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This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1895 Excerpt: ...If the cervix is dilated so that two fingers can be passed into the uterus, no further dilatation will be necessary at this time. The head should be carefully raised between pains, and no undue pressure made upon the membranes. The fontanelles are sought and examined. If any doubt of the real position remain after this, the ear should be felt; this will be an unfailing guide. If the occiput is posterior the cervix should be dilated, preparatory to performing the internal rotation, in the same way as has been described for podalic version. With the cervix fully dilated the hand is introduced into the uterus. If the head has slightly engaged, it should be gently pushed up. The fcetus is now grasped and slowly rotated in its long axis until the occiput is anterior. The hand should now be slowly withdrawn until the head can be grasped, and in this position the operator waits for uterine contraction. When this has occurred the head is driven down and engagement ensues. It is wise to retain the hand until two or three contractions have taken place, so that the head may be firmly engaged. The case may now be left to nature, or, if necessity demands, the forceps may be applied and extraction completed (Plate XIII). The course of action herein advocated is not novel, nor is it as radical as at first sight it may appear. The management of occipito-posterior positions has for a long time been a matter of strife among obstetricians. The lever, the forceps applied inversely, podalic version, the conversion into a face presentation, --such means from time to time have been advocated. When the occiput, in faulty position, has become impacted, certain of these measures are forced upon us, with consequent damage to the woman and with as yet not sufficiently recognized injury..
