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The Mechanism of Labour.
THE
248
MECHANISM
OF
LABOUR.
increasing support from local authorities as these The Mechanism of Labour. and more appreciated its importance. It has, of THERE are some great questions in medicine which are course, been found necessary largely to strengthen the public health service for the performance of the new duties cast always before us ; their importance is so obvious and the of clinical emergencies affected by them is so upon it ; and in the 307 areas referred to there were, at the occurrence that debate is persistent. One such question is the I date of the report, a total of 1084 medical officers in the frequent The history of the mechanism mechanism of labour.1 whole school service of England and Wales. middle of the eighteenth The grave remaining question, that of the treatment of of labour begins about the as with the discussion to the manner in which century the many ailments disclosed by medical inspection, is still the of the foetus enters the pelvic brim. At this head surrounded by difficulties from which a way of escape has to of DEVENTER, that before the be discovered. We have more than once laid down the period the old theory
received have
more
labour
in
the
child, up early stages principle that schooling being compulsory it is the duty the to this time underwent a breech, by presenting of the public to secure that it shall not be actively injurious the rotation so that the head entered pelvis to those who are compelled to submit to it. There can be complete with the occiput looking directly forwards, a view no doubt, of course, that the "over-pressure " described by which was based upon the position which the head many observers, and not always in strictly moderate terms, was injurious to a proportion of the children subjected assumed on its exit from the pelvic cavity, was held still Sir to it ; and, especially in the presence of common ocular con- by some writers, including LEVRET and RODERER. FIELDING in OULD the the first obstetrician year 1742 was ditions, much of the reading, writing, and needlework done in schools was open to similar condemnation. The community to point out that the head entered the pelvis in the has no right to inflict injury under the guise of benefit. transverse diameter, and that while the chest of the There can be no doubt that such injury has been inflicted, child was apposed to the sacrum of the mother its face or that the enthusiastic educators" of the nineteenth was turned so as to have the chin directly on one or other of the shoulders. OULD did not describe the passage century, who believed in "schooling"" as a panacea for all national evils, were as unconscious as NEWTON’S dog Diamond of the head through the pelvis, but his advice, when the of the amount of mischief which their good intentions might birth of the head was delayed on the perineum, to exert be instrumental in accomplishing. At present the great pressure on the chin through the rectum showed that he a change in the position of the head at the difficulty is to combine the proper treatment of the maladies recognised moment of its birth. It was left for SMELLIE to describe disclosed by inspection with a due preservation of a sense of in further detail, and in many respects most accurately, parental responsibility and independence. The report gives SMELLIE was well acquainted much reason to hope that some of the most prevailing the mechanism of labour. with of unreduced the variety occipito-posterior presentamaladies, such as caries of the teeth and the morbid conditions produced by the presence of vermin, will be greatly tions and with the manner in which their reduction normally diminished by the influence of the instruction concern- occurred. In his writings, too, we meet for the first time ing the importance of cleanliness which is even now with a correct conception of the effect of the general intrabeing given to the children, and as to the practical uterine pressure on the expulsion of the foetus, while he also effects of which the statements of both medical men and described the method of carrying out manual rotation of the teachers are distinctly encouraging. The remaining maladies head when it presented transversely at the outlet of the are chiefly ocular and aural troubles, favus, ringworm, pelvis. About the year 1764 MATTHIAS SAXTORPH published a adenoids, and tuberculous affections, and for all these it on the mechanism of labour, in which he pointed work would seem necessary that some provision should be made by that the head entered the out