitches, and by a careful management, 
 the woman recovered, and lived feveral 
 years. The, dodtor fays, it plainly ap- 
 peared, that the pain arifing from the 
 delivery of the Placenta and its continu- 
 ing, was the occafion of an inflammation 
 and obHruftion of that part of the Uterus 
 and neighbouring parts ^ and feveral wri- 
 ters corroborate this opinion, as Cypri-^ 
 anus^ Forrejius, Ruyfch, &c. Others have 
 given remarkable cafes of dropfies of the 
 Ovarium : particularly one is defcribed by 
 Drelincourt, which feem’d to be nothing 
 but a number of little globules cluHered 
 together, fome containing water, exceed- 
 ingly clear and limpid ; others, a yellow, 
 thin ferum, and others again a glutinous 
 
 matter f 
 
154 CASES IN MIDWIFERY. 
 
 matter ; fome were as big as pullets eggs, 
 others bigger than a man’s fill. The body 
 of the Ovarium^ with its contents, weighed 
 iixty pounds. Thefe few, out of many 
 inftances from authors of undoubted re- 
 putation, he alledges, fuffice to prove, that 
 the Ovaria, as well as the 'Tubc^ Fallopiance^ 
 ligaments, and Vterm itfelf, are not free 
 from dropfies, ^c. and that they are ow- 
 ing to obflrudlions, often occafioned by 
 rude and violent dealing with women in 
 hard labours. In No. 423. p. 729. is a 
 fimilar cafe from Mr. John Belcher , and in 
 No. 466. p. 223. another from Dr. Short, 
 
 N U M B. IV. C A S E L 
 Of the Lues Venerea. 
 
 In the year 1741, one of the poor wo- 
 men attended by my pupils, being near 
 the full time, had a bubo in the groin, 
 and her throat began to be alfedfed with 
 a venereal inflammation. Poultices were 
 applied, in order to bring the tumor to 
 fuppuration, and fmall dofes of calomel 
 were given internally, to reftrain the in- 
 fe6f ion, until fhe fhould be delivered. 
 Thefe methods feemed to fucceed j flie was 
 fafely delivered of a male child, which at 
 
 firfl, 
 
CASES IN MIDVv^IFERY. 155 
 
 jfirfi:, had no appearance of infedfion ; but, 
 in about eight days, the Scrotum and Pe- 
 nis began to fwell, inflame, and break out 
 in little ulcers, the v^fhole body was fooii 
 covered with venereal blotches, and it was 
 attacked by a cough, which deftroyed it 
 in three weeks after it was born, As for 
 the mother, the bubo was brought to fup- 
 puration and the matter difcharged, and I 
 defigned to have fent her to an hofpital 
 for tlie cure of the Lues^ as foon as fhe 
 fhould be in a condition to be removed j 
 but the ulcers in her throat grew worfe 
 and worfe 5 in about a fortnight after de- 
 livery, her lungs were affedted, a con- 
 fumption enfued, and death was the con- 
 fequence. 
 
 It is obferved in general, by the gentle- 
 men who have frequent opportunities of 
 falivating pregnant women in the hofpi- 
 tal, that it is performed fafer in the firft 
 |ix or feven months of pregnancy, than 
 in the laid two or three months, becaufe 
 they are then in danger of being deliver- 
 ed at the heighth of the falivation. But 
 that they are lefs fubjedf to mifcarry in the 
 fifth or fixth months, than in the firfl 
 four months ^ that women ought not to 
 
 undergo 
 
156 CASES IN MIDWIFERY. 
 
 undergo a falivation, unlefs the difeafe is 
 like to prove deftrudHve, by phagedenick 
 ulcers in the throat, &c. for if the dif- 
 eafe can be palliated, till the patient is 
 recovered of her lying in, if fhe fuckles 
 the child, and is then falivated, both 
 fhe and the child will be cured with 
 greater fafety. That women of a, full 
 habit fhould be blooded, live abftemi- 
 oufly, and take opening medicines, be- 
 fore they are anointed with the mercurial 
 ointment; alfo if the. Menfes are expected, 
 to wait till the evacuation is over, either 
 in thofe that are not pregnant, or in thofe 
 that have them during pregnancy. 
 
 The following obfervations are from Mau-~ 
 riceau, with regard to the treatment of 
 pregnant women, affedfed with the ve- 
 nereal difeafe. 
 
 In Obferv. 23. p. 20. He gives an Ac- 
 count of his being called to fee a young 
 woman, aged twenty-two, in her feventh 
 month of pregnancy, who was then under 
 a falivation for the Lues Venerea^ and wEo 
 fpit near three quarts a day, and yet was 
 happily delivered at the full time of a 
 healthy child. 
 
 In 
 
CASES IN MIDWIFERY. 157 
 
 In Obferv. 71. p. 60. He mentions his 
 having feen fuch a cafe as the former, on- 
 ly the patient was gone with child but 
 two months and a half, and a moderate 
 falivation was carried on for a month, and 
 the life of the warm bath was forbid, and 
 the woman was at lalt fafely delivered of 
 a healthy child. 
 
 In Obferv. 100. p. 83. A like cafe wirii 
 tlie former is mentioned, with a remark, 
 that in all cafes where a pregnant woman 
 is infe 61 ;ed with a Lues Venerea^ it is fafeR 
 and propereft to falivate them in the ear- 
 lier months of pregnancy, when the eva- 
 cuation will lefs affedl the Foetus. 
 
 N. B. Two other cafes are mentioned, 
 but in one of them the patient had only 
 a Gonorrhoea^ which though not cur’d, did 
 not affect the child, and in the other cafe 
 the patient was only fufpe^ted' of being 
 pox’d. 
 
15S CASES IN MIDWIFERY. 
 
 COLLECTION XII. 
 
 Of Mifcarriage, or Delivery before the 
 full time. 
 
 NUMB. I. CASE I. 
 
 Of what may occafion the death of the 
 Foetus in Utero. 
 
 In the year 1746, I was fent for to a 
 woman near the full time of her firfl preg- 
 nancy, who imagined Ihe was in labour : 
 but I found the Os Uteri clofe fliut, and 
 upon enquiring more minutely into the 
 nature of her complaints, I thought they 
 proceeded rather from the cholic than any 
 tendency to labour ; and flic told me, fhe 
 had not felt the child ftir for eight or ten 
 days. I ordered her to be blooded, and 
 the inteftines emptied by a glyfter, and 
 thefe evacuations, together with an opiate, 
 carried off the pains. In five or fix days, 
 I vv^^as called again, and found the Os Uteri 
 largely open, the pains firong and fre- 
 quent, and though the cafe was tedious, 
 Ihe was fafely delivered. 
 
 The whole body of the child, together 
 with the Fimis, was livid j and this lafc, 
 which was ten hand breadths long, had 
 
 a 
 
CASES IN MIDWIFERY. 
 
 a knot in the middle tight drawn, that 
 part which had palfed through the noofe 
 being fmall, and the reft very much fwell- 
 ed; the child feemed to have been dead 
 about fourteen days, and the death, 
 doubtlefs, proceeded from the knot’s be- 
 ing drawn fo tight, as to obftru6l the cir- 
 culation. 
 
 I was concerned in another cafe, where 
 there was a knot upon a long Funis, yet 
 not fo clofe drawn, but that the child was 
 alive. 
 
 CASE II. 
 
 I once delivered a woman of a dead 
 child, round whofe neck, the Funis had 
 formed a kind of noofe or knot : yet its 
 death feemed rather to proceed from a 
 hurt in the delivery ; for the arm prefent- 
 ed, and the child being brought footling, 
 I found more difficulty than ufual in de- 
 livering the head. 
 
 CASE III. 
 
 In the year i I was called to a wo- 
 man in labour, and felt the Os Uteri back- 
 wards towards the Sacrum, and a little 
 open, though I could feel no waters. 
 The head preffed down the Uterus before 
 
 it 
 
 7 
 
i6o CASES IN MIDWIFERY. 
 
 it to the lower part of the PubeSy and X 
 felt fomething unequal, like a long, flat 
 fubftance, between the Uterus and globu- 
 lar part of the head. This, upon deli- 
 very, appeared to be about two inches of the 
 Funis prefled flat and mortified j and the 
 child feemed to have been dead for fome 
 days. 
 
 CASE IV. 
 
 Another child which prefented with the 
 arm, I delivered footling, and found the 
 Funis wound three times round the neck,, 
 which at the Abdomen was drawn very 
 fin all, and flattened. This no doubt, was 
 fatal to the child, who had been dead 
 many days. 
 
 CASE V. 
 
 In the year 1749, I delivered a woman, 
 who, about fourteen days before, had 
 been excelfively frightened at the fecond 
 Ihock of the earthquake which happened 
 in London. In the inftant of her terror, 
 fire felt the child bound furprizingly in 
 her womb, a tremulous motion enfued, 
 and after that minute fhe never felt it 
 ftir. She was taken with a vomiting and 
 purging in the eighth month, which 
 brought on the labour pains, and deli- 
 vered 
 
 5 
 
CASES IN MIDWIFERY. i6i 
 
 Vered her of the child, which was intirely 
 mortified. The Cuticula was eafdy ffript 
 off, the Abdomen fwelled, and the fc'alp and 
 bones were loofe and pappy. 
 
 I have attended in many cafes where 
 much the fame fymptoms occurred in the 
 three or four laft months of pregnancyj 
 and the child was generally dead, though 
 fometimes it chanced to recover. Women 
 often mifcarry about the fourteenth or fif- 
 teenth day, after accidents, fevers, excef- 
 five fatigue, and labour is commonly 
 brought on by fuper-purgation, ficknefs 
 and reaching 5 and fometimes by the break- 
 ing of the membranes. I have likewife 
 known many women mifcarry, though 
 nothing extraordinary had happened, and 
 no caufe could be affigned for the death 
 of the child. 
 
 CASE VI. 
 
 In the year 1743, a woman five months 
 gone with child^ was feized with violent 
 pains at her navel and ftomach, together 
 with a continual vomiting. She had con- 
 ceived in March^ and in Auguji was taken 
 with a pain in her back, from a ftrain in 
 lifting a heavy pot j about a month after 
 M this 
 
1 62 CASES IN MIDWIFERY. 
 
 this accident, when her other complaints 
 began, flie perceived a fluid of a brownilh 
 colour and mortifled fmell, continually 
 draining from the Vagina^ and at different 
 times, feveral bones of the fingers and toes 
 of a child, came away. Anodyne draughts, 
 epithems and opening clyfters were admi- 
 niftred, to eafe the pain and reffrain the 
 vomiting ; but all to little purpofe. She 
 became gradually emaciated, being worn 
 out with pain, want of refl and noiirifh- 
 'ment : for, her ftbmach would retain nei- 
 ther folids nor fluids. To remedy this de- 
 -fedf, recourfe was had to broth-glyflers, 
 which were injedfed three or four times a 
 day, and contributed effcdlually to the 
 ■fupport of her flrength and conflitution. 
 ’When the fmall bones began to be evacu- 
 ated, and her fymptoms v/ere at the worff, 
 a male catheter had been introduced with- 
 in the Os Uterij but could not pafs above 
 ■ an inch beyond that part, and nothing but 
 a fbft fubftance could be felt. An attempt 
 was alfo unfuccefsfully made to dilate with 
 long, narrow-mouthed forceps j and in- 
 jecfions were thrown up by a long, flender 
 pipe made for the purpofe, which, how- 
 _ever, reached but a very little way within 
 
 the 
 
CASES IN MIDWIFERY, 163 
 
 the neck of the womb. At length, the 
 anodyne medicines took effedt, and the 
 nourifhing giyfters fucceeded to our wifh. 
 The foft parts of the child continued to 
 dilTolve and come away in form of a ca- 
 daverous ichor, till the month of Deem- 
 her, when this evacuation ceafed. How- 
 ever, fhe had feveral flight relapfes till the 
 May following, when fhe voided by the 
 AnuSj feveral bones of the fkull, and other 
 large bones of the body, the cartilages and 
 Ipungy ends of which were difiblved, 
 though they appeared to have belonged to 
 a Feetus five months old. During this 
 whole time, the lips of the Os 'Tinea were 
 fmooth, and the neck of the Uterus was 
 long, nor had flie the leafl; flooding, un-i 
 til three months after, that the menflrual 
 difeharge returned. This was her firft 
 pregnancy, fihce which fhe has not con- 
 ceived j and what is very remarkable in 
 the cafe, fhe never had pains about the 
 Uterus, but, only at the navel and Scrobi- 
 culus Cordis j and theft were doubtlefs ow- 
 ing to the bones working their way through 
 the womb and RcBwn. 
 
 M 2 CASE 
 
1 64 CASES IN MIDWIFERY. 
 CASE VII. 
 
 About the fame time, another woman 
 who had formerly bore a child, and was 
 in the fifth month of her fecond preg- 
 nancy, was taken with a flooding which 
 continued fifteen days, at the end of which 
 a mortified ichor flowed in large quantity 
 for the fpace of three weeks, though no 
 bones were evacuated. Some time after 
 this diforder, fhe recovered her flrength, 
 had a regular difcharge of the Menfes^ con- 
 ceived again, went on to the full time and 
 was fafely delivered. As in the former 
 cafe, part of the bones was diflblved, it is 
 probable that in this, there was a total 
 diflblution. 
 
 There are two x.'afes much alike in the 
 Pkilofcph. TranfaB. the firfl in No. 229. 
 p. 580. by Mr. yames Brodie^ of a negroe 
 woman, about the feventh month of her 
 being with child, whofe navel impofthu- 
 mated and broke of itfelf, and after it had 
 voided fome quantity of ichorous mat- 
 ter, whereby flie had fome eafe, the dif- 
 charge ceafed. In about a month after, it 
 impoftumated agaipi to a much greater 
 degree than before j a furgeon open- 
 ed 
 
CASES IN MIDWIFERY. 165 
 
 ed it with a large lancet, and after dif- 
 charging a great quantity of thin ichor, 
 extracted the bones of the Fcetiis. The 
 woman recovered and had a child after- 
 ward. 
 
 The other is in No. 461. p. 814. by 
 Dean. Copping, of a woman who went with 
 child for feven years, till Ihe became again 
 pregnant, and proceeded to the ninth 
 month, about which time there was a tu- 
 mor about the bignefs of a goofe egg, an 
 inch and a half above the Umbilicus^ which 
 broke of itfelf, and from a fmall orifice, 
 difcharged a ferous fluid. She had a mid- 
 wife and three or four phyficians, who 
 gave her over : fhe therefore fent for a 
 butcher ; when he came, an elbow of the 
 child prefented to view at the opening of 
 the tumor; and, at the requeft of the wo- 
 man and friends, to relieve her, he made 
 a large opening both above and below the 
 navel, which enabled him to fix his fin- 
 gers below the jaw of the Fcetus^ which 
 he eafily extradfed. He afterwards ob- 
 ferving a black fubflance, introduced 
 his hand into the opening, and extrafted 
 piecemeal the bones of ahother Foetus^ and 
 feveral pieces of black mortified fiefh. 
 
 M 3 She 
 
1 66 CASES IN MIDWIFERY. 
 
 She recovered, and was able to purfue her 
 domeftic affairs, only {he had an Exom- 
 fhalus ever after. 
 
 No. 275. p. lOQo. is an account of the 
 greateft part of a Fcetus voided by the na- 
 vel, feveral weeks after a midwife had de- 
 livered the Secmdines, which (he took for 
 a Mala on her finding no child. By Mr. 
 C. Birbeck. And in No. 302, p. 2077. 
 Sir Bh. Skipton communicates a cafe in 
 which part of the bones of a Fcetus were 
 voided through an impoffhume of the 
 groin. 
 
 In Phil. FranfaB. No. 243. p. 292. we 
 read of a woman who was delivered of a 
 child, and continued indifferently well for 
 two or three days after ; then new pains 
 came upon her, and for three weeks toge- 
 ther, there came from her daily fome quan- 
 tity of corruption, with pieces of flefli 
 and fkin j and flie continued dangeroufly 
 ill for about eight weeks, at the end of 
 which time fhe was relieved. 
 
 After two years, fhe began to breed 
 again, had three children in three years 
 following ; all which were drawn from her 
 by violence. During her lying-in with the 
 laff of thefe three children, fome bones of 
 
CASE'S IN 'MIDWIFEUY. 1 67 
 
 a Foetus came from her j 'after this, diners 
 other bones came away with her Catame^ 
 nia, and feveral, among.ft which were 
 fundry parts of the and fome of the 
 
 larger bones of the body of a Fcetiis^ work- 
 ed their way, by degrees, through the 
 flefh, above the Os Pubis.’ The Woman 
 was alive feveral years after. - • 
 
 Dr. CL Morely^ in Phil. Prunf. No. 227. 
 p. 486. defcribes the cafe of a woman, 
 who, after having had children, being 
 again pregnant, was invaded with - the 
 expefted labour-pains, which in a few 
 days went off j but the tumor in the -Ab- 
 domen remained. She returned to her ufu* 
 al employ, continuing for more than a 
 ' year, without being freed from her bur- 
 then. At laft a bone was difcharged, not 
 through the uterine paflage, but by the 
 Anus ; and, after Ibme interval of time, 
 many other bones were in like manner 
 evacuated j for fo long as the woman had 
 exceeded her due time of geftation, fo long 
 was fhe in difcharging the bones by Ifool, 
 whicli were all kept in a box, in which 
 they appeared fo numerous and with fo 
 many diftindt Ikulls, as might induce every 
 'one to believe that thxtt Fcetufes had lain 
 
 M 4 fo 
 
1 68 CASES IN MIDWIFERY. 
 
 fo long buried in the Uterus. The woman 
 did well, but two years after riding to 
 fome diftanee, the wound was broken open 
 again by the violent fhaking of the horfe, 
 of which rupture fhe expired. 
 
 Mr. Bernard Shiever^ in PJpil. I’ranf. No. 
 385. p. 172, writes of a woman of forty 
 one years of age, who conceived in July 
 
 1720, and having gone feven months with 
 child, though fometimes fhe had her Men- 
 fes in a fmall quantity, fhe perceived her 
 belly leffen, with only a kind of prefTure 
 remaining in her right fide : a month af- 
 ter, fhe conceived again, and in December 
 
 1721. was delivered of a dead female 
 child, of a proper fize : from that time 
 fhe kept her bed till "June^ 1724. In May 
 happening to go to flool, fhe felt a pain 
 in the Anus^ as if the ReBum would drop 
 from her and endeavouring with her fin- 
 gers to relieve herfelf, fhe extradted a piece 
 of the Cranium^ as big as a Swedijh crown, 
 and at the fame time two ribs were found 
 in the clofe-flipolj and fourteen days after, 
 the reft of the bones were voided the fame 
 way, of an excrementitious colour. The 
 woman did afterwards very well, and was 
 
 the 
 
CASES IN MIDWIFERY. 169 
 
 the mother of three children ; fhe alfo had 
 her Menfes naturally. ‘ 
 
 In the Phil. Pranf. No. 477. p. 529. is 
 a letter from Mr. ‘James Simo?i to the Prefi- 
 dentj concerning the bones of a Fcetus void- 
 ed per Anum. 
 
 A curious and worthy clergyman of the 
 county of Armagh^ fent me fome time ago 
 a parcel of bones with the following ac- 
 count of them j Az. 
 
 Rofe the wife of Mo?^faugh Mac Cornwall^ 
 of the parifli of PullyliJ}:)^ barony of Clare^ 
 in the year 1741. about the latter end of 
 May^ or the beginning of Juiie^ being in 
 the 37th year of her age, and mother of 
 feveral children, conceived as ufual ; but 
 in two or three days after, felt an excef- 
 ceffive unnatural kind of pain in the Ma- 
 trix, which continued with frequent faint- 
 ings, a depraved appetite and an exceed- 
 ing great weaknefs, till her child quicken- 
 ed j after which fhe proceeded reafonably 
 well in her pregnancy to the end of nine 
 months ; and then her child was alive, and 
 every thing right as the midwife thought. 
 She fell in labour, which lafted with pro- 
 per child-bearing pains for twenty-four 
 hours j but could not be delivered and 
 
 her 
 
170 CA^ES IN MIDWIFERY. 
 
 licr labour leaving her, the child was no 
 more obferved to ftir. In a month after, 
 her labour returned, and with many regu- 
 lar throes continued twenty-four hours 
 more j but to no purpofe, fave the dif- 
 charging of fome quantities of black cor- 
 rupted clots of blood ; of which kind alfo 
 die threw up much by vomit : then her 
 labour left her intirely ; and foon after, 
 ihe felt the decaying of the defh of her 
 infant, and the difcharge thereof both at 
 the Matrix and Ajius^ with fo putrid and 
 deadly a fmell, as was extremely naufeous 
 both to herfelf and others about her. Thus 
 fhe lived for upwards of twelve months, 
 and at that period her pains increafmg to 
 excefs, fhe began the difcharges of the 
 bones, which to the number of eighty and 
 upwards, fhe voided wholly by ftool ^ four- 
 teen the firft day, and two, three or four 
 at a time afterwards, for the fpace of 
 twelve months, or morej with moil in- 
 tolerable pains at the voiding of each 
 bone, efpecially a broad piece of the fkull ; 
 fo that from her conception to the day of 
 her death, which was the fourth of April 
 laft, makes up near four years j during 
 mod: of which time, never was a more 
 
 cala- 
 
CASES IN MIDWIFERY. 17 1 
 
 calamitous creature j for three years, fcarce 
 a day without fuffering mofc exquifite tor- 
 ture, being aifo attended with frequent 
 faintings, a continual want of appetite, 
 and an almoft perpetual loofenefsj info- 
 
 much, that it is miraculous how Ihe lived, 
 
 * 
 
 not eating in all that long fpace fo much 
 as would have fuftained a lucking child ; 
 even the very liquids at length not lying 
 a moment on her flomach j by which 
 means fhe became quite emaciated, and 
 difmal to look at, not being able to move 
 from one pofture to another, or to be 
 moved without fainting at every the leaft 
 touch or motion. The truth of ail which 
 I atteft to you, as I received it, partly 
 from the poor woman herfelf, and partly 
 from my wife, who vifited her frequently 
 during her illnefs. 
 
 In the fame 'TranfaBions^ No. 485. p. 1 2 1. 
 we find a letter from Mr. Fran. Drake, fur- 
 geon, F. R.S. to Martin Fculkes, Efqj con- 
 cerning the bones of a Feetus difeharged 
 through an ulcer near the navel. 
 
 Sir, Torke, ‘June 22, 1747. 
 
 Having a call from hence into Lincoln^- 
 JJnre lately to fee a patient, the apothecary 
 
 who 
 
172 CASES IN MIDWIFERY. 
 
 who attended him, informed me, amongft 
 other things, of an extraordinary cafe, 
 which had happened in that neighbour- 
 hood, a very few years ago. I have fince 
 been informed, on inquiry, that it has 
 not as yet been reprefented to the Royal 
 Society ; and therefore, I hope, you will 
 do me the honour to lay this account of 
 the cafe before them, 
 
 yane the wife of yames BurmajZy la- 
 bourer, at Scawby, near Brig in Lincoln - 
 Jhire, was about twenty-nine years of age 
 when Ihe married. About two years af- 
 ter, when fhe had had a child at full time, 
 fhe conceived again, and went regularly 
 on for four months. She then got a fall, 
 and about three weeks after, felt a load in 
 her belly ; which continued on the right 
 lide of the fame, for between two and 
 three years. The woman then grew very 
 big of another child, which prefled fo much 
 upon the lump as to give her great uneali- 
 nefs. However, flie went on to her time 
 with her double burden, and three years 
 and a quarter after the accidental fall, fhe 
 was delivered of a live child at full growth : 
 from wTiich time, fhe grew worfe and 
 worfe, with violent pain about the navel, 
 
 an4 
 
CASES IN MIDWIFERY. 173 
 
 and an inflamed tumor appeared near the 
 part. Upon application to a neighbour- 
 ing furgeon, fomentations were ufed, which 
 produced a fuppuration at a fmall breach 
 near the navel. The furgeon did not 
 know what to make of this fwelling, and 
 therefore did not venture to enlarge the 
 orifice j but it continued difcharging a fe- 
 tid purulent matter for three or four 
 months longer. About a year or more 
 after her laft delivery, the woman was 
 fuddenly feized in the night-time, and a 
 hardifh mafs of flefh feemingly about eight 
 inches long, was difcharged through the 
 old opening in her belly. The lump was 
 rather thicker than an ordinary man’s 
 wrift, and being opened contained all the 
 bones of a Fcetus of about four months 
 growth. At this time the woman was 
 much emaciated, occafioned by the large 
 difcharge of Pus from the wound ; and 
 what was much more extraordinary, what- 
 ever fhe eat or drank came half digefted 
 through the opening j white bread, or bet- 
 ter diet, came through in that manner, but 
 coarfe rye bread, or fuch like, were not 
 digefted at all ; for which reafon, the poor 
 woman muft inevitably have perifhed, had 
 , fhe 
 
174 CASES IN MIDWIFERY. 
 
 fhe not been fupported by a charitable gen- 
 tleman’s family in tlie village with diet fit 
 foj' her miferable circumffances. 
 
 She continued to difcharge her excre- 
 ment in this manner for fix months, and 
 then that fymptom left her j after which 
 the ulcer was kept open ether fix months, 
 when it dried up of itfelf naturally, with 
 a very firm but fmall cicatrix. I had the 
 curiofity to fee this woman, and Mr. 
 Charkfworth, Surgeon and Apothecary at 
 Brig fent for her* She appeared hale, 
 flrong, and in full health. I had the above 
 account of her cafe from her own mouth, 
 attefted by the furgeon who attended her. 
 I faw the bones of the Festus in Mr. Charlef- 
 wortF^ pofTeffion, perfe6lly white, and I 
 believe not one wanting. The woman fur- 
 ther told me, that nine months after the 
 wound was healed, fhe was delivered of 
 another live child at full time, but with 
 great difficulty. The whole time that the 
 bones of the Feetus may be fuppofed to have 
 lain in the woman’s belly, was about four 
 years and a half. Thus, Sir, I have drawn 
 up the account as well as I can, but very 
 inaccurately. I have purpofely omitted 
 terms of art^ in order to make myfelf bet- 
 
CASES IN MIDWIFERY. 175 
 
 ter underftood by thofe who are not furge- 
 ons or anatomifts. There are feveral par- 
 ticulars in the account, which I cannot 
 reconcile to any natural laws that I am 
 acquainted with. However, as the truth 
 of the whole is inconteflable, it fhews 
 mod; evidently, what wonderful things na- 
 ture can do, with proper affiftance. 
 
 In No. 486. p. 13 1, is related a cafe 
 and cure of a woman from whom a Fostus 
 was extradled that had been lodged in one 
 of the fallopian tubes, fent from Riga^ by 
 Dr. yames Mounfey. 
 
 NUMB. II. 
 
 Of Mifcarriages proceeding from, the fepa- 
 ration of the Placenta, and a diften- 
 tion of the Collum and Os Uteri. 
 
 CASE I. 
 
 Ifi the year 1751. a woman in the fe- 
 cond month of her fecond pregnancy, 
 ftarting out of bed in a furprize, felt fome- 
 thing as it were give way, and inllantly 
 mifcarried, with a large haemorrhage that 
 Ibon ceafed. 
 
 CASE 
 
 3 
 
176 CASES IN MIDWIFERY. 
 
 CASE II. 
 
 In the year 1750. I was about nine 
 o’clock at night called to a woman three 
 months gone with child, whom I had for- 
 merly delivered. In the morning fhe had 
 been feized with a flooding in confequence 
 of a fall down flairs ; upon which fhe was 
 put to bed, blooded, and took fome tinc- 
 ture of rofes with fyr. e Meconio, and 
 the difeharge abated a little j but return- 
 ing with greater violence in the evening, 
 a gentleman of the profefTion, who lodged 
 in the houfe, prefciib’d another venaefedlion, 
 together with flyptic medicines, fuch as the 
 Antiphthijic. Alum and Sa??g. Dracont 
 When I arrived, flie was exhauflcd, faint 
 and pale, the Os Uteri being clofe, though 
 fhe had the appearance of flight pains, 
 that recurred at long intervals. As the 
 danger feemed preffing, and all the com- 
 mon methods had been tried, without fuc- 
 cefs, I took the hint from Hoffman^ and 
 fluffed the Vagina tight with fine tow dipt 
 in OxycratCj which immediately ffopt the 
 difeharge : I then preferibed an ' anodyne 
 draught, with hve drops of the 'Vindi. 
 ‘Vhebaic. and two drachms of the Syr. de 
 7 Meconio^ 
 
CASES IN MIDWIFERY. ijj 
 
 Meconioy and direfted her to drink fre- 
 quently of chicken-broth. She dozed a 
 little, and between her dozings had every 
 now and then flight pains, though the 
 flooding did not return. Towards morn- 
 ing the pains grew fo flrong, that the tow 
 was forced through the Os exter?ium, toge- 
 ther With the abortion, about the fize of a 
 goofe egg, and fome coagulated blood. I 
 have hnce fuccefsfully ufed the fame mxe- 
 thod in feveral cafes where the flooding 
 was violent : indeed the flrong preffure in 
 the Vagina feems to dam up the internal 
 flooding, which, by diftending the Uterus^ 
 brings on labour pains. 
 
 CASE III. 
 
 On the eighth of July 1744, in the 
 evening, a woman ten weeks gone with 
 child, was taken with flight pains and a 
 flooding. The Os Uteri would hardly ad- 
 mit the tip of the fore finger, nor did the 
 opening increafe, though the difcharge 
 grew more violent at every pain. The 
 patient being exhaufled by the great lofs 
 of blood, was dire6fed to take Pil. Matth. 
 gr. X. in confequence of which, the pains 
 and flooding abated : towards morning, 
 N flie 
 
178 CASES iN MIDWIFERY. 
 
 Ihe enjoyed fome reft and fell into a breath- 
 ing fweat, and next day was much eafier, 
 her pulfe being raifed, and the difcharge 
 having acquired a pale colour. On the 
 tenth, it was no longer of a red hue, and 
 next day while fhe fat on the pot, making 
 water, the Secundines flipt away without 
 pain, the membranes having been broke, 
 and the embrio almoft quite diflblved. 
 
 She had twice before mifcarried in the 
 third month, and in fix months after the 
 laft of the tvvo mifcarriages, conceiv’d again. 
 As the former abortions had probably been 
 owing to a coftive conftitution and hard 
 ftrainirig at ftool, fhe was blopded fix 
 weeks after conception, and the fame eva- 
 cuation, to the quantity of fix or eight 
 ounces, twice repeated, at the interval of a 
 month ; at the fam.e time fhe was diredled 
 to take frequently at night, EleSf. Lenitiv. 
 gij. or two fpoonfuls of the 01 . Amygdal. d. 
 mixed with an equal quantity of the Syr. 
 Violaru?n^ fo as to procure an eafy paffage 
 every day. By thefe means, flie held out 
 to the end of the feventh month, when 
 fire was delivered of a child which is ftill 
 alive. In the fifth week of her laft preg- 
 nancy, (he was blooded to the quantity 
 
 of 
 
CASES IN. MIDWIFERY. 1-9 
 
 of eight ounces, but .negle6ling to under- 
 go tlie fame evacuation at the period of 
 another month, and being expofed to fome 
 fevere exercife, fhe was taken with a pain 
 in her back, of which fhe was relieved 
 next morning, by lofing eight ounces of 
 blood from the arm : however, fhe hap- 
 pened to overfb’ain herfelf again, and the 
 pain returned with a flooding, which oc- 
 cafioned the mifcarriage defcribed above. 
 
 e A S E IV. 
 
 • In April 1749. I was called to a gentle- 
 woman, who had been feveral years in a 
 bad flate of health, occafioned by frequent 
 colle6Uons of matter fome where about the 
 outfide of the Uterus^ which difcharging 
 itfelf into the Vagina^ flowed from thence 
 in large quantities. During this complaint 
 fhe had bore three children, and now was 
 feized with pains about the Oi to- 
 
 gether with a difflculty of making water 
 and in going to ftool, which fhe. imputed 
 
 to her old diforder. She had felt fome 
 » 
 
 fymptoms of pregnancy, fuch as flcknefs 
 and reaching in the morning, but as the 
 menftrual difcharge was regular, flie could 
 not think herfelf with child. Neverthe- 
 N 2 lefs, 
 
i8o CASES IN MIDWIFERY. 
 
 lefs, the pains increafed, and Ihe was fud- 
 denly delivered of a child in the beginning 
 of the fifth month, which, though not above 
 four or five inches long, lived fome hours. 
 The Scciindines did not come away, nor was 
 there any difcharge of blood : circumftances 
 which plainly proved that the Placenta ftill 
 firmly adhered to the Vterus j and as it 
 was impoflible to introduce the hand, I 
 thought it advifeable to leave it to come 
 away of itfelf, efpecially as the patient 
 was free from pain. A glyfter was admi- 
 niftred, after the operation of which, fhe 
 took an anodyne draught of Aq, Q’miam. 
 ten. ^ Syr. de Mtxonio^ and enjoyed good 
 reft that night. But, her pulfe being ra- 
 ther too low, I preferibed the following 
 drauglit to be taken three times a day, in 
 order to quicken the circulation. 
 
 ^ R /Jq. Cimiam. ten. Pulv. Contrayerv. comp: 
 3i. ' Cajtor Sal. volat.fuccin. a gr. v. Syr. Croci.^ 
 
 - 1- f: /• 
 
 By tills julap a flight fever was produced, 
 on the fifth day a flooding began, and the 
 Placenta being feparated was eafily ex- 
 tradfed. The flooding being at firft pretty 
 violent, was reftrained by repetitions of 
 the anodyne draught, and before the Se- 
 - cundi'nes 
 
CASES IN MIDWIFERY. iSi 
 
 cundines came away, fhe received a glyfter 
 every night. After this mifcarriage, fhe 
 enjoyed a better Rate of health than before. 
 
 CASE V. 
 
 In December 1744, an unfortunate wo- 
 man of the town, mifcarried in the fifth 
 month, and the midwife, from a miftaken 
 notion, that if the Flacenta is not imme- 
 diately delivered, the patient muft die, had 
 tried to pull it away with fuch force as 
 produced a violent flooding, of which fhe 
 died. 
 
 This was likewife the cafe of another 
 woman, who being delivered in the feventh 
 month, died inflantly 'of a flooding, occa- 
 floned by a violent feparation of the Pla- 
 centa. Thefe inflances ought effedlually to 
 caution praflitioners againft ufing violence, 
 either when the Uterus is but little diflend- 
 ed, or when the . Placenta adheres too 
 firmly to be feparated with moderate force. 
 
 CASE VI. 
 
 In the year 1749, I was called to a wo- 
 man four months gone with child, on the 
 eleventh day after the eruption of the 
 fmall-pox. She was then taken with pains, 
 but, being delirious, her cafe was not knpwn 
 N 3 until 
 
i 82 cases in midwifery. 
 
 until the nurfe observed blood upon the 
 deaths. I found the Oj confiderably 
 opened, and the difeharge being great, and 
 attended with frequent ftrainings, I broke 
 the membranes that were pulhed down 
 with the waters : this expedient flayed the 
 flooding, the Foetus " was foon delivered, 
 and had no mark of the fmall-pox, and 
 the Secundines came away in two hours. 
 But the difeharge had funk the puftules, 
 which were of the confluent kind, and 
 could not be raifed again. She died in a 
 few hours after the mifearriage. 
 
 In the German Ephemerides, Anni Pri- 
 mi, L. III. p. 139. there is an account of 
 a woman who had the fmall-pox before 
 fhe was delivered, and the child was mark- 
 ed with the fame difeafe. 
 
 In the Phil. Trajif. No. 493. p. 233. is 
 the cafe of a lady who was delivered of a 
 child, on whom the fmall-pox appeared 
 in a day or two after its birth 5 drawn up 
 by Cromwell Mortimer^ M. D. 
 
 In the fame Franfadi. No. 493,. p. 235. 
 are fome accounts of the Foetus in Utero^ 
 being differently affecled by the fmall-pox. 
 By William Watfon, F. R. S. alfo at No. 337. 
 p. 165. Vide Lamotte, Objervat. 129. 
 
 CASE 
 
CASES IN MIDWIFERY. 183 
 
 CASE VII. 
 
 In the year 1741, I attended a woman 
 who was very much weakened, by a con- 
 ftant draining of blood from the Uterus 
 for above four months, which had begun 
 two months after conception. I found 
 her pulfe low, her countenance pale, and 
 the v/hole furface of her body affected 
 with a fmall degree of an Anafarca. She 
 was directed to take hartihorn jellies, with 
 ftrong red wine 3 and afterwards being 
 feized with labour-pains, and an increafe 
 of the flooding, I prefcribed five grains of 
 Pil. Matth. which were repeated every 
 hour, until the pains and violence of the 
 flooding abated. The Os Uteri being 
 open, and the membranes pufhed down 
 with the waters, thefe lafl: were pierced 
 with a pair of fciflars, and the waters be- 
 ing' difcharged, the Uterus contracted fo as 
 that its veffels no longer poured forth their 
 contents, and came in contact with the 
 body of the child, which was delivered 
 when the pains returned. About one 
 fourth of the Placenta was then emaciated, 
 and covered with clotted blood, which had 
 taken the form of a white, thick mem- 
 N 4 brane. 
 
1 84 CASES IN MIDWIFERY. 
 
 branc, and lay betwixt it and the Uterus 'y 
 while tlie reft of the Placenta was plump, 
 red, and, covered with frefti grumes 
 of blood. The emaciated part had been 
 feparated, at the beginning' of the flood- 
 ing, and the other in time of delivery. 
 The child was alive, but very fmall, con- 
 fidering it was born in the feventh month. 
 
 CASE VIIL 
 
 Communicated in a letter from Mr. 
 
 dan^ dated dXFolkJione^ April 26, 1751. 
 
 The woman was four months gone with 
 child i had been troubled with a flight 
 flooding at times, for the fpace of three 
 weeks, and mifcarried of the Foetus about 
 ' an hour before Mr. Jordan arrived : and 
 he underftood that the Funis had feparated 
 from the Placenta, and come along with 
 the child. 
 
 The patient was low and faintifh, hav- 
 ing been very; much fatigued by the mid- 
 wife’s trying to extraCf the Secundines : 
 and Ihe had bearing pains that frequently 
 recurred, together with a flight flooding, 
 v.iiich however, was very inconfiderable. 
 He direHed her to drink frequently a lit- 
 tle caudle, and prefcribed an opiate,' by 
 
 which 
 
CASES IN MIDWIFERY. 185 
 
 which her ipirits were recruited, and the 
 pains for the prefent removed : but thefe 
 loon returned after ihe had enjoyed fome 
 reft. 
 
 Upon examination, he found part of 
 the Placenta in the Vagina^ fo that the Os 
 Internum was kept open : and that part 
 which remained in the Uterus adhei ed fo 
 clofely to it, that he could not feparate it 
 without fome difficulty. Immediately after 
 this feparation, the woman was eafed of 
 her pain , but fome time elapfed before fhe 
 recovered her ftrength. 
 
 Many cafes of this kind have occurred 
 in my pradtice. 
 
 When the hsemorrhage was altogether 
 flayed, or continued in fmall quantity af- 
 ter the delivery of the Fcetus, the Secun- 
 dines commonly were expelled by the after- 
 pains. But when the woman’s flrength 
 was in danger of being impaired by the 
 flooding, I always endeavoured to bring 
 them away with my fingers j and when 
 thefe would not reach them, employed the 
 blunt hook for the fame purpofe : nay, 
 when both thefe expedients failed, I have 
 reftrained the flooding by prefcribing opi- 
 ates from time to time, and afterwards 
 
 have 
 
1 86 CASES IN MIDWIFERY. 
 
 have found it more eafily brought away, 
 if it did not come of itfelf. 
 
 If part of the Placenta is come down 
 into the Vagina^ I cautioufly avoid fepa- 
 rating it from what remains in the Uterus^ 
 becaufe in that cafe the Os Uteri would 
 contradt and retain it for a longer time. 
 Whereas the Os internum is kept open and 
 irritated by the protruded part, fo as to 
 occafion every now and then a pain which 
 helps to feparate and force down the 
 other. 
 
 If the Placenta lies loofe, though kept 
 up by the contradlion of the Os Uteri, and 
 there are no pains to force it down, I open 
 the Os internum fo as to admit two fingers, 
 and bring it away with the blunt hook : but, 
 even this method has failed, and a draining 
 has continued for feveral days. I have 
 opened the Os Externum fo as to introduce 
 my h^nd into the Vagina, and infinuating 
 two fingers into the Uterus, have feparated 
 the Adhefion. Then, if I could not pull 
 down the Placenta with my fingers, I have 
 introduced the hook along them, and 
 turning the blunt point above the fepa- 
 rated cake, extra6led it, without further 
 difficulty, taking care all the time, that 
 
 ths 
 
CASES IN MIDWIFERY. 187 
 
 the point was towards the Flacenta^ and 
 did not touch any part of the Uterus. I 
 have tried to extract if with the polypus- 
 forceps, but feldom elFedled the extra6lion 
 without difficulty, becaufe this inftrument 
 takes more room, and is not fo eafily ma- 
 naged. 
 
 There is very rarely occafion for any 
 affiftance of this kind, which fhould ne- 
 ver be ufed, except when the patient is in 
 danger from long, continued drainings. 
 
 CASE IX. 
 
 Communicated by the fame gentleman. 
 
 A woman about five months gone with 
 child, was taken ill with a flight flooding, 
 which was reftrained by taking eight ounces 
 of blood from her arm, keeping her quiet 
 in bed, and giving her opiates from time 
 to time. Yet, on the leafl: motion the dif- 
 charge returned, and in about tive or fix 
 days, labour coming on, fhe was fafely 
 delivered of the Feetus and Secundines by 
 the labour-pains, but, it was a long time 
 before Ihe recovered her ftrength. 
 
 CASE 
 
1 88 CASES IN MIDWIFERY. 
 
 CASE X. 
 
 In the year 1729, J was called to a wo- 
 man who was feized with a pretty large 
 hoemorrhage, and mifcarried in the fifth 
 month. The Funis and membranes were 
 expelled at the fame time, but the Pla- 
 centa remained ; and though the difcharge 
 abated, a draining of blood continued to 
 weaken her, for the fpace of three months 
 after her abortion, when I was called, and 
 found her pulfe low, her countenance pale, 
 and her body emaciated. 
 
 Feeling the Os Uteri very rigid, but fo 
 open as to admit two fingers j I ordered 
 her to be laid in a fupine pofture acrofs the 
 bed, and gradually dilated the Os Exter- 
 mimy fo as to introduce my whole hand 
 into the Vagina. I then tried to dilate the 
 Os Internum^ but without fuccefs. How- 
 ever my hand being in the Vagina^ I could 
 now introduce my two fingers fo as to feel 
 the Placenta^ which was ftrongly com- ' 
 prefled by the Uterus into a confiflence of 
 a fchirrous fubftance, about the fize of a 
 large walnut, or pigeon’s egg. This I fe- 
 parated all round with my fingers, but as 
 I could not bring it down, I introduced a 
 ' long. 
 
CASES IN MIDWIFERY. 189 
 
 long, narrow pointed forceps, which, 
 however, did not fucceed : finally, I had 
 recourfe to the blunt-hook, with which I 
 brought it away in three feparate pieces. 
 The draining was ftopt, the woman reco- 
 vered, and afterwards bore children. In 
 this cafe, the Placenta, inilead of increaf- 
 ing and forming a Mola, according to the 
 notion of foine old writers, was fqueezed 
 into a fmall, round compa6l fubfcance, al- 
 mofi: as folid as a cartilage. 
 
 C A S E XI. 
 
 Communicated by Mr. Hcngejion,.m a letter 
 dated at i^^zV/ 5 ’, Jan. 1753. 
 
 He was called to a woman in the four- 
 teenth week of pregnancy, found her 
 much weakened by a flooding, and was 
 tpld fhe had been four and twenty hours 
 in that condition. On touching, he felt 
 the body of the Uterus, almoft even with 
 the Os Externum, the Os Inter?nim forwards 
 above the Pubis, and the Fundus Uteri back- 
 wards, and clofe to the lower part of the 
 Redlum at the Os Coccygis. 
 
 The woman lying on her fide, he di- 
 lated the Os Externum, and introducing two 
 fingers into the Os Internum, wEich was a 
 
 little 
 
ipo CASES IN MIDWIFERY. 
 
 little open, broke the membranes, in hope 
 that by diminifiiing the contents of the 
 TJteruSy he might ftay the haemorrhage : 
 but, after having waited fifteen minutes 
 to little purpofe, he again introduced his 
 hand into the Vagina^ and vvith his thumb 
 in the Os Vteri^ and his finger prelTed 
 backwards againfl the Fundus, he pulled 
 down the firff, while his fingers pufhed 
 up the Fundus above the Os Sacrum ; upon 
 which the contents of the womb flipt in- 
 to his hand. 
 
 The patient recovered, but laboured 
 under a Prolapfus Vagince^ occafioned by a 
 former fevere labour. She is now again 
 with child, and finding the. XJ term lying in 
 the fame pofition, he defires my advice, in 
 order to prevent another mifcarriage from 
 the preternatural lownefs of the Fundus, 
 which he apprehends will hinder the Ute- 
 rus from ftretching. 
 
 I advifed him to try to raife the Uterus 
 higher, and keep it up witli a round pef- 
 fary, or rather with one of that kind, 
 which have necks, and are kept up with 
 ftraps, tied to a belt that goes round the 
 woman’s waifte. Vide Tab. XXXYIIL I 
 likewife counfelled him to bleed her by 
 
 way 
 
 2 
 
CASES IN MIDWIFERY. 191 
 
 way of preventing a flooding, if her con- 
 •ftitution can bear that evacuation, and to 
 keep her body open. 
 
 Mauriceau^ in Obferv. 385. defcribes a 
 mifcarriage from a woman’s being too 
 much fhaken in a coach. 
 
 April I. 1685. He attended a woman 
 who had mifcarried an hour before, of a 
 fmall child of four months, which he 
 judged from its corruption, to have lain 
 eight or nine days dead in the womb, be- 
 fore nature of itfelf expelled it. The 
 body of this Fret us being very fmall, and 
 quite fhrivelled, had for that reafon, very 
 little dilated the internal orifice, fo that he 
 had no room for the prefent to bring away 
 the after-birth ; and therefore left it to na- 
 ture, which -did the bufinefs twelve hours 
 after. For he judged it better to do fo, 
 than to offer violence to the womb, by di- 
 lating fo much as was neceffary for ex- 
 •tradftng this - foreign mafs. This misfor- 
 tune -was owing to the woman’s being too 
 much fliaken and agitated, by-always ufing 
 a very uneafy coach. 
 
 -In Obfemj.- 614. Mar-ch' 16, 1691'. he 
 delivered a woman who had mifcamed 
 two hours before, of a Foeius of three 
 
 months, 
 
192 CASES IN MIDWIFERY. 
 
 months, which had been dead eight or 
 ten days, as appeared by its corruption* 
 The midwife, for w^ant of fufficient know- 
 ledge in her buhnefs, being incapable of 
 bringing away the after-birth, fo exceffive 
 a flooding was excited by its retention in 
 the womb, that the woman mufl have 
 run a great rifk of her life, if he had not 
 fpeedily delivered her of it, and fo put a 
 flop to the flooding J after which flie did 
 very well. 
 
 In Obferv. 694. he delivered a woman 
 of the after-birth of a fmall Fcetus of two 
 months, of which fhe had mifcarried three 
 hours before, without any manifefl caufe : 
 tie after-birth being retained in the womb 
 after the expulfion of the Fcetus^ occa- 
 fioned fucli a flooding, that the woman 
 had feveral times fainting fits, from which 
 fhe recovered as foon as he had delivered 
 her of that foreign mafs ; for, the flux then 
 ceafed, and the woman did very well. 
 This was the eleventh child of which Ihe 
 had mifcarried. 
 
 In Obferv. April 1687. He attend- 
 ed a woman who was near the brink of 
 the grave, it being the third day fince fhe 
 mifcarried of a child of four months, 
 
 whofe 
 
CASES IN MIDWIFERY. 193 
 
 whole after-birth was left intire in the 
 womb ; for, the midwife was not able to 
 deliver her of it, becaufe of the great dif- 
 ficulty fhe'foundj as file told him. Whence 
 that foreign mafs, there remaining for 
 three days, had caufed a prodigious flood- 
 ing ; and as nature had not yet expelled it, 
 and there was no hope of bringing it 
 away but by violence, becaufe the womb 
 was quite clofed, when he faw the woman. 
 It turned at length to a moft virulent pu- 
 trefaction, which caufed a continual high 
 fever, with tv/o or three exacerbations every 
 day, accompanied with faintings and other 
 fymptoms ufual on thefe occafions. But 
 for all thefe diforders and a bad diarrhoea 
 befides, fhe recovered her health, after a 
 moft grievous and troublefome fit of 
 ficknefs for five weeks. He had fome 
 years before attended the fame woman, 
 when fhe v/as extremely ill in the like 
 manner, after another mifcarriage, where 
 the after-birth had been likewife left be- 
 hind, the midwife not being able to bring 
 it away, and it was expelled by fuppuration 
 like this laft. 
 
 In Obf, 550. Ap?^il 1 6 8 9 . he delivered a wo- 
 man of a male infant, five months and a half 
 ' O grown. 
 
194 CASES IN MIDWIFERY. 
 
 grown, who was ftill alive, though the 
 mother had laboured under a moderate 
 flux of blood, which was almofl: conti- 
 nual, for the fpace of two months, in- 
 creaflng at laft to fuch a degree, as to ha- 
 zard an abortion. In this fituation he ad- 
 vifed the woman to keep her bed, or at 
 leafl: her chamber, that fo flie might, if 
 poflible, preferve her great belly to the 
 end of the term. But, inftead of hearken- 
 ing to his good advice, flie undertook a 
 journey in a coach, which was the diredl 
 way to deftroy her infant, who lived but 
 half an hour, though the niother w^as as 
 well after I had delivered her, as if flie 
 had lain in at the end of the natural term. 
 
 In Obf. 292. Nov.y, 1681. He fays he at- 
 tended a Woman who had mifcarried of a 
 dead child in the fixth month, by being jolted 
 in a coach. Twelve or fifteen days before 
 this accident, fhe had been too much 
 lhaken and jumbled on the road in travel- 
 ing. This brought upon her, pains in the 
 belly, which lafted all that time, till at the 
 end her waters flowed off in great abun- 
 dance without any real pain. As the in- 
 fant prefented an arm, the midwife believ- 
 ing at firU fight it was the foot, took no 
 
 cafe. 
 
CASES IN MIDWIFERY. 195 
 
 care, but drew it out as far as the Ihoul- 
 der, which put the child in a more unna- 
 tural poilure than it was in before. In this 
 fituation of affairs, being ordered to at- 
 tend the woman, he pufhed back the arm 
 into the womb j but as all the waters were 
 entirely run off the day before, and the 
 orifice of the womb was too flrait, and 
 too dry for him to introduce his hand 
 without violence ; in order to turn the 
 child, he judged it more prudent to trufl 
 nature with the expulfion of the child, 
 than attempt it with a too forcible extrac- 
 tion, plainly forefeeing, that fince it was 
 very fmall, it might eafily come away in 
 the fame pofture it was in, when the 
 womb fhould be fufficiently dilated ; be- 
 caufe the woman had already been mother 
 to a child that was full grown, and gone 
 out her term. It happened as he foretold, 
 twelve hours afterwards, nature of its own 
 accord expelling the child, by means of 
 fome pains which were excited by a cly- 
 fler he had prefcribed, and which had fuf- 
 ficiently dilated the orifice. But, the mid- 
 wife who flayed to attend her, miffing the 
 opportunity, let the womb clofe itfelf, and 
 could not bring away the after-birth, which 
 O 2 remained 
 
196 CASES IN MIDWIFERY. 
 
 remained fix hours longer, after which 
 nature of itfelf expelled it as it had done 
 the child j and the woman being thus hap- 
 pily delivered, did very well afterwards. 
 He did not know, but if he had tried to 
 take away the child by force, as he was 
 defired when he firft came, the violence 
 he muft have ufed in dilating the orifice, 
 fo as to be able to introduce his hand, 
 might have been very prejudicial to the mo- 
 ther j whom he prefeiwed by prudently com- 
 mitting the bufinefs to nature for reafons 
 declared above. 
 
