330 UNNATURAL EUTOCIA. 



793. The position of the knees being in all respects like that of 

 the feet, it is useless to give the mechanism of it apart; in fact, 

 whether the legs have descended, or remain bfent upon the thighs, 

 the lower extremities traverse the os uteri and straits of the pelvis 

 with equal facility. Perhaps they descend with rather less facility 

 in the second than in the first case mentioned, provided the mem- 

 branes give way when the neck is still incompletely dilated; but the 

 knees scarcely reach the vulva before the legs become extended, and 

 thenceforth every thing proceeds as if it had been a footling case. 



The knees present first, because they have been reversed, either 

 mechanically or by muscular action, in the cul de sac formed by the 

 apex of the ovum, at the moment when the membranes are ruptured, 

 or because the rush of fluid forces them along with it, rather than 

 the feet, which may be farther from the orifice; or because the breech, 

 which, presented first, mounts upwards again along with the feet, 

 under the influence of the contractions of the womb, so that the 

 knees only can be depressed into the opening of the neck; or yet 

 again, because, after the discharge of the waters, the legs are situated 

 crosswise above the uterine orifice, or have beeen arrested against 

 two opposite points of the strait. Moreover, we may conceive that 

 they may both descend at once, or only one of them along with one 

 foot, without that circumstance changing the progress of the labor; 

 and it was entirely wrong to attribute more danger to delivery by the 

 knees, than to those that take place by the feet. 



Presentation of the breech. 



837 in 37,895, Madame Lachapelle; 375 in 20,517, Madame Boivin;]42 in 

 1800, Merriman; 36 in 1897, Bland; J 26 in 6555, Boer. 



794. Presentation of the breech has always been regarded as 

 more dangerous, difficult and unnatural than that by the feet or 

 knees. It was thought that the size of the buttocks would not admit 

 of the expulsion of the child without the neck of the womb as well 

 as the perineum being violently contused or extensively lacerated; 

 but even had experience not pronounced upon the value of these 

 exaggerated fears, a moment's reflection would have shown how 

 unfounded they were. It is merely necessary to recollect the di- 

 mensions of the foetal pelvis, to be instantly convinced that, even to- 

 gether with the thighs, the size of the breech could never form an 

 insurmountable obstacle to delivery, unless there were some faulty 

 conformation of the straits. When the child comes doubled, the 

 pelvic extremity is too supple, too flexible, and accommodates itself 

 too easily to the form of the openings it has to traverse, for it to 



