410 DYSTOCIA. 



nucha, the parietal protuberances, the hips, &c., and in this respect 

 to deserve the attention of the accoucheur. 



935. I ought in this place to mention a kind of deviation that I 

 have never met vv^ilh but once, of which I have been unable to find 

 any cases described by the various authors, and which ought not to 

 be confounded with anterior obliquity. In a woman who came to 

 be confined at my amphitheatre in the month of May 1828, the 

 fundus of the uterus was rather inclined backwards than forwards; 

 the head of the foetus formed above the strait a considerable projec- 

 tion, which descended nearly to the vulva, and was at last situated in 

 front of the symphysis pubis; the os uteri, which was on a level with 

 the superior strait, seemed to be scooped out of the substance of the 

 posterior wall of the womb, which made it much longer behind than 

 before; in order to reach the orifice and penetrate towards the head 

 of the child, I was obliged to bend my finger so as to make it pass 

 almost horizontally above the pubis. Such a state of things sur- 

 prised me, and I mentioned it to the students, who easily satisfied 

 themselves as to its existence. The progress of the labor was so 

 much retarded by it, that after seven hours of pain and pretty strong 

 contractions, the os uteri, although very soft and very dilatable, was 

 scarely open at all. M. Desonneaux, whom I invited to see this 

 remarkable case, said that he had never noticed one like it, and 

 agreed with me that by means of position and the assistance of the 

 hand properly combined, I ought to try to carry the head to the 

 centre of the superior strait, by making it slide from below upwards 

 and from before backwards over the pubis. I began to execute 

 this manoeuvre at half past eight o'clock, and continued it alternat- 

 ing with several of the students until nine o'clock. From this time 

 there was no longer a tumor in front of the symphysis, and the 

 labor progressed so rapidly that in less than an hour the child was 

 born and the placenta itself expelled. 



Such a state of things seems to depend: 1st, on a posterior 

 inclination of the womb; 2d, on excessive inclination of the supe- 

 rior strait; 3d, on some deviated position of the fostal head, and, 

 perhaps, upon the thickness, or the unequal density of the walls of 

 the womb; to this displacement should be referred the positions 

 described under the name of siir-pubal by Madame Lachapelle aud 

 M. Duges. 



936. I have many times found the orifice turned so much back- 

 wards or to the outside, that its plane was almost parallel to the axis 

 of the woman's body, although the rest of the womb was scarcely 

 deviated at all. Excessive amplitude of the pelvis, great inclination 

 of its superior strait, and presentations of the vertex, are probably 



