not perceiving any kind of remiffion of any
one fymptom; hence much danger may
juftly be apprehended and predicted, few
recovering, and indeed in fome cafes it is
greatly to be fufpeded that apoplexy ter-
minates the whole affair.
Whatever may be the caufe of convul-
fions at the onfet of labor, whether owing
to fo great a mobility of habit, that, when
the firfl motion in the uterine fyftem is
given for labour, it is communicated
|;hrough confent to every mufcular fibre of
the body, fo as to excite or throw it into
convulfions; — or whether, from the gra-
dual dilatation or expanfion of the uterus
during geftation, there is at the period of
labor a lofs of tone in the uterine fyflem
from exceffive diftenfion, fo that to remove
this atony and to recover a due tone and
vigor in the moving fibres of the uterus,
nature roufes her utmoft efforts, ^nd in the
general commotion convulfions take place;
or whether convulfions, happening at the
K 4 oafet
( 5" )
onfet of or during labor, are owing to any
other caufe, I cannot fay.
But I believe, that, for the mofl: part,
their approach may in fome meafure be
forefeen, and their attack fufpe£led, and
this particularly if the wortian complains of
pain, or frequent giddinefs and fwimmings
in her head, and efpecially if the pain in-
creafes fo as often to be violently lancinat-
ing, or if fhe complains of dimnefs of fight,
or of feeing very indifl:in6lly, with a fre-
quent wavering mift coming before her
eyes, or if (he has fudden and violent rigors
following her labor pains, with a fluflied
bloated face, often turning a little blackifh;
and alfo if ihe has a kind of fpafmodic flric-
ture acrofs the thorax occalioning a very
great fhortnefs and difficulty in breathing ;
thus fome one or more of thefe fymptoms
may proceed, increafing more and more
violently, until fuddenly there comes on a
total abolition of fenfe, with fl:rong convuU
five motions in every part of the body.
With refpe£l: to the management requi-^
fite in fuch dreadful fituations, as the con-
vulfions muil be confidered as of the acute
8 kind,
( 57 )
kind, dependent upon exceffive irritability
and mobility of the nervous fyftem, the
treatment muft chiefly turn upon quieting
the nervous fyftem, and obviating the ef-
fects of its convulfive exertions ; hence the
means to be adapted for thefe purpofes
fliould be — If the convulfions are of the
hyfteric kind, firft to give the v^oman a free
admiffion of cool air, next to empty her
bov^^els with fome moderate purgative clyf-
ter, and then try to allay the convullivc
emotions with antifpafmodics, as tiuifl.
caftor. 51. fpt. aether, vitriol, comp. g". xxx.
tin£l. opii g". xv. in a little aqua pura, and
which may be repeated occafionally until
the hyfteria ceafes, which commonly hap-
pens before the labour is over ; and I have
known this medicine of great fervice in la-
bor, where a kind of hyfteric ftriclure com-
ing acrofs the thorax has occafioned a very
oppreffive breathing, greatly diftreffing to
the woman, particularly in time of labor
pain. — But if the convulfions are of the
epileptic kind, we muft not only admit of
cool air, but even fprinkle her frequently
with cold water ; aud as there is more or
lefs
( 58 )
iefs of an inflammatory diathefis and pie*
thoric habit merely from contraction of vef-
fels, fome blood, in proportion thereunto,
Ihould immediately be taken away. —
Leeches to the temples, if we were certain
that the bleeding after their falling off
would be profufe, would have very good
efFe£t ; and particularly fo, if there were
prefent any approaching fymptoms to apo-
plexy, as fometimes is the cafe. — Cupping,
with fcarifications on the head, would alfo
be very ferviceable ; but as the evacuatiori
by thefe means is generally (low and infuf-
ficient, we ihould always have recourfe to
bleeding from the arm or jugular vein, by
which means we may not only prevent a
rupture of the vefTels in the head, but alfo
remove a dangerous fuftocation of the lungs ;
and further, to affift thefe means, the
bowels ihould be emptied by a brilk purga-
tive faline giyfter ; after which, to remove
the general inflammatory fpafmodic affec-
tion of the epileptic convuhions, the feda-
tive antiphlogiftics with antifpafmodics may
be given, as vin. antimon. tartar, g". xx. —
Ix. tindt. opii g^\ xx. with fpt. lavend.
comp.
( 59 )
comp. g". X. in a little aqua piira, and the^
dofes fhould be repeated as the urgency of
the fymptoms feem to require, until fome
iiaufeating rather than an emetic efFedl of
the medicine takes place, or the convulfions
ceafe ; but, for the mofl part, all our af-
liftance proves ineffectual, for generally the
woman remains infenfible, and dies juft
before or foon after her delivery.
