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iritcrnura: ir til;;: b:-ccch is dcuin:d "bo\'c che brim of lile
rl!lvis. Jet him (l:de up th~ ih t cf his hand ~lon6 lhe bu:
tocks. anu rull dowlI Ihe 1c..'!!Swith I:'C olh er hllnd í by
" ll ieh mClhod th~ bn,:ch is difcnria,Jcd ami f<lrced int o
t h" m;ddle 01 .h. pelvis. S<c Pl,tc CX lll. fig. 3·
I n mof! .of thof, cafcs " h'. re thc child is preJlcd in'an
O\:al formo ir n~ith( r lhe hcad or brccch pn:feOf , tht: hc~d
is lO one fidc of lhe u'e: U~, an.:t Ihe brecch tú lhe o!hcr;
b.::c.i ufe it is wider fronl fide tu (jdc, lh::.n frcm lhe b:\ck
ca Ihe rore lurt i and ir eithu lhe hcad or breeeh is over
the os pubis, tht other is turncd off la ,he liJe: in 010 '
"ino thl! hcaJ or th:lUlders la {he fu ndus, thcy are ra¡red
wlth cre~tu cafe along lhe fide, (han· at lhe uack or rore
f :\rts, ror ¡he f.1me re:Lfons. .
H the hcad and r.lOuIJ,,, lidoIVer dOIVn, fa as lo hin·
der'the brr.ech (roln co'ning ¡long, :lnd lhe les, from be·
ing extr;¡éted, Jet him pL:OI up [he hc;td and fhoulders tO
t'te fundu5, ano pull OUt the Jc~s; then [ry 10 bring in
the br' eeh; aqd if it nill !ticks above, bec.ufe the head
a"d fhouJders are ~g::tin foreed clown by rhe éontfotétion
"r the uterus, he muf! with one haod t ak~ hold of the
J"'gs th at are no\\' ,;ti.hoUl the os externUIH, and, fliding
lhe othcr into ,he meros, pufh the t)e-au ano Choulders a–
gOl:n up lO [he fun¿us, ",hiJ(', M lhe (ame tim~, he pull,
, he legs and along with the fcet. If the legs can·
not be brought fanhc:r down than the ,acina, becaufc the
breech 1S high up, Jet him fl ip a noeJe over lhe (eel round
the anclC! , as befare obferved ; by whieh he may pull
dO~'n lhe JOW'er parts with' Qne: hand, whiJe lhe othcr ¡s
cmrloyed in pulhing up, 2S befare. By Ihis double puro
clufe, the child may be turoed «en in thé mof! diffieult
cafes : but the 0rerator, in pulling, mun bewareof ove~
ffraining the ligarnents of lhe joinu.
If lhe legs can be extr:¡(ted lhrough the os externum,
Jet a fingle cloth,.warmed , b. wrapped round th.m, in
order ro yi~Jd a firmer'ho!d tO the accoucheur ; but wheo
they can be brought DO lowu chan the neck of lhe-Uleru,
anj vagina, h. may ufe one of thefe fo llowLng noufes .
. L et "im take a nrong limber """, or foft g.rter h3lf·
worn , about one yard .nd an halr in length, 2nd mode·
ralely broad and Ihick ; if thick, .n eye may be m, d" at
one end of it, by doubling al>out two inche:, 2nd fcwing
it f!rongly ; and the orher rnd p', tfcd tnrough rhis don·
bliog. in order to m:\ke th~ noofe:; which being monnted
upon the thumb and finger. of hi. hand, mur¡ be introdu·
ced, and gently nipped over th: toe, aod feet of the child
fo as to embrace lhe andes, anu lhus applied it mu!l ba
dl':lwn tight vlith his mher hand ,
If the fON or fcet lhould be fu Oip?ery, that !t,s finge ••
canrot hold thcm, and work O\'er the onoft,! at the fame
time. it mua be withdra',vn and r.lounted round his lund
or 't".'rifi-; with which hand, \l,'11en introduced, he may
fake firm hold 00 both rcer, ir they ate as fM clown as
the v:lgína; then \'Jith the fin r;ers of his other hand, he
can /l,d. the noofe alonl: the hand anJ fi ngers .hat hold
the (eet, and lix it round the and e: but ir one:: root re·
mai ns wit!-;in the uterus, the fin gers of his othe r
C,l nnot rulb up lhe: nooCe (ar cnough tO nide it ovcr Ihe
ande : Ca ihat he mull have: rt:courfe to a dir..:ltor, like:
that for pc,Jypufu , mounted with lhe n('ore, whic.:h will
pUnl it along the hand amI fingers tbat holJ til e roOt , T he
F E H y,
noore' bc;n,!j thus í1ipp~ci over lhe fin~e:rs uFon [he ancle.,
he.: O1Il:l r\l!! lhc c:<trcraity of lhe 611 et ",hieh híuh p:\(fed
the: ",ye at the upper cnd of the dircél:or. and aCter il .is
ciofe: dr:\wn, l>ring down li,e innrument.
