PRESENTATION OF THE PELVIS. 317 



These disadvantages cannot be denied, or unknown by any well 

 informed practitioner: it would be wrong, however, to conclude from 

 the above, that the assistance of art will be always required merely 

 because the pelvic extremity of the child presents; on the contrary, 

 I think that we should always, in such cases, abandon the labor to 

 the resources of the organism, except an opposite conduct should 

 be imperiously demanded by some peculiar circumstances. If the 

 rupture of the membranes does not occur until after the complete di- 



ble, and which appears to me to be readily conceived of in the following man- 

 ner. When the vertex descends first, in any woman, the child begins to 

 breathe as soon as the mouth and nostrils are exposed to the air, and it general- 

 ly cries before the shoulders are born; but, when it is enabled to reach the air, 

 it becomes instantly a matter of indifference, as to its security, whether the after- 

 birth be detached or not. Now, it most generally happens that the afler-birth 

 is wholly or partially detached, by the constriction of the womb long before the 

 hips and legs of the child are expelled; for the womb, is by this time, grown so 

 small, that the placental superficies of it can no longer hold the placenta — This, 

 as I have said above, is a matter of indifference to the child as soon as it can 

 communicate with the atmosphere. 



In a pelvic presentation on the contrary — it is a matter of the greatest conse- 

 quence to the child's safety, that the detachment of the placenta should not take 

 place so early, for, although the feet or the breech is born, the child's head hav- 

 ing no access to the air, it perishes with a real, I might say a double asphyxia, 

 to wit, its placenta is separated from the mother, and its lungs receive no air. I am 

 far from asserting that the placenta is dctaclied in all cases at so early a stage of 

 labor as that which I have indicated, though I am free to utter my opinion that 

 in the vast majority of cases, the placenta is separated by the time the head 

 is fairly born, in ordinary vertex cases. 



Such are my views of the principal causes of death of the foetus, in breech and 

 footling cases. — It follows from the premises, that in all such labors the child 

 should be withdrawn so soon as it can be conveniently done. 



I am sure that in my own practice the results are far more favorable than 

 those cited by M. Velpeau. I do not think that one tenth of the cases of pelvic 

 presentation under my care, prove fatal to the foetus — and I attribute this success 

 to the custom which I have adopted, of procuring my forceps in good time, so 

 as to have them at hand, wherever the first examination discloses the existence of 

 a pelvic presentation. 



I make very slight tractions on the shoulders in order to facilitate the expul- 

 sion of the head — and as soon as I find that the head is not likely to come down 

 I grasp it in the forceps and deliver it at once. I have safely delivered a num- 

 ber of children who I think would have been born dead, but for such a pre- 

 caution. 



In a breech case, the life of the child will be lost by a few minutes delay in 

 the delivery of the head, and the tractions which are effected by pulling by the 

 shoulders, can never be of very considerable force, without injuring its cervical 

 spinal marrow. Hence, whenever, any considerable extrinsic force is required, 

 it should be applied by means of the forceps. — M. 



28* 