 InObfer.z^. ibjo.Nov.io. He tells us he 
 attended a woman fix months gone, who 
 for eight days paff, had a mojderate flux of 
 blood, in which were fome clots, occafioned 
 by the fhocks of a violent cough, which had 
 enlarged the orifice of the Uterus to a fin- 
 ger’s breadth j for this reafon he told her 
 file would certainly mifcarry in a little 
 time, although file felt no pain at prefent, 
 becaufe he was afilired, from the opening 
 of the orifice and difchargc of blood, that 
 it was impofiible for the agitation of fo 
 violent a cough not to aceomplifli the mif- 
 chief it had begun. The event anfwered, 
 for the next day the woman mifcarried of 
 
 a 
 
CASES IN MIDWIFERY. 197 
 
 a child, which lived but a day and an 
 half. 
 
 In Ohferv. 164. We find Xh 3 .t April 21, 
 1676. he attended a woman who had mif- 
 carried three hours before of a dead child of 
 four months. Three weeks before this, fhe 
 had received fome hurt in a crov/d at 
 church, from which time (lie always felt 
 great pains in her belly, and about the ninth 
 day after this accident, began to void a 
 little blood. From that time, flie never 
 felt her infant move, but had the misfor- 
 tune to lofe it without the after-birth, 
 which remained behind, the midwife not 
 being able to bring it away, becaufe the 
 womb clofed immediately on the expulfion 
 of the child. Having himfelf examined 
 whether there could be any means found 
 put to eafe this woman, and having dif- 
 covered, that the orifice of the womb was 
 only open enough to receive one finger, 
 he judged it the fafeft way at prefent to 
 trull nature, and pollpone the doing her 
 any violence, by endeavouring to extradl 
 this afteivbirth by fo narrow an orifice, 
 the remedy, in this cafe, appearing to him 
 worfe than the difeafe. So he deferred it 
 to the next day, when finding the womb 
 O 3 much 
 
198 CASES IN MIDWIFERY. 
 
 much more dilated, he happily delivered 
 her of her burden, and though fhe had at 
 that time a fever upon her fhe did very 
 well afterwards. 
 
 In Obferv. 508. He writes that in Nov. 24. 
 1687. he attended a woman who had juft 
 before mifcarried at the end of two months 
 and a half, of a fmall Fcetus no bigger than 
 a bee, which nature had expelled with a con- 
 fiderable quantity of blood, which had 
 been preceded by a diftillation of reddifh 
 fcrolity for feveral days. When he was 
 called to deliver her of the after-birth, he 
 found the womb was entirely fhut, and 
 that there was no way to bring it off but by 
 violent means, which might be more pre- 
 judicial to the mother than the relief he 
 could promife her from the extradfion, 
 would have been beneficial. For this rea- 
 fon he thought proper to truft nature with 
 the bufinefs, which was not accomplifhed 
 till the twelfth day after, the foreign mafs 
 lying all that while in the womb, and 
 was then expelled half fuppurated, after 
 which the woman did well. 
 
 The principal caufe of this abortion, as 
 he fuppofed was a great coftivenefs, in the 
 time of pregnancy, which in this woman 
 
 was 
 
CASES IN MIDWIFERY. 199 
 
 • V- 
 
 was fo extraordinary, that fhe was fome- 
 times fifteen whole days without going to 
 ifoolj fo that the great efforts fhe made 
 to eafe herfelf of excrements, exceffively 
 baked and hardened by fo long a flay, 
 did at the fame time very forcibly com^ 
 prefs the womb, which might very well 
 be fuppofed to fhake and loofen, and at 
 lafl expel the newly-conceived Foetus, as 
 was the cafe with this woman, who had 
 mifcarried feveral times before. 
 
 The following cafes are from Lamotte. 
 
 In Obferv. 129. In the year 1687. the 
 fmall-pox raged mValognesy which was more 
 fatal than general, mofl of thole that 
 caught it dying of it. Among others, a 
 lady of diflindlion, fix months gone with 
 child or thereabouts, fell ill with it j all 
 went exceeding well, the fever was mode- 
 rate, the puflules large, railed and white, 
 when on a fudden lire was taken -with a 
 convulfion j in lefs than half an hour the 
 puflules went in, and her whole body 
 turned black and mortified. He happen- 
 ing to be there by chance, gave her a few 
 fpoonfuls of wine j fome pains followed,- 
 and he delivered her immediately of a 
 O 4 live 
 
200 CASES IN MIDWIFERY. 
 
 live child, who died foon after j another 
 convuifioii came on and die died. 
 
 In Objerv, 15 1. A young woman that 
 lived two leagues off, having reached the 
 fifth month of her pregnancy, found her- 
 felf ill, as die thought, with the cholick. 
 Her mother fent for him in hade, left die 
 diould be in labour, as die really was, for 
 he found her brought to bed of a child of 
 five months, who was dill alive when he 
 came. As the Placenta had followed, he 
 left her to the care of her mother. This 
 young woman being again with child fome 
 time after, mifcarried again about the fifth 
 month, and • fo fuddenly, that they had 
 not time to let him know it: die came off 
 as well this time as before. Being a third 
 time wldi child, die was exceedingly watch-«r 
 ful over herfelf, to do nothing that could 
 forward her delivery. He bled her three 
 times in the fix di d months, and kept her 
 to a very regular moidening diet. She 
 carried her child to the feventh month j it 
 lived but a few days, He imagining it 
 was ov/ing to her regularity, that die car- 
 ried this child longer than ufual, die re- 
 folved to be dill more cautious the next 
 time j to that effedl, he bled and purged 
 
 her 
 
201 
 
 CASES IN MIDWIFERY. 
 
 her twice, after her getting up from this 
 lying in. He repeated the bleeding as 
 foon as fhe was breeding, and kept to it 
 every month. He kept her to a cooling 
 moiftening diet, not fuffering her to eat 
 any thing roafted or to drink any Ilrong 
 liquor : whether it was owing to this con- 
 ducl, or any other reafon, fhe was not 
 brought to bed before the ninth month, 
 and her labour was eafy, as it happened 
 alfo twice after this. But being with child 
 again, and more difordered at the fifth 
 month than fhe had been in the ninth, in 
 her three preceding pregnancies, fhe was at 
 fix months feized with labour-pains, and 
 the waters came away : fhe fent for him, 
 and he delivered her in a little while of 
 two little boys, who were alive, but died 
 foon after. He afterwards brought away 
 a large Placenta common to both children, 
 and fhe foon recovered. He has feveral 
 times fince laid her of one child only, whom 
 fhe has carried her full time, without any 
 inconvenience, 
 
 What follows is from Giffard. 
 
 In Cafe ii8. April i. 1730. He was 
 fent for to a poor woman in Knaves- Acre ^ 
 
 the 
 
202 CASES IN MIDWIFERY, 
 
 the wife of a fmith. She was about fix 
 months gone with child, and had been 
 feized with a flooding feme days be- 
 fore, for which her midwife had lately 
 come to confult him, when he order- 
 ed an aftringent mixture to be taken, to 
 the quantity of three or four fpoonfuls, 
 now and then, and a quieting aftringent 
 draught, to be continued every night, in 
 cafe her flooding did not flop. He like- 
 wife defired they would give him an account 
 of her the next dayj at the fame time tell- 
 ing the midwife that in cafe it continued, 
 the only means left to fave her life was to 
 deliver j but, as the method here preferib- 
 ed, had, in fome meafure, the defired ef- 
 fe£l for the prefent, he heard nothing far- 
 ther for two or three days : her flooding, 
 however, returning again, her hufband 
 came to him, and defired he would viflt 
 her ; which accordingly he did, and upon 
 examination, found the Os Internum not 
 dilated enough to receive the end of one 
 finger, and not eafily to be dilated j where- 
 fore he advifed a repetition of the medi- 
 cines before preferibed, and on the next 
 day, tlie man called again to tell him that 
 the draining continued, but was not fo 
 
 violent j 
 
CASES ra MIDWIFERY. 203 
 
 violent j however, as Ihe became weaker, 
 |ie defired he would fee her. He then found 
 the Os Internum as it was the precedent 
 day ; and, as he could not dilate it with his 
 fingers, he adyifed a continuance of the 
 mixture and draught. On the third day, 
 the midwife fent him word that the drain- 
 ing continued, but that the Os Internum 
 was dilated fomewhat more than the pre- 
 cedent day ; which gave him encourage- 
 ment to hope, that he might dilate it wide 
 enough, to pafs his hand and bring away 
 the Foetus. Upon his touching, he found an 
 opening large enough to admit the end of 
 three fingers, wherefore he endeavoured to 
 dilate it with his fingers, and ftretching 
 them wide from each other, he got in his 
 thumb, and afterwards his whole hand. 
 The firfl; thing he met with was part of 
 the Placenta feparated from the Uterus^ and 
 palling his hand by it, he felt the child 
 inclofed in the membranes, and floating in 
 the waters: he readily broke the mem- 
 branes with his fingers, and palling his 
 hand within them, foon met with a leg, 
 which he drew out, and taking hold of it 
 with a foft cloth, he gently pulled towards 
 him, at the fame time, advifing the woman 
 
 to 
 
204 CASES IN MIDWIFERY, 
 to affift by bearing ftrongly down ; and by 
 this method he prefently extracted the Foetus 
 whole and entire ; he was indeed afraid, as 
 it was very tender, that the limbs would 
 have feparated from the body ; the Pla- 
 centa readily followed, being before in part, 
 if not wholly, feparated from the Uterus : 
 the flooding flopped immediately on the 
 delivery. 
 
 Mr. Giffard gives a hiflory, in Cafe 1 57. 
 of a Feetiis above fix months old, contain’d 
 in a Sacculus without the womb, and pro- 
 truded through the Anus. Vide Extra-ute- 
 rine Fcetufes, Collect. V. 
 
 Mr. Chapman/m p. 206. gives the cafe of 
 a child that was delivered at the Anus about 
 fix or feven months old. There is likewife 
 
 An Account of an abortion, by Mr. 
 Monro, in the Medical Effays of Edinburgh, 
 Vol. II. p. 235. And of 
 
 Haemorrhages of the womb, flopp’d by 
 Puh. Stip. Helvetii. Voi. IV. p. 38. 
 
 To thefe it will not be improper to add 
 fome examples from Hoffman. 
 
 In Vol. III. p. 183. Obferv. i. We read of 
 a woman fifty years of age, the mother of 
 feveral children, who mifcarried in the third 
 
 month 
 
CASES IN MIDWIFERY. 205 
 
 month of her pregnancy, from a violent 
 fright and cold to which Ihe expofed herfelf. 
 There followed immediately a violent flood- 
 ing ^ after this fhe laboured under an uterine 
 hsemorrhage, which fometimes flopped for 
 a little, but immediately broke out again : 
 her belly fwelled, and fhe had frequent 
 palpitations, which made her fufpe6I her 
 being again with child, till a year had 
 elapfed. The tumor of her belly was 
 fometimes tenfe and hard, at other times 
 foft, her feet fwelled in the evening, and 
 fhe felt a weight in the hypogaflric re- 
 gion. 
 
 Various carminative laxatives and cly- 
 ffers were in vain adminiflered j but after 
 three days ufe of the Caroline mineral wa- 
 ters, the haemorrhage ftopt, and by conti- 
 nuing to ufe them, fhe evacuated a great 
 quantity of vifcid matter, both by flool 
 and urine, and the fwelling of her belly 
 fubfided. Wherefore, fhe entered the bath, 
 and after once bathing had violent pains 
 and fpafms, juft like thofe of a woman in 
 labour, and evacuated from the Uterus 
 fome flefh-like membranous bodies, com- 
 monly called MolaSy after which flie per- 
 fectly recovered her health. 
 
 In 
 
 2 
 
2o6 cases in midwifery. 
 
 In Vol. III. p. 183. Obf, 2. We have the 
 cafe of a young woman of a lax habit of body, 
 who had mifcarried four times in the third 
 and fourth months of her pregnancy. Being 
 with child a fifth time, fhe was blooded in 
 the third month j about her ordinary time 
 of aborting, file found fpafms, flatulencies, 
 and compreflion of her loins and Abdomen, 
 fuch as file w^as ufed to have formerly 
 when fhe mifcarried ; which, however, 
 were removed by fome antilpafmodic me- 
 dicines, by embrocating her Abdomen with 
 his Balfamum Vita, and by the application 
 of toafled bread to the umbilical region. 
 She had fome fpafms and pains in the fe- 
 venth month, but kept her burthen till 
 the ninth month, when fhe brought forth 
 a live child. 
 
 She conceived again, and by being blood- 
 ed in the third and feventh months, car- 
 ried her child to the full time. 
 
 InObferv. p. 185. We find that a flrong 
 vv^oman, thirty years of age, who had had 
 two live children, but afterwards fuffered fix 
 abortions, two in the feventh, and four in 
 the fifth months, being again pregnant, 
 had an uterine haemorrhage in the third 
 month, and was again threatened with 
 
 abortion % 
 
CASES IN MIDWIFERY, 207 
 
 abortion; but by letting blood immedi- 
 ately, the hsemorrhage ceafed ; by repeating 
 it often, and drinking nothing but pure 
 water, taking fome of the teftaceous pow- 
 ders, and by applying Barbetfs faponace- 
 ous plaiilers, with fome of the Oleum Hyof- 
 cia?ni, to her loins, fhe brought forth a 
 live child at the full time. 
 
 Hoff?na}i imagines the former abortions 
 to have been owing to the woman's being 
 plethoric, and drinking ftrong wine for 
 her ordinary drink, which fhe was ufed 
 to do. 
 
 In Vol. II. Sect. I. Ch. V. de Uteri Hamor- 
 rhagia immoderata, he relates the cafe of a 
 woman, of a healthy and plethoric habit of 
 body, twenty-eight years of age, and three 
 months gone with child, who was taken 
 with a difcharge of blood from the Vagina^ 
 which continued in a fmall degree for four- 
 teen days. But from ufing too violent 
 exercife, fhe was taken with a profufe flood- 
 ing, which threw her into faintings : after 
 trying both internal and external remedies 
 to no purpofe, he being called in to re- 
 lieve the patient in this extremity of dan- 
 ger, immediately ftuffed the Vagina with 
 tow, dipt in a folution of the Caput mor-- 
 
 tuum 
 
2o8 cases in midwifery. 
 
 tuum of vitriol, by which the difcharg'i 
 was in a very little time Rop’d, and by 
 corroborating diet and medicines, her 
 Rrength was recruited. The lint three 
 days after was extradled with great diffi- 
 culty, from its being matted and concreted 
 with the grumous part of the blood, on 
 which followed alfo a fmall fleffi-like fub- 
 ftance, with a little uncoagulated blood. 
 By taking proper medicines, with a nou- 
 riffiing diet, the patient recovered, after 
 which fhe was again pregnant, and fafely 
 delivered. He, in that part of his works, 
 where he treats, Convuljione Uteri^ five 
 Abortu^ gives ten different cafes of abor- 
 tions ; and although his method of pre- 
 fcribing is different from the praftice here, 
 yet his intentions of cure are the fame. 
 He orders venaefeefion, when neceffary, to- 
 gether with affringents, opiates, corro- 
 borating and laxative medicines, according 
 as the exigence of the cafe requires. 
 
 I find in practice, that the flooding com- 
 monly diminiffies, and frequently flops, 
 when the membranes break, and the wa- 
 ters come off : though in fome, the flood- 
 ing has continued, and in others, has been 
 immediately carried off by delivering the 
 
 Fla- 
 
^ASES IN Midwifery. 20^ 
 
 Placenta. This difference fhews, that thofe 
 who run into extremes, either in hurrying 
 off the Placenta in all cafes, or in leaving 
 its expulfion always to nature, err • for, a 
 pradlitioner ought to vary his method in 
 thefe cafes, as well as in others, according 
 as it fhall appear mod: proper, as in the 
 foregoing cafes of abortion from Mauri-^ 
 ceau. 
 
 NUMB. in. CASE I. 
 
 Of Marks and Mutilations. 
 
 When I defired the w^oman mentioned 
 in No. II. Cafe 7. to put out her tongue, 
 that I might examine it, in confequence 
 of her complaining that it was dry and 
 parched, I obferved fomething on the tip 
 of it like a plumb, of a green colour, 
 hard and painful. She told me that when 
 plumbs begin to ripen, it grows larger, 
 fofter and lefs painful, acquires a blue, 
 reddifh or purple colour, and fhe feels an 
 hard grifly fubdance like the done in the 
 middle : in winter it fhrivels and decreafes, 
 and next feafon refumes the fame appear- 
 ance. It feeras when her mother was with 
 child of her, fhe longed for fome plumbs, 
 which fhe cheapned, but would not buy, 
 P becaufe 
 
£10 CASES IN» MIDWIFERY, 
 
 becaufe flie thought them too dear j how- 
 ever, file had touched the tip of her tongue 
 ■with one of them, which fhe afterwards 
 threw down, and by this tranfient touch 
 the child was affe6led in the fame place, 
 
 CASE II. 
 
 I delivered a woman in the eighth month 
 of a child, from the outfide of whofe lit- 
 tle finger of the right hand, hung an ex- 
 crefcence about the fize of a nutmeg, re- 
 fembling one of the fmall potatoes, that 
 are ufed for feed, both in the colour, and 
 little indentations on its furfacej and fome 
 of the women affirmed the mother had 
 longed for that food, before delivery : the 
 tumor dropped off in a few days, in con- 
 fequence of a ligature tied round its neck : 
 but, the child had likewife a fuperfluous 
 little finger on the other hand, and a fu- 
 pernumerary little toe on each foot. 
 
 Notwithftanding thefe examples, I have 
 delivered many women of children ^vho 
 retained no marks, although the mothers 
 had been frightened and furprized by difi- 
 agreeable obje6ls, and were extremely ap- 
 prehenfive of fuch confequences. One wo- 
 man in particular, when three months 
 
 gone 
 
CASES MIDWIFERY. 21 1 
 
 gone with child, was furprized upon open- 
 ing the door, by a beggar’s thrufting a 
 bare Rump in her face, a circumftance, 
 which alarmed her to fuch a degree, that 
 Ihe made herfelf and all about her un- 
 happy, being fully perfuaded that her child 
 would be born with the fame mutilation j 
 and indeedj Ihe could fcarce be convinced 
 of the Contraryj when Ihe felt the child’s 
 arms, after it was delivered* 
 
 Schenkms, in Lib. IV* Je Gra^oldis^ from 
 p* 621* to 625* relates feveral obfervations 
 on the ftrange effects, produced from the 
 imaginations of pregnant women, occa- 
 fioned by different accidents that happen 
 to them in that ftate* 
 
 In the PhiL ^ranf. No. 493. p* 205. is 
 part of a letter from Mr. Be?t. Coke, F.R.S. 
 concerning a child born with the jaundice 
 upon it, received from its father ; and of 
 the mother’s catching the fame diftemper 
 from her hulband the next time of being 
 with child. 
 
 WAe EphemerUts Ann. Oftav. Obferv. 46. and 55. Anni 
 g, and to. Obferv. 23. Decuria fecunda Ephtmeridarum^ 
 Ann. prim. Obferv. 40. 
 
 MauriceaUy in p. 288. and Obferv^ 348. 
 relates his having delivered a woman of a 
 P 2 child. 
 
212 CASES IN MIDWIFERY. 
 
 child, whofe head was of a monftrous 
 figure, being all made up of face, as it 
 were, with great gogling eyes. It had to- 
 wards the Occiput a flefhy mafs, almoft 
 like the Placentay which feemed to come 
 out of the Cerebellum and nape of the 
 neck. The mother had felt this child 
 move in her womb, with more force than 
 her other children ; but it was dead born, 
 it having remained long in the paflage, 
 and afterwards been turned. The mother 
 imputed its monflrous fhape to her hav- 
 ing fixed her eyes fledfaftly on the figure 
 of an ane. 
 
 X 
 
 Vide Thil. Tranf. No 456. p. 341. and No. 461. p. 764. 
 
 I have delivered many women who were 
 prepoffeffed with things of this kind be- 
 fore delivery, which I have never yet found 
 to happen as they imagined. 
 
 I delivered a child lately who wanted 
 all the fingers of one hand, a circum- 
 ftance which was concealed from the mo- 
 ther for feveral days, and on alking her 
 before fhe knew of it, fhe acknowledged 
 that nothing extraordinary had happened 
 to her during her pregnancy. 
 
 COL- 
 
CASES IN MIDWIFERY. 213 
 
 COLLECTION XIIL 
 
 Of the htuation of the child during preg- 
 nancy, the figns of conception and pre- 
 mature labour, 
 
 NUMB. I. 
 
 Of the lituation of the child in Utero. 
 
 Vide Vol. I. L. 3. Ch. I. and II. 
 
 During a fuccefllon of many years, I 
 have been called to women who mifcarried 
 in the fourth or fifth month, and gene- 
 rally found the head prefenting. In the 
 years 1727. and 1748. I was concerned in 
 two cafes where the arms came down, and 
 were forced along double. In 1746. I de- 
 livered a woman in the fixth or feventh 
 month, with the waters and Secundines un- 
 broke, and there the head prefented. In 
 the year 1752, I found the Placenta pre- 
 fenting, and being forced down in the Fi?- 
 gina^ the head pufhed it out after the mem- 
 branes were broke. In the year 1747. a 
 woman in the fixth month, was brought 
 to bed of twins, and both children pre- 
 fentsd with the breech, and were fo deli- 
 P 3 vcrcd 
 
2:14 CASES IN MIDWIFERY. 
 
 vered one after another by the labour- 
 pains. 
 
 In the year 1751. Mr, Hunter opened a 
 woman, who died near her full time, and 
 found the head prefenting j the very next 
 year he had occafion to difiedl; another 
 fubjeft of the fame kind, and found the 
 child nearly in the fame fituation. In 
 both cafes, according to Mr, Quid s alle- 
 gation, one ear was to the Pubis, and the 
 other to the Sacrupi. 
 
 From thefe fubje£ls, fome very accurate, 
 ufeful, and curious plates, will be publilhed. 
 
 Pr, Camper, profeffor at Franiker in 
 Friejland, opened a womai:^ in whom the 
 child was htuated in the fame manner; 
 and I myfelf find the head prefenting fo, 
 in almoll: all natural labours. 
 
 Fix, Monro fhpwed me, Dec. 1753. fome 
 drawings of a fubje 61 :, which his father 
 had the preceding winter diflefled m the 
 public theatre ; tables of which are juft 
 publifhed in the Pkil. ‘Franf. of Edmburgh, 
 This was a woman faid to be fix months 
 gone with child, in whofe Uterus the Fcetus 
 lay in a longifti form, with the legs and 
 breech to the Fimdus, the head refting on 
 the brim of the Pelvis, and the fore-parts 
 
 of 
 
CASES IN MIDWIFERY. 215 
 
 ©f the child to the back-part of the womb, 
 though turned a little towards the left-lide. 
 He obferves, that though this F^tus, and 
 thofe examined by Mr. Hunter^ were found 
 with the head downwards ; yet this does 
 not feem to be always the cafe : for, the 
 children .appeared with their heads upper- 
 moft, and their faces towards the mother’s 
 belly, in one woman who died when eight 
 months gone, in another, who believed 
 herfelf at the full time, and in a third, 
 fuppofed to be in the feventh month, dif- 
 fedled by his father and himfelf. 
 
 LamottCy in Chap. XXI, Book I, gives 
 three inftances of pregnant women, whom 
 he had occafion to open. 
 
 In the firfl:, who was fix months gone, 
 and died of an apoplexy, the head, hand 
 and feet of the child occupied the inferior 
 part of the Uterusy while the back formed 
 a kind of vault, conformable to the fhape 
 of the womb, and the Placenta was be- 
 tween them. 
 
 In the fecond, who being five months 
 gone fell into a fainting, of which fhe did 
 not recover, the child lay acrofs the Uterus 
 with the legs bent up. 
 
 P 4 
 
 In 
 
2i6 . CASES IN MIDWIFERY. 
 
 In the third, who died in the fixth month, 
 of a fluxion upon her bread:, attended 
 .with a continual fever, the child’s legs 
 and buttocks were towards the bottom 
 of the VteruSy and the head downwards, 
 as in natural labours. 
 
 Vide Tab. 6, 7, 8, and 9. 
 
 From Dr. G arrow ^ dated Barnet^ Feb. 4, 
 
 1754^ 
 
 Sir, 
 
 The few following remarks I lately made 
 on opening the body of a young woman 
 juft dead, of a flooding, in the beginning 
 of the eighth month. 
 
 1. The Uterus, diftended by the waters, 
 "Placenta and Foetus, appeared pretty much 
 of an oval figure, prominent in the middle 
 and gradually flattening towards each fide, 
 
 2. The Fundus reached rather above the 
 middle fpace between the navel and Scro-r 
 biculus Cordis, prefflng up the Omentum and 
 Intefiines, fo as to make it eafily appear, 
 why umbilical ruptures are lefs' troubler 
 fome to women in the laft months of 
 pregnancy. 
 
 3 . The thicknefs of the Uterus was about 
 a quarter of an inch, as near as I could 
 guefs, without meafuring. 
 
 4. T|ie 
 
CASES IN MIDWIFERY. 217 
 
 4. The child lay on its -left fide, the 
 head prefenting, confequently the face and 
 fore-parts turned towards the. mother’s 
 right fide ; though not dire6Hy, but rather 
 inclining towards the Os Pubis. 
 
 5. The Placenta adhered to the Os Inters 
 num, nearly by its middle, or thickeft part, 
 in which part, I perceived a laceration up- 
 wards of an inch long, and penetrating 
 almoft through the fubftance of the Pla^ 
 centa, 
 
 6. There was not the leaft appearance 
 of blood in the navel-ftring, except a few 
 drops juft by the child’s belly j and I be- 
 lieve the whole quantity in mother and 
 child, at that time, was very inconfiderable, 
 but I had no opportunity of examining 
 further. 
 
 NUMB. II. CASE I. 
 
 Of the Signs of Conception. 
 
 In the year 1747. I vifited a woman 
 who was attacked by a fuper-purgation, in 
 the third month of her fecond pregnancy, 
 and dreaded a mifcarriage. I prefcribed 
 opiates, by which her diforder was imme- 
 diately reftrained ; but I could not diftin- 
 guiih the period of her geftation, by the 
 
 touch 
 
SI 8 CASES IN MIDWIFERY. 
 
 touch in the Vagina, becaufe the Uterus 
 moved eafily up and down. She had un- 
 dergone a regular difcharge of the Cata^ 
 menia in her former pregnancy, and in 
 this they had twice appeared j but, her 
 ficknefs at ftomach and reaching, which 
 fhe had before experienced, were the fymp- 
 toms from which fhe concluded herfelf 
 with child. The loofenefs was foon ftopt, 
 and fhe felt the motion of the F^tus in 
 about fix weeks, when the other diforders 
 abated. Vide Tab. VI. 
 
 CASE II. 
 
 In the fame year, I was confulted by 
 another patient, who had a regular dif- 
 charge of the Menfesy without Teachings ; 
 but fufpe6led herfelf of being pregnant, 
 by feeling a greater fulnefs about the third 
 month, and the bulk of the Uterus which 
 kept up the intellines ; and in five or fix 
 weeks after, her fufpicion was juflified by 
 tlie motion of the child, 
 
 CASE III. 
 
 In the year 1742, I was confulted by a 
 midwife about a woman fuppofed to be in 
 the eighth month of her pregnancy. I 
 
 was 
 
 T 
 
CASES IN MIDWIFERY. 219 
 
 was told fhe had been feized with a flood- 
 ing, and in danger of mifcarrying in the 
 fifth month, when a gentleman of the 
 profcflion was called, and ufed the com- 
 mon methods of reftraining the difcharge. 
 This happened twice after, and blooding 
 with reftringents were as often repeated. 
 The midwife, obferving that the patient 
 was not fo big as flie expelled to find her at 
 that period, defired me to examine, and I 
 propofed that the other gentleman fbould 
 be called to the confultation 5 but was given 
 to underfliand, that he was difrnifled, and 
 would never be employed again in the fa- 
 mily. The Os Internum was fmooth, and 
 with my finger in the Vagina^ I could eafily 
 move the Uterus upwards, and from fide 
 to fide, while the lower part of the Abdo- 
 men was perfeftly foft : from thefe obfer- 
 vations, I declared, that if fhe was at all 
 pregnant, fhe could not be above three or 
 four months gonej and flie afliired me, 
 that if fhe was not in the eighth month, 
 fhe xould not be with child at all. I then 
 concluded, that fhe had been obftrufted 
 four periods, and that the return of the 
 Menjes, had been miftaken for a flooding ; 
 and this was'certainly the cafe ; for, flie 
 
 continued 
 
220 CASES IN MIDWIFERY. 
 
 continued regular, without any other fympJ 
 tom of pregnancy. The gentleman, who 
 at firft attended her, had a few months be- 
 fore this occafion, affirmed, that he could 
 at any time difcover, whether or not a wo- 
 man was pregnant, and tell the period of 
 her geftation within eight days of the ex- 
 a6t truth. 
 
 C A S E IV. 
 
 Some years ago, I was follicited by the 
 midwife of Mary le Bon work-houfe, to 
 go thither, and fee a girl about twelve 
 years of age, luppofed to be eight months 
 gone with child, who was fent by the 
 overfeers of the parifh, to lie-in at the 
 Jioufe. She told me that feveral gentle- 
 men of the profeffion, as well as midwives, 
 had examined her ; that one of them had 
 offered to deliver her gratis^ and fome 
 others had made great intereft to be pre- 
 fent at the occafion. I accompanied the 
 midwife, and firft of all examined the ex- 
 ternal parts, when finding the paffage fo 
 fmall, that I could not introduce the tip 
 of my little finger, I made no hefitation 
 in declaring, that ftie had never converfed 
 with man. I found a large fwelling be- 
 twixt the Scrobiculus Cordis and the navel, 
 
 which 
 
CASES IN MIDWIFERY. 22 1 ' 
 
 which appeared to be the liver very much 
 enlarged. The Uterus it could not be j for 
 I pullied my fingers quite below it, and 
 prefled in the parietes of the Abdomen^ al- 
 moft to the Vertebrce of the loins. The 
 girl had been advertifed, and the matron 
 had got money from numbers who went 
 to fee her j and notwithftanding my de- 
 claration, the farce was carried on, until 
 people began to fufpe6t the deceit, when 
 fhe was fent to one of the hofpitals, for 
 the cure of her hepatic diforder. 
 
 CASE V. 
 
 I was called by a lady, to prefcribe me- 
 dicines for a favourite maid, who was 
 obftru6led ; and from whofe florid coun- 
 tenance, I immediately fufpe^led there was 
 fomething extraordinary in the cafe : for 
 women troubled with Ample obftru61;ions 
 of the Catamenia^ are commonly, in the 
 fixth month of the obftru6lion, of a pale, 
 bloated complexion. With great difficul- 
 ty file was prevailed upon to let me exa- 
 mine the ftate of the Uterus, by the touch, 
 when I plainly felt the ftretching of the 
 womb, in the Vagina, as well as the cir- 
 cumfcribed tumor a little below the Umbi- 
 licus. 
 
222 CASES IN MIDWIFERY* 
 
 licm. By which circumflances, I was cer^* 
 tified of her being fix months gone with 
 child. 
 
 In many cafes, however, when the wo- 
 man is fat, it is impoffible to judge from this 
 Ilretching, ’till about the feventh or eighth 
 month. 
 
 Lamottey in Chap. XI. Book I. gives le- 
 veral cafes on the infallible figns of preg-^ 
 nancy, in the laft four or five months of 
 uterine geftation. 
 
 Schenkiusy in Lib. JV". de ConceptionCy p* 
 617. compiles from different authors, fe- 
 veral obfervations of young girls, who 
 have conceived and bore children at the 
 age of eight and nine ; as well as of wo* 
 men pregnant after the age of threefcore. 
 
 HildanuSy Cent. 2. Obferv. 60. mentions 
 a girl of eleven, who had the Menfes j and 
 in Obf. 61. affirms, that this difcharge 
 continued in a woman to the age of fe^ 
 venty-eight. 
 
 In the Memoirs of the academy of Sci- 
 e 7 ices at Parisy FI. 1710. p. i6. we find 
 an account of a woman aged eighty*three, 
 who married a man of ninety-four, g.nd 
 was brought to bed of a boy at the full 
 time. 
 
 O 
 
 NUMB. 
 
CASES IN MIDWIFERY. 223 
 
 NUMB. III. CASE I. 
 
 Of premature Labour. 
 
 In the year 1728, a woman imagining 
 flie had gone her full time of a firft child, 
 fent for the midwife, who had attended 
 her three days, when the hufband came 
 and delired me to order fome medicines 
 to quicken the pains, or if I thought it 
 more necelTary, to go and fee his wife. 
 When I went to his houfe, I found the 
 midwife at work in ftretching the parts, 
 and, to ufe her own phrafe, in making 
 room for the child to pafs. I fat down to 
 wait for a pain during which I might exa- 
 mine, but nothing of that kind happen- 
 ing, I introduced my finger into the Va- 
 gina, and felt the Uterus quite light, with- 
 out the leaft diftenfion, nor was any 
 ftretching perceivable in the Abdomen. 
 Vide Tab. V. I then declared, fhe was 
 either not at all pregnant, or very young 
 with child, to the aftonifliment of all the 
 women, who coujd fcarce believe that the 
 midwife, who was not a young beginner, 
 could be fo far miftaken. For their fatif- 
 fadlion, I defired they would fend for ano- 
 ther midwife, who confirmed my declara- 
 tion. 
 
224 CASES IN MIDWIFERt. 
 
 tion. The woman had never been regu-a 
 lar in her Mejifes^ of which but a little 
 appeared at a time, and that feldom, and 
 this fmall evacuation, in all probability, 
 proceeded from her having been weakened 
 by large difcharges from fcrophulous ul- 
 cers. However, in eight months after this 
 period, flie was delivered of a full grown 
 child j and in all likelihood, the uneafi- 
 nefs of which die complained, when I was 
 called, was no other than breeding com^ 
 plaints. 
 
 CASE II. 
 
 In the year 1744, a young pra6litioner 
 in midwifery, having attended a patient 
 all night, fent for me in the morning, and 
 told me that the Os Uteri was a little open- 
 ed, that the membranes were broke and 
 tlie head prefented ; that the woman had 
 flight pains, and he had tried to flretch the 
 parts to no purpofe. Upon examination, 
 I found the Os Uteri open to the breadth 
 of half a crown, but thick and rigid; and 
 after Iraving waited fome time, obferved, 
 that the pains were flight and feldom re- 
 curred. This was her flrfl: child, and ac- 
 cording to her acco-unt, flie wanted three 
 weeks of being at the full time. 
 
 I 
 
CASES IN MIDWIFERY. 225 
 
 I told the gentleman, that in my opi- 
 nion, this was not real labour ; and that 
 the pains had been brought on by a loofe- 
 nefs, with which the was attacked the 
 preceding day. In confequence of my 
 advice fhe was blooded (her pulfe being 
 quick) and took an opiate, which carried 
 off the pains : though in three weeks the 
 real labour came on^ 
 
 CASE III. 
 
 In the year 1749, I attended a woman 
 come to the full time, of her firfl child ; 
 fhe had for three days been fubje6l to flight 
 pains, which recurred every now and then : 
 the Os Uteri was a little opened, but thick, 
 and as the head prefentedj though the 
 membranes had broke too foon, I refolved 
 to allow fome time for dilating the Os In- 
 terimm : I therefore, prefcribed vensefedtion, 
 a glyfler and opiate, in confequence of 
 which, fhe enjoyed a good night. But 
 after I was gone, -it was imagined, I want- 
 ed to protra6f the cafe, and a call was 
 given to a midwife, who affirmed, that 
 had fhe been fent for at firfl, the patient 
 would have beeri delivered before this pe- 
 riod. The flight pains, therefore, no 
 • fooner 
 
226 CASES IN MIDWIFERY* 
 
 fooner returned, after the effedl of the 
 opiate ceafed, than flie began to ftretch 
 the parts, and fatigued the woman fo 
 much, that they thought proper to call me 
 again in the evening; when finding the 
 pains inconfiderable, and the Os Uteri ^ 
 though more dilated, hill rigid, I ordered 
 the opiate to be repeated ; and next day 
 the pains growing ftronger, fhe was fafely 
 delivered. 
 
 CASE IV. 
 
 In the year 1753 . 1 was about fix in the 
 morning, called to a woman in her firfl 
 pregnancy. The membranes were broke, 
 the Os Uteri was conliderably opened, but 
 the child’s head being large, refled above 
 the brim of the Pelvis. (Vide "Pab. XII.) 
 while the Vagina and Os Externum feemed 
 very narrow and rigid. The midwife had 
 fatigued the patient by putting her in fe- 
 ver al different pofitions. Her fkin being 
 hot and dry, and the pulfe full and quick, 
 fhe was blooded to the quantity of ten 
 ounces, a glyfler was injedled, and after 
 its operation, fhe took a draught with 
 twenty drops of the ‘\tin 5 i. I’hebaic. and two 
 drachms of the Syr, de Meconio^ which 
 
 compofed 
 
CASES IM MIDWIFERY. 227 
 
 compofed and threw her into a plentiful 
 fweat. I was called again at night, when 
 I found the midwife had perfifted in fa- 
 tiguing her: the head was advanced to the 
 middle of the Vagina^ but the parts below, 
 were Hill very tight. I ordered the opiate 
 to be repeated j fhe enjoyed good reft, and 
 the parts being gradually diftended, fhe 
 was delivered next morning. 
 
 0^2 
 
 C O L- 
 
228 CASES IN MIDWIFERY. 
 
 COLLECTION XIV. 
 
 Of Natural Labours. 
 
 N U M B. I. C A S E I. 
 
 Of the Os Internum opened by the 
 waters and membranes. 
 
 Vide Tab. X. and XI. 
 
 In the year 1748, I was befpoke to at- 
 tend a woman in her firft child, and re- 
 ceived a call about the middle of the ninth 
 month, when fhe complained of pains in , 
 her head and back, and I underllood die 
 was coftive, and troubled with a T^enefmm^ 
 which die miftook for labour-pains. Af- 
 ter having felt her pulfe, which was quick, 
 fat by her fome time, and put the necef- 
 fary queftions to the nurfe, I directed the 
 patient to lie down on the fide of the bed, 
 and a quilt being thrown over her, placed 
 rayfelf behind, in order to examine. I 
 found the Os Internum foft, but not open, 
 {VideTIki. IX.) from which circumftance, I 
 declared die was not in labour j then I or- 
 dered her to be blooded to the quantity of 
 eight ounces, and a glyfter being inje6fed, 
 fhe was relieved of her complaints. In 
 a fortnight after this vifit, I was called 
 again, and found the labour begun ; the 
 
 Os 
 
CASES IN MIDWIFERY. 229 
 
 Os Uteri was exceeding thin, and open to 
 the breadth of half a crown, the mem^ 
 branes, with the waters, were pufhed down 
 by every pain, and the child’s head relied 
 upon the upper part of the Os Pubis. For 
 three or four days, Ihe had been fubje6l 
 to flight pains, which returned at long in- 
 tervals, then they became more frequent, 
 recurring every two hours, and by that 
 time I was called, they had grown flronger 
 and came falter. As Ihe was Rill coRive, 
 I prefcribed an emollient glyRer, by which 
 the indurated Pieces were difcharged, and 
 then the labour proceeded in a flow and 
 kindly manner, the membranes gradually 
 opening the mouth of the womb. I did 
 not confine her to any particular pofition, 
 but allowed her to walk about, and un- 
 dergo her pains, either fitting or lying in 
 bed. The membranes having fully open- 
 ed the Os Internum^ and being puflied down 
 in a globular form to the lower part of 
 the Vagina^ gave way during a pain, while 
 Ihe Rood leaning on the back of a chair, 
 a large quantity of waters was difcharged, 
 and the child’s head funk down into the 
 Pelvis. This was her firR child ; fhe was 
 of a Rrong conRitution, and the external 
 0^3 parts 
 
230 CASES IN MIDWIFERY. 
 
 parts were very tight ; fo that I would not 
 put her to bed, until the head fhould have 
 come lower down, and gradually opened 
 the Os 'Externum. But, thefe parts being 
 pretty well diftended, and every thing fall 
 approaching towards delivery, fhe was put 
 to bed, which was prepared by the nurfe, 
 and laid on her left fide : at every pain the 
 head advanced farther and farther, the re- 
 maining part of the waters was gradually 
 forced down, fo as to lubricate the parts ; 
 I then plainly felt the ear of the child at 
 the Fuhes^ the hind head at the lower part 
 of the left Ifchium, the Lambdoidal Suture 
 croffing the end of the Sagittal:, and the 
 Fontanelle on the other fide, higher up in 
 the Pelvis^ at which part the Sagittal was 
 likewife croffed by the coronal Suture. As 
 the head advanced, the Occiput was turned 
 in below the Os Pubis ^ the foft parts of 
 the mother, backwards, were protruded 
 in form of a large tumor, the Os Externum 
 was widened more and more, the Peri- 
 nceim lengthened to three fingers breadth, 
 and the fundament to two : the crown of 
 the child’s head turned gradually upwards 
 towards the upper part of the Labia^ the 
 forehead being backwards at the lower 
 
 part 
 
CASES IN MIDWIFERY. 231 
 
 of the Sacrum and Coccyx : advancing ftill, 
 the back part of the neck was felt below 
 the I^ubes 3 then tlit Perinccum being ftretch^ 
 ed to four or five fingers breadth, very 
 tenfe and thin, I applied to it the flat part 
 of my hand, during each fucceeding pain, 
 in order to prevent its being torn, and let 
 the head be delivered in a flow manner, 
 by rifing up with an half-round turn be- 
 low the Os Pubis. The fame pain that 
 delivered the head, forced down the flioul- 
 ders, which I helped eafily along with my 
 fingers placed towards the armpits. I kept 
 the child, after it was delivered, under the 
 cloaths, until it began to breathe and cry j 
 then I tied and divided the Funis^ put a 
 warm cloth round the head, and wrapping 
 it in a receiver, gave it to one of the 
 afliftants. The Placenta was gradually 
 forced down into the Vagina^ and extradl- 
 ed by pulling gently at its lower edge, 
 and at the Funis. The child was a ftrong, 
 healthy boy, and the mother recovered to 
 my wifli. 
 
 I have given a particular detail of this 
 cafe, in order to make young pradtitioners 
 acquainted with the common method of 
 acting in natural labours, thefe being the 
 O 4 circum- 
 
232 CASES IN MIDWIFERY. 
 
 circumftances that ufually occur to ah 
 healthy woman, in bearing her firft child. 
 Some flight pains recurring now and then 
 for fome days before the real labour, are 
 of advantage in flowly and infenfibly di- 
 lating the Os Uteri ; fo that when the 
 pains grow ftronger, the delivery is 
 the fooner effedfed. The Os Internum is 
 very different in different women, with re- 
 gard to the thicknefs and rigidity, and in 
 proportion to thefe, requires more or lefs 
 time for the dilatation. In forty-nine 
 cafes out of fifty, the membranes break 
 after the Os Internum is fully opened, fo as 
 that they are protruded into the middle 
 or lower part of the Vagina. After thefe 
 are broke, the pains frequently abate, for 
 a fhorter or longer time, and then grow- 
 ing ftronger, the child’s head is forced 
 lower down, and the forehead turns gra- 
 dually from the Ifchium into the hollow of 
 the Sacrum. Time fhould now be given 
 for the Vertex to open the Os Exter?mmy 
 and this is moft fafely effedled by flow 
 gradual pains ; for, there is feldom occa- 
 fion to lubricate or ufe other means for 
 firetching the parts. Indeed, in natural 
 labours, almofl our whole bufmefs confifls 
 
CASES IN MIDWIFERY. 233 
 
 in encouraging the patient, and prevent- 
 ing the Foiirchette or Frcenum Labiorum 
 from being torn, when the head is pro- 
 truded through the 0 $ Fxternum. For, 
 although it is commonly faid, that Rich a 
 woman was laid by fach a perfon, the de- 
 livery is generally performed by the labour- 
 pains ; and, if we wait with patience, na- 
 ture of herfelf will do the work. We 
 ought not therefore, to fatigue the patient 
 by putting her too foon in labour, accord- 
 ing to the common phrafe, but to attend 
 carefully to the operation of the pains, 
 and in moft cafes we fhall have nothing 
 elfe to do but receive the child. 
 
 CASE II. 
 
 In the year 1743. I delivered a woman 
 in the beginning of the feventh month, 
 of her third child ; her hufband had died 
 fuddenly about twenty days before, and 
 upoti that occafion, fhe had felt the child 
 move with great violence, and this was 
 fucceeded by a kind of tremulous motion, 
 after which fhe never felt it flir. On the 
 nineteenth day after this accident, die was 
 taken with a loofenefs, which brought on 
 labour-pains j the membranes broke when 
 
 the 
 
234 CASES IN MIDWIFERY. 
 
 the tnouth of the womb was fully opened, 
 and fhe was immediately delivered of a 
 dead child, which paffed eafily along, tho’ 
 its Abdomen was much fwelled. 
 
 NUMB. II. CASE I. 
 
 Of the Os Externum opened by the 
 Membranes. 
 
 In the year 1742, I was called to one 
 of the poor women whom my pupils at- 
 tended, and examining in time of a pain, 
 I found the waters had puflied the mem- 
 branes through the Os Externum^ in a large, 
 round, globular figure 5 and when the 
 pain abated and the membranes became 
 lax, I could eafily with my finger feel the 
 child’s head at the lower part of *the Va- 
 gina. I defired her to lie down with her 
 breech to the bedfide, and be covered with 
 a quilt j the pains which were ftrong, re- 
 turning at fliort intervals, forced the mem- 
 branes and waters with the child’s head 
 through the Os Externum:, even the fhoul- 
 ders and part of the body were delivered 
 before the breaking of the membranes, 
 which then gave way, tearing all round 
 
 from 
 
CASES IN MIDWIFERY. 235 
 
 from the edge of the Placenta, and re- 
 maining upon the head and body of the 
 child, which could not breathe until I 
 had ftripped them off. The v/oman had 
 bore children before this labour, the Pelvis 
 was large, the child come to its full time, 
 and of an ordinary fize, but the Placenta 
 came off with difficulty. I underftood 
 fhe had not undergone above fix pains 
 when I arrived, and before the pupils 
 could have notice to come fhe was deli- 
 vered. She expreffed great joy when ffie 
 jknew the child was born with a cawl, 
 which fhe dried and carefully kept, in full 
 perfuafion, that her child would never buf- 
 fer extremity either by fea or land, while 
 it remained in her poffeffion. 
 
 CASE II. 
 
 In the fame year, I was called to ano- 
 ther poor woman, whom I delivered by 
 myfelf. The membranes, waters and head, 
 were protruded through the Os Externwn, 
 while the patient flood leaning on the back 
 of a chair : then the membranes breaking, 
 were torn all round before the flioulders 
 were delivered, and remained flicking on 
 the head : the fame pain brought forth the 
 
236 CASES IN MIDWIFERY; 
 
 body and the Flacenta^ and I arrived juft 
 in time to prevent the child’s falling on 
 the ground. 
 
 CASE III. 
 
 In the year 1746. I attended a perfort 
 who fell in labour in the latter end of the 
 eighth month : fhe had formerly had quick 
 labours, and now the pains were ftrong 
 and frequent. The membranes and wa- 
 ters had opened the Os Externum^ and the 
 head of the child was low down, though 
 it did not advance in proportion to the 
 protrufion of the membranes, which, at 
 laft, were forced down about the fize of a 
 child’s head, without the Os Externum. 
 While the head was retarded in this fitua- 
 tion, the weight of the waters ftretched 
 down the membranes and formed the ap- 
 pearance of a large bag, narrow at the 
 upper part, which I pulled away, and threw 
 into a bafon. In three pains more, fhe 
 was delivered of a child, which had been 
 dead eight or ten days, with a fwelled Aif- 
 domeUi which had retarded the birth. 
 
 CASE 
 
CASES IN MIDWIFERY. 237 
 
 CASE IV. 
 
 In the year 1748. I was called, in a great 
 hurry, to a gentlewoman in labour of her 
 firft child, in the beginning of the feventh 
 month: but, before I arrived, the mem- 
 branes, with the Placenta^ waters and child, 
 were delivered altogether, and put in a ba- 
 fon by the nurfe, fo that I found the mem- 
 branes, whole, and the child Iwimming in a 
 great quantity of water. Without remem- 
 bring to fearch for the Allantois^ I opened 
 them in a hurry, and perceived that the 
 child had been dead ten or fourteen days. 
 
 C A S E V. 
 
 In the fame year my affiftance was de- 
 manded for another patient, come to the 
 full time in her firft child : the labour was 
 flow ; but, by degrees, the waters and mem- 
 branes opened the Os Internum and Pxter-- 
 nu?n^ without breaking, and the woman 
 was delivered of a dead child, whofe belly 
 fwelled. 
 
 CASE 
 
238 CASES IN MIDWIFERY. 
 
 CASE VI. 
 
 In the year 1751. I delivered a womarl 
 in the eighth month, whofe Os Externum 
 was opened by the membranes and waters, 
 which were pnfhed out a great way : the 
 child’s head was likewife partly protruded, 
 but yielded a very uncommon feeling to 
 the touch, as if there had been another 
 fet of membranes and waters, within which* 
 I thought I felt the loofe bones of the 
 Ikull. When I broke the membranes, I 
 felt the hairy fcalp, and difcovered an Hy- 
 drocephalus in the child, which was foon de- 
 livered, and lived fome days, though, from 
 its continual moaning, it feemed to be in 
 great agony. Vide Colledlion XLIIL 
 No. 13. 
 
 Bed des thefe, I have affifted in a great 
 number of cafes, where the membranes 
 have opened the Os Externum^ and the 
 head has been delivered before they broke. 
 Indeed, in all natural labours, I wait for 
 this operation, which renders the paflage 
 for the child much more eafy : and I never 
 tell the good women whether or not the 
 membrane remains upon the child’s head, 
 
 that 
 
CASES IN MIDWIFERY. 23^ 
 
 that they may not have an opportunity of 
 indulging an idle fuperftition. 
 
 Of the Os Internum opened by the child’s 
 head and membranes. Alfo of the Os Ex* 
 TERNUM opened in the fame manner. 
 
 Vide Tab. XIII. 
 
 NUMB. IIL CASE I. 
 
 In the year 1747* being called to a wo- 
 man in labour of her fecond child, I felt 
 the mouth of the womb largely open, and 
 the midwife faid that the membranes 
 were broke. This declaration had alarmed 
 the women, who entertained an idle no- 
 tion, that if fhe was not immediately de- 
 livered, fhe would lofe her opportunity j 
 and indeed this apprehenfion was the caufe 
 of my being employed. After fhe had un- 
 dergone two or three pains, I found that 
 the head had gradually increafed the dila- 
 tation of the Os Internum j that the mem- 
 branes were not yet broke, and that the 
 midwife had certainly miftaken a fmall 
 difcharge of urine for the waters. I then 
 alTured the patient that fhe was in no dan- 
 ger } and that, even though the membranes 
 had been broke, the delivery ought to be 
 4 left 
 
240 CASES IN MIDWIFERY. 
 
 left to the labour-pains : in confequencd 
 of which, the head was foon forced down 
 into the middle of the Pelvis, and the Os 
 Uteri being fully dilated, I felt the mem- 
 branes very fmooth. Another pain forced 
 the head down to the lower part of the 
 Pelvis, when the membranes fplitting up- 
 on the head, I could plainly diftinguiflt 
 the hair of the fcalp ; and the patient was, 
 in a little time, fafely delivered by the mid- 
 wife. I could feel no waters during la- 
 bour, and there was only a fmall quan- 
 tity difcharged, when the body was deli- 
 vered. 
 
 Both before and fmce this occafion, I 
 have been concerned in many cafes of the 
 fame nature, which generally prove eafy 
 and fuccefsful, and happen when the child 
 is furrounded by a fmall quantity of water. 
 I have been fometimes puzzled to know 
 whether or not the membranes were broke, 
 until the head came fo low down, that I 
 could ealily introduce the fore and middle 
 fingers, and feel the hairy fcalp. How- 
 ever, this uncertainty is of no confequence 
 in fuch eafy labours : at other times, I 
 could feel no waters, until the head de- 
 fcended low down, and then I have per- 
 ceived 
 
CASES IN MIDWIFERY. 241 
 
 ceived them protruding the membranes at 
 the back part of the Pehts. 
 
 Vide Tab. XIV. and XV. 
 
