A Case of Shoulder-Presentation; Spontaneous Expulsion

Officiating House-Surgeon, Midwifery Wards, Medical College Hospital. When the shoulder presents, the child, of course, lies across the mother's pelvis, with the head in one iliac fossa, and the breech in the other. Delivery is impossible while the child remains thus. It becomes absolutely necessary, therefore, that the position of the child should become changed before it can be expelled. In the majority of cases, we are called upon to bring about this change; but in some cases Nature herself effects this, without any assistance from oar hands. During uterine contractions under favourable circumstances, the abnormal presenting part may go up, and the breech may be substituted, or it may remain so, while the body of the child is doubled up, and so expelled ; the breech being the first to born. As no such cases appear to be on record in this country, where this occurrence is perhaps more frequent than in Europe, in consequence of the slender and diminutive size of many of the Bengallee children, the case given below, which occurred in the Midwifery Wards of the Medical College Hospital, will be found interesting, as illustrating one method of natural termination of shoulder presentation :? Kooranee, a Mohamed.m woman, a^ed 20 years, was admitted into the Midwifery Wards of the Medical College Hospital on the 13th of March, 1869, at 8 a. m. She was advanced nearly to the full term of her first pregnancy. Labor pains commenced at 3 p. m. in the afternoon of the previous day (12tli March), membranes ruptured at 9 p. m. The pains continued steady, and at 1 a. in. next morning an arm protruded from the valva. Two native dyees, who were attending the case, endeavoured to deliver the child by traction at the arm, but could not succeed. The humerus was fractured at about its middle.