On axis-traction forceps / by Alexander Russell Simpson.

Date:
1880
Catalogue details

Licence: Public Domain Mark

Credit: On axis-traction forceps / by Alexander Russell Simpson. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    always offers the best means of terminating the labour. I am un- hesitatingly on the side of those who in all such cases rejet^t out and out the treacherous help that seems to be offered in the oxytocic power of ergot. {2dhJ) Irregular Adionofthe Uterus.—The uterus, in certain cases instead of, as it were, sulking and ceasing its work, gets irritable, and is thrown into a series of irregular contractions. In this case pains are present, perhaps constant; but the contractions in the uterine walls are spasmodic and partial, and quite inoperative for the advance of the head. When the practitioner is sure that the bowels and bladder are clear, and the membranes still unbroken, the unmistakable indication is to bring uterine action to a stand- still by large doses of opium, chloral, chloroform or nitrite of amyl; and only where the membranes have been long broken and the waters much drained is there a call for immediate recourse to de- livery with the forceps. {oclly) There is a group of cases where contractions of the uterus, perhaps vigorous and regular enough, are yet not producing their due effect in consequence of their Mis-direction. It is usually an anterior deviation of the fundus that exists in consequence of re- laxation of the abdominal walls ; and probably proper posturing of the patient, or application of a bandage, will render the uterine effort efficacious. If not, some practitioners will apply the forceps, whilst others elect turning. 2g?, In the Abdominal Poiuer.—The secondary or accessory force supplied by the action of the abdominal and respiratory muscles fails in cases of exhaustion, of general debility, of paralysis, or in diseased conditions of some of the abdominal and thoracic viscera. In many of our patients we happily find a compensatory relaxa- tion of the soft passages, which offers such slight resistance to the progress of the passenger that the uterus is equal to the occasion, and expels its. contents without the usual aid of the accessory power. Sometimes the accoucheur can supplement the uterine effort by pressure with his hands or a bandage. But often he gives most effective aid by application of the forceps. 2. The fault is in the parturient Passages, soft or hard. \st, In the Soft Canals.—With regard, first of all, to the Cei-vix, I have to remark, that after all that has been said and written on the subject, I believe that the application of the forceps witliin the partially dilated os uteri is very seldom called for in practice. To my mind some other element of delay or danger must be present to warrant the extraction of the head witli the forceps through an imperfectly expanded cervix; and in such conditions the extraction should be conducted cautiously, and with the clear conviction that undue rapidity of action is liable to cause laceration of the cervical tissues. The Vaginal loalls, in the second place, may offer obstruc- tion to the normal progress of the head either from original or