DUKE HOSPITAL LIBRARY 
 DURHAM, N. C. 
 
 Rec'd . 
 
 Dr, W, C> Davison 
 
 Donor 
 
DATE DUE 
 
Digitized by the Internet Archive 
 in 2014 
 
 https://archive.org/details/obstetricplateswOOsmel 
 
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OBSTETRIC PLATES, 
 
 WITH EXPLANATIONS : 
 
 SELECTED FROM 
 
 THE ANATOMICAL TABLES 
 
 OF 
 
 WILLIAM SMELLIE, M.D. 
 
 LONDON: 
 
 SAMUEL HIGHLEY, 32, FLEET STREET. 
 
 MDCCCXLVIII. 
 
PRINTED BY C. AND J. ADLARD, 
 
 BARTHOLOMEW CLOSE. 
 
PLATE I 
 
 Shows a side view of the pelvis, sinned column, and 
 uterus, during the first stage of a natiu'al labour. 
 
 The child is seen in its most usual attitude and 
 position within the w^omb. It forms an ovoid, which 
 corresponds to the shape of the uterus at the latter 
 months of gestation. The head, which is the smaller 
 end of the ovoid, is presenting with the occiput to the 
 left side of the pelvis and the forehead, or larger fonta- 
 nelle, to the right side. The chin is slightly inclined 
 towards the chest; the arms touch the sides of the chest, 
 and the fore-arms and hands cross over the chest. The 
 legs are in a general state of flexion, and the feet cross 
 each other. 
 
 In the first stage of labom-, the lower part of the 
 womb, or os uteri, has to be dilated, so as to allow a 
 free communication between the cavity of the womb 
 and the vagina. Tliis is effected mechanically by the 
 womb contracting and forcing down a column of the 
 licfior amnii towards the os uteri, which press out the 
 membranes at this part, forming an even hemispherical 
 water wedge, by which the circle of the os uteri is 
 
4 
 
 equally enlarged. When the womb contracts, or, in 
 other words, during a labour-pain, the head of the 
 child is raised, as is seen in the plate ; the waters 
 gathering below it, and after the pain, when the womb 
 is relaxed, it again subsides on the os tiferi, and can 
 there be felt through the thin membranes. 
 
 PLATE I. 
 
 A. The last dorsal vertebra. 
 
 B. The OS pubis, on the left side, 
 c.c. The OS uteri, 
 
 D. The vagina. 
 
 E. The left nympha. 
 
 F. The left labium pudendi. 
 
 G. The remaining portion of the bladder. 
 
 H. The anus. 
 
 I. I. The left hip and thigh. 
 
I'L .i i J-: I 
 
.5 
 
 PLATE II. 
 
 The bones of the pelvis between the acetabula are here 
 removed with the bladder, and the head of the child is 
 seen in its second position, and in the second stage of 
 laboui'. The occiput is directed towards the ri(/Jit, and 
 not, as in Plate I, towards the left side of the pelvis, 
 and the os uteri having been fully dilated, and the 
 membranes ruptured, the head has sunk into the cavity 
 of pelvis. As the head descends from the brim of 
 the pelvis into the cavity, the vertex, or the presenting 
 part, moves gradually forward towards the ramus of 
 the iscliium, in doing which it adapts itself to the pelvis, 
 so as to pass where there is the most room. The 
 different planes of the brim cavity and outlet vary; and 
 they are so arranged, as that the head of the child, in 
 passing through them, is obliged to move forward in a 
 screw-like manner, and is unerringly, in natural labour, 
 dii'ected towards the outlet. 
 
6 
 
 PLATE II. 
 
 A. The uterus a little contracted, and thicker 
 
 from the partial escape of the liquoi' amnii, 
 
 B. • The anterior superior spinous processes of 
 
 the ilia, 
 
 c. The inferior part of the rectum. 
 
