MECHANICAL EXTRACTION OE THE ECETUS. 503 



cure hold. They can also be applied above the knees and hocks, when 

 it is necessary to amputate the limbs at these joints. The head may be 

 secured around the lower jaw, though this does not afford a very secure 

 hold. It is better to pass the noose into the mouth and around^'the top 

 of the head, like a gag-rope. 



When the cords are to be applied to the limbs, either of two modes can 

 be resorted to with this object. If the limb is bent, it must be extended 

 and brought opposite the inlet, or into the genital canal, as the case may 

 be. Then Rainard recommends that the fingers be gathered together 

 and slightly bent, so as to form a sort of cone, on which the running 

 noose of the cord — sufficiently wide to pass over the foot of the foetus — is 

 placed, as in fig. 145. The noose is kept in its place on the fingers, in 

 tightening the cord by the free portion which passes along the under side 

 of the hand and arm ; unless this precaution is adopted, the noose will be 

 pushed back over the hand when introduced into the vagina, and cannot 

 easily be got forward again. The hand and cord being oiled, are intro- 

 duced into the passage, and when the foot is reached it is seized in the 

 fingers ; these are then suddenly bent, so as to shorten the cone and 

 cause the noose to run on to the pastern by a gentle pull of the cord, 

 which can then be tightened and given to an assistant. 



The other method, which is Schaack's, and by some obstetrists con- 

 sidered preferable to that just described, consists in placing the middle of 

 the noose on the dorsal aspect of the ends of the two middle fingers, the 

 finger on each side holding it against these, while the thumb keeps it in 

 the palm of the hand (Fig. 155). The left hand maintains the cord suffi- 

 ciently tense to assist in keeping the noose on the hand ; and if the part 

 of the cord which runs through the loop i^ placed towards the thumb, the 

 latter can readily increase the size of the noose. The hand is passed 

 into the vagina sideways, the little finger downwards, and when the foot 

 is reached, the thumb and index finger are placed within the noose, which 

 they enlarge in separating from each other, while the remaining fingers, 

 flexing on the hand, are passed around the foot, and cause the noose to 

 glide over the hoof on to the pastern. The fingers now press oji the loop, 

 while the other hand, drawing at the cord outside the vulva, tightens the 

 noose around the limb. 



When the limb is flexed and cannot be extended, as at the knee or 

 hock, the looped cord may be employed ; though a long cord, doubled, 

 will be found to answer very well. This is passed round the flexure, the 

 doubled end pulled to the vulva, and the other end passed through it ; 

 this done, the loop may be tightened, passed up to the elbow or stifle, or 

 down to the pastern. 



The lower jaw is " corded " in a similar manner ; the mouth of the 

 foetus being opened, the noose is passed around the neck of the jaw, and 

 the knot or loop placed beneath the chin. 



As we have already remarked, when treating of certain presentations, 

 in some cases in which the use of cords is urgently indicated, the arm is 

 not sufficiently long to pass them to the region where they may be most 

 effectively employed ; while the energetic uterine contractions paralyze 

 the hand, and often prevent it manipulating accessible parts which it is 

 desirable to secure by these means. In these cases, \\\q. porte-cord \s of 

 great service. These porte-cords are of two kinds — straight and curved. 



The straight porte-cord is a rod of three-eight inch iron, about three 

 feet in length, a handle at one end, and an eyelet at the other, to receive 

 the cord (figs. 147, 148). 



