SHOULDER PRESENTATIONS. 455 



B. Presentation of the Sternvm. 



1024. The cephalo-pubic position (1st of Baudelocqiie) of the 

 sternum might, rigorously, be as well reduced to the left cephalo- 

 iliac, as to the right cephalo-iliac position; but it is generally reduced 

 to the latter, because it terminates it in the first position of the 

 feet. 



1025. In the right cephalo-iliac position (4th of Baudelocque) the 

 right hand must be made use of; it is to be introduced supine if the 

 head is in front, prone if in the contrary situation, and betwixt these 

 two attitudes provided the head be fairly to the right. The part that 

 is engaged must always be pushed back until the trunk of the foetus, 

 instead of being convex on its anterior face, shall become concave; 

 then the operator should endeavor to reach the right shoulder be- 

 hind which the fingers are to be applied, while the thumb rests on 

 the anterior surface of the thorax; afterwards, nothing more remains 

 to be done except to swing the bis-acromial diameter, so that its pos- 

 terior extremity may turn downwards, by acting upon it as upon a 

 lever of the first kind, whose fulcrum is represented by the thumb, 

 and the power by the fingers; this being done, the position difl'ers 

 in no respect from the corresponding one on the right side, and is to 

 be managed in the same way. 



1026. In the left cephalo-iliac position (3d of Baudelocque) the 

 left hand does what the right should do in the opposite position; it 

 pushes up the breast, gets hold of the left shoulder, draws it down 

 a little, and if the head were too far from the iliac fossa, it brings it 

 nearer to it, obtains a dorso-sacral position of the left shoulder, and 

 the rest of the manoeuvre presents nothing of a special character. 



C. Presentations of the Back. 



1027. Right cephalo-iliac position. If the head is to the right, in 

 front, or to the rear, in positions of the back, the right hand is to be 

 made use of as in positions of the sternum, and according to the same 

 rules. Consequently, it is introduced half prone, supine, or more or 

 less completely prone, accordingly as the head looks to the right, in 

 front, or to the rear; but in such a manner that the thumb may al- 

 ways pass in front of the right shoulder and breast, Avhile the fingers 

 rest upon the dorsal surface. In the first place, this shoulder is to be 

 brought down so as to make the other rise; it is then to be repelled, 

 by acting on it as upon the end of a powerful lever, which the thumb 

 tends to move and to oblige the foetus to turn on its great axis, until 

 the position of the back is converted into a corresponding or dorso- 

 sacral position of the right shoulder. 



This movement requires great care, for if the head does not go 



