460 DYSTOCIA. 



and along the posterior surface of the thighs; the thumb is placed on 

 the anterior and the fingers on the posterior hip; or, where the foetus 

 is still very movable, and very high up, it is enough to apply the 

 thumb under one of the ischia, and the fingers under the other; the 

 pelvis is then pushed towards the iliac fossa that corresponds to the 

 hand that is made use of; then by passing along on the outer surface 

 of the limb that is nearest the sacrum, the feet may be got hold of 

 and brought down, so as to allow us to embrace the forepart of the 

 legs with the hand, and deliver, as in a corresponding position of the 

 feet; that is, in the first if the left hand is used, and in the second po- 

 sition if it is the right hand. 



1039. In conclusion, the raancEuvre of the pelvis presents us but 

 two particular indications: 1. To draw it down with the fingers or 

 blunt hooks, when it is too low down to be pushed back again; 2. 

 To displace it whenever the thing is possible, so as to let the feet 

 pass down first. In both cases, when we employ only one hand, the 

 palm of which is directed so as to slide up along the child's abdo- 

 men and breast, we surely require for our guidance only the follow- 

 ing rule; that the fingers shall always be applied to the ischium or 

 hip that is opposite, and the thumb to the ischium or hip that corres- 

 ponds to the hand that is operating. Were the limbs found to be rever- 

 sed upon the dorsal surface, instead of being turned towards the abdo- 

 men, the thighs, should be acted on as we do on the arms, when dis- 

 engaging them at the inferior strait; the thumb fixed in the groin might 

 serve as a point d'appui; the fingers being moved along towards the 

 ham, would represent the power, and the knee would be obliged to 

 descend, drawing the leg along with it. The two limbs ought thus to 

 be brought either together or in succession, to their natural position. 

 In whatsoever way they may present, it is always better to make 

 them descend together, than one by one; however, where too much 

 difficulty is experienced, it would be imprudent to persist in endea- 

 voring to make them descend simultaneously. If one of them should 

 have already escaped, the anterior one for instance, and it should 

 be impossible to get the other one down, the delivery, in most 

 cases, would not be rendered on that account much more difficult: 

 it should be made use of to draw down by, while the index and 

 medius fingers, or a blunt hook, should be applied to the posterior 

 groin, as has already been mentioned. If, on the other hand, the 

 anterior member only should be retained at the superior strait, it is 

 still more important than in tlie former case to draw it near the other 

 limb, because we cannot so readily reach the groin in this situation, 

 and especially because the action of the blunt hook is not so advanta- 

 geous. 



1040. Remarks. In concluding this article, I shall take the liberty 



