LOCKED-HEAD. - 493 



grenous, and give rise to fistulas that are too commonly incurable, 

 or to some other alteration equally terrible. The compression of 

 the nerves, and of the vessels in particular, may give rise to para- 

 lysis, tumefaction, and the infiltration of the lower limbs and vulva; 

 the symphyses themselves, from being violently distended, occa- 

 sionally run some risk, where the expulsive efforts are vigorously 

 sustained. 



The long continuance of the labor after the discharge of the 

 waters, and the direct action of the contractions upon the body of 

 the child, expose it, in the first place, to the same accidents as all 

 long and difficult labors, that is to say, to asphyxia and death. 

 Again, the head, particularly where the pelvis is badly formed, as 

 tlie sacro-vertebral angle is very salient, cannot adapt itself to the 

 straits or excavation, as in a mould, without the brain itself under- 

 going a dangerous, and sometimes fatal compression. It may also 

 be followed by fractures, and external or internal extravasations, 

 lacerations, &c. 



1 103. It is clear that, in order to avoid so many dangers, the prac- 

 titioner ought promptly to interpose for the assistance of the power- 

 less organism; but by acting speedily there is risk of acting unne- 

 cessarily; by waiting he may lose the opportune moment; how then 

 are these two extremes to be avoided? The well-informed physi- 

 cian will readily succeed in this difficulty by taking care not to lay 

 it down as a principle, as has been recently done in some medical 

 journals, doubtless from oversight, that he must make haste to ex- 

 tract the child with the forceps, whether the head is locked or not, 

 whenever it has remained an hour or two in the excavation; the 

 woman ought never to be assisted in this way until there is a cer- 

 tainty that the head will not pass the passages spontaneously, or that 

 the delivery will not take place without exposing the patient to the 

 accidents heretofore indicated.* 



1104. Turning by the feet, as recommended by the ancients, 

 must not be performed merely because the head is really locked; 

 the slings, bandages, and fillets would in such cases be wholly in- 

 sufficient, and are at present no longer recommended by any body. 

 The lever, the spatula, and the separate branches of the forceps, 

 so much lauded by the accoucheurs of the last century, were suc- 



* From reading this sentence one might infer that the forceps are applicable 

 only for the safety or comfort of the mother; but, surely, the security of the off- 

 spring demands a share of our attention, and the legitimate uses of the instru- 

 ment are as frequently connected with the infant as with the parent. Many 

 children are rescued from death by speedy delivery with the forceps, the instru. 

 . ment being employed solely in their behalf. — M. 

 43 



