438 DYSTOCIA. 



first held together, should be almost immediately more or less sepa- 

 rated, so as to accommodate them to the form of the part that pre- 

 sents, and allow them to slip easily between it and the parietes of 

 the womb. In the contrary case, they are to be introduced one after 

 the other, and the cone formed by their junction is soon reproduced. 

 They are then gently passed onwards, taking care to stop upon the 

 recurrence of each pain, and always move in the axis of the supe- 

 rior strait. Here it is above all important not to be in a hurry: for 

 the movements and the efforts require the greatest gentleness; in- 

 stead of pressing forwards to dilate the os uteri, it is sometirhes bet- 

 ter to separate the base of the fingers moderately and by degrees, or 

 at least the portion of the cone already introduced into the orifice. 

 During this manoeuvre the other hand should be applied to the pa- 

 tient's hypogastrium, for the purpose of supporting the uterus, and 

 inclining it backwards or to one side if necessary. As soon as the 

 roots of the fingers have passed through the os uteri, the whole 

 hand enters without difficulty into the uterine cavity, and thenceforth 

 the intromission is effected. 



988. Period of exploration. Before proceeding any farther the 

 state of the case must be ascertained; we must be sure not to be 

 deceived as to the position of the foetus, not to confound the arms 

 with the legs, to see if any part is twisted out of its proper position, 

 and endeavor to learn where are the feet or breech after having first 

 recognised the head. Then, to get hold of the child for the pur- 

 pose of extracting it or changing its position, it is essential to re- 

 mark, that several points of its body could not bear the degree of 

 pressure which it is sometimes found to be necessary to exert. For 

 example, we ought to avoid pressing the ends of the fingers upon the 

 sutures, the fontanels, the abdomen, and sides of the thorax; for the 

 purpose of pushing up, turning, or extracting the foetus, we ought to 

 apply the hand only to the forehead, the occiput, the temples, the 

 parietal bones, the shoulders, the spine, the sternum, the hips and the 

 limbs. 



989. Mutation. After having ascertained the part that presents, 

 it is pushed up to free the superior strait, taking care to apply the 

 fingers to a surface as extensive as possible; then the feet should be 

 sought for, seized and brought to the orifice. The fostus must never 

 be brought down otherwise than in conformity to its natural flexures; 

 that is to say, it must be rolled up, on its anterior surface. By turn- 

 ing it over backwards, it would necessarily be brought in the direc- 

 tion of its extension; it would soon become an inflexible trunk, or 

 arc of a circle, which most generally would render the remainder of 

 the operation impossible; the uterine cavity would not be sufficiently 