pelvic brim most commonly public authorities. In London, as is well known, temporary in of the one oblique diameters and not, as SMELLIE arrangements have been made with certain hospitals, but it in the transverse. He and his master, BERGER, thought, will stand the test of experemains to be seen whether these had not observed this fact clinically but had only rience. They are likely to involve payments to the instituconfirmed the their observations dissection of the dead by tions which, sooner or later, may give rise to claims to interbodies of women. It is, indeed, probable that pregnant ference in the management of the institutions ; they will of Solayres’ obliquity usually given to this posiprobably require the addition to the ordinary staff of the name of tion the foetal head should rather be Berger’s obliquity, officers appointed for the special purpose and not likely can be little doubt that he was its since there original to attain permanent positions, and the distances between describer. SAXTORPH, like SMELLIE, attributed the the schools and the hospitals must usually be considerable and often prohibitory. The establishment of school clinics, forward rotation of the occiput to the influence of largely officered by the school medical officers themselves, to the bony pelvis and mainly to the action exerted It the expenses of which the parents should be made to con- upon the descending head by the ischial spines. that ROBERT is to note WALLACE JOHNSON, interesting tribute according to their means, remains as the alternative. To enforce contributions where they should be forthcoming a pupil of SMELLIE, also described the entrance of ought not to be difficult, since the ailing child might be the head into the pelvic brim withthe face a little refused admission to the school, and the parent proceeded towards the sacrum." SOLAYRÉS DE RENHAC in 1771 against for not taking the necessary means to bring it into a FœtalCritical Inquiry into the Causes of the Internal Rotation of the Head, by R. H. Paramore, M.D. Lond., Journal of Obstetrics and position to attend. Gynæcology of the British Empire, No. 4, 1909. onset
of
or
11
"
1A
its
THE
MECHANISM
OF
LABOUR.
249
presenta- presentations occurs when it might be expected that the point out the influence action of the pelvic floor would as readily cause a rotation exerted by the position of the occipito-atlantal articulation of the forehead forwards, the action of the contractions of in producing flexion of the head of the foetus, and the the uterus in causing rotation of the trunk has been called manner in which the propulsive force exerted by the uterine into play to assist, and indeed, according to some writers, contractions was communicated through the spine of the to initiate the rotation of the head. Thus the uterine foetus. He also was the first to describe the external rota- contractions are held to cause flattening of the uterine cavity tion of the head in conformity with the internal rotation of from before back, and so to cause a rotation forwards the shoulders. JANus BANG, a pupil of BERGER, described of the fœtus placed obliquely in that cavity. The
was
the first writer
tions of the
head,
accurately
as
he
was
to define the various
the first to
in 1774 the entrance of the shoulders into the
pelvis
in the
the back of the fœtus forwards is held further to be favoured by the projection of the spine of the mother, tending to prevent its rotation backwards. The objections to this view are furnished mainly by a study of frozen sections, which undoubtedly show, at any rate in the majority of instances, that the rotation of the foetal head
rotation of
opposite diameter to that of the head, and the external rotation of the latter with the internal rotation of the shoulders. In 1819 appeared the important work of Fr. C. NAEGELE, in which the mechanism of labour
fully and the relative frequency of the presentations pointed out. NAEGELE, like his precedes and does not follow the rotation of the trunk. In an attempt to overcome the objections which may be predecessors, attributed the forward rotation of the occiput to the influence of the bony pelvis, a view which held its urged both to the view that the pelvic floor plays the main own for many years, and which undoubtedly holds true even part in causing rotation, and to the further view that the at the present time as an explanation of the mechanism of action of the pelvic floor in producing this movement is labour in some conditions. NAEGELE’S viewsobtained assisted, if indeed the movement is not initiated, by the recognition not only among his own countrymen