 CASE IL 
 
 In the year 1745. I attended at a labour 
 in which the child’s head came down in 
 the fame manner as that defcribed in the 
 preceding cafe : the child was fmall and 
 came eafily along j but I could feel no 
 waters, nor did the membranes give way 
 until the head was delivered. In other 
 cafes where there was little or no water, 
 the membranes generally broke fooner. 
 
 NUMB. IV. CASE I. 
 
 Of a fmall child or large Pelvis. 
 
 In the year 1749. I was called to a gen- 
 tlewoman who hadbefpoke my attendance, 
 in confequence of her having been former- 
 ly fubjedl to lingering labours, from the 
 large fize of the child, and the fmallnefs 
 of the Pelvis y but, before I could reach 
 the place, fhe was delivered j and this un- 
 common facility proceeded from the very 
 fmall fize of the child, which was born 
 four or five weeks before the end of her 
 reckoning. 
 
 R 
 
 CASE 
 
242 CASES IN MIDWIFERY. 
 
 CASE II. 
 
 In the year 1751. my attendance was 
 befpoke for a woman in her firft labour, 
 by her friends who were afraid it would 
 be difficult, becaufe file was pretty much 
 diftorted, had been lickly during preg- 
 nancy, and took but very little nourifli- 
 ment. For two or three days, fhe had 
 been fubjecl to flight pains, but when they 
 became flronger, I was fuddenly called, 
 and when I reached her houfe, found the 
 child coming into the world. It was very 
 fmall, the Pelvis of a middling fize, and 
 the Os Uteri was pufhed down without the 
 Os Externum. The fuddeniiefs of the delF 
 very occafioned an inflammation of the 
 mouth of the womb, which abated in 
 confequence of her drinking plentifully of 
 diluting liquors : yet, after the ninth day, 
 fhe complained of great pain in that part 
 when fhe fat up, but was tolerably eafy 
 while fhe lay in the bed j for this reafon, I 
 prefcribed a longer term of confinement 
 than is ufual, and directed a fpunge dipt 
 in warm claret to be put up in the 
 gina^ and this application to be repeated 
 feveral times in a day : by thefe means the 
 8 com- 
 
CASES IN MIDWIFERY. 243 
 
 Complaint vanifhed by the end of the 
 month. 
 
 CASE IIL 
 
 About fix or feven years ago, I was 
 called to a patient on the thirteenth day 
 after delivery, who laboured under the 
 fame complaint which I have defcribsd in 
 the preceding cafe, and which was like- 
 wife the confequence of fudden delivery. 
 The Pelvis was large, and the Os Uteri be- 
 ing fwelled and painful to the touch, I 
 ordered her to be confined to her bed. 
 The family-phyfician being confulted, it 
 was agreed, that fhe fhould drink plenti- 
 fully of weak cawdle, chicken-broth, and 
 for a change, barley-water, in order to 
 promote a diaphorefis ; and that equal 
 parts of the emollient decodtion and French 
 claret fhould be applied in the Vagijia^ 
 with a fine linen rag. For many days the 
 pain always returned v/hen fne rofe from 
 bed, ’till one night being told the child 
 was very ill, fhe ran up to the nurfery in 
 a hurry, and this motion intirely carried 
 off the complaint. 
 
 R ^ 
 
 I 
 
244 CASES IN MIDWIFERY. 
 
 I have been concerned in many cafes, 
 where the women buffered, though not 
 to fuch a degree, when the labour was 
 precipitate, the child fmall, or the Pehis 
 large. 
 
 Many women have befpoke my attend- 
 ance, and notwithftanding all my care, 
 have been delivered before I could reach 
 the place j one woman in particular, who 
 bore five children fo fuddenly, that al- 
 though I lived in her neighbourhood, and 
 happened always to be at home, I never 
 could arrive time enough to affiff her, ex- 
 cept in her firft child. 
 
 COL. 
 
CASES IN MIDWIFERY. 245 
 
 COLLECTION XV. 
 
 Of lingering or tedious Labours. 
 
 N U M B. I. C A S E L 
 
 From the rigidity of the membranes when 
 puflied down with the waters. 
 
 In the year 1743. about feven in the 
 evening, I was called to a patient whofe 
 pains were pretty ftrong j the mouth of 
 the womb was largely open, the head pre- 
 fented at the upper part of the Pel-vis., 
 and, as ufual, relied againft the fuperior 
 part of the Os Pubis and during every 
 pain, a fmall quantity of the waters pulh- 
 ed down the membranes at the back part 
 of the Pelvis, I waited to fee if the child’s 
 head would advance, and though the Os 
 Internum was fully open, would not ven- 
 ture to break the membranes j becaufe 
 when I attended her at the birth of her 
 firft child, the preceding year, the labour 
 was lingering and tedious from the large 
 lize of the head, even though it had ad- 
 vanced farther, and the membranes were 
 broke. I was therefore loth to break 
 them, until the head fhould come lower 
 downj and fhe continued without any 
 R 3 fleep 
 
246 CASES IN MIDWIFERY. 
 
 {leep or reft, fubjeft to pretty fevere pains 
 at the interval of five or fix minutes, till 
 about feven in the morning, when, in Ipite 
 of all my care to prevent her being fa- 
 tigued, and the encouragement, of the fa- 
 mily-phyfician who was prefeiit, her fpirits 
 began to flag, fhe exclaimed flie Ihouki die 
 before delivery, and the friends leemed to 
 be anxious and uneafy about her fituauon. 
 During all this time, the head had not 
 advanced in the leaft, nor were the mem- 
 branes with the waters farther pulhed 
 down. I introduced my finger into the 
 Vagina^ and after two or three unfuccefs- 
 ful attempts, barft them during a Itiong 
 pain, by which means a arge quantity of 
 waters was difcharged, and the head forced 
 down to the middle of the Fehis. T his be^ 
 ing efledled, flie was loon delivered of a fine 
 child, though fmalier than the former. 
 
 CASE II. 
 
 In the year 1745. about three in the 
 morning, I w^as called by a midwife to 4 
 woman in labour of her firft child, and 
 underftood that the pains had been ftrong 
 and frequent, and that the friends being 
 uneafy, recourfe was had to my advice a id 
 
 alTiftance. 
 
CASES IN MIDWIFERY. 247 
 
 afllRance. I examined during a pain, and 
 found the mouth of the womb open to 
 about the breadth of a crown-piece, though 
 the Os Uteri was pretty thick and rigid. 
 She had been fatigued by walking, and 
 undergoing her pains {landing, and in va- 
 rious other politions ; had enjoyed little or 
 no reft for two nights, and was very cof- 
 tive. I prefcribed an emollient and laxa- 
 tive glyfter, after the operation of which, 
 I again examined during a pain, found 
 the Os Internum much in the fame condi- 
 tion, the membranes being flrongly pulhed 
 down with the waters ; and when, upon 
 the pain’s abating, the membranes became 
 lax, I felt the child’s head, which being 
 touched by the finger, fwam up and re- 
 turned : a circumftance that plainly proved 
 there was a great quantity of waters. I 
 allured the patient and her friends, that 
 the child prefented fair, and that there 
 was no apparent danger j then I advifed 
 the midwife to put her to bed, without 
 expofing her to any further fatigue, or de- 
 fining her to force down, except when 
 compelled by the pains i and in cafe fhe 
 Ihould not otherwife enjoy fome reft, I 
 prefcribed the following draught. 
 
 R 4 
 
 R 
 
248 CASES IN MIDWIFERY. 
 
 R Aq. Alexit. Simp. 3x1V. TinSi. Thehaic.gt. xv. 
 Syr. e Meconio 3ij. m. 
 
 And dire6led her to drink frequently of 
 weak, warm cawdle to promote a diapho- 
 refis. Next evening I received another 
 call, when the midwife gave me to under- 
 ftand that fhe had taken the draught, in 
 confequence of which fhe had enjoyed re- 
 frefhing reft and a plentiful fweat, altho’ 
 Ihe had been frequently waked by the pains; 
 and file told me that the membranes were not 
 yet broke, altho’ the mouth of the womb had 
 been fully opened for four hours. When I 
 examined, I found the membranes pufhed 
 clown with a large quantity of waters, to the 
 lower part of the Vagina., and when the 
 pain abated, felt the head pretty low ; it 
 ftill moved eafily up and down, whence I 
 concluded that either it was fmall, or the 
 Pelvis not narrow ; yet as this was her firft 
 labour, I waited two hours, in hope that 
 the membranes would advance farther, 
 and open the Os Externum ; but they re^ 
 maining in the fame fituation, I imagined 
 their rigidity retarded the delivery, and 
 breaking them in this perfuafion, the child 
 was foon delivered, 
 
 CASE 
 
CASES IN MIDWIFER.Y. 249 
 
 CASE III. 
 
 Ill the year 1745. I was, early in the 
 morning, called by a midwife to a woman 
 who had been four and twenty hours in 
 labour of her firfi: child, I found the 
 mouth of the womb largely open, the wa- 
 ters pufhmg down the membranes in a 
 large, globular figure, and as the violence 
 of the pain abated, I felt the head of the child 
 refting at the upper part of the Os Pubis, 
 The midwife told me the patient had been 
 in that condition feveral hours, but that 
 fhe was afraid of breaking the membranes 
 too., foon, becaufe fhe fufpedfed that ' the 
 wortian was a little diftorted and the Pel- 
 vis narrow : however, the friends being 
 concerned at her being fo long in labour, 
 and a difcharge of blood fupervening, fhe 
 had thought it neceflary to alk advice. 
 After having twice again examined during 
 pains, and maturely confidering the cafe, 
 I concluded that delivery was retarded by 
 the rigidity of the membranes which feem- 
 ed to be thicker than ufual ; for, as the 
 child’s head fwam up from the touch and 
 returned, it was plain that it could not be 
 
 engaged. 
 
250 CASES IN MIDWIFERY. 
 
 engaged, and that there was a great quan- 
 tity of the waters, Though flie had not, 
 to all appearance, loft above twelve ounces 
 of blood, yet as the difcharge feemed to 
 increafe, I broke the membranes during 
 the next pain, a large quantity of waters 
 was difcharged, and the child’s head was 
 forced more backwards, towards the up- 
 per part of the Pelvis. I likewife felt the 
 Os Internum loofe and foft ; 2nd as it was 
 no longer kept on the ftretch by the mem- 
 branes and waters, fhe became perfedfly 
 eafy, had no pain for a long time, and 
 the flooding intirely ceafed. Before the 
 membranes were broke, fhe had felt a 
 ftrong propenfity to fleep, which the. pains 
 prevented j but now I ordered her to be 
 undreffed, put in her naked bed, and kept 
 quiet, that, if poflible, fhe might enjoy 
 feme natural repofe. She accordingly refted 
 and was refreflied. As for the blood fhe 
 had loft, flie was rather benefited than in- 
 jured by the difcharge, for fhe had for 
 fome v/eeks complained of drowfinefs, ful- 
 nefs in her eyes, with pains and giddinefs 
 in the head, which were now removed, 
 infomuch, that flie declared herfelf much 
 more light and eafy. I defired the mid^ 
 
 wife 
 
CASES IN MIDWIFERY. 251 
 
 ’ ' wife to indulge her in her repofe, and 
 when the pains Ihould return, to let the 
 labour proceed in a flow and eafy manner, 
 allowing time for the head to ftretch the 
 Vagina and external parts ; and I told her, 
 that the patient being ftrong and healthy, 
 nothing elfe Vv^as neceffary, but that Ihe 
 Ihould frequently drink weak cawdle, broth 
 or barley-water, to encourage and fupport 
 a plentiful perfpiration. I was afterwards 
 informed, that fhe flept feveral hours, and 
 upon the return of the pains was fafely 
 delivered by the midwife, 
 
 C A S E IV. 
 
 In the year 1750. I attended a gentle- 
 woman, though not in labour of her firfl: 
 child, who fuffered all the complaints de- 
 feribed in the preceding cafe, except the 
 flooding. By my advice, fhe loft eight 
 ounces of blood, and was immediately re- 
 lieved : but the labour being retarded by 
 the rigidity of the membranes, though the 
 child’s head was pretty far advanced in the 
 Pehis^ they were broke, and in two or 
 three pains after, the woman was deli- 
 vered, 7 
 
 NUMB, 
 
252 CASES IN MIDWIFERY. 
 
 NUMB. II.4 CASE I. 
 
 From the rigidity of the membranes when 
 not protruded by the waters. 
 
 In the year 1745. I was, about four a 
 clock in the morning, called by a midwife, 
 to a woman whom file had formerly deli- 
 vered with eafe : but now die had been 
 in ftrong labour for many hours : die faid, 
 the waters had been draining off for the 
 fpace of three hours, and die had every 
 pain expedfed the delivery, which die fup- 
 pofed was retarded by the child’s being 
 large and dead. I found the child’s head 
 about two thirds down in the Pelvis, and 
 during ev^ry pain, perceived the difcharge 
 of a very little water, which I at firfl 
 miftook for thofe of the Uterus, But, up^ 
 on the cedatioii of a pain, raifing the head 
 a little with my finger, I obferved a large 
 quantity was difcharged from the bladder j 
 and when I felt for the hair of the fcalp, 
 I found the membranes fmooth and un- 
 broke, I again raifed the head, that the 
 patient might difcharge more urine, and 
 then the membranes fplit. By the next 
 pain, the head was forced down to the 
 
CASES IN MIDWIFERY. 253 
 
 Os Externum^ and in a very litde time the 
 child was delivered. 
 
 CASE II. 
 
 In the fame year, I attended a woman 
 in labour of her firfl child, and could feel 
 no waters, though the head and mem- 
 branes had gradually opened the mouth 
 of the womb, and were forced down to 
 the middle of the Pelvis j where, however, 
 they remained near two hours. As I could 
 infmuate my finger . all round the under- 
 part of the child’s head, felt the ear at the 
 Os Pubis, and diftinguilhed the Sutures, I 
 concluded that the head was not large, nor 
 the Pelvis narrow j but that this delay 
 mull proceed from the rigidity of the 
 membranes. Thefe, therefore, during a 
 pain, I endeavoured to wear thin, by rub- 
 ing them with the edge of my nail, which 
 was fmooth and fhort : accordingly in time 
 of the next pain, they fplit upon the head, 
 which was immediately forced down to 
 the Os Externum, and this being gradually 
 dilated, the child was delivered. 
 
 I have been concerned in many cafes of 
 the fame kind, where labour was retarded 
 by the rigidity of the membranes but as 
 
 I 
 
254 CASES IN MIDWIFERY, 
 
 I have frequently known tedious and 
 lingering cafes proceed from too much pre-^ 
 cipitation in breaking the membranes, I 
 choofe rather to err a little on the other 
 extreme, provided the patient is in no dan- 
 ger from weaknefs or flooding. 
 
 NUMB. IIL CASE 1 . 
 
 From the membranes breaking too foon, 
 
 ' In the year 1743* my attendance was 
 befpoke to a patient who was very fat and 
 unwieldy : fhe had been taken with fome 
 very flight pains, and the membranes 
 breaking, a great quantity of waters was 
 difcharged j upon which being called in a 
 great hurry, I found the mouth of the 
 womb open to about the breadth of a fix- 
 pence, and thin though rigid. She had 
 been five years before, delivered of a child 
 which followed immediately after the rup- 
 ture of the membranes, and fhe now ex- 
 pedled the fame expeditious delivery. I 
 told her that there was a great difference 
 between that labour and this, occafioned 
 by the long interval, by her prefent cor- 
 pulency, and the precipitate difcharge of 
 the waters, which might render the cafe 
 more tedious ; though, as the pains were 
 
 trifling. 
 
CASES IN MIDWIFERY. 25^^ 
 
 trifling, and the child prefented fair, I en- 
 couraged her to exert her patience, to ba- 
 nifh anxious thoughts, and avoid all 
 manner of fatigue j and as die Vv^-as coffive, 
 I prefcribed a glyfter, which had the defir- 
 ed effe£f. After this period, fhe continued 
 three days ' and three nights in a lingering 
 kind of labour, before the mouth of the 
 womb was fufficiently dilated; fo that I 
 was obliged to give her an opiate every 
 evening, and dire6l her to referve her 
 ftrength by lying moftiy in bed. The Os 
 Internum being fully opened, the pains grew 
 flronger, and fhe was foon delivered of a 
 very fmall child. 
 
 CASE II. 
 
 In tlie year 1745. I was called to a poor 
 woman, who had been two days in labour 
 of her third child, and found the Qs Uteri 
 open to about the breadth of a fhilling, 
 the lips being thick but foft ; the mem- 
 branes were broke, the child’s head refted 
 at the upper part of the Pelvis^ and -the 
 patient laboured under a loofenefs, which 
 probably had brought on fome flight pains. 
 She had been attended by a perfon of no 
 education or pradfice in midwifery, who 
 
 finding 
 
256 CASES IN MIDWIFERY. 
 
 finding the membranes broke, imagined 
 it was his btifmefs to promote the delivery 
 with all poffible expedition ; and with that 
 view, fatigued the patient exceffively, by 
 ordering her to walk about and bear down 
 with all her force at every inconfiderable 
 pain. 
 
 The woman being quite exhaufted, I 
 directed her to be put to bed and kept 
 quiet, and leaving a gentleman and mid- 
 wife, who at that time were my pupils, I 
 defied them to give her five grains of the 
 Pihilce Sapo?iace 6 e, and repeat the dofe once 
 or twice, if there fhould be occafion. By 
 thefe means, fie was freed of pain, pro- 
 cured reft and recovered her exhaufted fpi- 
 rits. She continued eafy for two days, ex- 
 cept in time of fome flight pains, which 
 every now and then recurred, and during 
 which a fmall quantity of the waters con- 
 tinued to be difcharged : but on the third 
 night, the pains increafed, the Os Uteri 
 became fofter, and was more and more di- 
 lated by the child’s head, which advancing, 
 plugged up the parts, fo as that the drib- 
 ling of the waters ceafed, and in a very 
 little time the woman was fafely delivered. 
 
 CASE 
 
CASES IN MIDWIFERY. 257 
 
 CASE III. 
 
 Soon after this occafion, I was called to 
 a labour by a gentleman of very little ex- 
 perience in the pra6lice of midv»dfery, who 
 4taking me afide, told me he was juft go- 
 ing to deliver a woman whom he had at- 
 tended a night and a day j and that, as his 
 charafter was not eftabliftied, he thought it 
 advifeable to have a perfon of the profef- 
 fion prefent. Indeed I was ftruck with his 
 apparatus, which was very extraordinary, 
 for, his arms were rolled up with napkins, 
 and a flreet was pinned round his middle 
 as high as his breaft.- His intention was 
 to turn the child and deliver footling ; and 
 he deiircd me to examine the woman, that 
 I might fatisfy the friends of the neceflity 
 he was under to take this ftep immediately, 
 for the prefervation of the mother and the 
 fruit of her womb. I felt the Os Internum 
 open to the breadth of a crown-piece, and 
 the head prefenting, and after having 
 fully informed myfelf of every circum- 
 ftance neceflary to be known, I concluded 
 that the labour had been rendered tedious 
 from the premature rupture of the mem- 
 branes. I then gave the gentleman a 
 S friendly 
 
£58 CASES IN MIDWIFERY, 
 
 friendly advice in private ; in confequence 
 of which he laid ahde his working-drefs, 
 and as the woman, who was Ifrong, had 
 enjoyed no reft the preceding night, an 
 opiate was adminiftred : ftie flept feveral 
 hours, and was refreihed, and toward si* 
 morning, the pains returning, delivered 
 the child and Secundmes. I have aflifted 
 in a number of fuch cafes, where, by a 
 cautious management, the parts were gra- 
 dually opened, and the women fafely deli- 
 vered. In many women, I have known 
 the membranes broke feveral days, weeks, 
 and even months before labour, and pro- 
 vided they were not much weakened, they 
 have been delivered with eafe. In my 
 pradHce, this cafe has chiefly prevailed 
 among fat women, and may perhaps be 
 owing to laxity. 
 
 CASE IV, 
 
 Communicated by Dr. D' JJrban^ of Rich- 
 mond^ in Surry. 
 
 In the year 1750. he was called to a 
 woman in labour, near Norwich j the wa- 
 ters had been draining off tor two days, 
 during which fhe had enjoyed no reft : the 
 was very weak and low-fpirited, had vio*- 
 
 lent 
 
CASES IN MIDWIFERY. 259 
 
 knt reachings with a Singultus, and when 
 he examined, he found the child’s head 
 prefenting: he diredled her to be put to 
 bed, prefcribed an anodyne draught, in 
 confequence of which Ihe had a refrefhing 
 deep of two or three hours, then the pains, 
 wliich were weak before, grew ftrong and 
 more frequent, and the woman was fafely 
 brought to bed. 
 
 He fays, he could have delivered with 
 the forceps, but followed my advice, which 
 was never to ufe them, but when they are 
 abfolutely necelTary. The fame method he 
 has fuccefsfully ufed upon feveral occafions. 
 
 CASE V. 
 
 I was called to a patient in labour of 
 her firft child. The membranes broke in 
 the evening, and fhe had frequent pains 
 all night, but would not allow me to exa- 
 mine till about eight o’clock next morn- 
 ing, when I found the child’s head refting 
 above the Pubis, and the Os Uteri foft and 
 lying loofe, as if it had been pretty largely 
 opened before the membranes broke : but 
 the V aghia was veiy flraight as well as the 
 Os Externum. She enjoyed no reft all 
 night, the pains grew exceftively ftrong 
 S 2 and 
 
 I 
 
26 o cases in midwifery. 
 
 and frequent, the child’s head had not ad- 
 vanced in the leall j and being apprehen- 
 five from her violent complaints of the 
 Abdomen, that the Uterus would burft by 
 fuch ftrong efforts, I preferibed a pa- 
 regoric draught to allay the violence of 
 the pain and procure deep. As fhe 
 had been ufed to take opiates, the dofe 
 amounted to thirty drops of the ‘TinB. 
 Thebaic, with sij. of Syr. de Meconio, and 
 fome fimple cinnamon-water. This pre- 
 feription had the defired effedl : flie dept 
 feveral hours, though every now and then 
 her deep was interrupted by a ftrong pain. 
 About twelve that night, when the effect 
 of the opiate was wore off, her violent 
 pains recurring, I was allowed to examine 
 again, and finding the head ftill in the 
 fame dtuation, the draught was repeated. 
 This kept her tolerably eafy till eight in 
 the morning, when the pains returning it 
 was again adminiftred : for the fame rea- 
 fon it was repeated at fix in the evening, 
 and four in the morning. About eight, 
 I was permitted to examine the third time, 
 when I felt the head pitched down in a 
 lensithened form to the middle of the Pel- 
 ; but the lower part of the Vagina was 
 
 ftill 
 
CASES IN MIDWIFERY. 261 
 
 IHll very narrow, as well as the Os Exter- 
 num^ and time was required for dilating 
 both, and for pulhing down and elongat- 
 ing the head, which was large. At the 
 beginning of labour fhe had fome loole 
 flools, but, made no water for three 
 nights and two days j fo that when 
 the effect of the opiate ceafed, the di- 
 ftenfion of the bladder aggravated the 
 agony of her fufferings, yet no perfua- 
 fions would induce her to let me draw 
 off the urine, and I was again obliged to 
 repeat the opiate. Her ftrong pains, which 
 every now and then recurred, flie endea- 
 voured to fupprefs, left I fhould defire to 
 examine, and would allow no body to be 
 with her but the nurfe. At length, I was 
 in the evening, fuddenly called from ano- 
 ther apartment, and finding the head al- 
 moft delivered, I had juft time to prevent 
 the laceration of the external parts. I 
 felt a languid motion in the veflels of the 
 Funis ; but could not, by all the ufual me- 
 thods, bring the child to breathe. I brought 
 away the Placenta^ found the Uterus in a 
 right ftate, and immediately drew off a • 
 large quantity of urine with the catheter. 
 Neveithelefs, I was obliged to repeat the 
 S 3 draught 
 
262 CASES IN MIDWIFERY. 
 
 draught four or five times in four and 
 twenty hours, becaufe fhe could neither 
 reft nor fweat without it, her pulfe flagg’d, 
 and her fpirits funk, and no other cordi- 
 als had the 'leaft effedt. After delivery, 
 her urine was obftrudled for three days, 
 and for eight weeks afterwards fhe loft the 
 power of retention, which, however, re- 
 turned with her ftrength. As for the 
 child, it was probably loft by her timo- 
 rous difpofition, in confequence of which 
 fhe refufed all affiftance at the latter end 
 of labour. 
 
 COL- 
 
CASES IN MIDWIFERY. 263 
 
 COLLECTION XVI. 
 
 Of lingering and tedious Labours. 
 
 N U M B. I. C A S E I. 
 
 From the forehead’s being prevented from 
 turning backwards into the lower and 
 concave part of the Sacrum. 
 
 Vide Tab. XIII. and SeCl. 3. 3d. 
 
 In the year 1749. I was cailed to a wo- 
 man who had been long in labour of her 
 firll child, and was naturally of a weak 
 and delicate conflitution. On that ac- 
 count, the midwife told me, fhe had kept 
 her moftl]r in bed, and done nothing to 
 fatigue her : Ihe faid, the labour had gone 
 on very well, though the pains were ilight 
 and at long intervals, and that fince the 
 difcharge of the waters, the child’s head 
 had advanced flowly to the external parts, 
 where it had ftopt for a confiderable time. 
 This account I found true, upon exa- 
 mination. A glyfter had been adminiftred 
 with good effedt, and the patient had en- 
 joyed a good deal of lleep between the 
 pains; but finding her pulfe rather too 
 weak and languid, I diredled her to take 
 S 4 two 
 
264 CASES IN MIDWIFERY. 
 
 two fpoonfuls of the following mixture 
 cveiy half hour. 
 
 R Aq. Cinnam. ten. Splrituof. Sal. Vol. 
 
 C.C. 9F. Conf.Cardiae.3\. Syr. Simp. ^(5. M. 
 
 I attended fome time, without perceiv- 
 ing that the head advanced to open the 
 Os Externum ; I felt one of the ears at the 
 Os Piibis^ the Lamdoidal croffing the end 
 of the Sagittal Suture at the lower part of 
 the right Os IJchium., and the Eontanelle on 
 the oppofite fide at the upper part of 
 the left : and I perceived that the pains 
 had not force enough to move the Occiput 
 from the right Ifchium^ fo as to pafs under 
 the Os Pubis., and the forehead from the 
 oppofite fide to the hollow of the Os Sa- 
 crum. I therefore, during the next pain, 
 introduced my fingers towards the child’s 
 left temple, and turned the forehead back- 
 wards to the Os Sacrum. The narrow 
 part of the head, being now towards the 
 fides and lower part of the Pelvis, the Ver-^ 
 tex immediately advanced forwards, gra- 
 dually opening the Os Externum during 
 every pain j and the woman being fafely 
 delivered, the Placenta feparated llowly, 
 and was difcharged in about half an hour. 
 
 CASE 
 
CASES IN MIDWIFERY, 265 
 
 CASE II. 
 
 In the year 1744. I was called to a wo- 
 man in labour of her firfl child, and found 
 a midwife and another male pra6titioner 
 in waiting : this laft gave me .to under- 
 ftand, that when he came, the patient had 
 been a long time in Ilrong labour s that 
 after the mouth of the womb was fuffi- 
 ciently opened, the membranes had broke, 
 and, the pains gone off for fome time, 
 though they returned with greater vio- 
 lence, and forced down the head to the 
 lower part of the Pelvis, beyond which 
 fituation it had not advanced in a whole 
 houi'j that he had attempted to deliver 
 it with a lack or fillet, which he had pro- 
 cured as a great fecret, but the head be- 
 ing large, he could not fix it properly, 
 neither could he, after repeated trials, bring 
 the child by the feet ; fo that he concluded 
 there was an abfolute neceflity for opening 
 the head. Upon examination, I found 
 the head in the fame pofition as that de- 
 feribed in the preceding cafe, or rather 
 higher in the Pelvis. The pains were to- 
 lerably flrong, the woman’s pulfe was 
 much more quick than is ufual, even in 
 
 time 
 
266 CASES IN MIDWIFERY. 
 
 time of pains, fhe complained of a violent 
 head-ach, laboured under great drought, 
 and her Ikin was very hot and dry. Of 
 thefe complaints, however, die was reliev- 
 ed by lofmg ten ounces of blood from her 
 arm. I told the gentleman, that as the 
 patient was ftrong and the pains conti- 
 nued, we ought to wait the efforts of na- 
 ture, without ufing either forceps or fil- 
 let, which I never applied, except to af- 
 liff nature when fhe was too weak. When 
 I examined again, I found the head lower 
 down, and moved the forehead backwards 
 towards the Os Sacrum j fo that the crown 
 of the head advancing opened the Os Ex- 
 ternumy and the patient was foon deliver- 
 ed of a child of an extraordinary fize. 
 But the fillet having galled and torn part 
 of the hairy fcalp from the Occiput^ was 
 the occafion of a violent inflammation, of 
 which the child died in a few days : The 
 mother, however, recovered tolerably well, 
 and fmce that time has had pretty eafy 
 labours. 
 
 CASE III. 
 
 In the year 1750. I was called by a 
 midwife to a very fat woman, near the age 
 
 of 
 
CASES IN MIDWIFERY. 267 
 
 of forty, in labour of her hrft child. The 
 membranes had been long broke before I 
 came, and I underfiiood that the friends 
 being uneafy, had fent for a gentleman of 
 the profeffion, who, in attempting to de- 
 liver the patient, faid he had broke his in- 
 ftrument, and went home in order to 
 fetch another, but, inftead of returning, 
 he fent a meflage, importing, that he was 
 obliged to go and attend another woman. 
 Her pains being ftrong, the Os Externum 
 and lower part of the Vagina were gently 
 dilated, and the forehead being moved 
 backwards at the fame time, the head ad- 
 vanced, and the woman was delivered in 
 about half an hour after I arrived. 
 
 There was a very fmall opening thro’ 
 one of the parietal bones of the child’s 
 fkull, yet none of the Cerebrum was eva- 
 cuated, though a great deal of blood was 
 difeharged, notwithftanding the applica- 
 tion of proper comprefles, and the poor 
 child died moaning, in five or fix hours af- 
 ter its birth. 
 
 CASE IV. 
 
 In the courfe of the fame year, I was 
 called by a gentleman who had formerly 
 
 attended 
 
268 CASES IN MIDWIFERY. 
 
 attended me for a fliort time, in belial^ 
 of a woman whom he had attempted to 
 deliver with the forceps. Fie faid, he w^as 
 lure they had been properly applied, that 
 he had pulled with great force without 
 being able to move the child’s head, 
 and that the woman was in fuch immi- 
 nent danger, he did not believe flie could 
 live until we fhould reach the houfe. Not- 
 withlianding this declaration, I found her 
 pulfe ftrong and good, as well as the pains, 
 and that not above one third part of the 
 head had come down into the Pelvis ; I 
 likewife underftood fhe was ufed to have 
 tedious labouj's, proceeding, in all proba'.- 
 bility, from the fmall fize of the Pelvis, 
 I privately convinced the gentleman of 
 his error, obferving, that as the pains wei^e 
 good, no force ought to be applied ; that 
 the forceps would never fucceed, except 
 when the head was come Jow^er down, 
 and even then ought not to be ufed, un- 
 iefs the w^oman was in danger from v/eak- 
 nefs and want of labour-pains. We pre^ 
 . fcribed a mixture to amufe the patient, 
 and in about five hours Ilie was fafely 
 delivered. 
 
 NUMB. 
 
CASES IN MIDWIFERY. 269 
 
 N U M B. II. CASED 
 Of the Vertex prefenting, though low 
 in the Pelvis, the forehead being to- 
 wards the Os Yubis. 
 
 Vide Tab. XX. XXL 
 
 In the year 1747. I was called by a mid- 
 wife, to a woman whom fhe had attended 
 near two days, and whofe former labours 
 had been very eafy ; from which circum- 
 ftance fhe inferred, that in this cafe, the 
 child was of an extraordinary fize. I 
 found the Fontanelle towards the left groin, 
 and the Lamdoidal crofling the Sagittal Su- 
 ture at the right fide of the Os Coccwis. 
 The Os Externum I gently opened during 
 every pain, raifing the head a little when 
 the pain began to abate, and moving the 
 forehead to the left fide of the Os Sacrum, 
 As the next pain increafed, I withdrew 
 my hand, which was followed by the 
 child’s head, and the woman was in a lit- 
 tle time delivered. 
 
 CASE II. 
 
 In the year 1744. I attended a gentle- 
 woman who had been eafy in her former 
 labours ; when I was called, the mem- 
 branes 
 
270 CASES IN MIDWIFERY. 
 
 branes were broke, and the mouth of the 
 womb was largely open ; though the head 
 advanced very llowly. At length, feeling 
 the Vertex at the lower part of the Coccyx^ 
 and the Fontanelle below the Pubis^ I at- 
 tempted, but to no purpofe, to raife the 
 head, and move the forehead to the right 
 fide of the Pelvis. Yet, when I withdrew 
 my hand, the head was forced lower down, 
 by a ftrong pain, the Vertex protruded the 
 Per 'inccum and pofterior parts, in form of a 
 large tumour, the forehead, face and chin, 
 turned immediately out from below the 
 Pubis^ and the Vertex was raifed upwards, 
 with an half round turn, from the Peri- 
 nreum and pofterior parts. The child was 
 Imall, and cried as foon as the head was 
 delivered, even before the body was ex- 
 tracted. 
 
 NUMB. III. 
 
 From the prefentation of the Fontanelle. 
 
 I have often been concerned in cafes, 
 where I found the Fontanelle prefenting; 
 they commonly proved tedious and lin- 
 gering, though the delivery was gene- 
 rally eft'efted by the labour-pains, and 
 the child’s head fometimes appeared in 
 
 form 
 
CASES IN MIDWIFERY. 271 
 
 form of a few’s back, a circumftance, 
 in all probability, owing to the prefllire 
 it fuftained in the Pehisy while it ad- 
 vanced in that unufual way. Sometimes, 
 in thefe lingering labours, I have, by 
 raifing up the forehead with my fingers, 
 altered the pofition, fo as to let the Vertex 
 fmk lower down, particularly in the follow- 
 ing inftance. 
 
 CASE I. 
 
 In the year 1750. I attended a gentle- 
 woman, whom I had formerly three times 
 delivered after eafy labours. The Os Uteri 
 was now fully open, and the membranes 
 broke foon after I arrived. Yet the head 
 did not advance as ufual, but relied at the 
 upper part of the Pelvis. As Ihe had been 
 long fatigued with fevere and fruitlels 
 pains, I examined the pofition of the head 
 more narrowly, and plainly perceived the 
 Fontanelle prefenting in the middle j but I 
 could not certainly difeover how the fore- 
 head lay, until I had gradually opened the 
 Os Externum during the pains. I then 
 found that the Vertex was to the left lide, 
 and the forehead with the face to the op- 
 pofite part. As Ihe lay in bed, upon her 
 
 left 
 
272 CASES IN MIDWIFERY. 
 
 left fide, I could not fo eafily affift in that 
 pofition j file was therefore, turned on 
 her back) her head and flioulders being 
 raifed a little with pillows, and her knees 
 held up towards her belly, as fhe lay acrofs 
 the bed j for her pains were alfo ftronger 
 while fhe continued in this pofture. In 
 the beginning of a pain, I gently intro- 
 duced my right hand into the Vagina^ and 
 raifed up ' the forehead and face j as the 
 pain increafed, I withdrew my hand, and 
 found the Vertex fink down to the lower 
 part of the left Ifchium. In a few pains, 
 the forehead turned backwards, the hind 
 head came out below the Pubes^ the Os 
 Externum was gradually opened, and the 
 child fafely delivered. 
 
 N U M B. IV. CASE!. 
 
 From the prefentation of the forehead. 
 
 Vide Tab. XXII. 
 
 In the year 1747. I was called to a wo- 
 man in labour, by the friends, who were 
 uneafy at the lingering cafe, and imagined 
 the midwife kept her in hand, becaufe fhe 
 had been feveral times delivered by ano- 
 ther midwife, and her labours were eafy. 
 
 5 I 
 
CASES IN MIDWIFERY. 27^ 
 
 I underftood the Os Uteri was fully open- 
 ed, and the membranes had been broke 
 feveral hours ; the child prefented fair, and 
 the pains were ftrong, yet the head had 
 advanced very little, though fince I had 
 been fent for, the child had defeended con- 
 liderably lower in the Pelvis. Upon exa- 
 mining in time of a pain, I really ima- 
 gined the Vertex prefented, and thought I 
 felt the Fontanelle to the lide, as in other 
 cafes j but when the head advanced, in 
 confequence of the fucceeding pains, and 
 protruded the Perincewn and poflerior 
 parts, I felt the eyes and nofe on the con- 
 trary lide, towards the lower part of the 
 Os IJchimn j and in another pain or two, 
 the Os Pxternum being fufficiently dilated, 
 the face turned in below the Os Pubis^ over 
 which the chin turned upwards j the Fon- 
 tanelle, Vertex and hind-head were raifed, 
 and came out with a femicircular turn 
 from the Perinceum and parts below, and 
 the body was delivered by the fame pain. 
 
 The child was fmall and dead, its fore- 
 head was raifed up in form of a fugar- 
 loaf, the V ?rtex being prelied flat, and the 
 face and hairy fcalp veiy much fwdied. 
 
 T 
 
 The 
 
274 CASES IN MIDWIFERY, 
 
 The mother, for feveral days after deli- 
 very, complained of great pain in her 
 back and at the Pubis, which feemed to 
 proceed from an over-ftraining of the liga- 
 ments at the junAure of the bones. But 
 by lying quiet, and drinking plentifully 
 of warm and weak diluting fluids, flie en- 
 joyed profufe fweats, and foon was freed 
 of thefe complaints. 
 
 CASE II. 
 
 In the following year, I alTifled in a 
 flmilar cafe, where the head was high up, 
 and had long refted at the brim of the 
 Pelvis. At firfl, I thought it prefented 
 fair, but as it did not advance for feveral 
 hours, notwithftanding the ftrong pains, 
 and I was told, that the patient had been 
 delivered of her fecond and third child be- 
 fore the midwife could reach the houfe, 
 I concluded, that the head did not prefent 
 in the common way, and introduced my 
 hand flowly into the Vagina, as Ihe lay on 
 her left fide then finding the forehead 
 prefenting with the face to the right Ilium, 
 I pulhed it up to that fide, and as I with- 
 drew my hand a little, ftill prefled it up 
 with my fingers, that it might not return 
 
 before 
 
CASES IN MIDWIFERY. 275 
 
 before the next pain, which forced down 
 the Vertex from the oppohte fide ; then the 
 head defcended gradually, and the woman 
 
 was delivered in a few pains. 
 
 % 
 
 NUMB. V. 
 
 From the Prefentation of the Ears. 
 
 I have known a few cafes in which the 
 ear prefented, and when the child was not 
 large, the pains commonly altered the po- 
 lition, by forcing down the Vertex^ and 
 the patient was ealily delivered. This was 
 commonly the cafe too, when the Fonta^ 
 nelle prefented : but when the head was 
 large, the labour was more tedious and 
 lingering, upon which occafion, I ufually 
 pufhed up the head fo as that the Vertex 
 might advance, particularly in the follow- 
 ing inftanee. 
 
 CASE I. 
 
 In the year 1749, being called by a mid- 
 wife, to a woman who had been long in 
 labour, I introduced my hand into the 
 Vagina, and finding the ear prefenting, 
 could perceive, when I raifed the head, 
 neck and Ihoulder to the back part of the 
 Uterus, that the upper part of the head 
 T 2 lay 
 
276 CASES IN MIDWIFERY, 
 lay over the Piibis^ the face being to the 
 right fide. As all the waters were dif- 
 charged, it would have required great force 
 to turn the child fo as to bring it by the 
 feet : I therefor^ raifed the head higher, 
 forcing the forehead upwards, and the 
 Vertex coming in as I withdrew my hand, 
 the child was prefently delivered. 
 
 N U M B. VI. C A S E I. 
 
 From the Prefentation of the Face, of the 
 Shoulder, and of the Bread:. 
 
 Vide Ttab. XXIII. 
 
 In the year 1740. being called to a wo- 
 man, who had been a great many hours 
 in labour, after the mouth of the womb 
 was fully opened, and the waters dif- 
 charged, I found the head low down in the 
 Pelvis^ the face prefenting, the chin at the 
 lower part of the Pubes, and the cheeks fo 
 exceflively fwelled, that at firft I imagined 
 the breech prefented, until examining a fe- 
 cond time with my fingers, I felt the mouth, 
 eyes and nofe. When the friends afked if 
 the cafe was dangerous, I precipitately an- 
 fwered, that there was no great danger, 
 but that of lofing the child, which might 
 be faved, if the mother was foon delivered. 
 
 And 
 
CASES MIDWIFERY. 277 
 
 And they replied, that provided the mother 
 was fafe, the child was of no great con- 
 fequence, as fhe had already more children 
 than fhe conld v/eli m^ffltein. The pati- 
 tient told me, fhe felt ti^^child flir every 
 now and then, and indeed I plainly felt 
 its motion by laying my hand on her belly. 
 However, as every body prefent declared 
 againft my giving any affiftance, and were 
 fatisfied with my telling them that the wo- 
 man was in no immediate danger, I left 
 her to the care of the midwife, who in- 
 deed had oppofed my being called. I 
 could eahly have delivered her with the 
 forceps, and ought to have faid in general 
 that there was danger in the cafe : I knew 
 the child’s head was fmall, and that the 
 delivery was retarded either by the navel- 
 ftring, or the contraction of the lower 
 part of the Uterus^ round the neck, or be- 
 fore the fhoulders j for, the head was pull- 
 ed up as the pains abated. 
 
 This vilit I made in the forenoon, and 
 the child was not delivered till the evening, 
 when I was called again in a great hurry, 
 to bring away the Placenta^ which was eah- 
 ly extracted. I examined the child, which 
 was dead, and found its head fqueezed to 
 T 3 a 
 
278 CASES IN MIDWIFERY. 
 
 a great length, the face and neck being 
 much fwelled and of a livid colour. 
 
 C A S E II. 
 
 In the year r^.4. I examined one of 
 the poor women, attended by my pupils, 
 in labour of her firft child, which lay very 
 high, and I thought I felt the breech pre- 
 fenting. The membranes had broke when 
 the mouth of the womb was dilated to the 
 breadth of half a crown, and the pains 
 being flight and the woman ftrong, I de- 
 fired the gentlemen to let the breech be 
 pufhed down gradually, and flowly dilate 
 the Os Internum^ and in the mean time, I 
 left a midwife to attend, and direfted her 
 to give us notice when that dilatation 
 fliould be effected. In about three hours, 
 I was called again, and underftood from 
 the midwife, that after the mouth of the 
 womb was fully opened, the child defcendi 
 ed very faft, prefenting at firft with the 
 cheek, but that now fhe plainly diftin- 
 guifhed the face. When I examined, I 
 found the chin down to the lower part 
 of the left Ifchium, the chin being turned 
 up below the Pubis ; and, in a few pains, 
 the Os Externum being fufliciently dilated, 
 
 the 
 
CASES IN MIDWIFERY. 279 
 
 the forehead and Vertex turned up from 
 the PerineeuMi and the woman was imme- 
 diately delivered of a fmall child, before 
 any of the pupils arrived. 
 
 % 
 
 CASE III. 
 
 Vide Tab. XXV. 
 
 In the year 1748. I was called to a wo- 
 man in labour, by a midwife, who told 
 me fhe found the opening of the child’s 
 head below the fhare-bones, and imagined 
 the child came wrong, with the forehead 
 to that part. At firft when I examined I 
 was of the fame opinion ; but during the 
 next pain, which was very ftrong, I found 
 the head was pulhed down much lower at 
 the back part of the Pelvis^ and feeling 
 at that part, with my finger, for the Lamb- 
 doidal Suture^ I plainly diftinguifhed the 
 face, and the chin backwards at the Coc-^ 
 cyx. In two pains more, the face and 
 forehead protruded the pofterior parts in 
 form of a large tumor, the Perinceum and 
 fundament were greatly lengthened, the 
 Vertex and Occiput flipped out from below 
 the Pubis ^ then the forehead and face turn- 
 ed up from the Perinceum^ which being 
 thin, I fupported with my hand, and the 
 T 4 woman 
 
28 o cases in midwifery. 
 
 woman was delivered of a fmall child. 
 Her Pelvis was large, and fhe ufed to have 
 very quick labours. 
 
 C A«S E IV. 
 
 In the year 1749. I attended a gentle- 
 woman, whom I had twice before deliver- 
 ed, after tedious labours, proceeding from 
 the largenefs of the children and the fmall 
 lize of the Pelvis. When I was called on 
 this third occafion, the mouth of the 
 womb was open to about the breadth of 
 a crown piece, the membranes and waters 
 were very tenfe during a pain, but being 
 relaxed when that abated, I felt fome part 
 of the child, though more unequal than 
 the Jlpex of the head. Having waited, till 
 by degrees the membranes had fully opened 
 the parts, and were pufhed down to the 
 lower part of the Fagina, I examined 
 again, and felt the child’s face prefenting 
 through the membranes. Reflecting upon 
 her former tedious labours, and forefeeing 
 that if I allowed the head to come along 
 in that pofltion, the patient would fuffer, 
 and that if I fhould bring it by tlie feet, 
 the child might be loft ; I directed her 
 to be laid on her back, with her breech 
 
 to 
 
CASES IN MIDWIFERY. 281 
 
 to the foot of the bed, and fupported with 
 pillows, between a fitting and a lying pof- 
 ture, on pretence that the labour would 
 be favoured by fuch a fituation. While a 
 woman fat behind fupportmg her head, and 
 one on each fide held up her legs and knees, 
 I gradually dilated the Os Externum during 
 the pains, until I could introduce my hand 
 into the Vagina. In pulhing it farther up, 
 I felt the membranes break, but, my hand 
 ffcill advancing, the Os Externum was plug- 
 ged up by the lower part of my arm, 
 which hindered the waters from being dif- 
 charged, until feeling the chin to the right, 
 and the forehead to the left-hde, I raifed 
 this laft upwards, grafping the Vertex^ 
 which was now lowermoft, with my fin- 
 gers and thumb. I then gently withdrew 
 my hand a little, to let the waters pafs, 
 that the Uterus might be contradfed, and 
 keep the child in that pofition. Finding 
 this expedient fucceed, I drew forth my 
 hand, vvhen the patient thought the child 
 was delivered. However, I convinced her 
 that what I had done was abfolutely ne- 
 ceiTary, and that fhe was now in a fair 
 way of delivery, provided fhe would exert 
 that courage and patience, which had fup- 
 2 ported 
 
282 CASES IN MIDWIFERY. 
 
 ported her in her former labours. Nor 
 was I difappointed in my prognoftic j for, 
 this delivery was much quicker than thofe 
 Ihe had experienced before. 
 
 CASE V. 
 
 In the year 1751. I was called to a wo- 
 man in labour, by a midwife who had 
 formerly attended my ledtures : Ihe inform- 
 ed me that the mouth of the womb was 
 largely open, and although the membranes 
 were not broke, Ihe could find fomething 
 like a hand and fingers : fhe likewife told 
 me, that the woman was ftraight made ; 
 that fhe had delivered her once before, 
 when the labour was very tedious, and the 
 head of the child, which was dead born, 
 fqueezed to a great length, I foimd every 
 thing as fhe had defcribed, and felt befides, 
 fomething like the fhoulder or hip, which 
 I was certain, could not be the head. As 
 her former labours had been difficult, and 
 I was afraid the child would be loft, fhould 
 it be brought by the feet, I refolved to 
 feize the opportunity of trying to bring in 
 the head, fmce the membranes were not 
 broke. I accordingly adhed pretty much 
 in the fame manner as in the preceding 
 
 cafe i 
 
CASES IN MIDWIFERY. 283 
 
 cafe j but found greater difficulty in bring- 
 ing in the head, which was more flipper y 
 and large than that in the former inftance ; 
 befides, I loft a great quantity of the wa- 
 ters, by being obliged, after I had pufhed 
 up the fhoulder, to withdraw my hand a 
 good way before I could bring in the head, 
 and in attempting to raife up the hand 
 that came down with it. The Vertex be- 
 ing turned down, and one of the ears to- 
 wards the Vertebra of the loins, I with- 
 drew my hand, when the forehead with 
 the right-hand was to the right, and the 
 Occiput to the left fide of the Pelvis^ and 
 the pains ceafed for fome time, as ufual, 
 after the membranes are broke. Having 
 now encouraged the woman, by teUing 
 her that the child prefented fair, I took my 
 leave, and in about three hours, fhe was 
 fafely delivered, though not without very 
 ftrong and fevere pains. 
 
 C A S E VI. 
 
 In the year 1752. I was called to a wo- 
 man, whom I had before delivered of a 
 child that prefented wrong, though I could 
 not fave it by reafon of her narrow Pelvis, 
 On this occafion, fhe had been fubjedl to 
 l fre- 
 
284 CASES IN MIDWIFERY. 
 
 frequent, tliough flight pains, the day be- 
 fore Ifaw her; towards morning the mem- 
 branes had broke, a fmall quantity of the 
 waters was difcharged, and fhe had no 
 more pains till my arrival. Upon examin- 
 ing, I found fome part prefenting, which 
 could neither be the head nor breech, and 
 I afterwards difcovered to be the breaft. As 
 the pains had ceafed, I was in hope that 
 fome of the waters was left in the Uterusj 
 although the membranes were broke, and 
 going to work as in the two former cafes 
 brought in the Vertex, with great difficulty, 
 occafloned by the flipperinefs of the body 
 and head, which laft, was, after many ef- 
 forts, and the return of ftrong pains, 
 fqueezed down in a longitudinal form, and 
 the woman fafely delivered. 
 
 In thefe cafes we are feldom called in by 
 the midwives before the membranes are 
 broke, otherwife we fhould, in praeterna- 
 tural pofitions, have a better opportunity 
 to bring in the Vertex, when the Pelvis is 
 fo fmall, or the head fo large, that the 
 child cannot be faved, if brought by the 
 feet. 
 
 CASE 
 
CASES IN MIDWIFERY. 285 
 
 CASE VII. 
 
 Communicated by Mr. Hargood, in a letter 
 dated at Chatham ^ 1751* 
 
 When he was called the midwife told 
 him the waters had been difcharged feveral 
 hours ; and he found the face prefenting 
 low in the Pelvis, the chin being towards 
 the right IfcMum. After fhe had under- 
 gone feveral pains, which did no fervice, 
 he refolved to deliver with the Forceps 
 but juft when he was about to apply them, 
 fhe was feized with a ftrong pain, during 
 which he affifted with his fingers in mov- 
 ing the chin towards the Pubis, and the 
 child was fafely delivered. 
 
 CASE VIII. 
 
 Communicated by Mr. Cook, Sept. 26, 1752. 
 
 I was called to a woman in labour, and 
 felt the child’s face prefenting. I under- 
 ftood that file had undergone two tedious 
 labours before, though the children were 
 very fmall ; whence I concluded her Pelvis 
 was narrow, and in palfing my hand into 
 the Vagina, I found it fo. Upon which I 
 laid afide all thoughts of turning the child 
 and delivering by the feet, as I ftiould have 
 
 done 
 
286 CASES IN MIDWIFERY. 
 
 done had the Pelvis been large. The face be- 
 ing high up, and her pains very ftrong, I wait- 
 ed to fee if they would bring it lower down, 
 and ill about fix hours my expe6lation was 
 anlwered, the chin being at the left Ifchium, 
 I then, during the pains, endeavoured to 
 raife it to the Os Pubis with my finger, 
 and in that manner the child was deliver- 
 ed. The head was fqueezed into a long 
 form, the parietal bones were prefled one 
 over another, and on one fide of the head 
 was a very deep impreflion formed by the 
 jetting in of the Os Sacrum. The face was 
 very much bruifed and fwelled, and the 
 child dead. I prelcribed an opiate for the 
 woman, who had undergone great fatigue; 
 fhe enjoyed good reft and did well. 
 
 COL- 
 
CASE 5 IN MIDWIFERY. 287 
 
 COLLECTION XVII. 
 
 Of tedious cafes from the rigidity of the 
 Os Internum, Vagina, or Os Ex- 
 ternum, as alfo from the wrong pofi- 
 tion of the mouth of the womb. 
 
 N U M B. I. C A S E I. 
 
 Of the rigidity of the Os Uteri. 
 
