TURNING. 429 



Upon the whole, the most favorable moment for turning is jnst 

 when the membranes are whole and the os uteri completely dilated. 

 This period ought, therefore, always to be chosen if possible, and if 

 there be no counter indication present. 



968. Position of the woman. Should it be necessary only to 

 bring back the head or buttocks, in case of deviated position of those 

 parts, to the superior strait, we might indeed leave the woman upon 

 her common bed; or in the situation she had occupied on her little 

 bed during the pains; but whenever it becomes necessary to seek 

 after the head or feet at some distance from the vulva, we ought to 

 act differently; however, the essential point on this subject is that 

 the vulva and perineum shall be completely at liberty, and that 

 nothing about the pelvis shall be left to interfere with the move- 

 ments of the accoucheur, and that the muscles shall not require to 

 be put in tension for the support of some other parts of the body. 

 Thus, she may be placed on her side, conformably to the precepts 

 of the English and American practitioners; on the edge or foot of 

 the bed; on the knees of some strong person; on a chair, a settee, 

 a table, or any piece of furniture suitably prepared for her. Upon 

 the whole, her attitude ought to be like that of a patient during the 

 operation of lithotomy. 



969. At the Maternite at Paris, and the Strasburg Hospital, one 

 side of the lying-in-bed is placed against a wall; as soon as an ope- 

 ration becomes necessary, the woman places herself crosswise upon 

 it, with pillows under her head and shoulders, towards the wall; 

 the sacrum rests upon the free edge of the bed; an assistant is 

 placed on the outside of each leg, and charged with the duty of 

 keeping them separate, and the legs and thighs flexed, while a third 

 is prepared to hand any thing that may be wanted during the opera- 

 tion. If they can be disposed of, other assistants secure the pelvis, 

 and prevent those disorderly movements which the sufferings of the 

 woman sometimes deprive them of the power of controlling. 



970. The same conduct may be followed in private practice, but 

 it appears to me better to slip the mattrass down so that the folded 

 edge may correspond to the foot of the sacking-bottom. The wo- 

 man is then in exactly the same condition as before, and the assis- 

 tants can more easily move round about her. It should be observed, 

 that many women are so courageous that it is not necessary to sup- 

 port either the legs or the head, and indeed, two chairs or two stools, 

 fixed so as to support the feet, might serve instead of assistants to 

 hold her legs, if assistants are wanting. 



There is no fixed rule as to the height of the bed; but it is well 

 to pay some regard to the stature of the accoucheur, the degree of 



