POSITIONS OF THE TRUNK. 421 



that the hack and the anterior surface of the fostus may present at 

 the superior strait; that these positions have been observed; that 

 proofs of them are contained in the works of Deventer, De la Motto, 

 &c., but that they are rare, and differ so little from the positions of 

 the side, as to require only very slight modifications in the manoeu- 

 vres appropriate to these latter. 



954. Baudelocque admits, further, that in the posterior surface 

 we should distinguish the occiput, the nucha, the back, the loins, 

 and the posterior surface of the pelvis; and that the anterior and late- 

 ral surfaces require the same subdivisions. But while we admit 

 that the foetus may, indeed, present by these diflerent points, it would 

 be, nevertheless, useless to adopt such numerous positions, for they 

 are of no practical application, overload the memory without any ob- 

 ject, and only serve to discourage die student. 



955. The simple good sense and observations of Denman and 

 Madame Lachapelle, prove that the nucha cannot maintain itself at 

 the superior strait, that it would soon give place to the head or 

 shoulder, and that positions of the hips or loins could not f;id to be 

 soon transformed into a direct or inclined position of the breech. 



It is, then, evident that a position of the abdomen has often been 

 supposed present, when, in reality, it was only an inclined position* 

 of the breech, feet, or knees, complicated with one of the arm, or 

 with a premature escape of the umbilical cord. Madame Lachapelle 

 thinks that the throat would not, under the contractions of the womb, 

 be long permitted to remain at the orifice, for the pains would bring 

 the face there far more easily. I am in possession of no facts to 

 militate against the opinion of this author, and know that on this 

 point many practitioners might have been deceived by the touch; 

 however, I can conceive that, where the occiput is very much re- 

 versed backwards, the chin may lodge upon some part of the pelvic 

 circle, and compel the anterior part of the breast and neck to fix it- 

 self at the orifice, while the breech, although retaining'its natural re- 

 lations to the abdominal members, remains at the fundils of the ute- 

 rus. In order, therefore, to avoid the reproach of abandoning one 

 Extreme for the purpose of falling into another, I shall admit the po- 

 sitions of the back, and of the anterior face of the thorax, as at least 

 possible occurrences. 



956. As to presentations of the side, they are too frequently 

 met with, for their existence ever to have been the subject of a doubt; 

 but the classification of Baudelocque, although recently brought for- 

 ward again in America by Dr. Dewees, one of the most distinguish- 

 ed accoucheurs in the new world, here requires the same reform as 

 in the anterior and posterior surfaces. The sides of the neck form 

 37 



