The workes of that famous chirurgion Ambrose Parey translated out of Latine and compared with the French. by Th: Johnson

CHAP. XXVI. Of the Chyrurgicall extraction of the childe from the wombe either dead or alive.

THerefore first of all the aire of the chamber must bee made tempe∣rate, and reduced unto a certaine mediocrity, so that it may nei∣ther * 1.1 be too hot nor too cold. Then she must be aptly placed, that is to say, overthwart the bed side, with her buttockes somewhat high, having a hard stuffed pillow or boulster underthem, so that she may be in a meane figure of situation, neither sitting altogether upright, nor altogether lying along on her backe; for so shee may rest quietly, and draw her breath with ease, neither shall the ligaments of the womb bee extended so as they would if shee lay upright on her backe, her heeles must bee drawn up close to her buttocks, and there bound with broad and soft linnen rowlers. The rowler must first come about her neck, and then crosse-wise over her shoulders, * 1.2 and so to the feet, and there it must crosse again, and so be rowled about the legs and thighes, and then it must be brought up to the necke againe, and there made fast, so that she may not be able to move her selfe, even as one should be tyed when he is to be cut of the stone. But that shee may not bee wearied, or lest that her body should yeeld or sinke downe as the Chirurgian draweth the body of the infant from her, and so hinder the worke, let him cause her feet to bee set against the side of the bed,

and then let some of the strong standers by hold her fast by the legs and shoulders. * 1.3 Then that the aire may not enter into the wombe, and that the worke may bee done with the more decency, her privie parts & thighs must be covered with a warm dou∣ble linnen cloath. Then must the Chirurgion, having his nailes closely pared, and his rings (if hee weare any) drawne off his fingers, and his armes naked, bare, and well anointed with oyle, gently draw the flappes of the necke of the wombe asunder, and then let him put his hand gently into the mouth of the wombe, having first made it gentle and slippery with much oile; and when his hand is in, let him finde out the forme and situation of the childe, whether it be one or two, or whether it be a Mole or not. And when he findeth that he commeth naturally, with his head toward the * 1.4 mouth or orifice of the wombe, he must lift him up gently, and so turne him that his feet may come forwards, and when he hath brought his feet forwards, he must draw one of them gently out at the necke of the wombe, and then hee must binde it with some broad and soft or silken band a little above the heele with an indifferent slack knot, and when he hath so bound it, he must put it up againe into the wombe, then he must put his hand in againe, and finde out the other foote, and draw it also out of the wombe, and when it is out of the wombe, let him draw out the other againe where∣unto he had before tyed the one end of the band, and when hee hath them both out, let him join them both close together, & so by them by little & little let him draw all the whole body from the wombe. Also other women or Midwives may help the en∣deavour of the Chirurgion, by pressing the patients belly with their hands downe-wards as the infant goeth out: and the woman her selfe by holding her breath, and closing her mouth and nostrills, and by driving her breath downewards with great violence, may very much helpe the expulsion. I wish him to put backe the foot into the wombe againe after he hath tyed it, because if that he should permit it to remain in the necke of the womb, it would hinder the entrance of his hand when he putteth it in to draw out the other. But if there bee two children in the wombe at once, let the Chirurgian take heed lest that he take not of either of them a legge, for by draw∣ing them so, hee shall profit nothing at all, and yet exceedingly hurt the woman. Therefore that he may not bee so deceived, when hee hath drawne out one foot and tyed it, and put it up again, let him with his hand follow the band wherewithall the foot is tyed, and so goe unto the foot, and then to the groine of the childe, and then from thence he may soone finde out the other foot of the same child: for if it should happen otherwise, he might draw the legges and the thighes out, but it would come no further, neither is it meet that hee should come out with his armes along by his sides, or bee drawne out on that sort, but one of his armes must bee stretched out a∣bove his head, and the other down by his side, for otherwise the orifice of the womb when it were delivered of such a grosse trunke, as it would be when his body should * 1.5 be drawne out with his armes along by his sides, would so shrinke and draw it selfe when the body should come unto the necke, onely by the accord of nature requi∣ring union, that it would strangle and kill the infant, so that hee cannot be drawne there-hence unlesse it bee with a hooke put under, or fastened under his chinne, in his mouth, or in the hollownesse of his eye. But if the infant lyeth as if hee would come with his hands forwards, or if his hands bee forth already, so that it * 1.6 may seeme hee may bee drawne forth easily that way, yet it must not be so done; for so his head would double backwards over his shoulders, to the great danger of his mother. Once I was called unto the birth of an infant, whom the midwives had assayed to draw out by the arme, so that the arme had been so long forth that it was gangrenate, whereby the childe dyed; I told them presently that his arme must bee put in againe, and hee must bee turned otherwise. But when it could not bee put backe by reason of the great swelling thereof, and also of the mothers genitals, I determined to cut it off with an incision knife, cutting the muscles as neare as I could to the shoulder, yet drawing the flesh upwards, that when I had taken off the bone with a paire of cutting pincers, it might come downe againe to cover the shivered end of the bone, lest otherwise when it were thrust in againe into the wombe, it might hurt the mother. Which being done, I turned him with his feete forwards, and drew him out as is before sayd. But if the tumour either naturally or by some

