VERSION BY INTERNAL MANIPULATIONS.
This may be either cephalic or podalic. The first, practised almost exclusively by the ancients, has to-day been rejected, and the latter sub stituted to such a degree that, when the word version is used unqualified, it refers to podalic version by internal manipulations.
Internal Cephalic Version.
Up to the times of Ambroiso Pare and of his pupil Guillemean, this form was alone practised, although hardly with success, since in 1122 we find Albucasis saying, with resignation worthy of a Mahommedan, " Ver sion will succeed in case it please God." It was Siegmundin, Busch, d'Outrepont, and others, who first laid down exact rules for its perform ance. The method recommended was (Busch) to rupture the membranes with the right hand where the head was to the left, and vice versa, and, seizing the head by the neck, to bring it to the superior strait. Two fingers steadied the head, and with the other hand the uterus was mas saged to excite it to contract, and the fingers in the vagina were only withdrawn when the head was firmly engaged.
D'Outrepont, and others, advised action on the trunk by means of the hand in the vagina, while the external hand endeavored to depress the head towards the superior strait. Hero is seen the germ of Braxton IIicks' method. IIohl and Wright counselled placing the right hand, where the head was to the left, on the head, the left hand in the vagina, and its fingers in the axilla. These fingers lift the body and press it towards the maternal right side, while the right hand pushes the head towards the superior strait, an assistant, at the same time, pushing the fundus uteri to the left. (Fig. 6.) Rigby (1844), Simpson (1845), Robert Lee, Braxton-Hicks, thus used both hands; but, as has been pointed out by Barnes, it is the external hand which does most of the work, and to-day, therefore, cephalic ver sion is performed by pure external manipulations at the end of preg nancy, and at the beginning of labor.
During labor, indeed, internal cephalic version has been justly aban doned. Usually it is impossible, or, if possible, podalic version is more
so, and should be chosen, since then we may end labor at will; the risk to the child will not be greater, and podalic version is always quicker than cephalic.
Podalic Version.
It is in the works of Celsus that we find the first rules applicable to this form of version—applicable, however, only when the foetus is dead. Although Villanova, (1312), Benivieni, (1502), and Rosslein, (1513), knew this method, it is not till the times of Ambroise Part., 1560, that we find a description of this method of version and extraction. In 1561, Franco reproduced the text of ParPs work, and in 1609, Guillemeau modified somewhat the operative method. From the time of Mauriceau (1668), Lamotte (1721), Puzos (1753), podalic version replaced cephalic version. In 1685, Portal performed version by one foot, and Puzos and Deleurye made clear the advantages of using a single foot. The latter, also, care fully differentiated version from extraction, and Denman (1788), and Boer (1791), insisted on this point. Finally, Osiander, Levret, Smellie, Stein, carefully studied the indications and operative technique, and Osiander showed that version may succeed, at times even when the head has already engaged, and this too, as he says, non vi sed arte.
Podalic version is then an operation which consists in bringing to the superior strait the pelvic extremity of the foetus, no matter what the previous presentation.
It is indicated whenever normal labor is impossible on account of ab normal presentation of the foetus, and where cephalic version is im pra3ticable. The indications, then, are: 1. Transverse presentations during labor.
2. Every complication which endangers the life of the mother and of the child, and which calls, consequently, for rapid termination of the labor. Such, for instance, are hemorrhage, eclampsia, rupture of the uterus, certain face presentations, prolapse of the cord, certain monstrosities, _ pelvic tumors causing dystocia, etc.