[We do not believe that Charpentier does justice to the method of re position by posture. Thomas, of New York, in an article published in 185e, amply demonstrates the value of the method, and it is as rational in theory as it is successful in practice. By posture we simply reverse the action of gravity, and in cases where the presenting part is not firmly engaged, the liquor amnii not entirely escaped—in short in cases where the foetus is still moveable—the cord will often slip back into the upper uterine segment, and will ordinarily remain there if care be taken to keep the patient in the semi-prone position until the presenting part has engaged. It is in the knee-chest position, furthermore, that manual and instrumental reposition should be tried, and the manipulation is in every way facilitated by working through the Sims' speculum. We would not be understood as meaning that reposition of the cord is a simple matter. We desire, purely, to lay stress on the fact that the postural method, under the given conditions, aided it may be by the hand or an instrument, is worthy of greater praise than Charpentier grants.—Ed.] Numerous instruments have been devised for reposition: the omphalosoter of Schaller, modified by Tarnier, (Fig. 161); the cord repositors of Braun (Fig. 162), Naegelt and Scanzoni; the sponge repositors of Osiander, Sax torph, and others; the slings, elastic rods, etc., of Eckhardt, Wellenbergh, Davis, Simon, and others; Murphy's repositor (Fig. 166), Lambert's (Figs. 163 to 165), and others too numerous to mention. The oldest and simplest method is that of Dudan, modified by Dewees. Naegel6 and Grenser describe it as follows: " The cord is surrounded by a loop of ribbon, the ends of which are tied. A portion of the loop is passed through the eve
of an elastic catheter armed with a stylet which retains the loop. (Figs.
167, 168.) The catheter is guided by the finger into the uterus, and the stylet is withdrawn, and finally the catheter, leaving the ribbon and cord in the uterus. Of course, care is to be taken not to compress the cord by the ribbon loop." We have used the following procedure on one occasion, and it succeeded admirably. It is a modification of Dudan's. We surround the cord with a silk loop and we tie this loop tight enough to prevent slipping, and yet not to compress. The terminal ends of the loop we next tie to an olivary elastic, or wax bougie. The cord is thus firmly held at the end of the bougie. We then pass the bougie into the uterus and leave it there, and this is wherein our method differs from others. The cord is not only held in place, but the bougie promotes what we desire, active contractions.
[Without wishing to detract from Charpentier's claim to originality, this method, the best of all, was suggested by Roberton, and has been employed frequently with success. He passed a doubled piece of ordinary twine through a catheter, and out at the eye. The cord is drawn through the twine loop, and the ends of the twine are tied to prevent slipping. The catheter is passed to the fundus with the cord and left there.
Ashford reported a case in the American Journal of Obstetrics, for 1878, where he attached the cord to a Gariel pessary, carried the pessary to the fundus, and inflated it. The method was successful.—Ed.]