Chapter XXI

IN CASES OF EXTREMITY, WHAT OUGHT TO BE DONE.

The woman being across the bed, let the operator put up his or her hand, if the neck of the womb be dilated, and remove the contracted blood that obstructs the passage of the birth; and having by degrees gently made way, let him tenderly move the infant, his hand being first anointed with sweet butter or a harmless pomatum. And if the waters be not come down, then without difficulty may they be let forth; when, if the infant should attempt to break out with the head foremost or cross, he may gently turn it to find the feet; which having done, let him draw forth the one and fasten it to the riband, then put it up again, and by degrees find the other, bringing them close and even, and let the woman breathe, urging her to strain, in helping nature to perform the birth, and that the hold may be surer, wrap a linen cloth about the child’s thighs observing to bring it into the world with its face downwards.

In case of a flux of blood, if the neck of the womb be open, it must be considered whether the infant or secundine come first, which the latter sometimes happening to do, stops the mouth of the womb, and hinders the birth, endangering both the woman and child; but in this case the secundine must be removed by a swift turn; and they have by their so coming down deceived many, who feeling their softness supposed the womb was not dilated, and thus the woman and child have been lost. The secundine moved, the child must be sought for, and drawn forth; and in such a case if the woman or child die, the midwife or surgeon is blameless, because they did their best.

If it appears upon inquiry that the secundine comes first, let the woman be delivered with all convenient expedition, because a great flux of blood will follow.

In drawing forth a dead child, let these directions be carefully observed by the surgeon, viz. If the child be found dead, its head being foremost, the delivery will be more difficult; for it is an apparent sign, by the woman’s strength beginning to fail her that the child being dead, and wanting its natural force, can be no ways assisting to its delivery; wherefore the most safe way for the surgeon is to put up his left hand, sliding it as hollow in the palm as he can into the neck of the womb, and into the lower part thereof towards the feet, and then between the head of the infant and the neck of the matrix; then having a hook in the right hand couch it close, and slip it up above the left hand, between the head of the child, and the flat of his hand, fixing it in the bars of the temple towards the eye. For want of a convenient coming at these in the occiputal bone, observe still to keep the left hand in its place, and with it gently moving and stirring the head, and so with the right hand and hook draw the child forward, admonish the woman to put forth her utmost strength, still drawing when the woman’s pangs are upon her. The head being drawn out, with all speed he must slip his hand under the arm-holes of the child, and take it quite out; giving these things to the woman, viz. a toast of fine wheaten bread in a quarter of a pint of Ipocras wine.

ARISTOTLE’S WORKS.

THE MIDWIFE.
GUIDE TO CHILD-BEARING WOMEN.