SHOULDER POSITIONS. 451 



sible to a transverse position, in turning there will be rather more 

 difficulty in those cases where it is farthest removed from that posi- 

 tion, and rather less where it is nearest to it; but there is no other 

 difference, and surely that is not enough to justify the importance 

 attributed by modern writers to the question, whether the cephalo- 

 anterior positions of the trunk ought or ought not to be admitted. 



1014. I have already pointed out the reasons that induce me to 

 admit the possibility of presentations both of the anterior and poste- 

 rior surface of the foetus; although they in reality require the same 

 manoeuvre as those of the lateral regions, I shall say a few words 

 about them notwithstanding, and successively pass in review the 

 positions of the side, the posterior and anterior surfaces, taking care 

 meanwhile to dwell only upon those to which a major part of the 

 others ought to be reduced in operating. 



A. Positions of the Shoulder and Side. 



1015. By following a numerical order in indicating positions, so 

 much confusion has been introduced, that it is almost impossible for 

 students to understand each other if they happen not to have studied 

 the same books. Thus, to speak only of positions of the trunk, in 

 Baudelocque's first the head is in front, in front and to the left ac- 

 cording to Maygrier, and directly to the left according to M. Gar- 

 dien: now, as this mode of proceeding is entirely arbitrary, and as 

 nothing can prevent one accoucheur, if he chooses, from calling that 

 a first position which another chooses to denominate the third, I have 

 thought I might arrange all the shoulder presentations under the titles 

 of dorso-pubic, dorso-sacral, and right or left dorso-iliac. This is 

 the way to avoid all ambiguity, and reduce to their just value the nu- 

 merous classifications which have successively appeared in France 

 since the time of Solayres. 



1. Positions of the Left Shoulder. 



1016. Dorso-sacral position (3d of Baudelocque). In this po- 

 sition, the head, which is on the left side, may be stopped above the 

 foramen ovale, the sacro-iliac symphysis, or even the iliac fossa; 



being referable to the corresponding varieties of the vertex positions, 

 its different shades require to be operated on like the left occipito- 

 iliac position. Only, instead of the head, it is the shoulder that is 

 to be pushed up, and instead of placing the thumb and fingers on 

 the temples, they are to be applied to the back, and to the fore part 

 of the thorax; in fact, turning, in this case, differs from that in ver- 

 tex positions, only in respect that the head is already raised or re- 

 versed, and that the first stage of the operation is effected by natural 

 means. 



