456 DYSTOCIA. 



with the trunk, the cervical portion of the spinal marrow runs the 

 greatest risk of being lacerated, or violently twisted in the second 

 stage of the operation; this danger is to be avoided as far as possible, 

 by pushing the chest very far backwards and upwards, so as to give 

 great depth to the curve of the anterior surface of the foetus; or if it 

 should be absolutely necessary, by getting hold of the head itself to 

 force the face to turn forwards and downwards. 



1028. Left cephalo-iliac position. The left extremity of the bis- 

 acromial diameter is taken hold of, the fingers on the back, and the 

 thumb in front of the left shoulder or sternum, and the cubital edge 

 turned towards the occiput; while the trunk is turning on its oc- 

 cipito-coccygeal axis, we should endeavor to comprise the head ia 

 the movement, and, if necessary, bring it near to the iliac fossa. In 

 one word, the left hand here acts as the right hand does in the oppo- 

 site positions; it converts positions of the back into positions of the 

 left side, which it afterwards terminates by delivery in the second 

 position of the feet. 



SECTION 3. 



Of the Manoeuvre in Presentation of the Pelvis. 



The manoeuvre in positions of the pelvis reduces itself in some 

 sort to that of the last stage, or stage of extraction, in the head or 

 trunk positions; I need therefore only add a few words to what has 

 been said farther back, in order to conclude all that concerns it. 



1029. Although, strictly speaking, the right hand might be easily 

 made use of in all the positions which it is proper to terminate by 

 the first of the feet positions, and the left only in the opposite cases, 

 it is, notwithstanding, better to do the very reverse. We can, with 

 the right hand, in all the right dorso-pelvic positions, push up one 

 buttock, or even both of them towards the right iliac fossa, reduce 

 inclined to central positions, and take hold of the limbs by their an- 

 terior surfaces, without being obliged to assume an awkward atti- 

 tude; whereas with the left liand the breast could not be raised with- 

 out difficulty, and it would be still less easy to reach the feet, if they 

 were not at some distance from the orifice. Lastly, by using the 

 hand that corresponds to that side of the mother's pelvis towards 

 which the child's heels are to be turned, while coming down, a half 

 prone position brings the palmar face of the fingers in front and on 

 one side; the operator is consequently in the most favorable condition 

 to prevent the back of the foetus from moving towards the sacro-iliac 

 symphysis, and on the contrary, to compel it to turn towards the 



