Selections from Ryan's Obstetrical Writings

The first rule to be observed by the practitioner of obstetric medicine is, to obey the summons to give his personal attendance to the parturient female, as soon as possible. This duty admits of no compromise, for it is of the first importance to ascertain the presenting part, before the disruption of the membranes; because, if preternatural, it can be more easily rectified before the completion of the first stage; for in such a case, the practice is to rupture the membranes, when the os uteri is sufficiently dilated, to seize the feet, and deliver the infant by the operation of turning. If the membranes have burst, the uterus is in close contact with the body of the infant; and if the pains be violent, as it mostly happens, the operation of turning cannot be performed; as the womb would be lacerated, which is a most fatal occurrence. Again, an early examination is most necessary, as flooding may destroy the patient, or the feet of the infant may be expelled, the body retained in the vagina, and such pressure made on the navel string as to impede the circulation of the blood between the mother and child, and kill the latter. The obstetrician, on his arrival, should ascertain all delicate inquiries from the nurse or other female attendant; and not in the sick-chamber. He should learn the duration of labor, the state of the bowels, and the history of the case, and impress the necessity of admittance to the patient as soon as possible. After admission into the sick chamber, he should approach the patient with his countenance contemplative, cheerful, nor grave and melancholy; his look pleasing, mixed with mildness and humanity, and expressive of a sincere desire of affording her alleviation. He ought to be polite and attentive, never proud, insolent, haughty or grave, which would alarm the patient, [237/238] who is generally timid and dejected.