at she will know whether the membranes are broken or
not. It may also be known by making her strain or vomit; by putting her
fingers down her throat, or by straining or moving her lower parts, but
let all be done immediately. If this should fail, let her take a draught
of elder water, or the yolk of a new laid egg, and smell a piece of
asafoetida, especially if she is troubled with a windy colic. If she
happen to take cold, it is a great obstruction to the afterbirth; in
such cases the midwife ought to chafe the woman's stomach gently, so as
to break, not only the wind, but also to force the secundine to come
down. But if these should prove ineffectual, the midwife must insert her
hand into the orifice of the womb and draw it out gently.

Having thus discussed common births, or such as are generally easy, I
shall now give directions in cases of extremity.

* * * * *

CHAPTER XVI

_What ought to be done in cases of extremity, especially in women
who, in labour, are attacked by a flux of blood, convulsions and
fits of wind._

If the woman's labour be hard and difficult, greater care must be taken
than at other times. And, first of all, the situation of the womb and
her position in lying must be across the bed, and she must be held by
strong persons to prevent her from slipping down or moving during the
surgeon's operations. Her thighs must be put as far apart as possible,
and held so, whilst her head must rest upon a bolster, and her loins be
supported in the same manner. After her rump and buttocks have been
raised, be careful to cover her stomach, belly and thighs with warm
clothes, to keep them from the cold.

When the woman is in this position, let the operator put up his or her
hand, if the neck of the womb be dilated, and remove the coagulated
blood that obstructs the passage of the birth; and by degrees make way
gently, let him remove the infant tenderly, having first anointed his
hand with butter or some harmless salve. And if the waters have not come
down, they may then be let out without difficulty. Then, if the infant
should attempt to come out head foremost, or crosswise, he should turn
it gently, to find the feet. Having done this, let him draw out one and
fasten it with ribbon and then put it up again, and by degrees find the
other, bringing them as close together and as even as possible, and
between whiles let the woman breathe, and she should be u