DISEASES OF THE GEXEEATIVE OEGANS. 201 



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 

 away 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 knife is inserted into the inner side of the joint and the 

 round ligament severed. The cord may now be dragged upon forci- 

 bly, and the muscles and other parts cut through as they are drawn 

 tense, until finally the whole member 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 hooks 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 {sarriim) 

 and the hip bone and sever their connections; then cut through the 

 joint {sym.j)hysis) between the two hip bones in the median line of 

 the floor of the pelvis, and then with a hook in the opening on the 

 pelvic bones {ohturator foramen) drag upon the limb and cut the 

 tense soft parts until the limb is freed and extracted. 



PRESENTATION OF THE BA( K. 



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. (PI. XVII, 

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

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

 until the ribs are met w^ith 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 both ends are equidistant the choice would fall on the hind 

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

 complication from the head. When the head is turned upward and 

 forward it will usually be preferable to bring up the hind limb, since, 

 owing to the drooping of the womb into the abdomen, rotation of the 

 fetus will usually be easier in that direction, and if successful the 