Such then is the treatment from medi-
cine in convulfions occurring at the onfet
of labor ; but with refpe6l to the delivery
in fuch cafes, much is to be left to nature :
the pradlitioner muft be very careful how
he excites pain by any unneceffary affiftancc
to promote delivery, left he thereby in-
creafes the convulfive exertions : he may
indeed at the invafion of the convulfions
touch the woman, but with a view only to
know the ftate of the os uteri, how ridd,
foft, or how far difpofed to dilate, but no
particular affiftance * is requifite until the
OS
* Immediate delivery is generally recommended in
convulfions at the onfet of or during labor, but I doubt
much of its propriety; at the onfet of labor it cannot be
performed
C 60 )
OS uteri is much dilated, and the child's
head funk far down into the pelvis ; and
even then, if the child is not retarded, and
the pains fufficiently ftrong, it muft ftill be
left to be expelled by the efforts of nature,
as in a natural labor ; but, when the ute-
rine parts are fufficiently dilated, if the head
fhould be retarded by any means, it may
then very flowly and gradually be extradled
with the Forceps, or, if the child fliould
prefent preternaturally, then the operator
muft very gradually, flowly, and with very
little force, introduce his hand into the va-
gina ; and on breaking the membranes, &c.
he mufl proceed on, and with all due cau-
performed without much force and injury, as the os uteri
is not then fufficiently dilated, and when labor is fome-
what advanced, if the convulfions are of the hyfteric
kind, it is certainly unnecefTary, as the convulfive emo-
tions commonly fubfide before the labor is over j and in
convulfions of the epileptic kind, as there is generally
fuch a ftrong fpafm throughout the mufcular fibres of the
uterine fyftem, it will be difficult even to effed a delivery
without much force, &c. (hence increafe of irritation and
confequently increafe of fpafm and convulfion) until the
OS uteri is entirely dilated by nature j and then, if the
head prefents, the child will foon be protruded into the
world without any affiftance.
tion,
( 6i )
tion, &c. deliver the child by the feet, as
in other preternatural cafes; after v/hich
the feparation of the placenta mud be left
to nature, and then finally extradled as in a
natural labor.
If now the woman fliould continue to
live, the greatefl: care mufi: be taken of her,
total filence muft be obferved round her, no
attendant or viiitor fhould unneceflarily be
admitted, and the room fhould be kept dark,
and of a moderate temperature (viz. between
50** and 60°) her food fhould conlift of thin
foft gruel, of which only a few fpoonfuls
Ihould be given at a time, and mild dofes
of fedative antifpafmodics, as camphor, caf-
tor, mufk, &c. with the fpt. asther. vitriol.
comp. &c. in a little aqua pura, may be
given her until the convulfive afFe61:ion is
entirely ceafed and fenfe returned, or death
has clofed the fcene. How far blif^ers may
be of fervice in fuch cafes, I cannot fay ;
they are recommended, and I have feen
them applied even on the head, but with-
out an5^ good effedt, and with the fame in-
efiicacy I hav^e known the warm batli
ufed.
Thus
( 6^ )
'hus much
labor.
Thus much for convuhlons durinS;
O'
It mufl: now, fifthly.
Be obferved with refped to the common
or ufual modes of managing natural labors,
as deiiring the woman to bear down and
force with her pains ; givhig her warm
Simulating liquors to increafe the fre-
quency and ftrength of them,, and likewife
for the practitioner to pretend to affift, as it
is called, with attempts to dilate the ute-
rine parts, and alfo when the child is paff-
ino: through the os externum to extricate
it quickly and forcibly, and after the child
is born, to attempt as precipitately, imme-
diately, and with fome force, to extradt the
placenta, are, I fay, modes, though too
frequently ufed by impatient and unthink-
ing pradlitioners, excellively wrong, abfurd,
and productive of the greatefh mifchief,,
nay, of every misfortune that can happen-
to a lying-in woman ; whereas if the labor
was entirely left to nature, nay rather re-
tarded, all would terminate well.
