Some years afterwards, the late Dr. Gooch had the opportunity of observing a case of spontaneous expulsion with great accuracy, and came to the same conclusion as Dr. Douglas had done. "Resolved to know what became of the arm, if this (the spontaneous expulsion) should happen, and thus fit myself for a witness on this disputed point, I laid hold of it with a napkin and watched its movements: so far from going up into the uterus when a pain came on, it advanced, as well as the shoulder, still forwarder under the arch of the pubes, the side of the thorax pressing more on the perineum and appearing still more externally; it advanced so rapidly that in two pains, with a good deal of muscular exertion on the part of the patient, but apparently with less suffering than attends the birth of the head in a common first labour, did the side of the chest, of the abdomen, and of the breech, pass one after the other in an enormous sweep over the perineum till the nates and legs were completely expelled." (_Ibid._) The celebrated Boer, has, however, detailed a case where the arm had prolapsed into the vagina, the hand appearing externally; and on introducing his hand for the purpose of turning, he felt the hand distinctly receding, and the breech beginning to occupy the cavity of the pelvis. This is very different to a case of spontaneous expulsion: "the child lay completely across, with its abdomen towards the back of the mother;"[110] it had, in fact, not yet begun to press against the brim, or to assume any definite position, there having been as yet but little uterine contraction, and both rectum and bladder being considerably distended. When these were evacuated the pains increased: the breech being nearest to the brim, descended, and the arm in consequence receded. Dr. Gooch considers it most probable that "it was only a breech presentation, the hand having accidentally slipt down into the vagina."