444 DYSTOCIA. 



are applied to their outer surfaces, and in such a way that the heels 

 lodge in the palm of the hand. If the head, forced down by the 

 womb, or ill supported by the wrist, should have approached too 

 near the orifice, we should, before we pull the feet down, and with- 

 out letting them go, push it up again towards the left iliac fossa 

 with the thenar. 



997. The first object of the tractions now to be performed, is to 

 turn the child, to compel the head to rise up towards the fundus of 

 the womb, whilst the pelvis is drawn into the superior strait, and to 

 convert one of the left positions of the vertex into one of the right 

 positions of the feet; that this mutation may yield all the advan- 

 tages we are authorised to expect from it, the back of the child 

 must always turn to the right, then a little in front, but never back- 

 wards. Consequently, the operator will carefully avoid inclining 

 the hand in supination, after he has begun to pull on the legs; he 

 should keep it in serai-pronation, to reduce to the second position of 

 Baudelocque; and even if that should not suffice, he ought to try to 

 get the right foot, which is in front, with the right hand, and draw 

 down solely, or almost solely, by it, until the tendency of the back 

 to direct itself backwards shall have been overcome. 



998. As soon as both of the feet have passed through the vulva, 

 they should be wrapped in a dry cloth so that they may be held 

 more firmly. The hips soon pass through the orifice, and present 

 at the inferior strait. As the limbs come forth, the hands, which 

 are applied, the right one in front and the left one behind, ought 

 to extend along them towards the vulva, so as to hold them by as 

 large a surface as possible; the thumbs are therefore placed behind; 

 the two last fingers on the anterior surface, and the index and medius 

 extended on the outside of each leg. or each thigh, until the hips 

 shall have been born. 



999. Before proceeding any further, it is proper to attend to 

 the umbilical cord, to see that it be not stretched, by carrying the 

 index and the thumb, or two other fingers of the right hand, towards 

 its insertion on the belly of the child. If it should be found tense, 

 a loop of it of sufficient length should be brought down by pulling 

 the placental portion, but never by pulling its abdominal portion; if 

 it is found not to be stretched any about the navel it may be let 

 alone; if it should proceed from the navel down betwixt the thighs 

 and then mount up along the child's back, so that the circulation 

 should appear to suff"er, it ought to be disengaged, and even divided, 

 should the danger appear to be pressing, and no other means of 

 disengaging the limbs be discoverable; but after that the labor ought 

 to be terminated within a very few minutes. 



