430 DYSTOCIA. 



inclination of the axes of the straits, and perhaps also to the stage 

 of the labor. 



971. Position of the Accoucheur. If the bed be a low one, the 

 accoucheur may sit down or kneel upon the floor. Nevertheless, a 

 standing posture is unquestionably the best, and whenever there is 

 a necessity for using much power it should be preferred. The pre- 

 cept of Levret on this subject has long been forgot, which was thus: 

 " the accoucheur should stand up, with his legs separated at an 

 angle of forty-five degrees, one foot being placed forwards and the 

 other backwards; that he should have the spine bowed, and lean 

 with the hand that he does not operate with upon some solid sub- 

 stance."* 



All this, says Roussel, may be called mechanics and geometry by 

 an operator who wishes to shed lustre on his art, but certain it is, 

 that a simple midwife, by relying upon her native dexterity, absolving 

 herself from the constraints of a prescribed position, and executing 

 all the motions that may be required by circumstances rather than 

 those demanded by the rule, will operate better than an accoucheur 

 no matter how gravely he may straddle his forty-five degrees. 



972. Taking off the coat, rolling up the sleeves, and putting on 

 an apron has seemed too grotesque to many moderns, who think 

 that the woman might be frightened by so many preparations, &nd 

 they ought therefore to be dispensed with; people may declaim after 

 this sort as much as they please in the study, but by the lying-in 

 bed it is otherwise. 



In fact it is not merely for fear of spoiling it that the accoucheur 

 ought to take off" his coat, but because, unless he does so, the move- 

 ments of his arms would not be free enough to permit him to ma- 

 nosuvre conveniently, and penetrate to the fundus of the womb. As 

 to the apron, it may doubtless be dispensed with: but what harm 

 can it do, and why is it more frightful here than in a surgeon making 

 his visits, or preparing for an operation? 



Some cloths to put under the feet, some napkins to wipe his 

 hands and arms when they become soiled, warm water, Cologne- 

 water, some vinegar, and a little good wine, in case the woman 



* If a woman lie upon her back for this operation, the practitioner has equal 

 access to the uterus with the right or left hand, the former of wliich is to be used 

 in occipito-posterior positions, and the latter in the occipito-anterior. If she lie 

 on the left side, the left hand is applicable for the occipito-anterior, and the right 

 for the occipito-posterior positions. But the right side is equally convenient if 

 we use the left hand for the occipito-posterior, and the right one for the occipito- 

 anterior position; it is of little consequence, therefore, which of the tliree atti- 

 tudes is taken by the patient.— 'M. 



