i68 DVSTOKTA, 



gentleness possible. The foetus may present in a variety of positions, in 

 which hind and fore limbs may offer first, either alone or together ; and 

 in the case of twins or monstrosities, the limbs of different creatures may 

 be encountered at the same time. If the presentation is anterior, the heacl 

 will be met with, and this is distinguished by the presence of the mouth, 

 eyes, and ears ; if it is a posterior presentation, then we have the rounded 

 croup, tail, hocks, and external genital organs. In other presenta- 

 tions, the neck is recognized by the mane, if it be a foal, in addition to 

 its shape, whether foal or calf ; the shoulders by the acromion processes 

 and withers; the chest, by the ribs and intercostal spaces ; and so on. 

 In addition to all this, the obstetrist should judge at the same time of 

 the volume of the foetus and its proportions. This is particularly 

 necessary in the case of monstrosities ; and in some instances it 

 is most difficult to decide what the hand may light upon in such an 

 examination. Kopp alludes to the case of a Mare which he examined 

 during parturition, when he found a foetus affected with hydroceusphal 

 to such a degree that for a long time he thought its head was the thorax. 



It cannot be too strongly impressed upon the minds of those who are 

 commencing obstetric practice, that such an examination should be so 

 complete as to furnish all the requirements of a sound diagnosis, on 

 which the indications for affording assistance can be readily based ; and 

 this exploration can only be said to be complete when the obstetrist is as 

 well acquainted with the position of the foetus and the obstacles to its 

 birth, as if he had scrutinized the whole with his eyes. 



Then he can decide as to the measures which are indicated by his 

 diagnosis, in order to bring the young creature into one of the best posi- 

 tions for delivery — either natural or artificial — so that this may be effected 

 with certainty and rapidity. 



These measures being decided upon, a methodical procedure is as 

 necessary in carrying them out, as in exploring the vagina and uterus. 

 The required assistants should be selected, and to each should be allotted 

 his share in the operation, in which he ought to be instructed briefly and 

 clearly; the instruments, cords, and other apparatus ought next to be 

 placed in readiness ; and then the task may be begun. When this is 

 once commenced, it should be conducted with prudence, and yet with 

 decision, all irrational and unnecessary manoeuvres being avoided ; while 

 every precaution being at the same time observed, there should be no 

 fear of irritating the organs or textures by manipulation, as they appear 

 to be endowed with a greater amount of tolerance at this than any other 

 time. 



In such cases, the operator should bear in mind that his task consists 

 in. removing or overcoming every thing which suspends, hinders, or inter- 

 feres with the natural course of parturition, and to bring this as near as 

 possible to a normal termination. He should understand and appreciate 

 the part Nature plays in this act ; only seeking to second her efforts so 

 long as she is competent to attain the desired end, by removing any 

 obstacles in the way. When Nature's efforts cease to be effective, they 

 should be imitated as closely as possible ; and no more ought to be 

 attempted than Nature herself would have accomplished under more 

 favorable circumstances. Art should never undertake what Nature can 

 effect ; and remembering this, the obstetrist will not only seek to learn and 

 appreciate the powers of Nature, but will be in a better position to calcu- 

 late how far he should himself interfere. 



