TURNING. 445 



1000. We continue the tractions obliquely downwards and back- 

 wards, that is to say, in the axis of the superior strait. As the 

 hips are disengaged they are in turn taken hold of, the left or pos- 

 terior one with the left hand, and vice versa, but in such a way 

 that the fingers are not applied higher up than the cristse of the 

 ilia, so as to avoid pressing upon the abdominal viscera. The belly 

 and the breast soon follow; this is the time that the arms rise up- 

 wards, that the shoulders engage, and that it is essentially important 

 to combine the efforts of the accoucheur with those of the woman, 

 in order to avoid a departure of tlie chin from the breast. What- 

 ever resistance may be met with in engaging the shoulders in the 

 excavation, we ought never to imitate those routine practitioners, 

 who, while they are pulling tiie child downwards, can never think of 

 any thing better than to make it revolve on its axis, or make its 

 whole body perform a more or less extensive movement of circum- 

 duction; neither should we move it alternately from the internal 

 surface of one thigh to that of the other, nor raise and depress it by 

 turns from sacrum to pubis and vice verso; such manosuvres could 

 not do any good, and would stretch the dorsal or cervical portions 

 of the spine too dangerously; when it is found insufficient to draw 

 downwards in the direction of the straits, it may be barely proper 

 to try the effect of diagonal tractions, that is to say, we may pull 

 downwards towards that oblique diameter, which at the superior 

 strait corresponds to the greatest diameter of the shoulders. In the 

 first place, while continuing to pull gently, we raise up the child's 

 pelvis, as if we intended to carry it towards the mother's left groin; 

 it is then depressed towards the right sacro-sciatic notch; afterwards 

 we continue to raise and depress it, until the shoulders, which in this 

 way engage one after the other, and receive the greatest part of the 

 force employed, are near enough to the inferior strait to be easily 

 got hold of; when the child has advanced thus far, we must attend 

 to the extraction of the arms. 



1001. When the child is small or the pelvis very large, the pre- 

 sence of the arms offers but a small obstacle to the escape of the 

 head, and we ought, properly, to abstain from disengaging them ; 

 but, in all other cases, they could not fail to embarrass the rest of 

 the operation, and prudence, if not an indispensable necessity, re- 

 quires that they should be brought down. Some authors have said, 

 that when applied alongside of the neck, they facilitate the passage 

 of the head, the dilatation of the vulva, that they obviate the contrac- 

 tion of the uterine circle, and the strangulation of the foetus, and that 

 they are never so large as to prevent the delivery from taking place; 

 but as this opinion is not founded on any plausible reason, it does no 



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