 D. D» The vagina largely stretched. 
 
 E. E. The OS uteri fully opened. 
 
 F. A portion of \\\& placenta. 
 
 G. G. The membranes. 
 
 H. H. The lig amenta lata. 
 
 i.T. The ligamenta rotunda; — they increase during 
 gestation, and become placed close to the 
 sides of the uterus. 
 
I'L.ii h: 
 
 Enijrayai />y J. Steward Se/i'. 
 
 /, /../,■„ /.JL'-/;,'/7 hj S.JIig7ary.62 .Fleet Sti€itSc3/. 
 
PLATE III. 
 
 The head m the first position of a natural labour* has 
 descended to the lowest part of thepelvis, and is about 
 to make its escape. The presenting part, which, in 
 this position, may very accurately be stated as the 
 upper and back quarter of the right parietal bone, is 
 just beginning, during a pain, to separate the lips of 
 the external genital organs, and the occiput rests against 
 the left descending ramus of the iscJdum. Sometimes, 
 as Smellie supposed, the occiput comes more imme- 
 diately under the arch of the pubis; but, as a rule, it 
 becomes fixed against one or other pillar of the outlet, 
 according to its original position being to the right or 
 left side, and the head in its passage outward, passes 
 around it. During the extension of the head from behind 
 forwards, the chin separates from the chest, and the soft 
 parts forming the floor of pelvis are put upon the 
 stretch. The rectum is pressed upon and yields its 
 contents ; the anus is stretched open, the perinmwi is 
 distended to its utmost, and the external organs are 
 fully expanded. 
 
 * Vide Plato 1. 
 
8 
 
 PLATE III. 
 
 A. The titerus contracted closely to the fcetus, after 
 
 the evacuation of the liquor amnii. 
 
 B. c.D. The vertebrce of the loins, os sacrum, and 
 
 coccyx. 
 
 E. The anus. 
 
 F. The left hip. 
 
 G. The perincemi, 
 
 H. The OS externum beginning to dilate. 
 
 I. The OS jmbis of the left side. 
 
 K. The remaining portion of the bladder. 
 L. The posterior part of the os uteri. 
 
 N.B. Although, for the most part, at or before this 
 period the waters are evacuated, yet it often happens, 
 that more or less will be retained, and not all dis- 
 charged till after the delivery of the child, occasioned 
 from the presenting part of the fvntus coming into close 
 contact with the lower or under part of the uterus, 
 vagina, or os eccternum, immediately or soon after the 
 membranes break. 
 
rLATK III 
 
 Enqraved by J^- Stewoft SenT. 
 
 Lender, T^Mu'^hcr? by S.Hi^JrZey,3Z. Fleet Street. 28 SJ. 
 
9 
 
 PLATE IV. 
 
 This and the three folloAving plates iUustrate the 
 manner in which the head of the child is released by 
 means of the forceps, when it becomes necessary to 
 deliver the mother, and attempt to save the child. 
 
 The forceps may require to be applied when the 
 head is still within the pelvic brim, or when it has 
 descended into the cavity, or to the outlet of the 
 pelvis — the only difference, so far as the instruments 
 are concerned — being that the former require a longer 
 pair of forceps. The position of the patient ought to 
 be on the left side, with the trunk directed forwards, 
 the nates overlapping the edge of the bed, and the 
 legs and thighs Avell bent. The forceps in this plate 
 are applied on the head when it is still detained at the 
 upper part or inlet of the pelvis, and in this position 
 they may be fixed in one of two ways — either, 1st. 
 Over the ears embracing the sides of the head, one 
 blade being in front behind the symphisis pubis, and 
 the other behind, between the sacrum and child's head ; 
 or the blades may be apphed respectively over the 
 forehead and occiput, corresponding with the sides of 
 the pelvis. The plate represents them in the fij-^st 
 position, although it may be remarked, that as the 
 
10 
 
 /jclvis is most usually coutracted in the coujugate 
 diameter, there is but little available space for the 
 application of the blades. 
 
