DYSTOKIA FROM JTALPRESENTATION OF FGETUS. 



439 



It only too often happens that the anii of the obstetrist is found to be 

 sadly too short in version and other manoeuvres, and these are conse- 

 quently rendered more difficult of accomplishment. With regard to this 

 it is well to point out, what is not always known, that the obstetrist should 

 always employ the arm corresponding to the side of the foetus on which 

 the limb, or part sought for, or to be manipulated, is placed. For in- 

 stance, if the foetus is in the anterior presentation and vertebrc-iacral posi- 

 tion, with the head bent round towards the left flank, or the left fore limb 

 (right hind limb in a posterior presentation) doubled under the body, he 

 will use his right arm ; but the left will be employed in the opposite 

 conditions. By doing so, the operator gains in length of arm, particularly 

 towards the shoulder, and can consequently reach deeper into the 

 uterus. 



Flexion and extension of a limb are often made simultaneously, and it 

 semetimes happens that in extending such a part as the head to straighten 

 it, it effects its own rotation. Extension alone serves to bring the limbs 

 from under the chest or abdomen ; flexion is rarely resorted to, and chiefly 

 when it is desired to return an extended limb ag;iin into the uterus. In 

 these operations on the limbs, when the weight of the foetus is an obstacle, 

 the body of the creature is inclined to the side opposite to that of the 

 limb to be manipulated ; thus, if the right limb is flexed under the body, 

 and we desire to extend it, the foetus is inclined from right to left, so that 

 the right side being raised, the limb can be taken from under it. The 

 body is turned in the way we have indicated for rotation. 



We have casually alluded to the attitude of the larger animals during 

 version, retropulsion, and rotation, and pointed out the advantage to be 

 derived from elevating the hind quarters, either by placing litter under 

 the hind feet, or causing the animal, if a Cow, to kneel on the -knees. 

 And we have also remarked that it is not always possible to obtain the de- 

 sired attitude, but that these manoeuvres must sometimes be performed 

 when the animal is recumbent. 



It may even happen that it will be advantageous to cause the animal to 

 lie. Leconte strongly recommends placing the animal on its sternum, and 

 flexing the fore and hind limbs under the body ; in this attitude the 

 uterine cavity can be more easily explored, and the necessary alterations 

 made in the position of the foetus : the operator lying extended behind 

 the animal. Some obstetrists place the animal on the right or left side, 

 the operator lying on either of his sides, according to the arm he intends 

 to use. 



Throwing down an animal for this purpose is always, however, to be 

 avoided if possible ; and if it is already down, it should either be placed 

 on its sternum or compelled to get up. When the the uterus is lying very 

 low in the abdomen, should the latter be extremely pendulous, or when 

 the foetus — as in the Cow — is fixed beneath the brim of the pelvis, it may 

 be found very advantageous to place the parturient creature on its back. 



As for the operator, he must conform his attitude to that of his patient. 

 We have already written on this point when treating of parturition, and 

 we have nothing to add. If the animal is standing and the hind quar- 

 ters are raised, and particularly if the obstetrist is not tall — and more 

 especially if the patient is a Mare, we may follow the plan adopted 

 with much success by Dickens {Veterinarian, vol. xxxiv., p. 260). This 

 consists in placing the animal, if the case is likely to be protracted, 

 H under an open shed, tving the head to the manger or rack, and supporting 





