DYSTOKIA FROM MALPRESENTATION OF FOETUS. 433 



to one more favorable, in order that natural or spontaneous birth may 

 be effected, or artificial extraction rendered possible. This change of 

 position can only be effected, as a rule, by moving the foetus itself, and 

 so altering its relations to the neighboring parts of the mother : the 

 movements being designated 7fiutations by obstetrists. 



The procedure varies with circumstances : sometimes, for instance, the 

 object rnay be achieved by merely altering the position of the parturient 

 animal; at other times by sustaining its abdomen and manipulating exter- 

 nally ; but in the great majority of cases, it is necessary to introduce the 

 hand into the genital canal, and operate directly on the body of the foetus. 

 The principal of these mutation movements are three in number: Retro- 

 pulsion. Rotation, and Version. 



In order, however, that these movements may be effected, certain con- 

 ditions are necessary. In the first place, it is absolutely essential that the 

 OS uteri be sufficiently dilated, or relaxed and extensible, for the hand to 

 reach the interior of the uterus ; next, the body of the foetus must be 

 movable in the uterus — a circumstance not always noted, as the organ 

 is often closely contracted on its contents, should the liquor amnii have 

 escaped some time, or- the foetus itself may be fixed in the pelvic canal. 

 And, finally, the foetal envelopes must be ruptured, as it is impossible to 

 manipulate the young creature effectively while it is entirely invested in 

 them. 



Before any alteration in the position of the foetus can be accomplished, 

 these conditions must be assured. 



Retropulsion, — When the foetus, in a vicious position, has entered the 

 pelvic cavity and become fixed there, or even when in the uterus and 

 approaching the inlet, before the position can be corrected it is nearly 

 always necessary to push it forward into the uterus ; as there only, from 

 the greater space this organ affords, and the elasticity of its walls, can 

 the impediment be overcome and adjustment effected. 



" Retropulsion " is often necessary during protracted labor, even when 

 the foetus is in a good position, to enable the obstetrist to attach cords to 

 the limbs or some part of the head or body. 



The retropulsion is sometimes easy, at other times it is most difficult 

 and laborious, and in certain cases it may even be altogether impossible. 



The most favorable attitude for performing this operation, in the larger 

 animals at least, is undoubtedly the standing one ; but the body should 

 not be perfectly horizontal, as a great, advantage will be derived from 

 raising the hind quarters to a considerable degree, as we thereby throw 

 the uterus and its contents forward, and away from the pelvic inlet. This 

 elevation may be effected by straw or litter placed under the animal's 

 hind feet. In order to obtain this inclination promptly, Schaack recom- 

 mends that the Cow be made to kneel on its knees ; two assistants keep- 

 ing the fore limbs flexed, while other two maintain the hind quarters in 

 an upright position. 



When the animal is recumbent and cannot be induced to rise, there is 

 but little, if any thing, to be gained by raising and supporting it by means 

 of slings or other appliances ; as the pressure which these produce on the 

 abdomen opposes the manoeuvres we have mentioned. Not unfrequently 

 the sight of a strange dog will cause the animal to get up. 



When, however, the Mare or Cow is exhausted, and it would be injudi- 

 cious or impossible to make it stand, then manipulation must be attempted 



28 



