After drawing the feet through the ostium vagina, and when the turning is completed, which he will know by exploring with the right

hand the form of the abdomen, and by perceiving that the hips of the child are engaging in the excavation, he should, if he draws at all by the limbs, make his chief effort of traction by means of the right leg, as in Fig. 101. By acting in this way he will cause the child's face to turn towards the left sacro-iliac junction. Before the turning, it looked towards the right sacro-iliac junction. Let him look again at Fig. 101, to see how he would make the face of the child come to the front of the pelvis if he should incautiously make tractions upon the left foot only.

When he has extracted the child as far as the navel, let him do what is represented in Fig. 102, that is to say, let him carefully draw down a considerable loop of the umbilical cord, so that no danger may be incurred of breaking it or tearing it out by its roots at the umbilical ring.

The patient should now be turned upon her back, and the child's legs should be wrapped in a napkin, to hold them securely. As soon as a good part of the thorax is expelled, let him pass two fingers upwards to the top of the shoulder that is most within reach, raising the body of the child upwards towards the woman's abdomen if he desires to get at the posterior shoulder, or depressing it towards the sacrum if he wishes to act on the anterior shoulder. Sliding his

Fig. 103.

fingers from the acromion as far as he can towards the bend of the elbow, let him force the elbow downwards, causing it to sweep along the breast of the child. As soon as the elbow is withdrawn, the hand will come forth and the shoulder be extricated, after which let him proceed in like manner with the remaining shoulder, using the fingers of the other hand as in Fig. 103.

Both shoulders being delivered, let the Student next raise the trunk of the child upwards towards the mother's abdomen, much higher than is represented in the annexed design, Fig. 104. It is extremely important not to forget this rule. What the Student wants at this point, is a great flexion of the head; let him, therefore, carry the breast far away from the chin by turning the child's trunk upwards towards, or even on the mother's abdomen,

as above directed, and then introducing one or two fingers into the child's mouth, let him pull the chin towards the uplifted breast of the child-thus restoring the chin to the breast. As a general rule, this manœuvre will effect the desired flexion; not always so, however, for the mouth sometimes may be

opened very wide, yet the upper maxilla not descend to close upon the lower. Let the Student, in this case, push the vertex upwards by means of two fingers inserted behind. the symphysis, and then, with a finger on each side of the nose, pull the superior maxilla downwards, to make it shut the mouth. The occipito-mental diameter, see-sawed in this manner, will be made to coincide with the axis of the inferior strait, whereupon, pulling by the shoulders with one hand, and by a finger in the mouth with the other,

Fig. 104.

the head may be withdrawn in a direction coinciding with the curve of Professor Carus.

Should the resistance to the escape of the head be too considerable,

and the child's life in danger from the delay, two fingers of the k hand may be passed into the vagina as high as the malar bones, one finger on each side of the nose. The fingers being now somewhe flexed, will thrust the posterior wall of the vagina away from the mouth and nostrils, giving free access of the atmospheric air to th orifices: the child, though unborn, will ery, and allow time for the patient to rest, and for the accoucheur to consider of his duty. I have heard this vagitus vaginalis for many minutes, and, indeed, b in this manner enabled the child to continue breathing until r forceps could be brought, from a considerable distance, to deliver t head. As to the manner of applying the forceps in this case, I rez the Student to the chapter describing the uses of that instrument.

The Stu lent ought carefully, yet promptly, to decide upon the of duty under the sudden emergencies of this sort of labor. To the matter before him in a clear light, let me reiterate the precept turn and deliver if the head be not in the vagina, and to delivery the forceps if it is wholly expelled from the mouth of the womb. 1 he should make a mistake as to these points of duty, he might inf serious injury upon his patient, by passing the blades of his instr ment within the contracting bands of the cervix uteri; or, on other hand, he might allow her to bleed to death from hemorrhag while expecting the return of the messenger sent to bring his fʊrap from the distance of half a mile.

the

I was sent for to assist a gentleman waiting upon a woman in laby and arriving at the spot in a very few minutes, found both the c and the mother dead upon the bed: my friend, the accoucheur, t me that he had been sent for with an urgent request to hasten to house, but being absent from his office, considerable delay occurred: when he came to the bedside, he found the woman flooding danger. ously, and much exhausted by the loss. Perceiving the exigency her case, he dispatched a messenger for his forceps; in the mean time the flooding continued. When the forceps were put in his hands, be was baffled, as he told me, in adjusting them-the head retreating wards whenever he attempted to apply them. After the loss of 12 additional portion of time-a fatal loss-he succeeded in seizing the head, and delivering the child, which was dead. The mother expire very soon after the birth of her infant. Suppose he had turned and delivered by the feet!

