On the theory and practice of midwifery / By Fleetwood Churchill ... With notes and additions, by D. Francis Condie.

Fleetwood Churchill

Date:: 1853

Credit: On the theory and practice of midwifery / By Fleetwood Churchill ... With notes and additions, by D. Francis Condie. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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$and gentle yet firm and persevering efforts made to pass the hand into the uterus. Dr. Blundell says, In ordinary cases, if the mouth of the womb be as broad as a crown-piece, and if the softer parts be relaxed thoroughly, the introduction of the hand is not exposed to greater risk than usual; there seem to be no circumstances preclusive of the operation, and the sooner you commence the better. (e) So far, although these cases are each more serious than the other, yet in none of them has any very great difficulty, either of decision or of execution, been experienced. We are, however, often called to a class of cases where our utmost judgment, patience, and skill will be needed. I refer to those cases of arm presentation, where, in the language of Foster, the membranes have been a long time ruptured, the waters totally eva- cuated, and the womb closely contracted around the fcetus, which is then thrust considerably into the pelvis, the parts of the woman being dry, hot, tender, and often in a state of inflammation and tumefaction, especially when unskilful endeavours have been used to extract or turn the fcetus, or to dilate the parts. In such a case, to force the hand through the os uteri would be to rup- ture that organ, and cause the death of the woman. It is admitted by all authors, I believe, that the operation must be postponed for a time, and means tried to soften the uterus and suspend its contractions. For this purpose all are agreed in the propriety of taking sixteen or eighteen ounces of blood from the arm, and following up this with a large dose (gtt. ]xxx. to gtt. c.) of laudanum. Dr. Collins has proposed another remedy of great value. He says, In such a situation, where the individual is strong and plethoric, twelve or fourteen ounces of blood should be taken from the arm, and a table-spoonful of the following mixture given every half-hour, which I have found exceedingly useful, both in quieting uterine action and inducing relaxation : R. Aquae Fontis, 3 ▼*■ Antim. Tartar, gr. iv. Aceti opii, gtt. xxx. M. By these means, after the lapse of a short time, we shall find the uterus relax, and the os uteri soften, so that with a little patience, gentleness, and time, \ve may attain our object. 3. When the cause is one of placenta prcevia, or even of accidental hemorrhage (if it demand delivery), it is a general rule to operate as soon as possible. The os uteri seldom offers any resistance, owing to the loss of blood ; and as this loss is necessarily increased by the natural efforts in unavoidable flooding, it is evident that the earlier we deliver, the better for the patient. If we decide upon trying this operation in convulsions, 'prolapsed funis, or ruptured uterus, it will be wise to attempt it as soon as the state of the os uteri will permit. 502. Dr. Simpson has renewed the proposal of M. Velpeau* to substi- tute turning, in certain cases of distortion of the pelvis, for craniotomy, on the ground that the base of the skull being narrower than the inter- parietal diameter, and the head more compressible under tractile than expulsive efforts, the child might be delivered, and perhaps saved by a less severe operation. And further, that as turning might be attempted * De l'Art d'Accouchement, vol i. p. 38.$