CHAPTER IX

Of Scirrhous Tumours, or Hardness of the Womb.

Ascirrhus, or a hard unnatural swelling of the matrix is generally produced by neglected, or imperfectly cured phlegm, which, insensibly, hinders the functions of the womb, and predisposes the whole body to listlessness.

One cause of this disease may be ascribed to want of judgment on the part of the physician, as many empirics when attending to inflammation of the womb, chill the humour so much that it can neither pass backward nor forward, and hence, the matter being condensed, turns into a hard, stony substance. Other causes may be suppression of the menses, retention of theLochein, commonly called the after purging; eating decayed meat, as in the disordered longing after thepleiato which pregnant women are often subject. It may, however, also proceed from obstructions and ulcers in the matrix or from some evil affections of the stomach or spleen.

If the bottom of the womb be affected, she feels, as it were, a heavy burden representinga mole,[7]yet differing from it, in that the breasts are attenuated, and the whole body grows less. If the neck of the womb be affected, no outward humours will appear; its mouth is retracted and feels hard to the touch, nor can the woman have sexual intercourse without great pain.

Confirmed scirrhus is incurable, and will turn to cancer or incurable dropsy, and when it ends in cancer it proves fatal, because as the innate heat of these parts is almost smothered, it can hardly be restored again.

Where there is repletion, bleeding is advisable, therefore open a vein in one arm and in both feet, more especially if the menses are suppressed.

Treat the humours with syrup of borage, succory made with a poultice, and then take the following pills, according to the patient's strength.

Hiera piera six drachms, two and a half drachms each of black hellebore and polypody; a drachm and a half each of agaric, lapis lazuli, sal Indiae, coloquintida, mix them and make two pills. After purging, mollify the hardness as follows:—the privy parts and the neck of the womb with an ointment of decalthea and agrippa; or take two drachms each of opopanax, bdellium, ammoniac and myrrh, and half a drachm of saffron; dissolve the gum in oil of lilies and sweet almond and make an ointment with wax and turpentine. Apply diacatholicon ferellia below the navel, and make infusions of figs, mugwort, mallows, pennyroyal, althea, fennel roots, melilot, fenugreek and the four mollifying herbs, with oil of dill, camomiles and lilies dissolved in it. Take three drachms of gum bdellium, put the stone pyrites on the coals, and let her take the fumes into her womb. Foment the privy parts with a decoction of the roots and leaves of dane wort. Take a drachm each of gum galbanum and opopanax, half an ounce each of juice of dane wort and mucilage of fenugreek, an ounce of calve's marrow, and a sufficient quantity ofwax, and make a pessary. Or make a pessary of lead only, dip it in the above mentioned things, and put it up.

The atmosphere must be kept temperate, and gross and salt meats such as pork, bull beef, fish and old cheese, must be prohibited.

FOOTNOTES:

[7]

Mole: "A somewhat shapeless, compact fleshy mass occurring in the uterus, due to the retention and continued life of the whole or a part of the foetal envelopes, after the death of the foetus (amaternal or true mole); or being some other body liable to be mistaken for this, or perhaps a polypus or false mole." (Whitney's Century Dictionary.)

Of Dropsy of the Womb.

Uterine dropsy is an unnatural swelling, caused by the collection of wind or phlegm in the cavity, membranes or substance of the womb, on account of the want of innate heat and of sufficient alimentation, and so it turns into an excrescence. The causes are, too much cold and moisture of the milt and liver, immoderate drinking, eating insufficiently cooked meat, all of which by causing repletion, overpower the natural heat. It may likewise be caused by undue menstruation, or by any other immoderate evacuation. To these may be added abortions, subcutaneous inflammations and a hardened swelling of the womb.

The signs of this affection are as follows:—The lower parts of the stomach, with the genitals, are swollen and painful; the feet swell, the natural colour of the face is lost, the appetite becomes depraved, and there is a consequent heaviness of the whole body. If the woman turns over in bed a noise like flowing water is heard, and sometimes water is discharged from the womb. If the swelling is caused by wind and the stomach feels hot, it sounds like a drum; the bowels rumble, and the wind escapes through the neck of the womb with a murmuring noise. This affection may be distinguished from true conception in many ways, as will be shown in the chapter onconception. It is distinguished from common dropsy, by the lower parts of the stomach being most swollen. Again, it does not appear so injurious in this blood-producing capability, nor is the urine so pale, nor the face so altered. The upper parts are also not so reduced, as in usual dropsy.

This affection foretells the ruin of the natural functions, by that peculiar sympathy it has with the liver, and that, therefore,kathydria, or general dropsy will follow.

In the cure of this disease, imitate the practice of Hippocrates, and first mitigate the pain with fomentations of melilot, dog's mercury, mallows, linseed, camomiles and althoea. Then let the womb be prepared with syrup of stoebis, hyssop, calamint, mugwort, with distilled water, a decoction of elder, marjoram, sage, origan, spearage, pennyroyal, and betony. Purge with senna, agaric, rhubarb, and claterium. Take spicierum hier, a scruple each of rhubarb, agaric lozenges, and make into pills with iris juice.