Hence let me fay, that a woman, at the
onfet
( 63 )
onfet of her labor, fhould be left entirely to
herfelf, to move where (he pleafes, but
Ihould keep herfelf cool ; fhe fhould be
fpoke to in a mild foothing, though cheer-
ful manner, and (he (hould be particularly
dcfired not to ufe any effort in forcing her
pains in order to accelerate her labor, for her
pains are now the natural and neceiTary
pains dilating the os uteri, &c. and were
fhe to ufe any forcing or bearing down with
them, the uterine parts would not fo readi-
ly dilate, but, on the contrary, the natural
courfe of her labour would be much per-
verted and prolonged ; all that the woman
has now to do, is to keep herfelf extremely
quiet, to take very little food only occa-
fionally, when thirfty a fpoonful or two of
thin foft gruel, left it (hould excite fick-
nefs * ; and (he (hould commit herfelf en-
tirely
* As the invpluntary a6^ions of vomking agitate and
afFeiSl every part of the body, fo more particularly during
labor fuch emotions always produce fudden and involun-
tary forcings of the uterus, and excite the woman to bear
down violently, greatly diftrefling, painful, and often in-
jurious to herfelf J therefore, if ficknefs fhould accom-
pany
( M )
tirely to the moderate and natural efforts of
nature, and not to be anxious about the re-
turn of pain, or the tedioufnefs of her lal?or ;
for in due time the uterine parts will ex-
pand and dilate, fo that the child, without
her forcing or bearing down, or any other
way llrivino^ or ftraininsc herfelf, will with
mere eale, and with the utmolt larety to
herfelf, be delivered.
Hence it is evident, that the praditioner
at the onfet of labor fhould attempt no-
thing ; and fo far from being folicitous for
the delivery, that he fhould avoid touching,
the woman ; and he fhould wait patiently
panv labor, it fiiould be fuppreffed. If poffible, by giving
her a little magnefia alba or creta prepared, with a few
drops of tin6l. opiij or fpt. aether, vitriol comp. in a
fpoonful of aqua pura, and ftie herfelf fhould be cautious
in her eating and drinking, fo as not to load or offend the
ftomach 5 a i^^ fpoonfuls occafionally at a time of any
thin foft gruel, will be fuificient to fupport her through
labor, and thus (he will avoid much fatigue, and the con-
fequences of violent and involuntary ftrainings, forcing
and bearing down of the uterus, and every injury that
can happen from fuch emotions of her ftomach and body.
And hence I will fay, contrary to the adage of old wo-
men, that a fick labor is not a fafe nor the beft labor.
until
( 65 )
Until by the tone of her voice, by the mo-
tion of her body, and by the frequency and
continuance of the returning pains, it is
evident, that her dehvery is drawing near ;
he then may touch her in order to know
the ftate of the uterine parts, how open
they are expanded, how far the child is ad-
vanced, and how fituated. If then every
thing is found to be natural, even though
the labor may be far advanced, it muft be
left to go on by the natural eitorts of the
labor pains ; for the practitioner muft be
very cautious in touching, left he breaks
the membranes too foon*; and he mull:
not even pretend to lend any affiftance,
or to ufe any force, or attempt to dilate the
parts, for the greateft fecret in midwifery
is to know when artificial affiftance, how-
ever gentle, is not neceffary, but will do
hurt; all then, that the pra6titioner has now
to do, is only to wait patiently, not to
touch the woman, but to exhort her to be
as quiet as poffible, and not even to bear
* That is, not before the os uteri is dilated as large
as, or almoft as large as the child's head, and which
fhould be far defcended Into the pelvis,
F dov/n.
( 66 )
«3own, flraiii or force herfelf, or even to
life any particular efforts with her natural
labor pains with a view to forward her de-
livery ; for fo far from being of fervice ta
her will fuch unneceflary exertions of her
pains be, that they will rather pervert her
delivery, and occaiion it to be much more
excruciating and diflireiling to herfelf; nay,
it will prolong it, as fuch exertions will
o;reatly fatigue her mind and body, and will
render the next returning pains irregular,
fo that the natural dilatation of the uterine
parts will not gradually go on, nor properly
take place ; for nature knows bell how
and when to unravel and unfold the fibrous
fl:ru(!lure of the os uteri, vagina, perinaeum,
&c. fo as to difpofe them for fuch a proper
dilatation and expanfion a^ to give an exit
for the child ; therefore if labor is hurried
in the dilatation &c. of thefe parts, num-
bers of fibres mud be greatly injured, and
perhaps ruptured, fo that they cannot re-
cover their proper places after the delivery ;
hence, from fuch lofs of tone, &c. many
difeafes and complaints to females arife, as
;»prolapius uteri, vagina:^, &c. conlequently
every
every labor, that is, where the head pre=
feiits naturally, fhould be left as much as
poffible to nature, even though it fliould
continue lingering &c. for feveral days,
and then no doubt but all will terminate
well, and the woman foon redbver.
