TURNING. 439 



spacious to admit of the evolution, and the least force would hazard 

 the luxation or fracture of the limbs, the rupture of the spinal mar- 

 row, and would give rise to extremely severe pains on the part of 

 the woman, and perhaps even to lacerations of the uterus. 



Whilst engaged in exploring, and turning the child, it is not less 

 essential to support the womb outwardly than it is during the time 

 of intromission. The hand that is held applied to the hypogastrium 

 may aid also by suitable pressure in causing the head, the shoulder, 

 or the limbs to descend, which renders the turning in all respects 

 easier aud surer; but for this precaution, the accoucheur would be 

 liable, when compelled to exert a certain degree of force, and par- 

 ticularly where the liquor amnii has been long discharged, to pro- 

 duce dangerous stretchings, to separate the vagina from the cervix, to 

 rupture the womb itself at some weak part, or at those points where 

 the womb is most strongly contracted on the projecting and solid 

 parts of the fostus. 



These mancBuvres ought always to be executed in the intervals 

 between the pains; they would be excessively dangerous if performed 

 during the contractions, and would generally occasion fatal lacera- 

 tions to take place; besides, it is often impossible at those times to 

 move the foetus; the hand soon becomes so compressed that it is 

 quickly benumbed, and completely loses all its powers of sensation 

 and motion; as soon, therefore, as a pain appears, all exertion is to 

 be suspended; it should not be begun again until the contraction has 

 ceased, unless, however, some serious circumstance necessitates a 

 very prompt termination of the labor. 



I ought, also, to warn the young practitioner, that in order to reach 

 the fundus of the womb, the arm must be introduced much farther 

 than he would at first suppose, and that to get into the axis of the 

 superior strait, the hand should be much more inclined forwards 

 than would be imagined upon the inspection of a dried pelvis. 



Most accoucheurs have recommended and still advise that the feet 

 should be seized, and not any other part of the limbs; in fine, the 

 feet are the only parts by which we are advised to pull, in the kind 

 of turning under consideration. Nevertheless, it is possible, it is in 

 many cases even advantageous, to follow the counsel given first by 

 Burton, reproduced by Delpech, and very recently again by Dr. 

 Breen — that is, to take hold of the knees* or hams, rather than the 

 feet. 



* It is quite as well to turn by the hams as by the feet — I, at least, have found 

 it so. It should be remarked, that where any considerable difficulty is expe- 

 rienced in the exploration for both feet, it is perfectly safe to draw down only 

 one, the turning is easily effected and the foetus is actually safer, because if only 