When diseases arise from moistness, purge with pills, and in those affections which are caused by emptiness or dryness, purge by means of a draught. Apply cupping glasses to the stomach and also to the navel, especially if the swelling be flatulent. Put a seton on to the inside of each leg, the width of a hand below the knee. Take two drachms each of sparganium, diambrae, diamolet, diacaliminti, diacinamoni, myrrh lozenges, and a pound of sugar; make these into lozenges with betony water, and take them two hours before meals. Apply a little bag of camomiles, cummin and melilot boiled in oil of rue, to the bottom of the stomach as hot as it can be borne; anoint the stomach and theprivates with unguent agripp, and unguent aragon. Mix iris oil with it, and cover the lower part of the stomach with a plaster of bay berries, or a cataplasm made of cummin, camomiles, briony root, adding cows' and goats' dung.

Our modern medical writers ascribe great virtues to tobacco-water, injected into the womb by means of a clyster. Take a handful each of balm of southernwood, origanum, wormwood, calamint, bay berries and marjoram, and four drachms of juniper berries; make a decoction of these in water, and use this for fomentations and infusions. Make pessaries of storax, aloes, with the roots of dictam, aristolochia and gentian, but instead of this you may use the pessary prescribed at the end of Chapter XVII. Let her take aromatic electuary, disatyrion and candied eringo roots, every morning.

The air must be hot and dry, moderate exercise is to be taken and too much sleep prohibited. She may eat the flesh of partridges, larks, grouse, hares, rabbits, etc., and let her drink diluted urine.

Of Moles[8]and False Conceptions.

This disease may be defined as an inarticulate shapeless piece of flesh, begotten in the womb as if it were true conception. In this definition we must note two things: (1) because a mole is said to be inarticulate or jointless, and without shape, it differs from monstrosities which are bothformataandarticulata; (2) it is said to be, as it were a true conception, which makes a difference between a true conception, and a mole, and this difference holds good in three ways. First, in its genus, because a mole cannot be said to be an animal: secondly, in the species, because it has not a human figure and has not the character of a man; thirdly, in the individual, for it has no affinity to the parent, either in the whole body, or in any particular part of it.

There is a great difference of opinion amongst learned writers as to the cause of this affection. Some think, that if the woman's seed goes into the womb, and not the man's, that the mole is produced thereby. Others declare that it springs from the menstruous blood, but if these two things were granted, then virgins, by having their courses or through nocturnal pollutions, might be liable to the same things, which none have ever been yet. The true cause of this fleshy mole is due both to the man and from the menstruous blood in the woman both mixing together in the cavity of the womb. Nature finding herself weak there (and yet wishing to propagate her species), labours to bring forth a defective conception rather than nothing and instead of a living creature produces a lump of flesh.

The signs of a mole are these. Themensesare suppressed, the appetite becomes depraved, the breasts swell and the stomach becomes inflated and hard. So far the symptoms in a pregnant woman and in one that has a mole are the same, but now this is how they differ. Thefirst sign of difference is in the movements of a mole. It may be felt moving in the womb before the third month, whereas an infant cannot be so felt; yet this motion cannot proceed from any intelligent power in the mole, but from the capabilities of the womb, and of the seminal vigour, distributed through the substance of the mole, for it does not live an animal, but a vegetable life, like a plant.Secondly, in a mole the stomach swells suddenly, but in true conception it is first contracted, and then rises by degrees.Thirdly, if the stomach is pressed with the hand, the mole gives way, and returns to its former position as soon as the hand is removed. But a child in the womb does not move immediately though pressed with the hand, and when the hand is removed it returns slowly or not at all.Lastly, no child continues in the womb more than eleven months, but a mole continues for four or five years, more or less, sometimes according as it is fastened to the matrix; and I have known a mole pass away in four or five months. If, however, it remains until the eleventh month, the woman's legs grow weak and the whole body wastes away, but the stomach still increases, which makes some women think that they are dropsical, though there is no reason for it, for in dropsy the legs swell and grow big, but in a mole they wither and fall away.

In the school of Hippocrates we are taught that bleeding causes abortion, by taking all the nourishment which should preserve the life of the embryo. In order, therefore, that this faulty conception may be deprived of that nourishing sap by which it lives, open the liver vein and saphena in both feet, apply cupping glasses to the loins and sides of the stomach, and when that has been done, let the uterine parts be first softened, and then the expulsive powers be stimulated to get rid of the burden.

