DYSTOKIA DEPENDING ON POSTERIOR PRESENTATION. 485 



The ends of the cords being joined together outside, assistants, under 

 the direction of the operator, pull with the necessary amount of force, 

 while the hand of the operator assists in the vagina, either in guiding the 

 foetus, seizing on and pulling at any part^that may offer, or smoothing 

 down the folds of mucous membrane in the canal which might otherwise 

 increase the obstacles. The foetus has been extracted alive by this pro- 

 cedure, 



Saake's method {Magazi?i vo7i Gurlt tmd Jlertwig, 1869) is somewhat 

 similar, except that there is only one cord, and that encircles the body 

 instead of the thigh. The cord has a ring or noose at the end, and this 

 or the other end is passed between the thighs and brought out at the 

 flank of one side; then the other end is also brought out in front 

 of the other flank. Both ends are carried to the top of the back, 

 the plain end is passed through the ring (Fig. 138) and brought out- 

 side the vulva. The body of the foetus is, it will be observed, en- 

 closed in a loop, the upper part of which — that over the loins — is car- 

 ried back over the tail to the buttocks, so that the cord now only encir- 

 cles the flanks. The advantages of this method over the other are chiefly 

 its simplicity, only one cord being required, and the better direction in 

 which traction can be exercised. 



Fi£. 138- 

 Thigh and Croup Presentation: Body Corded. 



In three cases this method was successfully employed by Saake. 



There can be no doubt that the foetus may be removed in this malposi- 

 tion, with both the hind-limbs extended forward under the abdomen. 

 Cartwright says : " I perfectly recollect, in one instance, delivering a Cow 

 of a very large calf with both of its hind-legs under its abdomen, and I 

 never saw a Cow after calving do better." In those instances which 

 are attended by success, it will be found either that the foetus is small or 

 the pelvis large and well-formed. 



Some practitioners resort to the sharp crotchets, fixing them in the 

 muscles of the croup, towards the hip joint ; but unless the hook has a 

 bearing on the femur the hold is not very firm. In a case of this kind, 

 Drouard found that the skin and muscles yielded, the femur was disartic- 

 ulated, and the hind-limb itself entirely torn away from the body. Not- 

 withstanding this diminution in the volume of the foetus, delivery was still 

 impossible ; the other limb was torn away in a similar manner, after which 

 a crotchet was fixed in each cotyloid cavity, and the foetus was then easily 

 extracted. In addition to the malposition, the young creature was affected 

 with hydrocephalus. 



The use of sharp crotchets in such cases is always attended with risk ; 

 should they slip during traction, or not be carefully implanted in the 

 foetus, they may do great, if not fatal injury to the mother. 



