Observations on the directions given by various writers on the practice of midwifery, for turning the child : with an account of an improved method of performing that operation / by John Breen.

  • Breen, John.
Date:
[1818]
Catalogue details

Licence: Public Domain Mark

Credit: Observations on the directions given by various writers on the practice of midwifery, for turning the child : with an account of an improved method of performing that operation / by John Breen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    utero. It is now fully ascertained, that the child is disposed in such a manner that it may occupy the least possible space. For this purpose the head is inclined on the chest, the spine incur-' vated forward, and the lower extremities so folded, that the knees are nearly in contact with the upper part of the abdomen, the heels applied to the breech, with the aiikles generally crossing each other. The superior extremities vary in their position, and perhaps will not be found exactly similarly circumstanced in any two cases. On the contrary, the position of the lower extremi- ties, with regard to the trunk, is nearly the same, whatever part may present at the brim of the pelvis in the commencement of labour. In proof of the constancy and uniformity of the rela- tive position of the lower extremities with regard to the trunk, it is observed, that the new-born infant, left to itself, folds its lower limbs in the manner now described. J^eviations then from this position must be considered as exceptions to a general law. Hence it would seem to follow, that where it may be ne- cessary to turn the child, the operator should not remove the in- ferior extremities from this natural position, provided he can ef- fect his purpose while they remain in it; and it is the principal object of this paper to shew, that, in most instances, he has this power. As the child occupies the least possible space in the uterus in the position described, more power and freedom is given, by this circumstance, to the hand of the operator, conse- quently any unfavourable situation of the child is more easily altered while it is in this position. Let us now consider what change of situation the child must undergo where we turn, in preternatural presentations of the su- perior extremities. Reflection will satisfy us, that it must re- volve on the lesser axis of the trunk, and describe an arch more or less extensive. By the lesser axis will be understood an ima- ginary line passing from side to side, nearly opposite the umbili- cus, represented in the plate by the line X x. It is obvious, that, in all presentations of the superior parts of the child, where it is turned, this kind of rotatory movement must be efiected. The next step is to ascertain how the child can be made revolve with the greatest facility in the manner pointed out. Since the writings of Ambrose Pare, who, in modern times, gave the first positive instructions to turn, most succeeding writers on midwife- ry, including Mauriceau, Smellie, Baudeloque, Denman, Ha- milton, Burns, and Merriman, direct a foot or the feet to be sought for, and the child to be thus turned. The error of these directions will, 1 conceive, be made to appear in the progress of this inquiry. The plate represents one of the most difficult preternatural cases, and is nearly a copy from Smellie, (being his 34th plate,)