DVSTOKIA DEPENDING ON ANTERIOR PRESENTATION. 453 



Indications. 



There is no difficulty in adjusting the head, if the obstetrist is called in 

 time, and it is movable towards the pelvic inl^t, but not engaged in that 

 opening. It is merely necessary to glide the hand along the floor of the 

 vagina into the uterus, pass it between the maternal pubis and the fore- 

 head of the foetus, downwards to the nose, which is to be received into 

 the hollowed palm and raised above the pubic brim, by flexing the wrist 

 and drawing it towards the vulva. When the nose is brought into the 

 genital canal, nothing more is' to be done than to pull the head into the 

 passage and complete delivery in the usual way. With the calf, whose 

 muffle is wider and cannot be so readily received into the palm of the 

 hand, it is better to introduce the fingers into its mouth, using them like 

 a blunt hook, or to seize the nose by pushing the index finger and thumb 

 into the nostrils, so as to throw the lower part of the head upwards. 



Anterior Presentatio> 



Fig. 116. 

 Extreme Downward Deviation of the Head. 



When, however, through delay or unskilful attempts at delivery, the 

 nape of the neck is firmly engaged in the inlet, there is no room to ad- 

 just the head, the lower part of which is jammed against the maternal 

 pubis below, and the vertex against the sacrum above. In such a case 

 delivery has been effected by passing the running noose of a cord round 

 the nose or the upper jaw of the foetus, and while an assistant pulled at 

 this, the operator, by pressing strongly against the top of the head, made 

 this swing backwards, the nose rising into the passage ; birth was then 

 accomplished in a few minutes. 



And ev^en with this degree of head deviation, delivery of the foal with- 

 out adjustment is not impossible : for Lecoq, quoted by Saint-Cyr, gives 

 an instance in which the upper part of the head and poll jvere so firmly 