but also contractions of the uterus, SELLHEIM has advanced another influenced obstetric thought and writers in many countries. theory based upon the conception of the adjustment of the The presence or absence in normal labour of the obliquity fœtus as a whole to the parturient canal. In this view the called by his name is, indeed, still a matter of discussion and internal rotation of the head is attributed to the unequal one which is likely so to remain. flexibility of the foetal axis in various directions, so that in its In any description of the mechanism of labour the question passage through the curved pelvic canal the foetal body bends about which a difference of opinion is most likely to arise itself in conformity to the curves of the birth canal. By is the causation of the internal rotation of the head in means of a number of very ingenious models SELLHEIM has its passage through the pelvis. The study of frozen sections attempted to prove his contention that the fœtal head can of pregnant women has rendered the primary movement be bent backwards to a greater extent than in any other of so-called flexion clear, and there is little doubt as direction and that this is due to the tone of the large group to the causation of the movement of extension by which of extensor muscles on the back and neck. He also regards the head emerges from the pelvic cavity or of the move- the position of the foetal head before the onset of labour as ment of external rotation which it undergoes after its one not of extreme flexion but as one midway between Of late years, however, the conditions found in flexion and extension. In the early stages of the passage of escape. the head through the pelvic canal as a result of the flexion some frozen sections have tended to throw doubt upon the usual explanation given of this external rotation of the head. of the head which occurs the tension of these extensor It is, however, principally with regard to the movement of muscles is increased. As the foetal cylinder therefore passes internal rotation and its causes that writers have differed, down through the bent birth canal the occiput rotates and, indeed, even at the present day the matter is far from forwards in conformity with the bend of the canal in this being settled. We have seen that the earlier obstetricians direction, and because the extensor muscles of the neck are to undo the position of flexion of the head which is held that it was determined by the shape of the bony pelvis, I that has some no this there can be and, indeed, question present during the descent of the head into the pelvic brim. influence. The shape of the bony pelvis will not, however, In an inquiry into the causes of the internal rotation of the explain the rotation forwards of the occiput in an occipito- fœtal head PARAMORE criticises SELLHEIM’S views and posterior presentation, and for this reason, among others, brings forward the objection that the conditions of VARNIER in 1888 pointed out the inadequacy of this the experiments are not analogous to those obtaining hypothesis to explain entirely the mechanism of labour in the living woman. He argues that this hypothesis is In seeking an explanation for these cases VARNIER, and disproved by the fact that in cases where it is certain that more especially VEIT, laid great stress upon the part played the bony pelvis exercises no influence upon the position by the soft structures of the pelvic floor. For them and for assumed by the foetal head-namely, where the head is their followers the internal rotation of the head is deter- unduly small or the pelvis unduly large-this rotation of the mined by the action of the inclined plane of the pelvic floor occiput often does not occur, that is, in the very cases in and the shape of the opening in that floor. And, indeed, the I, which, according to SELLHEIM’S view, it should occur most classical experiments of DUBOIS and of others lend great I frequently. OLSHAUSEN, too, has raised the objection support to this view-a view which is accepted by a great that the rotation of the trunk precedes that of the head, It is many obstetricians at the present day as sufficient and but in this he is not supported by most writers. correct. To meet the difficulty of explaining the fact that impossible, he writes, to believe that the foetal trunk, closely rotation of the occiput forwards in occipito-posterior embraced as it is by the soft parts, can be caused to rotate was
described
various
tending
*
THE POSITION &
250
by
the movements of the head.’.
then it must rotate
METHOD OF SCIENCE TEACHING IN SECONDARY SCHOOLS.
