But if these things have not the desired effect, and the woman’s danger increases, let the surgeon use his instruments to dilate and widen the womb, for which purpose the woman must be placed on a chair, so that she may turn her buttocks as far from its back as possible, at the same time drawing up her legs as close as she can and spreading her thighs open as wide as possible; or if she is very weak it may be better to lay her on the bed with her head downwards, her buttocks raised and both legs drawn up.  Then the surgeon may dilate the womb with his speculum matrices and draw out the child and the afterbirth together, if it be possible, and when this is done, the womb must be well washed and anointed, and the woman put back to bed and comforted with spices and cordials.  This course must be adopted in the case of dead children and moles, afterbirths and false births, which will not come out of themselves, at the proper time.  If the aforementioned instrument will not widen the womb sufficiently, then other instruments, such as the drake’s bill, or long pincers, ought to be used.

If any inflammation, swelling or congealed blood happens to be contracted in the womb under the film of these tumours, either before or after the birth, let the midwife lance it with a penknife or any suitable instrument, and squeeze out the matter, healing it with a pessary dipped in oil of red roses.

If the child happens at any time to be swollen through cold or violence, or has contracted a watery humour, if it is alive, such means must be used as are least injurious to the child or mother; but if it be dead, the humours must be let out by incisions, to facilitate the birth.

If, as often happens, the child is presented feet foremost, with the hands spreading out from the hips, the midwife must in such a case be provided with the necessary ointments to rub and anoint the child with, to help it coming forth, lest it should turn into the womb again, holding both the infant’s arms close to the hips at the same time, that it may come out in this manner; but if it proves too big, the womb must be well anointed.  The woman should also take a sneezing powder, to make her strain; the attendant may also stroke her stomach gently to make the birth descend, and to keep it from returning.

It happens occasionally, that the child presenting itself with the feet first, has its arms extended above its head; but the midwife must not receive it so, but put it back into the womb, unless the passage be extraordinarily wide, and then she must anoint both the child and the womb, and it is not safe to draw it out, which must, therefore, be done in this manner.—­The woman must lie on her back with her head low and her buttocks raised; and then the midwife must compress the stomach and the womb with a gentle hand, and by that means put the child back, taking care to turn the child’s face towards the mother’s back, raising up its thighs and buttocks towards the navel, so that the birth may be more natural.