In order to relax the ligatures of the mole, take three handfuls of mallows with their roots, two handfuls each of camomiles, melilot, pellitory of the wall, violet leaves, dog's mercury, fennel roots, parsley, and one pound each of linseed and fenugreek; boil them in oil and let the patient sit in it up to her navel. When she comes out of her bath, she should anoint her private parts and loins with the following ointment:—"Take one ounce each of oil of camomiles, lilies and sweet almonds: half an ounce each of fresh butter, laudanum and ammoniac, and make an ointment with oil of lilies. Or, instead of this, you may use unguentum agrippae or dialthea. Take a handful of dog's mercury and althea roots; half a handfulof flos brochae ursini; six ounces of linseed and barley meal. Boil all these together in honey and water and make a plaster, and make pessaries of gum galbanum, bdellium, ammoniac, figs, pig's fat and honey.

After the ligaments of the mole are loosened, let the expulsive powers be stimulated to expel the mole, and for doing this, all those drugs may be used which are adapted to bring on the courses. Take one ounce of myrrh lozenges, half an ounce each of castor, astrolachia, gentian and dittany and make them into a powder, and take one drachm in four ounces of mugwort water. Take calamint, pennyroyal, betony, hyssop, sage, horehound, valerian, madder and savine; make a decoction in water and take three ounces of it, with one and a half ounces of feverfew. Take three scruples each of mugwort, myrrh, gentian and pill. coch.; a drachm each of rue, pennyroyal and opopanax, and the same of asafoetida, cinnamon, juniper-berries and borage, and make into pills with savine juice, to be taken every morning. Make an infusion of hyssop, bay leaves, bay berries, calamint, camomiles, mugwort and savine. Take two scruples each of sacopenium, mugwort, savine, cloves, nutmeg, bay berries; one drachm of galbanum; one scruple each of hiera piera and black hellebore, and make a pessary with turpentine.

But if these medicaments are not procurable, then the mole must be pulled out by means of an instrument called thepes gryphis,[9]which may be done without much danger if it be performed by a skilful surgeon. After she has been delivered of the mole (because the woman will have lost much blood already), let the flow of blood be stopped as soon as possible.

Apply cupping glasses to the shoulders and ligatures to the arms, and if this be not effective, open the liver vein in the arm.

The atmosphere of the room must be kept tolerably dry and warm, and she must be put on a dry diet, to soothe the system; she must, however, drink white wine.

FOOTNOTES:

[8]

Mole: "A somewhat shapeless, compact fleshy mass occurring in the uterus, due to the retention and continued life of the whole or a part of the foetal envelopes, after the death of the foetus (a maternal or true mole); or being some other body liable to be mistaken for this, or perhaps a polypus or false mole." (Whitney's Century Dictionary.)

[9]

Griffin's claw, a peculiar hooked instrument.

Of Conception and its Signs, and How a Woman may know whether it be Male or Female.

Ignorance often makes women the murderesses of the fruit of their own body, for many, having conceived and finding themselves out of order, and not rightly knowing the cause, go to the shop of their own conceit and take whatever they think fit, or else (as the custom is) they send to the doctor for a remedy, and he, not perceiving the cause of their trouble, for nothing can be diagnosed accurately by the urine, prescribes what he thinks best; perhaps some diuretic or cathartic, which destroy the embryo. Therefore Hippocrates says, it is necessary that women should be instructed in the signs of conception, so that the parent as well as the child may be saved from danger. I shall, therefore, lay down some rules, by which every woman may know whether she is pregnant or not, and the signs will be taken from the woman, from her urine, from the child and from experiments.

The first day after conception, she feels a slight quivering and chilliness throughout herbody; there is a tickling of the womb and a little pain in the lower parts of her stomach. Ten or twelve days after she feels giddy and her eyes dim and with circles round them; the breasts swell and grow hard, with some pain and pricking in them, whilst the stomach rises and sinks again by degrees, and there is a hardness about the navel. The nipples grow red, the heart beats unusually strongly, the natural appetite abates, and the woman has a craving after strange food. The neck of the womb is contracted, so that it can scarcely be felt when the finger is put in. And the following is an infallible sign; she is alternately in high spirits and melancholy; the monthly courses cease without any apparent cause, the evacuations from the bowels are retained unusually long, by the womb pressing on the large gut, and her desire for sexual intercourse is diminished. The surest sign is taken from the infant, which begins to move in the womb in the third or fourth month, and not in the manner of a mole, mentioned above, from side to side like a stone, but gently, as may be perceived by applying the hand cold upon the stomach.

The best writers affirm that the water of a pregnant woman is white and has little specks init, like those in a sunbeam, ascending and descending in it, of an opal colour, and when the sediment is disturbed by shaking the urine, it looks like carded wool. In the middle of gestation it turns yellow, then red and lastly black, with a red film. At night on going to bed, let her drink water and honey, and if afterwards she feels a beating pain in her stomach and about the navel, she has conceived. Or let her take the juice of cardius, and if she brings it up again, that is a sign of conception. Throw a clean needle into the woman's urine, put it into a basin and let it stand all night. If it is covered with red spots in the morning, she has conceived, but if it has turned black and rusty, she has not.