If it
independently,
does not do
schools, it
is obvious that the nature of the
so
and if it does this then
it may well influence the rotation of the head and even possibly initiate it. On the other hand, AHLFELD brings forward the objection to OLSHAUSEN’S view that rotation of the head occurs in the first of twins when the uterine cavity is not flattened, and occurs also in the mechanism of labour with the after-coming head. It seems to us reasonable to suppose that the rotation of the head and the trunk may both be due to the same causes
science
training given
elementary schoolboys will be of great profession, falling as it must under to
interest to the medical the scrutiny of the General Medical Council. Few medical men will deny the importance attaching to the amount and kind of scientific teaching available at the secondary schools at the present time, for surely a man who is daily occupied
and may take place independently of one another. As Dr. FARAMORE points out, it is difficult to believe, in view of the large degree to which rotation of the head on the trunk can occur normally, amounting as it does to about 900, that any
in the observation and study of the highest of all natural forms and forces must appreciate more than most the number of ‘6well-educated"" men and women who are allowed to grow up without acquiring the slightest knowledge of the
physical world, who have no clear conception concerning the structure of the universe, or of the nature of the simplest physiological processes-to whom, for example, torsion of the body can influence or cause a rotation of the I I salt" suggests only a condiment of the table, while the head. He further maintains there is no satisfactory proof word "gas"" is limited to the household illuminant or is that in occipito-posterior presentations the forehead is on a a reminder of an unpleasant interview with the dentist. lower level than the occiput or that it meets the pelvic floor Whatever be the intellectual weapons with which the first. When rotation forwards of the occiput fails to occur coming generations are to be equipped for the business of he regards it as due, not to rotation of the forehead forwards, life, few will be found to deny that the purely classical but to a failure of the normal mechanism which should education based upon the traditions of Tudor days, and cause rotation of the occiput forwards. He appears to us developed by the headmasters of the seventeenth and to attribute the rotation of the head in occipito-posterior eighteenth centuries, is destined to be merged into a system presentations to rotation of the forehead backwards of instruction which advancing knowledge has made more rather than to rotation of the occiput forwards, and lays truly liberal. stress, as did FRITSCH, on the action of the anterior lateral Amongst the first principles of a liberal education we wall of the pelvis in causing rotation backwards of the reckon an intelligent, even if elementary, knowledge of forehead which is lying in apposition to it and pressed on natural science, for not only is a conception of " what to it by the uterine contractions. It must be remembered things are made of "-be those things animate or inanimatethat the anterior rotation of the occiput may occur of enormous practical use in nearly every human occupaquite early even before the head reaches the pelvic tion, but the lifting of the veil which hides the mysteries floor, and therefore any theory which takes into account of force and matter so completely from the ignorant that the action of the pelvic floor alone is not sufficient they do not even perceive them to be mysteries opens to explain all cases. It seems necessary to invoke more to the child’s expanding mind a region of interest, of than one factor to explain the internal rotation of the foetal wonder, and in some cases of reverence, which, under wise head, and the most probable explanation would appear to be guidance, cannot fail to broaden his vision and to equip that it is in reality due not only to the action of the pelvic him with such knowledge as is the foundation of true floor, but that the shape and varying degree of flexibility of wisdom. Indeed, Professor H. E. ARMSTRONG, the Presithe foetal head and the action of the uterine contractions in
producing
rotation of the
body
of the foetus must all
play a part in different circumstances and may all, indeed, participate in the production of the rotation in a normal case of labour. No doubt when we are in a position to reconstruct all the I phases of the movements of the foetus in its passage through the birth canal from a study of frozen sections we shall be able to give an accurate description of the mechanism of labour, and be better able to demonstrate the accuracy or inaccuracy of the various hypotheses which have been brought forward to explain its causation.
dent of the Association of Public School Science Masters, at the annual meeting held last week at Westminster School, advanced so large an estimate of the future part of the science master in
our public schools that his audience might tempted to believe him guilty of a ponderous compliment, had it not been for his subsequent denunciation of their present methods of teaching and of their un-
have been
take up the honourable burden which is to fall upon their shoulders until they have undergone a thorough revision upon some such lines as ProThe first aim fessor ARMSTRONG proceeded to indicate. to
preparedness
education, he said, should be to teach youth to see something ; at present we are content with teaching it to say something. Science is a recognition of truth, and the of
The Position and Method of Science Teaching in Secondary Schools. expounders THERE exists
a
considerable
body
of
opinion
that the
pounders
of
natural truth must inheritance from
solution of the
our
will
often anti-scientific headmasters.
be
difficulty of the medical students’ curriculum found to lie, not in the extension of its time,
but in the
relegation
of the
preliminary
science
subjects
may call the ante-natal days of the medical student-that is, to his schooldays. If this plan be generally adopted, as it has already been in a small number of to what
we
schools
of
with
prevail
over
the
ex-
words, who merely hold their pride of place
by
asperity
about the
a
long
narrowing
line of
literary
in
and
He continued to speak effect of the classical
education, and quoted this somewhat remarkable passage from at
a
the
discourse
delivered
Royal Institution
by the late Dean FARRAR
over
forty
years
ago:
"The
248
MECHANISM
OF
LABOUR.