If the 611et or garter is too n2f10Wor thtn, Jet it be
doubled in the middle, ,nd .h. noof< made by palling the
11,1,'0 t'nds \hrough the doubJing.
\VIren the bclly p"fenu, and the h<ad , lhouldcrs,
brcech, thighs, and legs, are turncd up ayer lhe oack lO
th~ fundus uler;; when ~he oack prerents, and all there
parts are upwards; whcn lhe fide preJents, w;th [he head,
Ih oulders, breeeh, th ighs and lel:' turned to the lid: .
back, or fore part of Ihe uterus :-In 2011 there caCes, when
th. ehild is prttfed into a round, <>r (more prop<rly) an
oval figure. ¡l may be, for the mon parl, moved round,
with onc halld inlroduced into lhe: uterus, the head and
lhou lders pulhed tO the fundus , and the lego and breeen
to the os ¡nteroum; which being efFe8:ed, lhe Jegs are
eafily brollght down . See Plate CXIll. fig. 4. Bu,
tbefe caf!s are more or lefs difficult a. the feet are farther
up, or Jower dowo, becaufe the bulinef. is to bring them
downwards.
WheD the breafl, Choulde:rs, neck, e:ar, or filce pre–
rent to the: os ¡nteroum , the breeeh, thighs, and lega
boio¡: tOwards tbe fundus, wi.h the fore parto of tbe fa:.
tu s turned either to the fid e. baek, or (ort:-part of the
\Vom.n's belly ; and the whole Iyiog in 'a longilh form,
the uterus bein¡: c10rcly eontraéted around its body like
a flH:ath; let the aceouchel! r introduce: his haDd iota the
vagi na, anJ opeo the: os intcrnum by puChiog up the bD'"
gen and h. nd B.ttened betweeo the parts <hat prefeo'
and the iofide of the membranes; and rell hi. hand io
Ihu 'fitu:uion. until he can diflingu iCh how lhe child lies,1
and forro a-right judgment how to luro and deJiver ; for,
ir thefe ci rcumflallce, are not m~turely conCidered, he will
begin to work in a confufed manner, fatigue himfclf and
the patient, aod fiod great difficulty iD turniog and ex–
tr.éting the child .
If .he feet aop leg. of the fa:tu. lie toward. tbe baek,
fiJ~" or funtius merí, the: woman ought to be bid on her–
bock, wi.h her breech raifed and 'hrought a little over
the bed, as formerly obfcrved; bec.ufe, in tbat poútion
he can more eafilJ rea~b the fee, thao in any other.
If they Jie' towards theJor<. part of th,. meru., efpe.
eially when th. belly is pcnd lllou. , lhe ollght to lie upon
her {ide; be:caufe:: in the other poflure; ir is oCten difficult
to tur~ the hand up to the rore-pul of lhe . womb;
whercas, if Ole is laid on the fide , the ri¡;ht h. nd
may be introdueed at the "PP" pa" .nd left fid: of the
brirn of toe pelvis. where it ¡s widdt. and then along
tlle: Core-part of the uterus, by which me;¡ns the fcel are
more cafily come aL If it is more conve:nil!nt for lhe
accoucheu r w ure his J~ft hand. lhe pat-ieol nlAy be turo.
e:a on her ritlH fide o Thlo! only inconvenience attend,ng
Ihc(c pofitions, ¡s, that the woman cannot be kept fo
/irm .nd neady, but will be 'pt to tof. about and n"ink
flom the oper.uor: and befides, thc:re m"y be a neeeffity
{Oi turning her upOr1 her uack, ;tfter the body is ddiver–
<d, befare he can extraél the head, efpecially il it be'
lar~c, or lhe pch'is narrow.
The. utuation of th: chi!d bein;; kUOIVD, and the pofi.ion,
ar,