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                 A

        S      E       T
                 OF
 ANATOMICAL   TABLES,
                 WITH
          EXPLANATIONS,

     And  an Abridgment of the
 PRACTICE OF  MIDWIFERY;
             WITH A VIEW TO
ILLUSTRATE A TREATISE ON THAT SUBJECT,
                 AND
           COLLECTION OF CASES.
                             I
By WILLIAM SMELLIE, m. d.
          PHILADELPHIA ;
PRINTED BY T. DOESON, AT THE STONE-HOUSE, N° £\3
         SOUTH SECOND-STREET.
1797. 
 
PREFACE.
    jTxS, in a long courfe  of teaching and
 practice in Midwifery, I hope I may without
 vanity  fay, that I have  done fornething  to-
 wards reducing  that Art  into a more fimple
 and mechanical method than has hitherto been
 done,  I have attempted to explain the fame
 in my Treatife of the Theory and  Practice of
 Midwifery and Collection of Cafes; and fmd-«
 ing that moft of the reprefentations hitherto
 given of the parts fubfervient to uterine gefta*
 tion and parturition were in many refpects de-
 ficient, I  have been induced  to undertake  the
 following  'Tables^  with  a view to  fupply iri
 fome meafure the defects of others, and at  the
 fame time to illuftrate what I  have taught and
 written on the fubject.  How far I have ob-
 tained  thofe ends,  it belongs to  others to
judge.   I  fhall only beg leave to obferve here
 by  way of Preface,  that the greateft part of
 the figures were  taken from Subjects prepared
 on  purpofe,  to fhew every thing that  might
                  A 2              conduce
 C 
iv              PREFACE.
                          •
conduce to the improvement of the  young  •
Practitioner:   Avoiding, however, the  ex-
treme minutia, and what elfe feemed foreign
to the prefent  defign ;  the fituation of parts,
and their refpectiVe dimenfions, being more
particularly attended to, than a minute anato-
mical invefHgai-.nn of rhpir ftru£ture.
   As thefe Tables may pofllbly fall into the
hands of fome who have not feen my  former
work,  I have  added an Abridgment of the
Practice; which, though far from being com-
plete, may ferve to illuftrate feveral things
which  otherwife, by  a bare reprefentation,
would be hardly intelligible.
   References are made to Vol. I. II. and I IT.
By Vol. I.  I  mean that which I firft publifh-
ed in the  year 1752, and  contains a  view of
the Theory and Practice of Midwifery ; Vol.
II. and ///. containing the Collection of Cafes
mentioned above.   My firft plan for thefe
 Tables  confined   them  to  the number  of
Twenty-two, which Mr. Rymfdyke had finidi-
 ed above  two years ago; but I foon faw that
 a further illuftration, and confequently an ad-
 dition  to  that number, was necefTary.    In
 eleven of thefe, Dr. Ca?nper, formerly Profef-
                                        for 
                PREFACE.             v
for of Medicine at Franequer in FriefJand, now
 Profeffor  of Anatomy and  Botany at Amfler-
 dam,  greatly  afiifted  me,  viz. Table XII.
 XVI. XVII. XVIII. XIX. XXIV. XXVI.
 XXVII.  XXVIII. XXXIV.  and  XXXVI.
 The reft were  drawn by Mr.  Rymfdyke; ex-
 cept the   thirty-feventh  and  thirty-ninth,
 which  were done by  another  hand.   The
 whole of the drawings are faithfully engraved;
 in which,  however,  delicacy  and  elegance
 have not been fo much confulted as to have
 them done  in a ftrong  and diftinct manner;
 with this view chiefly, that from the cheap-
 nefs of the work it may  be rendered of more
 general ufe. 
 
r 
>
PI. I-
I       Engraved, l>y   J.Iorman   ^^J 17 %6- 
EXPLANATIONS
             OP A SET OB

ANATOMICAL   TABLES,

     With  an Abridgment of the

   PRACTICE  OF  MIDWIFERY.
           THE FIRST TABLE,

    REPRESENTS, in a front view, the Bones
     of a well-formed Pelvis.

  A The five vertebra of the loins.
  B The osfacrum.
  C The os coccygis.
  DD  The offa ilium.
  EE The  offa  ifchium,
  F The offa pubis.
  G The foramina magna,
  HH The acetabula.
  IIII1I The brim of the pelvis, or that cir-
cumference  of its  cavity, which is defcribed
at the  fides of  the inferior parts of the offa
                                    ilium7 
 8           ANATOMICAL TABLES,
 ilium, and  at the back and fore  parts by  the
 fuperior parts of the  offa pubis and fic/am.

   In this  Table, befides the general ftructure
 and figure  of the feveral  bones, the dimenfions
 of the brim of the pelvis, and the diftance  be-
 tween the  under parts of the offa ifchium,  are
 particularly to be attended to ; from which it
 will appear, that the cavity of the brim is com-
 monly wider from  fide to  fide than from  the
 back to the fore part, but that the fides below
 are in the contrary proportion.  The reader,
 however,  ought not  to  conclude,  that every
pelvis is fimilar in figure  and dimenfions, fince
 even  well-formed ones differ in fome  degree
 from each  other.   In general, the brim of the
pelvis meafures about  five inches and a quarter
 from fide to fide, and  four inches and a quarter
 from  the back to the fore part ; there being
 likewife the fame diftance between the inferior
 parts of the offa ifchium.    All  thefe meafures,
 however, muft be underftood as taken from the
 fkeleton; for, in  the fubject, the cavity of the
pelvis is confiderably diminifhed by its tegu-
 ments  and contents.   Correfpondent  alfo to
 this diminution,  the  ufual  dimenfions of the
 head  of the  full-grown fcetus are but three
 inches and a half from  ear  to ear,  and  four
 inches and a quarter  from the fore to the hind
 head.
   Vide Tab.  XVI.  XVII. XVIII.  Alfo Vol.
 I. Chap. I. Sect. i. 2. 3. where the form  and
           4                      dimenfions 
7
          WITH  EXPLANATIONS, &C        9
dimenfions of the pelvis, as well as of the head
of the foetus, and  the manner in  which the
fame  is protruded in labour through the bafin,
are fully treated of.   Confult likewife Vol.  II.
Coll.  1.  No. i, 2. where cafes are given of
complaints of the pelvis arifing from difficult
labours.
B                THE 
IO
ANATOMICAL  TABLES,
           THE SECOND TABLE

 Gives a lateral and internal view of the Pelvis
   divided longitudinally.

   A The three lower vertebra of the loins.
   B The osfacrum.
   C The os coccygis.
   D The left os ilium.
   E The left os ifchium.
   F  The os pubis of the fame fide.
   G The acute procefs of the os ifchium.
   H The foramen magnum.
   Ill The brim of the pelvis.

   This Plate fhews the diftance from  the fu-
perior part of the osfacrum to the offa pubis, as
well as from the  laft-mentioned bones  to  the
coccyx, which in each amounts to  about four
inches and a  quarter.  The depth like wife of
the pofterior, lateral, and anterior parts of  the
pelvis, is fhewn, not in the  line of the body,
but in that of the pelvis from its brim  down-
ward, which is generally three times deeper on
the pofterior  than  anterior part,  and twice  the
depth of the  laft at the fides.
   From this view appears alfo the angle  which
is formed by  the laft vertebra of the loins and
the fuperior part of the os facrum,  as likewife
the concavity or hollow fpace in the pofterior
internal part of the pelvis, arifing from the cur-
                                      vature 
 
'iryrf

J> 
f
          WITH EXPLANATIONS, &C.        n
vature of the laft-mentioned  bone and coccyx ;
finally, the diftance  from which to the pofte-
rior parts of the offa ifchium is here exprefTed.
  VideTzh. XVI. XVII. XVIII.  XIX. Alfo
Vol. I. and  II. as referred to in the former
Table.
B 2               THE 
\
12          ANATOMICAL TABLES,

            THE THIRD TABLE

 Exhibits a front view of a diftorted  Pelvis.

   A The five vertebra of the loins.
   B The osfacrum.
   C The os coccygis.
   DD The offa ilium.
   EE  The offa ifchium.
   F The offa pubis.
   GG The foramina magna.
   HH The ace tabula.                           J

   From this Plate may  appear the great dan-    \
ger incident to both mother and child when the
pelvis is diftorted in this manner ; it being only     ;
two inches and an half at the brim from the pof-
terior to  the anterior  part,  and the fame dif-
tance between the inferior parts of each os ifcbi-   . .'
urn.  Vide Tab. XXVII. where the pelvis is one
quarter of an inch narrower at the brim than   ., ■
this, but fufficiently wide below.   Various are
the forms of diftorted bafins, but the laft men-
tioned is the moft common.   It is a great hap-
pinefs, however, in practice, that they are fel-
dom fo  narrow,  though there  are  inftances    i'
where they have been much more fo. The dan-
ger in all fuch cafes muft increafe or diminifh,
according  to  the degree of diftortion  of the     '
pelvis, and fize of the child's head.
   Vide Vol. I.  Book I.  Chap. i. Sect. 4,  5.
and Vol. II. Col.  1.  No. 3, 4, 5.   Alfo Coll.     j
31. 27. and 29,
                                       THE 
 
>
 
WITH EXPLANATIONS, &C.
*3
          THE FOURTH TABLE

  Shews the External Female Parts of Gene-
                   ration.

   A  The lower part of the abdomen.
   B B The labia pudendi feparated.
   G The clitoris and prteputium.
   DD The nympha.
   E The foff a magna or os externum.
   F The meatus urinarius.
   G  The franum labiorum.
   H  The perinceum.
   I The anus.
   K The part that covers the extremity of the
coccyx.
   LL The parts that cover the tuberofities of
the offa ifchium:

   As it is of great confequence to every practi-
tioner in midwifery, to know exactly the fitua-
tion of the parts concerned in parturition,  and
which have  not been  accurately defcribed by
former anatomifts with  a view to this particu-
lar branch, I  have given this draught from one
of the preferved fubjects which I keep  by me,
in order to demonftrate thefe parts in the ordi-
nary courfe of my lectures. From a view, then,
of the fituation of the  parts, it appears,  that
the os externum  is not placed in the middle of
                                        the 
 14          ANATOMICAL TABLES,
 the inferior part of the pelvis, but at the ante-
 rior and inferior part of  the  pubes; and that
 the labia cover likcwiie  the  anterior part of    \
 thefe bones.                                     ^
  Secondly, It may be obferved, that as the fra-    i
 num labiorum, which is  nearly adjoining to the
 inferior part of the off a pubis, is  only about  an
 inch from the anus, between which and  the
 coccyx there is  about  three inches diftance ;  it
 follows, that the anus is nearer to the firft men-
 tioned bones than to the latter.
  Thirdly, The view of this and the following
 Table will furnifh proper  hints with refpect to
 the  method of touching or examining the os ule-   m
 ri,  without hurting or inflaming the parts ; as    1
 it appears, that the os externum is placed for-
 wards towards the pubes, and the os uteri back-    \
 wards towards the retlum and  coccyx.  By this
 vsife mechanifm of nature many  inconveni-
 ences are often  prevented, which muft happen
 if thefe parts were oppofite to each other, and
 fituated in the middle of the inferior part of the
pelvis ;  particularly a prolapfus  of the vagina
 and uterus, either  in the  unimpregnated ftate,
 or  in any of the firft four months  of pregnan-
 cy ; as alfo too fudden deliveries in any of the
 laft months.
  Fourthly, From a view of the fituation of the
 parts>it will appear, that in labour, when the os
 uteri is fuffieiently opened  to allow  a pana^e for
 the head of thefcefus, the fame is protruded to
 the lower part of the vagina, by  which the ex-    s
                                      terna! 
          WITH  EXPLANATIONS, &C.       i-
ternal parts are pufhed out in form of a large
tumour,  as in Table XV.
   Laflly,  It may be obferved, that when it is
jieceffary to dilate the os externum, the principal
force ought  to be applied downwards and to-
wards the reclum,  to prevent the urethra and
neck of  the  bladder from being hurt or in-
flamed.
   Vide Vol.  I. Book I. Chap. 2. Sect. 1. Vol.
II. Coll.  2.
THE 
 l6         ANATOMICAL TABLES,

            THE FIFTH TABLE.

 Figure I.   Gives a front view of the Uterus
   in fitu fufpended in the vagina ; the anterior
   parts of the offa ifchium, with the offa pubis,
   pudenda, perinaum, and anus, being removed,
   in order to fhew the internal parts.

