Obstetric Operations 639 



While the fetus is being repelled, the assistant draws upon the 

 cord and advances the foot. The carpus, by this process, and 

 With the aid of the operator, passes into the lumbar region, 

 directed obliquely outwards and upwards into the upper portion 

 of the flank in order to afford the greatest possible amount of 

 room. The carpus (or tarsus) must not, for this purpose, abut 

 against the unyielding lumbar vertebrae or lateral processes, but 

 must be pushed outward against the yielding flank, and room 

 thereby afforded for the necessary extension of the foot. At the 

 proper time the operator inserts his hand, palm upwards, be- 

 tween the pubic brim and the foot of the fetus; grasping the toe 

 in the palm of his hand, the assistant, by the operator's direction, 

 applies traction upon the cord, and the foot glides over the pubic 

 brim, to become extended in the pelvic canal. 



Should the anterior limb be completely retained, instead of 

 merely flexed at the carpus, the procedure is similar. The foot 

 is now wholly out of reach, and the forearm can be reached only 

 with difficulty, or not at all until repulsion has occurred. When 

 sufficiently repelled, the forearm is grasped with the hand and 

 corded while the repulsion is continued, and the carpus is 

 gradually drawn up until it comes against the pubic brim, when 

 its further correction is carried out in the same manner as above 

 suggested. 



Similar rules apply to the corrections of the deviations of the 

 posterior limbs; .that is, the fetus must be repelled from the pelvic 

 inlet, and that part of the limb which can be reached must be 

 corded and brought up. This in itself acts as a repellant to the 

 fetal body, and Anally the tarsus is pushed obliquely outwards 

 and upwards into the upper flank region, the pastern corded, and 

 the toe, enclosed in the hollow of the operator's hand, is guided 

 over the pubic brim and extended in the pelvic canal. 



These changes in position constantly require a careful applica- 

 tion of mechanical principles, and are to be carried out with 

 caution. The work should be done as gently as possible, in order 

 to avoid arousing violent expulsive efforts. When they do occur, 

 and constitute too great an obstacle, they should be overcome by 

 such means as those suggested on page 619. While generally 

 we would brii^g about these corrections without haste, when we 

 reach a critical poirtt it is frequently essential that they should be 

 accomplished very promptly. Thus, when the carpus or tarsus 



