448 DYSTOCIA. 



the sacrum and the occiput beliind the symphysis, we should wait 

 for a pain; the woman should be told to bear dowii, and the two 

 hands being fixed as has been seated, we immediately begin to exert 

 some tractive force on the head, which is gradually drawn down in 

 the axis of the straits, while at the same time the trunk of the child 

 is gradually raised upwards, as if we were going to turn it over on to 

 the hypogastrium of the mother. 



1005. When the efforts of the accoucheur have not been sufhcient- 

 ly seconded by the contractions of the womb, or when, after the de- 

 livery of the shoulders, the head has not performed its flexion move- 

 ment, and is found to be arrested at the superior strait, it is some- 

 times very difficult to reach it, and still more so to get it down; how- 

 ever, until we can reacli it, all tractive force on the trunk is to be sus- 

 pended, for it would only tend to reverse it still more. The hands, 

 placed as before, should be carried further up. At this juncture it is 

 particularly useful to apply the fore and middle fingers to each side 

 of the nose; for by applying them to the inside of the mouth, there 

 would be a risk of depressing the lower jaw only, or of luxating it or 

 straining it to an injurious degree; but in this case also it is most dif- 

 ficult to reach this part of the face; and further, it must be confessed 

 that when we have reached it, if a good deal of force is required, the 

 fingers slip and get off from it with surprising facility; so that we are 

 mostly under the necessity of fixing them on the most movable part 

 of the face, a part the least calculated to bear the force necessary to 

 make the head turn forwards. 



1006. It is therefore indispensably necessary to stimulate the ac- 

 tion of the womb or that of the abdominal muscles; as the efiorts of 

 the woman oblige the anterior or mental branch of the sort of lever 

 represented by the head to descend first, the least pulling at the jaw 

 in a direction from above downwards is then very efficacious; those 

 tractions, on the contrary, which the accoucheur exerts on the trunk 

 of the body, being more particularly transferred to the occiput, tend 

 naturally to produce the inverse effect of the one we wish to obtain. 

 It is therefore essential not to pull, except upon the face, whether 

 there be any pains or not, until we have brought the occipito-bregma- 

 tic diameter of the head to correspond with one of the diameters of the 

 pelvis. 



1007. To the inconvenience of a reversion of the head there is 

 sometimes added another that never fails to be embarrassing; instead 

 of looking backwards and to the left, or directly left, the face is 

 sometimes found to turn more or less in front, or directly backwards, 

 so that the neck is twisted round on its own axis. In this state of 

 things all tractions on the trunk of the body would be dangerous. 