   A  The laft vertebra of the loins.
   BB The offa ilium.
   CC The ace tabula.
   DD  The inferior and pofterior parts of the
 offa ifchifim.  Vide Table XXIX. where the offa \ ',.
pubis anji the anterior parts of the offa ifchium \  i
 are reprefented by dotted lines.
   E  The part  covering the  extremity of the   ■
 coccyx.
   F  The inferior part of the rectum,
   GG  The vagina  cut ©pen  longitudinally,
 and ftretched on  each  fide of the collum uteri
 to fhew in what manner  the uterus is fufpended   1
 in the fame.                     4,              J
   HH Part of the vefica urinaria ftretched on   I
 each fide of the  vagina and inferior part  of the  .  I
fundus uteri.
   I  The collum uteri.
   K  The fundus uteri.
   LL The tuba  Fallopiana and fimbria.
   MM  The ovaria.
   NN  The ligament a lata and rotunda.
   GO  The fuperior part of the rectum.
                       4            Figure 
!
 
l&          ANATOMICAL  TABLES,
Figure  III.    Gives a front  view of  the
   Uterus  in  the  beginning  of the firft month
   of pregnancy;  the anteiior part being remo-
   ved, that the Embryo might  appear through
   the amnios, the chorion being diffected off.

   A The fundus  uteri.
   B The collum uteri, with  a view of the ru-
gous canal that leads to the cavity ofthefundus.
   C The os  uteri.
   Vide Vol.  I. Book I. Chap. 2, Sect. 3, 1.
Vol. II. Coll. 3.                           J
THE 
 
 
WITH EXPLANATIONS, &C.
            THE SIXTH TABLE.

 Figure I.   In the fame view and  fection of
   the parts as  in the firft figure of the former
   table, fhews the Uterus  as it appears in the
   fecond or third month of pregnancy, its  an*
   terior part being here likewife removed.

   F  The anus.
   G  The vagina, with its plica.
   HH The pofterior  and inferior part of the
 urinary bladder extended on each fioe,  the  an-
 terior and fuperior part being removed.
   11  The mouth and neck of the womb, as rai-
 fed up when examining the fame by the touch,
 with  one of the fingers in the vagina.
   KK  The uterus as  ftretched in the fecond or
 third  month, containing the embryo, with  the
placenta adhering to the fundus.

   It appears from this and the former Table,
 that at  this time nothing can be known, with
 refpect  to  pregnancy, from the touch in  the
 vagina, as the refinance of the uterus is fo incon-
 fiderable that it cannot prevent its being raifed
 up before the  finger; and even were it kept
 down,  the length of the neck  would  prevent
 the ftretching being perceptible.   The uterus
 likewife not  being ftretched above the pelvis^
 little  change  is  made as to the figure of the  ab-
 domen, further than that the inteflines are raifed
                   C %              a little 
        20          ANATOMICAL  TABLES,
        a little higher; whence poffibly the old obfer-
        vation of the abdomen being a little flatter at
        this period than ufual, from the inteflines being
        prelTed more to each fide.   Women at this pe-
        riod mifcarry oftener than  at  any other.   It is
        a great  happinefs, however,  in practice, that
        although they are frequently much weakened
        by large  difcharges,  yet they rarely fink under
        the fame, but  are fooner  or  later relieved by
        labour coming on, which gradually ftretches
        the neck and mouth of the womb, by the mem-
        branes being forced down with the waters ; and
        if the placenta is feparated  from the  internal of
        the uterus, all its contents are  difcharged.  But
        if the placenta ftill adheres, the membranes break,
        the  waters  and fatus  are expelled,  and  the
        flooding diminifhes, from the uterus, contracting
        clofe to the  fecundines, which alfo  are ufually
        difcharged fooner  or later.
          From the ftructure, finally, of the parts, as
        reprefented  in this and the former table, it may
        appear,  that it is much  fafer  to reftrain  the
        flooding, and fupport the patient, waiting with
        patience the efforts of nature, than to endea^
j        vour to ftretch the os  uteri, and deliver either
        with the hand or inftruments, which might en-
        danger a laceration  and inflammation of the
        parts.
          Vide C in Table XXXVII.   Alfo  Vol.  I.
        Book  IK Chap.  %, Sect.  2,  3, 4.   Vol.  II.
        Coll.  12. No. 2.
4
Figure 
           WITH EXPLANATIONS,  &C        2I
 Figure  If.   Reprefents  the  Uterus in the
   fourth or  fifth month of pregnancy, in the
   fame view and fection of the parts with the
   former figure, excepting that in this the an-
   terior part of the collum uteri is not removed.

   In the natural  fituation, the mouth and lips
 of the womb are covered with the vagina,  and
 thefe parts are contiguous  to each other;  but
 here the vagina G is a little ftretched  from the
 neck and lips of the former, in order to fhew
 the  parts more diftinctly.   I,  The neck of the
 womb,  which  appears  in  this figure thicker,
 fhorter, and fofter, than in the former. K, The
 inferior part of the fundus uteri;  the ftretching
 of which can fometimes be felt through the va-
gina, by puihing up a finger on the anterior
 or lateral part of the fame.
   The uterus now is fo largely ftretched a* to
 fill all the upper part of the pelvis, and begins
 alfo  to increafe fo much as to reft on  the brim,
 and  to be fupported  by the fame, the  fundus at
 the fame  time being raifed confiderably above
 the pubes.  From the abdomen being now more
 ftretched  the woman is more  fenfible ©f her
 growing bigger; and the uterus alfo,  from  the
counter-preiTure of the contents and parietes of
the abdomen, is kept down, and the os uteri pre-
vented from riling before the finger as former-
ly. In lean women, the ftretching of the uterus
can  fometimes be  perceived  in the vagina  at
this  period as well  as above the  pubes:  But
                                     nothing 
 22          ANATOMICAL TABLES,
 nothing certain can be difcovered from the re-
 finance or feel of the mouth of the womb or lips,
 which are  commonly  the  fame  in  the  firft
 months of pregnancy as before it.
  The fize or bulk of the fatus is finally here
 to be obferved, with the placenta adhering to
 the  pofterior part of the uterus.
  Vide the references to Vol. I. and II. in the
former Table.
THE 
7 
 
         WITH EXPLANATIONS,  &C.        23

          THE SEVENTH TABLE

Reprefents the Abdomen of a woman opened in
  the fixth or feventh month of pregnancy.

  AAAA  The  parietes of the abdomen open-
ed,  and turned back to fhew
  B The uterus.
  CCC The intefiines raifed upwards.
  The labia pudendi are  fometimes affected
in pregnancy with adematous fwellings,  occa-
fioned by the preflure of the uterus upon the
returning veins and lymphatics.  If the labia are
fo tumefied as to obftruct the patient's walking,
the  complaint  is removed by puncturing the
parts affected. By which means the ferous fluid
is difcharged for the prefent, but commonly re-
curs ; and the fame operation muft be repeated
feveral times  perhaps before  delivery;  after
which, however, the tumefaction entirely fub-
fides.   Here it may be obferved, that this com-
plaint can feldom or never obftruct delivery ; as
the  labia are fituated at the anterior part of the
offa pubis, and can  rarely affect the ftretching of
the  franum, perinaum,  vagina, and  rectum.
From this  figure it appears, that the  ftretching
of the uterus can eafily be felt at this period in
lean fubjects, through the parietes of the abdo-
men ;  especially if  the intefiines do not lie be-
fore it.   In  general  indeed,   as  the  uterus
ftretches, it rifes higher ; by which means  the 
_._  j 
WITH EXPLANATIONS, &C.
          THE EIGHTH TABLE.

in the fame view and fection of the parts as in
   Table VI. is reprefented the Uterus of the
   former Table, in order to fhew its contents,
   and the internal parts  as they appear in the
   fixth or feventh month of pregnancy.

   A  The uterus ftretched up to the umbilical
region.
   BB The fuperior  part of the offa ilium.
   CC The  ace tabula.
   DD The remaining pofterior parts  of the
offa ifchium.
   E  The anus,
   F The vagina,
   G  The bladder of urine.
   H  The neck of the womb fhorter than in
Table VI. and raifed higher  by the ftretching
of the uterus above the brim of the pelvis.
   I The veffels of the uterus larger than in the
Unimpregnated ftate.
   KK The placenta  adhering to the inferior
and pofterior part of the uterus.
   LL The membranes that furround the fatus,
the head of which is  here reprefented (as well
as of thofe in Table VI.) fituated downwards at
the inferior part of the uterus, and which I am
apt to believe is the ufual fituation of the fatus
when at reft and furrounded with a great quan-
tity of waters, as the head is heavier than any
                     D                 ether 
^
 l6          ANATOMICAL TABLES,
 other part.  With refpect to the iituation of the
 body of the fatus, though the fore-parts are
 often turned  towards the fides and pofterior
 parts of the uterus, they  are here, as well as in
 the foregoing  Table, reprefented at the anterior
 part or fore wards,  in order to  fhew them in a
 more diftinct and picturefque manner.
   Vide  Vol. I. Book  I.  Chap. 3.  Sett. 3,4.
 Vol. II. Coll.  13.  No. 1.

   From  this Table may appear the difficulty
 of ftretching the os uteri in flooding cafes, even
 at this period, from the length and thicknefs of
 the neck of the womb,  efpecially in a firft preg-
 nancy :  Much the fame method, however, is to
 be followed here as was  directed in  Table VI.
 till labour comes on to dilate the os uteri. If the
 flooding is then  confiderable,  the membranes
 fhould be broken, that  the uterus may contract,
 and thereby leiTcn the  difcharge.  The labour
 likewife, if it is neceflary, may be affifted by di-
 lating the os uteri in time of the pains; which
 alfo, if wanting,  may be  provoked by the fame
 method, when the patient is in  danger.   If this
 danger is imminent, and the woman feems ready
 to expire, the  uterus, as appears from this Ta-
 ble, is at this  time  fufficiently  ftretched to re-
 ceive the operator's hand  to extract the fatus,
if the os internum can be  fafely dilated.
  Laflly, It may be obferved that women are in
 greater  danger at  this  period  and afterwards,
 than in  the former months.
                                       Vide 
         WITH EXPLANATIONS, &C.       2f
  Vide Vol. I.  Book ill. Chap. 4. Sect. 3. No.
1, 2,  3. Vol. III.  Coll. 33. No. 2.  See alfo in
the Edinburgh Phyfical and  Literary Obferva-
tions, Art. xvii. the difiection of a woman with
child, by Dr. Donald Monro, Phyfician at Lon-
don.
D  2                THE 
2$          ANATOMICAL TABLES,

           THE NINTH TABLE

In the fame view and fection of the parts with
   the  former,  reprefents the  Uterus in  the
   eighth or ninth month of pregnancy.

   A  The uterus as ftretched to near its full ex-
tent, with the waters, and containing the fatus
entangled in the funis,  the  head prefenting at
the upper part of the pelvis.
   BB The fuperior part of the offa ilium.
   CC The ace tabula,
   DD The remaining  pofterior parts of the
offa ifchium.
   E  The coccyx.
   F The inferior part of the rectum.
   GGG The vagina ftretched on each fide.
   H The os uteri, the lips of which appear
larger and fofter than in the foregoing Table,
the neck of the womb being likewife ftretched
to its full extent, or entirely obliterated.
   II Part of the vefica  urinaria.
   KK The  placenta at the fuperior and pofte-
rior part of the uterus.
   LL The membranes.
   M  The funis umbilicalis.

   This and the foregoing Table fhew in what
manner the uterus  ftretches, and how its neck
grows fhorter, in the different periods of preg-
nancy ; as alfo the magnitude of the fat us, in
                                       order 
1
^ag. 16^
?/.5H
 
^    J 
          WITH EXPLANATIONS,  &C.      ,  2g
 order  more  fully to explain  Vol.  I. Book  i.
 Chap. 3. Sect. 4, 5. alfo Lib.  3. Chap.  1. Sect.
 1, 2. likewife Vol.  II. Coll. 13. No. 1.
   Notwithftanding it has been handed down as
 an  invariable truth, from the earlieft accounts
 of the art, to the prefent times, that, when the
 head of the fatus prefented, the face was turn-
 ed to the pofterior  part of the pelvis ; yet, from
 Mr. Oulfs obfervation, as well as from fome
 late diffections of the gravid uterus, and what
 I myfelf have obferved in practice, I am led to
 believe, that  the head prefents for the moft part,
 as is here delineated, with one ear to the pubis,
 and the other to the osfacrum ; though  fome-
 times this may vary, according to the form of
 the head, as well as that of the pelvis.
   Confult  Dr.  Hunter s elegant plates of the
gravid uterus.
THIS 
3*
ANATOMICAL
TABLES,
           THE TENTH TABLE

 Gives a front view of Twins in Utero in  the
   beginning of labour ;  the anterior  parts  be-
   ing removed, as in the preceding Tables.