 Before ap})lying the forceps, the as uteri should be 
 ([iiite dilated, the ear should be able to be felt, the 
 bladder should be emptied, and the rectum ascertained 
 to be free. Two lingers should be slipped along the 
 child's head within the os uteris behind the pubes, and 
 the front blade of the forceps, previously warmed and 
 well greased, should be directed within the fingers to 
 the side of the head, and there fixed over the ear ; 
 the handle is then passed backwards in accordance 
 with the brim of the pelvis, and is there to be held by 
 an assistant. The other blade is to be introduced in 
 the same w^ay with equal care, at the opposite part of 
 the pelvis ; and if they have been properly and evenly 
 directed, they will lock without difficulty, and the 
 head be grasped laterally by them (as seen in this 
 plate). When locking them, care must be taken that 
 no portion of the soft parts, as the nymphse, or the 
 hair be included. It is as well, when they are applied, 
 to secure them by tying the handles together by a 
 piece of tape, and then to grasp them previous to the 
 attempt at extraction. When drawing down with the 
 forceps, the power employed should be moderate and 
 steady, and the head directed downwards and back- 
 wards until it has passed through the brim. It will 
 then be found that, from the mechanical relations be- 
 tween the head and the pelvis, the former will screw 
 
11 
 
 round of itself without any active direction on the 
 part of the operator, until the occijmt appears at the 
 outlet, and the head eventually disengaged. 
 
 It is of importance to remember that, in extracting 
 the head with the forceps, the efforts should not be 
 continuous, but only at intervals, either concurrently 
 with the return of labour -pains, or in imitation of 
 them. 
 
12 
 
 PLATE IV. 
 
 A.A.B.C. 
 
 Ine Lumbar verteorcB, os sac mm, and coccyx. 
 
 D. 
 
 The OS pubis of the left side. 
 
 E. 
 
 The remaining part of the bladder. 
 
 F. 
 
 The intestimmi rectum. 
 
 G.G.G. 
 
 The uterus. 
 
 H. 
 
 The 7nons Veneris. 
 
 I. 
 
 The clitoris, with the left nympha. 
 
 X. 
 
 The corpus cavernosum clitoridis. 
 
 L. 
 
 The anus. 
 
 N. 
 
 The perinceu7n. 
 
 Q.P. 
 
 The left hip and thigh. 
 
 R. 
 
 The skin and muscular part of the loins. 
 
 K. 
 
 The left labium pudendi. 
 
ri. A i t: I 
 
 london.JPuili^ied by S.niffhJey.SZ.FuetSbneet.ldo' 
 
13 
 
 PLATE V. 
 
 The head of the fretus in this case may be taken to 
 represent its withdrawal from the brim of the pelvis 
 through the cavity, and towards the outlet — the forceps 
 having been applied when it was fixed at the brim — 
 or it may show the way in which the short forceps 
 should be applied when the head is detained at the 
 outlet. 
 
 The change in the direction of the head in its pas- 
 sage from the brim to the outlet, has been described 
 and illustrated in Plate III, and in attempting to 
 afford assistance by the forceps, it is necessary that the 
 same precautions should be attended to as in the pre- 
 vious case, Plate IV, and that the patient should be 
 placed in the same position, with the nates drawn well 
 over the side of the bed. The upper ear is to be the 
 guide for the adjustment of the first blade of the for- 
 ceps, which ought to be directed to this part by two 
 fingers of the left hand introduced between the ear 
 and the pelvis, and the blade in its passage should be 
 kept close to the side of the head. When the blade 
 is thus well placed, it should be held either by an 
 assistant, or between the thumb and little finger of 
 the left hand, the two fore-fingers being employed in 
 directing the second blade to the opposite side of the 
 
14 
 
 child's head. In bringing the locks together, care 
 must be taken not to catch the hair or the skin of the 
 external organs. The handles of the forceps may now 
 be grasped with the right hand, and steady traction at 
 intervals be made with them, the left hand being en- 
 gaged in supporting the perinceum. 
 
