518 
PROFESSOR SIMONDS’S LECTURE. 
The lecturer proceeded to point out the various cases of pre- 
ternatural presentation which were necessary to provide for. The 
position of the foetus in a perfectly natural labour was that in 
which the fore legs and the head protruded simultaneously; but 
there were many deviations from this position, which rendered the 
act of delivery a matter of great difficulty, and required the greatest 
caution on the part of the operator. Sometimes, the head came 
first., whilst the fore legs were doubled up in the womb ; at other 
times, the head was bent down or turned backwards; the foetus 
being dead in other cases, the hinder part presented itself. In 
adjusting the head when turned backwards, the most convenient 
instrument to be used was a hook. Many persons entertained great 
prejudices against using hooks, but without reason ; for they might 
easily be constructed in such a manner as to cause no injury to 
the mother. The head being got within reach, the hook should be 
placed within the orbit. A hook fixed to an iron rod with a joint 
might be used more efficiently than one attached to a line, be- 
cause, being introduced together with the arm of the operator, 
it could be either pushed forward or drawn back by the assistant ; 
and the operator could as readily, by means of the joint, effect an 
attachment to the orbit. 
The lecturer next referred to a presentation which, he remarked, 
was a very difficult one — that where the breech presented itself 
with the hind legs stretched along the under part of the body 
of the foetus. The object in this case is first to reverse the legs; 
which may be accomplished, though with some difficulty, by intro- 
ducing a line by means of a rod between the thighs, and passing 
this around each of the legs in succession. In some few in- 
stances, delivery might be effected without having the foetus pre- 
viously adjusted; but it was always desirable to adjust the foetus, 
or lessen its size by dissection. In other cases, a mechanical re- 
sistance was offered to delivery. One of these was dropsy of 
the belly of the foetus. When the head and fore legs came forward 
readily, and still resistance took place, such frequently arose from 
the unnatural size of the body. In this instance the foetus ought 
to be at once sacrificed; because, were it delivered alive, it could 
be scarcely expected to survive many days. To destroy it, a stilet 
in a metal sheath should be employed. The foetus being pene- 
trated by the stilet, the instrument should then be withdrawn from 
the sheath, which thus became a tube, through which a sufficient 
portion of the ‘fluid would escape to diminish the size of the body, 
and enable the operator to withdraw the foetus without difficulty. 
Another case of mechanical impediment arose from the enlarged 
size of the head. In this case the operator must introduce his hook 
with one hand, and attach it to the orbit, and with the other 
