464 DYSTOCIA. 



forehead towards the sacro-iliac symphysis or obturator foramen of 

 the side where there is the least pressure; but should some new diffi- 

 culty arise, rendering the immediate termination of the labor neces- 

 sary, the forceps would be applied, without regard to the presence of 

 the arm. 



In case the hands should present at the same time with the feet, 

 they doubdess would not long maintain their position; the contrac- 

 tions of the womb would soon force them to rise, by urging the 

 breech down. Besides, in order to obviate all cause of alarm, it 

 would be merely necessary not to confound them with the lower 

 extremities, and to pull upon the latter until the hips had come 

 down. 



Pean and Deleurye have advised, where an arm and shoulder fill 

 up the orifice too exacdy to allow the hand to reach the child's foot, 

 that we should begin by bringing down the other arm, so as to en- 

 able us to penetrate more easily into the womb. This precept has 

 been the object of much criticism: it has been said that two arms 

 must necessarily occupy more space than a single one; that by bring- 

 ing a second one alongside of the first, instead of overcoming the ob- 

 stacles, we should only increase them; and that, if the hand may be 

 carried up as far as to the arm that has not yet escaped, there is no 

 reason why it could not reach to the feet themselves. 



I have had no occasion to repeat the practice of Deleurye in this 

 respect; nevertheless, it seems to me to have been proscribed pre- 

 viously to being sufficiently examined. Baudelocque is, assuredly, 

 deceived, when he maintains that it is always as easy to reach the 

 feet as the arm that is still retained above the orifice of the womb; 

 the arm may be near enough to be seized with two or three fingers, 

 whilst the feet always require the whole hand to be introduced, and 

 most commonly to a great depth. By pulling upon the second arm 

 we tend to make the engaged shoulder mount upwards, and to con- 

 vert a position of the lateral surface into one of the sternal surface, 

 or dorsal surface, and I can conceive that in some cases there would 

 result an increased facility of passing the hand and of performing 

 the remainder of the manceuvre. 



But what shall I say of Dr. Davis, who recommends us in certain 

 cases of arm presentation to terminate the delivery by means of em- 

 bryotomy! of Douglass, and of Sims, who profess the same senti- 

 ment; and above all, of Dr. Lee, who, to spare the mother, sepa- 

 rates the arm from the body, perforates the thorax, fixes a crotchet 

 upon the pelvis or inferior part of thefcetal spine, and by means of 

 sufficient force thus extracts the child J as if this operation were 

 not an hundred times more dangerous, even for the woman, than the 



