492 LOCKED-HEAD. 



The pathognomonic sign, in these cases, is derived from the fixed- 

 ness of the head, which, in spite of the energy of the pains, makes 

 no advances for several hours together. While the pain is present, 

 it seems to advance a little; but immediately afterwards it rises again 

 up to the same point it occupied before; if the accoucheur endeavors 

 to push it up again with his hand, he finds that it is immovable, and 

 cannot succeed in dislodging it but with the greatest difiiculty. It 

 should also be understood that, by elongating, the head may appear 

 to descend, and approach near to the vulva, although its position 

 does not really undergo any alteration. This circumstance must be 

 what has so often deceived the accoucheur, making him suppose that 

 the superior strait was cleared, while in fact the occipito-bregmalic 

 circumference was not as yet engaged in it. An examination is 

 made; the vertex is found a few lines from the vulva, whence the 

 conclusion is drawn, that it hag descended into the excavation: to 

 avoid this mistake, and understand it, the practitioner should re- 

 member, 1. That the symphysis pubis is only from eighteen to 

 twenty-four lines in depth, and, consequently, that the swelling of 

 the cranial integuments may easily bring the vertex down even with 

 the vulva, although the parietal protuberances are still at the superior 

 strait; 2. That the finger must be carried backwards, especially, and 

 not merely in front, when we wish to ascertain what part of the pel- 

 vis is occupied by the head; and, 3. That the locked-head may take 

 place below the superior strait. 



1102. There are several degrees of this cause of dystocia: some- 

 times the disproportion between the head and pelvis is so small that 

 it only results in a somewhat slower labor and more fatigue for the 

 ■woman; at other times it is so great as to render the delivery exces- 

 sively diflScult, but absolutely impossible without assistance, provided 

 the contractions are well sustained; again, lastly, it is so great, that 

 nature is absolutely unable to triumph over it, and the resources of art 

 become indispensably necessary. 



In the case first mentioned, the locked-head is not very dangerous, 

 and ordinarily is accompanied only by a slight degree of irritation 

 and disposition to inflammation. 



In the second arid third, it constitutes a serious accident, both as re- 

 gards the mother and the child. The pains, which follow each other 

 to no purpose, though strong and frequent, at length end in a state 

 of general exhaustion and inertia, should the woman even be so for- 

 tunate as to escape an attack of inflammation of the womb or perito- 

 neum, a flooding, or convulsions. The bladder the rectum, the va- 

 gina, the urethra, and other soft parts in the pelvis, from being long 

 and severely compressed, may become contused, ulcerated, or gan- 



