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. XXVII.

Of delivering a dead Child.

WHen the Infant is dead in the Mother's Belly, the Labour is ever long and dan∣gerous, because for the most part it comes wrong; or, thô it comes right with the Head, the Woman's Pains are so weak and slow in these cases, that she cannot bring it forth, and sometimes she has none at all; forasmuch as Nature, half overthrown by the death of the Child, which cannot help it self, labours so little, that many times it cannot finish the business it has begun, but most yield without the help of Art, of which at that time it has great need. However, before you come to manual operation, endeavour to stir up the Woman's Pains with sharp and strong Cly∣sters, to bring on Throws to bear down and bring forth the Child: But if all this prevails not, she must be delivered by Art.

We have already declared the signs to know a dead Child in the Womb, of which the chief are; if the Woman perceives it not to stir, nor has a long time before; if she be very cold, much pain and heaviness in the bottom of her Bel∣ly; if the Child be not support∣ed, but always falls like a mass of Lead to that side on which the Woman lies, if the Burthen or Na∣vel-string has been a long time in the World; and if no pulsation be there felt; and that dark and stink∣ing putrid matter comes away from the Womb. All these signs toge∣ther, or most of them, shew the Child is assuredly dead; which when the Chirurgeon is certain of, he must do his endeavor to fetch it as soon as possible he can, and having placed the Woman accord∣ing to former directions; if the Child offers the Head first, he must gently put it back, until he has li∣berty to introduce his Hand quite into the Womb, and sliding it all along under the Belly to find the Feet, let him draw it forth by them, as is formerly taught; being very careful to keep the Head from being lockt in the passage, and that it be not separated from the Body, which may easily be done, when the Child being very rotten and putrefied, the Chirurgeon does not observe the circumstances of∣ten repeated by us, that is, (in drawing it forth) to keep the Breast and Face downwards. And if, notwithstanding all these pre∣cautions, the Head, because of the

great putrefaction, should be sepa∣rated and remain behind in the Womb, it must be drawn forth ac∣cording to the directions given in the proper Chapter.

But when the Head coming first, is so far advanced and engaged among the Bones of the passage, that it cannot be put back, then being very sure by all the signs to∣gether, or most of the chief of them, that the Child is certainly dead, 'tis better to draw it forth, than to torment the Woman too much by putting it back, to turn it and bring it by the Feet. But because it being a part round and slippery, by reason of the moisture, the Chirurgeon cannot take hold of it with his Fingers, nor put them upon the side of it, because the passage is filled with its big∣ness, he must take a crotchet, and put up as far as he can without vi∣olence, between the Womb and the Child's Head, where he must fa∣sten it, endeavoring to give it good hold upon one of the bones of the Skull, that it may not slide, for∣cing in the point of it, which must be strong, that it may not turn; and after the Crotchet is well fix∣ed in the Head, he may therewith draw it forth, keeping the ends of the Fingers of his left Hand flat upon the opposite side, the better to help to disengage it, and by wagging it by little and little, to conduct it directly out of the pas∣sage.

It were to be wished that it were possible to introduce the Crotchet so far, that one might fix it (for the better hold) in one of the Eye-holes, or cavities of the Ears; but very often there is not room at first to carry them beyond the middle of the Head, and then they must be fastned according to our directions; and rather, if possi∣ble on the hinder part than any other, that so it may be drawn forth in a streight line; and when by the first fastning of the Crotchet the Head is drawn lower, and be∣gins to be disengaged, you may loosen it out of the first place to fasten it farther up, that stronger hold may be taken, and so succes∣sively removing and fastning of it, until the Head be quite born, and then taking hold of it immediate∣ly with the Hands only, the Shoul∣ders may be drawn into the pas∣sage; and so sliding the Fingers of both Hands under the Arm-pits, the Child may be quite delivered, and then the Burthen fetcht to fi∣nish the operation, according to knowledge; being careful not to pull the Navel-string too hard, lest it break, as it often happens when it is corrupted.

If the dead Child (of which above all, there must be good assurance) comes with the Arm up to the Shoulders so extremely swelled, that the Woman must suffer too much violence to have it put back, 'tis best then to take it off at the Shoulder-joint, by twisting it three or four times about, as we have al∣ready taught in another place, by which means there is no need of either Knives, Sawes, or sharp Pincers, as some Authors will have it; it being very easily performed without all that provision, because of the softness and tenderness of the Body. After that the Arm is so separated, and no longer pos∣sessing the passage, the Chirurgeon

will have more room to put up his Hand into the Womb to fetch the Child by the Feet, and bring it away as has been directed.

Althô the Chirurgeon be sure that the Child is dead in the Womb, and that it is necessary to fetch it by Art, he must not therefore pre∣sently use his Crotchets, because they are never to be used but when Hands are not sufficient, and that there is no other remedy to pre∣vent the Woman's danger, or to bring the Child any other way; because, very often, thô he has done all that Art directs, persons present, that understand not these things, will believe that the Child was killed with the Crotchets, al∣thô it had been dead three days be∣fore, and without other reasonings or better understanding of the mat∣ter, for recompence of his saving the Mother's life, requite him with an accusation, of which he is al∣together innocent; and in case the Mother by misfortune should after∣wards dye, lay her death also to his charge, and instead of praise and thanks, treat him like a Butcher or a Hangman; to which divers Midwives are usually very ready to contribute, and are the first that make the poor Women, that have need of the Men, afraid of them. So much they are in fear of being blamed by them, for having them∣selves been the cause (as some of them often are) of the death of Infants, and many ill accidents, which after befall the poor Women, not causing them to be helped in due time, and from the moment they perceive the difficulty of the Labour to pass their understand∣ings.

To avoid therefore these calum∣nies, let the Chirurgeon never use these Crotchets but very rarely, and when there is no other way, as also to endeavour his utmost (as much as the case will permit) to bring the Child whole, although dead, and not by bits and pieces, that thereby the wicked and igno∣rant may have no pretence of blame. I say, as much as the case will permit, that is, with respect to the Woman under his hands: For to save her, he had better sometime bring the dead Child with instru∣ments, than kill her, by torment∣ing her with excessive violence to bring it whole. But, in a word, we must in conscience do what Art commands, without heed what may be spoken afterwards: And every Chirurgeon, that has a well ordered Conscience, will ever have a greater regard to his Duty than reputation; in performing of which let him expect his reward from GOD.