 In some cases a pair of forceps with a curve in the 
 blades, as represented in outline in this plate, may be 
 employed, but they are not so suitable as the straight 
 forceps, when the head is low down in the pelvis. 
 
 A. A. B.C. 
 
 The lumbar vertebra, os sacrum^ and coccyx. 
 
 D. 
 
 The OS picbis of the left side. 
 
 E. 
 
 The remaining part of the bladder. 
 
 F. 
 
 The rectum. 
 
 G.G.G. 
 
 The uterus. 
 
 H. 
 
 The mons Veneris. 
 
 I. 
 
 The clitoris, with the left nymplia. 
 
 X. 
 
 The corpus cavernosum clitoridis. 
 
 L.M. 
 
 The anus. 
 
 M.N. 
 
 The perinceum. 
 
 Q.P. 
 
 The left hip and thigh. 
 
 R. 
 
 The skin and muscular part of the loins. 
 
 K. 
 
 The left labium pudendi. 
 
 O. 
 
 The common integuments of the abdomen. 
 
 R. 
 
 The short forceps. 
 
 S. 
 
 Smellie's long curved forceps. 
 
PLATE V. 
 
15 
 
 PLATE VI, 
 
 In the same view and section of the parts, shows the 
 head of the fcetm in the same position, but brought 
 lower down with the forceps than in the former plate ; 
 for in this the os externum is more open, the occiput 
 comes lower down from ]jelow the piibes, and the 
 forehead past the coccyx, by which both the anus 
 and jperincBum are stretched out in form of a large 
 tumour. 
 
 When the head is so far advanced, the operator 
 ought to extract, with great caution, lest the parts 
 should be torn. If the labour-pains are sufficient, the 
 forehead may be kept down, and helped along in a 
 slow manner by pressing against it with the fingers, 
 on the external parts below the coccyx: at the same 
 time, the forceps being taken off, the head may be 
 allowed to stretch the os externum, more and more, in 
 a gradual manner, from the force of the labour-pains, 
 as well as assistance of the fingers. But if the former 
 
16 
 
 are weak and insufficient, the assistance of the forceps 
 must be continued. (Vide the description of the parts 
 in Plate IV.) 
 
 S, T, in this, represent the left side of the os uteri ; 
 the dotted lines demonstrate the situation of the bones 
 of the pelvis, on the right side ; and may serve as an 
 example of all the lateral views of the same. 
 
 a. b. c. h. The outlines of the c.v iliiiui. 
 
 D. e. f. The outlines of the pubis and iscliimn. 
 
 m. n. The foramen magnum. 
 
vi .n t: VI. 
 
17 
 
 PLATE VII, 
 
 In the same view and section of the pelvis, is intended 
 by outhnes to show that, as the external parts are 
 stretched, and the os externum is dilated, the occijput 
 of the foetus rises up with a semicircular turn from out 
 below the puhes, the under part of which bones are as 
 an axis or fulcrum on which the back part of the neck 
 turns, whilst, at the same time, the forehead and face, 
 in their turn upwards, distend largely the parts between 
 the coccyx and the os externum. 
 
 This is the method observed by Nature in stretching 
 these parts in labour ; and as Nature is always to be 
 imitated, the same method ought to be followed when 
 it is necessary to help along the head with the forceps. 
 
18 
 
 PLATE Vn. 
 
 A. A. B.C. The lumbar vertebra, os sacrum., and coccj/\r. 
 
 D. The OS pubis of the left side. 
 
 E. The remainmg part of the bladder. 
 
 F. The intestinum rechm. 
 G.G.G. The uterus, 
 
 H, The mons Veneris, 
 
 I. The clitoris, with the left nymph a. 
 X. The corpus cavern osum clitoriOk. 
 L.M. The anus, 
 
 M.N. The perinmim . 
 
