PARTURITION. 087 
It was the practice of the ancients to endeavour to 
pufti back the arm, and bring the head into the pelvis; 
but this method could feldom fucceed, and it was, after 
a time, laid afide, principally upon the authority of Am- 
brofe Pare, who directed that the feet fliould be fought 
for, and brought down, in all preternatural prefentations. 
It feems now generally agreed, that the preferable mode 
is to turn and deliver footling; for though it is fome- 
times practicable to return the arm, and bring the head 
to prefent, yet the chance of fuccefs in this way is very 
trifling. The eftablifhed practice, then, is for the ope¬ 
rator to pafs his hand into the uterus to take hold of the 
feet, and bring them without the os externum ; thus 
converting the prefentation of the arm into a prefenta- 
tion of the feet. 
Under this head we may alfo include thofe preterna¬ 
tural and very rare prefentations called by Merriman 
Dyftocia tranfverfa, tranfverfe or crofs prefentations; as 
of the neck, bread, back, belly, or fide: for it is quite 
obvious that a full-grown child cannot poflibly be ex¬ 
pelled through the natural paflages in fuch pofitions as 
thefe ; and confequently, unlefs nature perform the ope¬ 
ration of fpontaneous evolution, firft defcribed by Dr. 
Denman, both mother and child mull be deftroyed ; for 
the unavailing contractions of the uterus will firft ope¬ 
rate in impeding the circulation of the child ; and then, 
by‘pulhing forward its body with great force on the foft 
parts of the mother, will induce fuch a degree of pain 
and inflammation, that fhe muft at laft fink exhaufted. 
The practice of turning, as it is called, that is, of 
bringing down the feet in cafes belonging to this divifion 
of preternatural labours, originally fuggefted by Pierre 
Franco, but firft properly eftablifhed by Ambrofe Pare, 
has been the means of faving many valuable lives. In¬ 
deed the fuperiority of this practice to that of making 
the head prefent under fuch circurnftances muft be very 
obvious ; for, after the operator has got hold of the in¬ 
fant’s feet, he can complete the delivery without requir¬ 
ing the afliftance of pains. 
The dangers to be dreaded in performing the operation 
of turning are—rupture of the uterus, or fubfequent in¬ 
flammation of the paflages, and lofs of the child. When 
it is added, that a perfeverance for feveral hours is fome- 
times neceflary for accompliihing this operation, it muft 
be obvious, that it demands in many inftances a greater 
degree of patience, as well as dexterity, on the part of 
the operator, than mod cafes of furgery. We lhall there¬ 
fore offer a few obfervations on the method of proceeding 
in four different cafes, which will be fuflicient to enable 
the young practitioner to regulate his method of manage¬ 
ment in all others. 
i. If it fliould be afcertained, before the membranesare 
ruptured, and the waters difcharged, that the arm is the 
prefenting part, it will be right not to introduce the 
hand till the os uteri is fufiiciently dilated to allow 
the hand to pafs with tolerable eafe into the uterus ; for, 
till the membranes are ruptured, no danger exifts, and 
the dilatation of the parts is more eafily and conveniently 
effeCled by the bag of waters than by any other means. 
But, though it may not be expedient for the operator to 
proceed to the introduction of his hand till the os uteri 
is favourably dilated, yet he muft on no account quit 
his patient; for he may be obliged to proceed to artificial 
dilatation, without delay, fliould the membranes fud- 
denly give way. As foon as the os uteri is fufiiciently 
dilated, (and the more complete the dilatation of this 
part, the more fafe will be the delivery,) the operator 
muft dilate the external parts artificially, till they oppofe 
no further refiftance to the introduction of his hand. 
