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THE
MEDICAL
.. . AND .

PHYSICAL
| J O U R V 4

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PRINTED FOR RICHARD PHILLIPS, No. 6, BRIDGE-STREET,

BLACKFRIARS.

By William Thorns, Red Lion Court, Fleet Street.

( Entered at Stationers Hall. ]

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Printed for R. PHILLIPS, by W. Thorne, Red Lion Court, Fleet Street, London.

OBSERVATIONS ON SELECT SUBJECTS IN SURGERY.

By Mr. SIMMONS.
( Continued from Vol. xiv. pp. 481-490.)

ON A CASÉ REQUIRING THE USE OF THE CROTCHET.

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A Given disproportion between the head of the child and the diameter of the pelvis of the mother, constitutes a legitimate cause for the use of the crotchet. This disproportion may arise from the incompressibility or preternatural enlargement of the head itself, or from a malformation or morbid contraction in the passage of the pelvis. Either of these instances singly, and especially the union of two of them in the same subject, may render it expedient to open the head, in order to reduce its bulk, and restore the equilibrium between the body to be extruded and the cavity through which it has to pass. Uncontested as are these points of doctrine, their right application to the case before us is sometimes very difficult. In every such instance, the operator will be relieved from much painful anxiety by the death of the child; and the body, loosened in its texture by putrefaction, will oppose less resistance to its subsequent delivery. Yet, where the obstruction is still greater than is here supposed, and the labour consequently more 'lingering, the long continued pressure of the head may induce a mortification of the 11terus, or soft parts lining the pelvis. To the mother this is a source of danger that has met with less attention from practitioners than, in my opinion, it is entitled to receive. The early indications of it are those of inflammation, which is sometimes, though not always, ushered in by pyrexia, the pulse becomes hard and frequent; the pains almost incessant, are described to be like the cutting of a sharp instrument; the exclamations too are loud and shrill, No. 83.)

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