PARTURITION. 
before the attempt to introduce them, as this confider- 
ably facilitates the paffage. The late Dr. Thynne recom¬ 
mended to rub the arm with foapand water, fo as to form 
a ftrong lather upon it; this anfwers very well. Some 
have recommended decodtions of marfhmallow-roots or 
linfeed, fome the white of eggs, and others have pro- 
pofed to injedt warm oil into the uterus, preparatory to 
turning. 
Presentations of the bach, belly, orfides .—Each of thefe 
prefentations is Hated in the report from the Maifon 
d’Accouchemens to have occurred once in 5833 labours. 
Madame Boivin, in her Memorial de l’Art des Accou- 
chemens, has given delineations of thefe pofitions; but 
admits, that, in 20,517 cafes, delivered at the Hofpice de 
la Maternite at Paris, no inftanceof fuch prefentation oc¬ 
curred at the full term of geftation. Dr. Bland takes 
no notice, in his “ Calculations of Accidents in confe- 
quence of Parturition,” of thefe prefentations. Dr. 
Denman fays, “ I do not mention the marks by which 
the back, belly, or Tides, might be diftinguilhed, becaufe 
thefe, properly fpeaking, never conftitute the prefenting 
part; that is, though they may fometimes be felt, they 
never advance foremoft into the pelvis, in the commence¬ 
ment, at leaft, of a labour.” Dr. Hunter fays, “ I have 
read much in authors where the navel is faid to prefent, 
or, on the contrary, where, on introducing the finger, you 
feel the middle of the fpine : I do not believe there is the 
poffibility of fuch a thing in nature : the fhape of the 
uterus, pelvis, See. all deny it.” MS. Leftures 1765. 
In the very extenfive praftice of the late Dr. Merriman, 
and in that of his nephew, amounting together to nearly 
20,000 labours, no inftance has occurred of either of thefe 
prefentations, except in one or two cafes, where the mo¬ 
ther had not completed her feventh month of utero-gef- 
tation, and in thefe the children paffed doubled through 
the pelvis. 
A cafe of a back-prefentation is given by Dr. Merri¬ 
man, Appendix N° 18. The mode of proceeding is not 
at all clearly explained. The operator fays, “ As the 
pains were not ftrong, even at an early period of the la¬ 
bour, by introducing the finger, I could diftimftly feel 
the fpinous proceffes of the vertebrae of the child, palling 
in a direction towards the left ilium of the mother. As 
the os uteri was by no means in a fit ftate for the intro- 
dudlion of the hand, I determined to wait; the pains, 
however, did not increafe but in a very flight degree. 
After waiting from eleven in the morning till about two 
the next morning, finding the os uteri in a more re¬ 
laxed ftate, I determined to deliver her, which was done 
without much difficulty;” he does not fay how. “ The 
child was born alive and of the full fize ; the mother is 
doing well.” He very juftly concludes, “ I do not know 
that much practical information can be obtained from 
this cafe.” We may therefore juft obferve, that, lhould 
fuch an unufual prefentation occur, it is very probable 
that in the courfe of the labour the pofition would be 
changed to one more favourable. If no alteration took 
place fpontaneoufly, the introduction of the hand would 
be neceiTary, as foon as the parts were fufficiently dilated, 
to bringdown the feet, and to deliver before the ftrength 
of the patient was too much exhaufted ; and this we fup- 
pofe was the courfe purfued in the cafe we have men¬ 
tioned-. 
Smellie, Leake, and fome others, fpeak of having at¬ 
tended in prefentations of the umbilicus-, but, if it ever 
occurs, it is extremely rare. 
Prefentation of the funis umbilicalis does, however, 
often occur. This kind of prefentation appears to have 
been much mifunderftood formerly. It was fuppofed, 
when the funis came through the os uteri into the vagina, 
or without the os externum, that the child lay acrofs the 
pelvis, the belly being over the os uteri; and this is the 
reprefentation of the pofition given in Smellie’s plates ; 
nor is the opinion yet abandoned : M. Maygrier fup- 
pofes, that the prolapfion of the funis always indicates 
Vop. XVIIJ. No. 1274. 