If it is a male, the right breast swells first, the right eye is brighter than the left, the face is high-coloured, because the colour is such as the blood is, and as the male is conceived of purer blood and of more perfect seed than the female, red specks in the urine, and making a sediment, show that a male has been conceived, but if they are white, a female. Put the urine of the woman into a glass bottle, let it stand tightly stoppered for two days, then strain it through a fine cloth,and you will find little animals in it. If they are red, it is a male, but if white, it is a female.

The belly is rounder and lies higher with a boy than with a girl, and the right breast is harder and plumper than the left, and the right nipple redder, and the woman's colour is clearer than when she has conceived a girl.

To conclude, the most certain sign to give credit to, is the motion of the child, for the male moves in the third month, and the female not until the fourth.

Of Untimely Births.

When the fruit of the womb comes forth before the seventh month (that is, before it comes to maturity), it is said to be abortive; and, in effect, the children prove abortive, that is, do not live, that are born in the eighth month. Why children born in the seventh or ninth month should live, and not those born in the eighth, may seem strange, and yet it is true. The cause of it is ascribed by some to the planetunder which the child is born; for every month, from conception to birth, is governed by its own planet, and in the eighth month Saturn predominates, which is dry and cold; and coldness, being an utter enemy to life, destroys the natural constitution of the child. Hippocrates gives a better reason, viz.:—The infant, being every way perfect and complete in the seventh month, wants more air and nourishment than it had before, and because it cannot obtain this, it tries for a passage out. But if it have not sufficient strength to break the membranes and to come out as ordained by nature, it will continue in the womb until the ninth month, so that by that time it may be again strengthened. But if it returns to the attempt in the eighth month and be born, it cannot live, because the day of its birth is either past or is to come. For in the eighth month Avicunus says, it is weak and infirm, and therefore on being brought into the cold air, its vitality must be destroyed.

Untimely births may be caused by cold, for as it causes the fruit of the tree to wither and fall before it is ripe, so it nips the fruit of the womb before it comes to perfection, or makes it abortive;—sometimes by humidity, which weakensits power, so that the fruit cannot be retained until the proper time. It may be caused by dryness or emptiness, which rob the child of its nourishment, or by an alvine discharge, by bleeding or some other evacuation, by inflammation of the womb, and other severe disease. Sometimes it is caused by joy, anger, laughter and especially by fear, for then the heat forsakes the womb, and goes to the heart, and so the cold sinks into the womb, whereby the ligaments are relaxed, and so abortion follows. On this account, Plato recommended that the woman should avoid all temptations to excessive joy and pleasure, as well as all occasions for fear and grief. Abortion may also be caused by the pollution of the air by filthy odours, and especially by the smell of the smouldering wick of a candle, and also by falls, blows, violent exercise, jumping, dancing, etc.

Signs of coming abortion are a falling away of the breast, with a flow of watery milk, pains in the womb, heaviness in the head, unusual weariness in the hips and thighs, and a flowing of the courses. Signs denoting that the fruit is dead in the womb are sunken eyes, pains in the head, frights, paleness of the face and lips, gnawing at the stomach, no movements of the infant; coldnessand looseness of the mouth of the womb. The stomach falls down, whilst watery and bloody discharges come from the womb.

Directions for Pregnant Women.

The prevention of untimely births consists in removing the aforementioned causes, which must be effected both before and after conception.

Before conception, if the body be too hot, dry or moist, employ such treatment as to counteract the symptoms; if the blood be vitiated purify it, if plethoric, open the liver vein; if gross, reduce it; if too thin strengthen and nourish it. All the diseases of the womb must be removed as I have shown.

After conception, let the atmosphere be kept temperate, do not sleep too much, avoid late hours, too much bodily exercise, mental excitement, loud noises and bad smells, and sweet smells must also be avoided by those who are hysterical. Refrain from all things that may provoke either urine or menstruation, also salt,sour, and windy food, and keep to a moderate diet.

If the bowels are confined, relieve the stomach with injections made of a decoction of mallows and violets, with sugar and salad oil; or make a broth with borage, buglos, beetroot, and mallows, and add a little manna to it. If, on the other hand, she be troubled with looseness of the bowels, do not check it with medical advice, for all the uterine fluxes have some bad qualities in them, which must be evacuated before the discharge is stopped.

A cough is another thing to which pregnant women are frequently liable, and which causes them to run great danger of miscarrying, by the shock and continual drain upon the vein. To prevent this shave off the hair from the coronal commissures, and apply the following plaster to the place.

Take half an ounce of resin, a drachm of laudanum, a drachm each of citron peel, lignaloes and galbanum, with a sufficient quantity of liquid and dry styrax. Dissolve the gum in vinegar and make a plaster, and at night let her inhale the fumes of these lozenges, thrown upon bright coals. Take also a drachm and a half each of frankincense, styrax powder and red roses: eight drachms of sandrich, a drachm each of mastic, benjamin and amber; make into lozengeswith turpentine, and apply a cautery to the nape of the neck. And every night let her take the following pills:—Half an ounce each of hypocistides, terrae sigilatae and fine bole; two drachms each of bistort, alcatia, styrax and calamint, and one drachm of cloves, and make into pills with syrup of myrtles.

