. The science and art of midwifery. erful pains, a roomy pelvis, and a small foetus. Of these condi-tions, the first only is essential; Grenser \ has demonstrated that acontracted pelvis is not an insurmountable obstacle to spontaneousevolution, provided the conjugate diameter be alone shortened. Noris small size of the foetus essential to the occurrence of the process inquestion. Spiegelberg # states that it is often observed in cases wherethe foetuses are mature and well-developed. Softness and compressi-bility of the child naturally favor the production of spontaneous evo-lution, as is demo
. The science and art of midwifery. erful pains, a roomy pelvis, and a small foetus. Of these condi-tions, the first only is essential; Grenser \ has demonstrated that acontracted pelvis is not an insurmountable obstacle to spontaneousevolution, provided the conjugate diameter be alone shortened. Noris small size of the foetus essential to the occurrence of the process inquestion. Spiegelberg # states that it is often observed in cases wherethe foetuses are mature and well-developed. Softness and compressi-bility of the child naturally favor the production of spontaneous evo-lution, as is demonstrated by its frequent occurrence when the productof conception has undergone maceration. Mechanism.—The mechanism of the former and more ordinaryvariety of spontaneous evolution is as follows : The presenting shoulderis forced into the depths of the true pelvis by the violence of the uter-ine contractions, instead of being diverted laterally, as is the case inspontaneous version, and becomes firmly fixed beneath the symphysis,. Fig. 235.—Neglected shoulder presentation. Section through frozen corpse. (Chiara.) * Taylor, Am. Jour, of Obstct., July, 1881. f Kleinwachter, Arch. f. Gynaek, Bd. ii, p. 111. \ Grenser, Monatsschr. f. Geburtsk., Ed. xxvii, 1866, p. 445. * Spiegelberg, Lehrbuch, p. 541. 560 THE PATHOLOGY OF LABOR. while the corresponding arm protrudes through the vulva. The bodyof the foetus is then so forcibly flexed that the breech and the head liein close proximity to each other. The former is in contact with thesacro-iliac synchondrosis, while the latter is immovably held betweenthe breech and the upper border of the symphysis. The neck andshoulder, which rest against the lower border of the symphysis, nowbecome the pivot upon which the foetus rotates. The trunk of thefoetus is driven beyond the shoulder, and the thorax, breech, and legs are born in the order other shoulder then follows,and the head is finally expelled. The mechanism of the secondva
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