DISEASES OF THE FCETUS. 



385 



as the anterior presentation. In such a case, suppose the fore feet pre- 

 sent, these should be secured by cords> the ends of which may be given 

 to an assistant ; then the hand should be introduced into the vagina, and 

 if necessary the os should be dilated sufficiently to allow of another cord 

 being fastened on the upper, or, perhaps better, the lower jaw, which is 

 often wider. Traction can then be made during the throes of the 

 mother. 



When, however, traction will not effect delivery, because of the size of 

 the head, and the mother is becoming exhausted, the cranium must be 

 punctured — an easy operation when the presentation is anterior, but more 

 difficult when it is posterior. 



The puncture may be made by means of a bistoury, a scalpel or ordi- 

 nary knife, or, which is preferable, a somewhat large trocar and canula, 

 curved if possible. The most fluctuating part of the tumor should be 

 penetrated, and the fluid having escaped, the cranial parietes collapse, or 

 give way to pressure; the head is thus greatly reduced in size, and' de- 

 livery can be completed. 



Rainard recommends the puncture to be made on the side of the cra- 

 nium ; and should it be necessar34 to still further reduce the size of this 

 part by bone-forceps or other means, the side of the cranium will be found 

 most suitable. In the posterior presentation, the back of the head may 

 be punctured, and the weight of the young creature's body, hanging be- 

 yond the vulva, will sufficiently steady the head for this purpose ; but in 

 the anterior presentation, traction should be made by means of the cords 

 while the cranium is being opened. 



Rainard informs us that Conte, being called in to assist a Mare in foal- 

 ing, found a posterior presentation, and having diagnosed hydrocephalus, 

 he was able by version to convert it into an anterior presentation, when 

 the head was easily punctured. 



Embryotomy has been recommended in such cases ; but, beyond re- 

 ducing the size of the head, if that is the only obstacle, there is no neces- 

 sity for resorting to further breaking up of the body of the foetus. In- 

 deed, it will be found that, in ordinary cases, patience and judicious 

 manipulation will often enable the obstetrist to dispense with craniotomy. 

 This is well exemplified in the following instance. 



Drouard {Renieil de Med. Veterinaire, 1842, p. 40) was requested to attend a Mare 

 laboring under difficult parturition. The animal was nine or ten years old, in good con- 

 dition and well-formed, and had produced and reared three or four foals. The presen- 

 tation was posterior, with the hind legs bent forward under the body. The breech oc- 

 cupied the passage, and could not be moved forward to allow the hand to seize the 

 thighs and so bring up the legs ; the labia of the vulva were becoming swollen, and the 

 Mare, being exhausted by fruitless straining, was in a dangerous condition. There ap- 

 peared to be only two methods of delivering the animal : by practising embryotomy, or 

 forcibly extracting the hind extremities. For this purpose a strong hooked instrument 

 was fixed in the right hip of the foetus. Six or seven persons pulled energetically at 

 this instrument, while others supported the Mare and prevented her falling. As soon 

 as the skin and muscles began to give way, the femur became disarticulated, and was 

 drawn out. After this it was thought that' the other parts of the foetus might be ex- 

 tracted by ordinary means ; but tumefaction of the parts increased so rapidly that the 

 other extremity had to be removed in the same way. A hook was then in.serted into 



' each of the acetabular cavities, and the body of the foetus was easily drawn into the 

 vagina when, the head having arrived at the pelvic inlet, all further progress was stopped. 

 The hand was introduced into the uterine cavity, and a monstrous head was recognized ; 

 in this considerable fluctuation could be detected, and hydrocephalus was diagnosed. 

 Drouard was preparing to puncture the head, when the assi.stants, taking advantage 



lOf an effort of the Mare, pulled all together so stronglv, that they extracted the trunk 



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