   A The uterus  as ftretched with  the  mem-
 branes and waters.
   BB The fuperior parts of the offa ilium.
   CC The acetabula.
   DD  The  offa ifchium.
   E The coccyx.
   F  The lower part of the rectum,
   GG  The  vagina.
   H The os internum ftretched  open about a
 finger's breadth with the membranes and waters
 in time of labour-pains.
   II The inferior part of the uterus ftretched
 with the  waters which are below the head of
 the child  that prefents.
   KK The two placentas adhering to the pof-
 terior part of the uterus,  the two fatufes lying
 before them ; one with its head in a proper po-
 fition, at the inferior  part of the uterus; and.
 the  other .fituated preternaturally,  with the
 head to the fundus: The bodies of each  are
 here  entangled  in their proper funis,  which
frequently happens in  the  natural as  well  as
preternatural pofitions.
  LLL The membranes belonging to ezchpla-
eenta.
                                      This 
r
5 
^
i, 
          WITH  EXPLANATIONS, &C.       31
   This reprefentation of Twins, according to
the order obferved in my Treatife of xMidwife-
ry, ought to have been placed  among the laft
Tables ; but, as  that was of no  confequence, I
have placed it here in order to fhew the os uteri
grown much thinner than in the former figure,
a little open and ftretched by the waters and
membranes  which are  pufhed down before the
head of one of the fatufes in time of a labour-
pain.   With refpect to the  pofition of twins, it
is  often different in different cafes;  but was
thus, in a late diffection of a gravid uterus by
Dr. Mackenzie,
  Vide Vol. 1. Book 3. Chap.  1. Sed. 4. and
Chap.  j.  Sect. 1. and  Vol. II.  Coll.  14. and
Vol. III.  Coll.  3y.
THE 
32         ANATOMICAL TABLES,
           THE ELEVENTH TABLE

  Exhibits another front view of the Grwtid Ute»
    rus in the beginning of labour ; the anterior
    parts being removed, as in  the  former Ta-
    ble ;  but  in  this the Membranes,  not being
    broken, form  a large  bag containing  the
    Waters and Fatus.

    A  The fubftance of the uterus.
    BBCCDD The bones of the pelvis.
    E  The coccyx.
    F The inferior part of the rectum.
    GGGG The vagina.
    HH  The mouth of the womb largely ftretch-
 ed in time of a pain; with I, the membranes
 and waters.   This circumftance makes it ufu-
 ally certain that labour is begun ; whereas from
 the degree  of dilatation  reprefented in the
 former" Table  there is little to be  afcertained,
 unlefs the pains are regular and ftrong,  the os
 uteri being often found more open feveral days,
 arid even weeks, before labour commences.
   K The chorion.
   L The fame diftected off at the inferior part
 ofthe uterus, in order to fhew  the head of the
fatus through the  amnios.   N. B.  This hint
 is taken  from one of Dr.  Albinuss Tables of
 the gravid uterus.
   M  The placenta; the external convex fur-
 face of which, divided into a number of lobes,
          4                               I* 
J
 

! 
          WITH EXPLANATIONS,  &C.        33
 is here reprefented,  its concave internal parts
 being covered by the chorion.
   The placenta has been found adhering to all
 the different parts  of the internal furface of the
 uterus, and fometimes even over the infide of
 the os uteri;  this laft manner of adhefion how-
 ever always occafions floodings as foon as the
 fame begins to dilate.
   Table VI. VIII.  IX. X. fhew the internal
 furface of the placenta towards the foetus, with
 the veffels compofing its fub'ftance proceeding
 from the funis, which is inferted, in  different
placentas, into all the different  parts of  the
 fame, as well as in  the middle.
   The Thirtieth and Thirty-third Tables fhew
the infertion of the funis into the abdomen  of
the fatus.
   With refpect to  the expulfion of the placenta,
when the membranes  break, the uterus  contracts
as the waters are evacuated till it comes in con-
tact  with the body of the fatus:  The  fame
being delivered, the uterus grows much thicker,
and  contracts clofely to the placenta and mem-
branes,  by which means they are gradually fe-
parated, and forced into the vagina. This mews
that  we ought to follow the method which na-
ture  teaches, waiting with patience, and allow-
ing  it to feparate in  a flow manner: Which is
much  fafer practice, efpecially when  the  pa-
tient is  weak;  as  the difcharge  is neither fo
great or fudden as  when the placenta is hurried
down in the tbo common methcd.    But then
                      E                  vrs 
34         ANATOMICAL  TABLES,
we muft not run into the other extreme, but
affift when nature is not fuflicient to expel the
fame.
  Vide Vol. I. Book 3. Chap. 1. Sect. 4. Chap.
2. Sect. 2, 5.  VoL II. Coll. 14, 23.
THE 
f
I 
A
 
WITH EXPLANATIONS, &C
          THE TWELFTH TABLE

Shews (in a lateral view and longitudinal divi-
   fion of the parts)  the Gravid Uterus, when
   labour is fomewhat advanced.

   A  The loweft vertebra of the back.
   B  The fcrobiculus cordis; the diftance from
which to the laft mentioned  vertebra is here
fhewn by dotted lines ;  as alfo  part of the re-
gion  below the diaphragm.
   CC The ufual  thicknefs and figure of the
uterus when extended with the waters  at the
latter end of pregnancy.
   D  The fame contracted and  grown thicker
after  the waters are evacuated.
   EE The figure of the uterus wThen pendulous.
In this cafe, if the membranes break when the
patient is in an erect pofition,  the, head of the
foetus runs a rifk of Aiding over and above the
offa pubis, whence the ftioulders will be pufhed
into the pelvis.
   FF The figure of the uterus  when  ftretched
higher than ufual, which generally* occafions
vomitings  and  difficulty of breathing.   Con-
fult on this fubject Mr.  Levret/w le Mecha-
nifme  de differentes Groffeffes.
  'G  The os pubis of the left fide.
   HH The os internum.
   I The vagina.
   K.  The left nympha.
                     F. 2             L Ths 
 ;f>          ANATOMICAL TABLES,
    L The labium pudendi of the fame fide.
    M The remaining portion of the bladder.
    N The anus.
    OP  The left hip and thigh.

    In this period of labour the  os uteri being
 more and more ftretched by the membranes pufh-
 ing down, and beginning to extend the vagina,
 a great quantity of water is forced down at the
 fame time, and (if the membranes break) is dif-
 charged ; whence  the  uterus contracts itfelf
 nearer to the body of the fatus, which is here
 reprefented in a natural  pofition, with the  ver-
s tex refting at the fuperior part of the offa pubis,
 and  the  forehead towards the right  os ilium.
 As foon  as the uterus  is in  contact with the
 body of  the  fatus, the head  of the  fame  is
 forced backward  towards the os facrum from
 the line  of  the abdomen BG  into that of the
 pelvis, viz.  from the uppermoft  F to near the
 end  of  the  coccyx, and is  gradually  pufhed
 lower as  in the following Table.
    If the membranes do not break immediately
 upon their being pufhed into the vagina, they
 fhould be allowed to protrude ftill further in or-    i
 der to dilate the os externum.
    Vide Vol. I. Book i. Chap. 2. Sect. 2. Chap.
 3. bed.  3.  Book 3. Chap. 1.  Sect.  1, 2,4.    j
 Chap. 2.  Sect. 3.  Chap  3.  Sect.  4.  No. 5.
 Vol. II. Coll. 10.  No. 4. Cafe 3, 4. Coll.  14.
 Vol. Hi. Col. 34.  No. 2.  Cafe 4.

                                       THE
 
 
1
 
WITH EXPLANATIONS, &C.
37
        THE THIRTEENTH TABLE,

In the fame view and fection of the parts as in
   Table VI. fhews the natural pofition of the
   head of the Fatus when funk down into the
   middle of the Pelvis after the Os Internum
   is fully opened, a large quantity of the wa-
   ters being protruded  with  the Membranes
   through  the  Os  Externum, but prevented
   from being all difcharged, from the head's
   filling up the Vagina.       •

   A  The uterus a little contracted, and thicker,
from fome of the waters being funk down before
the child, or difcharged.
   BB The  fuperior  parts of the offa ilium.
   C  The inferior part of the rettum.
   DD The vagina  largely ftretched with the
head of the fatus.
   EE The  os internum fully opened.
   F  A portion of the placenta.
   GG The membranes.
   HH The ligament a lata.
   II  The ligament a  rotunda.  Both  thefe laft
ftretched upwards with the uterus.

   The vertex of the fatus being now down at
the inferior part of the right os ifchium, and the
wide part of the head at the narrow and inferior
part of the pelvis, the forehead by the force  of
the pains is gradually moved backwards; and 
3^          ANATOMICAL TABLES,
as it advances lower, the vertex and occiput turn
out  below the pubes,  as in  the next  Table.
Hence may be learnt of what confequence it is
to know,  that it is wider from fide  to fide  at
the brim of the pelvis, than from the back  to
the fore part;  and that  it is wider  from the
fore to  the hind head of the child, than from
ear to ear.
  Vide  Vol. I.  Book 1.  Chap.  1. Sett. 3,  5.
Alfo Book 3.  Chap. 3.  Sect.  3, 4. No. 3. Vol.
II. Coll. 14.
THE 
T
•  r 
 
WITH EXPLANATIONS, &C
39
       THE FOURTEENTH TABLE,

  In a fimilar view and fection  of the  parts
with Table XII. ihews the forehead of the fe-
tus  turned (in its progreifion downwards, from
its pofition in the former Table) backwards  to
the os facrum and the occiput below the pubes ;
by which means the narrow part of the head is
to the narrow part of the pelvis,  that is, be-
tween  the inferior parts of the  offa ifchium.
Hence it may be obferved, that though the dif-
tance between the inferior parts of the laft-men-
tioned bones is much the fame as between the
c&ccyx and pubes ; yet as the cavity of the pelvis
is much fhallower at  the anterior  than lateral
part, the occiput of the fatus, when come down
to the inferior part  of  either os ifchium,  turns
out below the pubes: this anfwers  the fame end
as if the pelvis itfelf had been wider from the
pofterior part than from fide to fide; the head
likewife  enlarging  the cavity by  forcing back
the coccyx, and pufhing out the external parts in
form of a large  tumour, as is more fully de-
fcribed in the following Table.
  Vide Vol.  I. II. as referred to in  the preced-
ing Table.
  A The uterus contracted clofelyto the fatus
after the waters are evacuated.
  BCD The vertebra  of the  loins, osfacrum.
and coccyx.
  E The anus.
      2                              F The
• 
 4°         ANATOMICAL TABLES,
   F The left hip.
   G The perinaum.
   H The os externum beginning to dilate.
   I The os pubis of the left fide.
   K The remaining portion of the bladder.
   L The pofterior part of the os uteri.

   N. B. Although for the moft part, at or be-
fore this period, the waters are evacuated, yet
it often happens that  more or lefs will be re-
tained,  and not all difcharged, till after the de-
livery of the child ;  occafioned  from the pre-
fenting  part of the fatus coming into clofe con-
tact with the lower or  under part of the uterus,
vagina,  or os externum, immediately, or foon
after the membranes break.
THE
• 
 
\
 
WITH EXPLANATIONS, &C
4*
         THE FIFTEENTH TABLE

Is intended principally to  fhew in what man-
  ner  the  Perinaum and external  parts ar«
  ftretched by the head of the Fatus, in a firft
  pregnancy, towards the end of labour.

  A The abdomen.
  B The labia pudendi.
  C The clitoris and its praputiym,
  D The  hairy fcalp  of the fatus fwelled at
the vertex in a laborious cafe, and protruded to
the os  externum,
  EF  The perinaum and anus pufhed out by
the head of the fatus in form  of a large tumour.
  GG The parts that cover  the tuberofities of
the offa ifchium.
  H The part that covers the os coccygis.