increasing support from local authorities as these The Mechanism of Labour. and more appreciated its importance. It has, of THERE are some great questions in medicine which are course, been found necessary largely to strengthen the public health service for the performance of the new duties cast always before us ; their importance is so obvious and the of clinical emergencies affected by them is so upon it ; and in the 307 areas referred to there were, at the occurrence that debate is persistent. One such question is the I date of the report, a total of 1084 medical officers in the frequent The history of the mechanism mechanism of labour.1 whole school service of England and Wales. middle of the eighteenth The grave remaining question, that of the treatment of of labour begins about the as with the discussion to the manner in which century the many ailments disclosed by medical inspection, is still the of the foetus enters the pelvic brim. At this head surrounded by difficulties from which a way of escape has to of DEVENTER, that before the be discovered. We have more than once laid down the period the old theory
received have
more
labour
in
the
child, up early stages principle that schooling being compulsory it is the duty the to this time underwent a breech, by presenting of the public to secure that it shall not be actively injurious the rotation so that the head entered pelvis to those who are compelled to submit to it. There can be complete with the occiput looking directly forwards, a view no doubt, of course, that the "over-pressure " described by which was based upon the position which the head many observers, and not always in strictly moderate terms, was injurious to a proportion of the children subjected assumed on its exit from the pelvic cavity, was held still Sir to it ; and, especially in the presence of common ocular con- by some writers, including LEVRET and RODERER. FIELDING in OULD the the first obstetrician year 1742 was ditions, much of the reading, writing, and needlework done in schools was open to similar condemnation. The community to point out that the head entered the pelvis in the has no right to inflict injury under the guise of benefit. transverse diameter, and that while the chest of the There can be no doubt that such injury has been inflicted, child was apposed to the sacrum of the mother its face or that the enthusiastic educators" of the nineteenth was turned so as to have the chin directly on one or other of the shoulders. OULD did not describe the passage century, who believed in "schooling"" as a panacea for all national evils, were as unconscious as NEWTON’S dog Diamond of the head through the pelvis, but his advice, when the of the amount of mischief which their good intentions might birth of the head was delayed on the perineum, to exert be instrumental in accomplishing. At present the great pressure on the chin through the rectum showed that he a change in the position of the head at the difficulty is to combine the proper treatment of the maladies recognised moment of its birth. It was left for SMELLIE to describe disclosed by inspection with a due preservation of a sense of in further detail, and in many respects most accurately, parental responsibility and independence. The report gives SMELLIE was well acquainted much reason to hope that some of the most prevailing the mechanism of labour. with of unreduced the variety occipito-posterior presentamaladies, such as caries of the teeth and the morbid conditions produced by the presence of vermin, will be greatly tions and with the manner in which their reduction normally diminished by the influence of the instruction concern- occurred. In his writings, too, we meet for the first time ing the importance of cleanliness which is even now with a correct conception of the effect of the general intrabeing given to the children, and as to the practical uterine pressure on the expulsion of the foetus, while he also effects of which the statements of both medical men and described the method of carrying out manual rotation of the teachers are distinctly encouraging. The remaining maladies head when it presented transversely at the outlet of the are chiefly ocular and aural troubles, favus, ringworm, pelvis. About the year 1764 MATTHIAS SAXTORPH published a adenoids, and tuberculous affections, and for all these it on the mechanism of labour, in which he pointed work would seem necessary that some provision should be made by that the head entered the out pelvic brim most commonly public authorities. In London, as is well