458 FCETAL DYSTOKIA. 



and then terminate delivery. But this indication cannot always be car- 

 ried out, especially when the head is beyond reach ; neither is it always 

 necessary that it should be followed implicitly, so far as the foal is con- 

 cerned, though in the case of the calf it is an almost absolute require- 

 ment. For the latter there are only two courses open — adjustment or 

 embryotomy. 



With regard to adjustment, it is generally recommended that the lower 

 part of the head should be secured, either by the hand or a cord passed 

 round the lower jaw, and strong traction employed. But this necessarily 

 produces twisting of the neck, which, in addition to rendering reduction 

 very difficult, endangers the life of the foetus. 



The better plan, therefore, appears to be as follows : Cord the pre- 

 senting fore-feet; push the foetus into the uterus, so as to clear it from 

 the inlet ; pushing either on the flexed neck or chest, and not directly 

 forward, but rather obliquely to the side opposite that to which the head 

 inclines, so as to bring this round to the inlet. This retropulsion, Man- 

 del asserts, has often alone brought the head into the. natural position. 

 If it does not, then the operation must be continued. If the fore-limbs 

 are in the way of the operator, they may also be pushed back into the 

 uterus. The head is then to be sought for, and version applied to it in 

 such a way as to bring its under surface uppermost. 



Schaack has communicated to Saint-Cyr his method of eifecting this : 

 The extremity of the jaws is employed to straighten the head, not by 

 lowering the chin and drawing it below the neck, but superiorly, after 

 forcing the chin and lower jaw up and outwards — the foetus is supposed 

 to be in the first position. In order to do this, as soon as the hand 

 reaches the muffle the fingers are passed into the submaxillary space, and 

 pressure is made on one of the branches of the lower jaw, so as to twist 

 the head outwards and upwards. When this is done, it is an easy matter 

 to put it in a good position by pulling at the nose, as traction then acts 

 exactly in the direction of the atloido-occipital and other joints of the 

 vertebrae ; whereas, if practised before this manoeuvre, traction tends to 

 twist the neck, and renders reduction much more difficult. 



The head being twisted in this way, it has now to be extended and 

 brought into the inlet. To eifect this, Bordonnat gives these directions : 

 Place the palm of the hand beneath the chin, seize each side of the lower 

 jaw by the fingers, the thumb being in the mouth behind the incisors. 

 This ensures a solid grip, and the head is brought into a good position 

 by direct traction towards the axis of the pelvis, this traction being ap- 

 plied in jerks rather than continuously. 'i1ie hand must not relax its 

 hold of the head, when at the inlet, until it has been corded, as it readily 

 slips back again. 



If the hand cannot accomplish this, a cord should be placed around 

 the lower jaw, behind the incisor teeth. This, however, is not always 

 easy, as only too frequently the fingers are paralyzed by the uterine con- 

 tractions. 



The porte-cord (Figs. 119, 120) maybe usefully employed in this direc- 

 tion, and the jaw secured. But sometimes, and generally with the foal 

 (which has no incisor teeth), the cord slips off when traction is applied ; 

 it must then be given up, and other means tried. When, however, it does 

 remain attached to the jaw, an assistant judiciously pulling at it will greatly 

 aid the operator, whose hand is manipulating the accessible parts of the 

 head. In this manipulation, even when the cord will not remain on the 