  The perinaum in this figure is ftretched two
inches, or double its length in the natural ftate ;
but when the os externum is fo much dilated by
the head of the fatus as to allow the delivery
of the  fame, the perinaum is generally ftretched
to the  length of three,  and  fometimes four
inches.   The  anus  is likewife lengthened an
inch,  the parts alfo  between it and the coccyx
being much diftended.  All  this ought to cau-
tion the young practitioner never to precipitate
the delivery  at  this time ;  but to wait, and
allow the parts to dilate in a  flow manner; as,
                     F                 from 
j        42         ANATOMICAL TABLES,
        from the violence of the labour-pains, the fud-
I        den delivery of the head of the foetus might en-
        danger the laceration of the parts.   The palm
i        of the  operator's  hand ought  therefore  to be
i        preffed againft the  perinaum,  that  the head
        may be prevented from paffing till the os ex-
        ternum is fufficiently dilated,  to allow its deli-
        very without tearing the franum, and parts
        betwixt that and  the anus, which are at this
        time very thin.
          Vide Vol. I. Book 3. Chap. 2. Sect. 2. Chap.
        3. Sect. 4. No. 1. and Book 4.  Chap. 1. Sect.
        I.   Alfo Vol. II.  Coll.  14, 24. Vol. III. Coll.
        40.
THE 
1
•4
> 
nxn.
 
WITH EXPLANATIONS, &c.
43
           THE SIXTEENTH TABLE

  And the three following fhew in what man-
    ner the Head of the Fatus is helped along
    with the Forceps, as artificial hands, when it
    is neceffary to  affift with the fame for the
    fafety of either Mother or  Child.  In this
    Table the head is reprefented as forced down
    into  the  Pelvis by the labour-pains,  from
    its former pofition in Table XII.

    AABC The vertebra of the loins, osfacrum,
 and coccyx.
   D The os pubis of the left fide.
   E The remaining part of the bladder.
   FF The inteflinum rectum.
   GGG The uterus.
   H The mons veneris.
   I The clitoris, with the left nympha.
   X The corpus convernofum clitoridis.
   V The meatus  ur'marius.
   K The left labium pudendi.
   L The anus. .
   N The perinaum.
   QP The left hip and thigh.
   R The fkin and mufcular part of the loins.

   The patient in this cafe  may be, as in this
Table> on her fide, with her breech a little over
the  fide or foot of the bed, her  knees being
likewife pulled  up to her belly,  and a pillcw
                   F %             ,  placed 
 44         ANATOMICAL TABLES,
 placed between  them, care being taken at the
 fame time that the parts are by a proper cover-
 ing defended from  the external air.   If  the
 hairy fcalp of the fatus is fo fwelled that  the
 fituation of the head cannot be diftinguiined by
 the futures as in Table XXI. or if by introdu-
 cing  a  ringer between the head of the  child
 and the pubes,  or' groins, the ear or back part
 of the neck cannot be felt, the os externum muft
 be gradually dilated  in the time of the  pains
 with the  operator's  fingers (previoufly lubri-
 cated with hog's-lard) till  the whole hand can
 be introduced into the vagina, and flipped up
 in a flattifh form between the pofterior part of
 the pelvis and  child's head.  This  laft is then
 to be raifed up as high as is poffible,  to allow
 room for  the fingers to reach the ear and pof-
 terior part of the neck.  When the pofition of
 the head  is  known,  the operator muft with-
 draw his hand, and wait to fee if the ftretching
 of the parts will renew or  increafe the  labour-
 pains, and allow more fpace for the advance-
 ment of the head in the pelvis.   If this, how-
 ever, proves of no effect, the »fingers are again
 to  be introduced as  before, and one  of the
 blades of the forceps  (lubricated  with lard) is
 then to be applied along the infide i*f the hand
 or  fingers, and left ear of the child, as repre-
 fented in the Table.   But  if the  pelvis is dif-
torted,  and projects forward  at  the fuperior
part of the osfaemm, and the forehead therefore
cannot be moved a little backwards, in order to
                                        turn 
          WITH EXPLANATIONS,  &c.        45
 turn the ear from that part of the pelvis which
 prevents the end of the forceps to pafs the
 fame ; in that cafe, I fay, the blade muft be in-
 troduced along the pofterior part of the ear at
 the fide of the diftorted bone.   The hand that
 was introduced  is then  to be  withdrawn, and
 the handle of the introduced blade held with it
 as far back as the perinaum will  allow, whilft
 the  fingers of the other hand are introduced
 to the os uteri, at the pubes, or right groin, and
 the other blade placed  exactly oppofite to the
 former.  This done, the handles being taken
 hold  of and joined together,  the  head  is  to
 be pulled lower and lower every pain,  till the
 vertex,  as  in this Table, is brought  down  to
 the inferior part of the left ifchium, or below
 the fame.  The wide  part of the head being
 now advanced to  the narrow part of the pel-
 vis betwixt the tuberofities of the offa ifchium,
 it is to be turned from the  left ifchium out be-
 low the pubes, and the  forehead backwards to
 the concave  part of the os facrum and  coccyx,
 as in Table XVII. and afterwards the head
 brought along and delivered as  in Table XVIII.
 and XIX.   But if it is found that the delivery
 will require a confiderable degree  of force from
 the head's being large, or the pelvis narrow, the
 handles  of the forceps are to be  tied  together
with a  fillet, as  reprefented in this  Table, to
prevent  their pofition being changed, whilft the
 woman   is  turned on her  back,  as  in Table
                                    XXIV. 
46          ANATOMICAL TABLES,
XXIV. which is then more convenient for de-
livering the head than when lying on  the fide.
  This Table fhews that the handles of the for-
ceps ought to be held as far back as the os ex-
ternum will allow, that the blades may  be in an
imaginary line between that, and  the middle
fpace between the umbilicus  and the fcrobiculus
cordis.   When  the forceps are applied along
the ears and  fides of the head, they are nearer
to one  another,  have a better hold, and mark
lefs than when over the occipital and frontal
bones.
  Vide Vol. I. Book 3. Chap. 3. from Sect. i.
to 6. and Vol. II. Coll. 25, 26, 27, and 29.
THE 
 
 
T
          WITH  EXPLANATIONS^ 8cC.


       ,THE SEVENTEENTH TABLE,

In the fame view with  the  former, reprefents
   in outlines  the Head of the Fatus  brought
   lower with the Forceps, and turned from the
   pofition in the former Table, in imitation of
   the natural progreffion  by the  labour-pains,
   which may likewife be fuppofed  to  have
   made this turn, before it was neceffary to
   affift with the Forceps, this neceflity at laft
   arifing from many of the caufes  mentioned
   in Vol. I.

   In this view the pofition of the forceps, along
the ears and narrow part of the head,  is more
particularly exprefTed.    It appears  alfo,   that
when the vertex is turned from the left os ifchi-
um, where it was clofely confined, it is difen-
gaged by coming out below the pubes, and the
forehead that was preffed againft the middle of
the right os ifchium is turned into the concavity
of the osfacrum and coccyx.  By this means the
narrow part of the head is  now  between the
offa ifchium or narrow part of the pelvis ; and as
the occiput comes out below the pubes, the head
palles ftill eafier along.   When the head is ad-
vanced fo low in the pelvis, if the pofition can-
not be diftinguitned by the futures, it  may for
the moft part be known by feeling for the back
pa t of the neck of the fatus, with a finger in-
troduced betwixt the occiput and  pubes, or to-
                                     wards 
 4$          ANATOMICAL TABLES,
 wards one of the groins.  If the head is fqueezed
 into a forsgifh form, as in Table XXI.  and has
 been detained many hours in this pofition the
 pains not being fufficient to complete the deli-
 very, the affiftance of the forceps muft be taken
 to fave the child, though the woman may be in
 no danger.  But if the head is high up in the
pelvis, as in the former Table, the forceps ought
 not to be ufed except in the moft urgent necef-
 fity.
   This Table alfo fhews that the handles of the
 forceps are ftill to be kept back to the perinaum,
 and  when in this pofition are  in a line with the
 upper part of the focrum,  and if held more
 backwards, when the head is a little higher,
 would be in a line with thefcrobiculus cordis. If
 the forceps are applied when the head is in  this
 pofition, they are  more eafily introduced when
 the patient is in a fupine pofition, as in Table
 XXIV.   Neither is it neceffary to tie the han-
 dles, which is only done to prevent their alte-
 ration when turning the woman from her  fide
 to her back.
   As I  have had feveral cafes where a longer
 fort  of forceps that are curved  upwards are of
 great ufe  to  help along the  head, when  the
 body is delivered firft, as in Table XXXV. the
 fame are reprefented here by dotted lines. They
 may be ufed in laborious cafes as  well as  the
 others,  but are not managed  with the fame
 ea^e.
4
Moft 
          WITH  EXPLANATIONS, '&C.        49
   Moft of the parts of this Table being marked
with the fame letters as the former, the defcrip-
tions  there given will anfwer in  this, except
the following.

   LM  The anus.
  .MN  The perinaum.
   O  The common integuments of the abdomen.
   R  The fhort forceps.
   S The long curved forceps. The firft of thefe
is eleven inches long, and the laft twelve inches
and a half, which I have after feveral alterations
found  fufficient; but  this  need  not  confine
others who may choofe to alter them from th'.;,
ftandard.

  Vide Table  XXXVJI.
&                TH£ 
<J0.
ANATOMICAL TABLE*,
       THE EIGHTEENTH TABLE,

In the fame view and  fection of the  parts,
  fhews  the Head of the Fatus in the fame
  pofition, but  brought  lower  down with the
  Forceps than in the  former Table;  for in
  this the Os Externum is more open, the Oc-
  ciput come lower  down from below the
  Pubes, and the Forehead paft the Coccyx, by
  which both the Anus and  Perinaum are
  ftretched out  in form of a large tumour, as
  in Table XV.

  When the head is fo far advanced, the ope-
rator ought to extract with great caution, left
the parts fhould be torn.  If  the labour-pains
are fufficient, the forehead may be kept  down,
and helped along in a flow manner by preffing
againft it with the fingers on the external parts
below the coccyx :  at the fame time the forceps
being taken off, the head may  be allowed to
ftietch  the os externum  more  and more in a
gradual manner, from the force of the labour-
pains as well as affiftance of the fingers.   But
if the  former are weak and  infufficient, the
affiftance of the forceps muft  be continued.
(Vide the defcription  of the  parts  in  Table
XVI.) ST, in this, reprefcnt the left fide  of the
os uteri.   'I he dotted   lines demonftrate the
fituaticii  of the bones of the pelvis on the right
                                      fide, 
I\uj. 28
PLxnn.
 
 
          WfTH EXPLANATIONS, &c.       M
fide, and may ferve as an example for all the
lateral views of the fame,

  abch  The outlines of the os ilium.
  Def The fame of the pubis and ifchium.
  ilk The acetabulum.  And
  mn The foramen magnum.

  Vide Vol.  I. Book  3. Chap.  5. Sect.  7*
Vol. II. Coll. 25.
G  a               THE
1 
5^"         Anatomical tables,
       THE NINETEENTH TABLE,

  In the fame view and fection of the pelvis, i#
intended  by outlines to fhew,-that as the exter-
nal parts  are ftretched,. and the  os externum is
dilated, the occiput of the fatus, rifes up with
a femicircular turn from out below  the pubes,
the under part of which bones are as an  axis,
or fulcrum, on which the back part of the neck'
turns, whilft at the fame time the forehead and
face, in their turn upwards, diftend largely the
parts between the coccyx and os externum.  This
is the method obferved  by nature in ftretching
thefe parts in labour; and as nature is always
to be imitated,  the fame method ought  to  be
followed  when it is neceffary to  help along the
head with the forceps.
  Vide the three former Tables for the defcrip*
tions and references.
tHE 
 
\
 
          WITH EXPLANATIONS, &c.       r*
                         0
        THE TWENTIETH TABLE,

 In the  fame fection of the parts, but with a*
   view of  the right fide, fhewsfhe  Head of
   the Fatus in  the  contrary  pofition to the
   three laft'figures, the  Vertex being here in
   the concavity of the Sacrum, and the Fore-
   head turned to the Pubes.

