FACE PRESENTATIONS. 71 



tion and sloughing of the soft parts from long-continued pressure 

 will ensue. 



The indications in the treatment are, 1st, to gain lime ; 2d, to 

 counteract i7iflammation. These will be fulfilled by a moderate 

 bleeding, if the constitution will bear it; by a dose of opium, to 

 moderate or suspend the uterine action ; and by small doses of tartar 

 emetic, with the hope of relaxing the system. To these means may- 

 be added, warm hip-baths, warm mucilaginous fomentations to the 

 parts, and the introduction of unirritating unguents into the vagina. 



If the rigidity be dependent upon the presence of cicatrices of the 

 OS uteri, vagina, or perineum, the result of laceration or sloughing 

 in former tedious labours, or occasioned by the ill use of instru- 

 ments, the same rules for treatment may be adopted. 



The uterus may acquire an inclination one way or another, 

 during pregnancy, from difierent causes, and this oblique position of 

 the organ may be a cause of delay in the progress of the labour. 

 In women who have borne many children it is often owing to re- 

 laxation of the abdominal muscles, which permits the uterus to fall 

 forwards, and thus the child's head, instead of being propelled into 

 the brim of the pelvis, is driven back against the upper part of the 

 sacrum. The nature of the obliquity is detected by a per vaginam 

 examination, which reveals the position of the os uteri ; if it be 

 lateral^ place the patient on the opj^osite side ; if anterior, let her lie 

 on her back, and support and draw up the fundus uteri by means of 

 a towel or napkin passed beneath the pendulous belly and fastened 

 behind the back, until the head shall occupy the inferior strait. 



There are various other causes that may render a labour tedious, 

 such as an over-distended bladder, or a rectum filled with hardened 

 faeces, a rheumatic condition of the uterus, tumours, and deformities 

 of the pelvis, &c. In the first case, the remedy is found in the in- 

 troduction of the catheter and drawing off the water ; in the second, 

 a stimulating injection should be given, or, if necessary, the hard- 

 ened foeces removed with the handle of a spoon ; in rheumatism of 

 the uterus, the patient generally complains of feverishness and rest- 

 lessness, the abdomen is tender, the urine scanty and high-coloured, 

 for some time before labour sets in. The contractions of the uterus 

 are rendered exceedingly painful, and at times inefficient. The 

 treatment consists in bloodletting, warm fomentations, an aperient of 

 mag. sulph. and sodse carb., and alkaline drinks. 



Tumours and deformities of the pelvis require instrumental aid, 

 and render an otherwise natural labour, preternatural. 



FACE PRESENTATIONS. 



Face presentations are deviations from those of the vertex, and 

 are not by any means as dangerous as they were formerly sup- 

 posed to be. Madame Lachapelle has laid it down as a" fixed prin- 



