80 OBSTETRICS. 



more backwards, so that when the trunk is born, the arch of the 

 cranium is directed to the hollow of the sacrum, and the inferior 

 surface of the lower jaw to the symphysis pubis. In the birth of the 

 head, whilst the under jaw presses with its inferior surface against 

 the OS pubis, the point of the occiput, with the vertex, followed by 

 the forehead sweeps first over the perineum ; thus bringing the 

 occipito-mental diameter into apposition with the antero-posterior of 

 the outlet. 



The diagnosis of breech presentations has already been given ; it 

 is not usually difficult. It may be confounded with the face, parti- 

 cularly where the labour has continued for some time, and the pre- 

 senting part is tumid. It will be distinguished from the latter by the 

 absence of the bridge of the nose, by the movable, single point of 

 the coccyx, by the contractility of the sphincter ani, by the tubera 

 ischii, by the cleft between the nates, by its roundness and softness, 

 and by the organs of generation. Of these, however, the point of 

 the coccyx and the sacrum are the best, as the others may be so 

 altered by swelling as not to be recognisable. The presence of the 

 meconium is not a certain sign, since it is occasionally met with in 

 cephalic presentation, where the child is subjected to strong pressure, 

 though in the latter case. Dr. Collins says it is more fluid, from being 

 mixed with the discharges from the uterus and vagina. 



The shape of the bag of waters^ is another diagnostic sign, being 

 less hemispherical and more cylindrical than in vertex presentations, 

 and more resembling an intestine in shape. 



Auscultation^ though not a certain test, is a corroborative proof; 

 the sound of the foetal heart will be heard higher in the abdominal 

 region, if the head be at the fundus uteri, than if it be seated in its 

 more natural position. The same is true of the movements of the 

 fcEtus, they being generally felt lower in the abdomen in breech 

 cases, than in those in which the vertex presents. 



Presentations of the breech, although perfectly natural labours, 

 are generally more tedious for the mother, and more dangerous for 

 the child than those of the head, for reasons already stated, viz. : 

 that when, in pelvic labours, the head enters the pelvis, if every- 

 thing be not favourable for its passing rapidly through it, the cord 

 is so long compressed that the child is almost certainly lost. 



Treatment. — Much more care and attention are required in the 

 treatment of these labours, than in those before described ; not only 

 to protect the soft parts of the mother, but also to preserve the child's 

 life, which is always placed in more or less danger. It is, therefore, 

 of great importance that a correct diagnosis should be made early. 

 Being satisfied that it is the breech which presents, the case requires 

 no interference until the breech shall have been expelled through the 

 external parts, further than to guard the soft parts of the mother, 

 and carefully to support the perineum. Above all things, the atten- 