In pregnant women, a corrupt matter is generated which, flowing to the ventricle, spoils the appetite and causes sickness. As the stomach is weak, and cannot digest this matter, it sometimes sends it to the bowels which causes a flux of the stomach, which greatly adds to the weakness of the womb. To prevent all these dangers the stomach must be strengthened by the following means:—Take one drachm each of lignaloes and nutmeg; a scruple each of mace, cloves, mastic, laudanum; an ounce of oil of spikenard; two grains of musk, half an ounce each of oil of mastic, quinces and wormwood, and make into an ointment for the stomach, to be applied before meals. Instead of this, however, you may use cerocum stomachile Galeni. Take half an ounce each of conserve of borage, buglos and atthos; two drachms each of confection of hyacinths, candied lemon peel, specierum, diamarg, pulo. de genunis: two scruples each of nutmeg and diambra; two drachma each of peony roots and diacoratum, and makeinto an electuary with syrup of roses, which she must take twice a day before meals. Another affection which troubles a pregnant woman is swelling of the legs, which happens during the first three months, by the superfluous humours descending from the stomach and liver. To cure this, take two drachms of oil of roses, and one drachm each of salt and vinegar; shake them together until the salt is dissolved, and anoint the legs with it hot, rubbing it well in with the hand. It may be done without danger during the fourth, fifth and sixth months of pregnancy; for a child in the womb is compared to an apple on the tree. For the first three months it is a weak and tender subject, like the apple, to fall away; but afterwards, when the membranes become strengthened, the fruit remains firmly fastened to the womb, and not subject to mischances, and so it remains, until the seventh month, until when it is near the time, the ligaments are again relaxed (like the apple that is almost ripe).

They grow looser every day, until the appointed time for delivery; if, therefore, the body is in real need of purging, the woman may do it without danger in the fourth, fifth or sixth month, but neither before nor after that unless in the case of some violent illness, in which it is possible that both mother and child may perish.Apply plasters and ointments to the loins in order to strengthen the fruit in the womb. Take one drachm each of gum Arabic, galangale, bistort, hypocistid and storax, a drachm and a half each of fine bole, nutmeg, mastic, balaust, dragon's blood and myrtle berries, and a sufficient quantity of wax and turpentine and make into a plaster. Apply it to the loins in the winter, and remove it every twenty-four hours, lest the loins should become overheated by it. In the interim, anoint the private parts and loins withcountess' balsambut if it be summer time and the loins hot, the following plaster will be more suitable. Take a pound of red roses, two drachms each of mastic and red Sanders, one drachm each of bole ammoniac and red coral, two drachms and a half each of pomegranate seed and prepared coriander seed, two scruples of barberries, one ounce each of oil of mastic and of quinces, and plantain-juice.

Anoint the loins also with sandalwood ointment, and once a week wash them with two parts of rose-water and one of white wine mixed together and warmed at the fire. This will assuage the heat of the loins, get rid of the oil of the plaster from the pores of the skin, and cause the fresh ointment or plaster to penetrate more easily, and to strengthen the womb. Some think that a load-stone laid upon the navel, keepsa woman from abortion. The same thing is also stated of the stone calledaetitesor eagle-stone, if it is hung round the neck. Samian stone has the same virtue.

Directions for Women when they are taken in Labour, to ensure their safe Delivery, and Directions for Midwives.

Having thus given the necessary directions to pregnant women, how to manage their health during their pregnancy, I will now add what is necessary for them to do, in order that they may be safely delivered.

When the time of birth draws near, the woman must be sure to send for a skilful midwife, and that rather too soon than too late. She must have a pallet bed ready to place it near the fire, so that the midwife and those who are to help her, may be able to pass round it, and give assistance on either side, as may be required. A change of linen must be in readiness, and a small stool to rest her feet against, as she will havemore power when her legs are bent, than when they are straight.

When everything is thus ready, and when the woman feels the pains coming on, if the weather be not cold, she should walk about the room, rest on the bed occasionally, waiting for the breaking of the waters, which is a fluid contained in one of the outward membranes, and which flows out thence, when the membrane is broken by the struggles of the child. There is no special time for this discharge, though it generally takes place about two hours before the birth. Movements will also cause the womb to open and dilate, and when lying long in bed will be uncomfortable. If she be very weak she may take some mild cordial to give her strength, if her pain will permit her; and if the labour be tedious, she may be revived with chicken or mutton broth, or she may take a poached egg; but she must be very careful not to eat to excess.