Whereas, on the contrary, if the prac-
titioner is impatient, and injudicioufly de-
fires the woman to affifl: her pains by hold-
ing her breath, at the fame time by for-
cibly ftriving and bearing down ; and be-
fides this, if he very officioufly attempts to
afTifl with his hand in touching her, and
thereby endeavours, however flowly, to
dilate the uterine parts, he will greatly
hurry the woman, and he will not only in-
flame the uterine parts, but will fo irritate
them as through confent of parts perhaps
to throw the woman into hyflerics, but at
lead to excite ficknefs and vomitings ; and
thus occallon the woman to force and bear
down violently and involuntarily, fubvert-
ing the natural and fpontaneous dilatation
of the OS uteri, vagina, perinaeum, &c. fo
very proper for the w^oman's fafe delivery
and recovery.
F 2 And
( 6S )
And now, granting, that the os uteri is
fufRciently dilated, that the membranes are
broken, and the waters are difcharging,
and that the head is fo far advanced as to
begin to bear upon the anus, nay upon the
periniEum, &c, neverthelefs the pra6:i-
tioncr even now, inftead of encouraging
the woman to bear down, fhould particu-
larly dehre her to the contrary, and to ufe
no more efforts to forward her delivery thaii
the mere natural bearings of her pains ; nay
he fhould delire her rather to fupprefs them ;
for at this period of labor much attention
iliould be paid to the woman, for the flower
or lefs forcing the pains are, theperinaeum,
&c. will have more time given it as g^ra-
dually to diftend ; and the os externum
will then fo expand and gradually enlarge,
that the child's head, inftead of being
forced, w^ill rather gently and flowly flip
through it into the world : the practitioner,
therefore, at all times in natural labors
fliould never touch the woman with any
other view than to know how labor ad-
vances ; his alfiftance in any other manner
is unneceflary ; for, if he now attempts to
dilate
( 69 )
dilate the perinaeum, &c. he will do much
mifchief. Hence as the head protrudes
through the os externum preffing on the
perinaeum, and greatly extending it out-
wards and backwards, the praditioner
fhould only apply the palm of his hand on
it, in order to give it fupport; which muft
be reo;ulated according to the woman's
bearings, &c. and he fhould now very par-
ticularly exhort the woman even not to
bear with her pains; for if (he does, and
particularly with a fudden and forcible ex-
ertion, he fhould then as forcibly prefs his
hand againil: the perinaeum, for without fo
doing and retarding the fudden expuliion of
the child's head, it is ten to one, but that
the perinaeum by fuch fudden bearing ex-
ertions will burft, and be rent even into the
anus, a dreadful confequence ! Whereas by
the woman's retarding, or rather as much
as poflible fhe can fupprefling or withhold-
ing her pains in their bearing down, the
child's head will flowly Aide through the
OS externum without hurting the perinae-
um, &:c. in any degree whatever, or any
accident whatever occurring.
F 3 . Tl^e
( 7° )
The child's head being thus flowly and
fafely delivered through the os externum,
the further deliverance of the child's^ body
mud not be immediately attempted, nature
muft be waited on. She has nov^ more to
do internally within the uterine fyftem, and
particularly within the cavity of the ute-
rus, than what fome praditioners may
think ; for by the flow and gradual delivery
of the head through the os ej^ternum, the
neceffary contra6lion of the fundus uteri as
gradually takes place, thereby the placenta
as gradually begins to be feparated from the
fundus uteri, and that without any enfuing
flooding ', and further, by letting the body
of the child reft, or rather retaining it
within the vagina during the next natural
returning pain or few pains of the wo-
man, the fundus uteri will further contradl,
which gives a more fafe, perfect and natu-
ral feparation of the placenta : all this a
good, humane and careful practitioner
fhould confider within his mind, fo that
when the natural pains of the woman come
on for the expulfion of the child's body, he
mufl not attempt officioufly to affift the de-
livery
( 7' )
livery thereof by pulling at the head to ex-
trad: the fhoulders, &c. but, on the con-
trary, he fliould rather prevent the fuddeu
and forcible expulfion of the Ihoulders, by
fupporting or rather moderately holding the
child's body within the vagina againft the
violent expulfive etforts or forcings of the
labor pains ; but when the pains recede,
then to let the child's body, as of its own
accord, flowly and gradually pafs through
the OS externum into the world ; hence in
a natural labor the woman fhould be de-
livered merely by her own natural efforts
or pains, and which fhe herfelf fhould not
attempt to increafe by any exertion, as
holdino; her breath, forcins: or bearing
down, nay by rather retraining or with-
holding her pains, her uterine parts will
gradually enlarge, diftend and open, and
every part of the child will pafs or rather
glide through the os externum, &c, flow-
ly and gradually, with very little pain to
herfelf, and without lacerating the peri-
nasum, or any hurt or injury whatever
happening ; and befides thefe advantapes,
as there v^ill be time for the fundus uteri,
F 4 ^Cp
( 72 )
&c. gradually to contrail:, and thereby
flowly, perfecSlly and naturally to feparate
and caft off the placenta, no undue reten-
tion of it will happen, or any violent flood-
ing enfue therefrom.
