Obstetric operations, including the treatment of haemorrhage / by Robert Barnes ... with additions by Benjamin F. Dawson.

  • Robert Barnes
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Licence: Public Domain Mark

Credit: Obstetric operations, including the treatment of haemorrhage / by Robert Barnes ... with additions by Benjamin F. Dawson. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    from disease, dilatatiou will oommouly proceed rapidly and smoothly under the eccentric pressure of these dilating water- bags, which closely imitate in their action the hydrostatic pressure of the liquor amnii. In the case of rigidity from morbid tissue, as from hypertrophy or cicatrices, something more may be necessary. The timely use of the knife will save from rupture, from exhaustion, or from sloughing. I have contrived a very convenient bistomy for this pmp)ose. It is carried by the finger into the os uteri; multiple small nicks are made in its circiimference ; and by alternate distension with the water-bags the cervix may be safely and sufficiently dilated. The foetus and the channel may be duly pro]3ortioned, but the podtion of the child is tinjjropitious. In this case all there is to do is to restore the lost relation of position. The hand, the lever, and the forceps are the instruments. There is disproportion. This may be of various kinds and degrees. The varieties will be more conveniently unfolded hereafter. It is sufficient to say here that all resolve themselves, in practice, into three classes— 1. Disproportion that can be overcome without injury to the mother, and with probable safety to the child. 2. Disproportion that can be overcome without injmy to the mother, but with necessary sacrifice of the child. 3. Disproportion that can be overcome with possible or pro- bable safety to both mother and child. The first class of cases may be relieved by the hands, or by the forceps. The second by reducing the bulk of the child to such dimensions as will permit it to pass through the contracted channel. The perforator, the crotchet, the craniotomy-forceps or cranioclast, the cephalotribe, the forceps-saw, and the wire- ecraseur are the principal instruments for bringing the bulk of the child down to the capacity of the pelvis. In the third class of cases we cannot insure the mother's safety by sacri- ficing her child. We therefore seek her prohable safety by an operation—the Csesarian section—which evades the difficulty of restoring the relation of bulk and capacity between foetus and pelvis, by extracting the foetus through an artificial opening in the mother's abdomen. The instruments required for this pur- pose are not specially obstetrical. But a bistomy, scissors, needles, and sutm-es, silk or silver, take but little room, and as
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