MIDWIFERY. 
section we certainly lose one life ; and by 
doing nothing we lose both. 
Preternatural Labour. We now proceed 
to a consideration of the third class of la- 
bours, into which we have divided our sub- 
ject, and which are generally denominated 
preternatural, or cross-births ; including all 
presentations but those of the head. This 
class is naturally, therefore divisible into 
presentations of the lower and presenta- 
tions of the upper extremities j aud to this 
sub-division we shall adhere. 
We know little of the cause of preterna- 
tural presentation ; perhaps it depends on 
a peculiarity of form either in the uterus or 
pelvis. It is said to arise from accidents, 
because there are more instances of it in 
the lower walks of life : that is very true ; 
and there are more aquiline noses among 
the poor people than among the rich ; and 
more noses of every kind, because the truth 
is, there are more individuals in one class 
than in the other. Preternatural births are 
most likely the effects of peculiarity of shape 
in the parts. 
Presentation of the lower Extremities, 
This constitutes our first division of la- 
bours of this kind,-and is capable of being 
finished by the powers of nature alone-; 
and the only consequence would be upon 
the child, to whom such delivery is not 
always safe ; for when the feet present, 
and the child is gradually expelled, the 
child in figure forms a cone, which all along 
increases to the shoulders, and the head is 
born last of all ; the navel-string would be 
born long before the shoulders were disen- 
gaged, the effect of which would be, that 
the circulation would be interrupted in the 
cord, and perhaps suspended ; for pressing 
the naval string before birth, is the same as 
pressing the throat after it; each produces 
death. After tliis observation, we have only 
to remark, tliat when the cord comes down 
by the navel passing through, a portion of 
the cord should be drawn slack after it that 
it may not be stretched by the child’s pas- 
sing under the pubes. 
When the feet or breech have presented, 
there is plenty of time to turn the occiput 
to the pubes long before tlie head is down. 
Whether one foot or the breech presents, it 
is belter to let it come so, than to go up 
and bring down either one or both feet ; 
because in breech presentations, the parts 
are gradually and well dilated before the 
cord is likely to be compressed, therefore 
it is safer ; besides, the inferior extremities, 
in breech cases, lie upon the sides of the 
abdomen, by which they protect the navel- 
string lying between the two from any pres- 
sure whatever. So that we see all breech 
cases should be left unturned ; and we may 
ascertain the breech from the head, by feel- 
ing the parts of generation, as well as various 
depressions without that uniform defined 
resistance which is given by the head. 
When the breech presents, the meconium 
will generally come away by the pressure 
squeezing it out of the abdomen. Suppose 
that in a breech presentation any accident 
happen to the woman, needing immediate 
delivery, it has been said that the forceps 
may be applied; but from frequent trials 
we can say that they are of no use ; they 
are not calculated to hold such parts, and 
always slip of}'. Another plan recommend- 
ed, is to get a handkerchief between the 
thighs and the body : this is an exceeding 
good purchase, but in the living subject we 
can scarcely do it ; vie cannot get it be- 
tween the legs and body. If neither of 
these plans sueceed, there is only one re- 
maining ; this is the carrying up the blunt 
hook, and so placing it over the thighs; this 
certainly commands the delivery ; and 
where a small equally applied force is suffi- 
cient, it will be both successful and safe : 
but as it is self-evident that iron must be 
always stronger than bone, there will be a 
great risk of breaking the thigh-bones by 
this instrument. Yet the woman is not to 
die to save the child’s thigh-bone from the 
risk of being broken ; and it is certainly 
better to have to treat a child with its thigh 
broke, than one whose brains have been all 
scooped out. We should, however, be 
careful never to employ the least unneces- 
sary force. 
The feet being born and the breech pas- 
sed, the part which next presents is the um- 
bilicus ; and as the body afterwards passes 
further down the cord will be both pressed 
and dragged ; and if a cylindrical yielding 
cavity be dragged, the cavity of that cylin- 
der is diminished in its calibre, and the tube 
will ultimately be obliterated ; so that the 
best practice will be, as soon as a part of 
tire umbilicus can be felt, to pass up tire 
finger and bring down sufficient to prevent 
its stretching in the progress of the expul- 
sion ; and as soon as the head is in the pel- 
vis, to bend the face down, bringing it for- 
ward upon the breast of the infant, and op- 
posite the os externum, by which means 
the child will commence breathing ; and if 
the naval-string only pulsate up to that 
time when breathing commences, tire child 
