PROLAPSED CORD. 397 



difficult to alter its position, the prognosis Avill be very unfavorable. 

 On the contrary, if the pulsations are kept up with some degree of 

 force, and the labor goes on rapidly, even althcJugh the cord be lank 

 and shrunken, its premature escape maybe followed by no unpleasant 

 effect. 



908. Treatment. There are different ways of remedying this 

 procidence. If the chdd presents transversely, by the shoulder, or 

 by the hip, and the os uteri be not sufficiently dilated to admit of an 

 attempt to turn, we must try to return the loop into the womb; where 

 the labor is pretty well advanced, we have to seek for the feet, and 

 it would even be dangerous, whenever the pulsations of the cord are 

 found to grow sensibly weaker, to wait for a complete dilatation be- 

 fore we act. 



Where the pelvic extremity of the fcetus presents, as soon as the 

 contractions become sufficiently strong, we have to favor their effect 

 by pulling downwards in a proper way upon the lower extremities. 

 But it is, particularly, where it escapes before the head that the cord 

 requires prompt assistance. 



In such cases the ancients confined themselves merely to pushing 

 it up again, and keeping it wrapped up in a linen rag in the vagina; 

 modern surgeons make use merely of their fingers, or of a piece of 

 whalebone surmounted with a sponge or with a ring. Ducamp has 

 recommended a species of pincers, enclosed in a canula, in most 

 respects similar to the porte-noeud of Dessault; M. Dudan thinks 

 we should be satisfied with a gum elastic catheter, No. 9, furnished 

 with its wire, which serves to fix the end of a ribbon passed through 

 one of the eyes of the instrument. With this ribbon M. Dudan sus- 

 tains the cord at the end of the catheter without compressing it, and 

 returns it into the cavity of the Avomb, where he afterwards leaves it, 

 first withdrawing the wire, and then the catheter itself. The canula 

 a charniere, proposed by Wellemborg, would in fact be more dange- 

 rous than useful, and I doubt whether any accoucheur will be ever 

 tempted to make use of it. It has also been advised to introduce 

 and fix graduated compresses or bits of sponge betwixt the head of 

 the fcetus and the parts of the modier. Finally, Mr. Croft finds, it 

 more expeditious and more safe to carry the whole hand into the 

 womb, so as to hook the loop of the cord over one of the limbs of 

 the child. 



Doubdess, most of these means might succeed; but there is not 

 one of them that ought to be adopted exclusively; for the condnet to 

 be pursued will necessarily vary according to the state of the cir- 

 cumstances. 



909. When the child is dead, the presence of the cord requires no 

 35 



