DIFFICULT PARTURITION. 235 



each of these points, or both flexed at the same joint, which nia> 

 be either hock or stifle. 



ASSISTANCE. 



What may be needed. — i'lcnty of bland oil, e. g., linseed, 

 two small window cords with smooth loops in one end of each to 

 loop around limbs ; one similar rope with short sharp hook in end 

 to hook in under jaw, or eye socket; a pair of small combination 

 pulleys, an embryotomy knife, large trocar and canula, some anti- 

 septic, e. g., creolin to be used in 4% solution for hands, instru- 

 ments and ropes. 



Suggestions. — Do not interfere until the water bag has rup- 

 tured spontaneously unless labor pains have continued for several 

 hours and water bag' does not appear. If the water bag ruptures, 

 in a natural way, and the head for example should present without 

 the feet, or the head and one foot, or if one hind foot presents 

 and not the other, or any evidently faulty presentation occurs, then 

 it is time to examine and plan for assistance. 



The first thing is to oil the arm and examine carefully to 

 learn the cause of trouble and position of foetus. Then decide 

 what you will do and how. If the condition is such that the de- 

 livery will probably be long and tedious, with the patient strain- 

 ing violently, it may be desirable to abate the labor panis with 

 tincture of opium. Otherwise it will be much better and labor 

 over sooner if the opium be not given. The rectum should also 

 be examined as the hand goes into the vagina, and if distended 

 should also be emptied. 



The patient should stand or lie with head down hill. It is 

 always much easier to operate with the patient standing. Be pa- 

 tient and not in too great a hurry, and make up your mind that 

 you will succeed be it ever so difficult. When missing members 

 are secured and ready to pull, pour plenty of oil, or in the absence 

 of oil warm water into the uterus, by means of a funnel and rubber 

 tubing. The parts that will offer friction are probably dry by this 

 time and should be freely oiled or moistened. 



It is frequently necessary to shove the foetus forward into the 

 uterus in order to secure and straighten some missing parts, and 

 for this purpose a smooth broom handle with a short brad in one 

 end will do fairly well; but the hand of the operator must be 

 guarding it, for fear it will slip and tear the mother. This is an 



