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. XXVI.

How to deliver a Woman, when the Child is Hydro∣pical, or Monstrous.

A Child may in the Womb have either the Dropsie of the Head, called Hydrocephale, or of the Breast, or of the Belly. And when these parts are so filled with water, that they are much too big for the passage through which the Child must issue; then notwith∣standing any Throws or endea∣vors, by which the Woman may attempt to bring it forth, 'tis im∣possible she should effect it with∣out the help of Art; as likewise when the Child is Monstrous, ei∣ther by being only too big in the whole Body, or in any particular part, or by being joyned to ano∣ther Child.

If the Child be living that has the Dropsie, when the Woman is in Labour, it must be destroyed to save the Mother, by making a hole in either the Head, Breast, or Belly of it, where the Waters are contained, that being emptied by the apertion so made, the Child may the easier be drawn forth, or else he must necessarily dye in the Womb, not being able to be Born; and remaining there will also kill the Mother. Wherefore to save her life, the Infant must be by an indispensable necessity brought forth by Art, since 'tis impossi∣ble it should come of it self; which may be done with a crooked knife sharp at the very point, the Chi∣rurgeon proceeding in the follow∣ing manner.

After that the Woman is placed conveniently for the operation, he must slide up his left Hand on the right side of the inferior part of the Infant's Head, if the waters be contained therein; which he will perceive by the extraordinary big∣ness and extent of it; the Sutures much separated, and the Bones of it far distant one from the other, by reason of the distention made by the inclosed waters, of which being very certain, let him slide with his right Hand along the in∣side of his left his crooked knife, taking care that the point of it, ••n introducing it, be always to∣wards his left Hand, for fear of wounding the Womb; and having conducted it close up to the Head, against one of the Sutures, let him turn the knife towards it, and make an Apertion large enough to let out the water: And then it will be very easie to bring forth the

Child; forasmuch as the other parts are then usually small, and much consumed.

If these Waters were contained in the Breast or Belly, then the Child's Head being no bigger than ordinary, may be born; but the Body being exceedingly swelled with the Waters, will stay be∣hind.

The case being thus, let the Chirurgeon slide up his lest Hand, as aforesaid, and the instrument with the right, just to the Breast or Belly, to make incision, and to let out the Waters: after which, he may with much ease finish the operation.

You must know, that 'tis much more difficult to deliver a mon∣strous Birth, or two joyned toge∣ther, than one that has the Drop∣sie: because the bigness of the Hy∣dropick parts may be easily lessened by a single incision, which is suf∣ficient to let out the Waters which distend; and then 'tis easy to dis∣patch the rest.

But when a monstrous Child, or a double one, is to be extract∣ed, a single apertion is not enough, but sometimes 'tis necessary to take off whole Members from these Bodies, which makes the operati∣on much more painful and labo∣rious, and requires more time and skill to effect it; in which case the left Hand must be introduced into the Womb, and the sharp knife with the right just to the parts that are to be divided and separated, and there with all the care that may be, the member of the monstrous Child must, if pos∣sible, be taken off just at the Joynt. And when there are two Children joyned together, the separation must be made just in the place where they joyn; and afterwards they may be delivered one after the other; always taking them by the Feet, and if it hath but one, the same thing may be accomplished, after having lessened the bigness of it, by cutting off some one of the Members.

The instrument ought to be as long as an ordinary Crochet, for the more surety and facility; be∣cause that holding the handle of it with the right Hand, it may be thrust, drawn, sloped and turned, without pain, to any side at plea∣sure; and with the lest, which is within the Womb, it may be gui∣ded to cut and dismember more skilfully and easily those parts which must be separated. Wherefore it ought to have a handle so long, that the Chirurgeon's right Hand without the Womb may hold and govern it as abovesaid, and conduct it the better in the operation; which would not be so safely and conveniently done, if this instrument were so very short, as all other Authors recommend: because in this occasion the Chirur∣geon's Hand is so constrained and pressed in the Womb, that he can hardly there have the liberty to move his fingers ends, which is the cause why he cannot without much difficulty govern such an instru∣ment with one Hand only, unless he would very much force and offer violence to the Womb, and there∣by exceedingly endanger the poor Woman's life. Let us now come to the extraction of a dead Child, and shew the several ways of doing it.