442 DYSTOCIA. 



passes along the anterior face of the sacrum, penetrates into the 

 orifice, and if the occiput is turned directly to the left, remains in a 

 state of semi-pronation, approaches a state of supination if the ver- 

 tex is in the first position, but must be held quite prone if the ver- 

 tex is turned backwards and to the left, &c. The head is to be taken 

 hold of and held in the hand, and not merely with the points of the 

 fingers. The thumb is placed on the right temple, or parietal pro- 

 tuberance, and the other fingers, being more or less separated, are 

 applied to the face and opposite temple. 



At first this part is thrust upv/ards and along the axis of the supe- 

 rior strait, that is to say, upwards and forwards; it is afterwards re- 

 jected towards the left iliac fossa, taking care to favor this movement, 

 with the right hand, which, being placed upon the hypogastrium, 

 sustains the fundus of the womb, and inclines it more or less back- 

 wards and to the right. 



993. Now is the time to go in search of the feet; for this end the 

 hand may pass along the anterior surface of the child, and arrive di- 

 rectly at the knees, or at the roots of the thighs; this is the shortest 

 route; but by following it we are liable to several errors, in short 

 to mistake the elbow for the knee, the foot for the hand, the arms 

 for the legs, and the safest way is to act in the following manner: 

 we begin by extending all the fingers, and the thumb also, towards 

 the left side of the head; they ought to be placed side by side, and 

 extended in order to occupy the least possible space; they are then 

 passed over the whole of the left lateral surface of the child, by 

 sliding along behind the neck, the shoulder, the breast, the flank and 

 the hip; during all this time the anterior part of the wrist supports 

 the forehead and prevents it from descending again into the strait; the 

 other hand pushes the womb backwards as much as necessary or 

 possible, and endeavors to bring the parts we are trying to get hold 

 of as near as possible to the fingers. 



994. If the legs are in their natural state of flexion, we endeavor 

 to carry the whole hand, flattened, above and behind the breast, 

 turning it more and more into a state of pronation as we proceed; 

 if they are on the contrary turned out of the way or displaced from 

 their natural positions, if it appears too difficult to envelop their 

 posterior surface in the palm of the hand, we should take hold of 

 both of them if possible, or at least that one which is nearest the 

 posterior surface of the womb, embracing their root with the thumb 

 which is fixed in the groin, and with the fingers whicli are kept 

 upon the posterior surface of the thighs. Should they be twisted 

 or crossed; should one of them be found flexed, and the other ex- 

 lended; finally, if we have attempted in vain to get hold of them 