accident, that is to say, by putrefaction, which may perchance come, bee so great that hee cannot bee turned according to the Chirurgions intention, nor be drawne out according as hee lyeth, the tumour must bee diminished, and then hee must bee drawne out as is aforesaid, and that must bee done at once. As for example, * 1.7 if the dead infant appeare at the orifice of the wombe, which our mydwives call the Garland, when it gapeth, is open and dilated, but yet his head being more great and puffed up with winde so that it cannot come forth, as caused to bee so through that disease which the Greeks call Mucrophisocephalos, the Chirurgion must fasten a hooke under his chinne, or in his mouth, or else in the hole of his eye, or else, which is better and more expedient, in the hinder part of his head. For when the scull is so opened, there will bee a passage whereat the winde may passe out, and so when the tumour falleth and decreaseth, let him draw the infant out by little and little, but not rashly, lest he should break that whereon he hath taken hold: the figure of those hookes is thus.

[illustration]

The forme of hookes for drawing out the infant that is dead in the wombe.

But if the breast bee troubled with the like fault, the hookes must bee fastened a∣bout the chanell bone: if there bee a Dropsie or a Tympany in the belly, the hooks must bee fastned either in the short ribs, that is to say, in the muscles that are be∣tweene the ribbes, or especially, if the disease doe also descend into the feete, about the bones that are above the groine; or else putting the crooked knife here pictured i•…•…he wombe with his left hand, let him make incision in the childs belly, and so get out all his entrals by the incision, for when hee is so bowelled, all the water that caused the dropsie will out. But the Chirurgion must do none of all these things but when the child is dead, and the woman that travelleth in such danger that shee cannot otherwise be holpen.

But if by any meanes it happeneth that all the infants members bee cut away by * 1.8 little and little, and that the head onely remaineth behinde in the wombe, which I have sometimes against my will, and with great sorrow seene, then the left hand being anoynted, with oyle of Lillies or fresh butter must bee put into the wombe, wherewith the Chirurgion must find out the mouth, putting his fingers into it; then with his right hand hee must put up the hooke, according to the direction of the left hand, gently, & by little & little, and so fasten it in the mouth, eye, or under the chin, and when hee hath firmely fixed or fastened it, hee must therewith draw out the head by little and little, for feare of loosening or breaking the part whereon hee hath hold. In stead of this hooke you may use the instruments that are here descri∣bed,

which therefore I have taken out of the Chirurgery of Francis Dalechamps, for they are so made, that they may easily take hold of a sphaericall and round body with the branches, as with fingers.

[illustration]

Gryphons Talons, that is to say, instruments made to draw out the head of a dead infant that is separated in the wombe from the rest of the body.

But it is not very easie to take hold on the head when it remaineth alone in the * 1.9 wombe, by reason of the roundnesse thereof, for it will slip and slide up and downe, unlesse the belly be pressed downe, and on both sides, thereby to hold it unto the in∣strument, that it may with more facility take hold thereon.

Notes

• * 1.1

  After what sort the woman in travell must be placed when the child, being dead in her wombe, must be drawne out.
• * 1.2

  How she must be bound.
• * 1.3

  How the Chi∣rurgion ought to prepare him∣selfe and his pa∣tient to the drawing out of the child from the wombe.
• * 1.4

  How the infant that is dead in the womb must be turned, bound and drawne out.
• * 1.5

  A caution to a∣void strangling of the infant in drawing out the body.
• * 1.6

  Why the child must not bee drawn out with his hands for∣wards. A history.
• * 1.7

  To diminish the wind wherewith the infant being dead in the wombe, swolleth & is pufted up that he cannot be gotten out of the wombe.
• * 1.8

  How the head of the infant, if it remaine in the wombe separa∣ted from the body, may be drawne out.
• * 1.9

  Why the head being alone in the wombe, is more difficult to be drawne out.