VERSION BY EXTERNAL MANIPULATIONS.
Struck by the infinitely better prognosis both for the mother and the child offered by vertex presentations, naturally the earlier obstetricians aimed at substituting the vertex for every other presentation. This practice, indeed, is found to have been prevalent amongst the very earliest races, and the Mexicans and the Japanese resorted to more or less crude methods to cause the fcetus to present in normal fashion. Thus, amongst the Mexicans, the woman, from the beginning of the seventh month, was subjected to massage in order to force on the fcetus presentation by the vertex, and if this did not suffice, she was seized by the feet, held head downward, and shaken until the desired end was attained. In Japan, a special family constitute the accoucheurs, and their method of action is the following: " If the vertex does not present, the woman loosens her clothing, and, lying on her back, the physician massages downward from the thorax towards the epigastric regions. If the fcetus is on the right side, the physician places his knees against the woman's left side, and with his hands pulls the fcetus over. If fiecal masses obstruct on the right side, these are pushed down by the physician's left hand, whilst his right shoves the fcetus where it belongs. No force is ever used in these manoeuvres. During labor, if the arm or the elbow presents, this is pushed back into the uterus, and held there by the right hand externally, whilst the left hand seizes the fcetus through the abdominal walls, and it is turned from right to left till the vertex presents." (Kangawa.) Hippocrates advised succussion; the Arabian physicians and Rhazes advised transferring all presentations into that of the vertex, the latter even going so far as to counsel amputation of the presenting part in order to gain space for the vertex.
Roesslein (1513) and Rueff (1554) counselled cephalic version even in case of breech presentation; but at this date, Ambroise Pare (1550) and his pupil Guillemeau, advise podalic version by internal manipulation, and under the influence of Mauriceau (1668) and of Lamotte (1721) cephalic version nearly disappeared from French practice. In 1690
Siegmundin again advocated cephalic version by internal manipulations. Again neglected for a while, it reappeared in 1750, through the influence of Smellie, who soon gave it up, and then it was advocated by Aitken in 1784, who advised an attempt at cephalic version always before recourse to podalic. It was not, however, until Wigand's time (1817) that cephalic version was carefully described, and its indications laid down.
In Germany, external version was practised from the time of the ap pearance of Wigand's monograph, by d'Outrepont (1812), Siebold (1821), Busch (1826), Michaelis (1833 to 1838), Kilian (1834), Lumpe (1843), Martin (1849), Naegele and Grenser (1854), Scanzoni (1855), Crede (1853), C. Braun (1859), Spaeth (1857), Hegar (1869), and above all, by Schroeder (1874 to 1876), Esterle (1878), and Spiegelberg (1878-1880).
In England, external version was not recognized by Ashwell (1828), Blundell (1830), Ramsbotham (1844); and although Rigby (1841) and Churchill (1842) were familiar with Wigand's monograph, they did not appreciate all the advantages to be derived from this operation. It is only since the appearance of the works of Barnes, Duncan, and Playfair, that it has become classic.
In America the same holds true, and it is only of late years that ex ternal version has acquired place amongst the obstetrical operations.
In France, in 1845, Hubert de Louvain demonstrated the advantages of external version, but it is only latterly that Tarnier and his pupils, Chantreuil, Pinard, and Budin, have made the method a familiar one to all.
" External version, " says Pinard, " ought to be practised in pregnancy in every case where, after the eighth month, the vertex lies in one of the iliac fosse, or in the upper uterine segment." For our part, we do not agree entirely with our colleague in regard to external version, for we make an exception in case of breech presentations.