418 DYSTOCIA. 



SECTION 3, 



Dystocia from Wrong Presentations of the Fcetus. 



It has been seen in another article that the presence of one of the 

 extremities of the occipito-coccygeal diameter of the foetus at the 

 superior strait is one of the first conditions of eutocia. All the cases 

 in which any other point than the head or pelvis presents ought 

 therefore to be classed among the cases of dystocia. I will add that 

 to them should be conjoined all the deviated positions of the head or 

 breech. 



§. I. Deviated Positions of the Head. 



Under this tide I comprise the positions of the sides of the head, 

 of the ears or of the temples, admitted by Mauriceau, Deventer, De 

 la Motte, and Baudelocque; and those of the occiput, in so far as 

 they really exist, as was understood by the last named author: as to 

 the forehead and face positions, since they do not, in general, pre- 

 vent a labor from terminating without assistance, I shall say nothing 

 about them in this place. 



950. Positions of the occiput or upper part of the nucha are rare, 

 and scarcely occur except in very decided anterior inclination of the 

 womb. Then the vertex may be turned towards some point on the 

 circumference of the pelvis instead of corresponding to the centre 

 of the strait; should pushing the womb backwards, keeping the wo- 

 man on her back, or the mere efforts of the organism prove to be 

 insufficient to re-establish the natural position, it would be necessary, 

 with the fingers, the lever, or one of the blades of the forceps, to 

 hook the upper part of the cranium, and draw it down towards the 

 centre of the excavation, upon which the labor would return to the 

 natural order. 



951. The lateral positions of the head, being nothing more than 

 slighdy modified positions of the vertex, are the same in point of 

 number with them; they are marked by the presence of the ear, of 

 the angle of the jaw, or the parietal protuberance: they are distin- 

 guished from each other by considering to which point of the strait 

 the posterior edge and lobule of the ear are turned; they are, more- 

 over, rare, and generally end in conforming themselves, spontaneous- 

 ly, to the corresponding positions of the vertex or shoulder. 



We ought, consequently, to trust to the efforts of the womb, as 

 long as the os uteri continues to be sufficiently dilated; if they then 

 persist, we must, as in positions of the occiput, endeavor to bring 



