Lectures on the principles and practice of midwifery / [James Blundell] ; edited by Charles Severn.

  • Blundell, Dr., 1790-1878
Date:
1842
Catalogue details

Licence: Public Domain Mark

Credit: Lectures on the principles and practice of midwifery / [James Blundell] ; edited by Charles Severn. Source: Wellcome Collection.

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    have one of those difficulties arising from that contraction between the front and back, of which I have said the brim is the most fre- quent seat, there is another mode of ascertaining the deficiency of room, which experience has led me to prefer before the preceding. If I were called to a woman supposed to labour under this con- traction, my first inquiry would be, How many children have you had? ‘Twelve,’ she might answer, if she were of the lower class of life. Were they born alive or not? If she told me that all or most of them were born alive, I should thence infer that contrac- tion of the brim was by no means probable. Now this is a ques- tion which any of you can put as well as the most accomplished professor ; it is so easy and so important that it ought to be your first inquiry. On the other hand, if she were to say, ¢ All my children were born dead, sir;’ then I should suspect a contraction. If I suppose a woman has a contraction of the pelvis, after making the inquiry I have mentioned, I make a careful examination with my fingers: and if a pelvis be of full size, I find myself there is no difficulty in reaching the promontory of the sacrum, though you, commencing practice, may perhaps not be able to distinguish it, because it lies so distant from the symphysis pubis, that the fingers must reach very far to find it; but if I findthe promontory coming forth as it were to meet the tip of the finger, so that in a manner we blunder upon it, then I know that contraction exists. To judge in this manner, however, it is necessary that you know the promontory when you feel it, a piece of intelligence which all do not possess. I have known the promontory mistaken for the child’s head; and I have heard of an attempt to introduce the perforator in such a case. If a patient have a pelvis in which contraction is suspected, I inquire in the third place, how long she has been in labour? If I find that she has been in labour only an hour or two after the discharge of the liquor amnii, 1 do not infer there is a want of room.at the brim; but if she have been in very strong labour, for twelve or twenty-four hours after the discharge of the liquor amnii, the softer parts being relaxed, and the foetus making no progress, the probability is that room is deficient. suspecting contraction of the pelvis, in the fourth place, I make my examination very carefully of the state of the child’s head, always to be felt. If it be not swelled, but apparently in a good condition, I have proof that it has not been injured by long pres- sure ; and I have presumption that there is no deficiency of room; but if, on the contrary, the parietal bones are lying over each other so as to form a ridge, and if the head feel considerably swelled and soft so as to resemble the breach, I infer that it has been subject to much compression, and that room is wanting. In the last place, as I wish always to ascertain this point with as much accuracy as may be, as soon as the head is fairly come down among the bones of the pelvis, I endeavour to pass the fin- gers between the symphysis pubis and the cranium, inferring on the one hand, that room is wanting, provided they cannot be passed