Abnormal Presentations of the Fetus 755 



consequently, thrown widely apart, coming in contact with the 

 brim of the pelvis, thus proving an obstacle to the progress of 

 the young creature." 



We interpret it as purely a flexion of the humero-radial articu- 

 lation, the consequent or coincident pushing of the shoulders 

 backward upon the sides of the chest, and the impaction of the 

 olecranon against the pubic brim. In this position, the trans- 

 verse diameter of the chest of the fetus is greatly increased by 

 the retention upon its sides of the entire volume of the fetal 

 shoulders, including the scapula and scapular muscles, the hu- 

 merus and the bulky anconean group of muscles. The perpen- 

 dicular diameter of the fetus is also greatly increased, because it 

 must represent the distance from the top of the spinous processes 

 of the dorsal vertebrae down to and including the olecranon, the 

 latter projecting downward to constitute an unyielding obstacle 

 which becomes lodged against the pubic brim. The condition 

 naturally belongs to the dorso-sacral position. 



The diagnosis depends fundamentally upon two facts. While 

 the two forefeet present normally and the nose is resting on top 

 of them in a normal position, so far as it is independently con- 

 cerned, there is an abnormal relation between the degree of ad- 

 vancement of the feet and the nose. While normally the nose of 

 the fetus rests about the middle of the metacarpus, in these cases 

 it is advanced to the fetlock or even further. Under these con- 

 ditions, if the obstetrist will introduce his hand along the ante- 

 rior limbs until he reaches the brim of the pubis, he will find the 

 olecranon tightly impacted against the pubic brim. 



The indications are simple and obvious, and consist merely in 

 releasing the olecranon from its incarceration in front of the pubis 

 and the proper extension of the limb in the birth canal. Little, 

 if any repulsion is required. When both limbs are retained, each 

 should be handled separately. The operator should insert his 

 hand along the inferior surface of the limb, with the palm turned 

 upward, until it has been forced between the pubis and the ole- 

 cranon, so that the latter rests in the hollow of the hand. An 

 assistant is then to exert traction sharply upward and backward, 

 while the operator causes the olecranon to glide over the pubic 

 brim and the anterior limb to become extended in the pelvic 

 canal. The same operation is carried out upon the other limb, 

 after which the fetus is delivered under ordinary precautions in 

 the dorso-sacral position. 



