654 Proceedings of the Royal Society 
pelvic brim to the axis of the uterus, or to the direction of the 
resultant of the forces of labour. In an elaborate paper Schultze* 
has attempted to show that similar results may be produced by 
flexion and extension of the spine. This author assumes that 
the lower lumbar vertebrae govern the uterine axis, and that the 
latter is normally inclined posteriorly to the plane of the pelvic 
brim. He therefore recommends that when difficulty arises at 
the brim, the spine should be flexed so as to bring the axes of the 
uterus and of the brim, if possible, into coincidence; and if we 
admit his assumptions, there can be no doubt as to the justice of 
his conclusion. For practical application, however, the proper 
treatment may be stated in such a way as to offend no theory as 
to axes of brim or of uterus, or so as to stand good whatever view 
is held on these points. When, before labour, or while the foetal 
head is still mobile above the brim, it is placed with its sagittal 
suture not traversing the centre of the brim, but lying anterior to 
it (as Smellie figures), then it will during early labour be pressed, 
with a loss of force, against the pubes, not directly into the brim. 
It will then be worth while to try whether flexion of the spine, by 
putting the woman into the attitude assumed in stooping forward, 
will correct the direction of the head [which I consider an unna- 
tural direction]. If it corrects it, the sagittal suture will be 
observed to leave the neighbourhood of the pubes and approach or 
reach the middle of the plane of the brim. Again, if the uterine 
axis, or the resultant of the forces of labour, has this posterior 
obliquity to the axis of the brim, then, in the first half of its course 
through the ligamentous pelvis, the foetal head may be expected 
to show the Nasgele obliquity — that is, its half lying in the ante- 
rior half of the pelvis will be lower than that in the posterior as 
regards the plane of the pelvic brim, being pushed down with 
greater force ; and it will be well worth while to try whether or not 
flexion of the spine will correct this direction of the head [which 
I consider an unnatural direction]. 
II. The second curvature of the pelvis, which I proceed to de- 
scribe, is, like the former, situated at the brim of the pelvis; but 
* Jenaische Zeitschrift fiir Medicin und Natur-Wissenschaft, iii. Band. 
S. 272. 
