Signs whether the Child be alive or dead. From the reluctance that every one must feel in opening the head of a child, it will be still a satisfaction to us to know whe ther it be alive or dead. The marks, then, are these : in the first place, supposing the child is alive, the pregnancy of the mother will continue to increase to the end of her time; and in labour there senting parts will have a firm elastic feel; the cuticle and hair will not come away on the finger : besides which, there will generally be a pulsation at the fontanelle. But the navel-string being pressed may cause death ; it may arise, and does often arise, without any cause that we are able to trace. We know that a child may die in utero from affections of the mind in the woman. The death of the child may be known by shivering fits preceded by a sense of coldness in the abdomen. While the child is alive, it assists in supporting its own heat ; but when dead, it necessa rily must obtain a degree of heat by rob bing the mother of part of the heat in the parts around, which explains the sense of coldness that is felt. The breasts, while the child is alive, increase, and continue firm and well supported; but when the child dies, they immediately become flac cid and empty. So that a woman, fre quently used to miscarriage, will foretel its approach by this alone. While the child us alive, it gives the sensation of a living weight, a weight which is capable of adapting itself to the different posi tions of the mother ; but when death deprives it of this power, the woman feels it flap from side to side, accord ing to the way in which she moves. She becomes sensible of weight to a much greater degree than before. Besides all which, there will be the cessation of mo tion in the fixtus, which is always perceiv ed by the mother some months before de livery. These are so many signs of the child's death, which may be observed be fore labour comes on.
There are others which accompany la bour : first, as the child is dead, the mem branes will be dead also and for that reason will break earlier than they other. wise would. It has been said, that the liquor amnii being turpid, points out the child being dead ; but this circumstance sometimes arises while the child is alive and well. The strongest sign is one by which we may tell it before even we see the woman ; it is by the waters being corrupted. The smell of putrefaction will sometimes decide the opinion of an experienced practitioner the instant he enters the door; also in examination, from the meconium coming away on the hand, in consequence of the spincter muscle be ing putrid and relaxed. The sutures of the head vacillate like bones in a bag. When we examine, the hair and cuticle will come away upon the finger.
When all, or even the greater part, of these signs are united, there can be no possible doubt that the child is no longer alive.
In what cases the Child'. head oholdd be opened. These cases are syncope, con vulsions, hemorrhage, on the part of the mother ; hydrocephalus iliternus on the part of the child. This last disease may be ascertained by examination, the sutures and fontanelles being at a greater dis tance than they should be, and the whole cranium very imperfectly ossified; but the most unequivocal evidence is the head's not entering the pelvis; by which we know that the head is too big for the pel vis, or that the pelvis is not large enough to receive the head into it, which is the same thing in effect.
When all the stages of labour are gone through, and the head is not advanced, we are led to examine and find out what the state of the child is. When we have ascertained the existence of a deformity of pelvis, we may generally tell the space left for the child's passage, by passing the finger from before backward ; that is, from the vagina ; the space under the arch of the pubes, backwards and rather upwards, towards the projecting front of the sacrum, where the first lumbar verte bra rests on it. Now, in a well formed pelvis this cannot be done ; it is not pos sible to reach the sacrum in this way; but in a deformed pelvis we may ascer tain the space pretty accur..tely ; when the distance between the projecting part ef the sacrum and the symphisis pubis is upwards of two inches, the delivery is very simple; it would be well if it were less so, as then it would not be so fre quently adopted as at present. Many a practitioner has sacrificed a child's life at the shrine of his own ignorance. It is much easier to apply the perforator and open the head of the child, than it is to apply the forceps ; in the latter some considera ble skill is required, in the former none.
Is what manner the !lead is to be opened.
The necessity for this operation being manifest, we must proceed as follows. First empty the bladder, then throw up an injection, that the rectum may be also cleared; next, introduce the hand into the vagina up to the os.uteri, upon which we are to pass the perforator, guarding the point with the utmost care, while passing it by means of the other hand purposely introduced before the instru. went. The points of this instrument are guarded by stops, by which, when we push the points through the child's head, we avoid the danger of their passing too far, and by coming through the opposite side of the head, of wounding the uterus. The way they are need is this: we bring the points upon a suture or fontanelle, re collecting that when they are introduced, the handles are close together, and con sequently that both the points form one perforator ; now when, by the hand in the vagina, we have laid the points opposite the part of the head we intend to open, we press the instrument down with force sufficient to make it pass through the in teguments, which, being done, and the perforator pushed in up to the stops, we are next to lay our hand between the handles and pass it up between them to the joint. The effect of this will be, by its acting as a wedge to force asunder the points, and to dilate and tear open the sides of the wound before made; we next close the sides of it and change its posi tion, so that the handles will have their rings in a horizontal position ; we then open the instrument again as before, which gives us a cruciform opening. This being done, the perforator is next to be pushed into the head, and screwed round backward and forward, so as entirely to break down the consistence and connec tion of every thing within the skull ; this will generally be sufficient, the pains will quickly press out the cerebrum, which may be removed from time to time ; or we may scoop it out with a table-spoen.