 Q.p. The left hip and thigh. 
 
 R. The skin and muscular part of the loins. 
 
 K. The left labium pudendi, 
 
 a.b.c.h. The outlines of the os ilium. 
 
 D.e.f. The outlines of pubis and ischium. 
 m.n. foramen maf/num. 
 
FL.irK vn. 
 
 Erutraved hv J Stewart J^n''. 
 
 L,nJ,n. rul'lM -by SMzgKLey.^ZMe^t Street. Id3] 
 
19 
 
 PLATE VIII. 
 
 The head is here seen having descended into the cavity 
 of the pelvis, with the face and anterior fontanelle 
 directed forwards, the latter being opposite to the left 
 acetabulum^ the occiput being directed backward to- 
 wards the right sacro-iliac synchondrosis. In this 
 position, under the influence of labour-pains, the occi- 
 jmt would move round to the right ischium, the face 
 making a simultaneous movement backward, so that 
 the head w^ould eventually be born in the same way 
 as if it had originally been placed as delineated in 
 Plate II. In this way the occiput makes a three- 
 quarter turn, which is generally effected without ma- 
 terial delay or difficulty. Sometimes this movement 
 of internal rotation cannot be completed, and then 
 the head of the child is born with the face forwards. 
 If the child's head is small, and the pelvis capacious, 
 and the soft parts relaxed, there will not be any 
 trouble in this mode of delivery ; but sometimes the 
 head becomes impacted, and then it is necessary to 
 deliver by the forceps. 
 
20 
 
 PLATE VIIL 
 
 A.B. The vertehrce of the loins, os sacrum, and coccyaj. 
 
 c. The OS pubis, on the left side. 
 
 D. The anus. 
 
 E. The OS externum, not 3^et begun to dilate. 
 
 F. The nymplta. 
 
 G. The labium pudendi, on the left side. 
 
 H. The hip and thigh. 
 
 M. The uterus contracted, the liquor amnii being all 
 discharged. 
 
1 
 
 Loridcn,D^hs}ied iy S.HighZcy.32.FUet Street. 183y. 
 
21 
 
 PLATE IX. 
 
 The head in this plate has descended into the cavity 
 of the pelvis, in the same position as Plate VIII, but, 
 owing to some obstruction in its course, the move- 
 ment of rotation is impeded, and under the influence 
 of labour-pains, the scalp has become swollen, forming 
 an elastic tumour, which has been named the capii/ 
 mccedaneum (k). Owing to the arrest of the head, 
 the forceps have to be applied, and they are placed 
 over the ears of the child, the same precautionary 
 rules being observed as in other cases. An effort 
 ought to be made by the operator to help the rotation 
 of the head by giving a screw-like movement to it 
 when extracting with the forceps, and he will often 
 succeed in bringing the occiput forward — this move- 
 ment being greatly aided by the mechanical relation 
 which subsists between the head and the pelvis under 
 this position. Sometimes, however, this will be found 
 to be impracticable, and the head will be born with 
 the face forwards, when the soft parts will be put 
 more upon the stretch, and require a very careful 
 support. 
 
 3 
 
22 
 
 PLATE IX. 
 
 'J'lie elastic swelling from the compression of 
 the scalp, and infiltration of the cellular 
 memhrane with serous fluid, called the caput 
 succedaneimi. 
 
 The forceps applied over the sides of the 
 child's head. 
 
 The bladder distended mth urine from com- 
 pression of the urethra. It shows the urgent 
 necessity for emptying it before applying 
 the forceps, or in any case of operative 
 midwifery. 
 
 The lower part of the uterus, which is removed 
 from the abdominal walls by the interposi- 
 tion of the distended bladder. 
 
 The OS uteri fully dilated. 
 
FLATK TX. 
 
 /,:• if,.'-hJ, y.32.yice.t Slrtet. KiSy 
 
23 
 
 PLATE X. 
 
