Cases in midwifery requiring manual & instrumental interference followed, in the former instance, first by trismus, then by hemiplegia of the right side; and ultimate recovery / by Charles Bell, M.D.

  • Bell, Charles, M.D.
Date:
1850
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Licence: Public Domain Mark

Credit: Cases in midwifery requiring manual & instrumental interference followed, in the former instance, first by trismus, then by hemiplegia of the right side; and ultimate recovery / by Charles Bell, M.D. 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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    The remarkable difference of opinion among- recent authors as to the frequency of the third position is less easily explained; and, although Naegele has given much instructive information on the subject, there still seems to be great misapprehension in regard to it. This is obvious from the very opposite statements given even by our highest authorities, in which the proporlion, in regard to the Hrst position, varies from 1 in 1336, according to Collins, to one in two and a-half according to Naegele. This celebrated author not only considers that, after the first posi- tion, the third is the most frequent in occurrence; but that these positions are The usual presentations of the head, and the rest are unusual. I have paid particular attention to the positions of the head ever since I had the great advantage of studying the subject in the General Lying-in Hospital in Lon- don, under the superintendence of Dr Rigby, the talented translator of Naegele's work; and I have no hesitation in say- ing, that my experience does not induce me to admit the high average given by Naegele and other recent authors; neither am I satisfied that the statistics in regard to the fourth position are correct and established beyond a doubt. I am more inclined to believe that this position, like the third, is one of the stages in the progress of the child through the pelvis, which is of more conimon occurrence than is generally supposed; and that it has escaped observation in many instances, in consequence of the rapidity and facility with which the head passes into the first position. The mechanism by which parturition is effected is another important question connected with this subject, which appears to be imperfectly understood. Naegele considers that the rota- tion of the forehead into the hollow of the sacrum in this case depends on the resistance opposed to the occiput by the in- ferior part of the pelvic cavity. This opinion has also been adopted by Dr Simpson, who treats this subject with his usual talents and research in a clinical lecture published by him some years ago. It is remarkable, however, that these eminent authors should suppose that so important a process should be the mere result of chance; and that Dr Simpson should ask the question, What part of the floor of the pelvis serves as the resisting plane upon, and by the aid of which the occiput is thus made to rotate forward? and should make answer, In some, any, and in others apparently every, successive portion of the concavity of the floor of the pelvis seems to serve this purpose. Were the change in the position of the head entirely depen- dent on the incidental resistance of some part of the pelvis, the result would be rendered very uncertain; which is not the case; as experience has proved, what was first observed by
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