Part 1 (1/2)

A System of Midwifery.

by Edward Rigby.

PREFACE.

This System of Midwifery, complete in itself, was published in London, as a part of Dr. Tweedie's ”_Library of Medicine_.” The first series of the Library, that on ”_Practical Medicine_,” recently completed, has been received with extraordinary favour on both sides of the Atlantic, and the character of the publication is fully sustained in the present contribution by Dr. Rigby, and will secure for it additional patronage.

The late Professor Dewees, into whose hands this volume was placed, a few weeks before his death, in returning it, expressed the most favourable opinion of its merits; and the judgment of such high authority renders it supererogatory to add a word farther of commendation.

It is only necessary for the editor to say that the production of the author is so complete as to have rendered his labour a light one. He has restricted himself mainly to such additions and references as he conceived would render the work more useful to American pract.i.tioners. The object of the publication being to present the most condensed view of each subject, he believed it to be inexpedient to depart from the plan by making extensive additions, and entering into the discussion of controversial points, most of which are of minor practical importance.

INTRODUCTION.

By the term Midwifery is understood the knowledge and art of treating a woman and her child during her pregnancy, labour, and the puerperal state.

We employ it in this extended sense, because most systematic writers of later times have adopted this arrangement. The terms, _Art des Accouchemens_ of the French, the _Ostetricia_, and _Arte della Parteria_, of the Italians and Spaniards, and the _Geburtshulfe_ of the Germans, are restricted to the process of parturition, although they have been and continue to be, used in the same extended sense as that in which we propose to use the term Midwifery.

Although pregnancy and parturition, strictly speaking, are perfectly natural functions, yet they involve such a complication and variety of other processes, and also changes of such extent, that the whole system is rendered more or less subservient to them during the periods of their existence: hence, therefore, their number and variety must ever render them more or less liable to deviations and irregularities of action, which will necessarily be aggravated by the effects of civilized life, and in many instances are productive of derangement in the general economy of the system. Under such circ.u.mstances the irritability of the system increases at the expense of its strength and vigour, and not only increases its liability to these derangements, but diminishes its power of resisting their effects.

In order that we may render the nature and treatment of the changes and phenomena, which take place in the human system during the periods above alluded to, more intelligible, we shall take a short anatomico-physiological view of the structure, form, arrangement, and function of the parts and organs which are more or less directly concerned in these important processes. This will embrace the subject of embryology, a department of physiological knowledge, which, though it has lately been much enriched by valuable discoveries, still affords a rich field of investigation and research.

The diagnosis and course of healthy pregnancy, and its various diseases, terminating with the subject of healthy parturition and its treatment will form the subject of the succeeding part.

Parturition properly speaking, will come under two separate heads _eutocia_ and _dystocia_; the one signifying natural or favourable labour, the other, unnatural, faulty, or unfavourable labour.

The concluding part will contain a short account of some of the more important diseases which occur to the female during the first month after parturition.

PART I.

THE ANATOMY AND PHYSIOLOGY OF UTERO-GESTATION.

CHAPTER I.

THE PELVIS.

_Ossa innominata.--Sacrum.--Coccyx.--Distinction between the male and female pelvis.--Diameters of the pelvis.--Pelvis before p.u.b.erty.-- Axes.--Inclination._

The Pelvis, as the frame-work which, in great measure, contains, supports, and protects, the complicated apparatus of the generative organs, first claims our attention; since an accurate knowledge of the form, size, and uses, of its different parts is indispensably necessary, not only to understand the situation of the viscera it contains, but also to form a correct view of the mechanism upon which the process of parturition depends.

This osseous ca.n.a.l or circular archway, consists essentially of three bones, the right and left os innominatum, which form the sides of the arch, with the sacrum between them, acting as a keystone, and supporting the whole weight of the trunk above.

_Ossa innominata._ The ossa innominata in early life consists of three distinct bones, the _iliac_ or _hip bones_ at the sides, the _ischia_ or lower portion upon which we sit, and the _ossa pubis_ which meet each other anteriorly to form the front part of the pelvis. In the adult these are consolidated into one bone, merely leaving irregular lines and ridges here and there to mark their previous existence.

These bones present several striking points of resemblance with those which belong to the upper extremities, viz. the scapula and clavicle; and in the early stages of development, this similarity is much more distinctly seen: it is remarkable, that although the ischia and ossa pubis are formed later than the ilia, yet they unite with each other much sooner than with the ilia, so that the two consolidated bones bear the same relation to the ilium which is separated from them, that the clavicle does to the scapula: many other points of resemblance between the bones of the shoulder and pelvis might be noticed if necessary. (Meckel, _Anat._ vol.

ii. p. 239.) The ossa innominata meet each other in front, forming the _symphysis pubis_, having layers of fibro-cartilage interposed between their extremities, and bound together by ligamentous fibres const.i.tuting the _ligamentum arcuatum_, or _annulare ossium pubis_, and by which a more rounded appearance is given to the pubic arch. They are united to the sacrum posteriorly, one on each side of it, forming the _right and left sacro-iliac symphysis_ or _synchondrosis_; this differs in many respects from the symphysis pubis, the cartilaginous coverings of the opposing bones being much thinner, especially those of the ossa innominata; the surfaces are extremely uneven from the deep indentations which each bone presents at this part, locking, as it were, into each other, and thus contributing greatly to increase the firmness of the joint, which is also still farther strengthened by the support of powerful ligaments.