DISEASES OF THE GENERATIVE ORGANS. 185 



water bags of one will naturally first enter and be the first to burst, 

 so the calf which occupied those membranes will be the first to enter 

 the passage and the other will be thereby excluded. When the 

 membranes of both have burst without either calf having become 

 engaged in the pelvis, it becomes possible for the fore legs of one 

 and the hind legs of the other to enter at one time, and if the strain- 

 ing is very violent they may become firmly impacted. (PL XVIII, 

 fig. 1.) The condition may be recognized by the fact that two of the 

 presenting feet have their fronts turned forward, while the two 

 others have their fronts turned backward. If the four feet belonged 

 to one natural calf, they would all have the same direction. By means 

 of this difference in direction we can easily select the two feet of one 

 calf, place running nooses upon them just above the hoofs or fet- 

 locks, and have an assistant drag upon the ropes while the feet of the 

 other calf are pushed back. In selecting one of the twins to come 

 first several considerations should have weight. The one that is most 

 advanced in the passage is, of course, the first choice. Though the 

 fore feet of one are presented, yet if the head is not in place the calf 

 presenting by its hind feet is to be chosen as being less liable to 

 obstruct. Again, if for either calf one limb only is presented and 

 the other missing, the one presenting two feet should be selected 

 to come first. As soon as one calf has been advanced so as to occupy 

 the pelvis the other will be crowded back so that it will not seriously 

 obstruct. 



Fore limbs curved at the knee — Limbs sprawling outward. — In 

 this case not only are the knees somewhat bent in a curve, but the 

 calf has a position as if it rested on its breastbone, while the legs 

 were drawn apart and directed to the right and left. The shoulder 

 blades being drawn outward from the chest and the elbows turned 

 out, the muscles extending from the trunk to the limb are unduly 

 stretched and keep the knees bent and the feet directed outward so 

 as to press on the sides of the passages. They become retarded in 

 their progress as compared with the more rapidly advancing head, 

 and may bruise or even lacerate the walls of the vagina. It would 

 seem easy to rectify this by extending the legs, but the already tense 

 and overstretched muscles operate against extension in the present 

 position, and it is not easy to rotate the limbs so as to apply the 

 shoulder flat against the side of the chest. Under these circumstances 

 a repeller (PI. XX, fig. 7) may be planted in the breast and the body 

 of the calf pushed backward into the womb, when the limbs will 

 extend easily under traction and the presentation becomes at once 

 natural. 



Fore limbs curved at knee — Flexor tendons shortening. — In this 

 case the feet will press against the floor of the pelvis though the 

 limb has no outward direction, and the shoulder meanwhile presses 



