MANAGEMENT OF LABOR. 353 



these precautions, the perineum sometimes tears, certain modern 

 surgeons have concluded that it is wholly useless to support it in any 

 way. If 1 can give credence to several young German and English 

 physicians, the accoucheur of the public establishment at Gottingen, 

 and the one who in 1834 directed the lying-in hospital of Dublin, 

 are of this opinion, and I am assured they even go so far as to think 

 that the precautions recommended on this head are all dangerous. As 

 success here depends less upon the means employed than upon the 

 hand that employs them, it is likely that a long time must elapse 

 before every body can be of one accord as to the value of those that 

 have been proposed. 



833. However this may be, the conduct recommended by reason 

 and experience is the fohowing; the hand, either naked, or what is 

 better, wrapped in a linen clotli, is applied transversely, so that its 

 cubital edge may correspond to the point of the coccyx, and that its 

 radial edge may be below the anterior commissure of the perineum, 

 the ends of the fingers may lodge between the labia and the thigh, or 

 extend on to the thigh, while the finger and thumb being separated, 

 are placed between the other labium and opposite thigh. In this 

 Avay we convert the inclined plane that the head has to pass over in 

 emerging from the soft parts, into a firm wall ; the hand is placed 

 there as if to continue the concave surface of the sacrum and coccyx, 

 and as to compel the head to adapt itself to the axis of the vulva; the 

 power that we employ must therefore act from behind forwards, from 

 the coccyx towards the pudendum, and not in the opposite direction 

 nor laterally. We must force the occiput to turn upwards towards 

 the pubis, and not hinder it from descending; besides, it is only at 

 the moment when the head begins to distend the vulva with a cer- 

 tain degree of force, that it imports us to act; previously to this 

 period the operation would be without object, and the accoucheur 

 would prove merely that he is ignorant of its mechanism. By trying 

 to bend the fingers a little, as has been recommended, for the pur- 

 pose of bringing the soft parts towards the median line, the hand is 

 rendered too concave, and does not support the head sufficiently, 

 and we thus promote exactly what we wish to avoid; by placing the 

 hand, as others recommend, in a state of supination, vertically, with 

 the fingers towards the coccyx, and the wrist towards the vulva, we 

 again miss the object, for our efforts are then directed with more 

 facility in front than behind, while the contrary is what we wish to 

 do. Finally, to prevent, as certainly as possible, any laceration 

 from happening, we may, after the manner of M. Flamaut, take 

 hold of the skin on the buttocks or posterior part of the pelvis 

 with both hands, and draw it forwards as much as possible; it is 



31* 



