546 ■ OBSTETRIC OPERATIONS. 



In the abdominal presentation with four legs in the vagina, Donnarieix 

 lays down the following procedure : Three pieces of supple twine are got 

 ready, as well as a strong cord. With the twine the pasterns of three of 

 the limbs are firmly bound, while the cord is fixed on the limb which is to 

 be detached, and confided to five assistants, who pull at the cord while the 

 other limbs are pushed towards the uterus. The knee, then the fore-arm 

 appear, and the lips of the vulva being kept widely separated, the ope- 

 rator makes a circular incision through the skin at this part ; traction is 

 again applied, the muscles tear, and gradually the joint is reached. The 

 tendons and ligaments are cut, and the leg being twisted as it is pulled 

 at, another cut of the knife finally removes it. 



With the Sheep or Goat, amputation of the fore-limbs of the fcetus is 

 very rarely indeed required, though, if necessary, it can be effected. The 

 same remark applies to the Bitch and Cat. 



Amputation of the Hind-Limbs. 



When the foetus makes a posterior presentation, with the hind-limbs 

 flexed at the hocks, and so firmly wedged in the canal that they cannot 

 be extended backwards, nor yet sufficiently bent to permit delivery — 

 which is far from being rare in the Mare — these joints are disarticulated. 



This is accomplished by passing a running noose round each leg, above 

 the hock, and tying it firmly there. Powerful traction being made on one 

 of the cords by four or five assistants, will bring the point of one of the 

 hocks to the vulva, the lips of which are separated, while the operator 

 divides the gastrocnemii tendons and the lateral ligaments of the joint, so 

 as to produce complete disarticulation. The tibia is then pushed into 

 the vagina, the other limb is amputated in the same way, and birth is 

 accomplished by pulling at both cords, which remain attached to the lower 

 end of the leg-bone. 



When the limbs are completely retained in the uterus in this presenta- 

 tion, the procedure recommended at pages 486 and 515 must be adopted. 

 We may remark that Carsten Harms recommends symphysiotomy to be 

 practised on the fcetus, when the buttocks present at the inlet — the sym- 

 physis pubis being cut through. By this means, the two borders of the 

 symphysis can be made to overlap, and the transverse diameter of the 

 pelvis thereby diminished. The finger-scalpel and spatula are the instru- 

 ments he prefers. The saw might be advantageously used. 



In certain kinds of monstrosity in which the posterior parts of the foetus 

 are double, or when the hind-limbs are in the vagina, and in consequence 

 of the narrowness of the maternal pelvis, or width of the croup, or 

 haunches of the young creature, birth cannot take place, them amputation 

 of the legs at the trunk may be necessary. Such an operation can be 

 rarely required, however. It is performed in a similar manner to that 

 for removal of the fore-limbs — subcutaneously. A cord is fastened to 

 each pastern, and, one after another, the limbs are drawn towards the 

 vulva ; a circular incision is made through the skin above the hock ; then 

 a longitudinal incision is carried as high as possible on the thigh, and the 

 skin separated in the ordinary way by means of the spatula — always as- 

 cending towards the croup ; the gluteal and other muscles attaching the 

 thigh to the pelvis are cut across, and the limb is at last torn away by 

 strong and sustained traction. 



Amputation of the hind-limb is a much more onerous and fatiguing 