 In the year 1731. I was called to a wo- 
 man turned of forty, in labour of her firll 
 child, who, though by her own and mid- 
 wife’s account, fhe had three or four weeks 
 to go, had been in a kind of lingering la- 
 bour for two days : at lix in the evening 
 the membranes broke, and as fhe lived at 
 a diflance, I could not be with her, till 
 about four next morning, when the mid- 
 wife told me that after the membranes 
 broke, ihe had every now and then a ftrong 
 pain, but that the mouth of the womb 
 was not opened as ufual by thefe pains, 
 and fhe was afraid that the womb and al- 
 together would be pufhed out of the body, 
 through the Os Externum. Upon examin- 
 ing in time of a pain, I found the mouth 
 of the womb open to about the breadth 
 
 of 
 
28S cases in midwifery. 
 
 of half a crown, but thick and rigid, and 
 forced about half an inch without the Os 
 Externum^ which was pretty highly dilated, 
 and I felt the child’s head prefenting. 
 There was an intenfe heat at the mouth 
 of the Uterus^ and file complained of great 
 pain in that part, even in abfence of the 
 labour-pains. She was of a ftrong and 
 healthy conftitution, though of a thin 
 habit, her pulfe was quick, full and hard, 
 her Ikin hot and dry, file laboured under 
 a fevere drought, and I underlfood fhe 
 had from time to time fwallowed cordials 
 to aflift the labour, fuch as white-wine 
 and malt fpirit. Having confidered the 
 circumftances of the cafe, I concluded that 
 the difficulty of delivery was owing to the 
 rigidity of the Os Intenmm^ for Ihe had 
 lain chiefly on the bed, without having 
 been fatigued ; that the head was but 
 fmall, becaufe it had puflied the mouth 
 of the womb fo low down, and that the 
 fever was owing to an indifcreet ufe of 
 fpirituous liquors. In confequence of thefe 
 refiedlions flie was blooded at the arm to 
 the quantity of twelve ounces, diredfed to 
 drink plentifully of barley-water, kept in 
 bed, lying on one fide, her breech being 
 
 raifed 
 
CASES IN MIDWIFERY. 289 
 
 raifed a little higlier than her body, and 
 during every pain, I kept up the Uterus 
 and head with my fingers, fo as to refill 
 and abate the violent force of the pains. 
 By thefe means, die was greatly relieved, 
 enjoyed between v/hiles gentle dumbers and 
 plentiful fv/eats, the mouth of the womb 
 turned more foft and yielding, and when 
 largely dilated, I pudied it gently up vdth 
 my fingers all round the head, which at 
 lafl glided eafily along, and was delivered. 
 
 I took the fame precaution in delivering 
 the fhoulders and body, defired the mid- 
 wife to confine her to her bed longer than 
 the ufual time, and advifed her to abftain 
 from any violent exercife for a confider- 
 able time after die diould be able to walk, 
 in order to prevent a Prolapfus Uteri. I 
 was afterwards informed that fhe recovered 
 very well, without being expofed to any • 
 fuch complaints in the lequek' 
 
 CASE II. 
 
 In the year 1746. I attended a patient 
 near forty, in labour of her third child, 
 who had been affiidled with a Prolapfus 
 Uteri ^ dnce her lafl pregnancy. When I 
 was called, die had fome dight pains, the 
 U mouth 
 
290 CASES IN MIDWIFERY. 
 
 mouth of the womb was very little open, 
 feemecl thin and rigid, and was fituated 
 more forwards in the Vagina^ than is com- 
 monly the cafe j the child’s head was prefs- 
 ed low down, and feemed fmall, but I could 
 feel no waters. Her pulfe being very quick, 
 Ihe was blooded to the quantity of eight 
 ounces, an emollient and laxative glyfter 
 being injefted, difcharged a great quantity 
 of hard F(^ces ; and as fhe had enjoyed no 
 fleep that day or the preceding night, I 
 prefcribed an anodyne draught, and di- 
 reffed her to drink plentifully of barley- 
 water. Thefe expedients fucceeded to my 
 wifh ; Ihe dept and fweated during the 
 greatell part of the night, and I was call- 
 ed again in the morning, vdien the pains 
 grew Ifronger and more frequent. I then 
 found the mouth of the womb much more 
 • open, though pufhed down without the 
 Qs Externum ; I likewife felt between my 
 fingers the hair of the child’s head, tho’ 
 the patient was not fenlible that the 
 membranes were broke, or the waters 
 drained off. During every pain, I kept 
 up the child’s head, and the mouth of the 
 womb, which I -gradually dilated with my 
 linger, till being fully opened, it eafily 
 I dipt 
 
GASES IN MIDWIFERY. 291 
 
 jlipt up all round the head, and this after- 
 wards opening the Os Externum by degrees, 
 was fafely delivered. 
 
 CASE III. 
 
 In the courfe of the fame year, I was 
 befpoke to attend a woman, who had been 
 fubjc6l to tedious labours, and when call- 
 ed, I found the child’s head pufhed down 
 to the anterior and inferior part of the Ute- 
 rus^ fo much at the fore-part, that it was 
 fome time before I could feel the mouth of 
 the womb, which was tilted backwards 
 and upwards to the upper part of the 
 Os Sacrum. In a few pains, the head 
 pufhed down the Uterus below the PubeSy 
 to the Os Externumy when I felt the Os 
 Uteri very thin and foft : and the patient 
 complained of great pain from this pro- 
 trulion of the lower part of the womb by * 
 the head. However, fhe was in a great 
 meafure relieved by my prelTing againft 
 it with my fingers at the fame time, in- 
 troducing the fore-finger of my other hand 
 into the mouth of the womb, I brought 
 it forwards to the Pubis, and kept it in 
 that pofition during feveral pains, which 
 gradually dilating it, the head was pufhed 
 U 2 lower 
 
292 t:ASES IN MIDWIFERY. 
 
 lower and lower, and by degrees I dipt up 
 the mouth of the womb, betwixt the Pu- 
 his and head, which afterwards made very 
 quick advances, and was foon delivered. 
 
 C A S E IV. 
 
 In the year 1 747. I attended a woman in 
 labour of her firif child, whofe belly was pen- 
 dulous, and hung forward over the Pubis, 
 (Vid. Tab. XII.) When I came die was pret- 
 ty ftraight laced, the pains v/ere ftrong, the 
 membranes pudied down with the waters, 
 the Os Externum was backwards and high 
 up, felt thick and rigid, and was opened 
 to about the breadth of half a crown. I 
 directed her to unlace, dedred the nurfe 
 to m.ake the bed fo as that her breech 
 might lie higher than her fhoulder, and to 
 raife up the belly with her hands in time 
 of a pain. The mouth of the womb was 
 gradually dilated, the membranes broke, 
 and the child’s head advanced lower in the 
 Pehis ; but the Os Internum remaining dill 
 backwards, and the head preffing down 
 the lower and aiiterior part of the Uterus^ 
 I was obliged to affid, as in the former 
 oafe, until the head was forced down, tho’ 
 8 it 
 
CASES IN xMIDWIFERY. 293 
 
 it dilated with great diiiiculty, and to 
 ftretch the Os Externum^ from time to 
 time, before the child could be delivered. 
 
 CASE V. 
 
 I was called to a patient not above fif- 
 teen years of age, in labour of her firfi; 
 child, and found the head of the child pre- 
 fenting, and that the membranes and wa- 
 ters, after having llowly dilated the Os In- 
 ternum^ advanced quite to the Os Exter- 
 num^ which I hoped they would open alfo 3 
 but they broke juft as they arrived at the 
 part. Then tlie head advanced and pufli- 
 ed out the lower parts, in form of a large 
 tumor, to the extent of five inches, the 
 Perineeum being very thin ; nevertheleft, 
 the Os Externum was very little dilated, 
 and the pains were fo ftrong, that I was 
 obliged to prefs the flat part of my hand 
 upon the parts, to prevent the Fourchette 
 from being torn, and by refifting the force 
 of the head againft the Os Exter?ium, al- 
 low it time for gradual relaxation. The 
 pains continuing to return every five or 
 fix minutes for the fpace of an hour, with- 
 out any alteration, I found it necelTary to 
 prefcribe an opiate to reftrain them, that 
 U 3 I 
 
294 CASES IN MIDWIFERY. 
 
 I might have time to lubricate with po- 
 matum, and dilate gently with my fingers. 
 By thefe means, the Os Extermm was gra- 
 dually ftretched fo as to allow the head to 
 pafs without any laceration of the parts. 
 
 CASE VI. 
 
 About the fame time, I attended ano- 
 ther patient, though not fo young, and 
 the labour proceeded much in the fame 
 manner : but, after having guarded the 
 parts, in order to prevent laceration, 
 during a few pains, I withdrew my 
 hand to take fome pomatum, for lubri- 
 cating the external parts j in that inter- 
 val a ftrong pain returned, contrary to 
 my expe6lation ; and, before I could 
 replace my hand, the child’s head was de- 
 livered, and the Ferinceum torn quite to 
 the Anus. This accident was owing to 
 my hurry and precipitation, in confequence 
 of which, I pafled my hand on the out- 
 fide of the fheet, and before I could dif- 
 entangle it, the damage was done. 
 
 Ever fince this misfortune, when I at- 
 tend women in labour of their firfi: chil- 
 dren, I always turn up and pin the upper 
 
 fiieet 
 
CASES IN MIDWIFERY. 295 
 
 Ihcet to the bed-quilt, as the child’s head 
 advances to the lower part of the Pelvis. 
 
 CASE VII. 
 
 Communicated by Dr. Aujlin^ of Edinburgh^ 
 in a letter dated 1749. 
 
 He was called to a young woman in la- 
 bour of her firfl child, who had acute 
 pains from Puefday till Saturday night, when 
 fhe was delivered. All that time the child’s 
 head was fqueezed in the Pelvis^ and for 
 twenty-rfour hours the bones rode on one 
 another in the Vagina. About two hours 
 before fhe was laid, he attempted to intro- 
 duce the forceps, which, however, he de- 
 clined ufing, becaufe the pains became 
 ftronger, and he imagined the child was 
 dead. Indeed, to all appearance it was 
 ft ill-born, but in a few minutes he was 
 agreeably furprized to find it alive, and 
 both the mother and the child did well* 
 though two days after delivery, he extrafted 
 from the woman five EngliJJj pints of urine 
 with the catheter. 
 
296 CASES IN MIDWIFERY. 
 
 COLLECTION XVIII. 
 
 Of lingering or dangerous cafes, from 
 weaknefs, anxiety, frights, floodings, 
 loofenefs, convulflons, fevers, &c. 
 
 N U M B. I. C A S E I. 
 
 From Weakness. 
 
 In the year 1743. I was called to one 
 of the poor women whom my pupils at- 
 tend, in labour of her firfl: child. She 
 was young, and fo exceffively weak from 
 want of nourifliment, that when we were 
 called, fhe feemed really expiring. Ano- 
 ther patient who lived in the fame houfe, 
 faid, this young vroman was an entire 
 flranger, who had been taken in as a lodger 
 the preceding night, and feemed to be in 
 a flarving condition j and at lafl; the poor 
 creature herfelf owned, that fhe had re- 
 ceived no fuftenance but water, for the 
 fpace of three days. She had been fub- 
 jecl to fome flight pains all the former 
 day and night : when I examined, I found 
 the mouth of the womb largely open,- the 
 membranes broke, and the head prefent- 
 ing j but the pains were at long intervals, 
 
 and 
 
CASES IN MIDWIFERY. 297 
 
 and her weaknefs fo alarming, that I im- 
 mediately fent for a roll and fome ale, 
 which was qualified with a little fugar, 
 nutmeg and geneva, to which laft I fiip- 
 pofed fhe was accuftomed, and therefore 
 judged it was a better cordial than any other 
 I could have prefcrih’d from an apothecary’s 
 fhop. Of this nourifhment, I directed 
 her to take a very little at a time, and ac- 
 cordingly, her exhaufted fpirits were gra^ 
 dually recruited, infomuch, that although 
 the cafe was lingering and tedious, die was 
 fafely delivered by the labour-pains. 
 
 CASE II. 
 
 In the year 1724. I v/as by a midv/ife 
 called to a woman of a weak habit and 
 melancholy difpofition, occafioned by the 
 exceflive flooding which had attended a 
 former delivery. She had become pregnant 
 again, before fhe recovered her ftrength, 
 was feldom able to rife out of bed, and 
 her ftomach was fo weak, that it could 
 receive or digefl but very little nourifh- 
 ment. The midwife told me her pains 
 were fo weak, fhe was afraid fhe could not 
 be delivered without afliflance ^ that fhe 
 had enjoyed httle or no deep for the fpace 
 
 of 
 
298 CASES IN MIDWIFERY. 
 
 of forty-eight hours, but had been fubje^b 
 to frequent faintings, from which fhe was 
 with difficulty recovered ; and laftly, that 
 the mouth of the womb was foft and a 
 little open. I felt her pulfe very low, and 
 examining during a pain, which feebly 
 protruded the membranes and waters, per- 
 ceived the child’s head : then bringing for- 
 wards with my finger, the Os Uteri to- 
 wards the Pubis^ I found it much more 
 open than the midwife imagined, and felt 
 fome indurated Faces in the ReBum. I 
 was alfo informed, that as fhe had an aver- 
 fion to all forts of nourifhment, fhe ate 
 very little, and fel dom had paffage in her 
 belly, and was commonly coftive. 
 
 I dire6led her to take frequently a tea- 
 cup full of chicken-broth, and between 
 whiles, a little of the weak cinnamon- 
 water. A glylfer of the broth being thrown 
 up, emptied the inteftines ; then half a 
 pint of the fame, in which two grains 
 of Opium were diffolved, being injected, I 
 defired that fhe might be kept quiet in bed, 
 in hope of procuring her fleep, and take 
 an ounce of ftrong cinnamon- water every 
 four hours. By thefe means the faintings 
 went off, file flept pretty well that night 
 
 he- 
 
CASES IN MIDWIFERY. 299 
 
 between the pains, and thefe gradually in- 
 creafing fhe was fafely delivered in the 
 morning. 
 
 CASE III. 
 
 In the year 1744. I attended a gentle- 
 woman, in labour of her third child. She 
 was of an hypochondriac difpofition, went 
 feldom abroad, towards the latter end of 
 pregnancy, could hardly be kept out of 
 bed, was, in the beginning of the eighth 
 month, attacked with frequent Teachings, 
 fo as to vomit up every thing Ihe ate or 
 drank, by which complaint the was re- 
 duced to a Rate of exceliive weaknefs, from 
 want of nourifhment. 
 
 I otRered the nurfe to inje6f about half 
 a pint of beef or mutton broth, by way 
 of glyfter, five or fix times a day, to pre- 
 vail upon her to rife frequently and walk 
 about the room, and likewife to go abroad 
 fometimes in a coach. 
 
 By this method fhe recruited a little, and 
 with the affiRance of fome mint and anti- 
 hyReric water, Rie could keep a little 
 broth in her Romach. I managed her 
 much in the fame manner as that defcribed 
 in the former cafe, in time of labour, which 
 though tedious, ended happily. 
 
 NUMB. 
 
300 CASES IN MIDWIFERY. 
 
 N U M B. II. C A S E I. 
 
 From Anxiety and Grief. 
 
 In the year 1747. I attended a gentle- 
 woman, in labour of her firR child, who, 
 a few clays before had been fo much af- 
 fecled with the fudden death of her huf- 
 band, that flie was feized with frequent 
 faintings and great anxiety of mind. When 
 I arrived, her pains vvere very weak, and 
 the membranes had broke even before the 
 mouth of the womb was much dilated j 
 and although the child’s head was fmall, 
 fire continued three days in a kind of la- 
 bour : yet, by encouraging and fupporting 
 her with cordials and nourifliing things, 
 and indulging her as much as poffible with 
 reft, fhe was fafely delivered of a child, 
 which feemed to -have died foon after flie 
 heard the melancholy nev/s of her huf- 
 band’s death. 
 
 CASE II. 
 
 In the year 1749. I was called to ano- 
 ther gentlewoman, in the fame circum- 
 ftances, overwhelmed with anxiety in con- 
 fequence of her hulband’s death, which 
 had happened about tv/o months before 
 
 her 
 
CASES IN MIDWIFERY. 301 
 
 her labour : I found her fo low, and the 
 cafe was fo tedious, that I was afraid flie 
 had not ftrength to undergo the delivery. 
 Yet by the management defcribed above, 
 fhe was fafely delivered of a weakly child. 
 
 I have attended many other women in 
 labour, whofe lives were endangered by 
 great weaknefs, proceeding from various 
 caufes ; yet, by fuch management they 
 were fafely delivered. Anxiety, misfortune, 
 and difappointment, frequently reduce wo- 
 men in labour, to the verge of death : la- 
 bour is often brought on by frights pro- 
 ceeding from different accidents, fuch as 
 that of fire in the neighbourhood : the 
 earthquake in the year 1749, produced fe- 
 veral cafes of this kind, and any thing 
 that affedls the paffions to a degree of vio- 
 lence or tranfport, will have the fame ef- 
 fe6f. On thefe occahons, delivery is fome- 
 times performed of a fudden, but if the 
 labour was begun before the patient was 
 feized with the emotion, it commonly 
 went off, nor did the pains return for a 
 long time. However, if thefe frights, &c, 
 are not attended with violent floodings, 
 convulfions or fevers, the patients gene- 
 rally recover, though fometimes the chil- 
 dren 
 
302 CASES IN MIDWIFERY. 
 
 dren are dead. Nay, even when thofe 
 bad fymptoms have accompanied the cafe, 
 I have known both mother and child hap- 
 pily faved. 
 
 NUMB. III. CASE I. 
 
 From Floodings. 
 
 In the year 1735. I was called to a wo- 
 man near her full time, who was feized 
 with flooding and labour, in confequence 
 of being frightened by a fire which hap- 
 pened in the houfe, as well as from the 
 fatigue incurred by removing the furni- 
 ture, When I arrived, the fire was ex- 
 tinguifhed, and I found her lying upon 
 liay in a barn, lofing blood very faft. The 
 mouth of the womb being pretty largely 
 opened, I immediately broke the mem- 
 branes, which, wdth the waters, were 
 puflied dow'n in every pain, and the 
 hsemorrhage foon flopped : the patient 
 was very cold, from the fe verity of the 
 winter feafon, and the thinnefs of her co- 
 vering, While I pradfifed in the country, 
 I always carried in my pocket, fome fpirit 
 of haitfliorn, tinfture of caflor, and liquid 
 laudanum, in feparate bottles j of thefe, 
 y/ith the afliflance of fome brandy and 
 V water. 
 
CASES IN MIDWIFERY. 303 
 
 water, I compofed a cordial and anodyne 
 mixture, of which fhe took frequently 
 two or three fpoonfuls, and being accom- 
 modated with more cloaths from the neigh- 
 bourhood, fhe recovered her natural heat, 
 and at laid enjoyed a plentiful fweat and 
 refrefhing repofe. The pains were flowly 
 augmented with long intervals ; as her 
 pulfe and ftrength returned the labour ad- 
 vanced, and although it was tedious, fhe 
 was at lafl delivered. Yet her deep was 
 afterwards interrupted by frightful dreams 
 of firei and Ihe often awoke in a deliri- 
 um, fo that twenty days elapfed before fhe 
 was out of danger. She had fuckled her 
 former children, but had no milk after 
 this delivery, and but a very fmall dif- 
 charge of the Lochia ; thefe evacuations 
 being impeded by the difturbance of her 
 thoughts : her greateft danger, however, 
 feeming to proceed from weaknefs occa- 
 iioned by the lofs of fo much blood, I 
 thought the principal objedl of regard was 
 the circulation, which was kept up by the 
 cordials and reftoratives ; and as fhe was 
 every now and then fubjedt to fliiverings, and 
 laboured under a low weak pulfe, I pre- 
 feribed repeated dofes of the bark and the 
 
 mode- 
 
304 CASES IN MIDWIFERY. 
 
 moderate ufe of French claret, from which 
 Ihe found great benefit. 
 
 When labour is brought on, and a flood- 
 ing occafioned by fuch alarms, fo that the 
 patient is exhaufted by the haemorrhage, 
 this is either diminiflied or entirely car- 
 ried off by breaking the membranes j and 
 of late, I have frequently fucceeded in flood- 
 ings that happened before labour, by gent- 
 ly dilating the mouth of the womb with 
 my finger, fo as to bring on the labour- 
 pains, as in the following cafe. 
 
 CASE II. 
 
 In the year 1745. I was called by amid- 
 Vv^ife, to a woman feized with flooding in 
 the middle of the ninth month, though 
 no vifible caufe could be alfigned for this 
 haemorrhage 3 and fhe had bore children 
 before, with very eafy labours. As the 
 difcharge was not fo great as to require 
 immediate alfiftance, and her pulfe was 
 rather firong than other wife, I ordered her 
 to be blooded to the quantity of eight 
 ounces, and to be kept quiet in bed j be- 
 ing coftive file received a glyfier, took fre- 
 quently two fpoonfuls of a mixture com- 
 pofed of fix ounces of the tijiclure of 
 
 rofes, 
 
CASES IN MIDWIFERY. 305 
 
 rofes, and about twenty drops of liquid 
 laudanum. The flooding abated, and flie 
 refted tolerably well that night j but when 
 flie rofe to have her bed made, fome large 
 dots were difcharged with a little pain, and 
 the flooding returned, though it was foon 
 reftrained when Ihe lay down again. In 
 this condition, fhe continued for feveral 
 days, during which, upon the. leafl: mo- 
 tion, fome clots or coagula were forced off 
 from the Vagina^ and followed by a frefli 
 difcharge, which, notwithftanding all our 
 efforts to encourage her and fupport her 
 flrength, gradually weakened her confti- 
 tution, and returning one evening with 
 greater violence, I v/as called in a hurry, 
 when I found her low and difpirited, and 
 her friends in great anxiety and conlfcrna- 
 tion. I had previoufly informed the mid- 
 wife and relations, of the imminent dan- 
 ger that threatned the patient, if the flood- 
 ing fliould not abate, or labour come on, 
 and defired that fome other gentleman of 
 the profeffion might be confulted for their 
 and my fatisfa6lion j however, this propo- 
 fal they declined. Thus left to my own 
 difcretion, and feeling the Os Uteri very 
 foft, though very little open, I gently in- 
 X troduced 
 
3c6 cases in midwifery. 
 
 troduced the tip of my finger, in order to 
 dilate it, and defired the patient to affiffc 
 my efforts by Ifraining downwards. This 
 method being gradually repeated every 
 now and then, the parts were opened to 
 the breadth of half a crown, and I pro- 
 duced fome flight pains that returned of 
 themfelves : yet, notwithftanding feveral 
 attempts, I could not break the membranes, 
 until, gradually flretching the Os Externum 
 during every pain, fo as to introduce my 
 hand into the Vagina, I tried to advance 
 my finger farther up ; but not fucceeding, 
 I infinuated the female catheter, which 
 breaking through the Chorion and Amnm,^ 
 the waters were difeharged in great quan- 
 tity, the flooding immediately abated, and 
 the child’s head was prefled down upon the 
 mouth of the womb. She now lay eafy 
 for a long time, without the return of a 
 pain, during which interval, fhe was nou- 
 riflied and fupported by frequently receiv- 
 ing a little broth. But being afraid that 
 there might be an internal flooding dam- 
 med up by the child’s head, I defired her to 
 force down, while I raifed the head with 
 my finger, and accordingly feveral coagula 
 were difeharged from the Uterus : I then 
 
 thought 
 
CASES IN MIDWIFERY; 307 
 
 thought it advifeable to bring on and encour- 
 age the pains, by Ilretching as before 3 and 
 to my with, the parts were more and more 
 dilated, the pains grew ftronger, and at 
 laffc the patient was fafely delivered. Dur- 
 ing labour, I frequently felt her pulfe, which 
 inftead of finking, rather grew ftronger. 
 
 CASE IIL 
 
 In the year 1750. I was called to a wo- 
 man, by a midwife, who told me, that the 
 patient had been feized with a violent 
 flooding, but labour coming on^ the mem- 
 branes had broke, and the haemorrhage 
 was abated j but flie had fent for me, be- 
 caufe fhe found the navel-ftring in the Va~ 
 gina^ and the woman was very weak, and 
 had little or no pains. 
 
 Indeed fhe was fo low, that I could 
 fcarcely feel her pulfe ; her lips were pale 
 and her extremities cold : I found the Fu- 
 nis in the Vagina, but could feel no pul- 
 fation : the child's head prefented, but 
 was kept forwards to the Os Pubis, by the 
 lower part of the Placenta, which lay along 
 the Sacrum 3 however, the flooding was in- 
 tirely flopped. 
 
 X 2 
 
 I 
 
3o8 cases in midwifery. 
 
 I immediately directed her to take fome 
 of the folution of portable foup j and hot* 
 bricks wrapped in flannel, being applied 
 to her feet and hands, in about an hour, 
 her pulfe grew Itronger, her extremities 
 recovered their natural warmth, and the 
 pains returned. Finding the head was 
 hindered from advancing, by the Placenta, 
 I brought down this laft, and the patient 
 was gradually delivered of a fmall dead 
 child ; but file continued fo weak, that for 
 many weeks after her delivery, file was 
 fcarce able to walk about the room. 
 
 CASE IV. 
 
 In the year 1744. I was called by the 
 friends of a gentlewoman, who had been 
 feized with a flooding the preceding night. 
 The midwife told me, that the mouth of 
 the womb was open to the breadth of a 
 crown-piece, that the Placenta prefented, 
 that the pains were very flight and at long 
 intervals, and that the flooding was then 
 more violent than when Ihe was called : 
 and I myfelf felt the pulfe was not fo weak 
 as one would have imagined, confidering 
 the quantity of blood fhe had loft. 
 
 In 
 
CASES IN MIDWIFERY. 309 
 
 In this patient, who had formerly bore 
 children, the difcharge began to appear in 
 the beginning of the eighth month, re- 
 turning every now and then, when Ihe 
 ventured to go abroad ; but, by the ad- 
 vice and afilllance of another gentleman, 
 who was now obliged to attend another 
 patient, it had been kept within bounds, 
 till this period, which was the beginning 
 of the ninth month. 
 
 As fhe would not permit me to examine, 
 I privately advifed the midwife to introduce 
 her hand into the Vagina^ and feel all 
 around for the edge of the Flacenta^ at 
 which part, Ihe might tear the membranes j 
 Ihe accordingly felt them at the left fide, 
 and a large quantity of the waters being 
 difcharged, the child’s head advanced, 
 prelling the under part of the Flafenta to 
 the right fide. Then the pains encreafed, 
 the head gradually dilated the Os Uteri ^ 
 and being fmall, defcended lower and 
 lower, fo that in a few pains the patient 
 was delivered. The flooding abated when 
 the v/aters were difcharged, and was in- 
 tirely flopped, as foon as the head plugged 
 up the Os Internum, From time to time, 
 I felt her pulfe, which continued in much 
 X 3 the 
 
310 CASES IN MIDWIFERY. 
 
 the fame Rate, or rather turned ftronger j 
 from which circumftance, I concluded, 
 there was very little, if any internal hse-.- 
 morrhage ; and her ftrength was kept up 
 by her taking frequently a tea-cup full of 
 broth, or wine and water. 
 
 CASE V. 
 
 In the year 1 747. I was called by a mid^ 
 wife to a gentlewoman, whom fhe had 
 formerly delivered of feveral children. 
 This patient was taken with a fmall dif- 
 charge of blood in the beginning of the 
 ninth month, when I prefcribed ven^fec- 
 tion and a glyfler; after the operation of 
 which, fhe received a paregoric draught. 
 But the difcharge continuing for feveral 
 days, though in a fmall degree, I examin- 
 ed and found the mouth of the womb very 
 foft, placed fo high, and fo far backwards, 
 that I could not perceive the Placenta pre- 
 fenting, though I felt through the Vagina 
 and Uterus^ that the child’s head refled 
 againfl the Os Pubis. As the difcharge 
 did not weaken the patient, nothing was 
 done, but I laid an injimftion upon her, 
 to refrain from going abroad : yet, in 
 
 about 
 
CASES IN MIDWIFERY, 
 
 about eight or nine days from this period, 
 file was attacked with labour-pains, and 
 the flooding increafing, I received another 
 call, when I was informed by the midwife, 
 that the mouth of the Vv^omb was largely 
 open, that the waters had been difcliarged 
 immediately before my arrival, that the 
 Placenta had come low down, but fhe 
 could feel no part of the child. A ftrong 
 pain imrnediately fucceeding, I examined 
 and found the Placenta pufhing through 
 the Os Externum^ and the delivery of this 
 was immediately followed by that of the 
 child, which was alive, although the Pla- 
 centa came firft. The midwife told me, that 
 when fhe found the Placenta prefenting, flie 
 was cautious of touching it with her fingers, 
 remembring that when fhe attended my 
 ledlures, I had obferved, that the death of 
 the child in flooding-cafes, might be ow- 
 ing to its lofing blood from the lacera- 
 tion of the cake. 
 
 CASE VI. 
 
 In the year 1750, I was called to a pa- 
 tient about the end of the eighth month 
 of her fecond premancv. The midwife 
 X 4 told 
 
312 CASES IN MIDWIFERY. 
 
 told me the waters had been difcharged 
 two hours before my arrival, and the flood- 
 ing flopped ; that feeling fomething like a 
 flefliy fubflance come down, fhe had tried 
 to pull it away, on the fuppofrtion that it 
 was a falfc conception, and that thefe at- 
 tempts were followed by a large quantity 
 of blood. This fubflance, upon examina- 
 tion, I found to be the Placenta low down 
 at the Os Externum^ and Aiding my finger 
 betwixt it and the Os Puhis^ I felt the child’s 
 head. During the next pain, fire was deli- 
 vered of the Placenta, which was much la- 
 cerated, and a dead child. I have been 
 concerned in many cafes, where the flood- 
 ing, when inconfiderable, was eafily flopped, 
 and the woman proceeded to the full time. 
 
 CASE VII. 
 
 From Mr. E. W. dated T. W. 1747. with 
 
 my anfwer. 
 
 Sometime ago, I was fent for to a wo- 
 man after the midwife had made ufe of all 
 her art to no effedl : upon enquiry, I 
 found fhe had not gone her full time, the 
 membranes were broke, and there had 
 been, and flil] was, a profufe flooding. 
 
 On 
 
CASES IN MIDWIFERY. 313 
 
 On touching, I could find no Os ’T’inccs. I 
 then introduced my hand, with fome diffi- 
 culty, through the Os Externum’^ but could 
 not readily meet with the Os being 
 
 oppofed by a loft fleffiy fubftance, which 
 I took for the Placenta^ and which proved 
 to be fo, as I afterv/ards found it. The 
 child lying fo high, and being hindered by 
 the Placenta^ I could not get my hand be- 
 yond the Os Internum, to feel the child, 
 which put me to a Hand. However, hav- 
 ing taken out my hand, I kept my coun- 
 tenance as well as I could, and advifed the 
 woman to be of good cheer. Now from 
 the great effufion of blood, together with 
 the foregoing circumftances, I thought it 
 abfolutely neceflary to attempt her delivery, 
 by opening the contradled parts, and turn- 
 ing the child; but I had no fooner fat 
 down before her, than, providentially, ffie 
 had a ftrong pain or two, and to my great 
 furprize, the child was brought into the 
 world, the Placenta coming firfb, in- 
 clofed within its membranes. This plainly 
 convinced m.e of the error of fome who 
 have afierted, that the Placenta always ad- 
 heres to the Fundus Uteri, feeing, in this 
 pafe, it was the reverfe. With regard to 
 
 this 
 
3 14 CASES IN MIDWIFERY. 
 
 this cafe, the information I Iliould be glad 
 to receive is this : fnppofe the child had 
 not been born as it was, whether I fhould 
 have endeavoured to pafs by the Placenta^ 
 or extradled it before the child ? and fup- 
 pofe part of the Os T!inc<2 is covered with 
 part of the Placenta^ how to adl ? 
 
 Vide Collea. XXXIII. No. II. Cafe III. 
 
 Anfwer to thefe Queries. 
 
 I had a cafe of pretty near the fame 
 kind j the Placenta adhered to the lower 
 part of the Uterus^ and as the Os Uteri 
 began to ftretch, that part feparated from 
 the Placenta^ and then a fmall flooding be- 
 gan. When I was called, the patient had 
 fome labour-pains, and on examining, I 
 found the Os Internum open about the 
 breadth of half a crown, and the Placenta 
 prefled a little down into it; as the difcharge 
 was not great and the woman ftrong, I de- 
 layed to deliver until the Os Internum fhould 
 be more open. Some hours after this, I was 
 again called, the flooding was pretty violent, 
 I found the Os Internum fully opened, and thq 
 Placenta fully prefenting ; I laid the wo- 
 man on her back, with her thighs raifed, 
 
 thew 
 
CASES IN MIDWIFERY. 315 
 
 then introduced my hand into the Vagina^ 
 paffed up by the Placenta into the Uterus^ 
 broke the membranes, and delivered the 
 child by the feet, by which means I prevented 
 the Placenta from coming down firfl:. The 
 child was alive, becaufe part of the Pla- 
 centa adhered to the lower fide of the Ute- 
 rus. I have had cafes where the Placenta 
 has come down into the Vagina before the 
 child’s head, and I was obliged to deliver it 
 firft ; but in fuch cafes the child is com- 
 monly dead. It appears, in your cafe, that 
 the Os Internum had been fully open, that 
 the Place?2ta filled all the upper part of the 
 Pelvis^ and that the child being fmall, and 
 the Placenta detached, they all flipped along 
 with eafe, and were fo fuddenly delivered. 
 
 CASE VIII. 
 
 In the year 1733.T was about five in 
 the afternoon, called by Mr. Burnet, to a 
 woman in the latter end of the eighth 
 month, who, the preceding night, had 
 been taken with a large haemorrhage of 
 the Uterus, and had, every now and then, 
 fome flight pains. ■ Feeling the Os Uteri a 
 little open, and the Placenta prefenting, I 
 advifed him to dilate gently, during every 
 
 pain, 
 
3i6 cases in midwifery. 
 
 pain, and as foon as he could reach the 
 edge of the Placenta, to break the mem- 
 branes. This he effe6led in a few pains : 
 the waters were no fooner difeharged than 
 the flooding ceafed j and the pains grow- 
 ing ftronger, pufhed down the child’s head, 
 which gradually dilated the Os Uteri. But 
 as it pafled, the detached part of the Pla^ 
 centa was forced down with it, and a6lu- 
 ally tore from the reft, fifteen or twenty 
 minutes before the child was delivered. 
 We now expected the child would be loft, 
 from this laceration, but contrary to our 
 expe6lation, it was alive, and did well; 
 the mother alfo recovered, though fhe had 
 loft a great deal of blood, and had faint- 
 ing fits before I was called. 
 
 CASE IX. 
 
 Communicated by Mr. "J , dated at 
 
 F , I75J- 
 
 I was called to a woman who had gone 
 her full time, and had for three or four 
 days been troubled with a flooding which 
 then increafed. 
 
 I immediately took ten ounces of blood 
 from her arm, and preferibed an opiate, 
 
 that 
 
CASES IN MIDWIFERY. 317 
 
 that laid her quiet about three hours, dur- 
 ing which the flooding abated. But when 
 Ihe awoke and began to ftir, it returned, 
 though not to fo violent a degree. 
 
 In the afternoon, I was allowed to exa- 
 mine, and found the Os Internum very thin, 
 dilated to the breadth of a fixpence : but, 
 as the flooding feemed to increafe towards 
 night, I ordered cloths dipped in cold oxy- 
 crate to be laid over the Abdomen ; this 
 apphcation being twice repeated, the flood- 
 ing intirely ceafed, labour-pains came on, 
 in lefs than an hour fhe was delivered of 
 a live female child, and both did well. 
 
 N U M B. IV. C A S E I. 
 
 From' Looseness. 
 
 In Augiiji Bilious cholicks, at- 
 
 tended with vomiting and loofenefs, being 
 epidemical, I was called to feveral women, 
 labouring under thefe complaints, at diffe- 
 rent times of pregnancy, and they were 
 generally removed by wafhing the ftomach 
 and inteftines with warm water, and af- 
 terwards prefcribing opiates. One cafe, 
 however, was more obftinate. I was call- 
 ed to a woman, who had been exhaufled 
 and weakned by evacuations, for the fpace 
 7 of 
 
3i8 cases in midwifery. 
 
 of twelve hours before my arrival ; I was 
 told by the midwife, that fhe was in la- 
 bour of her firft child, though fhe wanted 
 about three weeks of the full time ; but I 
 was not allowed to examine j a circum- 
 ftance at that time of little confequence j 
 becaufe, whether die was, or was not in 
 labour, the firft intention was to carry off 
 the vomiting and loofenefs, and recruit 
 her loft ftrength and fpirits, with all pof- 
 fible expedition. I immediately ordered 
 her to fwallow large draughts of mutton- 
 broth, which I found ready made, mixed 
 with warm water, and thefe being thrown 
 up at feveral times with little ftraining, fhe 
 took thirty drops of liquid laudanum in a 
 glafs of brandy and water ; but, this be- 
 ing immediately rejedfed by her ftomach, 
 I gave her half the quantity of the lauda- 
 num in a little broth, and applied to her 
 ftomach, a piece of brown paper moiften- 
 ed alfo with the laudanum ; flie now be- 
 gan to be gradually relieved of the pain, 
 vomiting and loofenefs, fo that I was per- 
 mitted to examine, and found the mouth 
 of the womb thick and foft, opened to 
 the breadth of a crown-piece ; I likevv^ife 
 felt the membranes, waters, and child’s 
 
 head. 
 
CASES IN MIDWIFERY. 319 
 
 head. The complaints beginning to re- 
 turn, I repeated the laft dofe, and in about 
 half an hour after flie had taken it, flie 
 fell into a found deep, which 1 aided feve- 
 ral hours, and awoke very much refreflied, 
 her complaints being intirely removed. 
 All that day, fhe felt no labour-pains, and 
 as fhe was very weak, I diredled her to 
 take frequently a fmall draught of pretty 
 ftrong chicken broth, by which die was 
 gradually recruited. She dept well that 
 night, and in the morning was taken in 
 labour, which proved tedious and linger- 
 ing 5 though die was at lad delivered of 
 a large child which was dead, and in about 
 fix weeks die was perfedfly recovered. 
 
 CASE II. 
 
 In the year 1743. I was called to a gen- 
 tlewoman attacked by a violent fuper-pur- 
 gation, in confequence of having caught 
 cold, by fitting in an open chaife in rainy 
 weather, when die was eight months gone 
 in her fecond pregnancy. She had beea 
 exhauded by the evacuation the preced- 
 ing day and night, during which die en- 
 joyed no repofe, and in the morning when 
 I was called, I found her pulfe weak and 
 
 dow. 
 
320 CASES IN MIDWIFERY. 
 
 flow, and her extremities cold ; and fhe 
 told me, tliat in ftraining upon the ftool, 
 fhe had' fomething like labour-pains. I 
 immediately pfefcfibed the following bolus 
 and draught. 
 
 R I’heriac. Androniach, dij.fumend. cum haiijlu 
 fequenti. 
 
 R Aq. Cinamomt Simp. nuc. Mofchat. 
 Liquid. Laudan. gut. v. Syr. e Meconio 
 
 I direfted her to drink plentifully of white 
 wine whey, and ordered warm bricks 
 wrapped in flannel, to be applied to her 
 legs and arms, in order to reftore the na- 
 tural heat, to promote a fweat, and encou- 
 rage refl. In the mean time, I examined 
 and found the Os Uteri largely open, and 
 the head prefentingj and by feeling the 
 hairy fcalp, perceived the membranes were 
 broke. In confequence of what I had pre- 
 fcribed, her extremities became warmer, 
 her pulfe rofe, die fell into a breathing 
 fweat, and flept three hours j but being 
 waked by a pain and frefh draining, I 
 ordered her- to take half the quantity of 
 the former prefcription, by which fhe was 
 again relieved, dropt adeep, and when die 
 waked in tlie. evening, was quite free from 
 
 the 
 
CASES IN MIDWIFERY. 32^ 
 
 tEe pain, griping and draining, thpugh 
 dill very weak and feeble. To obviate 
 this complaint, I directed her to take every 
 now and then, fome red burnt wine, with 
 nutmeg and toad, and in the intervals, 
 chicken-broth. She continued ealy the night 
 following; when I called next day, fhe 
 told me die had fome dight pains, and I 
 found the child’s head lower in the Pehis. 
 The pains increafed, and in, two hours 
 after I arrived, the child was delivered. 
 
 I have often known premature labour- 
 pains vanidi, and the woman proceed to 
 her full time. 
 
 NUMB. V. CASE I. 
 
 From Convulsions. 
 
 In the year 1746. I was called to a wo- 
 man, by a midwife, who told me, that 
 the labour had proceeded very well ; that 
 the membranes had not broke until the 
 mouth of the womb was largely opened : 
 but, that the head was no fooner forced 
 into the upper part of the Pelvis^ than the 
 patient was thro\yn into violent convul- 
 dons, which went off, and returned with 
 every pain. She was a drong young wo- 
 man, of a florid complexion. This was her 
 
 Y flrfl. 
 
322- CASES IN MIDWIFERY. 
 
 firll child ; and her. pulfe being full, hard 
 and. quick, ten ounces of blood were im- 
 mediately taken from her arm : the con- 
 vulfions abated every pain until they went 
 off intirely, and. in about an hour after 
 they left her, fhe was fafely delivered. 
 
 CASE II. 
 
 In the year 1747. a woman in her third 
 pregnancy, near her full time, being taken 
 with a giddinefs which was immediately 
 followed by ftrong convulfions, I was call- 
 ed by the midwife, and examining in time 
 of a convulfion, found the mouth of the 
 womb open, and the convulfion forcing 
 down the membranes and waters, in the 
 fame manner as they are ufually preffed 
 down by the labour-pains. She was in- 
 fenfible, and thefe fits returned every 
 fix or eight minutes : her pulfe being 
 ' very quick and full, I ordered her to be 
 blooded to the quantity of ten ounces, and 
 a bliiler to be applied to her back. In 
 confequence of thefe remedies, the. convul- 
 fions abated and foon went off, but fhe 
 was If ill infenfible, and incapable of fwal- 
 lowing any kind of liquid. The friends 
 being averfe to my delivering hi?r, I defir- 
 6 ed. 
 
CASES IN MIDWIFERY. 323 
 
 ed, that in cafe the convulfion fhould re- 
 turn, I might be immediately called in 
 order to deliver her, othervvife fhe would 
 certainly be loft. My prognoftic was lite- 
 rally verified : for in about an hour after 
 I went away, they returned with fuch vio- 
 lence, that ftie expired before I could reach 
 the houfe, but the child was delivered dur- 
 ing one of the fits. 
 
 In the courfe of this year, I attended 
 feveral patients who were attacked in this 
 manner, near their full time ; fome of 
 whom were relieved by blooding and blif- 
 tering, and went on to the ufual period : 
 while others, with v/hom this method did 
 not fucceed, were, with the children, faved 
 by immediate deliveryi Other pradlition- 
 ers had cafes of this kind, during the fame 
 time, fo that they feem to have proceeded 
 from the conftitution of the year. Vid» 
 Vol. IIL Collea. XXXIII. No. III. 
 
 CASE III. 
 
 Communicated in a letter from Mr. Mudge, 
 dated at Plymouth^ ^748* 
 
 In the morning he blooded a woman in 
 the ninth month of pregnancy, who com- 
 plained of a violent head-ach. He was 
 Y 2, again 
 
324 CASES IN MIDWIFERY, 
 
 again called in the evening, when fhe was 
 feized with convulfions, for which he pre- 
 fcribed a glyfter, blifters, a nervous mix- 
 ture, and drops. At nine, the fits became 
 more violent and continued longer j and 
 concluding that immediate delivery was 
 abfolutely neceflary to fave her life, he ex- 
 amined by the touch; then putting the 
 patient in a proper pofition, he introduced 
 his hand into the Vagina^ and tried to di- 
 late the Os Vteriy which was very rigid, 
 fcarce fo open as to admit a quill, and at 
 firR very difficult to be diftinguifhed. 
 
 After feveral unfuccefsful trials with his 
 finger, he was obliged to defiR, in hope 
 that it might be better difpofed to dilate 
 by to-moiTow morning, before wffiich time, 
 however, he was twice called in the night, 
 found her in continual convulfions, and 
 no alteration in the parts. About noon, 
 next day, he vifited and found her con- 
 vulfed without intermiffion, though the 
 force of the fits had not dilated the Os 
 Uteri in the leafl, neither could her mouth 
 be opened, fo as to receive any medicine. 
 At feven in the evening he was called in a 
 great hurry, when the midwife told him, 
 that now the child’s head was in the paf- 
 
 fage. 
 
CASES IN MIDWIFERY. 325 
 
 fage. He could fcarce believe this Infor- 
 mation, ■which, however, he found lite- 
 rally true, and fent for his forceps to af- 
 fift in the delivery : but, juft as he was 
 about to apply them, the head was forced 
 out by the convullions j he then deliv’^ered 
 the body, and afterwards extracted the 
 Placejtta, and the convulfions immediately 
 abated, 
 
 NUMB. VI. CASE I. 
 
 From Fevers. 
 
 In the month of March 1729. wliich, 
 in the country where I then refided, was 
 remarkable for a pleuritic fever that was 
 epidemical, and often proved mortal if 
 the patient was not plentifully blooded at 
 the firft attack, I was called to a gentle- 
 woman in the feventh month of her preg- 
 nancy, who had bore feveral children. She 
 was fuddenly feized with violent ftitches in 
 her right fide, and a great difficulty in 
 breathing, for which fhe immediately^ loft 
 ten ounces of blood. From other patients 
 attacked with the fame difeafe, I had taken 
 twenty ounces, and by repeating this eva- 
 cuation once or twice, had frec^uently car- 
 ried off the inflammation and fever, while 
 y 3 thofe 
 
326 CASES IN MIDWIFERY. 
 
 thofe who were blooded too fparingly or 
 too late, funk under the difeafej but I 
 would not venture to bleed this patient 
 to fuch a quantity, on account of her con-^ 
 dition. Neverthelefs, the fymptoms 
 were alleviated, though not removed by 
 the firft venaefedlion, I followed Sydenham s 
 method in prefcribing plenty of diluents, 
 and next morning repeated the blooding 
 to the fame quantity. Upon my firft ar- 
 rival, I had fent for an eminent phyfician 
 who lived at fome diftance, and he ap-r 
 proved of what I had done, advifing, that 
 as it would be hazardous to take a large 
 quantity at once from a perfon in her con- 
 dition, fhe might be blooded the oftener 
 and this method being followed, in two 
 or three days, relieved all her complaints, 
 having prevented a fuppnration, perhaps, 
 a mortification of the Pleura. Though, 
 much cxhaufted by thcfe evacuations, fhe 
 gradually recovered ftrength enough to, 
 proceed in her pregnancy, and in a fort- 
 night after her recovery, was fafely, tho’ 
 prematurely, delivered of a weak child, 
 which did not long furvive the birth. 
 
 case; 
 
CASES IN MIDWIFERY. 327 
 
 CASE II. 
 
 In the year 1746. I was called to a wo- 
 man in the ninth month of her fourth 
 pregnancy, who was leized with a violent 
 fever, in confequence of having caught 
 cold. She complained of a racking head- 
 ach, was between whiles delirious, and on 
 the fifth day of the fever, when I was 
 called, fell into labour. I felt her pulfe, 
 which was quick,, low and intermitting j 
 fhe laboui'ed under a Subfultiis T^endinumy 
 and was in a little time delivered of a very 
 weak child that foon died : her delivery was 
 attended with inconfiderable difcharges, 
 ^ and fhe expired that fame evening. 
 
 I have attended in many cafes, at diffe- 
 rent periods of pregnancy, in the begin- 
 ing, increafe, heighth, and declenfion of 
 fevers, and the patient commonly recover-- 
 .ed, if mifcarriage or delivery happened 
 at the begiiming or declenfion, provided 
 the difcharges were not extraordinary j but 
 when the fever v/as violent and at the 
 heighth, the patient ufually died : and the 
 child was frequently dead when delivered 
 in the decline of the fever. 
 
 Y 4 
 
 NUMB, 
 
32S CASES IN MIDWIFERY. 
 
 NUMB. VII. CASE I. 
 
 From the Smai.l-Pox. 
 
 The obfervations I have made on fevers, 
 will alfo hold good in the fmall-pox. 
 
 In the year 1749. I delivered a gentle^ 
 woman who had the confluent fmalhpox 
 in the fifth month of her pregnancy, from 
 which file recover’d, and proceeded to the full 
 time. No marks of the diflemper appeared 
 upon the child, which had not beeu dead 
 many days before delivery ; but the head 
 was dropfical, and could not be protruded 
 hy the pains, until the water was dif- 
 charged by perforation. 
 
 CASE II. 
 
 Mr. Cook^ who attended me in the year 
 1752. communicated the following cafe, 
 an account of which he received from the 
 country. A gentlewoman at Ofweftry in 
 Shropjhire^ aged twenty-eight, was in the 
 feventh month of pregnancy, on the 24th 
 day of february^ feized with the fymptoms 
 of the final 1-pox, and on the 28 th, the 
 eruption appeared very thick and very 
 fmall. A phyfician from Shrewjbury being 
 called^ found them of the confluent kind, 
 
 with 
 
CASES IN MIDWIFERY. 329 
 
 with petechial fpots, and prefcribed T)eco6l. 
 Cort. peruv. cum Elix. Vitriol et ‘TinB, Ro- 
 far, pro potu communi. She recovered of 
 this diforder, and was on the 29th of April 
 following, delivered of a dead child, up- 
 on whofe body the eruptions appeared to 
 be about the crifis. 
 
 COL- 
 
330 CASES IN MIDWIFERY. 
 
 COLLECTION XIX. 
 
 Of circumvolutions and knots of the Fu« 
 Nis Umbilicalis, contra( 5 Hons of the 
 Uterus before the Ihoulders, 8cc. 
 
 NUMB. I. CASE I. 
 
 Of Circumvolutions. 
 
 Vide Tab. IX. 
 
 In the year 1750. I was called to a gen« 
 tlewoman in the eighth month of preg- 
 nancy, by the midwife, who told me the 
 labour had been very tedious : the head had 
 been advanced to the Os Externum for 
 near two hours, but was drawn up again 
 after every pain. 
 
 The patient being averfe to my examin- 
 ing, I advifed the midwife to introduce a 
 finger or two in the RcBum during a ftrong 
 pain, when the head was low down, and 
 preffing againft the forehead at the root of 
 the nofe, keep the head in that pofition 
 for a few pains ; by this method the pati- 
 ent was foon delivered of a dead child, 
 round whole neck the Funis v/as four times 
 circumvoluted. 
 
 CASE 
 
CASES IN MIDWIFERY, 331 
 CASE II. 
 
 In the year 1745. I attended a gentle-* 
 woman in labour of her firfi: child, whole 
 Os Uteri dilated with the membranes and 
 waters, in a flow and gradual manner, 
 until it was fully opened, when the mem- 
 branes protruding to the Os Kxternum were 
 broke j then the head came dovm to the 
 middle of the Pehrs^ and being puflied 
 farther in time of a ftrong pain, it was 
 drawn back to the fame place, as the pain 
 abated, and continued to advance and re- 
 treat in this manner for feveral hours ; fo 
 that the patient v/as very much fatigued, 
 and her friends began to be very uneafy. 
 
 That I might examine more narrov/iy, 
 r began to dilate and open gently the Os 
 Externum during every pain, until I could 
 eafily introduce my fingers all round the 
 lower part of the child’s head, fo as to 
 perceive that the delivery was not retarded 
 by the largenefs of the head, or the fmall- 
 nefs of the Pelvis, neither colild it be de- 
 layed by the contradlion of the Uterus be- 
 fore the fhoulders, becaufe the head began 
 to be drawn upwards, immediately after 
 the membranes broke and the contradlion 
 
 feldom 
 
332 CASES IN MIDWIFERY. 
 
 feldom happens, until all the waters are 
 difcharged. From thefe circumftances, I con- 
 cluded that the difficulty proceeded from 
 the circumvolutions of the Funis TJmbilicalis 
 round the neck of the child. The right ear 
 of the Foetus was to the left groin of the 
 woman, and its left ear to her right fide 
 betwixt the Sacrum and the Ifchiumy the 
 forehead being to the left. 
 
