In the next place we must attend to the constitutional changes. For the first twenty-four hours after being taken in la bour the woman works away very vigor ously; while during the last twelve hours the labour will hardly make any progress, and she is sweating extremely. This state will at last change; it will dually sink down to a mumbling half de gra lirious state, wandering and low. No woman should be allowed to go in this state ; and if she be in such a situation, she should not be allowed to remain in it. For if the pressure of the vessels up on the brain be allowed to continue, she will become apoplectic. Besides, there will be harm done to the abdominal mus cles. What good will be done by allow the woman to deliver herself, if the vagina and bladder slough with the parts around, which is another thing that may happen ? In a consultation that was held in a case of this kind, it was agreed that nature certainly should be able to deliver the woman : she therefore was not inter fered with ; she (lid deliver herself, but lost her life for it; she died, and that at a time when an ear was to be felt, which certainlywas a piece of barbarity. It is safe to assert, that if, after we are able to feel the ear, the woman is not delivered in six hours, we ought always to deliver with instruments. We know that in stran
gulated hernia nature has, in one case out of 50,000, made an artificial anus through the side, after the parts themselves have sloughed off. But are we for that reason to avoid operating for the strangulated hernia ? Are we to leave the patient to the powers of nature ? There is not any difference between pushing a man into the water, and not helping him out of it, if we see him drowning ; neither in the same way is there any difference between destroying a woman purposely, and ne glecting to employ those means, which, when she is in danger, will certainly save her life. There are many other cases in which the forceps may with propriety be used : hemoptoe, syncope, flooding. pre sentation of the navel string, rupture of the uterus ; all these occurrences justify its application, provided the case is with in the power of management by these means, either forming impaction or ar rest.
We proceed, therefore, to examine in. to the origin and nature of the instru ments usually and advantageously em played on such occasions.