089 
the prefentation of the abdomen : “ Un figne rjui nc. laijj'e 
aiicun doute fur la prefentation du ventre, e’eft la pre¬ 
fence du cordon ombilical.” Methode pour manoeuvrer 
les Accouchemens, 1804. This, however, is feldom or 
never the cafe. When the funis prefents, there will be 
found beyond it, either the head, the nates, or one of 
the extremities. 
The difficulty in this cafe is not on account of danger 
to the mother, but becaufe there is a great probability of 
lofing the child. Attention muft be given to the pulia¬ 
tion in the funis. If no pulfation is to be felt, the child 
is already dead ; and the cafe is to be managed precifely 
as if the navel-ftring were not prolapfed. 
Should there however be a pulfation, we are allured 
that the child is yet alive ; and it becomes us to confider, 
in what way we can belt proceed, fo as to preferve its life. 
Three expedients for this purpole have been recom¬ 
mended. Firft, To let the labour advance, till the head 
of the child is within reach of the forceps, and then to 
haften the delivery by means of this inllrument. Secondly, 
To remove the navel-ftring out of the way of compreffion. 
Thirdly, To haften delivery, by turning the child and 
bringing it by the feet. 
The firft method probably poffeffes but little advan¬ 
tage, beyond what may be. gained by trufting the cafe 
entirely to nature. In fome inftances, where the mother 
has had children before, where the pelvis is very wide, 
the feetus final], and the pains ftrong and quick, the child 
has paffed alive without extraordinary affiftance. But 
the probability of this being effected is fo remote, that it 
would be wrong to truft to it, did any other means of 
affording affiftance prefent themfeives. Should it, how¬ 
ever be found impolfible to remove the funis out of the 
way of compreffion, or lhould the child’s head have funk, 
too low into the cavity of the pelvis, or lhould any other 
circumftance be prefent, fo as to render it hazardous to 
attempt, turning, the application of the forceps might be 
admiffible, as the only remaining refource. See Merri¬ 
man, p. 242. 
The fecond method would be the mod eligible, could 
it always be putin pradtice ; but the means of effedting 
a reduction of the prolapfed funis are not very eafy. It 
has been propofed, to carry it upon the points of the 
fingers, or upon a forked piece of cane or whalebone, 
through the os uteri, and above the head of the child, fo 
as to prevent the funis being prefled upon, as the head 
defeends through the pelvis. But this expedient has 
been often found to fail; for, upon withdrawing the fin¬ 
gers, or the forked flick, the funis ufually finks again 
into the vagina. Dr. Mackenzie once fucceeded, by 
drawdng without the os externum as much of the pro. 
lapfed funis as he could bring down, and inclofing the 
whole in a fmall bag, which was (lightly tied at the neck. 
This he paffed into the uterus beyond the child’s head, 
where it was retained, and the child was born alive; 
This method feems deferving of farther trials ; but Dr. 
Mackenzie never fucceeded in it but once. The late Sir 
Richard Croft has related two cafes, in which he fuc¬ 
ceeded, by carrying the prolapfed funis through the os 
uteri, and fufpending it over one of the legs of the child. 
In both thefe cafes the children were born alive. Mr. 
Hogben and Mr. Hopkins recommend fponge to be in¬ 
troduced, fo as to keep the funis from linking below the 
head, after it has been carried, as far as poifible, above 
the brim of the pelvis, either by the fingers, or any other 
contrivance. 
The third method propofed, viz. the haftening of the 
delivery by turning the child in utero, and bringing it 
by the feet, can only be reforted to under certain favour¬ 
able circumftances. It is to be recollefted, that no pof- 
fible advantage can accrue to the mother by turning the 
child; it is the benefit of the child alone that we have in 
view. In cafe then of a want of pulfation in the navel- 
ftring, which is a certain indication of the child’s death, 
turning ought on no account to be attempted. Or, 
8 N lhould 
