The attitude and positions, natural and preternatural, of the fœtus in utero, acts of the reflex or excito-motory system / by J. Y. Simpson.

  • James Young Simpson
Date:
1849
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Licence: Public Domain Mark

Credit: The attitude and positions, natural and preternatural, of the fœtus in utero, acts of the reflex or excito-motory system / by J. Y. Simpson. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    Levret/ Laniottc,^ and others,'' that the position with the head down- ward, and directed to the os uteri, is only taken towards the latter months ; and that it is assumed either gradually, or at last by a sudden movement and toppHng on the part of the foetus (the movement of cidbute of the older authors). Sir Fielding Ould ^ and Burton supposed that this downward movement of the foetal head did not occur till the commencement of labour. Whatever explanation may be given of the position of the infant in utero, one fact has been sufficiently established in regard to it by modern investigations; namely, that the position with the head lowest is not assumed till the latter months of utero-gestation. Before the beginning of the sixth or seventh month, the ovoid mass of the foetus lies in utero, in nearly an equal number of cases, with its cephalic and its pelvic extremities lowest, or over the os uteri; and in a considerable proportion of instances it is still placed across or transversely, so that the trunk is opposite the os uteri. Hence in abortions, presentations of the feet or pelvis are nearly as fre- quent as presentations of the head; and presentations of the arm at last, having become very large, it is carried downwards by its own proper weight. 5. Several causes may, however, prevent its descending, or derange its direction.' I place in this class defect of the liquor amnii, obliquity of the uterus, tumours in the uterus, premature efforts, and external violence.— L'Art des Accoitchemens, p. 41. ' The foetus, after the fourth month of pregnancy, has the head above, the breech below, the belly in front; but when it approaclies the period of its birth, it is the back which is in front, the head below, and the breech above. This observation proves that the infant, at the later periods of pregnancy, brings down its head to where its breech was before, and that it does so by bending forwards, whether gradually or all at once, ami this is what the ancients have called the culbute.—Levret, L'Art des Accouchemens, p. 74. 2 All authors,says Lamotte,agree that the child in the uterus has its back towards that of the mother, the heels backwards, the hands upon the knees, with the head resting on them till the seventh month ; that at this time the head, growing heavier by the increase of its bulk, draws the body down, making it topple, and that then the head is below and the feet above, the face towards the mother's back; as to any thing else, remaining in the same posture it was in before, which is the situation in which it remains to the ninth month, and in Avhich it comes into the world.—Lamotte, Treatise of Midwifery, Translation 3 See Heister's Compendium Medicinse, p. Ill; Manningham's Compendium Artis Obstetricariaj, p. 10 ; Haller's Elementa Physiologife, vol. viii. p. 412. 4 Treatise of Midwifery, p. 25 ; and Preface, p. xiv. 5 We must therefore,'' says Burton, assign some other cause, which ac- cording to Ould seems to be as follows, viz., that the Avhole spine is curved, and its head looks down, so that the fontanelle is just opposite the fore part of the mother's belly ; and therefore as the first and greatest eflFoi-ts for the expulsion of the child are in the bottom of the womb, which ]3resses^ directly on the back of the head, as is evident from the posture of the fcctus in utero, and from the foregoing description of the Avomb, they must of course im- mediately turn the head downwards towards the vagina, and its face to the mother's back, especially as it is at this time floating in the waters. Hence it happens, that the change of the posture of the foetus does not happen in a natural way till the first labour pains begin.—-Cw^cm's Essay towards a New System of Midwifery, p. 100,
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