known, temporary in of the one oblique diameters and not, as SMELLIE arrangements have been made with certain hospitals, but it in the transverse. He and his master, BERGER, thought, will stand the test of experemains to be seen whether these had not observed this fact clinically but had only rience. They are likely to involve payments to the instituconfirmed the their observations dissection of the dead by tions which, sooner or later, may give rise to claims to interbodies of women. It is, indeed, probable that pregnant ference in the management of the institutions ; they will of Solayres’ obliquity usually given to this posiprobably require the addition to the ordinary staff of the name of tion the foetal head should rather be Berger’s obliquity, officers appointed for the special purpose and not likely can be little doubt that he was its since there original to attain permanent positions, and the distances between describer. SAXTORPH, like SMELLIE, attributed the the schools and the hospitals must usually be considerable and often prohibitory. The establishment of school clinics, forward rotation of the occiput to the influence of largely officered by the school medical officers themselves, to the bony pelvis and mainly to the action exerted It the expenses of which the parents should be made to con- upon the descending head by the ischial spines. that ROBERT is to note WALLACE JOHNSON, interesting tribute according to their means, remains as the alternative. To enforce contributions where they should be forthcoming a pupil of SMELLIE, also described the entrance of ought not to be difficult, since the ailing child might be the head into the pelvic brim withthe face a little refused admission to the school, and the parent proceeded towards the sacrum." SOLAYRÉS DE RENHAC in 1771 against for not taking the necessary means to bring it into a FœtalCritical Inquiry into the Causes of the Internal Rotation of the Head, by R. H. Paramore, M.D. Lond., Journal of Obstetrics and position to attend. Gynæcology of the British Empire, No. 4, 1909. onset
of
or
11
"
1A
its
THE
MECHANISM
OF
LABOUR.
249
presenta- presentations occurs when it might be expected that the point out the influence action of the pelvic floor would as readily cause a rotation exerted by the position of the occipito-atlantal articulation of the forehead forwards, the action of the contractions of in producing flexion of the head of the foetus, and the the uterus in causing rotation of the trunk has been called manner in which the propulsive force exerted by the uterine into play to assist, and indeed, according to some writers, contractions was communicated through the spine of the to initiate the rotation of the head. Thus the uterine foetus. He also was the first to describe the external rota- contractions are held to cause flattening of the uterine cavity tion of the head in conformity with the internal rotation of from before back, and so to cause a rotation forwards the shoulders. JANus BANG, a pupil of BERGER, described of the fœtus placed obliquely in that cavity. The
was
the first writer
tions of the
head,
accurately
as
he
was
to define the various
the first to
in 1774 the entrance of the shoulders into the
pelvis
in the
the back of the fœtus forwards is held further to be favoured by the projection of the spine of the mother, tending to prevent its rotation backwards. The objections to this view are furnished mainly by a study of frozen sections, which undoubtedly show, at any rate in the majority of instances, that the rotation of the foetal head
rotation of
opposite diameter to that of the head, and the external rotation of the latter with the internal rotation of the shoulders. In 1819 appeared the important work of Fr. C. NAEGELE, in which the mechanism of labour
fully and the relative frequency of the presentations pointed out. NAEGELE, like his precedes and does not follow the rotation of the trunk. In an attempt to overcome the objections which may be predecessors, attributed the forward rotation of the occiput to the influence of the bony pelvis, a view which held its urged both to the view that the pelvic floor plays the main own for many years, and which undoubtedly holds true even part in causing rotation, and to the further view that the at the present time as an explanation of the mechanism of action of the pelvic floor in producing this movement is labour in some conditions. NAEGELE’S viewsobtained assisted, if indeed the movement is not initiated, by the recognition not only among his own countrymen but also contractions of the