DYSTOKIA DEPENDING ON ANTERIOR PRESENTATION 



449 



find the extremity of the fore-limb ; but in large Cows, and in the Mare, 

 particularly if the abdomen is pendulous, this is rarely, if ever, the case ; 

 indeed, sometimes the limbs can only be reached with the greatest diffi- 

 culty, though there is generally no trouble in introducmg the arm. When 

 the limbs can be felt, they are usually found to be in one of three posi- 

 tions : directed nearly vertically downwards, the fore-arms resting against 

 the brim of the pubis ; lying beneath the abdomen (Fig. 114) ; or closely 

 applied against the walls of the chest and the flanks. In many of these 

 cases, we have also the head in a vicious position. 



In the larger animals, when the two limbs are retained, birth is nearly 

 always impossible ; it may certainly be sometimes effected by violent 

 means, but then these are the. resort of brute force, and not of humane 

 and intelligent device, and nearly always entail the death of the mother. 

 With the smaller animals, when this complication is a cause of dystokia, 

 delivery can generally be effected by simple measures and gentle force. 



Indications. 



The indications are to reach the limb or limbs with the hand — resort- 

 ing to retropulsion if necessary — to gradually raise and bring them for- 

 ward, joint by joint, into the pelvis, and then to extract the foetus by 

 judicious traction. These indications are not attended with difficulty in 

 those cases in which the head is yet in the abdomen, or only at the pel- 

 vic inlet, and are easier carried out in the Cow than the Mare, Then if 

 the right limb is sought for. the left ha?id is introduced as far as possible 

 into the uterus, if the left limb the right hand ; it is passed between the 

 organ and the body of the foetus as far as the shoulder ; then the fore-arm 

 is seized, the thumb being in front and the other fingers behind — the index 

 towards the scapulo-humeral articulation, the little finger directed to the 

 bend of the knee. The fore-arm is now used as a lever of the first kind, 

 and its upper extremity thrown backward, its lower end forward, so as to 

 move the foetus more into the uterus, and obtain space to bring the limb 

 towards the pelvis, at the same time carrying the knee upwards in the 

 direction of the inlet. The hand then glides down to the metacarpal 

 bone, which is grasped in the same manner as the radius was — the thumb 

 forwards, other fingers backwards ; the knee is pushed away from the 

 inlet ; the fetlock, pastern, and foot are then successively raised, strongly 

 flexed in doing this, and then extended when above the rim of the pubis, 

 and brought into the genital canal. If the knee cannot be brought for- 

 ward or flexed by the hand, the lower end of the fore-arm should be 

 corded (running noose), or the blunt hook may be used. When the end 

 of the limb is brought in the pelvis it may be corded, and gentle traction 

 exercised by an assistant, while the operator adjusts the leg, more par- 

 ticularly towards the elbow. 



Another method is to seize the foot, the pastern being in the palm of 

 the hand, and to press on the front of the fetlock, so as to push back this 

 part and extend the joint, at the same time flexing the fore-arm on the 

 arm. On raising the foot as high as the os uteri, the hand is passed 

 higher up the limb, which is then draw-n into the pelvis, and a cord at- 

 tached. The "crutch" or " repeller " may be most usefully employed in 

 these manoeuvres, to keep the foetus forward in the uterus. When the 

 limbs of the foetus cannot be reached by the hand, it is advisable to raise 

 the front part of the mother by litter, placing the fore-feet on a box, or 

 even in the manger. 



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