CASE.-Some years ago, I was engaged by a tailor to take care d his wife in her approaching confinement: he was an avaricious follow, who disliked nothing more than the paying of a fee. In the mi

f the night, his wife was seized with the pains of labor, which imhediately became violent and expulsive. He ran for an old woman the neighborhood, who arrived just in time to receive the child, which she severed, and immediately proceeded to wash and dress it, eaving the woman lying upon the bed. "Ah-ha!" said the tailor, this is a very good thing; we'll cheat the doctor out of his fee." And so he rejoiced and was very glad; but in a short time the poor roman fainted, and remained a long time insensible; whereupon, he ame for me in furious haste, telling me that his wife was either dead r dying, and begging me, for God's sake, to give her speedy assistance. I soon reached the apartment, and found her speechless and pulseless, and pale, and lying in a puddle of coagula and fluid blood. Placing ny hand upon her abdomen, I found there was another child there. I now took away all her pillows; opened the windows; dashed water freely upon her face and neck; and with difficulty succeeded in getting down a few swallows of strong brandy and water. The head presented; I ruptured the membranes, and passing my hand upwards to the feet, seized them, turned and delivered the child, and immediately afterwards removed the placentas. I was for some time doubtful whether she would live or die, but she finally rallied under stimulation, and got quite well.

I think that four minutes had not elapsed from the time that I reached her apartment until the child was delivered. Suppose that, like my friend mentioned in the former case, I had sent to my house for the forceps, would my patient have survived? Suppose he, instead of sending for his instruments had immediately delivered her by turning, would he have lost both the mother and her child? It is said, that it is the last straw that breaketh the mule's back. It might as truly be said, that it is the last ounce that kills in the uterine hemorrhage.

Having now described the operation for delivery in preternatural labors, the head presenting in the first vertex position, I have to indicate the method of proceeding in the other positions of the vertex. In all important particulars of the management, the former directions may be regarded as sufficiently full. But, as in the second position, the face of the child looks towards the left sacro-iliac symphysis, it is necessary, on that account, to employ in the turning the RIGHT HAND, and not the left hand, as before.

By introducing the right hand for the operation, the head will be pushed out of the plane of the strait to the right upwards, and made to lodge in part upon the brim, and in part upon the wrist and inner face

and the child's life in danger from the delay, two fingers of the left hand may be passed into the vagina as high as the malar bones, one finger on each side of the nose. The fingers being now somewhat flexed, will thrust the posterior wall of the vagina away from the mouth and nostrils, giving free access of the atmospheric air to those orifices; the child, though unborn, will cry, and allow time for the patient to rest, and for the accoucheur to consider of his duty. I have heard this vagitus vaginalis for many minutes, and, indeed, have in this manner enabled the child to continue breathing until my forceps could be brought, from a considerable distance, to deliver the head. As to the manner of applying the forceps in this case, I refer the Student to the chapter describing the uses of that instrument.

The Student ought carefully, yet promptly, to decide upon the line of duty under the sudden emergencies of this sort of labor. To set the matter before him in a clear light, let me reiterate the precept, to turn and deliver if the head be not in the vagina, and to deliver by the forceps if it is wholly expelled from the mouth of the womb. If he should make a mistake as to these points of duty, he might inflict serious injury upon his patient, by passing the blades of his instrument within the contracting bands of the cervix uteri; or, on the other hand, he might allow her to bleed to death from hemorrhage, while expecting the return of the messenger sent to bring his forceps from the distance of half a mile.

I was sent for to assist a gentleman waiting upon a woman in labor, and arriving at the spot in a very few minutes, found both the child and the mother dead upon the bed: my friend, the accoucheur, told me that he had been sent for with an urgent request to hasten to the house, but being absent from his office, considerable delay occurred; when he came to the bedside, he found the woman flooding danger. ously, and much exhausted by the loss. Perceiving the exigency of her case, he dispatched a messenger for his forceps; in the mean time the flooding continued. When the forceps were put in his hands, he was baffled, as he told me, in adjusting them—the head retreating upwards whenever he attempted to apply them. After the loss of an additional portion of time-a fatal loss-he succeeded in seizing the head, and delivering the child, which was dead. The mother expired very soon after the birth of her infant. Suppose he had turned and delivered by the feet!

CASE. Some years ago, I was engaged by a tailor to take care of his wife in her approaching confinement: he was an avaricious fellow, who disliked nothing more than the paying of a fee. In the middle