TURNING. 441 



combined as to constitute, as it were, but one; at each pain the 

 womb ought to commence before the hand, and finish after it. By 

 pursuing this course we imitate a spontaneous delivery; the arms 

 sometimes descend before the head, which continues bent down upon 

 the breast, and the occipito-bregmatic diameter does not lose its 

 natural relation to the straits of the pelvis; it is in no case indispen- 

 sably necessary to pull hard enough to rupture the spinal marrow 

 or detruncate the foetus. If, on the contrary, there should be no 

 other chance of safety either for the mother or the child, than in a 

 prompt delivery, and should the contractions of the womb be too slow 

 and feeble to admit of his relying upon them, the tractions performed 

 by the accoucheur ought not only to assist, but they should more or 

 less become the substitutes of the powers of the woman: there can 

 be no hesitation in such a case; of two unavoidable evils we must 

 choose the least. I need not repeat that in the former as well as 

 in the latter case the tractions ought to be performed with great cau- 

 tion; never by jerks, and always in the axis of the straits. 



To conclude, extraction may be considered under two principal 

 points of view: 1. As a mere accessory power added to that of the 

 womb, and which hastens the termination of a painful function; 

 2. As a principal, or even sole resource, in cases where the organism 

 is powerless, or where it is of importance to empty the uterus within 

 a few minutes. This distinction being once established, I do not see 

 how any discussion can afterwards arise as to whether the child may 

 or may not be pulled downwards after it has been turned. As long 

 as the tractions are confined to the part first assigned to them, it is 

 evident they can be only of service, and no well informed man will 

 ever make use of them in the other way without a clearly understood 

 necessity for so doing. 



§. I. Of BriBi^lii^ DoiFn the Feet iv'heii the 

 Head is at the Orilice. 



Relatively to turning by the feet, the positions of the head ought to 

 be reduced to two: the left occipito-iliac, to which we bring the first 

 and fifth of Baudelocque; and the right occipito-iliac, which com- 

 prises the second and fourth of the same author, to which also we 

 ought to bring the occipito and fronto-pubic positions, should they 

 be met with. 



991. The first of these requires the left hand, and the right hand 

 is preferable for the second. 



A. Left Occipito-iliac Positions. 



992. The left hand enters the vagina in a state of pronation, 



