EM BR yq TOM V. 5 43 



The removal of one limb usually leaves a considerable space in the 

 genital canal, and this allows delivery to be completed. Sometimes, 

 however, and particularly when the head is deviated towards the flank, 

 it is necessary to remove the other limb ; and this, when effected, per- 

 mits the head to be sought for and rectified, version accomplished, etc., 

 according to the requirements of the case. 



Some practitioners operate in a somewhat different manner to the fore- 

 going. Lecoq, for instance, commences his incision at the upper part of 

 the shoulder, brings it down over the head of the humerus, on the side 

 of the fore-arm, and as far as the middle of the cannon, where he makes 

 his circular incision ; the skin is separated from this part upwards. In 

 some cases this procedure may be preferable to the other, and it cer- 

 tainly is less dangerous for the parent ; but it may sometimes happen 

 that the shoulder cannot be reached. 



Giinther pushed back the foetus as far as possible by means of the 

 crutch, then with the finger-scalpel divided the skin before and behind 

 the scapula, then across — below and above ; cutting through the pectoral 

 muscles, and then extracting the limb. Cartwright operates in a similar 

 manner to Lecoq. He first has a leg drawn out, and divides the skin as 

 far as possible ; or he introduces his hand, containing a knife, as high as 

 he can on the side of the scapula, and makes an incision thence down the 

 whole length of the limb to the pastern bones ; the skin is separated by 

 the fingers or spatula as far as possible from the entire leg, and the trans- 

 verse pectoral muscles cut through. The limb is then disjointed, either 

 at the pastern or fetlock ; the foot being left attached to the skin, as it is 

 afterwards found to be useful in the extraction of the body. Cords are 

 fastened around the limb above the fetlock-joint and knee, and the Cow 

 being firmly tied by the head, the necessary force is applied, and the 

 whole limb drawn away. He writes, " I have known, in some of these 

 cases, the limbs to separate at the shoulder joints, and yei; the foetus has 

 been extracted — both from the Mare and Cow — with the shoulders 

 attached, the points of the latter having, fortunately, not caught the edge 

 of the pelvis. The great danger in these cases is, that the shoulder joints 

 may catch against the pelvis and thus prevent extraction." 



Meyer recommends that the circular incision on the cannon be not 

 made until the skin is detached above, as this facilitates avulsion. 



It is well to divide as many of the muscles uniting the limb to the chest 

 as possible, and also to apply counter-extension by means of the arm 

 or crutch placed against the chest or opposite shoulder of the foetus ; 

 this also spares the mother much of the pain and exhaustion attending 

 extraction.- 



Amputation of the entire fore-limb, including the scapula, is a very 

 useful operation in the most serious cases of dystokia ; but there some- 

 times occur instances in which the whole leg need not be excised — as 

 when the legs are an obstacle rather from their length than their volume. 

 This happens, as has been described, in the abdominal presentation of the 

 foetus, when the limbs so often render version difficult — all of them being 

 perhaps in the genital canal, from which they cannot be advanced or 

 pushed back. In these circumstances, disarticulation of the limbs at the 

 knee or elbow joints is often practised — the latter being generally pre- 

 ferred ; though it must be remembered that excision at this part can be 

 but of limited value, and, in fact, is only useful in the presentation just 

 alluded to, because it does not give so much room as removal of the 

 scapula and humerus. 35 



I 



