Walcher's position employed at the Dresden Maternity Hospital in 21 cases. Pelvic contraction was present in each instance,—mainly, of the flat rachitic variety, the conjugate diameters vary ing from six and a half to nine centi metres. Excellent results followed the employment of this position in IS of the cases; in 10 of these, notwithstanding the increase in the diameter, a sponta neous delivery was even yet impossible. The increase varied from one-half to one and a half centimetres in nearly each case. The accuracy of this observation was verified by measuring the diameters of the foetal head, which in many in stances considerably exceeded the diame ters of the pelvic inlet. As is usual under these circumstances, the uterine pains were feeble and irregular, but as soon as Walcher's position was adopted they became stronger and more regular. Walcher's position is of service only if the foetal head is still free and movable above the pelvic brim, or has only en tered the inlet with but a small portion of its diameter. Huppert (Archly f. Gyniik., B. 56, II. 1).
Walcher's position is indicated in:— 1. Cases of protracted labor in which the dimensions of the pelvis are normal or the antero-posterior diameter is some what shortened, the head being above the brim. The patient being placed in the position of extreme extension for an hour or more, the pelvic joints may be come so relaxed or the antero-posterior diameter lengthened by the necessary half-inch, that the head will engage and labor be terminated normally or with forceps. The high forceps operation, version, or syniphysiotomy are thus avoided.
2. Cases in which version, either ceph alic or podalic, has been performed, or footling or breech cases. The flat pelvis, the generally-contracted pelvis, trans verse positions, and occipita-posterior positions are in this category.
3. Cases in which some form of opera tive procedure has already been adopted without success. It has thus far been used after high forceps operations, ver sion, symphysiotomy, craniotomy, and low forceps, and it will probably be shown to have a still more extensive field. A. F. Currier (Med. Rec., Feb. 8,
The Trendelenburg posture is of great value as a position for the total pation of the pregnant uterus or in acute collapse after labor. It has been advocated for versions and in the treat ment of prolapsed cord. An ironing board, or a reversed chair will answer every purpose for this position, the pa tient being fastened by rolled sheets.
In obstetric operations a combination of Trendelenburg and Watcher positions recommended. It is suitable for high forceps, version, high manual internal rotation for occipito-posterior position, reposition of cord, etc. The combined position is effected as follows: In mater nities the patient is placed on the Tren delenburg incline, and slid upward till she balances on her sacrum, the legs hanging over. In private practice a plain wooden chair with a flat back, and no rungs between the rear legs, will serve the purpose. The chair is placed on its face across the foot of the bed, the back forming the incline for the Trendelen burg position. A blanket or double sheet is laid along the chair-back and may fall over the chair-bottom. The patient, when anaesthetized, is placed on the in clined plane in such a manner that the buttocks rest on the upturned back edge of the chair-seat, and that they project a little beyond the chair-seat toward the operator, so as to give him unimpeded access to the vagina between the rear chair-legs. The patient is held in this position by means of a sheet twisted into a rope, and passing behind her neck and in front of the shoulders, while the two ends are made fast to the rear legs of the chair. Each knee is then grasped, and the legs swung outward until the thighs hang outside of the up turned chair-legs. The weight of the lower limbs causes them to drop toward the floor, with the knee lower than the hip.
The combination of the Trendelenburg with the Walcher posture levels the birth-canal, and does away with the necessity of the operator sitting on the floor or working from beneath in a most uncomfortable position. Dickinson (Amer. ,Tonr. of Obstet., Dec., '98) .
Surgical Treatment. — SURGICAL