   AB The vertebra of the loins, os facrum,
 and coccyx.
   C The os pubis of the right fide.
   D The anus.
   E The os externum not yet begun to ftretch.
   F  The nymph a.
   G The labium pudendi of the right  fide.
   H The hip and thigh.
   II The uterus  contracted, the waters being
 all difchargedr

   When the  head is  fmall,  and the pelvis
 large, the parietal bones and the forehead will*
 in this cafe,  as they are forced downwards by
 the labour-pains,  gradually dilate the os exter-
 num, and ftretch the parts between  that and
 the  coccyx  in form of a  large tumour, as in
 Table XV.  till the face comes down below
 the pubes, when the head will be fafely deli-
 vered. But if the fame be large, and the pelvis
 narrow, the  difficulty will be greater,  and the
 child in danger ; as in the folio wing Table.
   Vide Vol.  I. Book 3. Chap. 3. Sect. 4.  No.
3. Vch ILCoJh 16.  No. 2.
                                      THE 
 54         ANATOMICAL TABLES,

       THE TWENTY-FIRST TABLE
 Shews the Head of the Fatus  in the fame po-
   fition as in the former Table ;  but, being
   much  larger,  it is by  ftrong labour-pains
   fqueezed into a longiih form with a Tumour
   on the Vertex, from the long compreffion of
   the head in the Pelvis.  If the Child cannot
   be delivered with the labour-pains, or turned
   and brought footling,  the  Forceps  are to be
   applied on the  head,  as  defcribed in  this
   figure, and brought along as it prefents; but
   if that cannot be done without running the
   rifk of tearing the  Perinaum,  and even the
   Vagina and Rectum of the Woman, the Fore-
   head muft be turned  backwards  to the Sa-
   crum.   To do  this more  effectually,   the
   Operator muft grafp firmly with both hands
   the handles of the Forceps,  and at the fame
   time pufhing  upwards  raife the Head  as
   high as poffible, in order to turn the Fore-
   head to one fide, by which it is brought  into
   the natural pofition ; this done, the head  may
   be brought down and delivered as  in Table
   XVI. &c.

   Vide Vol. I. Book 3. Chap. 3. Sect. 4. No. 2*
and Vol.  II. Coll. 28.  Alfo the former Table
for the defcription of  the parts, except

   K The tumour on the vertex.   The fame
fompreflion and elongation of the head, as  well
                                        a^ 
r
Fu&.39
 
. 
          WITH  EXPLANATIONS, &X.       < $
as the tumour on the vertex, may be fuppofed
to happen in a greater  or lefs degree in the
XVI. XVII. XVlll.  XIX. Tables as well as
in this,  where the difficulty proceeds from the
fiead  being large, or the pelvis narrow.   Vide
Table XXVII. and XXVTII.
   Sometimes the forehead may be moved to the
natural  pofition by the affiftance of the fingers,
or only one blade of the forceps.   The forceps
may either be the ftraight kind, or fuch as are
curved  to one fide, when it is  neceffary to ufe
one or  both blades.
   M The vefica urinaria much diftended  with
a large  quantity of urine from the long preffure
of the  head againft the urethra;  which fhews
that the urine ought to be drawn off with  a ca-
theter, in  fuch extraordinary cafes,  before you
apply  the forceps,  or  in  preternatural  enfc*
where the child  is brought footling.
   N The under part ot  the uterw*
   00  The os uteri.
TiU 
   5^-       .ANATOMICAL TABLES,

        THE TWENTY-SECOND TABLE,

  Shews, in a front view of the  parts,  the Fore-
     head of the Fatus prefenting at the brim of
     the Pelvis;  the  Face being turned to  one
     fide ; the Fontanelle to the  other; and the
     Feet and Breech ftretched towards the Fun*
     dus Uteri.

    A A The fuperior part of the offa ilium,
     B The anus.
    C The perineum.
    D The os  externum; the thicknefs of  the
 pofterior  part before  it  js ftretched  with  the
 head of the child.
    EEE The vagina.
    F The os uteri, not yet fully dilated,
    GGG The uterus.
    H The membrana adipofa.

   If the face is not forced down, the head will
 fometimes come along in this manner, in which
 cafe the vertex will be flattened, and the fore-
 head raifed in  a  conical form ;  and when the
 head comes down to the lower part of the peU
 vis, the face or occiput will be turned from the
 *i:!e,  and come out below the pubes.  But  if
 the head is  large and cannot  be delivered  by
 the pains, or if the wrong pofition cannot be
 altered,  the child  muft, if poffible, be brought
footling, or delivered with the  forceps.
  Vide Vol. I. Book 3. Chap. 2. Sect. 3. Chap.
3.  Sect. 4. No. 3. Vol. II.  Coll. 16.  No. 4.
Coll.  23.                                 *
               *                       the; 
 
 
WITH EXPLANATIONS, &C.
      THE  TWENTY-THIRD TABLE

Shews, in a lateral view, the Face of the Child
   prefenting,  and forced down into the lower
   part of the Pelvis, the Chin being below the
   Pubes, and the Vertex in  the  concavity of
   the  Os Sacrum: The waters likewife being
   all difcharged,  the Uterus appears clofely
   joined to the body of the  Child, round the
   neck of which is one circumvolution of the
   Funis.

   AB The vertebra of the loins,  os facrum,
and coccyx.
   C The os pubis of the left fide.
   D  The inferior part of the rectum.
   E The perinaum.
   F The left labium pu^endi,
   GGG The uterus.

   When the pelvis is large, the head, if fmail,
will come along in this pofition;  and the child
be faved : For as the head advances lower, the
face and forehead will ftretch the parts between
the franum labiorum  and coccyx  in form of a
large tumour.   As the os externum  likewife is
dilated, the face will be forced through it; the
under part of the chin will  rife upwards over
the anterior  part of the pubes ; and the fore-
head, vertex, and occiput,  turn  up from the
parts below.  If the head, however, is large, it
                     H                will 
5&         .ANATOMICAL  TABLIS,
will be  detained either when higher or in this
pofition.  If this cafe, if the pofition cannot be
altered  to  the  natural, the child ought to be
turned,  and delivered footling.   If the pelvis,
however, is  narrow, and the waters  not all
gone, the vertex fhould, if poffible, be brought
to  prefent; but if the uterus is fo clofely con-
tracted  that this cannot be effected, on account
of fUe ftrong preffure of the fame, and flipperi-
nefs of  the child's  head, in this cafe the method
directed in the following Table is to be taken.
THE 
7 
I
 
WITH EXPLANATIONS, &C.
      THE TWENTY-FOURTH TABLE

 Reprefents,  in the lateral view, the Head of
   the  Fatus in the fame  pofition as  in  the
   former Table; but the delivery is fuppofed
   to  be retarded from the  largenefs  of the
   Head, or  a narrow Pelvis.

   In this  cafe,  if the  head cannot  be  raifed,
 and pufhed up into  the uterus,  it ought to be
 delivered with the forceps, in  order to fave the
 child.  This pofition of the chin to the pubes is
 one of the fafeft cafes where the face prefents,
 and is moft eafily delivered with the forceps,
 the  manner of introducing of which over  the
 ears is fhewn in this Table.   The patient muft
 lie on her back,  with her breech a little over
 the bed, her legs and thighs being fupported by
 an affiftant fitting on each fide. After the parts
 have been  flowly dilated with the hand  of the
 operator, and the forceps introduced, and pro-
 perly fixed along the ears of the child, the head
 is to be brought  down by degrees, that  the
 parts below the  os externum may be gradually
 ftretched: The chin  then  is  to be  raifed  up
 over the pubes, whilft the forehead, fontanelle,
 and  occiput, are  brought  out  flowly from  the
perinaum and fundament to prevent the fame
 from being hurt or lacerated.   But if the fatus
 can neither be turned, nor  extracted with the
 forceps, the delivery muft be left to the labour-
                   H  2              pains, 
 °°         ANATOMICAL TABLES,-
 pains, as long as the patient  is in no danger J
 but if danger  is apparent,  the  head muft  be
 delivered with the curved crotchets.  Vide Ta-
 ble XXXIX.
   When the face prefents, and  the chin is  to
 the fide of the pelvis, the patient muft lie  on
 her fide ; and after the forceps are fixed along
 the ears, the chin is to  be brought down  to
 the lower part of  the  os  ifchium, and then
turned out below the pubes, and delivered in a
 flow manner as above.
   Vide Vol. II. Coll. 16.  No. 6. as  alfo Tables
XVI. XVII. XVIII. and XIX. for the de-
feription  of the parts.
THE 
T 
T

 
WITH EXPLANATIONS,- &C        €l
      THE TWENTY-FIFTH TABLE

Shews,  in a lateral view  of the right fide, the
   Face of the Fatus  prefenting,  as in Table
   XXIII. but in the contrary pofition; that is
   with the chin to the  Os Sacrum,, and the
   Bregma to the Pubes, the Waters evacuated,
   and the Uterus contracted.

   A  The os externum not yet begun to ftretch.
   B  The anus.   Vide  Table XX.  for the fur-
ther defcription of the parts.

   In fuch cafes, as well as in thofe of the laft-
mentioned Table, if the child is fmall, the head
will be pufhed lower with the labour-pains, and
gradually ftretch  the lowrer part of the vagina,
and the external  parts ; by which  means the os
externum will be more and more dilated, till the
vertex comes out below the pubes, and rifes up
on the outfide ;  in which cafe the delivery  is
then the fame as in natural labours.  But if the
head is large, it will pafs along with great diffi-
culty ; whence  the brain, and vcffels of the
neck, will be fo much eomprefled  and obftruct-
ed, as to deftroy the child.  To prevent which,
 if called in time, before the head  is far advan-
 ced in the pelvis, the child ought  to be turned,
 and brought footling.   If the head however is
 low  down, and cannot be turned, the delivery
 is then to be performed with the forceps, either
 by bringing along the head as it prefents, or as
 in the following Table.   See the references in
 the preceding Table.
                                        THE 
6z
ANATOMICAL TABLES,
       THE TWENTY-SIXTH TABLE

 Reprefents by outlines, in a lateral view of the
   left fide of the fubjcct, the Fatus in the fame
   fituation as in the former Table.

   Th e head here is fqueezed into a very oblong
 form ; and though forced down fo as fully to di-
 late  the os externum, yet the vertex and occiput
 cannot be brought fo far down, as to turn out
 from below the pubes  (as in the foregoing Ta-
 bic), without tearing the perinaum and anus,
 as well as the vagina and rectum.
   The beft method in this cafe, after either the
 fhort or long curved forceps have been applied
 along the ears (as reprefented in the Table), is
 to pufh the head  as high up in the pelvis as is
 poffible ; after which, the chin is to be turned
 from the osfacrum to either os ifchium, and after-
 wards brought down to the inferior part of the
 laft mentioned bone.   This done the  operator
 muft pull the forceps  with one hand, whilft two
fingers of the other are fixed on the lower part
of the chin or under-jaw,to keep the face in the
 middle, and prevent the chin from being detain-
ed at the os ifchium, as  it comes along ; and in
this manner move the chin round with the for-
 ceps, and the above fingers,  till brought under
 die fubes ;  which done, the head will be eafily
 extraded, as in Table XXIV.
   If, before afHitancc has been called, the head
b  fo fqueezed down into the pelvis, that it is
                                 impoffible 
 
 
         WITH EXPLANATIONS, &C.        6$
impoffible to move the chin from the facrum to
either os ifchium, fo as to deliver with the for-
ceps for the fafety of the child, the  operator
muft wait with patience, as long as the woman
is not in danger, or there is no certainty of the
death of the fatus: But if the patient runs the
leaft rifk, the head muft be delivered  with the
crotchet.
  In general, with refpecr to the pofture of the
woman in the application of the forceps, when
the ears are to the  fides of the pelvis,  the for-
ceps, as was  obferved in Table XXIV. are moft
eafily introduced when the patient lies upon her
back, and her  breech over the fide of  the bed ;
but when the ear is to the pubes or groin, they
are better applied when the patient lies on her
fide, as was obferved in the cafes where the ver-
tex prefented.
  Vide Table XXIV. for the defcription of the
parts, and the references.  Alfo Table XXXIX.
for the manner of ufing the crotchet.
THE 
64
ANATOMICAL  TABLES,
     THE TWENTY-SEVENTH TABLE

Gives a lateral internal view of a diftorted Pel-
  vis, divided longitudinally, with the  Head
  of a Fatus of the feventh month paffing the
  fame.   Vide the Explanation of Table III.

  ABC The os facrum and coccyx.
  D The os pubis, of the left fide.
  E The tuberofity of the os  ifchium, of the
fame fide.

