Chirurgorum comes, or, The whole practice of chirurgery begun by the learned Dr. Read ; continued and completed by a Member of the College of physicians in London.

CHAP. XIV.

How to fetch a Child, when coming right it cannot pass, either because it is too big, or the passages cannot be sufficiently dilated.

THere are some Women, whose Children (notwithstanding they come right) remain some∣times four, five, and six whole days in the passage, and would continue there longer, if they were left alone, without being able to be born, unless assisted by Art; to which we are obliged, if we de∣sire to have the Mother's life. This happens oftnest to little Women of their first Children, and chiefly, if a little too much in years; be∣cause their Womb being very dry, cannot be so easily dilated, as others, who already have had Chil∣dren, or are not so old. When this happens, after that the Chi∣rurgeon hath done his endeavour to relaxe and dilate the parts, to facilitate the Child's birth, and that he finds all in vain, because the Head is much bigger than it should be, and that besides it is certainly dead (as it for the most part is, when it hath continued four or five days in this condition, after the waters are broke) which he may be more exactly assured of by the signs already described: He need then make no scruple to fa∣sten a Crotchet to some part of the Child's Head, and rather about the hinder part than any other, to draw it forth by this means direct∣ly, if possible; if not, let him make an incision with a streight or little crooked knife, which is best, about the Sutures, to empty thence some of the Brain, and so lessen the blgness of the Head, and im∣mediately after fix his crotchet fast to the Skull in the same place, whereby he will easily extract the Infant.

It is very certain when the Child is dead, one ought to do according to my direction, to save the Mo∣ther's life: But it is a very great que∣stion, Whether a live Child ought to be so dealt with to save the Mo∣ther's life, after there is no more hope that it can be born any other ways, because of the narrowness

of the passage, which cannot pos∣sibly be sufficiently dilated for its birth; or, Whether one ought to defer the operation, until there is a perfect assurance that 'tis dead? In this case I am apt to believe, that, since the Infant cannot avoid death, neither one way nor the other (for staying in the passage, without being able to be born, it must dye, and being drawn forth by crotchets, it is killed) one must and ought to fetch it out alive or dead, as soon as there is opportu∣nity to do it; and when all hope is lost that it cannot come any other ways, thereby to prevent the Mother's death, which could by no other means be avoided. Tertullian (as Riolanus very well notes in his 38th Chapter of the 12th Book of his Anatomical Ma∣nual) says upon this subject,

That it is a necessary cruelty, to kill the Child in this case, rather than to save it from the danger it is in of dying, and so certainly cause the Mother's death.

Not∣withstanding, this must not always be put in practice by the Chirur∣geon, but in such an extremity; and then he may do the work as dextrously as he can.