TURNING. 437 



much use where the waters have been long discharged, and the womb 

 strongly contracted on the child. 



SECTION 3. 

 Of Thrning by the Feet or Pelvis. 



The mancHuvre in turning by the feet consists of three principal 

 stages. It is necessary, 1. To introduce the hand; 2. To change 

 the position of the child; 3. To assist in the expulsion of the ovum. 



These three stages are never found together in turning by the 

 head, where, as has been already seen, the action of the hand is of 

 no further use after the head has been properly placed at the supe- 

 rior strait; in some of the feet positions the manoeuvre is almost 

 wholly confined to the stage of extraction. 



986. Introduction of the hand. Many authors advice us to pene- 

 trate into the vagina at the very moment of a strong uterine contrac- 

 tion; in this way, say they, the pain produced by the operation be- 

 comes confounded with the pain of the contraction, and the woman 

 does not distinguish them apart; then also the vagina is both enlarg- 

 ed and shortened by the temporary descent of the womb, which in 

 some sense comes down to meet the hand. In theory these asser- 

 tions may be very correct; but in practice they certainly do not au- 

 thorise the precept which it has been attempted to draw from it, and, 

 like M. Desormeaux, I think, from my own experience, that the 

 hand should generally be passed through the vulva in the intervals 

 between the pains. 



Whatever mode be adopted on this point, the fingers being placed 

 side by side, must first be introduced in the direction of the length 

 of the vulva; after which they are brought together in such a way, 

 that their palmar surface forms a kind of gutter, in which the thumb 

 is lodged, so that the whole may form a very long cone, the base of 

 which is found at the place of the metacarpo-phalangial articulations. 

 The hand thus gets into the vaginal cavity, following the direction 

 of the axis of the inferior strait. 



987. In order to penetrate through the os uteri, it is absolutely ne- 

 cessary to choose a time when the pain is off, so much so, that no- 

 body has ever dared to prescribe the contrary. Otherwise, in- 

 deed, it would often be impossible to get into the uterus; there would 

 be a risk of lacerating the orifice; in fine, it would be voluntarily to 

 create a thousand difficulties, and to expose the woman to numerous 

 dangers. 



If the dilatation is very much advanced, the fingers, which are at 



38* 



