364 EUTOCIA. 



enings of inertia; 3. That the child shall be in a good position; 

 and 4. That there shall be no other obstacle to the delivery. 



851. Should the os uteri not be largely dilated, we should be ex- 

 posed to the inconveniences connected with a premature rupture of 

 %e membranes; if the womb should cease to contract, or contract 

 only a little, we might give rise to complete inertia and all its con- 

 sequences; were the foetus badly situated, we should increase the 

 dangers of the presentation, and should the resources of art become 

 necessary, their application would be far less easy. But it should 

 be well understood that these general rules are not without excep- 

 tions: for instance, where the fluid enclosed in the amnios is in too 

 large quantity, it may be allowed to escape even although the open- 

 ing of the cervix is not considerable; the same holds, too, where 

 the position of the child is not fixed, where the hips, shoulders, head, 

 or any other part is found to present by turns at the centre of the 

 strait. In this case we seize the moment when the head is well 

 situated to rupture the membranes, because, were this rupture 

 left to nature, it might as well take place while it is unfavora- 

 ble as while the position is favorable. Where the bag of waters 

 does not retain the shape of a segment of a sphere, is very much 

 elongated, or pyriform, its presence being no longer of any use as to 

 the progress of the dilatation, it should be broken without too much 

 regard to the degree of the dilatation. The same principles guide 

 us in respect to the strength of the pains; their absence ought not 

 always to deter us, for the rupture of the membranes is often the 

 best, and sometimes the only means of restoring them. 



852. To effect this rupture there are a thousand different modes 

 of proceeding: the point of a bistoury, of a pair of small scissors, 

 of a common sewing needle or a knitting needle, of a pin, directed 

 by the pulp of the fore finger, has often been found sufficient, and 

 perhaps been employed with advantage; for one must be very un- 

 skilful or careless seriously to wound the mother or foetus with 

 either of those instruments; however, at the present day we proceed 

 generally in a different manner : the membranes are scratched 

 through with the finger nail, while they are tightly stretched; or we 

 endeavor to burst them with the end of the finger by suddenly 

 pushing upon the tumor from its point towards its base; and if 

 the first attempt does not succeed, we make a second, a third, &c., 

 always during the height of the pain; or again, and the method is a 

 better one, we firmly pinch a fold of the membranes, while in a 

 state of relaxation, and in such a way that the next contraction of 

 the uterus in essaying to form the bag again, does not fail to rupture 

 them. 



