_Malposition of the child.--Arm or shoulder the only faulty position
of a full-grown living foetus.--Causes of malposition.--Diagnosis
before and during labour.--Results where no assistance is rendered.--
Spontaneous expulsion.--Malposition complicated with deformed pelvis
or spasmodically contracted uterus.--Embryulcia.--The prolapsed arm
not to be put back or amputated.--Presentation of the arm and head.--
Presentation of the hand and feet.--Presentation of the head and
feet.--Rupture of the uterus.--Usual seat of laceration.--Causes.--
Premonitory symptoms.--Symptoms.--Treatment.--Gastrotomy.--Rupture in
the early months of pregnancy._
We have already stated that the presentations of the full-grown living
foetus may be brought under three classes, viz. those of the head, of the
nates or lower extremities, and of the arm or shoulder: the former two
have already been considered under the head of eutocia or healthy
parturition, and may be distinguished from the latter, by the great
peculiarity that in them the long axis of the child's body is parallel
with that of the uterus, whereas, in arm or shoulder presentations this
cannot be the case, its body lying across the uterus.
Although malposition of the child, strictly speaking, refers to one
species of presentation only, viz. to that of the arm or shoulder, yet it
has been rendered a matter of great perplexity by the speculations and
theoretical notions of authors. No one has propagated more serious errors
upon this subject than the celebrated Baudelocque, the more so as the
great authority of his name has tended to silence all doubts as to the
accuracy of his views upon this subject. Almost every author since his
time has contented himself with copying more or less from him, without
ascertaining by personal observation how far they corresponded with the
actual course of nature. By forcing a stuffed figure into a pelvis in
every possible direction, he succeeded in making actually ninety-four
presentations of the child, all of which he described as if they had
really occurred in nature.
Few have taken so simple a view of this subject as the late Dr. Denman.
"The presentations of children at the time of birth," says this
distinguished accoucheur, "may be of three kinds, viz. the head, the
breech or inferior extremities, the shoulder or superior extremities; the
back, belly, breast or sides, properly speaking, never constitute the
presenting part."
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