446 DYSTOCIA. 



deserve the trouble of being opposed, and at present no one follows 

 the practice. 



The member nearest the sacrum must always be extracted first; 

 should we begin with the other, we should meet with great difficulty, 

 and when we had succeeded, the other arm would not be found to be 

 at all more free. 



1002. The trunk, which should always be wrapped up in a cloth, 

 is supported by the right hand, as it is performing the oblique trac- 

 tions. The left thumb, in a state of pronation, is placed in the hol- 

 low of the corresponding axilla, while the index and medius are 

 applied to the outer and anterior surfaces of the arm, as far as the 

 bend of the elbow, as if to form a tackle for the humerus. We 

 then act upon the whole arm as upon a lever of the third kind; the 

 thumb represents the fulcrum, the fingers the power, and the re- 

 sistance is found in the forearm of the child. While we are thus 

 acting on the arm to bring it down, it must be carried in the direc- 

 tion of adduction, so that as it sinks down it may slide over the fore 

 part of the breast. If we should be content with hooking it with 

 one or two fingers, we would run a risk of fracturing the bone, or at 

 least of exerting the force only upon the shoulder-joint. When 

 the whole shoulder is much elevated, it is sometimes found advan- 

 tageous to follow the advice of Baudelocque, which has been re- 

 peated by almost all the accoucheurs of our own day, namely, to 

 divide this little operation into two stages, to put the hand, at first 

 in pronation, so that the thumb may for an instant take the place of 

 the other fingers, and operate in succession upon the whole limb, 

 beginning at the root of it; but this precaution is most frequently un- 

 necessary, and I have had no occasion to repent of having generally 

 neglected it. 



The arm having been brought down, it is to be extended along the 

 side of the thorax; the right hand deposits the trunk of the child in 

 the left hand, and then proceeds to disengage the anterior or sub-pubal 

 member, according to the method indicated above. 



1003. Instead of following their natural tendency to rise up along- 

 side of the head, the arms are sometimes turned backwards, and 

 that in two different ways: 1. One of them, or both, but generally 

 only one, and especially the one that ought to be found in front, is 

 fixed behind the neck, so as to arrest the progress of the occiput; 

 2. Previously to rising upwards, or even while in the act of rising, 

 they get behind, and cross each other upon the back, below the 

 shoulders, which may occasion their being luxated, or even frac- 

 tured, and greatly increase (he difficulties of the manoeuvre, provided 

 it be not remedied in good time. 



