454 DYSTOCIA. 



forwards, as if to make the spine turn upon its own axis; then trying 

 to reach the right side by passing along the front of the chest, while 

 the womb is forcibly pushed backwards with the left hand; lastly, 

 in taking hold of the feet, the right one first, so as to bring them 

 down in the first position. 



1022. In conclusion, all the positions of the leftside may be ma- 

 ii03uvred with the left hand. By not losing sight of the rule that the 

 thumb should always correspond to the sternal surface, the fingers to 

 the dorsal surface, and the cubital edge of the hand to the child's 

 head; by remembering that previously to going in search of the 

 feet, the head ought to be moved as near as possible to the left iliac 

 fossa, the practitioner will be aware of every thing that it is essential 

 to know concerning the manoeuvre for the left lateral surface. Should 

 he make use of his right hand, as his first object would be to raise 

 up the left shoulder, so as more readily to reach the right shoulder 

 and side, the case would evidently be converted into a right shoulder 

 position, properly so called, which I am now about to treat of. 



2. Positions of the Right Shoulder. 



1023. What I have now said of the left shoulder positions bein^ 

 strictly applicable to those of the right shoulder, it would be super- 

 fluous to enter upon new details concerning the latter. I shall merely 

 remark, that in the present case, the right hand performs the part 

 which was entrusted to the left in the former case; that the head is 

 to be moved towards the right iliac fossa previously to searching 

 further for the feet; lastly, that the foetus should be delivered in the 

 first and not in the second position of the feet. After all, to save 

 the necessity of particular description, in shoulder positions it is 

 enough to remember that the right hand always goes to the right 

 side, and the left hand to the left side, and that in all cases, tlie 

 fingers ought to be situated in regard to the foetus as has been 

 already mentioned. 



I will, however, observe, that these rules cannot be absolute; that 

 a knowledge of them merely renders the operation rather easier 

 that they may be modified in a great variety of ways; that they are 

 principally established for young physicians who are as yet insuffi- 

 ciently enlightened by experience, and wiio require a certain num- 

 ber of clues to lead them through the labyrinth of practice; lastly, I 

 will state that in cases where the hand is carried into the womb pre- 

 viously to the rupture of the membranes whether the child presents 

 with its right side or its left side, and in any position of the shoulder 

 whatever, we may arrive at the feet directly, and almost with equal 

 facility with either hand. 



