TURNING, CHOICE OF THE HAND. 433 



feet, the left hand is most suitable, in left occipito-pelvic positions, 

 that is, the first and fifth of Baudelocque. (First and fourth of Mx\I. 

 Maygrier, Capuron, Duges, &c; first, fourth, and fifth of Madame 

 Lachapelle; left-occipito-acetabular, and right fronto-acetabular of 

 ]M. Gardien.) The right hand, rigorously speaking, is only for the 

 diametrically opposite positions; but as it terminates a labor in the 

 first position of the feet, as it is more handy from customary use, 

 and as it manosuvres as well as the other in median positions, it 

 ought to be selected for all the right and antero-posterior positions. 



979. In shoulder presentations we may lay it down as a general 

 rule, that the left side requires the use of the left hand, and that 

 the right hand should operate in the positions of the right shoulder. 



980. Lastly, we ought to make use of the right hand in presen- 

 tations of the sternum, or back, whenever the head is not turned to 

 the left, and of the left hand in the opposite case. 



981. These general rules appear to me to be simple, applicable 

 to all cases, and easy to be understood. Baudelocque, Madame 

 Lachapelle, M. Duges, M. Desormeaux, and very recently, M. 

 Major, of Lausanne, also, have advised us to introduce that hand 

 which, when in a state of serni-pronation, will have the palm turned 

 towards the front of the child, and the fingers toivards its lower ex- 

 tremities; but this rule is too vague, and liable to too many excep- 

 tions for it to be used in practice. It is not perfectly exact, either 

 in positions of the pelvis, or those of the back or shoulder, and in 

 positions of the head and sternum it is only suitable in the first stage 

 of the operation. 



Those who have recommended the introduction of the hand that 

 is naturally turned towards the side of the pelvis where the feet are 

 situated, did not observe that it most commonly happens, even in 

 shoulder positions, that the feet remain up towards the fundus of the 

 womb, without being sensibly inclined to one side more than to the 

 other; neither did they remark that precisely the contrary rule is 

 followed where the pelvis presents first. 



When M. Gardien says that the right hand is required in all 

 those cases where the feet are to be brought down in the first, and 

 the left where they are to be brought down in the second position, 

 he has approached nearer to the truth, although his assertion is not 

 correct either, except for positions of the head and trunk; but he has 

 rather expressed a fact than endeavored to lay down a rule, which, 

 however, naturally follows from the principles that I have indicated 

 above. 



Dr. Breen advises us always to use the left hand, inasmuch, says 

 he, as the right is infinitely more commodious in assisting the action 

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