ARM PRESENTATIONS. 463 



removed from tokological doctrines, and had they not anew appealed 

 to the authority of A. Pare, Mauriceau, Deventer, De la Motte, 

 Puzos, Mesnard, Levret, &c., as if the modern accoucheurs had not 

 overturned, without exception, all the reasons advanced by their pre- 

 decessors in favor of the amputation, or tearing off of the arms! 



1044. I do not intend to deny that it never has been necessary 

 to separate from the trunk a member prematurely escaped, in order 

 to penetrate more readily into the womb; I merely assert that I can- 

 not conceive of such a necessity; that it is impossible to admit of it 

 except where the child is dead; that no matter how much the arm 

 may be infiltrated or swollen, a skilful accoucheur will always be 

 able to carry his hand into the womb without mutilating any thing; 

 lastly, that without being able to say how far the Norman surgeon 

 may have departed from sound rules, we must at least admit, that 

 the reasons and proofs cited by M. Roux for his excuse, would be 

 dangerous if taken in the very letter. 



1045. In order that delivery may be effected, the child's head 

 must pass through the os uteri: but the hand of the physician and 

 the arm of the child can never be equal in size to the volume of the 

 child's head. Therefore, the presence of an arm is incapable of pre- 

 venting the hand from passing into the uterus, even although there 

 should be infiltration and tumefaction of the labia; and after that, it 

 becomes completely useless to return the arm previously to going in 

 search of the feet. 



Therefore, when a hand appears at the vulva, and it is impossible 

 to ascertain certainly that the corresponding shoulder is at the supe- 

 rior strait, far from becoming alarmed, and pushing it back, it is, on 

 the contrary, best to secure it with a fiUei; the fillet being fixed, the 

 shoulder is next pushed up, and we proceed to get hold of the feet, 

 just as if there were no complication whatever. As we draw the 

 lower extremities downwards, the arm mounts upwards, and the fillet 

 serves to pull it along at the same time with the feet after the version 

 is complete. 



1046. Although the descent of the arm along with the head is 

 not a serious cause of dystocia, there are, notwithstanding, cases 

 where the course of the labor is really embarrassed by such an oc- 

 currence. Consequently, we may get rid of the complication if pos- 

 sible. If called before the superior strait has been passed, there is 

 no difiiculty in returning the child's hand into the uterus, and re- 

 taining it there by means of a few fingers until the head is well en- 

 gaged. If called at a later period, great difficulties are sometimes 

 experienced; in some instances the thing is impossible; we must, 

 under such circumstances, endeavor to make the hand slip along the 



