On the nature, mechanism, and treatment of face presentations / [James Marr].

  • Marr, James, -1866.
Date:
1842
Catalogue details

Licence: Public Domain Mark

Credit: On the nature, mechanism, and treatment of face presentations / [James Marr]. Source: Wellcome Collection.

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    the apex first; whereas in the former, the base of the cone passes first, and perhaps there is also a slight increase in the size of the tumour. But it is not so much any increase of size that we are to look to, as the incompressible nature of the bones of the face, and, consequently, the impossibility of their being moulded or adapted, as it were, to the passages, in the way the head can. Burns, although an advocate for interference in these presenta¬ tions, after giving the minute measurements of the face, makes the following statements:—“ On comparing these dimensions with the capacity of the pelvis, we see that there is space for the head to pass, though not so easily as when it presents natural¬ ly.” (Midwifery, p. 431.) If, then, wliat has just been stated in regard to the nature of face presentations, and their mode of transmission through the pelvis, be correct,—and Nsegele says, that during an extensive practice of twenty years, he has never seen a case where the face took any other direction than the one just described—the con¬ clusion forces itself upon us, that unless some unusual dispropor¬ tion or deformity exists, nature should be able to accomplish de¬ livery without the aid of art. Treatment.—1. Rectifying the position. “ By raising the fore¬ head, and turning the vertex obliquely down, and directing it to the left acetabulum.'’1 (Burns, op. cit. p. 432.) Several of our leading authors have, with Burns, under some restrictions, rer commended this mode of treatment; and we feel convinced that it too often is had recourse to in the present day, with any but advantageous results. Ramsbotham, in reference to it, says, “ that it is impossible, by any counter-pressure, to make a bene¬ ficial change in the situation of the head under a face presentation.” Any one reflecting on the size of the head, which, in its occipito¬ mental diameter is five inches, and the manner in which it is placed in these cases, must see at once, that it is physically im¬ possible to turn the head in this axis through the cavity of the pelvis, which is only four inches and a half, so as to make the chin approach the sternum, and allow the vertex to come down. Therefore, I have no hesitation in saying, that not only can no good be obtained by attempting this change of position, but that there is a tisk of doing positive harm by interfering with the mode of delivery which nature, as we have already pointed out, takes in those cases. 2. Turning.—This mode of treatment is the oldest, but, as we took occasion to mention, is still recommended by some of the most recent authorities in the present day, men whose opinions, from the position they occupy, unfortunately in the present in¬ stance, must have considerable weight with the profession. The objections which we have to offer to turning are:—
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