[In instances where these measures fail, the faradic current, weak, and never passed through the two poles of the foetus, should always be tried.
A number of instances are on record where it overcame rigidity, and from our experience in cases of uterine inertia, we should be inclined to rank it in value after chloral, which drug is of the greatest possible util ity.—Ed.] If the mother's life or that of the infant is in danger, we must proceed to dilate the cervix. In such cases, chloroform pushed to its fullest ex tent has been advised. We have but little confidence in it, because the uterine muscle resists above all others the action of chloroform; its con tractions have often persisted after the heart has ceased to beat. The ac tion of chloroform is too dangerous and variable for us to be willing to compromise the life of the mother when we have at our disposal other less dangerous means.
Dilatation of the cervix may be effected in a number of ways. Gradu ally by the hand, or by Barnes' dilators, and then with the greatest care. We reject absolutely the metallic dilators. If gradual dilatation of the cervix be not possible, we much prefer incision. This incision, it is un derstood, can only be practised when the resistance is at the external os. At the internal os, the hand and Barnes' dilators should alone be used. When these fail, our only resource is in the accouchement force, however dangerous it be. Venesection, pushed to syncope, often fails.
2. Placenta cervix, on the other hand, may at least be dilatable, and the hand is opposed by the placenta, either partially, or en tirely previa. We have seen, when studying this subject, that then the placenta must be partially separated, and the hand introduced above it.
3. Tumors of the such instances, as we have seen, we must await sufficient dilatation of the cervix, especially in the case of fibrous tumors; in case of cancer we must incise the cervix, and if this fail, re sort to perforation, or to embryotomy.
4. Obstacles in the Body of the Uterue.—llere it is not usually so easy to overcome the difficulties. Often, indeed, either because of premature escape of the waters, or prolonged labor, or premature administration of ergot, or repeated and inexpert attempts at version, the entire body of the uterus is contracted, in a state of tetanus as it were, and the body of the foetus is held so tightly that it is impossible to pass the hand. We must not then attempt version. To do so would inevitably cause rup ture of the uterus. The foetus must be mutilated, for thus alone can we save the mother.
The Search for the Feet.
There are a number of conditions which may interfere, and of these we mention mobility of the foetus or of the uterus. This may be reme died, in part, by allowing a little of the liquor amuii to escape, and in part by fixing the uterus. There are two other more frequent causes, how ever, and these are the displacement of the feet at previous attempts at version, and the difficulty of grasping them. When the feet have been displaced, we must hunt for them by following along the back of the foetus to the nates, thence to the thighs, and to the knees, and these, as we have seen, are firm enough to permit of version.
A further difficulty consists in anterior position of the feet. They are then situated above the pubes, in the hypogastric region, and, with the woman on her back, the hand cannot reach them, but is stopped by the inferior border of the symphysis. Then it is that the lateral position, and particularly the knee-elbow, are absolutely indispensable.. The woman in such position, the feet become posterior, the introduction of the hand is easy, and version as well, whereas before this seemed impossible.
A more serious difficulty is, at times, inability to firmly grasp the feet. In many cases, the foot may be brought down to the upper part of the vagina, but no further, the fingers slipping, and, in order to obtain firm hold, we must pass a sling over the foot, above the ankle, in order to make sufficient traction. The application of the sling is not as easy as one might think. When the foot is outside the vulva nothing simpler; but when the foot is in the vagina, particularly high up, the operation is a very delicate one. A running loop is made, and this is passed around the left fist. Introducing this hand into the vagina, the foot is seized by the fingers as high up as possible, and pulled down. With the fin gem of the right hand, the loop is pushed over the left hand, and its fingers on to the foot. Once on the foot it is pushed beyond the heel. When the two ends of the loop are pulled upon, the foetal limb is firmly. Unfortunately, this method, very simple in theory, is very diffi cult in practice. In the first place, the loop, wet by the discharges, does not slide easily over the fist and the fingers; then again, the foot may escape from the fingers, or it is difficult to push the loop over the heel, for we have introduced if not two hands, at least one and a portion of the other into the vagina.