

DYHTUKLl nv DISPLACEMENT. 305 



should be brought into the pelvic inlet, and cords attached to the lower 

 jaw, or Schaack's head-collar forceps (to bo hereafter described) may be 

 employed ; then having secured the head, the fore limbs are sought for, 

 and brought into the passage one after the other, where they are also 

 secured by cords around the pasterns. Sometimes these limbs cannot 

 be found, owing to their being bent back against the body of the foetus, 

 and this will certainly render delivery more ditlicult. 



Should the fn'tus present posteriorly, the case is more unfavouraljle ; 

 though if the hind limbs can be found and brought into the vagina, 

 delivery may soon be effected if there are no other complications. 



Cords being fastened to the pasterns, sulVicient and well-directed 

 traction should be employed on them, the hand of the operator remain- 

 ing in the pelvis if necessary, in order to guide the passage of the foetus. 

 Saint-Cyr suggests that an intelligent assistant may at the same time 

 bo directed to make methodical pressure on the hernia, in order to com- 

 plete its reduction, which is effected when the contents of the sac are 

 returned to the abdomen. 



At times this reduction is easy, and at other times it is extremely 

 dirticult. In the latter instances, all the more care is necessary that the 

 external manipulations are not too forcible, if it is desired to have a 

 living foetus. Should the resistance prove greater than the means which 

 may safely be employed to overcome it, then a surgical operation must 

 be determined on. When the muscles of the abdomen prove an obstacle 

 to the escape of the fcetus from the hernial sac, and produce a kind of 

 strangulation, an incision may be made through them in the most con- 

 venient part, as in the operation for strangulated hernia of the intestine. 



In other cases the Cajsarian operation may have to be resorted to, 

 and speedily, if the mother or progeny, or even both are to be saved. 

 Recourse to this formidable measure will only be had in particular 

 instances : as when the mother or fcetus is valuable, and other means 

 have failed or are not likely to succeed. 



And in uterine hernia this operation is undertaken in far more 

 favourable conditions than in some other circumstances which necessi- 

 tate its adoption. In this accident only the skin, and perhaps also 

 occasionally the tunica abdominalis, has to be cut through to expose 

 the uterus, which has not to be sought for among the mass of intestines 

 and laboriously withdrawn from their midst ; indeed, it generally 

 occupies the whole of the hernial tumour, and so closely, that there is 

 no danger of the intestines escaping during the operation. .\ simple 

 incision — no larger than is necessary — through the organ, a larger one 

 through the fa'tal membranes, and the prompt extraction of the foetus 

 therefrom, pretty nearly complete the task. 



If the Ctcsarian operation is timeously resorted to, the chances are 

 greatly in favour of delivering a living ftetus ; with the Cow a living 

 and perfectly viable Calf is almost certain to be obtained, even a long 

 time after labour has commenced and the " water- bag " has rup- 

 tured. And even with the Mare it is not at all impossible to rescue 

 a living Foal, if the operation is resorted to before rupture of the mem- 

 branes. 



The chances in favour of the mother are, of course, fewer than with 

 the fcetus ; for under the most favourable conditions, after removal of 

 the progeny, there will still remain the great hernial sac, which it will 

 be most ditttcult to keep the intestines from occupying, and still more 

 difficult to cure in a radical manner — judicious trussing and bandaging 



20 