 I refolved to affift in bringing the head 
 lower, and keeping it fo, with the help of 
 the forceps, had it continued much longer 
 in that fituation j but, as fhe had every 
 now and then a ftrong pain, I firft tried 
 what might be effe<fted by different pofiti- 
 ons, and diredled her to bear the pains, 
 ftanding, fitting, kneeling, lying on one fide, 
 or refting on the bed, in a pofture between 
 fitting and lying. This laft was the moft 
 fuccefsful, and in three or four ffrong 
 pains, the head, tliough ftill retradled, ad- 
 vanced lower and lower, and began to di- 
 late the Os Exterfiunh But, obferving that 
 it made another Ilop, I introduced two 
 fingers mta the R0um, when it was pufh- 
 ed down by a ftrong pain, and preffing 
 them againft the lower part of the forehead, 
 kept it down and prevented the head fi’orn 
 . ' ■ ■ return” 
 
CASES IN. MIDWIFERY. 333 
 
 returning, tmtil the return of the next 
 pain. I continued this method, in confe- 
 quence of which, the head advanced far- 
 ther and farther, and affifted the delivei*y of 
 it, by raifing the forehead upwards with 
 an half round turn from the lower part of 
 the Os Externum. The woman was foon 
 delivered, and the Funis was found three 
 times round the neck and once round the 
 arms of the child. 
 
 The hint of affifting in this manner, I 
 found in Mr. Quid s treatife, publilhed in 
 the year 1742, and 1 have frequently fol- 
 lowed it with fuccefs, when the forehead is 
 come down to the Os Coccygis j but when it 
 advances Hill lower, I withdraw my fin- 
 gers from the ReStum^ in ©rder to prevent 
 a contufion of that part, as well as of the 
 VaginUy and prefs with my fingers on the 
 external parts, and on each fide of the 
 Coccyx ; care, however, mufi; be taken, to 
 avoid the eyes in tlris preffure, otherwife 
 they will be afterwards inflamed. 
 
 I mufl obferve, that this affifiiance is not 
 to be ufed, except when the head comes 
 low down, without continuing to flretch 
 the Os Externum j for, although it is re- 
 traced after every pain j yet,, if by ad- 
 vancing 
 
334 CASES IN midwifery. 
 
 vancing a little in the time bf the paiil^ 
 it dilates this part, fuch gradual dilatation 
 is much more fafe for the vfoman, than 
 a fudden diftention, by which the parts are 
 in danger of being inflamed or lacerated. 
 
 CASE IIL and IV. 
 
 I have in this manner affifted in a few 
 cafes, where delivery was retarded by the 
 fhortnefs of the Funis^ particularly in the 
 year 1744. when the patient was delivered 
 by the forceps^ and in the year 1750. when 
 the woman was delivered by the labour- 
 pains, affifted in the manner defcribed 
 above : in this laft cafe the Funis was not 
 above two hands breadth long, though 
 very thick. 
 
 Mauriceau^ in p. 336, and Obferv. 406. 
 relates an inftance of his having delivered 
 a woman of her firft child, whofe naveh 
 firing was extremely fhort, and as thick as 
 its arm. The child had been dead feveral 
 days before delivery. 
 
 It may be proper to obferve, that when 
 labour is retarded by the fhortnefs or cir*- 
 cum volution of the Funis ^ the retradlion 
 or drawing back of the headj does not be- 
 gin to be perceived until it is low in the 
 
 Pelvis, 
 
CASES IN MIDWIFERY. 335 
 
 Fehis, whereas, it is fooner obfervablej 
 when owing to the contraction of the 
 ms before the fhoulders. 
 
 The head is alfo low down, before it 
 can be retarded by one of the fhoulders 
 relHng above the Os Pubis or Sacrum, in- 
 flead of being towards the lides at the brim 
 of the Pelvis, 
 
 NUMB. IL CASE I. 
 
 Of Knots. 
 
 Vide 7ab. XXIX. 
 
 In the year 1744. my attendance was 
 befpoke to a v/oman, who imagined her- 
 felf in labour about the end of the eighth 
 month. This, however, was no other 
 than a cholicky pain, proceeding from 
 coftivenefs, of which fhe was relieved by a 
 glyfter. 
 
 In a fortnight after this vilit, I was call- 
 ed, and found the membranes had broke ; 
 the waters were of a brownifh colour and 
 mortified fmell : the labour was lingering, 
 and the child, when delivered, of a livid 
 hue : the fcarf-fkin was eafily flript off, 
 Abdo??ien tumified, and the fwelled 
 and livid, about ten hand breadths long, 
 -wdth a tight drawn knot on the middle. 
 
 CASE 
 
336 CASES IN MIDWIFERY* 
 
 CASE II. 
 
 In the year 1747. I attended another 
 patient in a lingering labour, and deliver- 
 ed her of a live child, though there was 
 a loofe knot on the Funts^ which was very 
 long. 
 
 CASE III. 
 
 In the year 1748. I aflifted in a cafe, 
 where the Funis being nine hand breadths 
 long, had a loofe knot on it, and was 
 twilled round the neck of the child which 
 was dead i though I believe its death did 
 not proceed from the knot or circumvolu- 
 tion, which were very loofe, but from the 
 nature of the labour which was very lin- 
 gering, the head being fqueezed to a great 
 length, and the brain too long compreffed 
 in a narrow Pelvis. 
 
 NUMB. III. C A S E I. 
 
 Of contradlions of the Uterus before 
 the fhoulders, and thefe laft refting above 
 the Pubis or Sacrum. 
 
 Vide Tab. XIV. 
 
 In the year 1745. I difcovered by the 
 following cafe, that labours are often ren- 
 dered 
 
 3 
 
CASES IN MIDWIFERY. 337 
 
 dered tedious and lingering by the lower 
 part of the Uterus contradting before the 
 fhoulders, when the membranes break and 
 the waters are too foon evacuated : this con- 
 tradfion not only keeps up the body of the 
 child, butfometimes prevents the fhoulders 
 from turning from the upper part of the Pubis 
 to the fide of the Pelvis where it is widefb. 
 I was called by a midwife to a wmman 
 thirty five years of age, in labour of her 
 fii'ft child, the membranes having been 
 broke a long time. I found the head pre- 
 fented almoft as low as the middle of the 
 Pehisy and that the Os Liternufn was fully 
 open, and the pains fbrong and frequent, yet 
 the head did not advance, but receded a 
 little after every pain, a circumftance which 
 at firlb I imputed to the Funis. 
 
 Finding the woman very uneafy and her 
 friends importunate, I ammfed them with 
 a palatable mixture, of which I diredfed 
 the patient to take two fpoonfuls every 
 half hour, my intention being to gain 
 time ; for, I felt the child’s ear at the 
 upper part of the Pubis, the head was 
 fmall and very little engaged in the Pelvis, 
 and I could forefee nothing dangerous in 
 the cafe. I accordingly took my leave, afr 
 Z tet’ 
 
338 CASES IN MIDWIFERY. 
 
 ter having affured them flie was in a fair 
 way, and would in a little time be fafely 
 delivered by the midwife. In about two 
 hours, I received another cal], and was 
 told the medicine had done her no fervice. 
 I likewife undcrftood from the midwife, 
 that the child’s head was very little ad- 
 vanced, and that Ihe had kept her in an 
 eafy pofition, according to my dire6lion. 
 When I examined, during a ftrong pain, 
 I found the head lower down, but as the 
 pain abated, it was drawn back to its former 
 place : upon which, I turned her upon her 
 lide, in order to bring down the head with 
 the forceps, but firft refolved to try what 
 could be done by dilating the parts. Ac- 
 cordingly, placing her breech to the bed- 
 fide, I gradually opened the Os Externum 
 during every pain, introduced my hand 
 up the Vagina^ and with great difficulty 
 raifed the head above the brim of the 
 Pelvis. In pufhing up my hand, on the 
 pofterior part between the Os Uteri and 
 head, I felt the lower part of the womb 
 ftrongly contradled round the child’s neck ; 
 then by continuing to puffi up farther, I 
 raifed the child, and gradually ilretched 
 the contra(^ed part j fo that when I with- 
 drew 
 
CASES IN MIDWIFERY. 339 
 
 drew my hand, a Rrong pain immediately 
 followed, and forced down the head to the 
 lower part of the Pelvis^ and in a few 
 fubfequent pains the child was delivered. 
 
 Although the child is not large, nor the 
 Pelvis fmall, labour is frequently retarded 
 by fuch contra6lions, when the membranes 
 are broke too foon : fo that pra6Htioners 
 fhould avoid breaking them, until the 
 mouth of the womb is fully opened, that 
 the head by defcending immediately into 
 the PelviSi may plug it up and prevent the 
 waters from being too foon difcharged. 
 Except, however, in cafes of flooding, 
 where the lefs difficulty or danger muft 
 yield to the greater, and the membranes 
 be broke, in order to flay the hsemorrhage. 
 
 By thofe contra6Hons, the child’s head is 
 feldom kept up fo long as in the cafe de- 
 fcribed above, but is gradually pufhed 
 lower down j and the labour is more or 
 lefs lingering, according to the degree of 
 'Contraftion, and the ftrength or weaknefs 
 of the pains. In a word, there is feldom 
 occafion to affift, until the pains fail, as 
 we fhall obferve in the laborious cafes. 
 
34 ^ 
 
 CASES IN MIDWIFERY. 
 
 COLLECTION XX, 
 
 Of lingering cafes from the large fiz© of 
 the child, and the Hydrocephalus. 
 
 NUMB. I. CASE I. 
 
 From the large lize of the child. 
 
 Vide Tab. XXI. XXVII. and XXVIII. 
 
 In the year 1742. I was called to a wo- 
 man, whofe friends told me, Ihe had been 
 three days in labour, and that the mid- 
 wife, who had loft her opportunity, was 
 keeping her in hand. She, however, in 
 her own vindication gave me to under- 
 ftand that fire had delivered the patient 
 twice before ; that the firft labour was lin- 
 gering, and the child, which was fmall, 
 came before the time ; that the fecond was 
 alfo tedious, and the child, which was large, 
 ftill-born, becaufe they had fent for her, 
 when it was too late to fave it by making 
 more room : that, in order to obviate the 
 like misfortune upon this occafion, ftie had 
 been called in good time, and confiderably 
 dilated the parts ; but when the waters were 
 difcharged, the pains had not been ftrong 
 enough to deliver the child. She likewife 
 
 affirmed. 
 
CASES IN MIDWIFERY. 341 
 
 affirmed, that when fhe was called, there 
 was no opening of the Os hiternum:, which 
 did not begin till the preceding night; 
 but that the woman laboured under a cho- 
 lic, attended with a loofenefs which had 
 been ffiopt by fornething prefcribed by the 
 apothecary, upon which the pains grew 
 ftronger ; and that fhe, the midwife, had 
 loft no time, but tried all the diffierent pofi- 
 tions, and dilated the parts during every 
 pain. Indeed, the loofenefs had exhauft- 
 ed the patient, and fhe was moreover fa- 
 tigued by this unfkilful management of 
 the midwife, who was extremely ignorant, 
 had never received the leaf! inftrudtion, 
 and feemed incapable of profiting by her 
 miftakes in practice. 
 
 When I firft exarriined, I found the 
 mouth of the womb pretty largely open- 
 ed, but thick and fwelled ; the external 
 parts were likewife tumified and inflamed. 
 I afterwards, during another pain, felt the 
 head prefenting, though very high up. 
 Her pulfe being low and quick, I diredted 
 the attendants to put her to bed, and 
 keep her as quiet as poffible : and as fhe 
 was troubled with a great drought, I de- 
 fired her to drink barley-water, and take 
 Z 3 now 
 
342 CASES IN MIDWIFERY, 
 now and then a little weak broth, with 
 toafted bread ; and laftly, in order to amufe 
 herfeif and friends, I prefcribed a draught 
 of fyrup and fimple waters to be repeated 
 every two hours. Then exhorting her to 
 difregard the trifling pains flie had, I af- 
 fured her they would grow fircnger, and af- 
 fifl: the delivery with better effe6f, after 
 fhe fhould have enjoyed a refrefhing fleep. 
 Having given thefe directions, I took my 
 leave about eight in the morning, and re- 
 turning in the evening, was informed that 
 fhe had flept very found for five or fix 
 hours, fweated plentifully, and undergone 
 every now and then a fmart pain. 
 
 Finding the parts much fofter, the heat 
 abated, and the pains gradually pufhing 
 down the head of the child into the 
 I encouraged the patient, telling her fhe 
 w'as now in a good way, though, in con- 
 fequence of her weaknefs, her delivery 
 would require fome time, and therefore 
 fhe ought to exert her patience. I like- 
 wife privately direfted the midwife to let 
 her refl; in bed, and fleep as much as pofli- 
 ble, without fatiguing her by a repetition 
 of her former conduct. But notwith- 
 ftanding this exprefs admonition,, when I 
 
 was 
 
CASES IN MIDWIFERY. 34.3 
 
 was called early next morning, I under- 
 ftood die had a6ted diametrically oppodte 
 to my advice, by railing her out of bed, 
 and harrafling her in the manner already 
 defcribed, fo that die was quite funk and 
 difpinted, and the external parts were in- 
 damed and fweiled as before. She was im- 
 mediately replaced in bed, and a poultice of 
 bread and milk being applied to the parts, 
 I v/aited to fee the event. She dept and 
 fweated a good deal, and when waked 
 with a pain, took fome broth, warm wine 
 and water, and caudle alternately, at diffe- 
 rent times, fo as to be much recruited and 
 refredied; the inflammation alfo abated, 
 upon which the poultice was removed, and 
 the part cleaned, and the pains growing 
 flronger, die was delivered about noon, of 
 a dead child, whofe head was fqueezed to 
 a great length. 
 
 I afterwards delivered this woman three 
 times, and the children were all uncom- 
 monly large, but by giving her time, and 
 keeping up her ftrength, Ihe was fafely 
 brought to bed, and they were all alive. 
 
 Z 4 
 
 CASE 
 
344 CASES IN MIDWIFERY, 
 
 C A S E II. 
 
 In the year 1725. I was, in the evening, 
 called to a patient by the midwife, who 
 told me the woman had been long in la- 
 bour of her firft child, that the Os Uteri 
 had gradually and dowiy opened, that the 
 waters had been difcharged a great many 
 hours, and that the child’s head did not 
 advance. 
 
 Upon examination, I found the head 
 was come down to the middle of the PeU 
 nsis 3 and the woman being ffrong, with 
 a quick, full, hard pulfe, was blooded to 
 the quantity of ten ounces. She was 
 kept quiet in bed, and flept betwixt the 
 pains, every fecond or third of which 
 was pretty ftrong. I defired the midwife 
 to indulge her with all poffible reft, and 
 fend to me if fhe ftiould turn weaker, and 
 could not be delivered by the pains. 
 
 Accordingly, I was called next morn- 
 ing, when I found the child’s head ad- 
 vanced to the lower part of the Pelvis ; 
 but the patient being exhaufted, and her 
 pains growing weaker, I refolved to deli- 
 ver by turning the child, or if that ftiould 
 
 not 
 
CASES IN MIDWIFERY. 345 
 
 not be pra6ticable, to affiR with the fillet 
 or crochet. 
 
 After having gradually opened the Os 
 Externum with my fingers, I tried to raife 
 the head, and introduce my hand into the 
 Uterus, fo as to reach the feet : but the 
 contradlion was fo great, that I could 
 not advance farther than the upper part 
 of the Vagina : upon which I determined 
 to ufe the fiUet : when a ftrong pain com- 
 ing on, as I withdrew my hand, the head 
 defcended lower, and in two more pains, 
 the woman was delivered of a child whofe 
 head was fqueezed to a great length. 
 
 By this method I have feveral times fuc- 
 ceeded in fuch cafes, 
 
 CASE III. 
 
 In the fame year, I was called to ano- 
 ther woman, who had been long in labour 
 of her third child. When I firll examin- 
 ed, I thought I felt the breech of the child, 
 but afterwards found it was a large tumor 
 on the child’s head, which was pretty low 
 in the Pelvis. The patient had been much 
 fatigued by the imprudent management 
 of the midwife, the pains had turned weak, 
 and her pulfe was low. I diredled her to 
 
 be 
 
346 CASES IN MIDWIFERY. 
 
 be put to bed, to take fomething warm, 
 and try to doze between the pains. By 
 this method her exhaufted fpirits were re- 
 cruited, her pains grew ftronger, I afliiled 
 as in the preceding cafe, and fhe was de- 
 livered of a dead child, with a large head 
 fqueezed to a great length. 
 
 CASE IV. 
 
 In the year 1729. I was called to a pa- 
 tient, whom I had delivered twice before : 
 in her firft labour I ufed the crotchet, in 
 the fecond I tried the fillet, but without 
 fuccefs ; upon which I brought the child 
 hy the feet, though I could not fave it, be- 
 c^ufe the head was very large. 
 
 ^ .Having found by experience that feve- 
 ral children were loft by ufing thefe expe- 
 dients prematurely, and by turning the 
 child when a large head prefented in a 
 narrow Pehisy I refolved to manage this 
 cafe in a more cautious manner, and de- 
 fired that I might be called in time. 
 
 Accordingly, when I arrived, the mid- 
 wife told me, that the patient had not 
 been fatigued, and only once examined ; 
 the mouth of the womb was largely open- 
 ed, and the gentlewoman being of a weak- 
 
CASES IN MIDWIFERY. 347 
 
 ly conftitution, I kept her chiefly in bed. 
 The waters broke foon after my arrival j 
 the labour was veiy tedious from the large- 
 nels of the head, which advanced very 
 flowly in the Pehis ; but by encouraging 
 and keeping up her ftrength, Ihe was at 
 iafl: fafely delivered. 
 
 CASE V. 
 
 In the courfe of the fame year, I at- 
 tended a woman who had been long in 
 labour, and whofe waters were difcharged: 
 many hours before I arrived. I found the 
 mouth of the womb largely opened, the 
 child’s head advanced to the middle of the 
 Pelvis, the patient very much fatigued, 
 and the midwife told me her pains had 
 been flrong, but were much abated. 
 
 As I could not turn the child, I made 
 a noofe on a garter, which I, with great 
 difficulty, fixed over the fore and hind 
 head, and pulled gently during every pain ; 
 but, not fucceeding, I increafed the force 
 until the noofe flipped off. Then refolv- 
 ing to try what nature would do, I pre- 
 fcribed a gentle opiate, and fhe being kept 
 quiet in bed, enjoyed between the pains 
 fome refrefliing flumbers, by which her 
 
 ftrength 
 
348 CASES IN MIDWIFERY. 
 
 ftrength was gradually recruited, and the 
 pains growing ftronger, fhe was in about 
 two hours fafely delivered. The fillet had 
 galled and inflamed the hairy fcalp of the 
 child, which, however, in confequence of 
 proper applications, recovered in a few days. 
 
 CASE VI. 
 
 In the year 1750. I attended a gentle- 
 woman in the city, in labour of her firfl: 
 child. She was young, ftrong and healthy, 
 had gone a month beyond the common 
 time of reckoning, and the cafe was very 
 tedious. For, after the membranes had 
 broke, and the child’s head advanced a lit- 
 tle in the Pelvis^ fhe underwent many fe- 
 vere pains for the fpace of four hours, be- 
 fore it defcended to the lower part, where 
 it continued two hours longer before flie 
 was delivered. 
 
 I perceived that the greatefl: difficulty 
 proceeded from the large fize of the head j 
 and file being flrong, ai;id the pains brifk, 
 I thought nothing fhould be done, but to 
 encourage and prevent her from being fa- 
 tigued. However, before fhe was delivered, 
 her fpirits and pains began to flag, and 
 her friends became very anxious and un- 
 
CASES IN MIDWIFERY. 349 
 
 eafy ; indeed I myfelf was not without 
 apprehenfion that both fhe and the child 
 would be loll. 
 
 Though the pains were moft efFedlual, 
 while die continued in bed betwixt a fit- 
 ing and lying pofture, when they began to 
 grow weak, I refolved, as the head was 
 low down, to affift with the forceps : but, 
 before I ufed that expedient, I thought 
 proper to alter the pohtion, and try what 
 would be the effect of her taking fome 
 pains Handing, a pofture which had fuc- 
 ceeded in other cafes. She was according- 
 ly taken out of bed, and fome loofe cloaths 
 being put on, fupported between two wo- 
 men. Her pains increafed in confequence 
 of this alteration, and after fhe had un- 
 dergone feveral fevere ones, 1 found the . 
 child’s head began to move lower and 
 lower, and protrude the parts in form of 
 a large tumor. Then fhe was put to bed 
 again, and with great difficulty I faved the 
 Terinceum from being torn. After the 
 head was delivered, it required great force 
 to bring along the flioulders : indeed tliis 
 was the largeft child I ever brought into 
 the world. 
 
 The 
 
350 CASES IN MIDWIFERY. 
 
 The head was fqueezed to a great length, 
 had a large tumour at the Vertex^ and if 
 •the mother’s Pehis had not been very large, 
 tlie child could not poffibly have been faved. 
 
 CASE VII. 
 
 In the ye^r 1742. I was called to a pa- 
 tient about the age of forty, in labour of 
 her firfl: child ; though I was not permit- 
 ed to examine, but obliged to wait in 
 another apartment, in cafe of accidents. 
 By the midwife’s information from time 
 to time, I underftood the child advanced 
 very flowly after the Os Uteri was largely 
 opened, and the membranes had broke ; 
 and that the pains, though feldom, were 
 pretty ftrong. 
 
 In this manner labour proceeded for 
 the fpace of twelve hours, at the expira- 
 tion of which, the midwife told me that 
 although fhe had at firll found the child 
 was alive, by moving its head, Ihe was 
 afraid it was now dead, for the pains had 
 flagged for a long time, and a fmall part 
 of the head had been for two hours with- 
 out the external parts. However, the 
 child was delivered foon after fhe gave me 
 this account, and appeared to have been 
 
 but 
 
CASES IN MIDWIFERY. .3^1 
 
 but a very little time dead: and, in all 
 probability, when the head was fo low and 
 the pains abated, it might, have been faved 
 by the affiftance of the forceps, which fel- 
 dom or never fail when things are in that 
 fituation. 
 
 I afterwards learned, that the Ihynefs 
 of the patient proceeded from the artful 
 infmuations of the midwife, who terrified 
 her with dreadful accounts of the ufe of 
 inftruments. 
 
 During the firftyear of mypra6lice,when 
 I was called to lingering cafes which were 
 often occafioned by the imprudent methods 
 ufed by unlkilful midwifes to haften labour, 
 fuch as directing the patient to walk about 
 and bear down with all her ftrength at 
 every trifling pain, until fhe was quite ex- 
 Eaufted, and opening the parts premature- 
 ly fo as to produce inflammations, and 
 torture the woman unnecelfarily j on fuch 
 occafions, without knowing the fteps that 
 had been taken, I have been told that the 
 patient had been in fevere labour for many 
 hours, and fometimes days, and that now 
 I was called to prevent her from dying 
 with the child in her belly. Thus follicit- 
 ed, if the head was at the upper part of 
 
 the 
 
352 CASES IN MIDWIFERY. 
 
 the Pekis, I commonly turned the child, 
 and brought it by the feet ; and thus, if 
 fmall, it was ufualiy faved, provided it 
 was not dead before my arrival : but, when 
 the head was large, or the Pekis narrow 
 and diftoited, the force neceffary to ex- 
 tradf it, was often the occafion of it’s 
 death. On the other hand, when the head 
 was fo low in the Pelvis^ that I could not 
 raife it into the Uterus^ in order to be turn- 
 ed, I was obliged to dilate the Cranium 
 with the fciffars, and extract with my fin- 
 gers, affilfed by the blunt hook. This 
 method, however, I never pradlifed, ex- 
 cept when the head was low down, and the 
 patient fo much exhaufted that fhe could not 
 be delivered by the pains ; and, not even 
 then until after I had tried Mauriceaus fillet, 
 which always failed, and another intro- 
 duced by my fingers in form of a noofe, 
 which fometimes, though very rarely fuc- 
 ceeded, when the child was fmall. In or- 
 der to avoid this lofs of children, which 
 gave me great uneafinefs, I procured a pair 
 of French forceps, according to a draught 
 publifhed in the medical elTays by Mr. 
 Butter^ but found them fo long, and fo ill- 
 contrived, that they by no means anfwered 
 
 5 the 
 
CASES IN MiDWIFEkV. 353 
 
 the purpofe for which they were intended * 
 I afterwards perufed tlie treatises of Chap- 
 ■man ^nd Gifford^ who had frequently faved 
 children by a contrivance of this kindj and 
 adlually made a journey to London, in or- 
 der to acquire further information on this 
 liibjedf. Here I faw nothing was to be 
 learned 3 and by the advice of the late in- 
 genious Dcw Stewart, who was my paiti-^ 
 cular friend, I proceeded to Paris, where 
 courfes on midv/ifery were at that time 
 given by Gregoire. There likewife I was 
 very much difappointed in my expedla^ 
 tion : for, though his method might 
 be ufefui to young beginners, his ma=^ 
 chine was no other than a piece of baF- 
 ket-work, containing a real Pelvis covered 
 with black leather, upon which he could 
 not clearly explain the difficulties that oc- 
 cur in turning children, proceeding from 
 the contradfions of the Uterus, Os Inter- 
 num and Os Externum, And as for the 
 forceps, he taught his pupils to introduce 
 them at random, and pull witli great force, 
 though he preferred Chapmans iiiftrument 
 to that ufed by the French, and recom-- 
 mended the improvement made upon 
 A a Mauri- 
 
354 CASES IN MIDWIFERY. 
 
 Mauriceaih fillet, which can never be of 
 any ufe. 
 
 Little fatisfied with his manner of in- 
 ftrucling, I confidered that there was a 
 polTibility of forming machines which 
 fliould fo exa6lly imitate real women and 
 children, as to exhibit to the learner all 
 the difficulties that happen; in midwifery} 
 and fuch I adlually contrived, and made by 
 dint of uncommon labour and applicatio 
 
 I endeavoured to reduce the art of mid- 
 wifery to the principles of mechanifm, af- 
 certained the make, fliape and fituation 
 of the Pelvis, together with the form and 
 dimenfions of the child’s . head, and ex- 
 plained the method of extra6ling, from 
 the rules of moving bodies, in different di- 
 redions. Neverthelefs, I had flill fome 
 occafion to perceive that children were 
 loft, and the mothers endangered by turn- 
 ing, when the head was large and pre- 
 fented, or even by leaving the head to 
 flick long at the lower part of the Pelvis, 
 when the pains were weak and the patient 
 cxhaufled : for in this lafl cafe, the child, 
 when delivered, was commonly dead, in 
 confeq Lienee of the brain’s having been 
 eompreffed } and the fame long compref- 
 
 fion 
 
CASES IN MIDWIFERY. 35^ 
 
 fion had produced an inflammation in the 
 Vagina^ Os Internum, and fometimes in the 
 Uterus of the mother. To obviate thefe 
 misfortunes, I was fometimes obliged to 
 have recourfe to the fillet or forceps, with 
 which lafl; I frequently fucceeded, fo as 
 to fave the child j though the ufe of them 
 was fometimes attended with a laceration 
 of the external parts of the woman, un- 
 til I contrived an alteration in their form, 
 and gave new dire6lions for ufing them, by 
 which this inconvenience is prevented. 
 
 In a word, I diligently attended to the 
 courfe and operations of nature, which 
 occurred in my pra6Hce, regulating and 
 improving my own notions by that infal- 
 lible ftandard ; nor did I reje6f the hints 
 of other writers and pra6Htioners, from 
 whofe fuggelHons, I own, I have derived 
 much ufeful inftruction. 
 
 On the whole, I have given this fliort 
 detail of my own conduct, for the benefit 
 of young pra6litioners, who will fee, that 
 far from adhering to one original method, 
 I took all opportunities of acquiring im- 
 provement, and chearfully renounced thofe 
 errors which I had imbibed in the bcgin- 
 ing of life. 
 
 A a 2 
 
 N U M B. 
 
356 CASES IN MIDWIFERY. 
 
 N U M B. II. C A S E I. 
 
 From the Hydrocephalus. 
 
 In the year 1747* I attended a gentle- 
 woman in labour of her fourth child, and 
 felt the membranes pufhed down, and the 
 Os Internufn and Os Externum largely open- 
 ed. Before the membranes broke, the 
 child’s head continued a long time high up 
 at the brim of the Pehis, and felt in fuch 
 an uncommon manner, that I was for 
 fome time uncertain whether it was the 
 head or breech. But the waters being dif- 
 charged, it was pufhed a little lower down ; 
 then I felt the hairy fcalp, and perceived 
 the head was dropfical, from the loofenefs 
 of the bones and the great diflance be- 
 tween them. 
 
 After many fevere pains, the fcalp was 
 protruded to the Oi Externum, which the 
 contained water diftended to fuch a degree, 
 that the head palTed, and the child, which 
 was prefen tly delivered, feemed to have 
 been dead but a very little time. 
 
 CASE II. 
 
 In the year 1753. I was called to a wo- 
 man in labour of her firfl child. The 
 
 mem- 
 
CASES IN MIDWIFERY. 357 
 
 membranes and waters opened the Os Uteri 
 in a very flow manner, and when they 
 came down to the middle of the Vagina^ 
 felt as if there had been one fet of mem- 
 branes within another, though the internal 
 feemed to be much thicker than the exter- 
 nal. But before the Os Uteri was fully 
 opened, the real membranes broke, and 
 then I difeovered the other was the hairy 
 fcalp, pufhed down by water contained in. 
 the fkiiii. This the pains forced down 
 lower and lower, fo that the Os Internum 
 being fully opened, it flretched the Vagma 
 and Gs Externum in the fame manner as 
 they are commonly dilated by the mem- 
 branes and waters of the Secundines ; and 
 I felt the bones of the IkuU loofe and rid- 
 ing one another. 
 
 At length the head being delivered, I 
 was obliged to exert a good deal of force, 
 in bringing along the fhoulders and body, 
 becaufe the belly was fwelled. The Funis 
 was tumified and livid ; the child feemed 
 to have been dead for the fpace of eight 
 or ten days ^ and there was a large quan- 
 tity of water contained in its head. 
 
358 CASES IN MIDWIFERY. 
 
 COLLECTION XXL 
 
 Of lingering cafes from a fmall, narrow, 
 or diftorted Pelvis. 
 
 Vide Tab. XXVII. and XXVIII, 
 
 NUMB. I. 
 
 Although thefe labours may be feem to 
 be of the fame clafs, and require the fame 
 management with thofe that proceed frorn 
 a large head, there is an elfential differ- 
 ence : for, though they are much the fame 
 with regard to the efforts of the woman, 
 the operator in thefe has much lefs room, 
 when he is obliged to affift with his hand, 
 and the child’s head is disfigured and 
 compreffed into large indentations, occa- 
 fioned by the jetting in of the upper part 
 of the Sacrum and Vertebrae of the loins. 
 
 CASE I. 
 
 In the year 1750. I was befpoke to at- 
 tend a woman of a middling fize, and tp 
 appearance well made, who had bgen three 
 times before delivered of dead children. 
 The firft prefented with the arm, and the 
 midwife having kept her two days in hand, 
 with promifes of fafe deliverv, the friends 
 
 V ... *1^ j ' •* 
 
 3 called 
 
CASES IN xMIDWIFERY. 359 
 
 called a gentleman of the profeffion, wI;o 
 with great difficulty extradted the child by 
 the feet, and was fo much fatigued witJi 
 the operation, that he was obliged to keep 
 his bed for feveral days. In her next 
 child I was employed, after fhe had been 
 weakened and exhaufted by another mid- 
 wife, who with 'great felf-fufficiency had 
 undertaken to bring matters to an happy 
 iffue. 
 
 Having waited a long time to no pur- 
 pofe, I tried the forceps j and thefe failing, 
 dilated the Cram urn according to the me- 
 thod defcribed in laborious births. Then 
 I found the difficulty proceeded from the 
 large fize of the head, and the jetting in 
 of the upper part of the Sacrum^ which 
 was not above three inches and an half 
 from the Os Pubis. In her third labour, I 
 attended by myfelf 3 but the breech un- 
 luckily prefenting, and the child being 
 very large, I could not poffibly fave it, 
 for I was fain to ufe the curved crotchet 
 in delivering the head, to the great grief 
 and mortiffcation of the poor mother, who 
 had fuffered fo much and loft three children. 
 
 - When I was called to her in labour of 
 her fourth child, the mouth of the w'omb 
 A a 4 was 
 
360 CASES IN MIDWIFERY. 
 
 was open to about the breadth of a fhiU 
 ling, and the child’s head refted on the 
 upper part of the Pubis^ but was thrown 
 a little more forward than ufual, by the 
 jetting in of the upper part of the Sacrum^ 
 and the laft Vertebra of the loins. La-, 
 hour being juft begitn, I encouraged the 
 patient by telling her that I had faved ma-r 
 ny children even where the Pehh was 
 narrower than her’s, and that I was now 
 in great hope of fucceeding, provided the 
 child was not of an extraordinary fize. 
 As file had flept but little the preceding 
 night, and her pulfe was rather full, I or- 
 dered ten ounces of blood to be taken from 
 her arm, and her inteftines to be emptied by 
 a glyfter s and taking my leave in the morn- 
 ing, defired the nurfe would not fend for 
 me until the membranes fhould be broke. 
 She was accordingly kept quiet in bed, 
 and enjoyed fome refrefhing deep, and in 
 the evening, I received a meffage j then 
 the membranes were broke, the mouth of 
 the womb being largely opened and the 
 head beginning to be fqueezed in at the 
 upper part of the Pelvis, but when the 
 membranes gave way, the pains abated, 
 as is commonly the cafe when the head 
 
CASES IN MIDWIFERY. 361 
 
 Is not fmall,.-or the Pelvis large : for the 
 pains fhe nad hitherto . undergone, pro- 
 ceeded from the membranes if retching the 
 mouth of the-womb j. and now the head 
 being kept up, did not continue th^ dif- 
 teniion of thefe parts, but locked them up 
 fo as to detain a quantity of waters Rill 
 in the Uterus^ 
 
 I went away again, defiring the nurfe 
 to fend for me when the pains fhould re- 
 turn and grow Wronger ; and in about three 
 hours I returned, in confequence of ano- 
 ther call, when I underifood a great many 
 cloths had been wetted, and that the pains 
 were become ftronger and more frequent. 
 I then feit the child’s head fqueezed lower 
 down, and but little water being difcharg- 
 ed in time of a pain, I concluded that the 
 whole quantity was almoft expended, and 
 that the Uterus was clofe contraifed to the 
 body of the child. 
 
 As the patient had been chiefly in bed, 
 during the whole day, I directed her to 
 take her . pains in a fititng pofture, and 
 now and then to walk about without fa- 
 tiguing, herfelf She therefore fat in an 
 eafy chair, leaning backwards, and in this 
 manner took her pains, until towards morii- 
 
 iiig. 
 
362 CASES IN MIDWIFERY. 
 
 ing, being very much fatigued, fhe was 
 again put into bed and laid on her back, 
 her Ihoulders being raifed with pillows fo 
 as that her pofture was between fitting and. 
 lying. I defired her in time of a pain to 
 pull up her legs, while an affiifant fup- 
 ported her feet, and dire6led her not to 
 force down, except when the pain was 
 Ifrong. The head continued to advance 
 very flowly, the bones of the Cranium rid- 
 ing over one another, tlie Vertex was 
 fqueezed down in a conical form to the 
 lower part of tlie left Ifchium 3 the fore- 
 head being at the upper part of the right, 
 or rather above the brim of the Pelvis on 
 that lide ; the Fontanelk was ftill very high 
 up, and I felt the at the Os Pubis. At 
 every third or fourth pain, which was ge- 
 nerally the firongeff, the head advanced, 
 and the Occiput was gradually raifed to the 
 I'pace below the Piibis^ the forehead turn- 
 ing backwards to the lower part of the 
 Sacrum and Coccyx. 
 
 The head being now fo low down, and 
 difengagcd from its confinement and pref- 
 fure at the upper part of the Pelvis, pro^ 
 ceeded much more eafily than before 3 howrr 
 ever, as the child was large, and might be 
 
 loft 
 
CASES IN MIDWIFERY. 363 
 
 loft in being detained too long by the con- 
 traction of the Uterus before the fhoulders, 
 I affifted a little, when the forehead was 
 come down to the lower part of the Coc- 
 cyx, by placing my fingers on each fide of 
 it, in time of a ftrong pain, in order to 
 prefs the head forwards to the fpace below 
 the Pzibis, and prevent its being drawn 
 back, upon the abatement or cefiation of 
 the pain. 
 
 The head being delivered, I was fain to 
 ufe a good deal of force in extracting the 
 fhoulders : for, although I had brought 
 them down to the lower part of the IJchi- 
 UMy I could not effeCi; the delivery, until 
 I introduced a finger above one of them, 
 up to the middle of the arm, and by 
 prefting towards the Sacrum, brought it 
 down with an half round turn 3 upon which 
 the body followed. 
 
 The circulation in the being flopp’d, 
 
 the child, which was very large, and whofe 
 head was comprelTed in a longitudinal 
 form, lay five or fix minutes before it be- 
 gan to breathe. 
 
 The woman recovered of this, much 
 better than of her former labours. 
 
 CASE 
 
364 CASES IN MIDWIFERY. 
 
 CASE II. 
 
 I delivered the fame patient of another 
 child in the year 1753. when the labour 
 proceeded much in the fame manner, with 
 this difference, however, that the membranes 
 were unluckily broke by her motion in 
 getting out of bed before fhe had any 
 pains. I being called, in confequence of 
 this accident, found the Os Uteri foft and 
 yielding, though very little open, and the 
 child’s head refting above the Or Pubisy - as 
 in the former cafe. She was blooded and 
 received a glyfter as in the preceding cafe^, 
 but, as the pains were not begun, and I 
 was engaged at another labour, I left a 
 midwife with proper diredlions how to 
 manage when the pains fliould come on, 
 until I fhould be at leifure to come and at- 
 tend her. 
 
 Soon after I went aw'-ay, the pains be- 
 gan, and a large quantity of waters was 
 from time to time difeharged : when I 
 returned in the evening, I found the Or 
 Uteri pretty largely opened, and the head 
 pufhed down to about one third of the 
 Pelvis ; and taking it for granted, that 
 fhe would have many more ftrong pains, 
 
 and 
 
CASES iJi MIDWIFERY. 365 
 
 and that all the waters were not yet dif- 
 charged, I lay down in a bed to take fome 
 reft, becaufe I had been much fatigued the 
 night before, and defired the midwife to 
 call me as foon as the head ftiould be come 
 down to the lower part of the Pehis, The 
 patient bore many very fevere pains with 
 extraordinary courage, the child’s head was 
 in the fituation defcribed, in about three 
 hours after I went to bed, and in half an 
 hour after I rofe, the woman was fafely 
 delivered of a live child. 
 
 CASE IIL 
 
 In the year 1750. I attended a woman 
 whofe Pelvis was alfo diftorted, and rather 
 fmaller and narrower than that defcribed in 
 the preceding cafe. She had, the year be- 
 fore, been long in labour, and much ex- 
 haufted before Ihe was delivered by another 
 gentleman, who was obliged to open the 
 child’s head. 
 
 I being called at the beginning of this 
 fecond labour, managed her much in the 
 manner above defcribed, and with great 
 difficulty faved the child, which was fmall : 
 but when I attended her again in her next 
 lying in, I could not fave the child, which 
 
 though 
 
366 CASES IN MIDWIFERY* 
 
 though larger than the former was not 
 above the common fize. Vide the crotchet 
 cafes. 
 
 CASE IV. 
 
 In the year 1742. my attendance was 
 befpoke to a woman who had been four 
 times delivered by another gentleman of 
 dead children ; and it was alledged her 
 Pehis was fo narrow and ill-formed that 
 ilie could not poffibly bear a live child, 
 
 I was averfe to interfere with any other 
 practitioner, and aClually refufed to un- 
 dertake the cafe, until I was importuned 
 by two of her acquaintance . whom I had 
 delivered, and alTured that the other gen- 
 tleman would never be employed again at 
 any rate : upon thefe reprefentations I pro- 
 mifed to attend this patient, who was a 
 little woman, of a delicate conftitution, 
 fubject to idterical complaints, for which I 
 advifed her to confult fome phyfician, tho’ 
 in this particular die negleCled my advice, 
 on the fuppofition that her healtli was 
 mending. 
 
 Soon after my firft vifit, I was called to 
 her when Ihe imagined herfelf in labour, 
 and found the mouth of the womb but 
 
 very 
 
GASES IN MIDWIFERY. 
 
 very little open, though foft and yield- 
 ing. Her pains feemed to proceed from 
 her being coftive, yet I felt the head reft- 
 ing above the Pubis^ and was agreeably 
 furprized to find the Pehis was not fo nar- 
 row as it had been defiribed : for, with 
 the tip of my finger I could hardly reach 
 the jetting forwards of tlie lafl: Vertebra of 
 the loins and upper part of the Sacrum ; 
 from which circumftance, I underftood, 
 the Pelvis at that part was not above half, 
 or three quarters of an inch narrower than 
 thofe that are well formed. I therefore 
 hoped, that if the child was not large it 
 might be faved, provided I could keep up 
 the woman’s ftrength. With this view, 
 after having encouraged her by communi- 
 cating my opinion, I preferibed a glyfier, 
 after the operation of which fire took the 
 following draught, 
 
 R Aq. Cimmom. Simp. cum fpiritii sij. 
 
 ConfeV, Damocrat. gfi. Syr. e Meconio ^ij M. 
 
 It was now late, and I being uncertain 
 when labour would begin, flayed wdth her 
 during the befi: part of the night, but 
 went away as foon as tfie draught had 
 throwm her into a profound deep. She 
 
 was 
 
368 CASES tN MIDWlEERt, 
 
 was free from pain all next day, but I w&3 
 called the following morning, when I un- 
 derftood Ihe had trifling pains in the night, 
 though fhe had flept in the intervals* I 
 found the waters pufhing down the mem- 
 branes and the mouth of the womb open 
 to about the breadth of a crown j and fhe 
 being weary with lying, I advifed her to 
 rife and take her breakfaff. Having fat 
 with her about two hours, during which 
 the pains were but flight and returned fel- 
 dom, and believing they would not grow 
 much flronger, until the mouth of the 
 womb fhould be fully opened, the mem- 
 branes broke, and the waters difcharged* 
 I propofed to go and vifit fome other pa-‘ 
 tients, and laid injundlions upon the nurfe 
 to put the woman to bed, and fend for 
 me as foon as matters fhould be thus ri^ 
 pened* 
 
 She feemed uneafy at my going, and 
 afraid I would not return, obferved fhe 
 had been already two days in labour ; that 
 the other gentleman would not have wait- 
 ed fo long, but delivered her before this 
 time, either by turning the child or ex- 
 tradlins: it with inftruments : the nurfe too 
 made refiedlions of the fame nature. 
 
 6 
 
 I 
 
CASES IN MIDWIFERY. 36^ 
 
 1 paid very little regard to what they 
 laid of my predeceffor, becaiife I could not 
 pretend to judge of his practice j unlefs I 
 had been prefent, and known the particu- 
 lar ’ circa mftances ; and nothing can be 
 more abfurd than to jullify or condemn 
 upon the hearfay of ignorant people, wlx) 
 are always apt to run into extremes of 
 praife or difpraife* 
 
 I therefore told her, die had not been in 
 real labour till the night before ; that I would 
 do every thing in my power for the fafety 
 of herfelf and the child ; and begged that, 
 if die was in the lead diffident of my dcill, 
 die would fend for the perfon who former- 
 ly delivered her ; for I would not attempt 
 to force matters, as there was really no 
 danger, even if the labour dioukl continue 
 eight days longer. This declaration quieted 
 the anxiety of the patient and nurfe, and 
 I was permitted to go away, after I had 
 promifed to return upon the fird notice, 
 which w^as given about eleven ; but at two, 
 I was fent for in a great hurry. The nurfe 
 had put her to bed, and I, during a ftrong 
 pain, felt the membranes pufning down 
 large and full through the Os Exte 7 ~nu?}jy 
 and as the pain went off and they were 
 
370 CASES IN MIDWIFERY* 
 
 relaxed, I perceived the head was at the 
 lower part of the Pelvis. I had fcarcely 
 time to put on a night-gown, when ano* 
 ther pain returned, and the woman was 
 immediately delivered of a fmall child. 
 From the eafmefs of the birth, and the 
 round form of the head, which was not at 
 all comprefled, I am inclined to believe that 
 though the child had been of an ordinary 
 fize, it would have been faved. 
 
 The patient recovered much better and 
 fooner after this, than her former de- 
 liveries ; the jaundice vanifhed, and in 
 two months die w'as healthier and flronger 
 than fhe had been for many years. 
 
 N U M B. II. C A S E I. 
 
 From inflammatory or oedematous dwell- 
 ings of the Pudenda, fchirrous tumors, 
 polypus or callofity in the Vagina or 
 Os Uteri. 
 
 Vide Sea. III. No. V. 
 
 In the year 1742. a woman in the lat- 
 ter end of her firfl; pregnancy, had oeda- 
 matcas dwellings in her legs, thighs and 
 .PudtTida j and, being obliged to walk one 
 dDjr through the city, was very much 
 fatigued and in great pain. When I 
 6 exa- 
 
CASES iM MIDWIFERY. 371 
 
 examined the parts, the fwelEng, which 
 before was oedomatous, feemed to have 
 contradled an inflammatory hue ; the left 
 leg and thigh were much more tumifled 
 than thcfe of the right fide, and the fkin 
 was fomething of a livid colour. Twelve 
 ounces of blood were immediately taken 
 from her arm, fhe was put to bed, and in 
 confequence of fomentations, in three days 
 the pain and inflammation abated : but, 
 the fwelling of the Pudenda ftill continuing, 
 I prefcribed an emollient cataplafm to be 
 frequently renewed, and from the firfl: day 
 file had taken two dofes of gentle, cooling 
 phyflck. On the fifth day flie was taken 
 in labour, and though the parts were flill 
 fwelled, and ftretched with great difficulty, 
 fhe was at lafl; fafely delivered. 
 
 The poultice was ftill applied, the {well- 
 ing gradually fubfided, and flie recovered 
 tolerably well. 
 
 CASE II. 
 
 In the courfe of the fame year, I was 
 called by a midwife to a woman at Chelfea 
 who was in labour. The Labia Pudendi 
 were fo exceffively fwelled, that both pa- 
 tient and midwife believed the child could 
 B b 2 not 
 
372 CASES IN MIDWIFERY. 
 
 not poffibly pafs : and the tumefaclion waS 
 attended with fuch pain, that for three 
 days Ihe had been obliged to keep her bed 
 and he on her back, without daring to al- 
 ter that pofition. 
 
 When I examined her during a pain, I 
 found the Oj Uteri very little open, and 
 thence concluding labour was but juft be- 
 ginning, I pundlured the parts in feveral 
 places with a lancet, a large quantity of 
 ferous fluid was difcharged, the fwelling 
 fubfided, and labour proceeded in a flow 
 manner until Ihe was delivered. 
 
 Such cafes have often occurred in my 
 praftice, and I never knew them attended 
 vrith any bad confequence. For, when 
 the fwelling is too great to permit the 
 child to pais, it is commonly reduced by 
 punctures^ or when of the iniiammatory 
 kind, by bleeding, cataplafms and fomen- 
 tation. 
 
 CASE III. 
 
 In the year 1744. a woman in labour 
 of her firft child, was attended by a mid- 
 wife, who imagined fhe felt the child’s 
 head, though very fmall, in the Vagma ; 
 but, examining again after a few pains, 
 
 fhe 
 
CASES IN MIDWIFEHY. 373 
 
 ilie felt that fiibhance puflied to one fide 
 of the Pehis, and the membranes and 
 waters forcing down at the other ; thefe 
 being broke and difcharged, file found 
 fomething like another head come nown 
 alfo. She being alarmed at this frrange 
 circumilancej recourfe was had to a gen- 
 tleman of the profeilion, who being alio 
 puzzled, made a pretence to leave her, and 
 afterwards fent a meffage, deiiring that an- 
 other might be called, as he was indif- 
 penfably engaged. But, before any alliil- 
 ance could be procured, the woman was 
 delivered by the labour-pains of a middle- 
 fized child : and it was not till fome 
 months after, that the fubftance was found 
 to be a fchirrous tumor, or excrefcence of 
 the polypus kind, adhering to the outfide 
 of the Os Uteri, 
 
 In fome few cafes, after fevere labour, I 
 have felt what | fuppofsd to be hard cica- 
 trices or cailofities at the Os Uteri, Vagira and 
 Os Externum, by which the delivery was 
 retarded. 
 
 CASE. IV, 
 
 In the year 1750. my attendance was 
 befpoke to a woman who had recovered 
 B b 3 with 
 
374 CASES IN MIDWIFERY. 
 
 with great difficulty after a former tedious 
 labour. 
 
 When I examined, the Os Uteri was open 
 to about the breadth of a crown, the mem- 
 branes, with the waters were puffied ibrong- 
 ly down, and I felt uncommon hardneffes 
 and Ibridtures at the Os Uteri, on the Fa- 
 gina, and at the lower part of the Oi Ex- 
 ternum, 
 
 The nurfe, who formerly attended her, 
 told me, that for fome days after her laft 
 delivery, little fleffiy fubhances were now 
 and then difcharged, of a blackifli colour 
 and bad fmell j and that a long time elapfed, 
 before fhe recovered and was able to fit 
 up. 
 
 ■ >The labour now proceeded very flowly, 
 until the mouth ^f the womb was fully 
 opened, and the membranes breaking, the 
 contradled Vagina v/as gradually Ibretched 
 by the head of the child ; for notwith- 
 ftanding the callohties which ftill conti- 
 nued, the neighbouring parts yielded by 
 degrees, and although it was long before 
 the Os Externum was fufficiently dilated, 
 at lall the child was delivered. 
 
 I managed this cafe with great cau- 
 tion, becaufe, from the imperfect accounts 
 
 of 
 
CASES IN MDVv^IFERY. 375 
 
 of her former labour^ I fiippoled there 
 had been a violent inflammation, and that 
 the callous flri6lures were the confequence 
 of a partial mortification which had been 
 feparated and call off by nature. 
 
 I kept her moffly in bed, and dui'lng 
 every ffrong pain, prefied my fingers againft 
 the head, fo as to abate the force of the 
 protrufion, and allow time for the relaxa- 
 tion of the ftridtures ; by which means 
 the labour fucceeded beyond expe6lation, 
 
 NUMB. IIL CASE I. 
 
 Of the detenfioii of the flioulders and body 
 of the child, after the head is delivered. 
 
 In the year 17^5. I was called to a pa- 
 tient in labour, after the child’s head w^as 
 delivered, as the midwife could not extradl 
 the body, though fhe had pulled a long 
 time with a good deal of force. I found 
 the navel-ffring furrounding the neck, and 
 luckily hooking with my finger that part 
 of it which was next the child’s belly, it 
 was fo loofe as to flip over the head j I 
 undid two other circumvolutions in the 
 fame manner, and the child being difen- 
 tangled, v/as immediately delivered. 
 
 B b 4 
 
 I 
 
376 CASES IN MIDWIFERY. 
 
 I have, in many other cafes, freed the 
 child from the circumvolutions of the Fu- 
 nis, in the fame manner, and was difpofed 
 to believe, that it was very feldom if ever 
 necelTary to cut and tie this rope before the 
 delivery of the child, until my opinion 
 was altered by the two following inftances. 
 
 CASE II. 
 
 In the year 1749. I was called in a great 
 hurry to a woman vv^hofe delivery was re- 
 tarded by the fame caufe defer! bed in the 
 foregoing cafe, and tried to difengage the 
 child from the circumvolutions of the Fu- 
 nis, though without effedl. Then, with- 
 out waiting to make a ligature in two 
 places, as we are commonly diredfed to do, 
 I inhnuated my fingers between one of the 
 turns and the child’s neck, fnipt the Funis 
 in two with my feiilars, and delivered the 
 body of the child, which was dead. 
 
 The face and neck were very much 
 fwelled, and in this laid appeared a deep 
 impreflion from the tightnefs of the cir^- 
 cumvolution. 
 
 CASE 
 
CASES IN MIDWIFERY. 377 
 
 CASE III. 
 
 In the year 1751. I was concerned in 
 another cafe of the fame nature, and after 
 having attempted, without fuccefs, to diD 
 engage the child by turning the Funis over 
 the head with my finger, I made a liga- 
 ture in two places, between which I fnipt 
 it afunder. 
 
 The confequence of this operation, was, 
 the immediate delivery of a flrong lively 
 child : another ligature was made near the 
 Abdomen, and the fuperfxuity of the Funis 
 cut off. 
 
