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. VII.

Of laborious and difficult Labours, and those against Nature, their causes and differences, together with the means to remedy them.

FOr the easier and better ex∣plaining these things, we say, that there are three sorts of bad Labours; to wit, the painful or la∣borious; the difficult; and that which is altogether contrary to Na∣ture.

The laborious is a bad Labour, in which the Mother and Child (though it comes right) suffer ve∣ry much, and are harassed more than ordinary.

The difficulty is not much un∣like the first; but besides, it is ac∣companied with some accident which retards it, and causeth the difficulty: But the wrong Labour, or that against Nature, is caused by the bad situation of the Child, and can never be helped but by manual operation, or the Chirur∣geon's Hand. In the laborious and difficult Labours Nature always does the work, being a little assist∣ed: but in that contrary to Nature, all its endeavours are vain and use∣less, and then there is no help but in an expert Chirurgeon, without whom she must certainly perish.

The difficulties of Labour pro∣ceed either from Mother, Child, or both.

From the Mother, by reason of the indisposition of her Body; or it may be from some particular part only, and chiefly the Womb: or also from some strong passion of the Mind, with which she was before possest.

In respect of her Body, either because she may be too young, ha∣ving the passages too strait, or too old of her first Child; because her parts are too dry, and hard, and cannot be so easily dilated, as hap∣pens also to them which are too lean. They who are either small, short, or mishapen, as crooked Women, have not a Breast strong enough to help their pains, and to bear them down; nor those that are weak, whether naturally, or by accident; and crooked persons have sometimes the bones of the passage not well shaped. They that are teuden and too apprehen∣sive of pain, have more trouble than others, because it hinders them from doing their endeavour: And they likewise who have small Pains and slow, or have none at all. Great Colicks hinder Labour also, by preventing the true Pains. All great and acute Diseases make

it very troublesome, and of a bad consequence, according to Hippo∣crates, 3 Aph. Sect. 5. Mulierem gravidam morbo quopiam acuto cor∣ripi, lethale. As when she is ta∣ken with a violent Fever, great Flooding, frequent Convulsions, Dysentery, or any other great di∣stemper. Excrements retained cause much difficulty, as a Stone in the Bladder, or when it is full of Urine, without being able to void it; or when the great Gut is repleted with hard Ordure, or the Woman troubled with great and painful Piles, and their ill situati∣on sometimes retard it extremely.

As touching the difficulty pro∣ceeding from the Womb only, it must be either be from its bad si∣tuation or conformation, having its Neck too strait, hard or callous, whether naturally, or by any acci∣dent, as having had there a Tu∣mor, Aposteme, Ulcer or superflu∣ous flesh whether on the Neck or inward Orifice; or because of any cicatrice caused by a preceding bad Travail.

Bes••les, those things which are or may be contained in the Womb with the Child, do also cause diffi∣cult Travail; as when the Mem∣branes are so strong, that they cannot be broken, which some∣times hinders them from advancing into the passage; or so tender, that the waters break too soon, for then the Womb remains dry. When there is a Mole, or the Af∣ter-burthen comes first, which al∣ways causes Flooding, and certain∣ly the death of the Infant, if the Woman be not presently delivered of them by Nature or Art; yea, and when the Navel-string comes first, the Child is suffocated, if not speedily born; strong passions of the Mind do likewise contribute much to it, as fear, sorrow, and others of the like nature. The Woman that miscarries has more pain than a Woman at her full time; as also than one that is hurt, althô she be very near her time.

As to the hindrances caused by the Infant, they are, when either its Head or whole Body are too large, when the Belly is Hydropi∣cal; when it is monstrous, having two Heads, or being joyned to another Child, Mole, or any other strange thing; when it is dead, or so weak, that it contributes no∣thing to its Birth; when it comes wrong, or when there are two or more: besides all these different difficulties of Labour, there is yet one caused by the Midwife's ig∣norance, who for want of under∣standing her business, instead of helping, hinders Nature in her work.

Let us now treat of the means, by which all these may be prevent∣ed, and the Woman succored in her bad and difficult Labour, as may easily be done, if we perfect∣ly know all these causes and diffi∣culties; as when it happens by the Mother's being too young and too strait, she must be gently treated, and the passages anointed with Oil, Grease, and fresh Butter, using these things a long time before the hour of Labour, to relax and di∣late them the easier, lest there should happen a rupture in any part, when the Child is born; for sometimes there happens a dilace∣ration to the Fundament, by which both are rent into one outwardly.

If a Woman be in years of her first Child, let her lower parts be likewise anointed, to mollifie the inward Orifice, and the Vagina or neck of the Womb, which being more hard and callous, do not ea∣sily yield to the necessary distensi∣on of Labour; which is the cause why such Women are longer in Labour than others, and why their Children (being forced against the inward Orifice of their Womb, which is, as we said, a little cal∣lous, and also for remaining long in the passage) are born with great bumps and bruises on their Heads. Small and mis-shapen Women should not be put to Bed, till at least their Waters be broke; but rather kept upright, and walking about the Chamber, if they have strength, being supported under their Arms; for in that manner they will breath more freely, and mend their pains better than on the Bed, where they lye all on a heap. Let those that are very lean, also moisten these parts with Oyls and Ointment, to make them more smooth and slippery, that the Head of the Infant and the Womb be not so compressed and bruised by the hardness of the Mo∣ther's Bones, which form the pas∣sage.

