TURNING. 447 



In the first case, we commence by disengaging the arm that is not 

 deviated; we then push the trunk up a little, so as to compel the head 

 to rise, and as far as possible to diminish the pressure upon the 

 other arm; after which the fingers and the thumb ought to be ap- 

 plied as has been already directed, and act upon the same principles, 

 but with rather more gentleness. If the arm resists, we attempt to 

 make it rise up above the occiput, and the blunt-hook proposed by 

 M. Dubois ought not to be employed until all other attempts shall 

 have proved to be insufficient. 



In the second, even although the forearm should have passed 

 quite across to the opposite side, as seems to have happened in a 

 case under the care of M. Duges, and even though it should have 

 risen as high as the nucha, it ought always to be hooked with the 

 middle and fore finger to draw it down along the child's back, and 

 bring it out of the vulva; it is generally pretty easy to succeed in this 

 manoeuvre, but the breast has sometimes to be pushed strongly up, 

 or the trunk more or less considerably rotated, before it can be ef- 

 fected. 



1004. Should the exertions of the accoucheur have been well 

 seconded by the contractions of the womb, the head ought now to 

 have descended into the excavation, or at least be considerably en- 

 gaged within the superior strait, so that the occipito-bregmatic and 

 bi-parietal diameters would be found to be in proper relation to the 

 oblique diameters of the pelvic circle. 



In that case, the right hand, passing along the front of the breast 

 and throat, penetrates in a flattened and half-supine position quite 

 into the vagina; the thumb and two last fingers are placed on the 

 sides of ihe throat, the index and medius should be directed on to 

 the chin, or in the mouth, or what is still better, on each side of the 

 nose, for the purpose of keeping the head in its natural stale of flex- 

 ion, and approximate the facial extremity of the occipito-mental di- 

 ameter as much as possible to the sternum; after having placed the 

 right hand properly, the foetus is to be laid on its belly upon the an- 

 terior surface of the corresponding arm, which is then much depress- 

 ed towards the perineum, without, however, pulling, for the object 

 at that moment is merely to disengage the vertex from the pubic 

 arch. In the next place, two or three of the first fingers of the left 

 hand are to be carried under the occiput, to sustain it, and prevent it 

 from engaging before the chin; the thumb, the other fingers, and the 

 rest of this hand are applied naturally behind the neck, and we at- 

 tempt to push the head upwards in the axis of the superior strait, so 

 as to cause it more easily to perform its pivot-motion. 



When we have succeeded in getting the face into the hollow of 