 In a few cafes I have found delivery re- 
 tarded by the fliortnefs of the Funis ; but 
 the child was always fafely delivered, by 
 turning the body along the breech of the 
 mother. 
 
 CASE IV. 
 
 In the year 1730. I received a fudden 
 call to a gentlewoman in labour j the 
 child’s head had been delivered a long 
 time, and the midwife had pulled with a 
 great deal of force, at intervals. But be- 
 fore I arrived, the patient was delivered 
 
37 S CASES IN MIDWIFERY. 
 
 of a dead child, whofe fhoulders were re- 
 markably large. I have been called hj 
 midwives to many cafes of this kind, m 
 which the child was frequently loll. 
 
 CASE V. 
 
 In the year 1753. I attended in a labour 
 that was rendered tedious by the large fize 
 of the body after the head was delivered. 
 I attempted to bring down the fhoulders. 
 in the gentlefc manner, according to the 
 diredtions in my treatife, but found I could 
 not fucceed without ufmg fuch force as would 
 overRrain the neck, and deftroy the child : 
 for the fhoulders were fo high that I 
 could not reach with my fingers to the 
 armpits. I then introduced the blunt 
 hook, but could not fucceed, without mn-% 
 ing the rifque of breaking the arm, or 
 ©verftraining the joint at the fhoulder; 
 and, as the woman had ftrong pains, I 
 refolved to wait their effedf, without ufmg 
 any violence that might endanger the life 
 of the child : accordingly, in three pains, 
 I brought the flioulder down to the Os 
 iernurtiy then turning one of tire arms into 
 the hollow of the Sacrum^ the body fol- 
 lowed, and the child was born alive. From 
 
 this 
 
CASES IN MIDWIFERY. 379 
 
 this and other cafes, I have learned to w^ait 
 the effe6l of the labour-pains, rather than 
 to ufe violence in pulling at the neck. 
 
 CASE VI. 
 
 Communicated in a letter from Mr.^ 
 
 dated at E , 1749. 
 
 I have had lately another melancholy 
 cafe in midwifery. I was fent for to a 
 woman, aged forty, who had born feveral 
 children before. When I came, I found 
 the frontal and parietal bones feparated 
 from the reft and without the Vagina, the 
 brain being evacuated. I flipped up my 
 fingers, and found the Os ’Emcee contradl- 
 ed about the neck of the child, and en- 
 deavoured to pull it away, but in vain. I 
 then fent for Mr. D. and Mr. neither of 
 whom could come. I next fent for Mr. L. 
 who came, and I defired him to fee w^hat 
 he could do, as my fingers were numbed. 
 He firft got one hand into the Uterus, and 
 then flipped up the fingers of the other, 
 and brought away the child. The woman’s 
 pulfe before delivery was ftrong, and fhe 
 had little flooding : but we had not been 
 gone a quarter of an hour v/hen we were 
 
 fent 
 
380 CASES IN MIDWIFERY. 
 
 fent for again. They told us, that im- 
 mediately after we went away, which was 
 about five minutes after delivery, fiie was 
 feized with a fhivering and vomiting, and 
 had fainted. We found her in a fwoon, 
 and held fpirits to her nofe : but fhe could 
 not fwaliow, and died in about half an 
 hour after delivery. 
 
 Quere. What was the caufe of her 
 death ? Was it owing to the lypothymia, 
 occafioned by pain or lofs of blood, which 
 indeed was not confiderable ? Or might it 
 not be owing to a rupture of the internal 
 orifice, v^^hich the vomiting feemg to have 
 prognofticated ? 
 
 The ANSWER. 
 
 I really think you have had your fliar^ 
 of bad and unfuccefsfui cafes : but, in all 
 of them, erpecialiy the laid, you adled with 
 prudence in lending for others of the pro- 
 ieffion. 
 
 Id cafes where the head is delivered, and 
 tlie ilroulders are fo large, or the iov/er 
 part of the Uterus is fo contradred, that 
 the body cannot be brougiit away by pull- 
 ing with moderate force, if the woman’s 
 
 pains 
 
CASES IN MIDWIFERY. 3S1 
 
 pains have not intirely left her, or fhe is 
 not in a dying condition from floodings, 
 or other fymptoms, the befl: method is to 
 wait for the effe6l of the laboor-pains : 
 for I have lately been concerned in a cafe 
 of a weak woman, where the body of a 
 live child was delivered half an hour after 
 the head was without the Os Externum. 
 
 Now, as your patient was not weak, I 
 think you might have waited and amufed 
 her with medicines. Or if fhe had turned 
 weak, and nature feerned infufficient, you 
 might have puflied up your hand, and af- 
 ter having ftretched the contradled part, 
 tried to deliver the child : if this method 
 had failed, recourfe might have been had 
 to the crotchet, as the child was already 
 dead ; this being fixed upon the body, would, 
 by dilating the ‘Ehorax or Cojiee, have dimi- 
 nifhed the bulk, and brought down one 
 flioulder a great way before the other. 
 
 I cannot pretend to afcertain the caufe 
 of the woman’s death. 
 
 I have been concerned in feveral cafes, 
 where, though the Os Internum was tore, 
 the patient has recovered without vomiting 
 or any other bad fymptoms ; and have 
 known other women die, as it were, in- 
 
 ftantaneoufly 
 
3^2 CASES IN MIDWIFERY. 
 
 ftantaneoufly after delivery, though I al- 
 ways imputed fuch fudden death to their 
 being exhaufted by long labour, the fud- 
 den emptying of their veiTels, and a greater 
 lofs of blood than their conftitution could 
 bear. 
 
 COL- 
 
CASES IN MIDWIFERY. 383 
 
 COLLECTION XXII. 
 
 Of children fnppofed to be dead-born ; of 
 the head fqueezed into different forms 1 
 of the Funis not fufficiently tied, broke 
 Riort, or feparated in a wrong place. 
 
 N U M B. I. CASE! 
 
 Of children fnppofed to be dead-born. 
 
 In the year 1 747. I was called by a mid- 
 wife to a woman in labour in the feventh 
 month, wEo before I arrived, had flooded 
 a good deal, though the lisemorrhage was 
 flopped. 
 
 The patient was foon delivered of a 
 child, to all appearance dead ; and, after 
 the midwife had tried the common me- 
 thods of rubbing the temples and breafl: 
 with brandy, whipping and holding onion 
 to the mouth and nofe, it was laid by in 
 a clofet. About five minutes were con- 
 fumed in thefc experiments, and in two or 
 three minutes more, while I was prefcrib- 
 ing fome medicines to recruit the weak 
 patient, I heard a kind of whimpering 
 noife in the clofet, and not knowing where 
 tiie child Vvas laid, afked if there was a 
 
 kitten 
 
384 CASES IN MIDWIFERY. 
 
 kitten confined in that place. The nurfe 
 immediately ran into the clofet, and brought 
 out the child, which was alive, and after- 
 wards reared, though with great difficulty. 
 
 CASE II. 
 
 In the year 1749. I attended a woman 
 in labour, and the navel-ftring prefenting 
 with the arm, I delivered the child by the 
 feet. From the pulfation in the arteries of 
 the Funis, I knew it was alive j but I 
 found great difficulty in delivering the 
 head, and was obliged to reft feveral times 
 before I could effebt it j fo that the pulfa- 
 tion ceafed, and the child feemed to be 
 dead, after all the common efforts were 
 ufed for its recovery. 
 
 Neverthelefs, I inflated the lungs, by 
 blowing into the mouth through a female 
 catheter, and the child gave one gafp, up- 
 on which I repeated the inflation at fe- 
 veral intervals, until the child began to 
 breathe, and it adtually recovered. 
 
 NUMB. 
 
CASES IN MIDWIFERY. 38; 
 
 N U M B. II. C A S E I. 
 
 Of the child’s head fqueezed into different 
 forms. 
 
 In the year 1750. I attended a woman 
 who had before been fubjedf to lingering 
 labours, occafioned by the fmall fize of her 
 Fehis : at this time, however, the delivery 
 was pretty quick, becaufe the child was 
 fmall, and the bones of the Cranium eafily 
 yielded and rode one another. But the 
 head being fqueezed to a great length from 
 the face to the Vertex^ I preffed the palms 
 of my hands againft both thefe parts, and 
 with great eafe brought it to a better form. 
 
 CASE II. 
 
 In the courfe of the fame year, I attend- 
 ed a woman who had a large and well- 
 Biaped Pehis, and had formerly been fa- 
 voured with very quick labours : but, on 
 this occafion, the child being large and 
 the mother weak, the delivery was tedious, 
 and though the child’s head was compreff- 
 ed into a longitudinal form, I eafily reduc- 
 ed it into the natural fhape. 
 
 C c 
 
 In 
 
386 CASES MIDWIFERY. 
 
 In all cafes where the head was thus 
 fq'Lieezed, I have been able to alter the 
 form by a gentle preffure between my 
 hands ; unlefs it had been comprefied for 
 many hours by being retained in the Pel- 
 'visy and then I have found it impofhble to 
 make an effedtual alteration. 
 
 NUMB. III. CASE I. 
 
 Of the Funis not fufficiently tied, broke 
 
 Ihort, or feparatcd in a wrong place. 
 
 In the year 1726. I delivered a woman 
 whofe cafe was preternatural, and though 
 the navel -ftring was thicker than ufual, I 
 thought I had tied it fufficiently, and the 
 child being laid by the fire, continued in 
 that fituation a good while before it was 
 drefled, becaufe the attention of myfelf 
 and the attendants was engrofled by the 
 mother, who was extremely weak and 
 low. After flie was recovered and laid 
 properly in bed, I went towards the child, 
 and was very much furprifed to fee fo much 
 blood loft, and to obferve it ftill flowing 
 from the Fu?iis. I no fooner difcover- 
 ed this, than I made another ligature 
 on the outfide of the former, and, pull- 
 ing it very tight, the difcharge lefl'ened, 
 2 though 
 
CASES IN MIDWIFERY. 387 
 
 though it did not intirely ceafe, until I 
 had made a third. The child, which feem- 
 ed to be healthy and florid when firfl: born, 
 was exhaufted by this haemorrhage, and 
 continued weak and pale for feveral days, 
 until it was recovered by fucking the mother. 
 
 Thick navel-ftrings require very firm 
 ligatures, and a good portion of them 
 ought to be left in the feparation. 
 
 CASE II. 
 
 In the year 1744. having delivered a 
 woman whofe cafe was laborious, I defir- 
 ed one of the afliftants to hold the child 
 before the Funis was cut or tied, until I 
 fhould move the woman a little further 
 into the bed, that fhe might not run the 
 rifque of catching cold. 
 
 The alTiftant, who received it in a hurry 
 and trepidation, pulled away fo fuddenly, 
 as to break the Fmiis fliort from the belly, 
 when the midwife perceiving the child 
 bleed exceflively, took hold of the part, and 
 prefled it firmly between her fingers and 
 thumb. 
 
 I had juft; room enough to make a liga- 
 ture, and was obliged to take a ftkch with 
 a needle, in order to fecure it from flipping. 
 
 C c 2 CASE 
 
388 CASES IN MIDWIFERY. 
 
 CASE III. 
 
 In the year 1745. after having delivered 
 a patient of a fmall and weakly child, I 
 tied and cut the navel-ftring, and put the 
 child into the hands' of a woman, who 
 pretended to great Ikill and experience, 
 and had come thither to fuperintend my 
 conduct. I no fooner laid hold on the 
 Funis, than feeijng the ligature upon it, I 
 was convinced that I had feparated the 
 rope between it and the child’s belly, and 
 not a little difturbed, as I had to deal with 
 fuch a cenforious matron j however, I re- 
 collefted myfeif in an inftant, and defired 
 to fee the child, that I might know whe- 
 ther or not the navel-ftring had bled fuffi- 
 ciently, for, by fuch a difcharge I had of- 
 ten prevented convulfions in children. I 
 immediately perceived the blood fpringing 
 out from the arteries with great force, and 
 before I could make a proper ligature, the 
 child had loft three or four ounces, by 
 which evacuation it continued feveral days 
 in a very weak condition. Indeed, when 
 the child is large, and the head has long 
 been comprelied in the Pelvis, I have ima- 
 gined, that by tying the ligature flightly 
 
 at 
 
CASES IN MIDWIFERY. 389 
 
 at firR, fo as to let the Funis difcharge two 
 or three fpoonfuls, eonvulfions have been 
 prevented : but this was a finall child that 
 pahed eafily, and could not well bear fuch 
 an evacuation. 
 
 Neverthelefs, my miftake turned to my 
 advantage with the knowing lady, who 
 was very loud in my praife, for having 
 found out fuch an effedlual and extraordi- 
 nary method of preventing eonvulfions in 
 children. 
 
390 CASES IN MIDWIFERY. 
 
 COLLECTION XXIII. 
 
 Of cafes in which the Placenta was 
 with difficulty delivered. 
 
 CASE I. 
 
 In the year 1725. I was called to a wo- 
 man in labour in the feventh month, who 
 flooded violently, and delivered her fafely 
 of the child : but as the Placenta did not 
 follow^ I introduced my hand, and felt 
 fome parts of it hard and fehirrous, which 
 I feparated with great difficulty. The 
 flooding which had flopped, now return- 
 ed, and the patient in a little time fell into 
 fainting fits, and expired. 
 
 CASE II. 
 
 In the year 1744. I was called to deli- 
 ver the Placenta in a woman who had mif- 
 carried in the fixth month, and finding it 
 a cafe of the fame nature with that de- 
 feribed above, I refolved to adfwith greater 
 caution, and extradled thofe parts only that 
 feparated with eafe, leaving fuch as flrong- 
 ly adhered to come away of themfelves. 
 
 I told the midwife my reafons for a< 5 l- 
 ing in this manner, ^and prognoflicated 
 that what remained would be expelled in 
 
 two- 
 
Cases in midwifery. 391 
 
 two or three days, arid pafs for commoit 
 clots or coagula. This accordingly hap- 
 pened, without any bad conrequences to th^ 
 patient. 
 
 CASE III. 
 
 In the courfe of the fame year, about 
 feven in the evening, I, at the delire of a 
 phyfician, vifited a poor woman, who had 
 been delivered at eight in the morn- ^ 
 ing j but, as the midwife had broke the 
 Funii in pulling, the Placenta ftill remain- 
 ed, to the great terror of the patient and 
 her friends. Imagining that a good deal 
 of force would be required to extradt it, 
 
 I ordered the woman to be laid fupine 
 acrofs the bed, with her breech to the fide, 
 and her legs raifed up and fupported by two 
 affiftants. Then anointing my hand, and 
 introducing it into the Vagina^ I gradually 
 dilated the Os Internum.^ but found the 
 lower part of the Uterus fo llrongly con- 
 traffed, that I, at firft, defpaired of mak- 
 ing further progrefs j and the force I ex- 
 erted was fo great, and my hand went up 
 fo high, that I was apprehenfive of tear- 
 ing the Uterus from the Vagina. Feeling 
 the womb roll about, under the relaxed 
 parieties of the Abdomen j I prelTed one 
 C c 4 hand 
 
392 CASES IN MIDWIFERY. 
 
 hand on the outfide, to keep it down and 
 prevent its motion, while I proceeded 
 flowly, pufhing up and ftretching by in- 
 tervals, with my fingers in the form of a 
 cone. By thefe means, I gradually dilated 
 the parts, though I was obliged to change 
 hands feveral times, becaufe my fingers 
 were cramped, and at length, with great 
 difficulty, I reached the Fundus^ where the 
 Placenta had been fo frrongly confined. 
 H'^ving gained my point thus far, I eafily 
 feparated, and brought it gently along. 
 
 C A S E IV. . 
 
 In the year 1729. immediately after de- 
 livery in a laborious cafe, I introduced 
 my hand to bring down the Placenta^ and 
 it paffed up, as I imagined, into the 
 lower part of the UteruS ' ; pufhing up far- 
 ther along the navel-firing, my fingers 
 flipt into a contradled part, and the Pla- 
 C€7ita felt as if it had been contained in a 
 feparate cavity from the Uterus. As I pufhed 
 up, in order to dilate the contradled part, it 
 rofe up higher and higher, moving from fide 
 to fide, under the relaxed parietes of the 
 Abdomen^ until, by applying my other hand 
 on the outfide, I preffed down the Fundus^ 
 
 and 
 
CASES ui MIDWIFERY. 393 
 
 and kept it Ready. Then I gradually di- 
 lated, and infinuating my hand into the 
 part where the Placenta was confined, I 
 felt it lying loofe and detached from the 
 Fundus, feemingly retained by this contrac- 
 tion only j fo that is was eafily extra6led. 
 
 From this and feveral other cafes of the 
 fame kind, I was difpofed to believe Dr. 
 Simpfons theory concerning the contradtion 
 of the upper part of the neck of the Ute- 
 rus, until I found, in a great number of 
 inftances, the whole lower part of the 
 Uterus contrafted as defcribed in the third 
 cafe. 
 
 : C A S E V. 
 
 In the year 1745. I found j after delivery, 
 the edge of the Placenta at the infide of 
 the Os Uteri, and waited fome time to fee 
 if it would come away of itfelf, but the 
 - midwife informing me that it had conti- 
 nued in the fame fituation for a confider- 
 able time before I was called, and that fhe 
 had tried the common methods of pulling 
 at the Funis, and dire6ling the patient to 
 bear down, I introduced my right hand 
 : into the Vagina, as the woman lay on her 
 left fide, and pufliing up along the navel- 
 
 ftring. 
 
394 CASE$ IN MIDWIFERY. 
 
 firing, found the, Placenta adhering to the 
 back-part of the Uterus j then grafping it 
 with my whole hand, I attempted to fe- 
 parate by fqueezing j this expedient fail- 
 ing, I attempted to part the upper-edge 
 with my fingers, but it adhering firmly 
 at that part, and my hand being much 
 confined, I withdrew it, and introduc- 
 ed the left, with the back to the Sa- 
 crum. I now gradually feparated the 
 lower edge of the Placenta from the infe- 
 rior and pofterior part of the Uterus ; and 
 finding it adhere firmer as I reached far- 
 ther up, I preffed my fingers with greater 
 force againfi thefe parts, which felt cal- 
 lous, and by degrees difengaged them from 
 the Uterus ; by this time, imagining I had 
 feparated the whole Placenta j I attempted 
 to bring it along, by pulling at its lower 
 part as well as at the Funis,, but thefe 
 efforts proving ineffedlual, I pufh’d up again 
 and made a total feparation, after which 
 I brought it away in a' very ragged condi- 
 tion : but the woman complained of a good 
 deal of pain, loft an uncommon quantity 
 of blood, and continued weak for a long 
 time. 
 
CASES IN MIDWIFERY. 395 
 
 I have often thought that this hurry- 
 ing method was unneceffary, and produc- 
 tive of many complaints to the patient : 
 for in many cafes that have fince occur- 
 ed hi my pra6tice, the Placenfay when the 
 edge of it was found at the mouth of the 
 wornb^ has come down of itfelf at leifure, 
 the woman has loft lefs blood, and reco- 
 vered better, than where force hath been 
 ufed to extradl it immediately. 
 
 CASE VI. 
 
 In the year 1747. I was called to a wo- 
 man who had been delivered feveral hours, 
 and the midwife told me fhe had at firft 
 tried gentle methods to bring down the 
 Placenta^ but to no purpofe, and afterwards 
 introducing her hand along the navel-ftring, 
 could not find it. 
 
 I infmuated my hand as fhe lay on her 
 left-fide, and found thtPlace?ita contained, 
 as it were, in a diftindl; cavity at the upper 
 part, and left fide of the Uterus ; but as the 
 patient moved from me, and could not be 
 kept fteady, and the Uterus rolled about as 
 I endeavoured to dilate the contradfed 
 parts, I put her in the pofition defcribed 
 
 in 
 
396 CASES IN MIDWIFERY. 
 
 in the third cafe, and extracted the Pla~. 
 in the fame manner. 
 
 The appearance here was different from 
 any I had formerly feltj there was a pretty 
 large fpace for the hand in the Uterus, and 
 the Placefita felt as if it had been contain- 
 ed in a feparate cavity on one fide, the 
 entry of which would at firft fcarce ad- 
 mit two or three of my fingers. 
 
 I underftood from the midwife, that the 
 membranes had broke long before deli- 
 very, that the woman was very big, and 
 a large quantity of water had been dif- 
 charged. This fudden evacuation, in all 
 probability, was the caufe of the womb’s 
 contra6ling itfelf into fuch a cavity around 
 the Placenta. 
 
 CASE VII. 
 
 In the fame year, I was called to a wo- 
 man in labour, and finding her belly pen- 
 dulous, I ordered her to' be laid on her 
 back with her fhoulderslow and her breech 
 raifed. The child’s head being fmall, fhe 
 was foon delivered, and I defired the mid- 
 wife to let the Placenta come flowly away. 
 Neverthelefs, as it was not immediately ex- 
 pelled, and fhe was loth to- lofe the credit 
 
 of 
 
CASES IN MIDWIFERY. 397 
 
 of the operation, fhe pulled with fuch force 
 as 'broke the Funis clofe to the Placmta, 
 and afterwards introduced her hand to fe- 
 parate, though without fuccefs. I was 
 then called from the next room to her af- 
 fiftance, and being informed of the acci- 
 dent, took the opportunity of the patient’s 
 being ftill in the proper polition, to in- 
 troduce my right hand into the Uterus^ to 
 the forepart of which I found the Placenta 
 adhering : but it was fo much forwards, 
 that I could not feparate, while flie re- 
 mained in that pofition ; I therefore turn- 
 ed her on her left fide, fo as that my hand 
 could reach farther forward, and effected 
 the reparation. 
 
 CASE VIII. 
 
 In the year 1750. ^fter having delivered 
 a woman of a dead child, I found the 
 Placenta gradually defcended into the Va- 
 gina 'y znA, imagining it was fully dlfen- 
 gaged from the Uterus, I helped it along, 
 by pulling gently at its under edge, and 
 at the navel-firing. However, it was fo 
 tender, from being moitified, that fome 
 part of it was left behind j but feeling the 
 Os Uteri clofely contra<^ed, . and the womb 
 
 itfelf 
 
398 CASES IN MIDWIFERY, 
 itfelf reduced to the fize of admail child’s 
 head, I thought it was pity to give the 
 woman frefh pain by dilating the parts, 
 and the fragments were difcharged in three 
 days, without any other inconvenience to 
 the woman than the bad colour and fmell 
 of the Lochia^ which gave no uneafmefs 
 or alarm, becaufe I had apprifed the nurfe 
 of what would happen. 
 
 CASE IX. 
 
 In the year 1752. I delivered the wife 
 of a gentleman who had formerly attend- 
 ed my Ie6lures. The Placejita was expell- 
 ed by the labour-pains, fo that I did no- 
 thing but help it through the Os 'Externum j 
 but the membranes were tore all round 
 from the edge of it, and detained in the 
 Uterus^ which was contra6fed as in the for- 
 mer cafe. 
 
 The gentleman agreed with me that it 
 was more prudent to let them come away 
 of themlelves, than to run the rifque of 
 hurting and inflaming the womb, and 
 they were accordingly difcharged in four 
 or five days, vv^ithout the leafl; inconvenience 
 to the patient. Vide Ruyfch, Tom. 3. 
 Dec. 2. p. 30. 
 
 And 
 
CASES IN MIDWIFERY. 3^9 
 
 And Mr. 'Portal, Obferv. XVI. relating to 
 the Os Internum, tore by its being miftaken 
 for the Placenta. 
 
 C A S E X. 
 
 Communicated in a letter from Mr. — 
 dated ^746. 
 
 About nine in the evening, he was fent 
 for to a woman who had been delivered of 
 a live child that morning, but the Placenta 
 remained ; and he found her in ftrong hy- 
 fteric or convulfion fits, which recurred al- 
 mofi: without intermiffion. The Placenta 
 adhered fo firmly to the Uterus, that with 
 great difficulty he feparated part of it, and 
 what came away was brought off in feve- 
 ral pieces : but the woman died in a few 
 minutes after the operation. 
 
 Thefe are only a few from the many 
 cafes of this kind, in which I have been 
 concerned. 
 
 When I lived in the country, I was fel- 
 dom called to deliver the Placenta, except 
 in laborious and preternatural cafes, and 
 then the woman was generally fo weak 
 and fatigued, that I was afraid of wait- 
 ing, and therefore extradled the Placejita 
 
 foon 
 
400 CASES IN MIDWIFERY. 
 
 foon after the child was born : but in com* 
 mon labours, the midwives proceeded with 
 patience and caution, bringing it away, 
 by pulling gently at the Funisy diredling 
 the patient to force down, or provoking 
 her to puke by tickling her throat with a 
 feather. 
 
 When I fettled in Londotiy I found the 
 pradlice, in this par ticular, quite different ; 
 the women were always in a fright when 
 the Placenta was not immediately deliver- 
 ed, when it was in the leaft lacerated, or 
 when any part of it and the membranes 
 were I'etained. For this reafon, male prac- 
 titioners were fo often called j and they, 
 from miftaken notions adopted from for- 
 mer writers, never failed to blame the mid- 
 wives for having neglefted fo long to deli- 
 ver the Placentay obferving that if they had 
 been called at firft, before the Uterus was 
 contra6led, they could have eafily prevent- 
 ed the bad confequences which were likely 
 to enfue. Such infinuations alarmed the 
 women, and, in order to avoid thefe re- 
 proaches for the future, the midwives did 
 not wait as formerly, but hurried off the 
 Placenta immediately after the child. But 
 this practice did not anfwer their aim : 
 
CASES IN MIDWIFERY. 401 
 
 for, if the Placenta was torn, or any part 
 of it, or the membranes retained, and the 
 patient chanced to be feized with a fever, 
 perhaps from a different caufe, fo as not 
 to recover in the ufual way, it was always 
 imputed to the retention of thefe portions, 
 and the midwife blamed accordingly^ 
 
 I have been often amazed at the ridicu- 
 lous and fuperifitious obfervations of prac- 
 titioners, with regard to the knots upon 
 the FuniSi fchirrous appearances, and 
 the different fhape or figure of the Fla-- 
 centa^ which was often kept nine days in 
 water, and the circumffances of the wot 
 man’s recovery, predi6led from its colour* 
 
 I at firft fwam with the ffream of ge- 
 neral pradlice, till finding, by repeated ob- 
 fervation, that violence ought not to be 
 done to nature, v/hich flowly fcparates 
 and fqueezes down the Placenta by tlie 
 gradual contradlion of the Uterus j and 
 having occafion to perceive, in feveral in- 
 ftances, that the womb was as ftrongly 
 contracted immediately after the delivery 
 of the child as I have found it feveral 
 hours after delivery ; I refolved to change 
 my method, and aft with lefs precipita- 
 tion, in extracting the Placenta. What 
 D d helped 
 
402 CASES IN MIDWIFERY. 
 
 helped to deterinine me upon this occa- 
 lioil, was a cafe in which the woman was 
 fo weak, that I durft not venture to fepa- 
 rate, though I waited three hours, with- 
 out finding the Placenta at the Os Uteri ; 
 neverthelefs, when Ihe recovered a little, a 
 few after-pains came on, and forced it down 
 to the Vagina. 
 
 Soon after this occurrence, in confult- 
 ing Riiyfch about every thing he had writ 
 concerning women, I found him exclaim- 
 ing againft the premature cxtradlion of the 
 Placenta', and his authority confirmed the 
 opinion I had already adopted, and in- 
 duced me to choofe a more natural way of 
 proceeding. When I have feparated the 
 Funis, and given away the child, I intro- 
 duce my finger into the Vagina, to feel if 
 the Placenta is at the Os Uteri j and if this 
 be the cafe, I am fure it will come down 
 of itfelf at any rate. I wait fome time, 
 and commonly in ten, fifteen or twenty 
 minutes, the woman begins to be feized 
 with fome after-pains, which gradually fe- 
 parate and force it along ; by pulling gent- 
 ly at the Funis, it defeends into the Vagina, 
 then taking hold of it, ! bring it througli 
 the Os Externum. But if, after having 
 
 waited 
 
CASES IN MIDWIFERY. 403 
 
 waited a confiderable time, without feeling 
 any part of the Placenta, or perceiving 
 any natural efforts for its expulfion, I pro- 
 voke the woman to reach, and if this ex- 
 pedient 'is not attended with fuccefs, I in- 
 finuate my hand gently, and deliver the 
 cake, obferving always a medium between 
 the two extremes of practice, namely, 
 that of delivering too fobn, and that of 
 waitiiig too long for its expulfion. But 
 it muft be obferved, that in laborious or 
 preternatural cafes, when the woman is in 
 danger, I commonly affift fooner. 
 
 D d 2 
 
 COL- 
 
404 CASES IN MIDWIFERY. 
 
 COLLECTION XXIV. 
 
 Of laborious cafes, when the Vertex pre- 
 fents, and the child’s head is low in the 
 Pelvis. 
 
 CASE I. 
 
 In the year 1730. I was in the morning 
 called to a woman in her firfl pregnancy, 
 who had been long in labour, and very 
 much fatigued by the officioufnefs of the 
 midwife. I found the child’s head at the 
 lower part of the Pehis, where, as the, 
 midwife told me, it had remained from 
 eight o’clock of the preceding night, tho’ 
 fhe had tried all the different pofitionsj 
 and I underftood that the waters had been 
 draining off for twenty four hours. 
 
 Having loft fome children in cafes of the 
 fame nature, by turning, and others by 
 being obliged to deliver with the crotchet, 
 after having tried Mauriceaus fillet with- 
 out fuccefs, I refolved to form a fillet into 
 a noofe, and endeavour to fix it round the 
 upper-part of the head with my fingers, 
 hoping that I fliould fucceed in this cafe, 
 becaufe I found the head was fmall, by 
 moving my fingers eafily round it. Yet, 
 
 before 
 
CASES IN MIDWIFERY. 405 
 
 before I would attempt this method, I pre- 
 fcribed ten drops of liquid laudanum, by 
 which fhe procured fome deep, and her 
 ftrength being recruited, the pains return- 
 ed, though v/eakly, and the head was 
 forced down a little by each, though it af- 
 terwards recoiled to its former dtuation : 
 a circumdance, which I at fird imputed 
 to circumvolutions of the Funis, or the 
 contraflion of the Os Uteri round the neck 
 of the child. The Os Rxternum having 
 been fudiciently opened by the midwife, 
 I tried to hide up the noofe mounted on 
 my fingers, along the fido of the head, and 
 after m.any unfiiccefsful efforts at length 
 fixed it 5 then I pulled gently with one 
 hand during every pain, v/hile I preffed 
 with the fingers of the other, at the op- 
 pofite fide ; and thus pulling and moving 
 from fide to fide, I made fhift to deliver, 
 though not without having ufed a good 
 deal of force ; and the hairy fcalp was 
 pretty much galled, but not fo as to en- 
 danger the life of the child. 
 
 When I introduced the noofe, I was 
 certified that the difficulty did not proceed 
 from the contradlion of the Os Uteri round 
 the neck, by feeling the OsFincce at the 
 D d 3 middle 
 
4o6 cases in midwifery. 
 
 middle of the head ; and when the child 
 was delivered, the Fimis was not circum- 
 voluted, round the neck, fo that I could 
 not find out the caufe that retarded the 
 labour : I continued feveral years in this 
 uncertainty, until I difcovered that, in many 
 cafes, this obftrudtion proceeds from the 
 contradlion of the lower part of the Uterus 
 before the hioulders, or from the reten- 
 tion of thefe upon the Pubis. 
 
 CASE II. 
 
 In the year 1733. I was concerned in a 
 cafe of the fame nature, and found the 
 woman much weakened by frequent dif- 
 charges of blood. I delivered her in the 
 manner defcribed in the former cafe, of a 
 child that had been dead for fome days ; 
 though I was obliged to exert greater force, 
 becaufe the head was larger, by which 
 means the fcalp was more galled, and part 
 of it torn from the Cranium. 
 
 C A S E ^ III. 
 
 In the year 1737. I tried to ufe the 
 fillet upon a child which was higher in the 
 Pehis^Vit could not fix it until I puflied 
 the head above the -brim j then my hand 
 
 having 
 
CASES IN MIDWIFERY. 407 
 
 having more room, I accompliflied my aim 
 and fucceeded better in this than in the 
 former inllance, for the hairy fcalp was 
 not fo much galled, bscaufe the woman 
 had ftronger pains to affift the expulfion. 
 
 I tried the fillet in feveral other cafes, 
 without fuccefs, and was obliged to deli- 
 ver with the crotchet, becaufe the children 
 were large. In the three cafes I have re- 
 lated, the head being fmall, I attempted 
 to turn and bring the child by the feet ; 
 but was prevented by the flrong contrac- 
 tion of the Utei‘us-, and I am now certain, 
 that had I then known how to ufe the 
 forceps, I could have delivered with great 
 eafe, not only in tliefe but in feveral other 
 cafes where I failed with the fillet, 
 
 D d 4 
 
 COL- 
 
4o8 cases in midwifery. 
 
 COLLECTION XXV, 
 
 Of laborious cafes, when the head of the 
 child is low in the Pelvis, and deliver- 
 ed with the forceps. 
 
 Vide Sedt. 4. No. i. Tab. XVIT, XVIII, and XIX. 
 
 N U M B. I. C A S E I. 
 
 From weaknefs and anxiety of mind, 
 
 In April 1747. being called in the even- 
 ing to one of the poor women who adr 
 mitted my pupils, I found her in labour 
 of her third or fourth child, and reduced 
 to extreme weaknefs by long falling, as 
 Ihe had not been able to go abroad for fe- 
 veral days to beg in the ftreets. I imme- 
 diately fupplied her with fome cawdle^ 
 bread and broth : but her ftomach was fo 
 weak, that it could retain but very little j 
 for though I defired fhe fliould take it at 
 hrft by cupfuls, die was fo greedy of nou- 
 ridirnent that die fwallowed too much at 
 once. However, die was afterwards re- 
 trained from doing herfelf an injury, and 
 her ftomach kept enough to recruit her 
 ftrength, in fome meafure. I found the 
 Os Uteri largely open, the membranes 
 broke, and the head, at the upper part of 
 
 the 
 
CASES IN MIDWIFERY. 409 
 
 the Pehis, and left one of the eldeft pupils 
 to manage the labour, advifing him to 
 perlift in giving her nourifliment, at pro- 
 per times and in fmall quantity, and to 
 let her lie moftly in bed, that fhe might 
 enjoy fome deep and refrefhment. 
 
 Indeed, when we firfl: arrived, all of us 
 were of opinion that fhe would expire ; 
 but in two hours I found her pulfe raifed, 
 and her ftrength recruited, though (he was 
 ftill weak, and her pains feldom recurred. 
 Thus fhe continued all night, (leeping be- 
 tween the pains j and when I called in the 
 morning, I found the child’s head advanc- 
 ed lower in the Pehis. I could then di- 
 ftinguifh, with my finger, the ear at the 
 Puh's ; and by the fore-part of it, I difco- 
 vered, that the forehead was to the left- 
 fide of the brim of the Pehis, and the 
 Gcciput down at the lower part of the right 
 Ifchium. I likevvife perceived that the head 
 was not large, becaufe I could eafily intro- 
 duce my finger all round the lower part 
 of it: and I felt the Lambdoidal Suture 
 croffing the end of the Sagittal on the 
 right, and the Fontarnelk higher up on the 
 left fide. 
 
410 CASES IN MIDWIFERY. 
 
 I left her again, after having defired the 
 pupil to proceed in the fame cautious man- 
 ner, hoping, that as the patient was much 
 recruited, the pains would grow ftronger, 
 and deliver the child. 
 
 Being called in the evening, and under- 
 ftanding that the pains were Rill weak, 
 and the goffips uneafy, I examined in 
 time of a pain, and found the head was 
 lower, with the left ear turned to the left 
 groin of the mother, the Vertex pufhed 
 out the Perinceiim and parts adjacent, in 
 form of a tumor, and nothing retarded 
 delivery, but the weaknefs of the pains. 
 
 I waited an hour longer, encouraging 
 the woman and her friends to exert their 
 patience ; but finding that, after die had 
 undergone feveral pains, the head did not 
 advance, and that I could eafily affift the 
 labour, I placed her in the pofition chofen 
 for lithotomy, gently dilated the Os Exter- 
 num with my fingers during every pain, 
 when one was going off, flipped up the 
 fingers of my right hand to the Os Uteri, 
 on the left fide of the Vagina, introduced 
 one blade of the forceps betv>/een them and 
 the head, turned the blade up towards the 
 woman’s groin, over the child’s ear, hold- 
 6 ing 
 
CASES IN MIDV/IFERY. 41 1 
 
 ing it in an imaginary line with the Scro- 
 biculus Cordis : then withdrawing my right 
 hand, with which I took hold of the han- 
 dle, I introduced the lingers of my left, 
 on the oppofite hde, but more backv/ards, 
 to the fpace betwixt the Sacrum and Ifchi- 
 um, where the other ear was litiiated, with- 
 in the Oj Uteri, and prelling the head 
 againil the blade that was introduced, fo 
 as to keep it in its place, I with my right 
 hand infmuated the other, blade in the 
 fame manner on the right fide of the Va- 
 gina. Having fecured and locked them 
 together, I waited for a pain, and then 
 pulled gently, by which means the head 
 advanced llowly and gradually. This ope- 
 ration I repeated during every pain, the 
 Os Extcrrcum was gradually dilated, the 
 child’s forehead turned into tlie lower and 
 back-part of the Pchis, and the Vertex 
 came out below the Os Pubis. By this 
 time the tumor occahoned by the dihenlion 
 of the external parts, was become much 
 larger, tlic Pcrimciim was extended near 
 three indies, the fundament frretched to 
 two, and the parts between this and the 
 Cocegx much enlarged. The Occiput com- 
 ing out from below tire Os Pubis', fo as 
 
 that 
 
4-12 CASES IN MIDWIFERY. 
 
 that I could with my finger feel the back 
 part of the child’s neck, I flood up, turn- 
 ed up the handles of the forceps, and 
 gently moved from blade to blade, while 
 at the fame time I preiTed the flat part of 
 my hand upon the Periiusumy to prevent 
 its being lacerated. Thus I continued 
 pulling upwards, by intervals, until the 
 head was fafely delivered then taking off 
 the forceps, the body was eafily extracted. 
 
 While I was employed in tying the Fu- 
 niSy fome of the pupils obferved, thro’ the 
 thin covering, that the woman’s Abdomen 
 was fliil very big, and on examining in 
 the Vaghiay I felt the membranes and wa- 
 ters of another child, vvhich I brought by 
 the feet, after the patient had taken fome 
 wine and water, and recovered of the fa- 
 tigue of the firfl delivery. 
 
 I ufed the forceps in this cafe, as a pair 
 of artificial hands to affifl the delivery, be- 
 caufe the pains were too weak to expel the 
 child. 
 
 CASE II. 
 
 In that fame year, I and miy pupils at- 
 tended another woman, in labour of her 
 hril child, who was reduced to a very 
 
 weak 
 
CASES IN MIDWIFERY. 413 
 
 weak and low condition, by a tertian ague 
 and extreme poverty. I was obliged to 
 affiilwith the forceps, in the fame manner 
 as in the foregoing cafe, but the head was 
 not fo foon delivered, becaufe the parts 
 were more rigid. One of my female pu- 
 pils firll: obferved, that the Abdomen was 
 very large after delivery, and I found there 
 was a fecond child, which was likewife 
 brought by the feet. 
 
 CASE III. 
 
 In the year 1749. I was called to a wo- 
 man who was taken in labour of her firfl 
 child, and reduced to a very low Rate by 
 violent floodings, with which fhe was 
 feized in the beginning of labour. Ac- 
 cording to the midwife’s report, I found the 
 mouth of the womb open and backwards, 
 and the waters were not yet difcharged. 
 As the patient loft blood very faft, I in- 
 troduced a Anger into the Os Internum^ and 
 brought it forwards towards the Pubis^ and 
 this irritation produced a pain which pufli- 
 ed dov/n the waters and membranes : thefe 
 I tried to break, but not fucceeding, I with 
 two fingers pulled forvrard the Os Uteri a 
 fecond time, and another pain enfuing, I 
 , , flipped 
 
4H CASES IN MIDWIFERY. 
 
 flipped the point of my fciffars between 
 them, and as the cliild’s head lay at a dif- 
 tance, ealily fnipt the membranes. The 
 waters were immediately difcharged in great 
 quantity, and as the head came lower and 
 locked up the parts, the flooding diminifli- 
 ed, and in a little time intirely ceafed. I 
 then diredfed the woman to take a little 
 broth frequently, and fome wine and wa- 
 ter, or cawdle, until the broth could be 
 made, and defired the attendants to give 
 her two fpoonfuls of the following mix- 
 ture every now and then, as a cordial. 
 
 R Cinamom. Simp. §v. Thebaic. gut. x. 
 
 Syr. e Meconio 5ij. M. 
 
 Her pulfe being very low, the pains 
 ceafed for a confiderable time, but by 
 degrees flie recovered from the extreme 
 . languor occafioned by lofs of blood ; and 
 as the difcharge was flopped, I exhorted 
 the women to wait patiently for the efforts 
 of nature, and ordered the midvvfife to 
 keep her quiet, and continue to adminifler 
 the broth by little and little, as her flo- 
 mach could bear it, until the lofs of blood 
 fhould in fome meafure be fupplied. At 
 the fame time, as (he was inclined to doze, 
 I defired that flie might have no more of 
 
CASES IN MIDWIFERY. 415 
 
 the cordial. Thefe dire6Hons I left in the 
 evening, and I v^as called again at fix next 
 morning, when the midwife told me the 
 pains had returned foon after I left the pa- 
 tient, but were fo weak, that although 
 the child’s head was come low down, it 
 could not be delivered without affiflance. 
 Upon examination, I found the Vertex at 
 the Os Externum^ and the back-part of the 
 neck at the Pubis-, and the patient, though 
 much recruited, being ftill weak and the 
 pains languid, I diredled the midwife to 
 proceed in fupporting her with the broth, 
 and preferibed a cordial mixture, without 
 any opiate, to amufe the woman and her 
 friends. 
 
 I received another call at twelve, when 
 I found things in the fame condition 5 the 
 pains being fo feeble, that although the 
 Vertex was at the Os Exzernum, they had 
 not force fufficient to propel it : I there- 
 fore began to dilate the Os Externu?n gra- 
 dually during every pain, and moving her 
 breech to the fide of the bed, though in 
 consideration of her weaknefs, I let her lie 
 on her left fide, I introfiuced the blades of 
 the forceps, one after another, at each fide, 
 between the Sacrum and Ifchiimi, moving 
 
 them 
 
4i6 cases in Mlt)WIFERY. 
 
 tliem forwards over the ears of the child j 
 and although I could not reach the Os 
 Uteri with my fingers, yet they paffed w^ith- 
 out much difficulty. When they were 
 exactly oppofite to each other, and in a 
 line with the Scrobiculus Cordis^ I managed 
 them as in the two former cafes, and deli- 
 vered the head flowly. 
 
 CASE IV. 
 
 On the third day of Jtdy 1750; I re- 
 ceived a melTage from a midwife' defiring 
 me to preferibe fome medicines to quicken 
 the labour-pains in a woman whom fhe 
 attended. As I was then engaged, and 
 would not preferibe without being more 
 fully informed of the patient’s condition^ 
 I fent one of my elder pupils to receive a 
 more perfebl account from the midvAfe 
 herfelf ; who told him, that the poor wo- 
 man had been three days in labour, but 
 would not allow him to examine, though 
 fhe earneftly requefted my affiflance. 
 
 As foon as I was difengaged, I accom- 
 panied him to the place, where I found this 
 loquacious midwife extremely ignorant, 
 without the lead; tindlure of knowledge in 
 her profeffion. When called to the patient, 
 
 whofo 
 
CASES IN MIDWIFERY. 417 
 
 whofe pains were juft beginning in this 
 her iirft labour, (he had walked her about 
 and fatigued her fo much, that fire was 
 quite exhaufted, and the pains had intire- 
 ly ceafed. She faid flie had done all that* 
 lay in her power to make room for the 
 child, and that her fingers were fwelled 
 and painful with ftretching the birth ; but 
 fhe could not inform me how long the 
 waters had been difcharged. Finding, up- 
 on examination, the head at the lower 
 part of the Pdvis, and the hairy fcalp of 
 the child, as well as the Os Externum o'f 
 the mother, very much fwelled, I ordered 
 her to be put to bed, prefcribed an ano- 
 dyne mixture of Aq, Fo?itan. PmEl. 
 Thebaic, gut. xx. fweetned with fugar, di- 
 recfed her to take two fpoonfuls every half 
 hour, in order to procure fieep, and ap- 
 plied to the Os Externum a large poultice 
 of loaf-bread and milk, with hogs-lard. 
 Thefe fteps were taken in the evening, and 
 I was again called at three o’clock in the 
 morning, when I went, attended by my 
 pupils, who were permitted to be prefent. 
 The woman had enjoyed tolerable reft, and 
 the poultice being removed and the parts 
 Tvafhed, we perceived the fwelling was 
 E e . much 
 
41 8 CASES IN MIDWIFERY. 
 
 much abated; fo that we waited feverai 
 hour-s in expedlation that the pams would 
 increafe, fo as to dilate the Os Externum 
 (lowly, and effe6l the delivery. In this 
 hope, however, w'e were dilappointed : 
 then I refolved to afTiil: with the forceps, 
 as. the head was fo low down; though it 
 was fo fwelled, that I could not diftinguifli 
 its pofition : for I could feel neither fu- 
 ture, eai’ or back-part of the neck. Ne- 
 verthelefs, I concluded, that as it was lb 
 low down, the ears would be to the (ides 
 of the Pelvis, efpecially as the foft parts 
 below w^ere protruded by the head, yet not 
 lb much as to allow me to reach to the fore- 
 head, if backward, by introducing a fin- 
 ger in the ReBum. However, I thought 
 it highly probable, that the forehead was 
 backward towards the rather than 
 
 ibrw^ard to the Piihis, and in this perfua- 
 fion, 1 diredted the woman to be laid on 
 her back acrofs the bed, with her breech 
 a little over the fide, her head being fup- 
 poi ted by the bolfter and pillows, and two 
 aihfiants holding afunder and fupporting 
 her legs. Then I introduced a blade of 
 the forceps, on each fide of the head, and 
 gradually alfifting as in the foregoing cafes, 
 
 delivered 
 
CASES IN MIDWIFERY. 419 
 
 delivered the woman without lacerating her 
 parts, or even marking the child’s head. 
 
 C A S E V. 
 
 Communicated in a letter by Mr» Pudtk-‘ 
 comb ^ 2it Lyn Regis y 1743. 
 
 He was called to a woman who had 
 been two days and nights in labour, and 
 very much fatigued. The pains had left 
 her, and though the head prefented at the 
 upper part of the Pehisy he delivered her 
 fafely of a live child, whofe head retained 
 no impreflion or mark of the forceps. 
 
 C A S E VI. 
 
 Communicated in a letter from Mr. Jor- 
 dariy dated Folkjloney 1751. 
 
 - The woman had been for a conliderable 
 time in ftrong labour, fo that her face was 
 exceffively fwelled, - her eyes ready to il-art 
 from her hean, and fhe was hardly aoie 
 to {peak. The Labia were very mucn tu- 
 mified, the Vertex preiented, the head was 
 low im the Pelvis and lay diagonal, the 
 forehead being to the fide of the Sacrum^ 
 and the Ovciput at the mother’s groin on 
 the oppofite fide, in which fituation it had 
 continued for the fpace of five hours, r- 
 E e 2 After 
 
420 CASES IN MIDWIFERY. 
 
 After having placed her in a fupine pof- 
 ture, he introduced the forceps, and deli- 
 vered her of a dead child.. As fhe labour- 
 ed under a Dyfuria^ from the tumefaftion 
 of the parts, cataplafms were applied, and 
 in a few days carried off that complaint, 
 
 He likewife v/rote that he had in the 
 lame manner delivered a young woman of 
 a live child. 
 
 CASE VII. 
 
 Communicated by Mr. BrookeSy in a letter 
 North Waljhamy iyS9’ 
 
 The woman had been long in labour, 
 and the waters were difcharged. The 
 child’s head was low in the Pelvis, the 
 forehead being towards the left Ifchimn, 
 but fo fcrongly comprelled that he could 
 not raiie it. He was therefore obliged to 
 introduce the forceps diagonal- wife, fo that 
 one blade was at the fore-part- of the ear, 
 and the other at the back-part of the other 
 ear. After having turned the forehead, 
 backwards, into the hollow of the Sacrum, 
 he delivered the woman ; and the midwife, 
 and all prefent, were agreeably furprized 
 when they heard the child cry, as they 
 
 took 
 
CASES IN MIDWIFERY. 421 
 
 took it for granted its life could not be 
 faved. 
 
 Mr. Brookes fays he did not ufe this me* 
 thod until after he had waited two hours, 
 to fee if, by dilating the parts, the child, 
 which was the woman’s firft, could not be 
 delivered by the labour-pains. 
 
 N U M B. II. C A S E I. 
 
 From anxiety of mind. 
 
 In Nov. 1745. being called to a patient, 
 the midwife told me that the labour had 
 gone on as well as fhe could delire, until 
 an officious woman came in, and in her 
 hearing, faid, there was a fire in the neigh* 
 bourhood. She was fo much alarmed and 
 affected at this report, that Ihe was imme- 
 diately feized with faintings and ffiiverings, 
 and her pains in a manner ceafed. 
 
 Upon examination, I found the head 
 low in the Pelvis, the back-part of the 
 neck being at the upper part of the Pubis j 
 from whence I concluded, that the fore- 
 head was turned to the concavity of the 
 Sacrum, and that the ears were at the lides 
 of the Pelvis, all the back and lower part 
 of vffiich was hilcd up with the parietal 
 bones. 
 
 E e 3 
 
 The 
 
422 CASES IN MIDWIFERY. 
 
 The patient being of a weak and lax < 
 habit, her pulfe low and her fpirits de- 
 prefl'ed, I prefcribed the following julap. 
 
 R Aq^. Cinatnom. fmp. Qnamom. fpirit. ^15. 
 
 TinEl. Cajicr.. Sp. C.C. a gut. xx?c. ConfeSt*^- 
 Cardiac, Syr. CrocL §1^. M. 
 
 Of this fhe took two fpoonfuls frequent- 
 ly, by which her ftrength was a little re- 
 cruited, but her pains continued weak and 
 feidom recurred, and I plainly perceived, 
 that the labour was retarded by nothing 
 blit the want of Ifronger efforts j for I 
 knew the child wasTmall, becaufe I pafled 
 my fingers all round the head, which was 
 not retraced after a pain,- 
 
 I had placed her in a pofition betwixt 
 fitting and lying at the bed’s foot, one 
 woman being behind to hold up her head 
 and IhouldciS, and two others on each 
 fide to lupport her legs, in hope that the 
 weight of ihe child might aflilf the deli- 
 very. But finding, that although the head 
 was fo low, it did not advance, and hav- 
 ing waited to no purpofe for the effe6f of 
 a great many fucce|Tive pains, which I 
 encouraged and endeavoured to increafe 
 by hrciching every now and then the Dj 
 'Externum with one or two fingers, I thought 
 
CASES. Yn midwifery: 4^3 
 
 it.wbuld be the fafeft method, both for the 
 mother and child, to affift as in the former 
 cafes of this colledlion.. 
 
 Although a fupine pofition would have 
 better favoured the introdudlion of the 
 forceps, yet, as the patient was weak 
 and the weather cold, I kept her on 
 - her left fide, her breech being moved 
 to the bed-fide, and her knees up towards 
 the Abdomeuy witli a pillow between to keep 
 them afunder. 
 
 Then iniinuating two fingers of my right 
 hand between the Sacrum and left Ifchiumy 
 to the infide of the Os Uteri y I with the 
 other, introduced one of . the blades, turn- 
 ing it forwards to the left ear of the child. 
 Now withdrawing my right-hand, with 
 which I held this blade, until I pufhed up 
 the fingers of the left-hand at the other 
 fide, between the Sacrum and right JJchiumy 
 to the Os Internuiriy I introduced the other 
 blade, moving it forwards oyer the right 
 ear, and taking care, as I went up, to turn 
 the handles of the forceps more and more 
 backwards. Finding the blades exactly 
 oppofite to each other, I locked them, and 
 began to pull gently from blade to blade 
 during every pain, As the head advanced 
 E e 4 and 
 
424 CASES IN MIDWIFERY, 
 and dilated the Os Externum^ I, with my 
 right hand, turned the handles of the for- 
 ceps more and more towards the Os Pubis^ 
 at the fame time prehmg the palm of my 
 left-hand upon the Perinceuniy which was 
 now pretty much diftended. In a few 
 pains the head was delivered, by moving 
 the handies with an half-round turn to- 
 wards the Abdomen and between the thighs, 
 while, with the other hand, I flipped back 
 the Perinceum over the forehead and face 
 of the child. Then taking off the forceps, 
 the body was delivered, and the Placenta 
 coming down, was foon extracted. 
 