The weak Woman should be strengthened, the better to sup∣port her Pains, giving her good Gelly Broths, with a little Wine and a Tost in it; or other good things, as the case requires.

If she fears the Pains, let her be comforted, assuring her, that she will not endure many more, but be speedily delivered: On the contrary, if her Pains be slow and small, or none at all, they must be provoked by frequent and somewhat strong Clysters, that so they may be excited by strain∣ings at stool; and afterwards let her walk about her Chamber, that the weight of the Child may also help a little. If the Woman Floods, or hath Convulsions (which is by many too long neglected) she must be helped by a speedy deli∣very. If she be costive, let her use Clysters, which likewise may dissipate a Colick, at those times very troublesome, causing great and useless pains, very hurtful, because they fleet to and again through the Belly, without bear∣ing down, as they should do. If she cannot make water, because the Womb bears too much on the Bladder, let her try, by lifting up her Belly a little, or else by in∣troducing a Catheter into her Bladder to draw forth her Urine.

If the difficulty or flowness of the Labour comes from the ill po∣sture of the Woman, let her be placed in a better, more conveni∣ent to her habit and stature. If she be taken with any distemper, she must be treated for it accord∣ing to its nature, with more cau∣tion than at another time, ha∣ving always regard to her present condition. If it proceed only from the indispositions of the Womb, or from its oblique situa∣tion, it must be remedied as well as can be, by the placing of her Body accordingly. If it be by its vitious conformation, having the Neck too hard, and too callous, and too strait, it must be anointed with Oils and Ointments, as above directed.

If it come from a strong Cica∣trice, which cannot be mollified, of a preceding Ulcer, or a rupture of a former bad Labour so agglu∣tinated, it must be separated with a fit instrument, lest another La∣ceration happen in a new place, and leave the Woman in a worse condition than before; it must be made in that place, where the case most requires it; taking care that it be not upwards, because of the Bladder. If the Membranes be so strong, as that the waters do not break in due time, they may be broken with the Fingers, provi∣ded the Child be come very for∣ward into the passage, and ready to follow presently after; for otherwise there is danger, that by breaking these waters too soon, the Child will remain dry a long time; and to supply that defect, you must moisten the parts with Fomenta∣tions, Decoctions, and emollient Oils; which can never be so well, as when Nature does its own work with the waters and ordinary slime, which always happen well, when they come in time and place.

Sometimes these Membranes with the waters, press three or four Fingers breadth out of the Body before the Child, resembling a Bladder full of water; there is then no great danger to break them, if they be not already; for when it so happens, the Child is always rea∣dy to follow, being in the passage; but above all, be careful not to pull it out with your Hand, lest thereby you loosen, before its time, the After-burthen, to which it ad∣heres very strongly. If the Navel∣string comes first, it must be pre∣sently put up again, and kept up, if possible; or else the Woman must be immediately delivered. But if the After-burthen comes first, it must never be put up again; for being come forth, it is altoge∣ther useless to the Infant, and would be but an obstacle and hin∣drance in the way; if it were put up in this case, it must be cut off, having tied the Navel-string; and afterwards draw forth the Child as soon as may be, lest it be suffoca∣ted.

If the Woman has had a fall, or is hurt, let her immediately keep her Bed and take her rest. If it be any passion that retards the La∣bour, and cannot totally be over∣come, let them endeavour to mo∣derate it. If it be shamefacedness or modesty, the persons who are the cause of it must quit the cham∣ber. If it be timidity and fear of pain, she must be advised, that it is the will of GOD it should be so, and that her Labour will not be so bad as she imagines, per∣swading her to submit to the neces∣sity, pressing on her the consola∣tion of the unfortunate, whose pain always seem more suppor∣table by the consideration that it is common; so she must be inform∣ed, that others endure the same pain, and greater than hers. If she be melancholick, let her be diverted by some good news, pro∣mising her such a Child as she de∣sires. And in a word (thô she suf∣fer much) she must consider it but as a bad journey, which one quarter of an hours good weather makes one forget all past, as she will, when she is brought to Bed; assuring her chiefly, that she is in no danger, especially when it is

not very apparent, for then one ought to acquaint her with it, that she may settle both her tem∣poral and spiritual Affairs.

When the difficulty is only cau∣sed by a dead Child, the method mentioned in the natural Labour must be observed; and besides, the Woman must do all she can to further her Delivery, because the Child can do nothing, nor can it when it is very weak. She must take in the-interim some Confortatives to prevent Fainting, because of the putrid Vapors, ascending from the dead Child. But when it has so great a Dropsie, either in the Head or Belly, as that it cannot be born, because of the great distention and bigness of these parts, then we are obliged to open these parts to let out the water. And if it be of an enormous bigness, either Head or Body, or if it hath two Heads, or is joyned to another Child, or to a big Mole, there is a necessity, for to save the Mother, either to dilate the passage proportionable to the bigness of the monstrous Child, if it be possible, or else, which is better, to draw forth the Child by pieces, to prevent the Mothers perishing with the Child, which else would certainly happen, if this course be not taken. And if there be two Children, the Rules given before in that case must be observed. But if the Midwife can∣not remedy all these accidents, she must then readily send for an ex∣pert Chirurgeon, for his advice, or to do what he thinks fit. Let us now pass to Labours contrary to Nature, which can never be done without manual operation, and shew what is then to be done.