uterus, SELLHEIM has advanced another influenced obstetric thought and writers in many countries. theory based upon the conception of the adjustment of the The presence or absence in normal labour of the obliquity fœtus as a whole to the parturient canal. In this view the called by his name is, indeed, still a matter of discussion and internal rotation of the head is attributed to the unequal one which is likely so to remain. flexibility of the foetal axis in various directions, so that in its In any description of the mechanism of labour the question passage through the curved pelvic canal the foetal body bends about which a difference of opinion is most likely to arise itself in conformity to the curves of the birth canal. By is the causation of the internal rotation of the head in means of a number of very ingenious models SELLHEIM has its passage through the pelvis. The study of frozen sections attempted to prove his contention that the fœtal head can of pregnant women has rendered the primary movement be bent backwards to a greater extent than in any other of so-called flexion clear, and there is little doubt as direction and that this is due to the tone of the large group to the causation of the movement of extension by which of extensor muscles on the back and neck. He also regards the head emerges from the pelvic cavity or of the move- the position of the foetal head before the onset of labour as ment of external rotation which it undergoes after its one not of extreme flexion but as one midway between Of late years, however, the conditions found in flexion and extension. In the early stages of the passage of escape. the head through the pelvic canal as a result of the flexion some frozen sections have tended to throw doubt upon the usual explanation given of this external rotation of the head. of the head which occurs the tension of these extensor It is, however, principally with regard to the movement of muscles is increased. As the foetal cylinder therefore passes internal rotation and its causes that writers have differed, down through the bent birth canal the occiput rotates and, indeed, even at the present day the matter is far from forwards in conformity with the bend of the canal in this being settled. We have seen that the earlier obstetricians direction, and because the extensor muscles of the neck are to undo the position of flexion of the head which is held that it was determined by the shape of the bony pelvis, I that has some no this there can be and, indeed, question present during the descent of the head into the pelvic brim. influence. The shape of the bony pelvis will not, however, In an inquiry into the causes of the internal rotation of the explain the rotation forwards of the occiput in an occipito- fœtal head PARAMORE criticises SELLHEIM’S views and posterior presentation, and for this reason, among others, brings forward the objection that the conditions of VARNIER in 1888 pointed out the inadequacy of this the experiments are not analogous to those obtaining hypothesis to explain entirely the mechanism of labour in the living woman. He argues that this hypothesis is In seeking an explanation for these cases VARNIER, and disproved by the fact that in cases where it is certain that more especially VEIT, laid great stress upon the part played the bony pelvis exercises no influence upon the position by the soft structures of the pelvic floor. For them and for assumed by the foetal head-namely, where the head is their followers the internal rotation of the head is deter- unduly small or the pelvis unduly large-this rotation of the mined by the action of the inclined plane of the pelvic floor occiput often does not occur, that is, in the very cases in and the shape of the opening in that floor. And, indeed, the I, which, according to SELLHEIM’S view, it should occur most classical experiments of DUBOIS and of others lend great I frequently. OLSHAUSEN, too, has raised the objection support to this view-a view which is accepted by a great that the rotation of the trunk precedes that of the head, It is many obstetricians at the present day as sufficient and but in this he is not supported by most writers. correct. To meet the difficulty of explaining the fact that impossible, he writes, to believe that the foetal trunk, closely rotation of the occiput forwards in occipito-posterior embraced as it is by the soft parts, can be caused to rotate was
described
various
tending
*
THE POSITION &
250
by
the movements of the head.’.
then it must rotate
METHOD OF SCIENCE TEACHING IN SECONDARY SCHOOLS.
