436 DYSTOCIA. 



head is, and where it is probable that the labor would terminate 

 spontaneously if the head were at the strait. Moreover, after having 

 attempted to perform it in vain, we are not prevented from still pro- 

 (;eeding in search of the feet, which can be as readily found after 

 as before the attempt has been made: if the head seems disposed to 

 come down, we may endeavor to bring it down; if not, we have 

 only to direct the hand towards the feet. I do not think, however, 

 that this kind of turning ought to be preferred in the inclined posi- 

 tions of the pelvis, nor, a fortiori, where the breech presents fairly. 

 MM. Flamant and Schweighaeuser wish it to be preferred in all 

 cases, even where there are accidents on the part of the mother, be- 

 cause, when the head is once brought to the strait, it can be laid hold 

 of with the forceps. Perhaps they might be imitated with advantage 

 in some cases where the fcBtus is very movable in the uterus; but I 

 doubt if it be possible where the waters are gone off, and the womb 

 strongly contracted on the child. 



985. Thus, the woman being placed as has been directed, the left 

 hand is introduced if the head is to the right, and the right hand, on 

 the contrary, if to the left; and either one or the other almost indif- 

 ferently, if the vertex is turned in front or directly behind. 



In the first place, the part that is engaged is to be pushed up- 

 wards; we should try to remove it from the strait, snd direct it to- 

 wards the iliac fossa that is opposite to the one occupied by the 

 vertex; in this way the womb is enabled to exert its power on the 

 head and return it to the centre of the pelvis. After having thus 

 raised up the shoulder, if the head does not descend, it must be 

 sought for with the hand, and taken hold of with all the fingers, 

 which draw it down as with a crotchet, and at the same time en- 

 deavor to make it assume, in preference, one of the occipito-anterior 

 positions. When the head has been brought to the centre of the 

 pelvic circle, it is left there, and the delivery requires no further as- 

 sistance, provided there be no other accident in the case; if the con- 

 trary should happen, the forceps should be immediately substituted 

 for the hand. 



Wigand, in speaking of cephalic version, says that we may often 

 succeed in operating without introducing the hand into the genital 

 organs; he thinks that by acting upon the womb through the abdo- 

 minal parietes, and assisting it by the posture of the woman, we may 

 most commonly bring back the head to the superior strait. Before 

 I was acquainted with the doctrine of the German professor, I had 

 already followed this precept, and have in conforming to it found 

 .that it is, in fact, sometimes possible to restore to the vertex its na- 

 tural position; but I do not think that this manceuvre can ever be of 



