DISEASES OF THE GENERATIVE ORGANS. 219 



si roii*,' tract ion can IK- made without interfering with the full flexion of the 



limbs on the body, and if the ease is a suitable one, and the body of the 



and the passages are both well lubricated with oil or lard, a suc- 



;'M! parturition may be accomplished. A less desirable method is to 



put a rope round one thigh or a rope round each and drag upon these, 



but manifestly the strain is not so directly on the spine, and the limbs 



may be somewhat hampered in flexion. 



This method being inapplicable, the next resort is to cut off one or 

 both hind limbs at the hip joint. Free incisions are made on the side 

 of the haunch so as to expose the hip joint, and the muscles are cut a- way 

 from the head of the thigh bone down to its narrow neck, around which 

 a rope is passed and firmly fixed with a running noose. The joint is 

 now cut into all around, and while traction is made on the cord the 

 kuife is inserted into the inner side of the joint and the round ligament 

 severed. The cord may now be dragged upon forcibly, and the muscles 

 and other parts cut through as they are drawn tense, until finally the 

 whole meml>er has been extracted. Traction on the rope round the 

 other thigh will now suffice to extract, in the majority of cases, but if it 

 should fail the other limb may be cut off in the same manner, and then 

 hoojcs inserted in front of the brim of the pelvis. or in the openings in 

 the bones of its floor (obturator foramina) will give sufficient purchase 

 for extraction. Another method is to insert a knife between the bone 

 of the rump (sacrum) and the hip bone and sever their connections; 

 then cut through the joint (symphysis) between the two hip bones in the 

 median line of the floor of the pelvis, and then with a hook in the open- 

 ing on the pelvic bones (obturator foramen) to drag upon the limb and 

 cut the tense soft parts until the limb is freed and extracted. 



PRESENTATION OF THE BACK. 



In this presentation straining may be active, but after the rupture of 

 the water-bags no progress is made, and the hand introduced will 

 recognize the back with its row of spinous processes and the springing 

 ribs at each side pressed against the entrance to the pelvis. (Plate xvn, 

 Fig. 6.) The presence or absence of the ribs will show whether it is 

 the region of the chest or the loins. Hy feeling along the line of spines 

 until the ribs are met with we shall learn that the head lies in that 

 direction. If, on the contrary, we follow the ribs until they disappear, 

 and a blank space is succeeded by hip bones, it shows that we .are 

 approaching the tail. The head may be turned upward, downward, 

 to the right side or to the left. 



The object must be to turn the fetus so that one extremity or the 

 other can enter the passage, and the choice of which end to bring for- 

 ward will depend on various considerations. If one end is much nearer 

 the outlet than the other, that would naturally be selected for extrac- 

 tion, but if Iwth ends are equidistant the choice would fall on the hind 

 end, as having only the two limbs to deal with, without any risk of 



