: 92a BOTANIC PHYSICIAN. 
also be laid flat during this contraction, Jest the womb be injured 
by its action on the knuckles. In this manner we are to proceed, 
alternately resting and exerting ourselves, till we can lay hold of one — 
or both feet. 
_ There is sometimes much difficulty in getting to the feet, andin ~ 
os ing them, especially when the womb is contracted in a longi- 
tudinal form. In such cases it is often convenient, when we can 
reach to the knees, to bend them cautiously, and bring down the legs 
and feet together. Before we begin to extract, however, we must be 
well assured that the parts we have hold of are the feet; and then 
we must extract them slowly and steadily, for if we hurry they may 
slip from us, and return again. is 
_ When the feet are brought down, if there be difficulty in extract- 
ing them, we must endeavor to slide a noose, first formed upon our 
wrist, over the hand, to secure the feet, by which the hazard of their 
return will be prevented, and the succeeding part of the operation 
much facilitated. When the noose is fixed over the ancles, we must 
pull by both ends of it with one hand, and grasp the feet with the 
other, but we must not attempt to proceed hastily. When there is 
afterwards much difficulty in extracting the child, it is probably owing 
to its body being jammed across the upper aperture of the pelvis. It 
will then be proper to pass the finger and thumb as before directed, 
_ toraise the shoulders and body of the child towards the body of the 
__ womb, with one hand, and with the other extract at the same time 
with the noose. : 
When the breech of the child has entered the pelvis, we must pro- 
ceed with deliberation ; but there will be little farther difficulty, ex- 
cept from the smallness of the pelvis, of which we shall speak in the 
irth distinction is, when, together with any of the cir- 
attending the foregoing distinctions, there is a great dis- 
tween the size of the head of the child, and the dimen-. 
: cavity of the pelvis. 
The degree of difficulty in these cases is greater or less according 
to the degree of disproportion ; but the difficulty of extracting any 
part of the body of the child is little, compared with that which at- 
tends the extracting of the head. We will, therefore, suppose the 
body of the child to be brought down, but thatthe head cannot be 
extracted by any of the methods before recommended. The force — 
ith which we endeavor to extract, must then be increased, till it is 
pt to overcome the difficulty or resistance ; beginning, how- 
1 moderation, and gradually increasing our efforts, aecord- 
_ ing tothe exigencies of the case. This force should be exerted by 
_ intervals in the manner of natural pains. 
head should not descend with the force which we judge can 
safely exerted, we must rest, and give it time to collapse. We 
may then renew our attempts, extracting from side to side, or back- 
wards or forwards, as may best conduce to ease the head through 
the distorted pelvis, alternately resting and endeavoring to extract. 
But if the head should descend in ever so small a degree, the force i 
not to be increased with a view of finishing the delivery expeditiously. 
but we must be satisfied with our success, and proceed circumspect 
