DISPLACEMENTS OF THE WOMB. 409 



of the womb strictly so called. In fact, although the deviation of 

 the orifice pretty frequently coincides with that of the fundus of the 

 organ, it is nevertheless undeniable, that one is often met with, with- 

 out the other. 



933. When the womb is inclined laterally or backwards,, no great 

 difficulty can arise as to the delivery of the child, provided there 

 should be no other cause of dystocia. In tiie anterior obliquity, on 

 the contrary, especially when it is to a great extent, the assistance 

 of art may become indispensably necessary. The woman should 

 be directed to lie down at the very beginning of the labor, and told 

 to remain in a horizontal posture taking care to keep the hips con- 

 siderably elevated; the hypogastrium is to be pressed backwards, 

 while by means of one or two fingers introduced into the vagina we 

 attempt to draw the os uteri to the centre of the pelvis. These last- 

 mentioned tractions, which are useful where the orifice is found 

 raised upwards towards the sacro-vertebral angle, need not be tried 

 in cases where the womb, instead of being inclined by a see-saw 



■ motion, is bent forwards on its anterior surface, like a chemist's 

 retort? But in that case we should direct the woman to moderate, 

 or even to suspend, her eflA)rts; for, during the pains, the action of 

 the diaphragm and abdominal muscles tends constantly to augment 

 the obliquity, and thus to annul the efforts of the practitioner in a 

 contrary direction. In the spring of 1825 I was called by M. Ma- 

 jeste to a woman whose labor had been at a stand for several hours, 

 notwithstanding the pains were very severe. The womb, bent into 

 the form of a retort, was so disposed that at each contraction its pos- 

 terior surface became quite horizontal. I showed the patient that 

 her efforts were not only of no use, but also that they were sufficient 

 to prevent her labor from coming to a conclusion. She was obedient 

 to the counsel I gave her, and resisted, as far as she possibly could, 

 the sensations that excited her to bear down. It was not long be- 

 fore the womb rose up of its own accord during the contraction, the 

 head soon engaged, and in two hours afterwards the child was born. 

 There are, therefore, certain cases of inclination where the labor 

 ought to be abandoned almost entirely to the mere contractions of 

 the womb. 



934. Doubtless, Moschion and Deventer were wrong in maintain- 

 ing that obliquity of the womb most frequently produces a transverse 

 position of the foetus; but it would be quite as unreasonable to main- 

 tain that this effect never does take place. If the inclinations of the 

 womb do rarely suffice to produce real transverse or shoulder pre- 

 sentations of the foetus, they, at least, seem to me to be very fre- 

 quently the causes of presentations of the face, the forehead, the 



36 