There are many postures in which women are delivered; some sitting in a chair, supported by others, or resting on the bed; some again upon their knees and resting on their arms; but the safest and most commodious way, is in the bed, and then the midwife ought to observe the following rules:—Let her lay the woman upon her back, with her head a little raised by means of a pillow, with similar supports for her loins andbuttocks, which latter should also be raised, for if she lies low, she cannot be delivered so easily. Then let her keep her knees and thighs as far apart as she can, her legs bent inward towards each other, and her buttocks, the soles of her feet and her heels being placed upon a small rest, placed for the purpose, so that she may be able to strain the stronger. In case her back should be very weak, a swathing band should be placed under it, the band being doubled four times and about four inches broad. This must be held by two persons who must raise her up a little every time her pains come on, with steady hands and in even time, but if they be not exact in their movements, they had better leave her alone. At the same time two women must hold her shoulders so that she may strain out the foetus more easily; and to facilitate this let one stroke or press the upper part of her stomach gently and by degrees. The woman herself must not be nervous or downhearted, but courageous, and forcing herself by straining and holding her breath.

When delivery is near, the midwife must wait patiently until the child's head, or some limb, bursts the membranes, for if the midwife through ignorance, or through haste to go to some other woman, as some have done, tears the membrane with her nails, she endangers both the womanand the child; for by lying dry and lacking that slipperiness which should make it easy, it comes forth with severe pains.

When the head appears, the midwife must hold it gently between her hands, and draw the child, whenever the woman's pains are upon her, but at no other times; slipping her forefingers under its armpits by degrees, and not using a rough hand in drawing it out, lest the tender infant might become deformed by such means. As soon as the child is taken out, which is usually with its face downwards,—it should be laid upon its back, that it may receive external respiration more freely; then cut the navel string about three inches from the body, tying the end which adheres to it with a silk string, as closely as you can; then cover the child's head and stomach well, allowing nothing to touch its face.

When the child has been thus brought forth, if it be healthy lay it aside, and let the midwife attend to the patient by drawing out the afterbirth; and this she may do by wagging and stirring it up and down, and afterwards drawing it out gently. And if the work be difficult, let the woman hold salt in her hands, close them tightly and breathe hard into them, and by that she will know whether the membranes are broken or not. It may also be known by making her strain or vomit; by putting her fingers down her throat,or by straining or moving her lower parts, but let all be done immediately. If this should fail, let her take a draught of elder water, or the yolk of a new laid egg, and smell a piece of asafoetida, especially if she is troubled with a windy colic. If she happen to take cold, it is a great obstruction to the afterbirth; in such cases the midwife ought to chafe the woman's stomach gently, so as to break, not only the wind, but also to force the secundine to come down. But if these should prove ineffectual, the midwife must insert her hand into the orifice of the womb and draw it out gently.

Having thus discussed common births, or such as are generally easy, I shall now give directions in cases of extremity.

What ought to be done in cases of extremity, especially in women who, in labour, are attacked by a flux of blood, convulsions and fits of wind.

If the woman's labour be hard and difficult, greater care must be taken than at other times.And, first of all, the situation of the womb and her position in lying must be across the bed, and she must be held by strong persons to prevent her from slipping down or moving during the surgeon's operations. Her thighs must be put as far apart as possible, and held so, whilst her head must rest upon a bolster, and her loins be supported in the same manner. After her rump and buttocks have been raised, be careful to cover her stomach, belly and thighs with warm clothes, to keep them from the cold.

When the woman is in this position, let the operator put up his or her hand, if the neck of the womb be dilated, and remove the coagulated blood that obstructs the passage of the birth; and by degrees make way gently, let him remove the infant tenderly, having first anointed his hand with butter or some harmless salve. And if the waters have not come down, they may then be let out without difficulty. Then, if the infant should attempt to come out head foremost, or crosswise, he should turn it gently, to find the feet. Having done this, let him draw out one and fasten it with ribbon and then put it up again, and by degrees find the other, bringing them as close together and as even as possible, and between whiles let the woman breathe, and she should be urged to strain so as to help nature in the birth, that it may be brought forth. Andto do this more easily, and that the hold may be surer, wrap a linen cloth round the child's thighs, taking care to bring it into the hand face downwards.

In case of flux of blood, if the neck of the womb be open, it must be considered whether the infant or thesecundine, generally called the afterbirth, comes first, and as the latter happens to do so occasionally, it stops the mouth of the womb and hinders the birth, and endangers both the woman's and the child's life. In this case the afterbirth must be removed by a quick turn. They have deceived many people, who, feeling their softness, have supposed that the womb was not dilated, and by that means the woman and child, or at least the latter, have been lost. When the afterbirth has been removed, the child must be sought for and drawn out, as directed above; and if the woman or the child die in such a case, the midwife or the surgeon are blameless because they have used their best endeavours.

If it appears upon examination that the afterbirth comes first, let the woman be delivered as quickly as possible, because a great flow of blood will follow, for the veins are opened, and on this account two things have to be considered.

First:—The manner in which the afterbirth advances, whether it be much or little. If the former, and the head of the child appears first,it may be guided and directed towards the neck of the womb, as in the case of natural birth, but if there appears any difficulty in the delivery, the best way is to look for the feet, and draw it out by them; but if the latter, the afterbirth may be put back with a gentle hand, and the child taken out first. But if the afterbirth has come so far forward that it cannot be put back, and the child follows it closely, then the afterbirth must be removed very carefully, and as quickly as may be, and laid aside without cutting the entrail that is fastened to it; for you may be guided to the infant by it, which must be drawn out by the feet, whether it be alive or dead, as quickly as possible; though this is not to be done except in cases of great necessity, for in other cases the afterbirth ought to come last.

