428 DYSTOCIA. 



SECTION 1. 



Of Turning in general. 



The necessity of acting with the hand to change the position of 

 the fcEtus or assist in its expulsion having been clearly ascertained, 

 it should be communicated to the relatives or friends of the woman, 

 and they should be informed of the dangers to which the child is 

 exposed. Provided the case be at all doubtful, or if the family have 

 not implicit confidence in him; if his age, or above all his reputation 

 do not place him beyond the reach of the envenomed shafts of envy, 

 it is well for the safety of all parties, that the accoucheur should 

 request a consultation with one or more of his brethren, best known 

 by their experience and knowledge. 



966. As to the woman herself, she ought to be informed of the 

 advantages of the operation, and of the evils of retarding it or of not 

 performing it; but it is important that she should be kept in ignorance 

 of the risks the foetus is about to run, and the sufferings to which 

 she is exposed herself. These precautions being taken, we should 

 next think of what period of the labor we should choose for the ope- 

 ration; of the position most favorable for the woman and for the ac- 

 coucheur, then of the position of the child, and lastly, determine 

 which hand should be introduced. 



967. The time for acting. As long as the membranes remain 

 whole, and the orifice undilated, we may wait: if the labor is diffi- 

 cult only in consequence of the faulty position of the child, and the 

 woman is in danger, it suffices that the orifice be soft and dilatable, 

 we may operate. In all cases where the membranes are ruptured, 

 there is not an instant to lose;* however, where the womb has been 

 for a long time contracted, where there are great irritation, heat, 

 fever, or any symptoms of inflammation, these epiphenomena ought 

 to be first combated by bleeding, baths, sedatives, ointment of bella- 

 donna, &c. according to circumstances. 



* M. Velpeau says " in all cases where the membranes are ruptured there is 

 not an instant to lose" — Let not the young and inexperienced practitioner em- 

 brace tliis doctrine. — The rule is, that we may turn whenever we can do so with- 

 out violence to the os uteri. All prudent authors concur in opinion that it must 

 never he forced — gentle attempts to dilate, may be made from time to time — 

 but as to absolutely forcing open an undilated and rigid os uteri — the attempt 

 would be worthy of condemnation — Hence in fact, the operation must be deter- 

 mined by the judgment of the attendant — always using as his watch-word no 

 violence. — M. 



