498 FCETAL DYSTOKIA. 



the fcetus projected about five inches beyond the vulva, and a close inspection of them 

 led to the discovery that the two fore ones were in the upper angle of the vulvular 

 opening, the hind ones on the floor of the vagina; a cross presentation was, therefore, 

 diagnosed, the fore part of the foetus lying to the left, the hinder parts to the right in 

 the uterus. It was decided to perform version, and convert the presentation into a pos- 

 terior one ; for this purpose it was deemed necessary to excise the fore limbs at the 

 knee. This was done subcutaneously, from the fetlock to the knee, the skin being pre- 

 served to cover the end of the arm-bones. No difficulty was experienced in pushing 

 the remaining portion of the fore-legs into the uterus ; but great trouble was experienced 

 with the hind-limbs, as they could not be withdrawn, though traction had been exerted 

 on them by six strong men. The foal was extracted' as far as the hocks, and then re-' 

 mained in a lateral position, and it seemed as if the Mare could have been more easily 

 moved by pulling than the young creature ; the left side of the croup and tail of the 

 latter was wedged in the pelvic canal. Through energetic and steady pulling, however, 

 the foal was at last extracted. The head was found to be of a concavo-convex shape, 

 as in Fig. 85, and this deformity was evidently the cause of the malposition. The Mare 

 recovered. 



2. The same authority {Ibid., 1871, p. 130) mentions that he was called to a fine and 

 valuable Mare which had been in labor for ten hours, but no progress had been made 

 in birth. On his arrival he found that the foal was dead ; that the four limbs were 

 crossed on each other, and projected beyond the vulva as far as the fetlocks. Gierer 

 decided to push the fore part of the foal into the uterus, and deliver by the posterior 

 presentation. The fore-limbs were skinned as high as the knees and removed at these 

 joints, the skin being here also used to cover the cut surface, so as to prevent injury to 

 the maternal organs. The stumps were with great difficulty thrust forward into the ute- 

 rus ; then the hind-limbs were energetically pulled at, after the tail of the foal had been 

 brought into the passage, and delivery was at length accomplished. During the opera- 

 tion the Mare lay a good deal ; it rested for seven days before recovery took place. 



3. In the Compte rendu of the Brussels Veterinary School for 1872-73 {Annates de Med. 

 Veterinaire de Bruxelles, 1874, p. 389), Degive describes two cases of this presentation. 

 The first occurred with a heavy draught Mare, eight years old, which had been eigh- 

 teen hours in labor, and had been roughly handled by incompetent persons. It was 

 brought into the school infirmary, ^^'here it appeared somewhat prostrated, but it did 

 not make any expulsive efforts. Two feet of the fcetus were apparent in the vulvular 

 opening. The vulva was swollen, and the vaginal mucous membrane was deeply con- 

 gested and abraded, an abundant dirty-red fluid escaping from the opening. On explor- 

 ing the canal the foetus was found to be dead, its fore-limbs in the passage and their 

 feet beyond the vulva. One of the hind limbs was directed slightly upwafd, backward, 

 and to the right, and lay against the side of the maternal pelvis; the other hind-limbs, 

 not so advanced, lay on the left, and the foot was jammed against the brim of the pubis. 

 The base of the neck could be felt, and the head seemed to be curved obliquely for- 

 ward, upwards, and a little to the left. The case was deemed a serious, if not a hope- 

 less, one, particularly because of the Mare's exhaustion. 



Attempts were made to straighten the neck, by first cording the protruded fore-feet, 

 trying to push the hind ones into the uterus, and bringing the head forward ; the Mare 

 at one time standing, at another lying with the hind-quarters raised. These attempts 

 were futile, and as it was considered impossible to rectify the direction of the head and 

 neck, it was sought to convert the presentation into a posterior one. This also was a 

 failure, and even the fore-limbs could not be returned into the uterus. Excision of the 

 latter was therefore decided upon, and it was executed by making a circular incision 

 around the fetlock, then a longitudinal incision through the skin from the fetlock to the 

 shoulder on the inside of one limb, outside of the other for convenience ; the legs were 

 now torn off, after dividing the pectoral muscles, and some of those at the neck and 

 withers. The foetus was then easily extracted by pulling at the hind feet. The Mare 

 rapidly sank, however, and died in about an hour afterwards. The uterus was found to 

 be ruptured. The head of the foetus was distorted laterally, and the neck was also de- 

 viated, depressed, and atrophied on the side to which the head was bent : deformities 

 which had evidently occurred some time before birth. The attempts at extraction of 

 the foetus had occupied three and a half hours, the greater part of the time having been 

 devoted to version attempts, and trying to straighten the neck. Failure was attributed 

 to retraction and loss of elasticity in the uterus, and the foetus being dead. It is ad- 

 mitted that a different result might have been attained had the fore-limbs been ampu- 

 tated earlier : this operation being always easy, and generally followed by great ad- 

 vantages. 



In the second case the presentation was the same, but the Mare was not nearly so 

 exhausted, having been only a few hours in labor; it had also escaped the maltreatment 