 CASE II. 
 
 In the year- 1746. my attendance was 
 befpoke to a woman who loff her hufband 
 during her pregnancy : fhe was naturally 
 of. a weak and delicate habit of body, but 
 her weaknefs was fo much increafed by the 
 grief produced from this misfortune, that 
 Ihe looked like one ftarved by want of 
 deep, appetite and digeftion. When la- 
 bour came on, I was afraid fhe would have 
 funk under it ; for flie fainted feveral 
 times, and threw up every liquid or cor- 
 dial that was given to fupport her, 
 
 i 
 
 j 
 
CASES IN MIDWIFERY. 425 
 
 I kept her conftantly in bed, and as it ^ 
 was her firft child, the Os Uteri was very 
 flowiy opened by the waters and mem- 
 branes, which luckily did not break, un- 
 til this part and the Vagina were fully di- 
 lated ; and as for the Os Externum, 
 
 I feared would not fa eafily yield, it was 
 lubricated with pomatum, and I every 
 now and then gradually ftretched it with 
 niy fingers, during a pain. When the 
 membranes broke, a large quantity of wa- 
 ters were difcharged, the child’s head be- 
 ing Imall, foon came down to the Os Ex^ 
 ternum, the pains intirely ceafed, fhe CQuld 
 now keep fome broth on, her flomach, lay 
 a long time quiet and eafy, and enjoyed 
 fome deep, by which fhe was very much 
 refrefhed. 
 
 In about two hours after the waters 
 ceafed to flow, fhe was taken with fome 
 flight pains, by which the head was pro- 
 pelled in a flow manner, and pufhed the 
 external parts a little outward, though it 
 had not force fufficient to dilate the Oi 
 Externum for delivery. 
 
 After having waited in vain a confider- 
 able time, in hope that the pains would 
 at laft effedl this dilatation, and the pa- 
 tient’s 
 
426 CASES IN MIDWIFERY. 
 
 tient’s ftrength beginning to fail again, I 
 applied the forceps, and delivered her 
 pretty much in the manner defcribed in the 
 foregoing cafe. 
 
 CASE III. 
 
 In the courfe of that fame year, I was 
 called to a woman by fome of her neigh- 
 bours, who told me, it was not known 
 that fhe was with child until fhe was in 
 labour, when her mother had beaten, ab- 
 ufed and exafperated her to fuch a degree, 
 that fhe had become frantic, and, in her 
 turn, threfhed the mother, midwife and 
 all prefent, who had at length locked her 
 in a room by herfelf : they therefore, beg- 
 ed I would vilit her and bring my pupils 
 along with me. 
 
 We found her lying in bed, fo fullen, 
 tliat fhe would not fpeak vv^hen the wo- 
 men told her, they had brought feveral' 
 doftors to keep her in order. I examined 
 as fhe lay. and feeling the child’s head low 
 in the Pelvis, waited a long - time for a 
 pain, but to no purpofe, fhe feemed to be 
 afraid and lay very quiet. Her breech be- 
 ing moved towards the bedlide, fome of 
 the gentlemen kept her in that pofition, 
 
 until 
 
CASES 'IN MIDWIFERY. 427,:. 
 
 imtil I introduced . the . blades r pf the for- - 
 ceps, as in the two laft cafes, ^ with this 
 difference,, the forehead was backwards, 
 though towards the right fide, that is to 
 the membranous part that fills up the 
 empty fpace between Vs\^ Sacrum and If- 
 chium. . ... . ■ 
 
 She lay quite calm and refigned, while 
 I introduced and placed the blades oppo- 
 fite to each other, and locked the handles 
 firmly with a fillet, to prevent their flip- 
 ing off the head, in cafe fhe fliould prove 
 rcffadtory ; then, ihe having no pains, I 
 pulled the head lower and lower, until the 
 Perhimm and fundament began to diftend, 
 when I turned the forehead more back- 
 wards into the concavity of the Sacrum 
 and Coccyx. I afterwards pulled at inter- 
 vals, and, as the head advanced and Os 
 Externum ftretched, I turned the handle of 
 the forceps more and more towards the 
 Puhis^ and, delivered the head and body of 
 the child as in the two former cafes. 
 
 . I have often been called, with my pupils, 
 to the affiffance of poor women, who 
 were reduced to a fick and weakly condi- 
 tion by poverty, and the want of the ne- 
 ceffaries of life, as well a§ by being fa- 
 tigued 
 
428 CASES IN MIDWIFERY, 
 
 tigued by midwives, who, to ufe the com- 
 mon phrafe, had put them too foon upon 
 labour. Many of thefe women have, by 
 means of reft and nourilliing things, reco- 
 vered ftrength, and been delivered by the 
 labour-pains ; though fometimes, when the 
 child’s head was lov/ down, and the pains 
 fo weak as to prove ineffedtual, I have, 
 as in the above cafes, ufed the forceps, 
 without doing any violence to mother oj: 
 child. 
 
 CASE IV. 
 
 Communicated by Mr. yiyre, in a letter 
 dated Bojion in Lmcolnjhire, 1748. 
 
 While he attended my ledtures in the 
 year 1 746, he was called to a woman, who, 
 the day before, had complained of an head- 
 ach, to which ftie had been fometimes fub- 
 }e6f ; early in the morning flie was feized 
 with convulfions, and lay infenfible between 
 the fits. 
 
 He found the Os Uteri open to the 
 Ijreadth of a crown, and very thin j under- 
 ftood the membranes were broke j and the 
 convulfions adled as labour-pains. A fmall 
 flooding beginning, he tried to aflift by 
 ftretching the parts, which yielded with 
 
 fome 
 
CASES IN MIDWIFERY. 429 
 
 fpine difficulty, and the head being advanc- 
 ed, he delivered the child with the forceps, 
 which had made a fmall impreffion, tho* 
 without excoriation. 
 
 The woman continued infenfible for 
 three days, but had no fits after delivery, 
 except a few that were flight in the even- 
 ing, and fhe at length recovered. The 
 child too, which was weak at firft, did 
 well. 
 
 CASE V. 
 
 A robuft young woman, in the ninth 
 month of her pregnancy, was, without any 
 apparent caufe, fuddenly feized with vio- 
 lent convulfions, about fix o’clock in the 
 morning, after having complained all night 
 of an head-ach and ficknefs at her ftomacli 
 with vomiting, which however ceafed 
 when fhe was taken with the convulfions. 
 About ten o’clock, I found her violently 
 convulfed, and the Os T^incce a little open- 
 ed: as fhe had a florid complexion and 
 full pulfe, twelve ounces of blood were 
 immediately taken from her arm, a Simu- 
 lating glyfter was injedted, and a cephalic 
 julap prefcribed ; but, notwithSanding • 
 tliefe remedies, fhe continued convulfed 
 
 and 
 
43 P QASfi'^; in..,MIDWIFERY* 
 
 and quite infenfible. Being called again 
 by the midwife at eight o’clock, I found 
 her extremely low, her pulfe being fcarce 
 perceptible 4 _ and,, upon examination, I 
 perceived ...the . child’s - head was, by the 
 violence of the convullions,. forced low down 
 into the cavity of the Belvis^ with the ear 
 towards the Os JBubtSy and the forehead 
 turned to the Os Hiumy bn the left-hde. 
 
 The forceps” being introduced, in the 
 manner defcribed above, the woman was 
 readily delivered, and the Placentay which 
 firmly adhered to ihs, FundusVteriy VJZ.S 
 terwards brought away. She feemed eafier 
 after delivery, but her pulfe was fo low 
 that it could not be felt, and fhe expired 
 in about half an hour. 
 
 • From all thefe circumftances, it plainly 
 appears, that if the woman had been fooner 
 delivered, fhe might have recovered as well 
 as the perfon mentioned in the former cafe. 
 
 COL- 
 
CASES IN ’MIDWIFERY. 431 
 
 COLLECTION XXVI. 
 
 Of difficult cafes from the rigidity of the 
 parts, circumvolutions of the Funis, 
 and contraftions of the Uterus, in 
 which the forceps were ufed. 
 
 NUMB. I. CASE I. 
 
 From Rigidity. 
 
 V 
 
 In May 1742. I was called to a young 
 unfortunate creature, about the age of fif- 
 teen, who was in labour. The membranes 
 were broke before I arrived, and the Os 
 XJteriy which was open to the breadth of 
 half a crown, was very thin, but felt rigid 
 in time of a pain. 
 
 Labour proceeded very flowly all night, 
 and when I returned in the morning, I 
 found the child’s head low in the Fehis^ 
 and the Vertex protruding the parts belowi 
 in form of a large tumor j but the Os Ex- 
 ternum was fo ffraight and rigid, that I 
 could fcarce introduce two fingers, and the 
 pains were fo flrong that I was afraid of 
 a laceration. In order to prevent this, I 
 with the palm of my hand applied againfl 
 the Perinezum, reflrained the force of the 
 3 head, 
 
432 CASES IN. MIDWIFERY* 
 
 head, and when the pain v/ent ofF, dilated 
 the Oj Externum by little and little* How^ 
 ever, two hours elapfed before it was fo 
 opened, as to admit all my fingersj which 
 were fo tired and cramped, that two of the 
 pupils were obliged in their turns to affift 
 in tlie fame manner, and in about two 
 hours more, it was fo largely dilated, as 
 to receive about one third part of the child’s 
 head, that pufhed out in a conical figure. 
 
 By this time the poor creature was very 
 much fatigued, and the pains were become 
 fo languid, that there was no longer occa-^ 
 lion to prefs tire hand againfl the external 
 part ; and, though we continued to en- 
 courage her, and fupport her witli caw'’* 
 die and broth, that the parts might have 
 time to dilate, hie and they grew gradu- 
 ally weaker and weaker, and I began to 
 be afraid, that if affiftance fhoUld be lon- 
 ger delayed, fhe might be in danger of her 
 life ; for fhe was every now and then at- 
 tacked with fainting hts. When her pains 
 began to grovv languid, I had placed her 
 in a pofture betwixt fitting and lying, with 
 her breech to the bed’s foot, fo that with- 
 out altering her pofition, I applied the 
 forceps, and with great difficulty delivered 
 
 her 
 
CAsES IN MIDWIFERY. 433 
 
 hdr of a child, whofe head being large, 
 was fqueezed to a great length, but in a 
 few days retrieved its round form. 
 
 The parts of the mother were fo much 
 Inflamed, that for fevcral days fhe labour- 
 ed under much pain and difficulty of urines 
 
 CASE II. 
 
 In the following year, my attendance 
 was befpoke to a woman in her firfl; preg- 
 nancy, turned of forty, and of a thin, 
 though healthy conftitution. The pains 
 proceeded flowly as in the former cafe, fo 
 that three days elapfed in a kind of linger- 
 ing way, before the rupture of the mem- 
 branes, which were puihed down in form 
 of a long gut. The waters being difcharg- 
 ed, the child’s head, which v/as fmall, ad- 
 vanced downwards, pufhing before it the 
 Os Uterij which was not enough dilated to 
 allow it to pafs j this I kept up during 
 every pain, ftretching it with my fingers, 
 until I flipped it all round over the head. 
 As the Os Externum^ in the former cafe, had 
 given me fo much trouble, I now began in 
 time to dilate it during every pain, and 
 fucceeded fo well, that I was in hope the 
 head would not be long retained after its 
 F f arrival 
 
434 CASES IN MIDWIFERY. 
 
 arrival at that part. I found this precau- 
 tion was right ; for, the woman had been 
 fo much and fo long fatigued before the 
 Os Uteri and Vagina were fufficiently dif- 
 tended, that when the head came down 
 and puflied out the external parts, her 
 Ifrength and patience were alraoft quite 
 exhaufted : neverthelefs, by amufmg and 
 encouraging her, fhe exerted her courage 
 and fortitude for two hours longer, though 
 to very little purpofe ^ and at laft, perceiv- 
 ing the pains were too weak to force down 
 the head, and dilate the parts fo as to let 
 it pafs, though about one fourth part of it 
 was already protruded through the Os Ex- 
 ternum j obferving thefc circumflances, I 
 fay, I tried to introduce the whalebone fil- 
 let, defcribed in my treatife, and all edged 
 to be an excellent contrivance for helping 
 along the head in fuch cafes 5 this I en- 
 deavoured to infmuate betwixt the child’s 
 head .and Sacrum of the mother, but, as 
 it could not be properly fixed over the 
 chin, I withdrew it, and applying the for- 
 ceps along the ears at the lides of tha 
 Pehis, affifled the delivery as in the for- 
 mer cafe. 
 
 The 
 
CASES IN Midwifery. 43 j 
 
 The child was large, and the head be- 
 ing comprelTed into a lengthened form, pro- 
 duced convulfions, of which, however, it 
 recovered, in confequence of my allowing 
 the Funis to bleed a little. 
 
 NUMB. IT. CASE I. 
 
 From circumvolutions of the Funis, or 
 contraflions of the UxERUSi 
 In Muj 1748. one of the poor women 
 attended by my pupils, was taken in labour, 
 which went on in the common way. The 
 membranes and waters pufliing down open- 
 ed the Os Externum^ and when they broke, 
 the head came down to the middle of the 
 Pelvis • but when' propelled a little farther 
 by two or three fuccefiive pains, it return- 
 ed to the fame place, and continued to 
 advance and retreat in this manner for the 
 fpace of feveral hours j fo that the woman, 
 was much fatigued, and the pains became 
 weaker and lefs frequent. As this diffi- 
 culty neither proceeded from the large lize 
 of the head, nor the narrownefs of the 
 Pelvis^ I concluded it muff be owing to 
 the Funis rather than to the contradlion of 
 the Uterus before the Ihoulders, becaufe this 
 retraffion of the head happened imme- 
 F f 2 diateiy 
 
436 CASES IN MIDWIFERY. 
 
 diately after the rupture of the membranes, 
 and before all the waters were evacuated : 
 and, I was certain, that it could not he 
 occafioned by the expanfion which hap- 
 pens in the Abdomen of a dead child, be- 
 caufe I plainly feltit alive by the motion 
 of its head. 
 
 Thus convinced, I diredfed the patient 
 to be placed in a pofture between fitting 
 and lying, which, I imagined, might af- 
 fift the delivery j when the head was forc- 
 ed down in time of a pain, I introduced 
 a finger into the ReBum^ and tried to keep 
 down the head, but could not reach fo 
 high up as the forehead, which was to the 
 right fide of the Sacrum. I then, during^ 
 every pain, gradually opened the Os Ex- 
 ternum, which eafily yielded, the woman 
 having had children before, and introduc- 
 ing a blade of the forceps along each ear, 
 that is, one at the left-fide of the Sacrum, 
 and the other at the right groin, I locked 
 them together, fo that when the pain re- 
 curred, I could keep the head down, and 
 prevent its being retra<fl;ed : in the time of 
 the next pain I brought it lower, and turn-, 
 ed the forehead into tlie hollow of the 
 Sacrum and, in two pains more, it was 
 
 advanced 
 
CASES IN midwifery! 437 
 
 advanced to the lower part of the Coccyx ; 
 when it was in this fituation, I introduced- 
 two fingers into the Re5fum to keep if 
 down j but it being fiill too high up, I, 
 during the next pain, brought it lower, 
 when, finding I could command the head, 
 by prefiing my fingers againfl: the Sinciput 
 at the root of the nofe, I took off the for- 
 ceps with my other hand, and helped the 
 head along in the manner defcribed in the 
 lingering cafes. 
 
 T)iQ,Fums being thirty inches in length, 
 was twice circumvoluted round the neck, 
 and once round tfie arm. 
 
 C A S E II. 
 
 In the month of September of the fame 
 year, I attended a private patient who had 
 been very much weakened by flooding from 
 time to time. The membranes broke, and 
 the labour proceeded tolerably well j but 
 when tlie head came low down, it was 
 drawn back after every pain, as in the for- 
 mer cafe. 
 
 Having fixed the forceps, I brought the 
 forehead down below the Coccyx j but, as 
 her pains were weak, and this was her 
 firfl: child, I kept on the inftrument until 
 
 . . F f 3 one 
 
43 S CASES IN MIDWIFERY, 
 
 one third of the head was without the Os 
 ^xtermim^ and I found I could eafily keep 
 down the head by preffing my fingers 
 againft the external parts on each fide of 
 the Coccyx. After having taken off the 
 forcepSj I during each fucceeding pain, 
 preffed the head upwards with that hand, 
 while with the fingers of the other, I fiip- 
 ed the Os Externum over the child’s head. 
 The Funis was uncommonly fhort, and 
 once round the neck, 
 
 CASE III, 
 
 In Augufi 1750^ I was, at three in the 
 morning, called to a woman in labour, 
 by a midwife, Vv^ho told me, the waters 
 had been difeharged two days, even before 
 the Os Uteri was much opened; that after 
 this difeharge the pains were lingering, and 
 fome part of the waters continued to drib- 
 ble until the evening before I was called, 
 when the head came lower down ; but now 
 it was after every pain drawn back out of 
 reach, and the pains were now grown much 
 ftronger. 
 
 I took the proper opportunity of examin- 
 ing, and found the head propelled to the 
 middle of the Fehis by every pain, after 
 
 which 
 
CASES IN MIDWIFERr. 439 
 
 which it was drawn back to the ripper 
 pait. 
 
 After having feen her undergo feveral 
 ftrong pains, by which the head was not 
 at all advanced, I eafily introduced my 
 hand into the Vagina of the patient, who 
 had born feveral children, and, as the 
 pain abated, raifed the head fo high above 
 the brim of the Pelvis, that I could pafs 
 my right hand flattened along the left fide, 
 and over the forehead and face of the 
 child, where I found the lower part of the 
 Uterus flirongly contracted. I continued to 
 pufh farther up and dilate the part fo as 
 to be able to bring the child by the feet ; 
 but finding this expedient impracticable 
 from the force of the contraction, I with- 
 drew my hand in the beginning of a pain, 
 and the child’s head was immediately forced 
 down to the Os Externum, though it was 
 afterwards retraCted to the middle of the 
 Vagina. However, having fucceeded fo 
 far, I waited for the effect of feveral pains, 
 which I hoped would force the head lower 
 down, now that it had made fuch pro- 
 grefs j but, finding my expectation difap- 
 pointed, and knowing it would be an eafy 
 talk to affift the delivery, I had recourfe to 
 F f 4 tlie 
 
44P CASES IN MIDWIFERY. 
 
 the forceps. One ear of the child being 
 to the Pu6is, and the other to the Sacrum^ 
 and the woman lying on her left-fide, I 
 W'ould not alter her pofition, but brought 
 her breech to the bedfide, and moved her 
 head to the upper and back-part of it. 
 Then fitting in a low chair behind _the pa- 
 tient, the forceps being privately difpofed, 
 I eafily introduced the fingers of my right 
 hand to the Os Uteri, between the Pubis and 
 head of the child which was fmall and 
 infinuated one blade of the forceps, gently, 
 that I might not hurt the bladder ,; then I 
 introduced the other blade upon, my left- 
 hand, between the other fide of the child’s 
 head and the Sacrum, carefully turning 
 back the handle, in order to humour its 
 curve ; and being certain;, that the' inftru- 
 ment was well-fixed, pulled gently from 
 blade to blade, and kept the head from 
 being retradled as the pain abated. 
 
 I continued to affift in this manner, 
 during every pain, until the Qcciput was 
 brought to the lower part of the right 
 chium, then turning the forehead into the 
 concave part of the Sacrum, the Occiput 
 came out from below the Pubis, and the 
 head was flowly delivered. 
 
 CASE 
 
CASES^ IN MIDWIFERY. 441 
 ' CASE IV. 
 
 In 06 iober' following v/e had a public 
 cafe of this nature, at which my pupils 
 attended. The waters had been long dif- 
 charged before the head was forced into 
 the Pelvis, and we managed the labour in 
 the cautious manner defcribed above ; yet, 
 after I had dilated the parts and applied 
 the forceps, I could not by repeated trials 
 bring the head through the Os Externum. 
 Being affured from experience, that the 
 obftrudHon proceeded either from the con- 
 tra6i:ion of the Uterus, or the detenfion of 
 one Ihoulder above the Pubis, and not 
 from a tumefadtion of the Abdomen, be- 
 caufe I felt a pulfation, though very weak 
 at the Jpontanelle, I difengaged the inftru- 
 ment, and railing the head again, found 
 the difficulty was owing to the left Ihoul- 
 ders being ov^ 'the Pubis, 
 
 ..As the woman lay on her back, I intro- 
 duced my Tight hand, but could neither 
 force the fhoulders to the right fide of the 
 Pelvis, nor pufh the child farther up, fo 
 as to bring it by the feet, though the head 
 was not large. I then, withdrawing my 
 fight, introduced my left hand on the 
 
 other 
 
442 CASES IN MIDWIFERY, 
 other fide, and raifing the head, tried again 
 to pufh up at the anterior parts of the 
 child, fo as to reach the feet : but failed 
 once more, from the ftrong contraction of 
 the Uterus, However, getting hold of the 
 left arm, I brought it down, and as I with- 
 drew my hand, the head followed to the 
 Os Externum and lower-part of the Pelvis. 
 I turned the right arm to the right fide of 
 the Sacrum^ the pains being weak, again 
 fixed the forceps, which I moved in a pro- 
 per manner, and pulling gently at the 
 hand, delivered the head, which was fol- 
 low'ed by the body. 
 
 CASE V. 
 
 In ‘Jime 1751. I was called by a mid- 
 wife to a woman who had been many 
 hours in labour, and found, that after the 
 difcharge of the waters, the head was 
 forced low down by every pain, but after- 
 w^ards drawn up again. I was like wife in- 
 formed, that formerly flie ufed to have 
 large children and quick labours. 
 
 Encouraged by this intimation, I tried 
 to turn the child, but was prevented by the 
 flrong contraClioh of the Uterus ; but, in 
 making this trial, and raifing the head, I 
 j not 
 
CASES IN MIDWIFERY. 443 
 
 not only found the Ftmis furrounding the 
 neck, but likewife the Uterus contracfed 
 before the fhoulders. This laft, I dilated 
 with my fingers as much as poffible, then 
 withdrawing my hand, applied the forceps 
 and delivered the child, which had been 
 dead for fome days. The Funis was three 
 times round the neck, being much tumi- 
 fied and of a livid colour. 
 
 /:■ 
 
 COL. 
 
444 CASES IN MIDWIFERY. 
 
 C O L L E C T I O N XXVII. 
 
 Of laborious cafes occafioned by the large 
 fiZe of the child’s head, the narrownefs 
 or diftortion of the Pelvis, when the 
 head is low and delivered with the for- 
 ceps. 
 
 NUMB. I. CASE I. 
 
 f 
 
 From the large fize of the child. 
 
 In the year 1745. my attendance was 
 befpoke to a woman who had loft her firft 
 child, in confequence of its large fize. This 
 fecond labour went on in the ufual way, 
 until the Os Uteri was largely opened by 
 the waters and membranes, which break- 
 ing, the Vertex advanced too near the mid- 
 dle of the Pehis. Then the pains ceafed 
 for about two hours, during which the 
 patient lay eafy and enjoyed fome deep. 
 After this intermiffion, a pain began to re- 
 cur every now and then, and a good deal 
 of v<^ater being difcharged, they turned 
 ftrong and frequent : as for the. patient, 
 whole conftitution was weak, I kept her 
 moftly in bed. 
 
 The parietal bones began to ride each 
 other, the hairy fcalp became loofe and 
 
 wrinkled. 
 
CASES IN MIDWIFERY. 445 
 
 wrinkled, and the head was gradually and 
 flowly fqueezed down to the lower part of 
 the Pelvis, where it remained for a confi- 
 derable time. The Occiput was ftrongly 
 prefled againfl: the lower part of the right 
 IJchium, the Fontanelle being at the upper 
 part of the left 5 but the head was fqueezed 
 to fo great a length, and fo firmly com- 
 preifed againfl: the infide of the Pubis, that 
 I could not reach the ear with my finger. 
 
 After many flrong pains the patient’s 
 flrength and fpirits began to flag, and both 
 fhe and the friends became apprehenfive, 
 that this child alfo would be lofl, notwith- 
 flanding the encouragement I gave, by 
 telling them that I had delivered many wo- 
 men of live children, after they had been 
 much longer in -labour. 
 
 The force of the pains was by this time 
 abated, yet every now and then fhe was 
 taken with one flronger, that forced the 
 head a. little lower, fo that I could feel the 
 child’s left ear towards the left groin of the 
 mother. 
 
 At length- the patient being flill more 
 funk, and perceiying no further advance 
 toiwarfls delivery, I introduced the forceps 
 as ihe lay on her fide, and,, during every 
 ' ' pain. 
 
 7 
 
446 CASES IN MIDWIFERY. 
 
 pain, tried to bring the head lower, and 
 turn the forehead backwards to the Sacrwru 
 But, in this attempt, the inftrument began 
 to hip, fo that I was obliged to unlock 
 them, and move each blade upwards again 
 over the ears ; the handles being fixed and 
 tied with a garter, I turned the patient on 
 her back, and direfted an afliftant on each 
 fide to fupport the legs : matters being thus 
 difpofed, I waited for a pain, and gradu- 
 ally delivered her as in the former cafes* 
 The child, whofe head was fqueezed into 
 a lengthened form, feemed at firh: to be in 
 a convulfion, but foon recovered, in con- 
 fequence of my letting the Funis difcharge 
 about two or three fpoonfuls of blood. 
 
 CASE II. 
 
 In March 1746. I was called by a mid^ 
 wife to a cafe refcmbling the former, and 
 tried the whalebone fillet. (Vid. Tab* 
 XXXVIIL) which I could not get over 
 the chin ; £0 that finding the principal hold 
 was on the face, I withdrew it, and wait-* 
 ing fome time, until the patient and the 
 pains grew weaker, I applied the forceps^j 
 with which I delivered as in the other 
 cafes of this coliedlion. 
 
 My 
 
CASES IN MIDWIFERY. 447 
 
 My reafon for withdrawing the fillet, 
 was becaufe I durft not venture to exert 
 fo much force as was requifite for delivery, 
 left the part of which I laid hold, fhould 
 have been galled to the bone : for I knew 
 one inftance in which the fillet had been 
 nfed, and actually fcalped the child j and 
 another, in which the cliild’s under jaw 
 Jiad been cut to the bone bv the force of 
 pulling. 
 
 CASE III. 
 
 In the courfe of the fame year, being 
 called to a woman, who according to the 
 midwife’s report had been three days in 
 labour, I found the child’s head at the 
 lower part of the Fehis^ and a large tu- 
 mor on the Vertex., protruded without the 
 Os Externu??i. She had been in a flow 
 kind of labour all Saturday and part of 
 Sunday, when the membranes breaking, 
 the pains became ftrong, and continued 
 fo all Swiday night ^ by thefe the head had 
 been pufhed down, but did not advance 
 farther than the fituation in which I found 
 it, on Monday night. 
 
 The patient was much exhaufted by fa- 
 tigue and the length of the labour, and 
 
 her 
 
448 CASES IN midwifery. 
 
 her pains being languid, I prefcribed a 
 cordial mixture, with ConfeB. Cardiac 
 and flowly dilated the Os Externum during 
 every pain. By thefe efforts the pains 
 grew ftronger, and I expe6led the head 
 would foon be delivered. But being diff 
 appointed in my hope, I thought it was 
 pity the woman fhould be kept any longer 
 in fuch a difagreeable way, and as fhe lay 
 on her left fide, I endeavoured to raife the 
 head, fo as to know its pofition. I failed, 
 however, in my attempt, and there was 
 no room for introducing a finger or two 
 to feel either the neck or ear at the Pubis’, 
 though as the head was fo low down, I 
 thought it was probable, that the ears were 
 to the fides of the Pehis. I then diredfed 
 her to be turned on her back, and fupported 
 by affiffants, as the patient in the former 
 cafe j and fat down with a refolution to 
 deliver, either with the forceps or crotchet, 
 in order to fave the woman’s life ; though 
 I determined to try the forceps firft, that 
 the child alfo, if poffible, might be faved. 
 As the head, which was comprelfed into a 
 great length, filled up all the lower part 
 of the Pehis, fo that I could not intro- 
 duce my fingers to guide the blades of the 
 
 forceps. 
 
XiiSES ,iN MIDWIFERX. 449 
 
 fducdpB on the ;inhde of ’the OsHI^eri^ '^ 
 attempted to introduce them feverai times, 
 until I was certain that they were fafely 
 pad: this place, , and no.t on the outfide of 
 the Or Being convinced that I had 
 
 ib.far gained my points I began to bring 
 the head lower diiring every pain, and at 
 ladidelivered the woman of a dead child, 
 whofe head was fqueez.ed to a great length. 
 
 ' C ; A S E IV. 
 
 -In the year 1751. I attended a woman 
 in labour of her fird child. She had un- 
 dergone lingering pains all Sunday night, 
 and I was called next morning at feven. 
 -But the pains being inconfiderable, the 
 membranes unbroke, and the patient re- 
 -ferved, I was not allowed to examine un- 
 til t^s when the pains grew dronger. ■ In- 
 troducing my finger into the V-agina, I felt 
 the 'Reftum full of indurated Faces, the Os 
 ■Uteri foft, thin and pretty open, the wa- 
 ters pudiing down the membranes, and 
 when\the pain went off, the child’s head 
 reding againd the upper-part of the Pubis. 
 
 I immediately prefcribed a glyder, which 
 operated to fatisfadtion j and as die had 
 enjoyed fome deep in the forepart of the 
 Q g night. 
 
450 CASES IN MIDWIFERY. 
 
 night, I defired fhe might rife until the 
 bed could be prepared before labour fhould 
 be farther advanced. Every thing pro- 
 ceeded in an eafy and flow manner, and 
 fhe took her pains in an eafy chair, till 
 about twelve, when Ihe was pretty much 
 fatigued j I then diredied her to take fome 
 pains on the bed, and now felt the Os Uteri 
 largely opened, the membranes puflied 
 down large and full to the Os Externum j 
 but the head was not at all advanced. 
 Judging from this circumftance that it 
 was large, I would not allow her to be 
 put in naked bed too foon, becaufe, if af- 
 ter the rupture of the membranes, the 
 head fhould not come down without difii- 
 cuity, it might be neceflaiy to aflifl the 
 delivery by different pofitions : and, in the 
 mean time, as the pains were ftrong and 
 frequent, I directed them to get ready 
 cloths to receive the waters as fhe lay on 
 her fide, for I now expe61:ed that the mem- 
 branes would foon give way. Accordingly, 
 the waters were in a little time difcharg’d i but 
 perceiving that the pains foon after abated, 
 and the head did not advance, I allowed 
 her to rife and walk about, and fhe took 
 her pains fometimes in a ftanding and 
 4 fometimes 
 
CASES IN MI^)WIFEPvY, 451 
 
 fometimes in a fitting pcmtion : though, in 
 ordbr'to prevent her being fatigued, fho 
 every now and then refted on the bed half 
 fitting and half lying. By thefe meafis, 
 the pains encreafed, and at two next morn- 
 ing, the head was advanced to the Os Ex- 
 ternum and lower part of the Pehis : that 
 it might not be detained too long in this 
 fituation, I began to dilate the Os Exter- 
 num a little, during every pain, and thefe 
 efforts kept up the pains, which were be- 
 come languid, in confequence of the fa- 
 tigue fuftained by the patient. The head 
 was not at all advanced at four o’clock, 
 when I plainly felt the Occiput flrongly 
 preffed againft the lower part of the left 
 Ifchiumy the parietal bones riding one an- 
 other, the head, which , was large, fqueezed 
 to a great length, and one of the ears at the 
 Pubis. Perceiving the pains were not flrong 
 enough to pufh the head farther, fo as 
 that the Occiput might rife from the If- 
 chium to the fpace below the Pubis, and 
 the forehead turn back into the hollow of 
 the Os Sacrum j and knowing that I could 
 oafily aflift and alter the pofition with the 
 forceps, I thought it was pity that the 
 mother and child fliould run any farther 
 - g 2 rifque„ 
 
452 CASES IN MIDWIFERY. 
 
 rifque, and ordering her to be put in nak- 
 ed bed, I applied the inftrumeiit, and deli- 
 vered the child, as in Coll. XXVI.' No. JL 
 Cafe III. 
 
 C A S E V. 
 
 In December 1750. a woman had been 
 in labour of her fecond child, for many 
 hours after the Os Uteri was largely open- 
 ed, and the membranes had broke, and 
 the midwife had affured the friends, that the 
 head would be delivered by each fueceffive 
 pain. At length, however, the patient’s 
 llrength beginning to fail, they fent for 
 me at three in the morning, when I found 
 the child’s head low down, pufhing out 
 the parts, in form of a large tumor, and 
 the leal p very much tumified. ■ ' 
 
 After having tried m vain to adifl: the 
 birth, by gently dilating the Os Externum^ 
 during feveral pains, I directed *the patient 
 to be put in a fupine pofture, and as fhe 
 Was very weak, fat down with a refolution 
 to deliver, either with the forceps or crotch- 
 et; for I found it was impradlicable to 
 bring the child by the feet. The head was 
 fo large, and compreffed into fuch a 
 lengthened form, that I could not pufh 
 
 up 
 
CASES IN ; MID WIFERY. 4^1 
 
 tip my finger at the Pubisy to feel the ear 
 ^)r neck ; neither, could I difiiiiguifii the 
 fituation of the head by the futures, be- 
 caufe the fcalp was fo much fwelled : nor 
 could I move the head upwards, in order 
 to feel the upper parts, fuch as the ear, 
 neck or face. But iuppofing from the 
 touch of the lower part of the head, that 
 one part prefled more againfl: the left If- 
 chium than the right, I concluded that the 
 forehead was at the right fide of the Sa- 
 crum^ and the Occiput flopped between the 
 left Ifchium and groin. 
 
 In this perfuafion, I introduced one 
 blade between the child’s head and the mo-- 
 ther’s right groin, and the other at the left 
 fide of the Sacrum along the ears, then lock- 
 ing the handles, I tried to turn the forehead 
 more backwards, but could not, until I had 
 pulled the head a little lower, when I deli- 
 vered, as in Col. XXVI. No. II. Cafe I. ' 
 
 C A S E VI. 
 
 In the January following, my afliflance 
 was follicited in a cafe of pretty much the 
 fame nature. The woman was greatly 
 fatigued and exhaufled with labour, the 
 child’s head was comprelfed to a vaft 
 G g 3 length, . 
 
454 CASES IN MIDWIFERY. 
 
 length, and fo puffed, that I could not 
 dilHnguifh its true pofition ; nor could I 
 raife it fo as to examine higher up. Ne-» 
 verthelefs, as it was very low, I fuppofedl 
 that the ears were towards the fides of the 
 Pehisy and having laid her in a fupine 
 pofture, I introduced the forceps, infi- 
 Buating one blade on each fide, as ufual. 
 But the head ftuck fo faft that I could 
 not move it lower j then I attempted to 
 turn it to the right fide of the Sacrumy 
 imagining the forehead might be to the 
 left, as I had moftly found it j yet here 
 alfo failing in my endeavours, I turned 
 the other way, w^hen it yielded with great 
 cafe, and the Vertex coming out below the 
 Pubisy the head was brought along, and 
 delivered without further difficulty, 
 
 One blade of the forceps was fixed be- 
 fore the left ear, and over the temple of 
 that fide, and the other behind the right 
 ear and lower- jaw j the impreffion was 
 deeper than ufual, but not fuch as to do- 
 any injury to the child. 
 
 N. B. In the two former cafes, I firfl of 
 all tried to move the Occiput downwards, 
 and turn the forehead back to the Sacrum,y 
 7v'ith one blade of the forceps. 
 
 ' NUMB, 
 
CASES IN MIDWIFERY. 45^ 
 
 NUMB. II. CASE I. 
 
 From a fmall or diftorted Pelvis, when 
 the child’s head is low. 
 
 My attendance was befpoke to a woman 
 who had before loft a child, which was 
 fuppofed to have been too large to pafs 
 through the Pelvis j for Ihe was of a 
 fmall make and ftature. 
 
 In "January 1748-9. Ihe was taken in 
 labour when I happened to be engaged, 
 fo that I was obliged to fend a midwife to 
 attend her, and before I could fee her, 
 the membranes were broke, the Os Uteri 
 was largely open, and the head fqueezed 
 into the middle of the Pelvis^ in form of 
 a cone or fugar-loaf. 
 
 The midwife had kept her moftly in 
 bed to prevent her being fatigued, and I 
 advifed her to continue in the fame litua- 
 tion, until ftie complained of being weary 
 of that, polition, and of violent cramps in 
 her limbs. Then getting up, ftie walked 
 about the room, and took her pains fome- 
 times ftanding and fometimes fitting : tho’ 
 I delired fhe would not fatigue herfelf by 
 walking or ftanding too long, nor force 
 down, except when the pains were ftrong, 
 G g 4 In 
 
456 GASES in MIDWIFE^#. 
 
 In this cautious manner, fhe ,was .manage 
 ed all night, during which flie fefted at 
 intervals upon the bed, until fhe was com- 
 pelled to rife by tlie violence of the cramps 
 that feized her as fhe lay ; and, as I exar 
 mined every now and then, I found the 
 head advance by little and little, every 
 third or fourth pain, which was ffronger 
 than the reft. At fix in the morning, the 
 Vertex was prefled down to the lower, part 
 of the Pelvis, below the right Ifchium j 
 but at eight, it had made no further pro- 
 grefs, though it was fqueezed to a great 
 length, and the parietal bones rode one 
 another. By this time, the patient was 
 very much fatigued, her pains were be- 
 come W'eaker, and at fmall intervals fhe 
 was fubjedf to Teachings, which, however, 
 fupplied the defedf in the labour-pains, 
 by forcing the head fo low as to protrude 
 the Perinceum and adjacent parts, in form 
 pf a large tumor* I waited fome time, in 
 hope, that this extraordinary affiftance 
 would deliver the child : but the patient 
 being fdddenly feized with a fainting fit, I 
 thought it was high time to have recourfe 
 to a' more effedfual expedient, and the 
 child’s left ear being to her left gnoin, and 
 
 the 
 
CAS® 'iw Midwifery, 
 
 at'tiie left fide of the Sacrum^ 
 I TAoved Her breech fp the bedfide as file 
 Jay on her left fide, introduced the forceps 
 atong the ears, as in Collecl, XXY. No. IL 
 Cafe E' and in' that manner fafely delivered 
 the woman of a live child, which had 
 beCh retarded by the fmallnefs of the Pel-- 
 though it was not at all diftprted, 
 
 C A S E II. 
 
 t 
 
 In the year 1750, I Vv^as called by a mid^ 
 wife to a woman of a fmall ftature, about 
 ten in tfie morning, when I found the 
 Vertex at the lower part of the left Ifchi- 
 um^ and the head fqueezed into a longi- 
 tudinal form, as in the preceding cafe : as 
 for the waters, they had been draining off 
 for fome.time before I arrived, 
 
 The patient being pretty much exhauft- 
 ed, was put in bed j and, as fhe had been 
 feized with a loofeilefs at the beginning of 
 Jabour, and enjoyed no fleep the preced- 
 ing night, I prefcribed an anodyne mix- 
 ture of "Thebaic, gut. xv, & Syr. e 
 
 Meconio siij. in Aq. Simp. ^v|3. of which 
 fhe took two fpoonfuls immediately, to be 
 repeated occafionally until refl fliould be 
 procured. This prefcription had the de- 
 
458 CASES IN MIDWIFERY. 
 
 lired efFe6l ; and next morning about eight* 
 I was called, and informed, that although 
 the pains had been ftronger, the head was 
 very little advanced. I now felt the Ver- 
 tex had made fome progrefs j the Occiput 
 was turned below the Pubisy and the fore- 
 head to the Sacrum^ though not fo low, 
 as that I could affift with my fingers in 
 the ReSlum, or at the fides of the Os Coc- 
 cygis. The pains were likewife become 
 weaker, and the patient’s ftrength began 
 again to fail. The child’s ears being by 
 this time to the fides of the Pelvis, and 
 nothing wanted but pains to promote the 
 birth, I dire6led her to be placed in a fu- 
 'pine pofition on the bed, and with the 
 forceps delivered her of a dead child. 
 
 CASE III. 
 
 In the year 1749 . 1 was called by a mid- 
 wife to a woman who had been fickly 
 from her infancy, and very much diftorted. 
 The membranes had been broke and the 
 waters difcharged feveral days before fhe 
 was in labour, and the midwife, who had 
 attended her fince the preceding morning, 
 affured me fhe had been in ftrong labour 
 fpr four and twenty hours. I found the 
 
 Vertex 
 
CASES IN MIDWIFERY. 4^9 - 
 
 Vertex prefenting, the mouth of the womb 
 fully opened, and the head down to the 
 lower part of the Pelvis j but when I in- 
 troduced a finger betwixt it and the Pubis, 
 
 I could not reach fo high as to feel the 
 ear, nor could I diftinguilh by the futures 
 the right fituation of the head. Never- 
 thelefs, the patient being weak and low, 
 
 I direfted her to be laid aero fs the bed in 
 a fupine pofition, and introducing the for- 
 ceps at random, by the fides of the Pelvis, 
 tried by gentle efforts, during every pain, 
 to bring the head lower downj but find- 
 ing I could not move it without ufing fucli 
 violence as might be prejudicial to the mo- 
 ther and child, I withdrew the inftrument 
 and refolved to wait a little longer ; and, 
 as the patient had flept but very little for 
 two nights, and was much fatigued, I 
 preferibed an anodyne draught, by which 
 Ihe procured reft and was refrefhed. Then 
 the pains returning, and forcing down the 
 head, fo as to protrude the external parts, 
 
 I received another call, and found the back 
 part of the neck at the Pubis : from this 
 cjfcumftance, I knew the forehead was in 
 the hollow of the Sacrum, and that the 
 ears were to the fides of the Pelvis ; I, 
 
 there- 
 
400 CASES IN MIDWIFERY. 
 
 therefore, after liaving allowed her to take 
 g. few pains, Which were weak, confidfer- 
 ed, that as the head was fo low down, 
 the afliffance of the forceps might prove 
 effe6lual in helping it along ; fo having 
 placed her in the pofitioii defcribed above, 
 I introduced them along* the ears of the 
 child, and by pulling gently, during every 
 pain, delivered the head, which ’was fqueez- 
 ed to a great length : but the Os Exter^ 
 mlM was fo rigid, that half an hour elapf- 
 ed, before it could be dilated fo as to let 
 the head pafs, without laceration. 
 
 After delivery, I introduced a finger into 
 the Vagina^ and found the Pelvis fo di^- 
 ftorted, from the jetting forwards of the 
 upper part of the Sacrum^ that had the 
 ehild been large, its life could not poflibly 
 have been faved. The head was of a 
 lengthened form, and contorted to one 
 fide, and there was a deep impreflion above 
 the ear. The forceps- too, when firjft fixed, 
 had impreffed the forehead, though the 
 mark difappeared in five or fix days : but 
 they made a very inconfiderable impreflion, 
 when they were fixed the fecond time along 
 the ears, 
 
 CASE 
 
CASHES I ,IN 46 1 
 
 ; ' CASE 'jy^.7 ; " 
 
 .In the year 1744. a midwife called nje 
 to a woman, whom fhe had formerly t|s- 
 Ijt^ered of a dead child j .and. fhe faid, ,|he 
 had on that occafion felt an. uncommQU 
 l?limp backwards. 
 
 - When I. examined her, the membranes 
 were^ broke, and the-child’s head, was.fmik 
 down to the middle of UiQ ..Pelvis, where 
 it ;Was retarded by a jetting-in at the OJ.idr 
 die of the Sacrum \ for, inflead of feeling 
 it "concave, . I found a prominence, as , if 
 one of the bones in. the middle had .been 
 pufbed before ,the reft ^ and .the Vertex ef 
 the child feemed to be preffed down in a 
 flattened form, by the woman’s pains, which 
 were ftrong.and frequent. 
 
 - :I was -called about three, in the morn- 
 ing, and prefcribed fome innocent things 
 to amufe the. patient and her friends, who 
 were extremely anxious, and went away^ 
 after having defired that fhe might not 
 hurried about or fatigued. I received. an- 
 other fummons about nine, when I found 
 xhs. Vertex fqueezed down, to the lower part 
 of the Pelvis, the woman exhaufted, and 
 her pains abated. As . I at that. time ima- 
 gined. 
 
462 CASES IN iVUDWlEERVi 
 
 gined, with others, that in labours, tibe 
 forehead was moEly to the Sacrum^ and the 
 eats to the fides, I caufed the patient to be 
 laid acrofs the bed on her back, as in Col* 
 ledt. XXV. No. I. Cafe I. and applying 
 the forceps along the head, at the fides of 
 the Pehis, tried during every pain to help 
 it along, that this child might not be loft 
 as the former was. As the refiftance was 
 great, I gradually increafed the force, and 
 though the forceps hipped feverai times, I 
 at laft delivered the head, by grafping the 
 handles more firmly, and pulling up to* 
 wards the Pubes. But the Perinceum was 
 torn by the fudden delivery, becaufe I did 
 not then know how to make the proper 
 turns, and proceed in the flow and cauti- 
 ous manner which I have fince adopted. 
 The child’s head was fqueezed into a lon- 
 gitudinal form, flattened on the fldes, with 
 a deep impreflion on the Cranium above 
 the ears j and from an indentation on the 
 Os Frontisy by a blade of the forceps, which 
 had been fixed on that and the Occiputy I 
 difeovered, that the ears were not to the 
 fides, as I had imagined. 
 
 Thefe impreflions had very much galled 
 and inflamed the parts; but, in corTcquence 
 
 of 
 
CASES IN MIDWIFERY. 463 
 
 ©f proper care, they digefted, and the child 
 recovered, and as he grew up, the marks 
 diminlfhed and difappeared. I told the 
 midwife and nurfe, that the patient’s 
 rinaum was cracked, and defired they would 
 not make her'uneafy, by informing her of 
 an accident which would be attended with 
 rio bad confequences. Accordingly, the 
 .parts were perfectly healed in the Ipace of 
 twenty days. 
 
 C A S E V. 
 
 In the year 1747. a midwife demanded 
 my affiftance in behalf of a woman, whom 
 jChe had once before delivered, with diffi- 
 culty, of a dead child in the eighth month. 
 In this labour, the membranes were no 
 fooner broke than I received a call, and 
 found the pains ftrong, the child’s head 
 advanced to the middle of the FMs, and 
 the Vertex gradually defcended to the lov/er 
 part of the Ifchia^ which feemed remark- 
 ably near to one another. The head be- 
 ing luckily fmall, and the Occiput to the 
 left Ifchkmy I refolved, after having wait- 
 ed a confiderable time, to turn the fore- 
 head backwards to the Os Sacrum^ on the 
 fuppofition, that the narrow part of the 
 
464 CASES IN MmWlEERA^ 
 
 iiead .would more readily pafs . between tlie 
 Jfchia. TEus. determined,. licept the pas 
 jiibnt on her fide, apd applied one blade of 
 the forceps at the Pubisy and the other; at 
 ihQ Sacrum along the child’js ears, and with 
 ^reat di fiiculfy turned the forehead to the 
 Sacrum y but before I could deliver the 
 head, I was obliged to alter their pofition* 
 Ifixing ^one beliind the left ear, and the 
 other before the right ear, backwards, at 
 the right fide of the Sacrum. 
 
 I attended in another cafe of this kind* 
 in which I was obliged to. open the child's 
 head, on account of its large fize* 
 
 ' C A S E VI* 
 
 Communicated by Mr. y in a letter 
 d^ted G-^, 1749*.. , . > 
 
 The membranes had been broke, and 
 the woman in drong labour for more than 
 twenty hours, and- was weak.ftom being 
 ■over^fatigued. After fhe had taken a few 
 pains, he found the head did not advance^ 
 and confidered, that although it was high, 
 yet it might be dangerous to wait longer, 
 on account of the patient's weak condition* 
 In puilijng up his hand into the Vagina^ 
 he found one ear backwards, and above 
 7 the 
 
CASES IN MIDWIFERY. 465 
 
 the "upper part of the Sacrum, which pro- 
 jefted conhderabiy forwarclsj v/ith the laid 
 Vertebra oi the ioinS. The head felt alfo 
 very large, and tiie forehead was to the 
 right-lide j he introduced the blades of the 
 fhort forceps, that were covered with lea- 
 ther 5 but being afraid that the handles 
 were too ihort, he brought thefe out, and 
 introduced a longer kind uncovered, whicli 
 was the kind he had ufed, when he at- 
 tended me. After he had fixed thefe pro- 
 . perly, he tried feveral times, in vain, to 
 bring the head lov/er. Upon Vv'hich he re- 
 folved to give up that method and open 
 the head 3 but finding the forceps did not 
 flip, but kept a firm hold, he refolved to 
 try and make one effort more^ and after 
 pulling with all his firength, and moving 
 the handles of the forceps over the Pubis^ 
 he got the head delivered 3 yet not with- 
 out bending backward, that blade of the 
 forceps, that was next to the Pubis. She 
 was delivered of a dead child about noon. 
 In the evening, flie feemed to be in a good 
 way, and in a breathing fweati Next 
 morning, flie was attacked vv^ith a violent 
 loofenefs, Vvdiich he reftrained with opiates^ 
 but that evening flie was comatous, and 
 H h expired 
 
-466 CASES IN MIDWIFERY. 
 
 expired next morning : he fuppofed the laft 
 . bad fymp.tom occafioned by their giv- 
 ing her without his knowledge, half a 
 pint of rum at. two draughts. 
 
 As he defil ed my opinion of this me- 
 lancholy cafe, I wrote him the follow- 
 ing letter, with another cafe of the fame 
 kind. 
 
 London, 1749- 
 
 “ Sir, 
 
 I received yours oi July the i6th, which 
 I ought to have anfwered before this time : 
 I contrived the lad: forceps with fhort.er 
 handles, on purpofe that too great force 
 might not be ufed j and when they are not 
 fufficient to open the head, I would ex- 
 tradt with the crotchet. No doubt, I fhojald 
 perhaps have been tempted even to ‘ufe 
 as great force as you did when there was 
 fo good a hold; but yet you may confi- 
 der, how much the foft parts of a woman 
 muft fuffer, by the bending fo ffrong an 
 _ inftrument againfl them, as the blade you 
 fent me. If you had been fooner called 
 to prevent the woman s being over-fatigued 
 - till the liead came lower, there might have 
 
 been 
 
CASES IN MIDWIFERY. 467 
 
 been a chance for faving the child. When 
 the Fehh iS' narrow and the head large, 
 and fo high that you cannot, or dare not, 
 turn the child, and the woman in danger 
 from extream weaknefs, it is right, firh:, 
 to try the forceps 5 but when you find it 
 ' won’t come along with a moderate force, 
 the crotchet muft be ufed j for we ought 
 never to endanger the life of the mother, 
 to fave the child. 
 
 CASE VII. 
 
 I had a cafe of the fame kind fome time 
 ago, but not fo difficult as yours j the 
 membranes were broke many hours, and 
 tile head was forced into the middle of the^ 
 Pehis. Mr. M — rd was fent for, tried the 
 forceps, but having no affiflants to hold the 
 Woman firm, did. not fucceed ; then he fent 
 for me, and I was allow’d to carry along with 
 me four pupils. The ears were to the Pubis 
 and Sacrum, the forehead to the left fide, 
 and the upper pa.t of the Os Sacrum jetted 
 in forward j as I could not turn the fore- 
 head with my hand a little backward, or 
 pafs the blade of the forceps along the ear 
 at that part, I introduced it behind the 
 H h a ear 
 
468 CASES IN MIDWIFERY, 
 
 ear at- the fide of the Os Sacrum^ and the 
 other at the forepart of the Pelvis towards 
 the left groin, and before the other ear, fo 
 that the forceps was fixed diagonally on 
 the head, and the fame as to the Pelvis, 
 
 I ufed a good deal of force, by which I- 
 delivered the head, taking care to make 
 the feveral turns in extracting it. The child 
 had been dead many hours, the head was 
 large, and fqueezed of a yery long figure, 
 the parts of the woman very much fwelled. 
 She was attacked with a violent loofenefs, 
 which was carried off by proper remedies, 
 and fhe recovered flowly. When the parts 
 are inflamed and much fwelled, the Lochia 
 fometimes are obflru6ted and fall upon 
 the inteflines j efpecially, if the patient has 
 been exhaufled by a tedious labour. 
 
