452 FCETAL DYSTOKIA. 



downwards, ana is at the same slightly flexed, the nose comes in contact 

 with the brim of the pubis, and is retained there ; while the uterine con- 

 tractions, pushing on the body, propel the fore-limbs, if they are in a 

 favorable direction, into the genital canal. Thus it will be understood 

 that, if the expulsive efforts continue, the head becomes more and more 

 flexed as the foetal mass is carried towards the vulva (as is delineated in 

 the shaded and unshaded foetuses in Fig. 115), until, from vertical and 

 oblique, the face becomes horizontal, and rests on the floor of the pelvis 

 of the mother, the lower jaw against the throat ; the neck becomes pro- 

 portionately flexed, and as labor goes on the head is retained, as well as 

 the cervical portioij|of the former ; so that when the obstetrist introduces 

 his hand into the genital canal, the feet are found presenting towards 

 the vulva, but far in front of them (or behind them, as the explorer stands) ; 

 this may be designated a 7ieck ox poll presentation {unshaded foetus in Fig. 



Fig. 115. 

 Anterior Presentation : Downward Deviation of the Head. 



If, however, the forehead or occipital region comes in contact with 

 the brim of the pubis, the uterine contractions cause it to descend below 

 the level of that bone ; while the shoulders and crest of the neck are im- 

 pelled towards the inlet, and may enter it, according to circumstances. In 

 this case the head lies towards the abdomen of the foetus, the neck 

 bending downwards, and the mane (if a foal) alone meeting the hand ; 

 while the fore-feet may protrude in the vagina, or even beyond the vulva 

 (Fig. 116). 



The diagnosis of this deviation is not difficult. When the anterior limbs 

 are in a proper direction, the feet and upper part of them are readily 

 found, and their inclination should be noted ; but in a slight complication 

 the whole of the head cannot be discovered — only the ears, eyes, nape of 

 the neck, and the forelock and mane, if a foal. When the deviation is 

 greater or extreme, in the foal only the neck can be felt, and the direction 

 of this is ascertained by noting its anatomical features and their situation. 

 With the calf, which has a shorter neck, it may be possible to reach the 

 head or nose. The upper ridge of the neck is always a safe guide to 

 follow in discovering the direction of the head. 



