Volume 1

A treatise on the science and practice of midwifery / by W. S. Playfair.

  • Playfair, W. S. (William Smoult), 1836-1903.
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on the science and practice of midwifery / by W. S. Playfair. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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    by tbe other buttock, and the sacral spinous processes are sufficient to prevent a mistake. 2. The elboio is rarely felt at the os, and may be readily recognised by the sharp prominence of the olecranon, situated between two lesser prominences, the condyles. As the elbow always points towards the feet, the position of the foetus can be easily ascertained. 3. The hand is easy to recognise, and can only be con- founded with the foot. It can be distinguished by its bor- ders being of the same thickness, by the fingers being wider apart and more readily separated from each other than the toes, and above all by the mobility of the thumb, which can be carried across the palm, and placed in apposition with each of the fingers. It is not difficult to tell which hand is presenting. If the hand be in the vagina, or beyond the vulva, and within easy reach, we recognise which it is by laying hold of it as if we were about to shake hands. If the palm lie in the palm of the practitioner’s hand, with the two thumbs in apposition, it is the right hand ; if the back of the hand it is the left. Another simple way is for the practitioner to imagine his own hand placed in precisely the same position as that of the foetus ; and this will readily enable him to verify the previous diagnosis. A simple rule tells us how the body of the child is placed, for, provided we are sure the hand is in a state of supination, the back of the hand points to the back of the child, the palm to its abdomen, the thumb to the head, and the little finger to the feet. It is perhaps hardly proper to talk of a mechanism of shoulder presentations, since, if left unassisted, they almost invariably lead to the gravest consequences. Still, nature is not entirely at fault even here, and it is Avell to study the means she adopts to terminate these malpositions. There are two i^ossible terminations of shoulder presen- tation. In one, known as ‘ spontaneous version^' some other pai’t of the foetus is substituted for that originally presenting; in the other, ‘ spontaneous evolution’ the fictus is expelled by being squeezed through the pelvis, without the originally ])resenting j)art being withdrawn. It cannot be too strongly impressed on the mind that neither of these can be relied on in practice. The elbow. The hand. Mode of detecting which hand is present- ing. Mechan- ism. The two possible termina- tions of shoulder presenta- tion by the natural powers.