DIFFICULT PARTURITION (DYSTOKIA) 277 



The patient should stand or lie with head do^vnhill. It is 

 much easier to operate with the patient standing. Occasionally 

 it is of great advantage to have the patient on one side or the 

 other or on her back for a time so as to place the missing part 

 on the upper side. Be patient and not in too great haste. 

 When missing members are secured and all is ready to pull, 

 pour plenty of oil, or, in the absence of oil, warm water, into 

 the uterus and vagina by means of a funnel and rubber tubing. 

 The parts that will offer friction are probably dry by this time, 

 and should be freely oiled or moistened. Clean, non-irritating 

 oil is better. 



It is frequently necessary to shove the fetus forward into the 

 uterus in order to secure and straighten some missing parts. 

 Tearing the mother is an accident that must be carefully avoided 

 on account of probable blood poisoning (septic infection). 



"When one part presents, and others are to be secured, or when 

 one has been secured and it is desirable to return it into the 

 uterus to secure another part, make sure of progress gained by 

 attaching a rope to the part secured. If the patient cannot be 

 made to stand, have her on the side opposite the missing part, 

 which thus comes on top. "Work between labor pains, and, when 

 all ready to pull, the assistance should be given moderately and 

 while the mother is straining. Great force is seldom justified 

 either by necessity or by results. 



Dropsies. — Sometimes the retarded delivery is due to large 

 accumulations of fluid in the brain cavity (hydrocephalus) of 

 the fetus or within the abdominal cavity (ascites), or to a general 

 accumulation of fluids or gas beneath the skin in the connective 

 tissue and also in the abdominal cavity (general dropsy). In 

 these eases the difficulty may be overcome by tapping the brain 

 and squeezing the soft bones together, or tapping the abdominal 

 cavity and allowing the fluid to escape. A large trocar attached 

 to rubber tubing is convenient for this operation. 



Gaseous distention. — Difficulty in delivery may be due to an 

 excessive accumulation of gases within the body of a dead and 

 decaying fetus, and the obvious treatment is to tap with trocar 

 or knife and allow gas to escape. 



Embryotomy. — If it becomes necessary to open the fetal body 

 or remove one or more of the fetal limbs, and veterinary help is 

 not available, the operator must know that these are difficult 

 operations and observe certain precautions. 



