Turn-of-the (19th) century perspective on breech

My most recent discovery while digging through medical archives: a 1901 British Medical Journal article about about breech presentation by Dr. Herbert R. Spencer, an obstetrician in London. He writes about the risks of breech birth, which to a modern reader, are astonishingly high. He strongly advocates for external cephalic version as a solution to the dangers of breech presentation.

While the middle of the paper was informative, the beginning and end, quoted below, were brilliant. I enjoyed his dry sense of humor and his ability to capture the reader's interest.

The full text is available here for free download.

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THE DANGERS AND DIAGNOSIS OF BREECH PRESENTATION, AND ITS TREATMENT BY EXTERNAL VERSION TOWARDS THE END OF PREGNANCY.

By HERBERT R. SPENCER, M.D., B.S.LoND., F.R.C.P.

Professor of Obstetric Medicine in University College, London; Obstetric Physician to University College Hospital.

BMJ, May 18, 1901

Pliny in his interesting Natural History informs us that it is contrary to nature for children to come into the world with the feet first, and that those who did were called "Agrippa"' from the fanciful etymology aegre partus, or "born with difficulty." This mode of delivery was thence known as the Agrippine birth. Pliny tells us that M. Vipsanius Agrippa was almost the only instance of good fortune among those who were born in this way. "And yet," he writes, "even he was affected by the unfavourable omen of his birth, as shown by the unfortunate weakness of his legs, and his short life" (which perhaps might have resulted from his abnormal birth) "and by the wicked lives of his wife and children," which we shall be less disposed than Pliny to attribute to the mere mode of delivery. I give this quotation from Pliny as it shows the existence amongst the Romans nearly 2,000 years ago of a belief in the difficulties attending and the disabilities following delivery by the lower extremity….

[External cephalic version], of course, involves the necessity of the patient's being examined during pregnancy, a necessity which is not recognised by all doctors or patients. Yet it is time that this examination became a routine practice, for without it patients and their infants are occasionally brought into the greatest peril, and not rarely lose their lives. As a result of this routine examination conditions may be recognized which can be obviated by timely interference. I believe the presentation of the breech to be one of these conditions; and I am sure that its treatment by external version during pregnancy is so free from objection that it is worthy of extensive trial. It is in the hope that others may be induced to practise it that I have ventured to publish such a small number of cases. It would be a great gain to be able to prevent this dangerous presentation, and to be sure that the child would always present by the head; for, in the words of Pliny, it is natural for man to come into the world by the head and to be carried to the grave by the feet--"Ritu naturae mos est capite gigni pedibus efferri."