 This plate illustrates that deviation from an ordinary 
 presentation of the head, in which the chin becomes 
 separated from the chest at the commencement of 
 laboiu", and the occiput is turned back upon the neck, 
 so that the face is converted into the presenting part. 
 In the present figure this change is not quite com- 
 pleted, the forehead or brow of the child being the 
 most depending part; but the effect of the pains 
 would probably soon bring the face down, and a true 
 face presentation be formed. 
 
24 
 
 PLATE X. 
 
 A A. 
 
 The superior parts of the ossa ilia. 
 
 B. 
 
 The anus. 
 
 C. 
 
 The perincemn. 
 
 D. 
 
 The OS externum. 
 
 E.E.E. 
 
 The vagina. 
 
 F. 
 
 The OS uteri not yet fully dilated. 
 
 G.G.G. 
 
 The uterus. 
 
 H. 
 
 The memhrana adiposa. 
 
PL A 'IE X 
 
 G 
 
 L vmirn. , IhihW^al ly S.mg'hlcy X? TIc&t SlTeit- 133/' 
 
PLATE XL 
 
 Shows the position which the chiki's face assumes 
 when it has passed through the cavity of the pelvis under 
 a face presentation. The face having entered the brim 
 of the pelvis with tb.e forehead directed towards one 
 ilhcm, and the chin to the other ; the effect of the 
 pains is to press that side of the face lowest which is 
 in front behind thepubes, so that this side of the face 
 becomes the presenting part, and the soft parts swell 
 out from being compressed. As the face descends 
 through the cavity, the chin moves towards the arch, 
 beneath one pillar of which it becomes temporarily 
 fixed. It is represented in the plate at this stage, and 
 as the head is born, the face, forehead, and vertex 
 successively pass out, tm^ning upwards over the pubes, 
 and in their course putting the pemimtm severely on 
 the stretch. Nature is almost always competent to the 
 safe dehvery of the child under these circumstances, and 
 there is no need for the practitioner to attempt to alter 
 the position. Great caution is requisite not to hm-t 
 the child's features by frequent examination, and the 
 perincBum ought to be gently drawn forward when sup- 
 ported, in order to prevent its giving way at its free 
 margin, where laceration usually commences, and some- 
 times extends so far back as to rupture the sphincter 
 cmi, and lay the rectum completely open. 
 
26 
 
 PLATE XI. 
 
 A.B. The vertebrae of the loins^ os sacrum, and 
 coccyx. 
 
 c. The OS pubis y on the left side. 
 
 D. The inferior part of the rectum. 
 
 E . The perincBum . 
 
 F. The left labium pudendi. 
 G.G.G. The uterus. 
 
PL A TE XI. 
 
 G 
 
 G 
 
 London.FuhLu^hM. 2ry 'J.m^Tilcv. C}2.J-le€t Street. 1S3 J. 
 
27 
 
 PLATE XII. 
 
 In this plate it has been necessary, for the dehvery of 
 the child, luider face presentation, when the face is at 
 the outlet, to have recourse to the short forceps, and the 
 way in which they lie in relation to the face and head 
 are well and faithfully represented. Before applying 
 the forceps, the bladder and rectum should be emptied 
 of theu^ contents, and the nates be drawn well over the 
 edge of the bed. One blade of the forceps ought to 
 be directed over one side of the face extending over 
 the ear, and the other on the opposite side, and then 
 locked together. There is not much difficulty in ad- 
 justing the instrument under these circumstances, the 
 head being securely grasped at its sides. With the 
 purchase afforded by this adaptation, the face may 
 gradually be brought forward beneath the arch of the 
 pubes, and in its delivery be directed carefully for- 
 wards and upwards, the soft parts being gently dilated 
 and fully supported. 
 
n u t: Ml 
 
 London Tuilisked by S.Hig}ile_y . SZ.FlMt Street, ld3J . 
 
I 
 
 Smellie 
 18W