440 DYSTOCIA. 



990. Extraction. When the mutation has been completed, and 

 the child reduced to one of the positions of the extremities of its 

 great diameter, we may stop, provided the pelvis be well formed and 

 the womb retains sufficient energy to terminate the rest of the labor. 

 This is the way we are compelled to act in all cases of version by 

 the head, unless we choose to apply the forceps; but when the feet 

 are brought down, ought they also to be abandoned after they are 

 placed in a situation which no longer prevents the spontaneous de- 

 livery of the child? To authorise this advice it has been supposed: 

 1. That pulling on the child ought always to be avoided when not 

 absolutely necessary; 2. That tractions force the arms to rise along 

 side of the head, which prevents its advance, and that they almost 

 always place the occipito-frontal or occipito-mental diameters in the 

 situation that ought to be occupied by the occipito-bregmatic; 3. 

 That in rapidly passing through the os uteri, the belly and breast of 

 the fcEtus are subjected to too sudden a compression; 4. Lastly, that 

 the womb, being too suddenly emptied, may become inverted, fall 

 into inertia, and give rise to hemorrhage, &lc. All these inconve- 

 niences are real, and nothing would be so easy as to enlarge the list: 

 but on the other hand, it should not be overlooked that the woman 

 submitted to the operation only for the hope of being soon delivered; 

 that her family and attendants cannot be satisfied until the child is 

 completely expelled; that, in case of abundant hemorrhage, of syn- 

 cope, of lypolhymia, convulsions, premature descent of the cord and 

 exhaustion, we have no right to wait; that inertia ought rarely to 

 occur in such circumstances, seeing that the manosuvre is better cal- 

 culated to remedy than produce it; that the compression of the ab- 

 domen, when the hand has been previously introduced into the 

 womb, ought not to inspire any great alarm; that, at least, it is scarcely 

 more to be feared where we draw the foetus down by the hand, than 

 where it is simply pushed down by the efforts of the mother; lastly, 

 that it is possible to avoid one extreme without falling into another, 

 and that, it is as dangerous, in the practice of midwifery, not to act 

 apropos, as to do so without any necessity. 



A well informed and prudent man will therefore preserve a just 

 medium, and proportion his manoeuvre to the circumstances of each 

 particular case. If not pressed by any important circumstance, he 

 will wait, and excite the uterine actions so as to draw the child down- 

 wards concurrently with them, for the two actions ought to be so 



one foot is employed for the mutation and extraction, the other one is folded up, 

 on the child's body, which makes of the case a sort of breech presentation. The 

 head is extracted more easily the greater the dilatation of the parts effected be- 

 fore the head comes to the opening. I speak from experience. — M. 



