PRESENTATIONS OF THE PELVIS. 329 



before the shoulders, when the woman was left to her own powers, 

 and nothing more was done than to support, without pulling at the 

 trunk until the expulsion of the head. 



791. Though so many authors have professed the opposite opi- 

 nion,^ which still prevails very generally, it depends solely on the 

 circumstance, that the persons who assist lying-in women, rarely 

 consent to remain inactive in a footling delivery; they lay hold on the 

 members that spontaneously present, and the very natural, and in 

 itself considered, laudable desire to put an end to the sufferings of the 

 mother, causes them to pull with more or less force upon the child, 

 and a phenomenon which is produced merely by art, is then very 

 readily mistook for a natural one. Where the womb, assisted by 

 the muscular contractions of the abdomen, is alone charged with 

 the duty of expelling the ovum, all the parts of the child are pushed 

 down simultaneously, and so folded and pressed together, that it is 

 very difficult for one of them to rise upwards while the others are 

 descending; as the uterus does not contract from its fundus towards 

 its cervix only, but also circularly, from above downwards, by a sort 

 of vermicular or peristaltic movement, the elbows or arms run no 

 risk of lodging against the upper edge of the pelvis. 



792. If, on the contrary, the foetus is extracted and not simply 

 expelled, as the tractions come to act ultimately upon the breast and 

 head, it follows, that these parts only are dragged downwards, while 

 the arms, retained in their position by the womb, remain where they 

 were, and can only descend in a direction extending from the shoul- 

 ders towards their free extremities. 



Nevertheless, I do not believe it right to deny, as Madame Lacha- 

 pelle does, the possibility of the phenomenon admitted by the older 

 accoucheurs to take place in every spontaneous delivery. We may 

 conceive that the arms, when once they have reached the excavation 

 along with the shoulders, being no longer directly urged by the 

 uterine efforts, may rise upwards by sliding along the sides and 

 fore part of the breast, or rather, that the head, supporting from this 

 moment, the whole action of the expulsive powers, may cause the 

 face and breast to descend into the inferior strait, without necessa- 

 rily carrying the elbows along with them. It must be so, further, 

 since M. Gardien affirms that in many labors terminated by the feet 

 without any assistance, he has seen the arras rise along the sides of 

 the neck and head, and since M. Deneux told me he had observed 

 the same thing. 



Presentation of the knees. 



4 in 20,517, Madame Boivin; 9 in 22,243, Madame Lachapelle. 



29* 



