Fig. 112.
Mode of introduction of the first branch.
and if this cause the patient no pain, it will prove that no portion of the soft parts is included in the grasp.
When the instruments are thus firmly flexed upon the head, the handles will always point out the line in which the tractive effort is to be made, within will always be the axis of the cavity occupied by the head.
It frequently happens that the forceps must be applied in other positions of the head, and when they cannot be applied in the lateral halves of the pelvis, as in the former cases, for in so doing they could not be placed on the sides of the head, where they ought always to be applied. We may lay it down them as general rule that the sagittal suture and the posterior fontanelle will always afford positive guides for the correct application of the forceps; and when we know the direction of the sagittal suture, and the position of the posterior fontanelle, we then know where the sides of the head are and what point is to rotate under the arch of the pubis. Then the blades are to be introduced as in the manner first described, and as the blades are slipped around on the sides of the head the concave margin of the
Fig. 113.
Introduction of the second brand.
Blades must look towards the posterior fontanelle, for this point most usually rotates to come under the pubis arch, now the pivot of the male blade will be parallel to the suture. There are cases when the occiput is found to be too far back, so that we know it will rotate into the hollow of the sacrum. In these exceptional cases the concave margins of the blades must look towards the anterior fontanelle, for that point will rotate to come under the pubic arch. Now it will not always be possible to apply the forceps by introducing the male blade first. It is better to do so when it is possible, for then the lock comes nicely together, without being compelled to separate the handles far part, so as to bring the male blade under the female blade, as it happens when the female blade is introduced first.
when the instruments are locked, the direction of the handles will always indicate the direction in which the tractive force is to be applied. When the head is in the superior strait, and the instruments are locked, the handles will always be at the extreme posterior commissure of the vulva, which shows (the females lying on her back) that the tractive force is to be made downwards and backwards, just as the handles point. As the head descends into the cavity more and more, the handles will elevate themselves more and more, till at the instant of the disengagement of the head from the vulva the handles will point most or directly upwards. While operating, then, it is
Fig. 114.
The forceps applied and locked.
wise, after any tractive effort, to let go our grasp, that the handles may point in what direction the next effort should be made. The tractive efforts should be made with every pain, and only then. They should be made to imitate the uterine contractions as nearly as possible, resting when they rest, and drawing as carefully and gently as possible when they expel,- yet with sufficient force to be made effectual.
Great care should be used not to wound the soft parts by swaying the instrument sideways or upwards and downwards, as all these motions are useless. As the perinaeum becomes distended, we should advance slowly and cautiously, giving the parts time to dilate, so as not to cause rupture or laceration. With a little common sense, guided by good judgment, the application of the forceps in an easy matter.
The use of anaesthetics in these operations is particularly objectionable; since it tends to render them more dangerous. For, when pain is produced by pressure with the forceps, we know all is not right; and hasten to correct the error. But where the patient is rendered unconscious by the use of anaesthetics, this valuable indication of is lost.
Not only should the application of the forceps be unattended with pain, but no force should be used in applying them. The blades should slip in very easily; and they will certainly do so if the palmar surfaces are kept properly applied to the head, and if the instruments are not hurriedly introduced.
When the head remains after the body as been delivered and after flexing the head by pressure with the finger in the child’s mouth, which would seldom happen, the child should be crowded to the posterior and the forceps applied upon the sides of the head after flexing the head as much as possible, the concave surface of the handles being applied next to the child. If this attempt result in failure, the craniotomy forceps must be applied. The vectis or lever is a very useful little instrument, which might be used to advantage much more frequently than it is. The vectis may very easily be applied over the occiput, sinciput, or sides of the head; and by making a fulcrum of one hand, the other can cause considerable traction. In facial presentation, particularly when flexion takes place slowly, the vectis may be made to take the place of the forceps. And in any flexion of the head this instrument may be of great use, as in some posterior facial presentations. In using this instrument, however, great care must be taken that we do not, in the least, make a fulcrum of the side of the pelvis, but use the free hand altogether for the purpose of a fulcrum.
INDUCTION OF PREMATURE LABOR.
The induction of premature labor by artificial means is admissible under certain circumstances. By premature labor, we mean, that only which, may take place after the viability of the child is established beyond a doubt. This period first occurs immediately after the close of the seventh month.
In all cases where the excavation of the pelvis is so obstructed by any cause, either by pelvic deformity or by tumors of any kind that cannot be reduced, or pushed above the superior strait, which will prevent the passage of the child at full term, premature labor may be effected; provided always, that such a course will give a reasonable assurance of saving the life of the child and at the same time of preventing greater sufferings and danger to the mother.
Should the history of the patient prove that she cannot give birth to a child at term, and should the smallest diameter be about two inches and a half, premature labor should be resorted to immediately after the completion of the seventh month. If we could be assured that the smallest diameter is three, or three had a quarter be assured that the smallest diameter is three, or three and a quarter inches, we may delay the operation till about the eighth month.
Under judicious Homoeopathic treatment, no disease condition of the patient would ever render necessary a premature delivery. Neither would it ever prove admissible to induce premature labor, where the previous history goes to show that the child perishes at the eighth, or eighth and a half month. For all such cases are perfectly curable by medicines. See Diseases of Pregnancy.
The best mode of operation for the induction of premature labor is simple and safe. Many others might be enumerated, but as their practical value is as nothing when compared to that should to be described, we shall not even mention them. The patient to be operated upon may assume the same position as in labor. The bed should be protected with oil-cloth or India-rubber cloth, arranged so as to guide a stream of water from the vulva into a pail or tub placed near the bed. Another pail must be provided, containing tepid water, with a common syringe the warm water should be thrown directly upon the os uteri. This operation of irritates and softens the neck of the uterus, so that contractions set in in the course of an hour or two, and thus labor is provoked and takes place in the most natural manner possible, except when it occurs in nature’s own way at full term. The operation will fail unless the stream is so directed that it shall fall directly upon the neck of the uterus. It should be repeated in the course of two hours, unless the first experiment is successful. The common pump syringe is the best for this purpose; though the India-rubber (or bulb) syringe will answer; but not the common squirt-gun syringe. The quantity of water used at each operation should be about ten quarts. The value of this made of operation above all others, is beyond all question, in every respect, in safety for mother and child.
Of the production of Abortion, that vexed, that much abused, that awfully abused, that wickedly abused presumption, we have this to say: Can it be right under any circumstances whatever? Is it right to commit wilful murder under any circumstances whatever? If not, then it is never right to produce abortion, under any circumstances whatever, for is not abortion actual murder!
Under Homoeopathic treatment we have abundance of proof that no state or condition of health demands this operation; for the subject of such a malady as might be thought to require it under Allopathic treatment, is cured by Homeopathy, not only of such ailments as are developed by pregnancy, but the general health is also restored. Chronic maladies are even more easily cured under the influence of pregnancy than in any other condition; and every abortion that is perpetrated is not only murder of the production of conception, but also a slow murder of the mother herself.
