412 DYSTOCIA. 



could not descend. I applied the forceps, and the child was brought 

 away living. 



' §. II. dystocia clepessdm^ ou the Foetws. Mon- 

 strosity. 



938. Excessive volume. There is no doubt, says M. Duges, that 

 where the child is very tall it may render a labor more tedious, 

 painful and distressing, especially if the passages are not soft and 

 small, as in a first labor; but it is not yet proved that great size in 

 a well formed child at full term has ever alone constituted an insur- 

 mountable obstacle to spontaneous parturition. 



If it be true that Baudelocque, Chaussier, M. Capuron, &c., have 

 seen children born, weighing near thirteen, twelve, or even ten 

 pounds, it is, nevertheless certain that we no longer see them reach- 

 ing to the weight of fifteen, twenty, and twenty-five pounds, nor any 

 ■whose length exceeds from twenty-two to twenty-three inches. But 

 as it is an easy matter to ascertain that the head of a foetus of twenty- 

 two inches will not be quite four inches in its occipito-bregmatic 

 and bi-parietal diameters, it is at once evident that, even in case of 

 extreme size, spontaneous delivery is not impossible. It should be 

 remarked, however, that in that case the least narrowness of the 

 pelvic cavity, especially in the perineal strait, must promptly become 

 the cause of dystocia. 



On the other hand, the practitioner ought to know that under such 

 circumstances, version by the feet is never proper. Indeed, where 

 the head presents, although its shortest diameter and smallest cir- 

 cumference are almost always in relation with the largest diameters 

 of the pelvis, it is rarely that in extracting the child by the feet the 

 occiput is not forced to turn over more or less upon the back, while 

 the occipito-frontal, which would be nearly five inches long, would 

 take place of the occipito-bregmatic diameter, perhaps it might even 

 be the occipito-mental that would be thus situated, and that would 

 be at least five and a half inches in length. 



The best course is to confide in the resources of the organism, and 

 where it is indispensably necessary to act, to attempt the application 

 of the forceps rather than venture upon turning; and should it be a 

 presentation of the pelvic extremity of the ftetus, either originally or 

 by turning, every precaution should be employed to prevent an arm 

 from becoming locked behind the neck. 



939. Infiltration of the integuments of the head, and sanguine 

 tumors, sometimes evidently increase the size of the head, but rarely 

 to such an extent as to furnish any real obstacle to delivery. Har- 

 nier, to be sure, has remarked that where thrombuses and infiltra- 