 CASE VIII. 
 
 Communicated in a letter, from Mr. AyrCy 
 dated BoJlonj Lincolnjhire, 1750. 
 
 The labour went on in a flow manner, 
 and by waiting patiently, the head, after 
 many fevere pains, was forced down into 
 the Pelvis. As the woman lay on her fide, 
 he introduced one blade at the Pubis, and 
 the other at the Sacrum^ and pulled with 
 
 con- 
 
GASES IN MIDWIFERY. 469 
 
 confiderable force during every pain ; but 
 the forceps flipping, he was obliged, to in- 
 troduce them again as before ; and, giv- 
 ing the forehead a turn backwards, the 
 child was, in two pains more, delivered. 
 
 He fent two other cafes of women who 
 had been long in labour in their firft chil- 
 dren, the ears were towards the Fitbis and 
 Sacrum^ and one of the women, was very 
 fat, and about forty ; he delivered both 
 cafes fafely with the forceps, after finding 
 the pains were going off and the patients 
 turning weak.' 
 
 CASE IX, 
 
 I had a cafe from L, , in 1753. by 
 
 which the gentleman feems to have been, 
 too much in a hurry. After ufing great 
 force, he delivered the child, which was 
 alive, but the head was much galled Vvdth 
 the blades, and the woman was carried off 
 in a few days by a purging. 
 
 In another cafe, the fame gentleman 
 tried ^o deliver with the forceps when 
 the V-ertex prefented, and the forehead was 
 to the Pubis ; as he was not able to raife 
 the head, fo as to turn the forehead back- 
 wards, he pulled it along as it prefented, 
 H h 3 and 
 
470 CASES ijj MIDWIFERY. 
 
 and finding that as the Vertex pufhed out 
 the Perinaum^ it was beginning to tear, 
 betook off the forceps, and the head was 
 afterwards delivered with the labour- 
 pains, and both mother arid child did 
 well. 
 
CASES IN MIDWIFERY. 47,1 
 
 C O L LECTION XXVIII. 
 
 Laborious cafes, in which the Vertex 
 prefenting with the forehead to the Pu-- 
 Bis or groin, the patient was delivered 
 “ with the forceps. . 
 
 Vide Vol. I. Lib. III. Ch. III. Sea. 4. No. 2. and Tab. XXL 
 
 CASE I. 
 
 In the year 1744. I was called to a wo- 
 man who had been long in labour after 
 the membranes were broke. I found the 
 fex was down to the lower part of the Pel- 
 “vis j but the fcalp being much tumified, I 
 could not diftinguifh by the Sutures^ the 
 real pofition of the head. The woman be- 
 ing much exhaufted, the pains weak, and 
 the head low, I thought it was proper to 
 alTift the delivery, to prevent her and the 
 child from being in danger. For that 
 end, I caufed her to be placed in a fupine 
 pofidan, as in Col. XXV. No. I. Cafe I. 
 I then, during every pain, dilated the 
 Os Externum^ raifed the head above the 
 brim of the Pelvis, and introduced my 
 htiger? and hand flattened betwixt the head 
 and Sacrum, where I felt the back part of 
 the neck, which informed me that the 
 sorehead was to the Pubis. Conlidering 
 H h 4 that 
 
472 CASES IN MIDWIFERY. 
 
 that the . difficulty or obflrudfioii gf the 
 delivery proceeded only ' from the wrong 
 pofition of the head, I firft tried to turn 
 the forehead towards the back-part of the 
 Pelvis^ and, failing in the attempt, from 
 the flipperinefs of the fame, I endeavour-^ 
 ed to bring the child footling : failing in 
 this effort alfo, from the ffrong contrac- 
 tion of the Uterus^ I withdrew my hand, 
 and applying the forceps along the ears, 
 ufed a good deal of force to extradl the 
 head as it prefented, I brought it fo low 
 that I felt the Fontanelk one inch or more 
 below the Pubis 3 but, could not bring it 
 farther, unlefs I had torn the Vertex thro’ 
 the Perm<^um and Anus^ which were now 
 greatly ftretched. Then I difengaged and 
 brought down the forceps, and introduced 
 a blunt hook, that had a round button on 
 the end for that purpofe, up along the 
 fide of the head, and above the chin. 
 With this hold, I pulled down the fore- 
 head and face below the Piibis^ and then 
 delivered the child. This v/as, at that time, 
 the common method, when the head was 
 large, and fqueezed to fuch a length, as 
 to prevent the forehead’s coming out, ei- 
 ther with frrong labour or the forceps j 
 6 but 
 
CASES IN MIDWIFJ^Y. 473 
 
 but the bad confequences that might enfue 
 both to mother and child, made me afraid 
 to continue in this method of pra6lice. 
 For the Perinmim was commonly tore, and 
 that part of the child was fometimes fo 
 much bruifed, as to produce a violent in- 
 flammation, which deftroyed the child j 
 but a lucky incident which happened the 
 year following, gave me the hint of a bet- 
 ter-method, as in the following cafe, 
 
 C A S E II. 
 
 A midwife called me in the year 1745. 
 to a woman in the morning, who had been 
 mott of the foregoing night in ftrong la- 
 bour. I felt the Vertex at the lower right 
 fide of the Sacrum. Her pains were ftill 
 pretty ftrong, although the had loft, both 
 before and after the membranes were broke, 
 a large quantity of blood. I found alfo 
 the Fontanelle at the left groin, which af- 
 fured me, that the delay of the delivery 
 proceeded from the forehead’s being at that 
 part. The patient being placed as in 
 Colle6t. XXV. No. I. Cafe I. I introduced 
 the forceps along the ears, holding the 
 handles when fixed towards the Vertex^ 
 which was to the right fide of the Os Coc- 
 
 cygzs. 
 
474 CASES 'TN MIDWIFERY. 
 
 cygis. Then I began to pull from fide to 
 fide, by which means the head advanced 
 a little, but not fo much as to allow the 
 forehead to turn out below the Pubis. In 
 repeating thefe efforts, the forceps flipped 
 off three times j though I did not obferve, 
 till afterwards, that one of the blades by 
 giving way, was the occafion of their flip- 
 ing off the head. As I found I could not 
 deliver the head, by pulling either down- 
 wards to bring out the forehead, or up- 
 wards, becaufe the head would not yield 
 that way, on account of the chin’s being 
 prefied againft the breaft, neither did I chuff 
 to try the blunt hook, becaufe of the bad 
 confequences attending that method. I 
 was alfo averfe and loth to deffroy the child 
 by opening the head. While I paufed a 
 little, confidering what method I fhould 
 take, I luckily thought of trying to raiff 
 the head with the forceps, and turn the 
 forehead to the left fide at the brim of the 
 Pehis where it was wideff, an expedient 
 which I immediately executed with greater 
 cafe than I expected. I then brought down 
 the Vertex to the right Ifcbiiim^ turned it 
 below the Pubis, and the forehead into 
 the hollow of the odcrum ; and fafely deli- 
 
 ^^ered 
 
CASES IN MiDWIFpRY. 47^ 
 
 vered the head, by pullihg it up from-the 
 Perhi^eum and over xht Pubis. This me- 
 thod fucceeding fo well, gave me' great joy, 
 and was the firib hint, in confequence of 
 which I deviated from the common me- 
 thod of pulling forcibly along, and fixing 
 the forceps at random on the head : my 
 eyes were now opened to a new field of 
 improvement, on the method of ufing the 
 forcBps in this pofition, as well as in all 
 others that happen when the head prefents, 
 
 CASE III. 
 
 In the year 1749. I, with my pupils, at- 
 tended one of our women mDrury~lane : the 
 membranes had broke in the evening, and 
 file had frequent and firong pains all night. 
 When they fent for me in the morning, I 
 felt fomething like the Vertex down at the 
 lower part of the Pelvis and Ihe was 
 much in the fame condition, as the woman 
 defcribed in Col. XXV. No. I. Cafe I. but 
 we were all miftaken as to the pofition of 
 the head ; for I, as well as the pupils, ima- 
 gined, that, as the head was fo low, the 
 forehead mufi: be turned back to the lower 
 part of the Sacrum ; and that on account 
 of the head’s being fqueezed to a great 
 
 length, 
 
 O ^ 
 
476 CASES IN MIDWIFERY. 
 
 length, we could find neither neck, nor 
 ear at the Pubis. We were like wife mif- 
 takcn as to the Sutures^ fuppofing, what 
 was called by the ancients, the back Ewz- 
 tanelle^ where the Lamdoidal erodes the end 
 of the Sagittal^ was the fore Fontanelle^ 
 which was backwards towards the Sacrum. 
 I told all prefent, that as the head was fo 
 low down, and the delivery retarded by 
 the weaknefs of the pains, it was fafer for 
 both woman and child to deliver her with 
 the forceps j and, efpecially, as I was pretty 
 certain of fucceeding, without doing injury 
 to either, being certain, as fhe had formerly 
 quick and eafy labours, that the impedi- 
 ment proceeded only from weaknefs, and 
 perhaps a larger child than ufua], which 
 might be in danger of being loft by lon- 
 ger delay. I had her then put in the fame 
 pofition, and applied the forceps in the 
 fame manner as in the aforementioned 
 cafe. I then pulled gently every pain, and 
 the woman being expofed to ftiew the ope- 
 ration, I was furprifed to fee, what I 
 imagined the Occiput^ come along from 
 under the Puhis^ not with hair, but bald 
 and fmooth. Introducing my finger, I 
 now plainly perceived, that we had been 
 
 ; > all 
 
CASES IN MIDWIFERY. 47^ 
 
 all miftaken as to the pofition ; for I felt 
 the root of the nofe, and eye-brows v/ith- 
 in the Fubis. As the head was now fo far 
 advanced, I thought it would be better 
 firft to try to bring it along in that man- 
 ner : therefore, I continued to puli along 
 gently ; but inflead of pulling upwards as 
 before, to raife the head from below the 
 Oi Pubis, I pulled downwards, to bring 
 the forehead and face out from below that 
 bone ; they accordingly flipped out gradu- 
 ally, and when the chin was delivered from 
 below the Pubis, I turned up the handles 
 of the forceps towards the face, pulled the 
 head upwards, and delivered it according 
 to the diredlions laid down in thofe cafes 
 where the face prefents. Vide Col. XXX. 
 No. II. Cafe I. The woman was not tore, 
 the child’s head was fqueezed to a great 
 length, but was neither hurt nor marked 
 with the forceps. 
 
 CASE IV. 
 
 I was called to a patient by a midwife, 
 in March 1751. v/ho informed me thatflie 
 had delivered the woman feveral times, and 
 her labours v/ere commonly tedious from 
 her having large children > but that this 
 
 v/as 
 
4^8 CASES IN MIDWIFERY. 
 
 was worfe, and more tedious than any of 
 the former j for although the waters were 
 a long time come off, and the head had 
 been low in the bafon for many hours, fo 
 that Ihe expected every pain would deliver 
 the child, all endeavours had proved in- 
 dfedtual, and (lie had fent for me, becaufe 
 file was afraid of both mother and child. 
 She alfo told me, that die imagined the 
 head did not prefent right, for fhe found 
 the opening at the jQiare-bone, and ima- 
 gined, this vras the occafion of the diffi- 
 culty. On examining, I found it as Ihe 
 had related, and was much pleafed with 
 the midwife’s honeft behaviour, and faga- 
 cious remark. I felt alfo the Vertex back- 
 wards, puffiing outward the Os Ccccygis and 
 fundament. Although the pains were m ueh 
 abated, and weaker, according to the mid- 
 wife’s account, yet every now and then 
 fhe had one pretty ftrong. As I found her 
 pulfe rather low and funk, I ordered her 
 a cordial mixture, and waited with pati- 
 ence to try if the head would advance far- 
 ther, that the forehead and face might, 
 by that means, puffi out below the Pubis 
 but ffiiding it did not advance, and that 
 the pa. ns were not fuffic-ientj I thought it 
 - : . ' was 
 
 3 
 
CASES IN MIDWIFERY, 479 
 
 was proper to ufe the affiftance of the fo rceps, 
 
 I then had her placed as in the former cafe, 
 opened the Os Externum gradually with my 
 fingers, fcooped up tlie head above the brim 
 of the Pehisj and as I flipped my hand 
 flattened betwixt the Sacrum and the child’s 
 head, I felt with my fingers the back-part 
 of the neck, which more fully confirmed 
 the midwife’s opinion and mine, of the 
 forehead’s being towards the Pubis. After 
 I had brought down my hand, and found 
 no advantage from feveral following pains, 
 I introduced the forceps along the ears, 
 having fixed them, and preffed the handles 
 as far back as the Perinceum would allow 5 
 and tried to bring the forehead and face 
 below the Pubis^ by little and little, every 
 pain, but did not fucceed. Thus difap- 
 pointed, I piifhed up the head with the 
 forceps to the brim of the Pehis^ turned the 
 ^ forehead to the left-fide thereof, and brought 
 the Vertex down to the lower part of the 
 n^t Ifchium j then turn’d the forehead back- 
 wards to the concave part of the Sacrum, 
 the Occiput below the Pubis, and delivered 
 the head and body as in the former' cafe. 
 
 Thofe cafes in which the Vertex prefents 
 with the forehead to the groin or Puhis^ 
 
 happqn 
 
4^0 C:x\SES IN MIDWiFERY. 
 
 happen but feldom 5 and if the head is 
 fmall, it is commonly delivered v^^ith the 
 labour-pains, becaufe the external parts, 
 from the Os Coccygis to the Fra?nm la-~ 
 biorum j will frequently ftretch down fo much 
 as to allow the forehead and face to come 
 out from below the Pubis, and if the pains 
 fall off, and the woman become low and 
 weak, the forceps will affift where the 
 pains are infufficient3 but if the head is 
 large and fqueezed to a great length, thofe 
 parts will feldom ftretch fo much as to al- 
 low the delivery to be performed in that 
 manner, either with the pains or forceps, 
 without the danger of tearing the Peri- 
 nceum, and even fometimes the Vagina and 
 Re6ium into one cavity 3 belides, if the 
 head ftops there a long time, the child is 
 frequently loft from the long compreflion 
 of the brain, excluftve of the danger fron^ 
 bruifmg and inflaming the parts of the 
 woman : to prevent all which inconveni- 
 encies, it is better to help in time, and de- 
 liver, if poffible, according to the above 
 method 3 efpecially, in thofe cafes, where 
 you cannot alter the wrong pofition vyith 
 your hand, or one blade of the forceps, or 
 turn the child,, and deliver by the feet. 
 
 ... CASE 
 
CASES IN MIDWIFERY. 481 
 
 CASE V. 
 
 Communicated by Dr. Durban, in a letter 
 dated 1752. 
 
 The woman had been in flrong labour 
 for many hours, after the waters were dif- 
 charged ^ as the Os Uteri was not fufhcient- 
 ly open, he adminiftred opiates from time 
 to time, which refrefhed her much ; but, 
 after waiting a long time, and the woman 
 growing weak, and falling into faintings, 
 he tried to dilate the parts during every 
 pain, and at laft found, that what ob- 
 Rru6fed the head’s advancing, was no other 
 than the forehead’s being to the Pubis, 
 He then introduced and fixed the forceps 
 along the ears, but could not move or al ; 
 ter the forehead to the fide and back part 
 ff the Pelvis. , yet, by dint of pulling with 
 great force, he, at laft, delivered the head, 
 as it prefented. The child was alive, and 
 the mother recovered. 
 
 He fent me an account of two other 
 cafes, in which the head prefented fair, 
 but as the women were much fatigued 
 and weakened before he was called, he de- 
 livered each with the forceps, and faved 
 I i the 
 
482 CASES IN MIDWIFERY. 
 
 the children as well as the mothers. One 
 of the women was violently cramped in her 
 limbs, when he introduced the forceps, 
 and the other was attacked with a flopd’^ 
 
 
 COL- 
 
CASES IN MIDV/IFERY. 483 
 
 COLLECTION XXIX, 
 
 Laborious cafes of women delivered by the 
 forceps, the Vertex prefenting, the ear 
 to the Pubis, and the head higher in 
 the Pelvis. 
 
 CASE I. 
 
 I was called to a poor woman in the 
 year 1745. who had been deferted by her 
 midwife, fo that I received but an uncer- 
 tain account of the cafe. I was told in 
 general, that flie had loft a great deal of 
 blood, that her midwife had fatigued and 
 wrought on her very much. I found her 
 pulfe very weak, her countenance pale, and 
 cold fweats on her extremities. The mouth 
 of the wom.b was largely opened, the 
 membranes Vv^ere broke, the head was 
 fmali and down to the middle of the Pelvis^ 
 the Occiput to the left Ifchium^ and the ear 
 to the right groin. I was alfo told, that 
 the labour-pains had all along been triflings 
 and had intirely left her, after the waters 
 came off : as the flooding was moftly abat- 
 ed, I ordered her to take fome broth, or 
 brown caudle to -fupport or nourifh her. 
 Flaving fent for thofe who were under my 
 I i 2 in-- 
 
484 CASES IN MIDWIFERY. 
 
 inftru6lions, we attended fome time to fee 
 if the labour-pains would return, but to 
 no purpofe j and being afraid of cenfure, 
 if Ihe fliquld die undelivered, I thought 
 it was proper to fupply the place of the 
 pains, by afljfting the delivery with 
 the forceps, efpecially as fhe had for- 
 merly bore children, and the head was 
 fmall. The ears being to the Fubis and 
 Sacrum, I kept her on her fide, and apply^ 
 ing each blade of the forceps, brought 
 down the Occiput to the lower part of the 
 left Ifcbium, and turned the forehead back- 
 wards to the Sacrum ; then I delivered the 
 head by turning the handles of the forceps 
 forwards to the Pubis, the thighs of the 
 woman being kept afunder by a thick pil- 
 low placed betwixt the knees at the fame 
 time fupporting the Perinceim, with one of 
 my hands, to prevent its being tore. Thus 
 the patient was fafcly delivered of the child, 
 and afterv/ards of the Placenta •, for tho’ 
 Ihe continued long weak, flie at length 
 recovered. The child appeared to have been 
 dead two or three days, the lips and fcro= 
 turn being livid. 
 
 CASE 
 
tASES IN MIDWIFERY. 485 
 
 CASE II. 
 
 In the year 1746. I was called to a wo- 
 inan mFarkers-Lane^ who, as the people 
 about her alledgedi had been in labour 
 eight days : they faid, three liiidwives had 
 attended and left her j that Ihe was very 
 poor, and in a ftarving condition. I found 
 the head of the child, in time of a pain^ 
 pulhed down with its Vertex to the lower 
 part of the left Ifchiu?n, but after the 
 abatement of the pain, which was very 
 weak, it was retrailed to the upper-part. 
 As this was in the middle of the day, I 
 fent for fome broth and bread from a cook’s- 
 fhop, in order to refreih her. I found, by 
 her own relation, that the midwives had 
 all tried to deliver her by hurrying and 
 placing her in different pofitions ; that file 
 had got little or no deep for two nights ; that 
 the waters came oft the preceding day, 
 and her pains had never fmce been flrongen 
 Her pulfe was weak and low ; but, on 
 taking a little nourifliment, die recovered 
 fome ffrength , and after having lent for 
 thofe v/ho were under my inftruclions in 
 midwifery, I left her to the care of one of 
 the elder pupils j advifing him to keep her 
 I i 3 quiet 
 
48-6 CASES IN MIDWIFERY. 
 
 quiet in bed, and to give her from time to 
 time, a little broth or brown cawdle 3 for 
 although I found the cafe was fuch, that 
 I could deliver her with the forceps, yet I 
 thought it v/as better to try if fhe could 
 be delivered by the labour-pains, which I 
 hoped would grow ibronger, after flie fhould 
 have enjoyed fome refrefliing deep, and 
 her firength diould be recruited by nou- 
 rhhment. I was called again, about one 
 o’clock next morning, when I underflood 
 die had every now and then dept betwixt 
 the pains, which recurred at long inter- 
 vals, and were dill weaker than I expefl-^ 
 ed, confidering that her drength and fpi- 
 rits were much recruited. I found the 
 head v/as in the fame fituation, and dill 
 drawn back as before* After examining 
 more narrowdy, I could eafily feel one of 
 the ears at the Pubis, the fore-part of it 
 being upwards and towards the right-dde, 
 and perceiving the head was not large, I told 
 the attendants, that the delivery feemed to 
 be retarded by the contradlion of tht Ute- 
 rus before the fhoiilders, and the weaknefs 
 of the pains, w hich had not force fufhcient 
 to overcome that refidaiice 3 that I did not 
 quedion, as die was now dronger, they 
 
 might 
 
 O 
 
CASES IN MIDWIFERY. 487 
 
 might in time be fufficient, without any 
 other affiftance i but I thought it a pity to 
 keep her longer in fuch a fituation, as I 
 could eafily affift with the forceps> by pul- 
 ing along the head by little and little every 
 pain, and preventing it from being after- 
 terwards retraced. Accordingly, I kept 
 the patient on her fide, until I applied the 
 forceps, as in Col. XXVI. No. II. Cafe ill. 
 then tied the handles together with a 
 fillet, and turned the patient on her back, 
 as in Colleff . XXV. No. I. Cafe I. Thefe 
 previous fteps being taken, I pulled gently 
 during every pain, until I brought the 
 head a little lower, and could turn the 
 forehead from the right fide of the Pelvis 
 to the Sacrum : after this change was ef- 
 fected, I continued to affifi: and bring the 
 head lower j and the parts below were gra- 
 dually pufhed out with the head in form of 
 a large tumor. This being the woman s 
 firft child, the Prenum felt veiy rigid, and 
 was ftretched with difficulty, and the Pe- 
 rinceiini^ and parts about the fundament 
 and Os Coccygis felt ftill very thick ; but as 
 I continued to keep down the head, and 
 affifi: by pulling during every pain, thefe 
 parts were more and more firretched, and 
 I i 4 became 
 
488 CASES IN MIDWIFERY. 
 
 became thinner j and tlie Os 'Externum was 
 at lad; lb much dilated as to allow the head 
 to pafs and be delivered, as defcribed in the 
 lad cited cafe : but more than half an hour 
 elapfed after the head was brought low 
 down, before the Os Externum was fo much 
 dilated, that I durd venture to pull up the 
 head from the Perineeum^ which I was 
 afraid, every time I pulled, would crack 
 and give way ; for, it v*^as now as thin as 
 a piece of parchment at the edge, and was 
 lengthened to more than three inches. 
 
 CASE IIL 
 
 I was called in the year 1749. about fe* 
 veil in the morning, to a woman near the 
 feven dials. The midwife told me that 
 when die was called the preceding even- 
 ing, die had found her in pretty drong 
 labour-pains j that about twelve the wa* 
 ters came off, immediately after the dif- 
 charge of which, the patient v\^as thrown 
 into violent convulfions, which went off 
 and returned three or four times ; and die 
 had dozed and lain dupid betwixt the fits. 
 I examined, and found the head of the 
 child lying much in the pofition de^ 
 Icribe l above, only the head was lower 
 
 down. 
 
CASES IN MIDWIFERY. 489 
 
 down, and the Occiput to the under-part 
 of the right Ifchium. I could alfo plainly 
 diftinguifh the Lamdoidal eroffing the end 
 of the Sagittal Suture, the head fqueezed 
 to a longilh form, one of the parietal bones 
 riding over the other, and the Fo?itanelle 
 up at the middle of the left Ifchium. Dur- 
 ing the time of my examining, Ihe was 
 thrown into a fit, which lafied near a mi- 
 nute, and a6fed much the fame as a labour- 
 pain, by pufhing the head a little lower, 
 though it returned gradually to the fame 
 place, as the violence of the convulfion 
 abated. The midwife had not obferved 
 this circumftance in time of the former fits, 
 but told me, that it had continued in that 
 pofition, without advancing for two or three 
 hours. As the woman’s pulfe was quick 
 and full, I ordered her immediately to lofe 
 eight ounces of blood, and defired the 
 midwife to fend for me, if the convulfions 
 fliould return, and the delivery be much 
 longer delayed. The woman was now 
 quite infenfible, and did not fetm to an- 
 fwer or take notice, even when we called 
 to her aloud. I was again fent for about 
 nine, when the midwife informed me, that 
 the fits had returned oftener and with 
 
 greater 
 
490 CASES IN MIDWIFERY. 
 
 greater violence. I found the head in the 
 fame pofition, but about an inch lower, 
 and I now could feel the ear at the Fiibisi 
 I tried to flretch the Os Exter? 2 im gradual- 
 ly, evei-y now and then, to fee if it would 
 bring on a labour-pain, but to no purpofe^ 
 In about twenty minutes, fhe was attack- 
 ed with another fit, which was very vio- 
 lent, continued longer than the for- 
 mer, and had much the fame effe6ls. I 
 then confidered, that although it was pro- 
 bable, the repetition of thefe fits might 
 act in the fame manner as labour-pains, 
 and deliver the child j yet, the continuance 
 of them might Hill more and more indan- 
 ger the life of the woman. Therefore, I 
 eafily firetched. the Os Externum as fhe lay 
 on her fide, and introduced the forceps, as 
 in the former cafe, and as I found the 
 head was large, I aifo tied the handles of 
 the forceps, and turned her on her back. 
 After I had brought the forehead to the 
 hollow of the Os Sacrum^ and was begin- 
 ing to deliver the head in a flow manner, 
 fhe was attacked with another fit, and as 
 the Os Externum eafily yielded, fhe was 
 fafely and foon delivered. The fits did 
 not return, fhe fell into a plentiful fweat, 
 
 and 
 
CASES IN MIDWIFERY. 491 
 
 2-Tid the ftupidity gradually wearing off, 
 fhe next morning recovered her fenfes, and 
 was agreeably fiirprized to find herfelf de- 
 livered, and the child alive. 
 
 CASE IV, 
 
 In the year 1750. I was fent by a rela- 
 tion to fee an unfortunate woman, who 
 v/as pretty old and in labour of her firfi: 
 child. She was in a low and weak con- 
 dition, partly from grief and anxiety, and 
 partly from having been exceffively fatigued 
 by the midwife, who wanted to hurry over 
 the labour as foon as polTible. The mem- 
 branes had broke the preceding day, and 
 it was now about five in the morning. I 
 found the head prefenting, and down to 
 the lower part of the Pehis, though it had 
 not begun to pufii out the foft parts in 
 form of a tumor. I could not diftinguifh 
 the pofition of the head from the SiitureSy 
 the hairy fcalp being fo much fwelled. 
 Ho'vever, I judged that the forehead was 
 to the left fide of die PehiSy from feeling 
 a part of the head preffed fiirongly againft 
 the lower pait of the right IJchiiun, and 
 floDiiig uDwards to the middle of the left : 
 I couid but jufl reach the tip of the ear 
 
492 CASES IN MIDWIFERY. 
 
 at the Pubisj with my finger, the hea<l 
 v/as fo large, and fo ftrongly comprefl'ed 
 againfi: that bone* 
 
 I was informed that the pains had been 
 very ftrong, though now they were weak, 
 and recurred at long intervals. Her pulfe 
 was fiink^ and fhe was taleen with faintings 
 and ficknefs at her ftomach, which pro- 
 duced violent teachings. Thefe, however^ 
 fupplied the place of labour-pains, and 
 afliftcd the delivery by forcing down the 
 head. To encourage thefe efforts, as well 
 as to recruit her ftrength, I diredfed her 
 to drink every now and then a little warm 
 wine and water j and in this manner fhe 
 proceeded for about an hour, when find- 
 ing the head had made but final! progrefs^ 
 and being afraid that her fpirits would faiJj 
 I thought it was moft expedient to call in 
 the afiiftance of the forceps. After hav- 
 ing gradually dilated the Os Exter7tiim, as 
 fhe lay on her left fide, I tried to intro- 
 duce my finger between the head and the 
 Pubis, to the Os Uteri, in order to guide 
 the point of the blade ; but finding there 
 was not room for both, and being afraid 
 of hurting the bladder, I turned her on 
 her back, fo as that fire lay in the fame 
 
CASES IN MIDWIFERY. 493 
 
 pofition, and was fupported in the fame 
 manner defcribed in Colledl. XXV. No. I. 
 Cafe I. with this difference, that as the 
 feafon was very fevere, I ordered a veffel 
 with hot water to be placed under the bed=- 
 fide, that the warm fleams might mitigate 
 the cold, to which fhe was more expofed 
 in this than in the other pofition. 
 
 Having fully opened the Os Externum, I 
 turned the back of my hand down towards 
 the&rrz^;^,andraifedorfcooped up the head 
 gently to the upper part of the Pelvis j and 
 now with my fingers I felt the right ear 
 backwards, and the pofterior part of the 
 neck at the right-fide j and diflinguifhed 
 that the Pelvis was not diflorted, though 
 the head was large and fqueezed to a great 
 length. Thus informed, I introduced one 
 blade of the forceps, at the back-part, be- 
 fore I withdrew my hand j then infinuat- 
 ing the other at the left fide, towards the 
 left groin, I moved it gently to the fpace 
 below the Pubis, and over the child’s ear. 
 The inflrument being locked, I preffed the 
 Occipvtt from the right Ifchimn with two 
 fingers, while I gradually turned, as I pull- 
 ed, the forehead backwards to the Sacrum, 
 and delivered the woman with the fame 
 
 pre^ 
 
494 CASES IN MIDWIFERY. 
 
 pre. aution I had obferved in the fecond 
 cafe of this colle6lion.’ 
 
 CASE V. 
 
 In the year 1745. betwixt eleven and 
 twelve at night, I was called to a woman, 
 by a midwife who told me the patient had 
 been two days in labour ; that the waters 
 had been difcharged the preceding day 5 
 that there was a crofs-bone, which pre- 
 vented the child’s head from coming along, 
 and had been the occafion of her lofing 
 two children before j and that, as the pains 
 were grown weaker, and the woman was 
 much fatigued, fhe had defired the rela- 
 tions to demand my aififtance. I foiind 
 the head pretty nearly in the fame pofition 
 as that defCribed in the former cafe, tho’ 
 higher up ; but, as I did not think the wo- 
 man in great danger, and learned from the 
 different accounts, that fhe had been put 
 too foon upon labour, and was over-fa- 
 tigued, I delired die would lie quiet in 
 bed, without forcing down, except when 
 file was obliged by the pains. She com- 
 plained of great pain at the jun6ture of 
 the OJfa Pubis, as well as behind, where 
 the OJJa hmominata join the Sacnim •, and, 
 
 i her 
 
CASES IN MimVIFERY. 495 
 
 her pulfe being low, and the labour-pains 
 weak, I prefcribed the following cordial 
 and anodyne mixture. 
 
 R Jq. Cinnamom. Simp. |viS. Pulv. Caflor. gr. x. 
 
 Salvolat. C.C. gr.vi. Syr. e Meconio M. 
 
 Sumat Cochlear, ii Stalhn, et repet. omni 
 femihora. 
 
 In confequence of this prefcription, Ihe 
 lay quiet and dept between the pains, fo 
 as to be much recruited by fix next morn- 
 ing, when I received another call. The 
 head feemed to be but fmall, although it 
 was fqueezed down of a conical and flat 
 form ; and, as flie had formerly loft two 
 children, I refolved to attempt the faving 
 of this, efpecially as 1 could eafily feel 
 the ear at the Pubis. JHaving gently di- 
 lated the Os Extermmi^ Vvdth my left hand, 
 as Ihe lay on her left-flde, I raifed the 
 head to the brim of the Pelvis, and with 
 my fingers felt that the whole obfirufti- 
 on proceeded from the projedHon of the 
 upper-part of the Sacnmi, with the laft V ?r- 
 tebra of the loins ^ at the fame time, I felt 
 the back-part of the neck at tlie right-fide. 
 
 After I had withdrawn my hand, I wait- 
 ed fome time, to fee if the pains Vv^hich 
 were but weak, would force the head lower 
 
 down 5 
 
496 CASES IN MIDWIFERY, 
 
 down ; but, finding it did not advance, I 
 introduced on^ blade of the forceps at the 
 right fide of the Sacrum, along the back- 
 part of the child’s right-ear, in order to 
 avoid the projection of the laft Vertebra of 
 the loins, then infinuated the fecond blade 
 before the left ear, at the left .groin of the 
 mother, and as I brought down the head, 
 
 I turned the forehead to the Sacrum, This 
 alteration being effeCted, I unlocked the 
 forceps, and fixed them over the ears, to 
 prevent the child’s head from being mark- 
 ed at the temples, and pulling flowly dur- 
 ing every pain, fafely delivered the patient 
 of a live child. 
 
 CASE VI. 
 
 In the year 1751. I alTifted in a fimilar. 
 cafe ; the woman was taken in labour, and 
 began to flood violently j but the difcharge 
 abated when the membranes broke, and 
 the patient being weak, I delivered her 
 pretty much in th^ manner defcribed in 
 the preceding cafe. 
 
 CASE VII. 
 
 In the year 1753. my attendance was 
 befpoke to a woman, who had been ricketty 
 '• - in 
 
CASES IN MIDWIFERY. 497 
 
 ill her youth, and was very much diflort^ 
 ed. The labour at hrd: proceeded in a gra^ 
 dual manner, the membranes pulhing down 
 and dilating both the Os Internum and Os 
 Externum^ before they broke j but after 
 the waters were difcharged, the pains ceafed 
 for fome time. Upon examination, I found 
 the Pelvis was narrow and difirorted, and 
 with my finger felt the projedfion of the 
 lafl: lumbar Vertebra : the pains, however, 
 gradually returned and grew frronger, and 
 the child’s head advanced fiowly. I did 
 not confine her to any particular pofition. 
 I had been called at ten o’clock at night ; 
 the membranes broke about four in the 
 morning j at fix in the evening fhe began 
 to be very much fatigued, and by this time 
 the head was fqueezed into a conical and 
 flattened form, down to the lov/er part of 
 the Pubis, And I found by the Sutures^ 
 that the forehead was to the right Ifchium. 
 
 I now confined her to her bed-, that fhe 
 might not be over-fatigued, and file took 
 hei’ pains, lying fometimes on her back, 
 and fometimes on her fide. 
 
 About three o’clock in the morning, the 
 head fqueezed to a great length, had ad- 
 vanced to the lower part of the Pehis^ 
 K k where 
 
49^ CASES IN MIDWIFERY. 
 
 where it was fo firmly locked, that I could 
 not introduce my finger at the Pubis^ 
 to feel the ear. But the patient being 
 exhaufled and weak, I introduced the for- 
 ceps in the manner defcribed in Cafe V. 
 and tried to move the head fo as to turn 
 the forehead to the Sacrum. Thefe endea- 
 vours proving ineffeclual, I withdrew the 
 inftrument, and waited till about fix 
 o’clock, when the head was prefTed a little 
 lower down j then having rccourfe to the 
 forceps again, I fucceeded, and fafely deli- 
 vered the woman, as in Cafe II. and V. 
 yet fhe complained very much of the diflen- 
 fion and contufion of the parts. As for the 
 child, it was dead, and its death in all 
 probability oceafioned by the long com- 
 preflion of its brain : and its head was 
 Squeezed to a very extraordinary length ; a 
 circumflance from which I at firE ima- 
 gined it was lower in the Pelvis than it 
 afterwards appeared to be. 
 
 CASE VIIL 
 
 A midwife, who had formerly attend- 
 ed a woman of a fmall fize, in a labour 
 which had been very tedious from the dif- 
 ficulty in bringing along the head' of the 
 
 5 Feeh/s 
 
CASES IN MIDWIFERY. 499 
 
 Foetus which was ftill-born, the head be- 
 ing compreffed to a prodigious length, and 
 the woman’s life greatly endangered; in 
 order to avoid cenfure> and prevent, as much 
 as in her lay, the bad confequences that 
 might attend her fecond labour, Ihe had 
 recourfe to my afliftance. The patient be- 
 ing a poor woman, I went, accompanied 
 by three of my pupils, and found the 
 child’s head pullied down but a very little 
 way into the Pelvis, the forehead refting 
 upon the left-lide of the upper-part of the 
 Os Sacrum, and the hind-head againft the 
 right groin. We likev/ife felt the Sagittal 
 Suture running along the left fide of the 
 Os Pubis, towards the left of the Os Sa- 
 crum j and the hairy fcalp of the Fcetus 
 very much tumified. 
 
 The patient being laid on her back, and 
 her breech brought to the bed’s-feet, I 
 opened the Os Externum flowly, and pufti- 
 ing up my hand along the lide and pofte- 
 rior part of the Pelvis, felt the left ear of 
 the child, by which I knew the forehead 
 was towards the back, though a little to 
 the left-lide of the woman : I at tlie fame 
 time felt the upper part of the Sacrum and 
 loweil Vertebra of the loins, proje6Iing fo 
 K k 2 far 
 
500 CASES IN MIDWIFERY. 
 
 far forwards as to reach within three inches 
 of the OJfa Pubis^ The pains being Rill 
 pretty Rrong, I waited feme time, to fee if 
 the head would advance, but it made not 
 the leaR progrefs j the pains and patient grew 
 weak, the Uterus was Rrongly contracted , 
 and, as the former child had been loR by 
 the long prelTure on the brain, I refolved 
 to try the forceps, and fhould that method 
 prove ineffedlual, as I feared it would, to 
 open the head and deliver with the crotchet. 
 Having, therefore, introduced the Reel 
 extradtors, which, on this occafion, I pre- 
 ferred to thofe made of wood, I fixed 
 them along the fides of the ears, and pull- 
 ing downwards, at firR, with a good deal 
 of force, when I found the head defeend 
 to the lower part of the Pchis^ I turned 
 the forehead into the hollow of the Os 
 Sacrum, fo that the hind-head came out 
 from below the Os Pubis : then diredling 
 one of my pupils to prefs the flat part of 
 his hand againR the Perineum, which was 
 very much diRended, I raifed up the for- 
 ceps, and pulled the head half-round, for- 
 wards and upwards, on the out-fide of 
 the Pubis j and I afterwards delivered the 
 body of the child, which v/as of a fmall 
 
 fize. 
 
CASES IN MIDWIFERY. 501 
 
 iize, and the lower-parts were befmeared 
 with Meconium. One blade of the for- 
 ceps had been fixed along the fore-part of 
 the ear, and refled on the temple, while 
 the other extended along the back of the 
 left ear, to the cheek, and the impreflion 
 which they made was very inconfiderable. 
 As for the woman, fhe recovered much bet- 
 ter than I could have expedled. When I 
 afterwards introduced my hand to deliver 
 the Placenta, it went up with difficulty, 
 and I was then confirmed in the opinion, 
 that the diftance between the projeftion of 
 the lower Vertebra of the loins and the Os 
 Pubis did not exceed three inches. 
 
 I had before this occafion contrived a 
 particular kind of wooden forceps, with 
 which I had frequently delivered j but, I 
 now fubflituted fteel covered with leather, 
 in the room of wood which is not fo dur- 
 able. 
 
 K k 3 
 
 C O L. 
 
502 CASES IN MIDWIFERY. 
 
 COLLECTION XXX. 
 
 Of laborious cafes from the prefentation 
 of the forehead or face, in which the 
 women were delivered by the forceps. 
 
 Vide Vo'. I. Book III. Ch. III. Seft. 4. No. 4. and Tab. 
 
 XXII, XXiil, XXIV, XXV, and XXVI. 
 
 CASE I. 
 
 In the year 1748, I was called by a mid- 
 wife to a woman in Windmill-^Street, who 
 formerly ufed to have very quick labours ; 
 but this had been very tedious, from the 
 wrong prefentation of the child’s head. 
 The midwife told me, fhe felt fomething 
 like the eyes towards the patient’s left 
 groin j and when I examined in time of 
 a pain, I found her information true, and 
 that the forehead prefented, with the face 
 to the left-Iide, and the Fonta?ielle to the 
 right. In this fituation, I underftood it 
 had ftuck for a long time, without mak- 
 ing the leail progrefs, although the pains 
 had been ftrong and frequent. 
 
 While fhe lay on her fide, and took fe- 
 veral pains, I confidered the cafe ^t leifure 
 and as the Pehis was large, refolved, if 
 poffible, to alter the polition of the head, 
 and fhould I fail in that attempt, turn the 
 child, and bring it footling. But, after 
 
 hav^ 
 
CASES IN MIDWIFERY. 503 
 
 having dilated the Os Externum, fo as to 
 admit my hand, I found all my efforts in- 
 effeflual, either to raife the forehead to 
 the left-fide of the Pehis, that the Vertex 
 might come down to the other fide, or to 
 return the child into the Uterus, fo as to de- 
 liver it by the feet j for the Uterus was fo 
 ftrongly contracted as to foil all my attempts. 
 
 Thus baffled in thefe endeavours, I in- 
 troduced one blade of the forceps, along 
 the left ear, at the Pubis, and the other 
 on the oppofite part, at the Sacrum, and 
 began to turn the face backwards to 
 the left fide of the Sacrum, that the 
 Vertex might come out from below the 
 Pubis i • but recolledling, that the Vertex 
 would be turned fo far up between the 
 Ihouiders, as to render the delivery diffi- 
 cult, I reduced the face to its former fitua- 
 tion at the left-fide, and bringing the head 
 by degrees lower and lower, very eafily 
 turned the face and chin to the fpace be- 
 low the Pubis ; then holding the handles 
 of the forceps towards the patient’s belly, 
 delivered the child, v/hofe forehead was 
 raifed in a conical form, while the back- 
 part of the Parietal and Occipital bones 
 were fqueezed fiat. I tried with my hands 
 K k 4 to 
 
504 CASES IN MIDWIFERY. 
 
 to mould it into a better diape : but it had 
 been fo long compreffed, that I could not 
 alter the form.. 
 
 CASE II, 
 
 In the year 1749. I attended in a cafe 
 where the face prefented. The waters had 
 been feveral hours difcharged, and the 
 midwife told me, that the head had ftuck 
 a long time in that pofition, without ad-r 
 vancing in the leaf! s and when I examine 
 ed, I found the chin to the lower part of 
 the Fubisy and the forehead to the Os Sa- 
 crum. The patient being greatly fatigued, 
 and the force of the pains very much 
 abated, I refolved to affift as foon as poffi- 
 ble with the forceps, in order to deliver 
 the child, which I knew to be alive j for 
 in examining the fituation of the head, 
 my finger flipping into the mouth, I felt 
 it move its tongue and lower jaw j though 
 I did not mention this circumflance to the 
 mother, that fire might not be overwhelm- 
 ed with anxiety, in cafe it fliould be afteiv 
 wards ffill-born. 
 
 The ears being to the fides of the Pel- 
 vis, I caufed the patient to be laid fupine 
 ^Ci'ofs the bed, as in Col. XXV, No. I. Cafe I. 
 
 anc| 
 
CASES IN MIDWIFEPvY. 505 
 
 and having gradually dilated the Os Exter- 
 numy endeavoured to introduce the fingers 
 of tny right hand, to th.e Os Uteriy at the 
 left-fid e of the Pelvis i but I could nei- 
 ther reach that part, nor raife the head 
 to make more room for my fingers. Then 
 I tried to infinuate a hlade of the forceps, 
 between the head and my fingers, in an 
 imaginary line, with the Scrobiculus Cordis 3 
 but finding a confiderable refifiance, and 
 being afraid that the blade would pafs on 
 the outfide of the Os Uteriy I withdrew the 
 inftrument, However, after two or three 
 trials, in which I kept the point clofer to 
 the head of the child, I effedled my pur- 
 pofe, and introduced the other blade on 
 the oppofite fide, in the fame flow and 
 cautious manner. Then locking and tying 
 the handles together with a fillet, I began 
 to pull during every pain, and as I pulled 
 with my right-hand, I preiTed down the 
 chin with two fingers of my left. The 
 Perineeim and parts below, were now pu fil- 
 ed out in form of a large tumour ; the an- 
 terior part of the neck being brought 
 down to the lower-part of the Pubisy I 
 turned the handles of the forceps towards 
 that bone, pulled the head upwards fo as 
 
 to 
 
5o6 cases in midwifery. 
 
 to raife the Parietal and Occipital bones 
 from the back-parts, and bring them (low- 
 ly with an half-round turn upwards thro’ 
 the Os Externum j and, at the fame time, 
 I kept my left-hand firmly preffed againfi; 
 the Perinceum, in order to prevent its lace- 
 ration. I afterwards delivered the body 
 of the child, whofe face was livid, and 
 very much fwelled, though the Ecchymofis 
 went off as the tumefaction fubfided. The 
 form of the head, which was fqueezed to a 
 great length, I altered a little, by prefling 
 the Vertex and forehead betwixt my hands. 
 
 CASE III. 
 
 In the year 1746. about nine o’clock in 
 the morning, I was called by a gentleman 
 who had formerly attended my ledlures, 
 to a woman in labour, and found the 
 child’s face prefenting. He told me a mid- 
 wife was employed to deliver the patient, 
 but his attendance had been befpoke in 
 cafe any extraordinary incident ihould in- 
 tervene; and as the cafe had turned out a 
 preternatural pofition of the head, his af- 
 fiftance was follicited, and he had that 
 morning made feveral unfuccefsful attempts 
 
 to 
 
GASES IN MIDWIFERY, 507 
 
 to ralfe it into the Uterus^ and bring the 
 child by the feet. 
 
 As I could not accompany him imme- 
 diately to the place, the midwife in the 
 mean time called in another pra6litioner, 
 who, when I arrived, propofed, that the 
 woman fliould be delivered with the whale- 
 bone and fillet. Upon examination, I 
 found the face prefenting, about two thirds 
 of the head down in the Pehis, which I 
 concluded to be large, becaufe her former 
 labours had been quick and eafy, and 
 the chin at the lower part of the right 
 Os Ifchium, I therefore gave it as my 
 opinion, that fhe might be eafily delivered 
 with the forceps; but defired the other 
 gentleman to take his own way, if he 
 thought it a better expedient. Upon his 
 declining the talk, and the other’s requeft 
 that I would lay the woman, I caufed her 
 breech to be moved to the fore-part of the 
 bed, as fhe lay on her right-hde, and a 
 pillow to be placed between her knees, 
 w^hich were held up towards the Abdomen* 
 Thefe previous ffeps being taken, I intro- 
 duced the fingers of my right-hand up the 
 Vaginay between the child’s head and the 
 Os Sacrum, until I felt the Os Uteri, and 
 
 inli- 
 
5o3 cases in midwifery. 
 
 infinuated one blade of the forceps along 
 the ear, holding the handle down to- 
 wards the chin, that the blade might go 
 lip in a line to the Vertex^ which was 
 above the brim of the Pelvis to the left- 
 fide ; and as the point palTed the Cs In- 
 ternu?n^ I withdrew my left-hand, to al- 
 low room for turning the handle back- 
 wards to the PeruuEum^ that I might the 
 more eafily pufh the point forwards, and 
 follow the convexity of the Sacrum. Tak- 
 ing hold of the handle with my left-hand, 
 I introduced the fingers of my right be- 
 twixt the Pubis and the child’s head, to the 
 Os Uteri ^ and infinuating the other blade 
 betwixt the head and my fingers, gently 
 pufhed it within the mouth of the womb j 
 but as it met with fome difficulty, I with- 
 drew my fingers to give more room, and 
 preffing the point clofer to the head, in- 
 troduced it flowly and with great caution, 
 that the bladder and Os Internum might 
 not be bruifed. 
 
 Both blades being thus introduced in the 
 fame direction, and the handies locked to- 
 gether, I pulled gently, moving the head 
 from ear to ear, until it was brought lower 
 down into the Pelvis^ then with the affi fi- 
 ance 
 
CASES IN MIDWIFERY. 509 
 
 ance of two fingers preffed above it, I 
 turned the chin and anterior part of the 
 neck, forwards, from the lower-part of 
 the right IJchium^ to the fpace below the 
 Pubis ; fo tliat the forehead was at the 
 fame time turned from the left ifehium to 
 the lower-part of the Sacrum and Coccyx ; 
 lallly, I moved the handles towards the 
 Pubis, and delivered the woman of a child, 
 whofe face was fwelled, and whofe head 
 was compreffed like that deferibed in the 
 former cafe : the long compreffion had 
 rendered the arms paralytic, though this 
 misfortune was foon remedied by fridtioii 
 and embrocations. 
 
 C A S E IV. 
 
 In about two months after the forego- 
 ing cafe happened, I was called by a mid- 
 wife, to a woman in. labour, and found 
 the child’s face prefenting and fo excellive- 
 ly fwelled, that I at firft miftook it for ther 
 breech j but, on further examination, I 
 felt the mouth and chin towards the Sa- 
 cr.uin, and the Fontanelle at the Pubis, 
 
 The midwife told me, that the waters 
 had been long difeharged; tliat notwith- 
 ffanding a fuccellion of ilrong labour-pains, 
 
 the 
 
516 CASES in MIDWIFERY. 
 
 the head had made no progrefs for feveral 
 hours } and that as the pains had greatly 
 abated, fhe defired the relations to demand 
 farther affiftancej at the fame time fhe 
 gave me to underRand that the woman’s 
 former labours had been quick and eafy. 
 
 Her ffcrength and fpirits being exhaufted, 
 I encouraged her with hope, and refreflied 
 her with a glafs of warm wine ; then di- 
 recting them to place her in the politioii 
 defcribed in the fecond cafe of this Col- 
 lediion, I gradually dilated the Os Exter-^ 
 num. This dilatation being effedled, I in- 
 troduced the fingers of my right-hand be- 
 tween the Sacrum and the chin, and raifed 
 the head to the upper-part of the Pelvis^ 
 but found the contradlion and refiftance 
 of the Uterus fo great, that I could not 
 poflibiy turn the child and bring it by the 
 feet. I then introduced the blades of the 
 forceps along the ears, holding the handles 
 as far back as the Perinceum would allow, 
 that the blades being in a line with the 
 middle fpace between the Umbilicus and 
 Scrohiculus Cordis^ might be nearer the Ver^ 
 teXi and have a better hold of the head. 
 Having locked the handles, I endeavoured 
 to bring the head, lower down; but could 
 
 not 
 
CASES IN MIDWIFERY. 511 
 
 not move it j then I tried to turn the chin, 
 firft to one fide and then to the other j 
 failing likewife in this attempt, I pufhed 
 up the head, moving from blade to blade, 
 and turned the chin to the upper-part of 
 the left Ifchiim ; but as I again endeavour- 
 ed to bring down the head, the chin Ruck 
 fo fall that I was afraid of ftraining the 
 lower- jaw, and obliged to pufh up the 
 head a fecond time, with the forceps. I 
 now introduced two fingers above the chin, 
 and pulling the forceps with my left-hand, 
 brought it down to the lov/er-part of the 
 Ifchiumj and turned it with the fore-part 
 of the neck, to the Ipace below the Pubis ; 
 then Handing up and pulling the handles 
 towards the Abdomen^ delivered the head, 
 which was greatly tumefied. Nay, after 
 the body was delivered, the child lay a long 
 time without breathing or giving any figns 
 of life. 
 
 CASE V. 
 
 In the year 1752. I was called to a wo- 
 man, who had been long in labour, and 
 found the face prefenting with the chin 
 to the lower-part of the Sacrumy though 
 a little to the left-fide ; indeed, the face 
 
 was 
 
512 CASES IN MiDWIFERr. 
 
 was.fo low down, as to protrude the parts 
 of the woman in foj'm of a tumor ; and 
 her pains were by this time much weaken- 
 ed. The weather being extremely cold, I 
 allowed her to continue lying on her fide, 
 though a fupine pofition would have beeii 
 more convenient, and cauling her brcech 
 to be moved a little over the bed-fickj while 
 her head and fhoulders lay towards the 
 other fide, I introduced the forceps, as in 
 the former cafe : but finding it imprac- 
 ticable to raile the head, I was obliged to 
 pull it along in the time of every pain as 
 it prefented. The parts between the Coc- 
 cyx and Os Externum v/ere gradually ex- 
 tended by the face and forehead of the 
 child, and at laff yielded, fo as to allow 
 the Vertex to come out from belovr the 
 Fiihis-, then turning the handles of the 
 forceps towards that bone, I delivered the 
 woman fafely of a dead child, which was, 
 ‘-in all probability, loft by the long com- 
 preF n of its head in the Pelvis. 
 
 FINIS.