Dr. R. W. Johnson, who dedicated his _New System of Midwifery_, &c. to Dr.
W. Hunter and others, in 1769, and probably attended his lectures,
expresses a similar opinion, and says, that in these cases "nature herself
will do the work." (p. 267.) Dr. Alexander Hamilton, in 1784, also speaks
favourably of these presentations. "The head will, however, in most cases,
advance in that position by the force of the natural pains, though the
delivery will be more slow or painful." (_Outlines of the Theory and
Practice of Midwifery._)
Farther experience has shown that, so long as the pelvis is of the natural
size, the head can be born in this position without peculiar difficulty,
the soft parts usually require a little more dilatation than where the
cranium presents, and, therefore, this stage of the labour is generally
somewhat slower. Although presentations of the face are not so favourable
for the child as those of the cranium, they stand next to them in point of
safety. Where the cranium presents, a slight misproportion between the
head and pelvis produces little or no increase of difficulty to the
passage of the child; but under similar circumstances, where the face
presents, the difficulty may become very serious, for if the labour is
prolonged, "the brain and vessels of the neck," observes Smellie, "will be
so much compressed and obstructed as to destroy the child." (Explanation
to table 25.) A similar view has been given by Dr. Denman, and still more
recently by Professor Chaussier, of Paris, and Professor Naegelé; the two
latter authorities examined the brain in several still-born children where
the face had presented, and invariably found the cerebral vessels gorged
with blood.
The presenting side of the face when born is frightfully distorted by the
livid swelling above-mentioned; the mouth is pulled to one side and
upwards; the angle of the eye is drawn downwards, and the corresponding
ala of the nose scarcely discernible amid the purple mass of tumefaction:
the less this is meddled with the better, for in the course of a day or
two the parts will have returned to their condition; whereas, if friction
or hot poultices, &c., be used, ulceration may be the result, and produce
considerable disfigurement.[80]
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