In drawing out a dead child, these directions should be carefully followed by the surgeon, viz.—If the child be found to be dead, its head appearing first, the delivery will be more difficult; for it is an evident sign that the woman's strength is beginning to fail her, that, as the child is dead and has no natural power, it cannot be assisting in its own delivery in any way. Therefore the most certain and the safest way for the surgeon is, to put up his left hand, sliding it into the neck of the womb, and into the lower part of it towards the feet, as hollow in the palmas he can, and then between the head of the infant and the neck of the womb. Then, having a forceps in the right hand, slip it up above the left hand, between the head of the child and the flat of the hand, fixing it in the bars of the temple near the eye. As these cannot be got at easily in the occipital bone, be careful still to keep the hand in its place, and gently move the head with it, and so with the right hand and the forceps draw the child forward, and urge the woman to exert all her strength, and continue drawing whenever her pains come on. When the head is drawn out, he must immediately slip his hand under the child's armpits, and take it quite out, and give the woman a piece of toasted white bread, in a quarter of a pint of Hippocras wine.

If the former application fails let the woman take the following potion hot when she is in bed, and remain quiet until she begins to feel it operating.

Take seven blue figs, cut them into pieces and add five grains each of fenugreek, motherwort and rue seed, with six ounces each of water of pennyroyal and motherwort; reduce it to half the quantity by boiling and after straining add one drachm of troches of myrrh and three grains of saffron; sweeten the liquor with loaf sugar, and spice it with cinnamon.—After having rested on this, let her strain again as much aspossible, and if she be not successful, make a fumigation of half a drachm each of castor, opopanax, sulphur and asafoetida, pounding them into a powder and wetting the juice of rue, so that the smoke or fumes may go only into the matrix and no further.

If this have not the desired effect, then the following plaster should be applied:—Take an ounce and a half of balganum, two drachms of colocynth, half an ounce each of the juice of motherwort and of rue, and seven ounces of virgin bees' wax: pound and melt them together, spreading them on a cere-cloth so that they may spread from the navel to the os pubis and extending to the flanks, at the same time making a pessary of wood, enclosing it in a silk bag, and dipping it in a decoction of one drachm each of sound birthwort, savin colocinthis, stavescare and black hellebore, with a small sprig or two of rue.

But if these things have not the desired effect, and the woman's danger increases, let the surgeon use his instruments to dilate and widen the womb, for which purpose the woman must be placed on a chair, so that she may turn her buttocks as far from its back as possible, at the same time drawing up her legs as close as she can and spreading her thighs open as wide as possible; or if she is very weak it may be better to layher on the bed with her head downwards, her buttocks raised and both legs drawn up. Then the surgeon may dilate the womb with his speculum matrices and draw out the child and the afterbirth together, if it be possible, and when this is done, the womb must be well washed and anointed, and the woman put back to bed and comforted with spices and cordials. This course must be adopted in the case of dead children and moles, afterbirths and false births, which will not come out of themselves, at the proper time. If the aforementioned instrument will not widen the womb sufficiently, then other instruments, such as the drake's bill, or long pincers, ought to be used.

If any inflammation, swelling or congealed blood happens to be contracted in the womb under the film of these tumours, either before or after the birth, let the midwife lance it with a penknife or any suitable instrument, and squeeze out the matter, healing it with a pessary dipped in oil of red roses.

If the child happens at any time to be swollen through cold or violence, or has contracted a watery humour, if it is alive, such means must be used as are least injurious to the child or mother; but if it be dead, the humours must be let out by incisions, to facilitate the birth.

If, as often happens, the child is presentedfeet foremost, with the hands spreading out from the hips, the midwife must in such a case be provided with the necessary ointments to rub and anoint the child with, to help it coming forth, lest it should turn into the womb again, holding both the infant's arms close to the hips at the same time, that it may come out in this manner; but if it proves too big, the womb must be well anointed. The woman should also take a sneezing powder, to make her strain; the attendant may also stroke her stomach gently to make the birth descend, and to keep it from returning.

It happens occasionally, that the child presenting itself with the feet first, has its arms extended above its head; but the midwife must not receive it so, but put it back into the womb, unless the passage be extraordinarily wide, and then she must anoint both the child and the womb, and it is not safe to draw it out, which must, therefore, be done in this manner.—The woman must lie on her back with her head low and her buttocks raised; and then the midwife must compress the stomach and the womb with a gentle hand, and by that means put the child back, taking care to turn the child's face towards the mother's back, raising up its thighs and buttocks towards the navel, so that the birth may be more natural.