  The head of the fatus here, though finall, is
with difficulty fqueezed  down  into the pelvis,
and changed  from a round to an oblong form,
before it can pafs, there being only the fpace of
two inches and one quarter between the projec-
tion of the fuperior part of the facrum and the
offa pubis.  If the head  is foon delivered, the
child may be born alive : But if it continues in
this manner  many hours, it  is  in  danger of
being loft, on account of the long preflure  on
the brain.  To prevent  which,  if the labour-
pains are not fufficiently ftrong, the head may
be helped along with the forceps,  as  directed
in Table XVI.
   This figure may ferve as an example of the
extreme  degree of diftortion of the pelvis, be*  '
tween which and the well-formed  one are
many intermediate degrees, according to which
the difficulty of delivery muft increafe, or dirni*
niih,  as well as from the difproportion of the
          i                           pelvis 
T
Pag.  3<3
PI.XX.V1L
.-J 
T
 
          WITH  EXPLANATIONS, &C        65
pelvis and head of the fatus;  all which  cafes
require the greateft caution, both as to the ma-
nagement and fafety of the mother and child.
   Vide Vol. 1. Book 3. C hap.  2.  beet. 7.  No.
5. Chap.  3. Sett. 4. No. 3. Vol. II. Coll. 21,
No. 1.  and Coll. 29.
THE 
66
ANATOMICAL  TABLES,
         THE TWENTY-EIGHTH TABLE

►    Gives a  fide-view of a diftorted Pelvis, as in
      the former Table, with the Head of a full-
      grown Fatus fqueezed into the Brim,  the
      Parietal Bones decuffating each other, and
      compreffed into a conical form.

      ABC The osfacrum and coccyx.
      D The os pubis of the left fide.
      E The tuberofity of the os ifchium.
      F The proceffus acutus.
      G The foramen magnum.

      This Table fhews the impoflibility in fuch a
    cafe to  fave the child, unlefs by the Cafarean
    opertion ; which, however, ought never to be
    performed,  excepting when it is impracticable
    to deliver at all by any other method.  Even in
    this cafe, after the upper part of the head is di-
    minifhed in bulk, and the bones are extracted,
    the  greateft  force muft be applied in order to
    extract the  bone  of the face and bafis of the
    fkull, as well as the  body of the fatus.
      Vide Vol. 1.  Book 3. Chap. 3. Sect. 7. Chap.
    5. Sect. 3,  and Vol. III. Coll. 31, 39.
THE 
 
 
WITH EXPLANATIONS, 8cc.
      THE  TWENTY-NINTH TABLE

Reprefents,  in a front view of the Pelvis, as in
   Table XXII. the Breech of the  Fatus pre-
   fenting,  and dilating the Os Internum, the
   Membranes being too foon broke.  , The fore-
   parts of  the Child are to the pofterior part
   of the Uterus; and the  Funis with a knot
   upon it furrounds the neck, arm, and body.

   Some time after this  and the following Ta-
bles were  engraved, Dr.  Kelly fhewed me  a
fubject he had  opened,  where the breech pre-
fented  itfelf, and lay much in the fame pofition
with its body as in the ninth Table,  fuppofing
the breech in that figure turned down to the
pelvis,  and the  head up to the fundus uteri.
   I  have fometimes felt, in thefe cafes, [when
labour  was begun, and  before the  breech was
advanced into the pelvis~\ one hip at the facrum,
the other refting above the os pubis, and the pri-
vate parts to one fide :  But before they could
advance lower, the  nates were turned to the
fides and wide  part of the  brim of the pelvis,
with the private parts to the facrum,  as in this
Table ; though  fometimes to the pubes, as in the
following Table.  As foon  as the  breech ad-
vances to the lower part of the bafin, the hips
again return to their former pofition, viz. one
hip turned out below the os pubis, and the other
at the back parts of the os externum.
12
N.B. 
 DS          ANATOMICAL  TABLES,
    N. B.  In this  cafe the  child, if not very
 large,  or  the pelvis narrow, may be often de-
 livered alive by the  labour-pains ;  but if long
 detained at the  inferior part of the pelvis, the
 long preffure of the funis may obftruct the cir-
 culation.  In moft cafes where the breech pre-
 fents, the  effect of the labour-pains ought to be
 waited for, till  at leaft they have fully dilated
 the os internum and  vagina, if the fame have
 not been ftretched before with the  waters and
 membranes.   In the  mean time,  whilft  the
 breech advances, the os externum may be dilated
 gently during every pain, to allow room for in-
 troducing  a finger or two  of each hand to the
 outfide of each  groin of the fatus, in order to
 affift the delivery when the nates are advanced
 to the lower part  of  the  vagina.  But if  the
fatus is larger than ufual, or the pelvis narrow,
 and after a long time and many repeated  pains
 the breech is not forced down into the pelvis,
 the patient's ftrength at the fame  time failing,
 the  operator muft  in a gradual manner  or en
 the parts,  and,  having introduced a  hand into
 the vagina, raife cr pufh up the breech of the
fatus, and bring down the legs  and thighs.  If
 the uterus is fo ftrongly contracted that the legs
cannot be got down, the largeft end of the blunt
 hook is to be introduced,  as directed in Table
 XXXVII.   As  foon as the breech or legs are
brought down, the body and head are to be de-
livered as defcribed in the  next  Table,   only
there is no  neceffity here to alter  the pofition
of the child's body.
                                        Vide 
          WITH EXPLANATIONS, &C.       69
   Vide  Vol. I. Book 3. Chap.  4.  Sect. 1  2.
Vol. III. Coll. 32.
   The defcription of the parts in this, and the
following Table, is the fame as in Table XXII;
only the dotted lines in this defcribe the place of
the offa pubis, and anterior parts of  the  "offa if-
chium which are^emoved, and may ferve in this
refped as an example for  all the other front-
views, where,  without  disfiguring  the  Table,
they could  not be fo  well put in.
THE 
70
ANATOMICAL  TABLES,
         THE THIRTIETH TABLE

   Shews, in the fame view and with the fame
references as the former, the breech ofthe fatus
prefenting;  with this difference, however, that
the fore-parts of the child are to the fore-part
of the uterus.  In this cafe, when  the breech
coming double as it prefents is brought  down
to the hams, the legs muft be extracted, a cloth
wrapped round them,  and the fore-parts of the
child turned to the back-parts  of the woman.
If a pain fhould in the mean time force down
the body of the child, it ought to be pufjied up
again in  turning,  as  it turns eafier when  the
belly is in the pelvis, than when the breaft and
fhoulders  are engaged; and as fometimes  the
face and forehead are rather towards one  of the
groins, a  quarter  turn  more brings thefe parts
to the fide of the pelvis, and a little backwards,
after which the body is to be brought down.  If
the child  is not  large, the arms need not be
brought down, and the head may be delivered
by preffing back the fhoulders and body of  the
child to "Cueperinaum,  and whilft the chin and
face are within the vagina, to bring the occiput
out from below the pubes, according  to Da-
venter s method.   Or the operator may intro-
duce a finger or  two  into the mouth,  or  on
each fide of the nofe, and, fupporting the body
on the fame  arm,  fix two fingers of the other
hand over the fhoulders,  on each fide of the
                                    child's 
 
■     '   *.  7     •           ■   ■■'* 
          WITH EXPLANATIONS, &c.        yj
child's neck, and in this manner raife the body
over the pubes, and bring the face and forehead
out with a femicircular turn upwards, from the
under part of the os externum.  All this  may
be  eafily done when  the woman lies on  her
fide; but if the child is large, and the pelvis
narrow, it is better to turn the patient on her
back, as defcribed in Table XXIV.; and after
the legs and body are extraded as far as the
fhoulders, the arms are to be cautioufly brought
down, and the head delivered.  If the woman
has ftrong  pains, and when  by the felt pulfa-
tion of the  funis umbilicalis,  or  the ftruogling
motions of the fatus,  it is certain that the child
is ftill  alive,  wait with patience for the affift-
ance of the labour :  But if that and the hand
are infufficient,  and the pulfation of the funis
turns weaker, and if the child cannot be brought
double, the  breech muft be pufhed up;  and if
the refinance of the uterus is fo great, as to pre-
vent  the  extraction  of the  leg?,  the patient
ought to be turned on her knees and elbows.
When the legs are thus brought down, the wo-
man, if needful, is to be again turned to her back,
to allow more freedom to deliver the body and
head, as before defcribed.   If the  head after
feveral trials cannot be delivered,  without en-
dangering  the child,  from  overftraining  the
neck, the long curved forceps ought to  be ap-
plied, as in  Table XXXV.   If thefe  fail,  and
the patient is not in danger, fome time may be
allowed for the  effect of  the  labour-pains;
     4                                which 
72          ANATOMICAL TABLES,
which likewife proving infufficient, the crotchet
muft be ufed as in TableXXXIX. and when
it is certain that  the child is dead, or that there
is no poflibility of faving it.
THE 
T 
T
 
w
          WITH EXPLANATIONS, &C.       73

       THE THIRTY-FIRST TABLE

Reprefents, in a front  view of the Pelvis, the
  Fatus compreffed, by the contraction of the
  Uterus into a round  form, the fore-parts of
  the former being towards the inferior part of
  the latter, and one  Foot and  Hand fallen
  down into the  Vagina.   In this figure the
  anterior part of the  Pelvis is removed by a
  longitudinal fection  through the middle of
  the Foramen Magnum.

  A A The fuperior parts of the offa ilium.
  BB The uterus.
  GG The mouth of the womb ftretched,  and
appearing in
  OOOO The vagina.
  D The inferior  and pofterior part of the os
externum.
  EEEE The remaining part of the offa pubis
and ifchium.
  FFFF The membrana adipofa.

  This and the three following Tables, repre-
fenting  four different   preternatural pofitions
of the fatus in utero, may ferve as examples for
the manner of delivery in thefe as well as in all
other preternatural cafes.
  In all preternatural cafes, the fatus may be
eafily turned and delivered by the feet, if known
before the membranes are broke, and the waters
                   K            difcharged; 
74          ANATOMICAL TABLES,
difcharged ; or if the pelvis is narrow, and the
patient  is ftrong, the  head, if large, may be
brought  down fo as to prefent in  the  natural
way : but if all the  waters are  difcharged,  and
the uterus is ftrongly contraded to  the body of
the fatus, this laft method can feldom take place
on account of the ftrong preffure of the uterus,
and flipperinefs of the child's head.
  In the prefent cafe, the  woman may either
be laid  on her back  or fide,  as defcribed in
Tables XVI. and XXIV.;  and the operator,
having flowly dilated  the os externum with his
fingers,  muft introduce the  fame into the  va-
gina, and pufh up into the uterus the parts of
the fatus that  prefent; or if there is fpace for
it, his hand may pafs in order to dilate the os
internum if not fufficiently previoufly ftretched
by the membranes and waters.   This done, he
muft advance his  hand into the uterus to know
the pofition of the fatus: and, as the breech is
rather lower than the head,  fearch for the other
leg, and bring down both feet without the os
externum. A cloth muft then be wrapped round
them; and,  having grafped  them with one
hand, he is to introduce the other into the ute-
rus,^  in  order to  raife the head of the fatus,
whilft the legs and thighs are pulled  down by
the hand that holds the feet.   When the head
is raifed, and does not fall down again, the hand
of the operator  may be withdrawn  from the
uterus, and the delivery completed as direded
in the two former Tables.   By the artlefs me-
                                      thod 
          WITH EXPLANATIONS, &C.       75
thod of taking  hold and  pulling one or both
feet, the breech may come down and  the head
rife to the fundus ; but if this  fhould  not hap-
pen, there will be great danger of overftraining
the fatus, which  is prevented by the former
method.   If the membranes  are broken  before
the os uteri is largely opened, and the hand of
the operator cannot be introduced, which fome-
times happens in  a firft pregnancy, the parts
of the fatus  fhould be allowed to protrude ftill
further, by which means the rigidity  of the os
internum will in time be leffened.
   Vide Vol. 1. and  III. on preternatural labours.
K 2               THE 
?6         ANATOMICAL TABLES,
       THE THIRTY-SECOND  TABLE

 Reprefents, in the fame view with the former,
   the Fatus in  the contrary  Pofition; the
   Breech and  Fore-parts being towards  the
   Fundus  Uteri,  the  left  Arm in  the Vagina,
   and fore Arm without the Os  Externum, the
   fhoulder being likewife forced into the  Os
   Uteri.

