MIDWIFERY. 
is safe in all that regards suffocation ; and 
as to the head remaining within the os ex- 
ternum, it is of no consequence whatever. 
If the child’s head cannot be brought 
through we may pull, drawing it with cau- 
tion. Some practitioners will pull the child 
very hard, which is quite improper; not 
that it is any material object to the woman, 
but to the child ; the force being applied 
witli the hopes of the child’s being born 
alive ; but is it very likely that its life will 
be saved, after a leg or an arm is pulled off, 
or after the body is pulled so hard as nearly 
to be separated from the head ? 
Second division of Preternatural Labour. 
The other division of this class of labours, is 
that in which the upper extremities present. 
This is now and then an original presenta- 
tion ; but sometimes it is artifical. It may 
be called original if felt before the mem- 
branes be broken, in the absence of a pain. 
It may be called artificial when the hand 
being felt by the practitioner, perhaps with 
some other part, is drawn down through 
the os uteri, and the position of the presen- 
tation varied; though it originally was a 
head presentation, it may be made a shoul- 
der presentation. When the hands are at 
the os uteri, they are easily distinguished 
from the feet by the thumb not being in the 
same line with the fingers ; while in the foot 
we distinguish the toes and heel. The 
shoulder has been mistaken for the back, 
and it is a mistake easily made in practice. 
In distinguishing, we should recollect the 
superior extremities have the scapulas be- 
hind them, while at the breech we feel the 
organs of generation. We may here lay 
down a rule, which is of the greatest conse- 
quence, and applies to all kinds of practice 
in midwifery ; that is, that the shoulders 
and arm will never pass together ; the la- 
bour may continue, but if that presentation 
be not altered the woman will be worn out 
and die. We must return an upper extre- 
mity ; and never regard it as a matter of 
choice, but as a rule of practice which must 
always be adopted. We must turn, because 
it is a presentation that cannot be deliver- 
ed. This altering the position of the child, 
in utero, is called the art of turning, which 
art, in modern science, is attributed to Am- 
brose Paree, though it is mentioned as far 
back as the time of Celsiis, who says it is 
sometimes necessary; he does not, however, 
say whetlrer it were ever done on a living 
child. Aihbrose Paree’s words are, “ that 
in all cases where the upper extremities 
present, you must turn and bring down the 
feet ; and if the midwife cannot do it her- 
self she must send for a surgeon who can.” 
The nature of these presentations may 
vary so much that it may be necessary to 
mention some circumstances. Suppose a 
case in which the waters are not yet dis- 
charged, and the labour is going on very 
naturally, but by examination through the 
membranes between the pains, we find that 
an arm or shoulder presents, yet we may, 
perhaps, not know exactly the parts; in 
such case, we should not be absent from the 
woman upon any account, at the time of the 
membranes breaking, for it will make all the 
difference in the world as far as relates to 
that labour. We must ascertain the exact 
position of the child, and we must then pro- 
ceed to turning. The question now is, what 
time in the progress of the labour is most 
proper for this operation ? Bourdelois says, 
when the membranes are broken, and the os 
uteri dilated. Dr. Hunter is of tire same 
opinion. Dr. Clarke differs from them both, 
and Justly ; for he found that if we delay 
turning till the w'aters have come away, 
and the os uteri is quite dilated, we allow it 
to remain to the increasing the difficulty of 
the operation. If we take it when the os 
uteri will admit the finger and knucles, it is 
the better time, because we then turn the 
child as if in a bucket of water; and this 
gives us so clear an advantage that it needs 
no explanation. This then is the most con- 
venient period, and we should begin by 
dilating the os externum, previously inti- 
mating our design to the patient, cautioning 
her not to be in the least frightened at what 
we are going to say ; we may then inform 
her “ that the child does not lie quite right, 
but it may soon be set right, and with little 
trouble.” It being then agreed upon, the 
woman is to be laid close to the edge of the 
bed ; and we roll up the sleeve of our shirt 
and pin it, anoint the hand and fore-arm, 
and dilate by forming our hand into a cone, 
first going gradually through the os exter- 
num, taking our time, and being very gen- 
tle ; but we should not pass on dilating be- 
yond the vagina, until our hand passes 
easily tlirough ; if we do we shall feel ffie in- 
convenience of it afterwards, by the contrac- 
tion of those parts : having got our hand 
through the vagina, we may let it remain 
awhile, and should a pain come on, it 
may waste itself on our hand. We should 
then gently begin again to dilate till we get 
our hand into the uterus; when we turn 
the child gradually round, bringing tlie head 
to its proper situation. 
