536 EXTRACTION OF THE HEAD. 



pelvis, it almost always happens in consequence of its being badly 

 situated at the superior strait, or because the accoucheur was not 

 skilful enough to disengage it in time: in this case the detachment no 

 sooner takes place than the head becomes in some sort movable in 

 the womb, which soon brings it to the best possible situation; a few 

 pains then succeed in expelling it, and the assistance of art is, for the 

 most part unnecessary. In other cases the detruncation of the fcetus 

 takes place because, having been dead for some time, it is already 

 nearly in a putrid state. If we wait for a short time, under these 

 circumstances, the brain shrinks, the bones of the cranium become 

 very movable, may over-ride each other, and although at first the 

 pelvis might have been too narrow, the head nevertheless escapes 

 spontaneously at last; upon these results, and also upon the evils 

 that have often been found to follow upon unskilful attempts to 

 hasten the delivery, the English practitioners cited above found the 

 precept that the expulsion of the head should be confided to the 

 powers of nature alone; but as the labor has already lasted too long, 

 and as in some instances it would be necessary to wait several days 

 as the extreme irritation of the uterus would expose it to the hazard 

 of becoming inflamed, and the woman might die of exhaustion be- 

 fore the escape of the head it would be imprudent and unreasonable 

 not to give proper assistance. We ought not, says M. Desormeaux 

 to act with inconsiderate haste; there are cases where it is proper to 

 temporise; it may be necessary to restore the strength by means of 

 some aliment, a little wine, or other strengthening articles. Baths 

 and antiphlogistics, &c. may be required previously to any other re- 

 course in consequence of an incipient inflammation of the womb or 

 peritoneum, &c. 



In cases where the hand alone may suffice, that is to say, where 

 the head is small, or requires to be placed in a better situation for 

 descending, an attempt should be made to get hold of the lower jaw, 

 then, after having brought the occipito-mental diameter into line with 

 the axes, it should be drawn down as far as possible, coincidently 

 with the eflTorts of the womb or those of the patient. 



Next to the hand the forceps is the best and safest resource that 

 we have; but it is not always possible to apply it, while the head is 

 still at the superior strait, and in some cases its employment does not 



ceps, described in the Pliila. Prac. of Midwifery, to which I beg to refer the 

 reader.— With the instruments there described and figured, I beheve it is quite 

 practicable to deliver, per vias naturales, whenever the diameter is not below one 

 inch and a half, and with a perfect assurance that the patient shall not suffer 

 from any wound inflicted by the instrument itselC It is manufactured by Mr. 

 John Rorer, North Sixth st., Philada. — M. 