If it
independently,
does not do
schools, it
is obvious that the nature of the
so
and if it does this then
it may well influence the rotation of the head and even possibly initiate it. On the other hand, AHLFELD brings forward the objection to OLSHAUSEN’S view that rotation of the head occurs in the first of twins when the uterine cavity is not flattened, and occurs also in the mechanism of labour with the after-coming head. It seems to us reasonable to suppose that the rotation of the head and the trunk may both be due to the same causes
science
training given
elementary schoolboys will be of great profession, falling as it must under to
interest to the medical the scrutiny of the General Medical Council. Few medical men will deny the importance attaching to the amount and kind of scientific teaching available at the secondary schools at the present time, for surely a man who is daily occupied
and may take place independently of one another. As Dr. FARAMORE points out, it is difficult to believe, in view of the large degree to which rotation of the head on the trunk can occur normally, amounting as it does to about 900, that any
in the observation and study of the highest of all natural forms and forces must appreciate more than most the number of ‘6well-educated"" men and women who are allowed to grow up without acquiring the slightest knowledge of the
physical world, who have no clear conception concerning the structure of the universe, or of the nature of the simplest physiological processes-to whom, for example, torsion of the body can influence or cause a rotation of the I I salt" suggests only a condiment of the table, while the head. He further maintains there is no satisfactory proof word "gas"" is limited to the household illuminant or is that in occipito-posterior presentations the forehead is on a a reminder of an unpleasant interview with the dentist. lower level than the occiput or that it meets the pelvic floor Whatever be the intellectual weapons with which the first. When rotation forwards of the occiput fails to occur coming generations are to be equipped for the business of he regards it as due, not to rotation of the forehead forwards, life, few will be found to deny that the purely classical but to a failure of the normal mechanism which should education based upon the traditions of Tudor days, and cause rotation of the occiput forwards. He appears to us developed by the headmasters of the seventeenth and to attribute the rotation of the head in occipito-posterior eighteenth centuries, is destined to be merged into a system presentations to rotation of the forehead backwards of instruction which advancing knowledge has made more rather than to rotation of the occiput forwards, and lays truly liberal. stress, as did FRITSCH, on the action of the anterior lateral Amongst the first principles of a liberal education we wall of the pelvis in causing rotation backwards of the reckon an intelligent, even if elementary, knowledge of forehead which is lying in apposition to it and pressed on natural science, for not only is a conception of " what to it by the uterine contractions. It must be remembered things are made of "-be those things animate or inanimatethat the anterior rotation of the occiput may occur of enormous practical use in nearly every human occupaquite early even before the head reaches the pelvic tion, but the lifting of the veil which hides the mysteries floor, and therefore any theory which takes into account of force and matter so completely from the ignorant that the action of the pelvic floor alone is not sufficient they do not even perceive them to be mysteries opens to explain all cases. It seems necessary to invoke more to the child’s expanding mind a region of interest, of than one factor to explain the internal rotation of the foetal wonder, and in some cases of reverence, which, under wise head, and the most probable explanation would appear to be guidance, cannot fail to broaden his vision and to equip that it is in reality due not only to the action of the pelvic him with such knowledge as is the foundation of true floor, but that the shape and varying degree of flexibility of wisdom. Indeed, Professor H. E. ARMSTRONG, the Presithe foetal head and the action of the uterine contractions in
producing
rotation of the
body
of the foetus must all
play a part in different circumstances and may all, indeed, participate in the production of the rotation in a normal case of labour. No doubt when we are in a position to reconstruct all the I phases of the movements of the foetus in its passage through the birth canal from a study of frozen sections we shall be able to give an accurate description of the mechanism of labour, and be better able to demonstrate the accuracy or inaccuracy of the various hypotheses which have been brought forward to explain its causation.
dent of the Association of Public School Science Masters, at the annual meeting held last week at Westminster School, advanced so large an estimate of the future part of the science master in
our public schools that his audience might tempted to believe him guilty of a ponderous compliment, had it not been for his subsequent denunciation of their present methods of teaching and of their un-
have been
take up the honourable burden which is to fall upon their shoulders until they have undergone a thorough revision upon some such lines as ProThe first aim fessor ARMSTRONG proceeded to indicate. to
preparedness
education, he said, should be to teach youth to see something ; at present we are content with teaching it to say something. Science is a recognition of truth, and the of
The Position and Method of Science Teaching in Secondary Schools. expounders THERE exists
a
considerable
body
of
opinion
that the
pounders
of
natural truth must inheritance from
solution of the
our
will
often anti-scientific headmasters.
be
difficulty of the medical students’ curriculum found to lie, not in the extension of its time,
but in the
relegation
of the
preliminary
science
subjects
may call the ante-natal days of the medical student-that is, to his schooldays. If this plan be generally adopted, as it has already been in a small number of to what
we
schools
of
with
prevail
over
the
ex-
words, who merely hold their pride of place
by
asperity
about the
a
long
narrowing
line of
literary
in
and
He continued to speak effect of the classical
education, and quoted this somewhat remarkable passage from at
a
the
discourse
delivered
Royal Institution
by the late Dean FARRAR
over
forty
years
ago:
"The