If the child happens to come out with one foot, with the arm extended along the side and the other foot turned backwards; then the woman must be immediately put to bed and laid in the above-described position; when the midwife must immediately put back the foot which appears so, and the woman must rock herself from side to side, until she finds that the child has turned, but she must not alter her position nor turn upon her face. After this she may expect her pains and must have great assistance and cordials so as to revive and support her spirits.

At other times it happens that the child lies across in the womb, and falls upon its side; in this case the woman must not be urged in her labour; therefore, the midwife when she finds it so, must use great diligence to reduce it to its right form, or at least to such a form in the womb as may make the delivery possible and most easy by moving the buttocks and guiding the head to the passage; and if she be successful in this, let the woman rock herself to and fro, and wait with patience till it alters its way of lying.

Sometimes the child hastens simply by expanding its legs and arms; in which, as in the former case, the woman must rock herself, but not with violence, until she finds those parts fall to their proper station; or it may be doneby a gentle compression of the womb; but if neither of them avail, the midwife must close the legs of the infant with her hand, and if she can get there, do the like by the arms, and so draw it forth; but if it can be reduced of itself to the posture of a proper birth it is better.

If the infant comes forward, both knees forward, and the hands hanging down upon the thighs, then the midwife must put both knees upward, till the feet appear; taking hold of which with her left hand let her keep her right hand on the side of the child, and in that posture endeavour to bring it forth. But if she cannot do this, then also the woman must rock herself until the child is in a more convenient posture for delivery.

Sometimes it happens that the child presses forward with one arm extended on its thighs, and the other raised over its head, and the feet stretched out at length in the womb. In such case, the midwife must not attempt to receive the child in that posture, but must lay the woman on the bed in the manner aforesaid, making a soft and gentle compression on her belly, oblige the child to retire; which if it does not, then must the midwife thrust it back by the shoulder, and bring the arm that was stretched above the head to its right station; for there is most danger in these extremities; and, therefore, themidwife must anoint her hands and the womb of the woman with sweet butter, or a proper pomatum, and thrust her hand as near as she can to the arm of the infant, and bring it to the side. But if this cannot be done, let the woman be laid on the bed to rest a while; in which time, perhaps, the child may be reduced to a better posture; which the midwife finding, she must draw tenderly the arms close to the hips and so receive it.

If an infant come with its buttocks foremost, and almost double, then the midwife must anoint her hand and thrust it up, and gently heaving up the buttocks and back, strive to turn the head to the passage, but not too hastily, lest the infant's retiring should shape it worse: and therefore, if it cannot be turned with the hand, the woman must rock herself on the bed, taking such comfortable things as may support her spirits, till she perceives the child to turn.

If the child's neck be bowed, and it comes forward with its shoulders, as it sometimes doth, with the hands and feet stretched upwards, the midwife must gently move the shoulders, that she may direct the head to the passage; and the better to effect it, the woman must rock herself as aforesaid.

These and other like methods are to be observed in case a woman hath twins, or threechildren at a birth, which sometimes happens: for as the single birth hath but one natural and many unnatural forms, even so it may be in a double and treble birth.

Wherefore, in all such cases the midwife must take care to receive the first which is nearest the passage; but not letting the other go, lest by retiring it should change the form; and when one is born, she must be speedy in bringing forth the other. And this birth, if it be in the natural way, is more easy, because the children are commonly less than those of single birth, and so require a less passage. But if this birth come unnaturally, it is far more dangerous than the other.

In the birth of twins, let the midwife be very careful that the secundine be naturally brought forth, lest the womb, being delivered of its burden, fall, and so the secundine continue longer there than is consistent with the woman's safety.

But if one of the twins happens to come with the head, and the other with the feet foremost, then let the midwife deliver the natural birth first; and if she cannot turn the other, draw it out in the posture in which it presses forward; but if that with its feet downward be foremost, she may deliver that first, turning the other aside. But in this case the midwife must carefully see that it be not a monstrous birth, insteadof twins, a body with two heads, or two bodies joined together, which she may soon know if both the heads come foremost, by putting up her hand between them as high as she can; and then, if she finds they are twins she may gently put one of them aside to make way for the other, taking the first which is most advanced, leaving the other so that it do not change its position. And for the safety of the other child, as soon as it comes forth out of the womb, the midwife must tie the navel-string, as has before been directed, and also bind, with a large, long fillet, that part of the navel which is fastened to the secundine, the more readily to find it.

The second infant being born, let the midwife carefully examine whether there be not two secundines, for sometimes it falls out, that by the shortness of the ligaments it retires back to the prejudice of the woman. Wherefore, lest the womb should close, it is most expedient to hasten them forth with all convenient speed.

If two infants are joined together by the body, as sometimes it monstrously falls out, then, though the head should come foremost, yet it is proper, if possible, to turn them and draw them forth by the feet, observing, when they come to the hips, to draw them out as soon as may be. And here great care ought to be used in anointing and widening the passage. But these sort ofbirths rarely happening, I need to say the less of them, and, therefore, shall show how women should be ordered after delivery.

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