   The operator in this cafe muft introduce his
 fingers bet veen the back part of the vagina and
 the arm of the fatus, in order to raife the fhoul-
 der and make room for preffing  his hand into
 the uterus to diftinguifh the pofition.  This be-
 ing known, he ought to pufh  up the fhoulder
 to that part of the uterus where the head is
 lodged, in order to raife the  fame  to the fun-
 dus.   If the body of  the fatus does not move
 round, and thereby lie  in a more  convenient
 pofition for bringing down the legs, the hand
 of the operator ought to be pufhed  up ftill
 higher to fearch for and take held of the feet,
 which are to be brought down as far as poffi-
 ble.   If this  fhould  not change the pofition,
 the fhoulder  is to be pufhed up, and  the legs
 pulled down, alternately, till they are brought
 down into the vagina, or without the os extern
num ; after which the  delivery may be com-
 pleted, as in the former cafe.
If 
t 
 
          WITH EXPLANATIONS, &C.        77
   If the feet cannot be brought down lower than
into the vagina, a noofe may be introduced over
both ankles, by which the legs are brought low-
er by pulling the noofe with  one hand, whilft
the other, previoufly introduced into the uterus,
pufhes up the  fhoulders and head.   By this
double force  the  pofition of the fatus is to be
altered, and the delivery effeded. In thefe cafes,
as the fhoulder is raifed to the fundus, the arm
commonly returns into the uterus ; but if the
arm is fo fwelled as to prevent the introdudion
of the  operator's  hand, and  cannot  be folded
up or returned into the uterus, it muft be taken
off at the  fhoulder,  or elbow, in order to deli-
ver and fave the  woman.  If both arms come
down, when  the breaft  prefents, the  methods
above defcribed are to be ufed.
   Vide the explanations and  references of the
foregoing Table to illuftrate  this and  the fol-
lowing.
THE 
7°         ANATOMICAL TABLES,
         THE THIRTY-THIRD TABLE

  Exhibits, in the fame view likewife of the Pel-
    vis with the former,  a  third pofition of the
    Fatus  when  compreffed  into  the  round
    form ;  the  Belly, or Umbilical Region, pre-
    fenting at the  Os Internum,  and the  Funis
    fallen down into the  Vagina, and appearing
    at the Os Externum.

    The delivery in this cafe is to be effeded, as
 in the former Table, by pufhing up the breaft,
 and bringing down the legs.  When the belly
 prefents,  it is  eafier coming at  the  legs,  than
 when the breaft prefents, becaufe in the former
 cafe the head is nearer to the fundus uteri,  and
 the legs and thighs lower. If the belly or breaft
 is forced down into the lower part of the pelvis,
 the child will be in danger from  the bending of
 the vertebra, and the preffure of the fpinal mar-
 row.   So great a force is alfo required to  raife
 thefe parts up into the uterus, in  order to come
 at the feet, that it will be fometimes neceffary
 to turn the woman to her knees and elbows, to
 diminifh the refinance of the abdominal muf-
 cles.  When the funis comes down without the
 os externum, if there is a puifation felt, it muft
 immediately be replaced, and kept warm in the
 vagina, to preferve the circulation, and prevent
 a ftagnation from its being cxpofed to the cold
air.  if the funis comes down  when the head
        *   ,                        prefents, 
7
 
 
                                       T

          WITH EXPLANATIONS, &C.
prefents, the child is in danger, if not fpeedily
delivered with the pains, or brought footling.
  See the two  former Tables for the explana-
tions and references.
THE 
SO         ANATOMICAL  TABLES,
      THE THIRTY-FOURTH TABLE

Shews,  in a lateral view of the Pelvis, one of
   the moft difficult preternatural  cafes.   The
   left Shoulder, Breaft, and Neck of the Fatus
   prefenting, the Head refleded over the Pubes
   to the right Shoulder and Back, and the Feet
   and Breech ftretched up to the  Fundus, the
   Uterus contraded at the fame time,  in form
   of  a  long Sheath,  round  the Body of the
   Fatus.

   ABC The os facrum and coccyx.
   D The os pubis of the left fide.
   E Part  of the urinary bladder.
   F The rectum.
   KL  The private parts.
   M  The anus.
   MN  The perinaum.
   V The meatus urinarius.
   O The os uteri, not yet opened, and fituated
backwards towards the rectum and coccyx.
   RS The fame reprefented in dotted lines, as
opened when the labour is begun.
   1H The fame more fully dilated, but nearer
to the pofterior than anterior part of the pelvis.
   WP The fame not fully ftretched at the fore-
part, though entirely obliterated at the back-
part, the uterus and vagina  being  there only
fometimes one continued furface.
4
Hence 
 
l/'i
 
          WITH EXPLANATIONS,  &C.        $t
  FIenci; it appears why the anterior part of
the os uteri is frequently protruded before  the
head of the fatus at the pubes, which, if it re-
tards delivery, is removed by Aiding it up with
a finger or t\vo between  the head and laft-men-
tioned  part.   Vide  Tables  IX.  X. XL XII.
XIII.
  The manner of delivery in the  pofition  of
the fatus, as reprefented in this Table, is to en-
deavour  with  the hand to force up the part
prefenting, in order to raife ^the head to the fun-
dus.  If  this is impoffible from the  ftrong con-
tradion of the uterus, the operator muft pufh
up  his hand in  a flow  and  cautious manner
along the breaft and belly of the child, in or-
der to come at the legs and feet, which are to
be taken  hold of,  and brought down as far as
the pofition of the fatus will  admit of.   The
body is then to be moved round, by pufhing up
the lower parts, and pulling down  the upper,
till  the feet are brought without the  os externum,
and the delivery completed as  in Table XXXI.
But if the feet cannot be got down, fo as to be
taken hold of without the us externum, a noofe
muft be  fixed over the ancles, as  in Table
XXXII.
  Vide Vol.  I. and III. as direded in Table
XXXI.
L
THE 
 82         ANATOMICAL  TABLES,

        THE THIRTY-FIFTH TABLE

 Shews, in a lateral view of the Pelvis, the me-
   thod of affifting the Delivery of the Head of
   the Fatus with the long curved  Forceps, in
   preternatural Cafes, when it cannot be done
   with the  hands,   as defcribed  in  Tables
   XXIX.  and XXX.

   A  The  three  loweft vertebra of  the loins,
 with the os facrum and coccyx.
   B  The os pubis of the left fide.
   CC' The perinaum and anus preffed back-
 wards with the forceps.
   D  The intefiines.
   EE The parietes of the abdomen.
 -  FFF The uterus.
   G  The pofterior part of the os uteri.
   H  The rectum.
   I The vagina.

   After the body and arms of the  child are
delivered, and the different methods ufed  to
bring  down the head with the hands, as direded
jnthe above Table, and more fully defcribed in
Vol. I. and III. the following method is to be
tried in order to  fave the child, which muft
Otherwife be loft by overftraining the neck and
fpinal  marrow.  The woman being in the fu-
pine pofition, as in Table  XXIV.  one of the
affiftants ought to  hold the body and arms of 
Pag. 4S)
PLxxxk
 
*
/ 
           WITH  EXPLANATIONS, &C        $3
 the child  up towards the abdomen of the wo-
 man, to give .more room to the operator, who
 having introduced one hand up  to the child's
 face, and  moved  it  from the fide a little back-
 wards, for the eafier application of the forceps
 along the  fides of the head, muH. then  turn his
 hand to one of the ears, and  introduce one of
 the blades with  the other hand between the
 fame and  the head, with the curved fide to-
 wards the pubes,  as  in this Table.  This done,
 the hand is to be brought down to  hold the
 handle of  the blade of the forceps, till the other
 hand is introduced  to  the other fide of the
 head, by  which  means  the  fame is  preffed
 againft the blade that is up, and which is thus
 prevented  from flipping, whilft the other hand
 introduces  the fecond  blade  on the   oppofite
 fide.  The blades being thus  introduced, care
 muft be taken, that  in joining them no part of
 the vagina is locked in.   After the forceps are
 firmly fixed along the fides of the head, the
 fifce and forehead muft be turned again to the
 fide of the brim of the pelvis,  by which means
 the wide part *of the  head is to the wide part of
 the brim.  This done, the head is to be brought
 lower,  and the force gradually increafed, ac-
 cording to the refiftance from the largenefs  of
 the head,  or narrownefs of the pelvis.   The
 forehead, when brought low enough down,  is
 then to be turned into the concavity of the  os
facrum and coccyx, the  handles of the forceps
 raifed upwards, and the fame caution ufed in
                     l 2            bringing 
84         ANATOMICAL TABLES,
bringing the head through the os externum, as
defcribed in Table XIX. and  XXX.   By this
method the  head will  be delivered, the child
frequently faved,  and the ufe of the crotchet
prevented,  except in thofe  bafins that are fo
narrow, that it is impoffiblc to deliver without
diminifhing the bulk  of the head.
  Vide Table XXXIX.   Alfo Vol. I.  Book 3.
Chap. 4. Sed. 5. Vol. III. Coll. 34, t>S>
THE 
 
 
WITH EXPLANATIONS, &C
8j
       THE THIRTY-SIXTH TABLE
                                      m
Reprefents, in a lateral view of the Pelvis, the
   method of extrading, with  the affiftance of
   a curved  Crotchet, the head of the Fatus,
   when  left in the  Uterus, after the Body is
   delivered and feparated from it, either by its
   being too large, or the Pelvis too narrow.

   ABC The osfacrum  and coccyx.
   D  The os pubis of the left fide.
   EE The uterus.
   F  The locking part of the crotchet.
   ghi The point of the crotchet on  the infide
of the cranium.

   If  this cafe happens from the forehead's be-
ing towards the pubes,  or the  child long dead,
and fo mqrtified that both the body and under-
jaw are feparated unexpededly,  the  long for-
ceps  that are curved upwards  will be fufficient
to extrad the head; but if the  fame is large,
and the pelvis narrow, and the delivery cannot
be effeded  by the above method, then the head
muft  be opened, that its bulk may diminifh, as
it is extraded.   The patient being placed either
on her back, or fide, as in the explanation of
Table XVI.  and XXIV.  the  left hand  of the
operator is to be introduced into the uterus, and
the forehead of the fatus turned to  the right
fide of the  brim of the pelvis, and a little back-
                                      wards, 
 86         ANATOMICAL TABLES,
 wards, the chin being downwards; after which
 the palm of the hand and finders are to be  ad-
 vanced as high as the fontanelle,  and the head
 grafped with  the thumb and little  finger on
 each fide, as firm as is poffible, whilft an affift-
 ant preffes on each fide of the  abdomen with
 both hands, to keep the  uterus firm in the mid-
 dle and lower  part of the fame.   This done,
 the operator having with his  right hand intro-
 duced  and applied the  crotchet  to  the  head
 (the point being turned  towards  the  forehead,
 and the convex part towards the facrum J, he
 muft go up along the  infide of the left hand as
 high as the fontanelle, and there,  or near it, fix
 the point of the crotchet,  keeping ftill the left
 hand in the former pofition, till with the other
 he pierces the cranium with the point  of the in-
 ftrument,  and tears a large opening in it from
 k to /; after this,  keeping the crotchet fteady,
 he may Aide down his left hand  in a cautious
 manner, left the former pofition fhould be alter-
 ed, and  the head will  fink lower  down by the
 affiftant's  preffing on  the abdomen.   The two
 fore-fingers of the left hand are then to be in-
 troduced into the mouth, and the thumb below
 the under-jaw, the hand being above  the blade
 of the crotchet. When this firm hold is taken,
 the operator may begin  and  pull flowly with
 both hands; and as the brain difcharges through
 the perforation, the head will diminifh, and
come along.   If  this  method fhould  fail from
 the flipperinefs of the  head,  or  its  being fo
                                     much 
         WITH EXPLANATIONS, &C.       Sj
much offified that a fufficient opening cannot
be made, the vertex muft  be turned  down to
the brim of the pelvis, the fontanelle backwards
and each blade of the long forceps introduced
along the fides of the  head, with  the  curved
fide towards the pubes.   After they are joined
and locked, the handles are to be tied together
with a fillet, to keep them firm on the head;
an  affiftant is to  keep the handles backwards
till the cranium is largely opened with the long
fciffars fhewn in Table  XX XIX.   This done,
the head is to be  extraded in a flow manner,
firft turning  the  forehead to.the  fide of the
brim; and as the  brain evacuates, and the head
comes lower down, again turning the forehead
into the concavity of the facrum, and completing
the delivery, as in Table XVI.
   This Table may alfo ferve for an example, to
fhew the method  of fixing the crotchet on the
head, when although the body is not feparated
from it, yet it cannot  be delivered with the
operator's hands, or the long forceps, as in Ta-
ble XXIX. and XXXV.
   Vide Vol. 1. Book 3.  Chap. 3. Sed. 7. Chap.
4. Sed. 5.  Alfo Vol. III.  Coll. 31, 36.
THE 
88
ANATOMICAL TABLES,
      THE THIRTY-SEVENTH' TABLE,

 And the two following, reprefent feveral kinds
   of Inftruments ufeful in  laborious and diffi-
   cult Cafes.

   a The ftraight fhort forceps, in the exad
 proportion as to the width between  the blades,
 and length from the points to the locking part:
 The firft  being two and the /econd  fix inches,
 which with five inches and a half ^the length of
 the  handles),  makes in  all eleven inches and a
 half. 1 he length of the handles may be altered
 at j)leafur£.   1 find, however, in pradiee, that
 this ftandard is the moft convenient,  and with
 lefs  diiiiculty introduced,  than when longer,
 having alfo  fufficient force to deliver  in moft
 cafes where their affiftance  is neceffary.   The
 handles and loweft part  of the blades may as
 here be covered with any durable leather; but
 the blades ought to be  wrapped round with
 fomething of  a -thinner  kind, which may be
 eafily renewed .when there is the leaft fufpicion
 of venerealinfeciion in a former cafe :  By be-
 ing thus covered, the forceps can  have a better
 hold, and  mark lefs the head of the child.   For
 their eafier introdudion, the  blades ought like-
wife to be greafed with hog's lard.
  b  Reprefehts the pofterior part of a fingle
blade, in order to fhew  the  open part of the
fame, and the form and proportion  of  the
          4                           whole. 
 
