422 DYSTOCIA. 



too deep a notch betwixt the shoulders and head, not to yield a pas- 

 sage to one of these parts; the side of the chest being less round, 

 and particularly not so smooth as the point of the shoulder, could 

 not hinder the latter from engaging in the os uteri; lastly, the flanks 

 would soon bring about a hip or breeeh position. 



957. Causes. Inclinations of the womb or of the straits of the 

 pelvis, sudden and irregular movements of the fostus, certain atti- 

 tudes of the woman long persisted in, are the principal causes to 

 which, in the present state of our knowledge, we may attribute the 

 bad positions of the foetus. 



958. Hippocrates was the first one to say that the foetus in utero 

 was in some degree situated similarly to an olive or a cork in a long 

 necked botde; that in order to escape from the genital organs, it must 

 present one of the ends of its long diameter; and that any other pre- 

 sentation was dangerous, rendered delivery impossible, and imperi- 

 ously demanded the assistance of art. 



This doctrine, which has been republished by all the authors since 

 the father of medicine, and against which no one has made any ob- 

 jections even in our own days, is, notwithstanding, not free from all 

 doubt. 



The comparison instituted by Hippocrates is not correct, except 

 in so far as the foetus remains in a normal position; in the other 

 cases, the child represents neither an oval nor a cone placed trans- 

 versely or obliquely: whilst the head turns on one of its sides, be- 

 hind, or in front, whilst the shoulder, the breast, or the back tend 

 to engage, the remainder of the trunk continues, notwithstanding, 

 in due relation with the vertical axis of the uterus, whenever the 

 contractions are somewhat energetic; and thenceforth the foetus is 

 in no respect like a cork that presents crosswise in the throat of a 

 vial. 



959. No doubt the hand of the accoucheur is often necessary, and 

 even indispei'ksable, when it is neither the head nor pelvis that pre- 

 sent; but it is also certain that the organism alone would, in many 

 cases, triumph over this obstacle were the labor left to itself. Peo- 

 ple have in practice reasoned as if the positions of the trunk, when 

 once determined, could never change. But daily observation proves 

 that the difl^'erent points of the fostus, though very remote from each 

 other, may, during a labor, present alternately at the orifice; that po- 

 sitions of the back or shoulder may be converted into positions of the 

 head or breast; that positions in appearance the most unfavorable 

 might sometimes be replaced by normal positions, were all accou- 

 cheurs sufficiently ivell informed to know how to ivait. 



9G0. Those passive movements undergone by the fostus in utero, 