Whereas, on the contrary, if the wo-
man is violent in her pains, bearing or
forcing downwards with all her ftrength ;-
or more particularly, if the pradtitioner is
impatient to deliver the body of the child
immediately after the head is born ; and
particularly, if it happens to be a fmall
child, and the uterus much diftended with
water, he will prevent the natural, gradual
and fpontaneous feparation and expulfion of
the placenta ; for generally the uterus will
contra(5l where there is leaft refinance to
it ; fo when the child is very fuddenly de-
livered, the contradion will always be to-
wards the cervix uteri (for as yet there is
an adhefion between the fundus uteri and
the placenta), and occafion what is called
the hour-glafs contraclion of the uterus,
retaining the placenta as within a purfe,
with its mouth drawn clofe together by its'
ftrings : and now, if the practitioner is not
very
\ ( 73 )
very circumfpe(5l and careful, he will cre-
ate much mifchief, and even occafion death
itfelf ; for if he is in a hurry to extra<5l the
placenta, not giving time for a proper re-
paration of it, and relaxation of the hour-
glafs contra6lion of the uterus, or not
thinking that there may be a twin child*
behind, if he pretends very unthinkingly to
extract the placenta by pulling at the funis
with fome degree of force, if that is weak
and (lender it will for the moft part break,
and leave the body of the placenta behind ;
and then perhaps, if he is impetuous, he
will be fo very imprudent as raflily to in-
troduce his hand into the uterus ; and if
then he finds not another child within the
* As a woman may have twin children, it is necef-
fary foon after one child is born, the funis umbilicalis
tied and cut, and the child delivered to the nurfe, for the
pra£litioner to touch the woman, in order to know, be-
fore he thinks on the extraction of the placenta, if there
be a twin child remaining within the uterus ; if fo, and
the head prefents, the delivery of it muft be left to nature,
and to the natural efforts of her pains ; but if any other
part prefents, it then muft be delivered as in preternatural
labors; after which the pradlitioner muft leave the fepa-
ration of the placenta to nature, and then to be extradled
as in other natural labors.
Uterus,
( 74 )
Uterus, he will violently tear off, and fepa-
rate the placenta, and thus extra£l it, leav-
ing the connecting or anaftomofing vefiels
of the uterus vv^ith the placenta ruptured,
open and bleeding ; hence the woman will
foon become faint from lofs of blood, and
hence will arife many other very dangerous
and deplorable difeafcs often terminating in
death. Again, if there is no twin child
within the uterus, and the funis is fo ilrong
as to withftand breaking on being forcibly
and violently pulled, then there will enfue
either a very difagreeable bearing down of
the vagina, or, as I have feen, a total and
complete inverfion of the uterus, and from
which death has foon followed.
Therefore, I would advife every prac-
titioner to proceed (lowly and tenderly in
delivery, to give time for a gradual, natural
and neceiiary contra6lion of the fundus
uteri, fo that the perfed and natural fepa-
ration of the placenta may take place ; and
further, for the fafe and total expuliion of
the placenta, the praflitioner fhould, after
the child is born (although there is no twin
child behind in the uterus), wait patiently
8 fov
( IS )
for fome time, that it may be feparated by
nature, and protruded from the uterus into
the vagina by the natural pains of the wo-
man ; and indeed by a flow and gradual
conducing of the labor, the placenta gene-
rally Will be fafely, gradually and perfedly
feparated from the fundus uteri, and will
then for the moft part be naturally pro-
truded fo far as to fall down into the va-
gina almoft immediately after, or as foon as
the child is delivered 5 and if fo feparating
in time pf labor, and laying in the vagina,
it then feldom caufes or creates much after
pain, nay little or no pain ; therefore, after
the pra6litioner has waited for fome time
after delivery and no returning after-pains
of the woman occur, as generally in fuch
cafes do not (all which obfervation and ex-
perience will foon teach him to know), he
may then touch the woman ; and on find-
ing the placenta laying within the vagina,
he may then be affured, that the fundus
uteri is properly contraded, and that the
placenta is perfedly, totally and naturally
feparated therefrom, and is delcended into
the vagina, and that by a gentle bearing
down
( 76 )
down of the woman, as if going for ftool,
and at the fame time the praditioner gently
drawing the funis downwards, the placenta