■**.
-JT
•"-«£■: 
         WITH EXPLANATIONS, &C        89
whole.   The handles, however, as here repre-
fented, are rather too large.
  Vide Table XXI. for the figure and  propor-
tions of the long  forceps, that are  curved up-
wards, and covered in the fame manner as the
former.
  The forceps were  at firft  contrived to fave
the fatus, and prevent, as much as poffible, the
ufe of fharp inftruments;  but even to this fa-
lutary method,  recourfe ought not to be had
but in cafes where the degree of force  requifite
to  extrad  will  not endanger, by its confe-
quences, the life  of  the mother:  For, by the
imprudent ufe of the forceps, much more harm
may be done than good.
  See the explanation of  Table XVI.  Alfo
the preface to Vol.  II. with the  cafes in  the
Colledion on that fubjed.
  c The blunt hook which  is ufed for three
purpofes.
   Firfi, To affift the extradion of the head after
the cranium is opened with the fciffars,  by intro-
ducing the fmall  end along the ear on the out-
fide of the head to above  the  under jaw,  where
the point is to be fixed; the other extremity of
the hook being held  with one hand, whilft two
fingers of the other  are to be introduced into
the aforefaid opening, by which holds the head
is to be gradually extraded.
   Secondly,  The  fmall ends  is ufeful  in abor-
tions in any of the firft four or five months, to
hook down the fecundines, when lying locfe in
                     M                  the 
 £0         ANATOMICAL TABLES,
 the uterus, when the patient is much weakened
 by floodings from the too long retention of the
 fame, the pains alfo being unable to expel them,
 and when they cannot be extraded with the fin-
 gers.   But if the placenta ftill adheres, it is  dan-
 gerous to ufe this or any other inftrument to ex-
 tract  the fame, as it ought to be left till it fepa-
 rates  naturally.  If a fmall part of the fecundines
 is protruded through the os  uteri,  and pulled
 away from what ftill adheres in the uterus, the
 mouth of the womb contrads, and that irritation
 is thereby removed which would have continu-
 ed the pains, and have feparated and difcharged
 the whole.
   Thirdly, The  large hook at the other end is
 ufeful to affift the extradion of the body, when
 the breech prefents; but fhould be  ufed with
 great  caution,  to avoid the diflocation or frac-
ture of the thigh.
   Vide Table X XIX.   Alfo  Vol. I. Book 2.
Chap. 3. Book 3, Chap. ;,. Sed- 7. and  Chap.
4. Sed, 2. Vol. II,  Coil.  12. Vol. 111. Coll. 11
tii*-: 
 
 
          WITH EXPLANATIONS, &C       Of


      THE  THIRTY-EIGHTH TABLE.

   A,  represents the  whale-bone fillet,
which may be fometimes  ufeful in laborious
cafes, when the operator is not provided  with
the forceps  in fudden and unexpeded exigen-
cies.
   When the vertex of the fatus prefents,  and
the head is forced down into the lower  part of
the pelvis, the woman weak, and the pains not
fufficient to  deliver k, the double of the fillet is
to be introduced along the fore-part of  the pa-
rietal bones to the face,  and if poffible above
the under-jaw ; which  done,  the  whale-bone
may be either left in or pulled down out of the
fheath, and every weak pain affifted by  pulling
gently at the fillet.   If the head can be raifed
to the upper part of the pelvis,  the fillet  will be
more eafily  got over  the chin,  which is a fafer
and better hold than on the  face.  If the face
or forehead prefents, the fillet is to be intro-
duced over the occiput.   Vide Vol.  I. Book 3.
Chap. 3. Sed. 2. Vol. II. Coll. 24.
   In fuch cafes, likewife the whale-bone may
be  fupplied  by  a twig  of any  tough  wood,
mounted with a limber garter or fillet fewed in
form of a long fheath.
   BB  Gives two views of a new kind  of pef-
fary for the  prolapfus  uteri, being  taken from
the French and Dutch kind.  After the uterus
                    M  2                 is 
O2         ANATOMICAL TABLES,
is reduced, the large end of the peffary is to be
introduced into the vagina,  and the os uteri re-
tained in the concave part, where there are three
holes to prevent the ftagnation of any moifture.
The fmall end without the os externum has two
tapes drawn through the two holes, which are
tied to four other tapes, that hang down from a
belt that furrounds the woman's body,  and by
this means keep up the peffary.   This fort may
be  taken out by the patient when fhe  goes to
bed, and introduced again in the morning; but
as this fometimes rubs the os externum,  fo as to
make its ufe uneafy, the round kind marked C
are of more general ufe.  They are made of
wood, ivory,  or cork, (the laft  covered  with
cloth and dipt in wax) : The peffary is to be
lubricated  with  pomatum,  the  edge  forced
through the paffage into the vagina, and a fin-
ger introduced into the hole in the middle lays
it acrofs within the os  externum.   They ought
to be larger or  fmaller, according to the widenefs
or narrownefs of the paffage, to prevent  their
being  forced out by any extraordinary (train-
ing.   Vide Vol. 1.  Book 4. Chap. 1.  Sed. 7.
Vol. III. Coll. 24.
   DD Gives  two views of a female catheter,
to fnew its degree of curvature and different
parts.   Thofe for  common ufe  may be made
much  fhorter for  conveniency of  carrying in
the pocket: But fometimes, when the head or
body of the child preffes on the bladder above
                                        the 
          WITH EXPLANATIONS, &C.        93
the pubes, it requires one of this length ; and in
fome extraordinary cafes, I have been obliged
to ufe a male catheter.
   Vide  Vol. I. Book 2. Chap. 1.  Sed. 1, 2,
Vol. II. Coll.  1 a No.  2.
 
94
ANATOMICAL  TABLES,
       THE THIRTY-NINTH TABLE.

   a Represents a  pair of curved  crotchets
locked together in the fame manner as the for-
ceps. It is very rare that the ufe of both is ne-
ceffary, excepting when the face prefents with
the chin turned to the facrum, and when  it  is
impoffible to move the head to  bring  the child
footling, or deliver with the forceps.   In  that
cafe, if one  crotchet is not fufficient, the other
is to be introduced, and when joined together
will ad both as crotchets, in opening the  cra-
nium, and, as the head advances,  will likewife
ad as forceps in moving and turning  the head
more conveniently for the delivery of the fame.
They may alfo be ufeful  to affift when the
head is left in the uterus, and one  blade is not
fufficient.   There is feldom occafion, however,
for the fliarp crotchet, when the head prefents ;
the blunt hook in  Table XXVII.  being com-
monly fufficient, or even the forceps to extract
the fame, after it is opened with  the fciffars.
Great care ought to be  taken,  when the fharp
crotchet is introduced,  to keep the point to-
wards  the fatus,  efpecially in cafes where the
fingers  cannot be  got up to guide the fame.
The dotted lines along the infide of one of the
blades, reprefent a  fheath that is  contrived to
guard  the point   till it is introduced high
enough;  the ligature at the handles marked
with the two  dotted lines is then  to be  un-
                                       tied, 

 
 
          WITH EXPLANATIONS, &C.       95
tied, the fheath withdrawn, and the  point be-
ing uncovered, is fixed as  direded  in  Table
XXXVI.
  The point,  guarded with this  fheath, may
alfo be ufed inftead of the blunt hook.
  b  Gives a view of the back-part of one of
the crotchets, which is twelve inches long.
  c  Gives a front-view of  the point, to (hew
its length and breadth, which ought to  be ra-
ther longer and narrower than here reprefented.
  d Reprefents the fciffars proper f&r perfora-
ting the cranium  in very narrow and diftorted
pelvifes.   They ought to be made very ftrong,
and nine inches at leaft in length, with ftops cr
refts in the  middle of the blades,  by which a
large dilatation is  more eafily made.
  The above inftruments ought only to be ufed
in the moft extraordinary cafes, where it is not
poffible to fave the woman without their affift-
ance.
   Vide Vol. I. Book 3. Chap. 3. Sed. 5. Chap.
5. No. 1. Vol. 111. Coll. 31, 2>5-
AjyDh 
^6          ANATOMICAL TABLES,
           ADDITIONAL  TABLE.
                 Numb.  XL.

   Among  the few improvements which have
 been made in the obftetrical apparatus fince the
 days of Dr. Smellie, the moft important are the
 alterations in the forceps, by which the incon-
 veniencies formerly attending the ufe of that in-
 ftrument are obviated, and the operation is ren-
 dered mcge fafe and eafy.
   In contriving thefe alterations, the inten-
 tions were,  i. That the large curves fhould cor-
 refpond as nearly as  poffible with that  of the
pelvis.   2. That their points fhould be thrown
 forwards,  and made round, to prevent their
 hitching,  or even preffing uneafily againft any
 part of the pelvis;  and likewife to maintain
 their hold of the head, whilft it is to be brought
 forwards in that  curved line of diredion which
 nature obferves.    3.  That  an  inverted curve
 fhould be  made towards the joints, whereby the
 perinaeum  may be faved from  injury,  the ex-
 trading force rightly conduded, and the han-
 dles at the fame time kept from preffing unea-
 fily on the  inferior and  anterior  parts  of the
pubes.   4. That their fubftance fhould-^re-
 duced as much as poffible, fo that they are not
 made flexible, or fo thin at the edges as to
 hurt the part.  5. That their clams  be made
 to prefs equally on the child's head, and fpread
gradually from the joint, fo as not to dilate the
          2                              os 
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4:    * 
            TH  EXPLANATIONS, &C       gf
os vagina  .oO fuddenly.   6. That the clams
be of  a  due breadth,  with the outer  furface
a  little convex,  and extremely fmooth, that
they may not prefs uneafily or  hurt the wo-
man.  7. That  their length be fuch as can be
applied fafely and commodioufly within the
pelvis, and at the fame time fuit the different
fizes of the heads as much as poffible.
   The inftrument, executed according  to thefe
intentions, is called the Short  Curved Forceps.
It confifts of two blades,  or  parts ;  each  of
which is diftinguifhed  into  the handle  A, the
joint BB, and the clams DD. See fig. 1 which
reprefents the inftrument finifhed and  locked,
in which ftate it meafures about 11  inches, and
when  properly made,  weighs  about 11 ounces
troy.  The  clams muft be covered with  the
beft  morocco leather  fhaved  thin, moiftened
with water,  and fewed on  with waxed filk.
   N.  B.  Several inconveniencies both in the
 introdudion  and confequences, having been
 found to attend the ufe of the forceps with the
 clams covered, praditioners at prefent  very ge-
 nerally prefer thofe of polifhed fteel.
   Fig.  2.  A catheter with a  fmall curve to-
 wards the point, which is better adapted to the
 female urethra than the ftraight one.   U may
 be perforated with 8,  12, or 16 holes  in rows,
 as here  reprefented, and terminated by a flight
 very  fmooth rounded or  oblong knob.  The
 length fhould be nearly fix inches, and the dia-
 meter not too fmall.
                       N                t'g- 
9^         ANATOMICAL TABLES.
  Fig. 4. The perforator of Dr. Denman, as it
is called by workmen,  though Dr. Orme ; -r-
haps firft introduced it into pradice : It is !'ow
employed by many praditioners  in preference
to Dr. Smellie's.  If Dr.  Smellie's fhould  be
ftill ufed, the fharp edges ought to be removed;
they fhould,   like thofe here  reprefented,  be
curved towards the point, and  fhould be pro-
vided with blunt knobs inftead of angular refts,
which  expofe  the patient to the hazard  of
having the parts wounded  or lacerated.
  Fig. 4.  The blunt hook at prefent ufed,  ha-»
ving a fwell in the middle by which the extrac-
tion can be accomplifhed with more fafety and
fuccefs than with the ftraight hook,
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