Then,flowly carrying his hand through the vagina to the 
os uteri, he muft gently infinuate it through this part, 
in the abfence of a pain. If he fliould find the os uteri 
lefs relaxed than he expeCted, or than is neceflary, he 
muft proceed to ufe artificial dilatation here too, very 
flowly effecting this, and intermitting his endeavours, 
from time to time, as he fhall judge prudent. Having 
obtained room to pafs his hand through the os uteri, he 
muft rupture the membranes by prefling a finger firmly 
againft them ; when his hand will immediately come in 
contaCl with the body or limbs of the child. He is then 
to pafs his hand forwards till he reaches the feet, which 
he fliould be careful to draw down along the belly, not 
over the back of the child; and, proceeding flowly, he 
will find, that, as the feet are brought lower, the prefent¬ 
ing arm will be retraCted ; and, when the nates are brought 
to occupy the hollow of the facrum, the arm will be 
drawn nearly or completely within the uterus. The cafe 
now becomes precifely fimilar to a feet-prefentation, and 
is to be managed accordingly. This is the eafieft and 
fafeft cafe of turning; for the uterus is kept diftended 
all the time by the liquor amnii, which, after the mem¬ 
branes are ruptured, is prevented from pafling off by the 
operator’s arm plugging up the vagina and os externum. 
So that the efforts of the accoucheur to turn are not im¬ 
peded by the contraction of the uterus upon the body of 
the child. 
2. Sometimes it will be found that the arm is lying in 
the vagina, or without the os externum, the liquor amnii 
having been fome time difcharged, the os uteri nearly or 
quite dilated, and the patient either quite free from 
pains, or having pains feldom occurring. Here is ano¬ 
ther cafe in which it is advifable to proceed, without de¬ 
lay, to deliver by turning the child : but the turning 
will not be fo eafily effeCled in this as in the former 
cafe, becaufe the uterus will be in a ftate of contraction 
on the body of the child. There will therefore be greater 
difficulty in pafling up the hand to reach the feet. Still, 
if there be only the paflive contraction of the uterus, the 
delivery may be effeCled without much trouble. By 
paffive contraction is underftood that contraction of the 
uterus which always takes place in confequence of the 
difcharge of the waters, and which may be confidered 
“ as the exercife of that inherent difpofition, by which 
efforts are made by the uterus to recover its primitive 
fize and fituation, when any caufe of diftenfion is re¬ 
moved this paflive contraction admits of different de¬ 
grees of intenfity. By aClive contraction, is meant the 
occurrence of Itrong mufcular aCtion, whether regular, 
as in labour-pains, or irregular, as in fpafm. For a fur¬ 
ther elucidation of this, fee Denman’s Introduction to 
Midwifery, 4-to. p. 440. 
The hand is to be paffed cautioufly as before. It 
muft be infinuated, in the molt gentle manner, through 
the os uteri, and flowly conducted over the furfaceof the 
child, till it reaches the feet. Should uterine aCtion be 
excited during the time that the hand is in the uterus, 
it muft be kept in a flattened form clofe upon the body 
of the child ; or may be a little withdrawn while the 
pain continues ; and, when the pain has fubfided, the 
hand may again be cautioufly carried forwards. It is 
generally more difficult in this than in the former cafe, 
to lay hold of both the feet; we muft fometimes, there¬ 
fore, be content with one only; but the turning is al¬ 
ways much more fafely and eafily accompliftied when we 
can command both feet than when we have only been 
able to reach one. 
3. It may happen, that afuperiorextremity prefents, the 
liquor amnii is evacuated, and the os uteri but little di¬ 
lated, perhaps very firm and rigid. In this cafe, a 
cautious attempt may, if the attendant thinks fit, be 
made to produce artificial dilatation ; but it will proba¬ 
bly be found neceflary to wait with patience till the 
parts become more relaxed or dilated : for, as there 
would of courfe be great refiftance to the introduction of 
the hand, it is probable that the attempt to force it into 
the uterus would excite inordinate or fpafmodic aCtion ; 
and a laceration of the uterus, or other lerious mifchief, 
might enfue. By allowing time, however, the rigidity 
would diminilh, the parts would dilate, flowly and un- 
towardly indeed for want of the mechanical, or wedge¬ 
like. 
