590 FCETAL DYSTOKIA. 



was in the act of parturition. The foetus was in the natural position, 

 and the head and fore-limbs were external to the vulva. Strong 

 traction was employed to extract it, during which the abdomen 

 ruptured, and it was estimated that more than twenty litres of fluid 

 escaped. The Cow was in great danger for a month afterwards. 



Diagnosis. 



The nature of the obstacle can only be ascertained by vaginal or 

 uterine exploration, though an examination per rectum may assist in 

 leading to a correct diagnosis. 



In vaginal exploration the great size of the abdomen in ascites, the 

 distention of its parietes, and the fluctuation on pressure, should reveal 

 the state of affairs. Not unfrequently, however, the body of the foetus 

 so completely blocks up the passage that it is impossible to pass the 

 hand, and it may be necessary to remove the protruding limbs by 

 embryotomy in order to diminish its volume. Hesitation in resorting 

 to this operation is usually unjustifiable, as the foetus is nearly always 

 dead, and if alive it cannot exist after birth. 



It has been recommended, in addition, to remove the two first ribs 

 or divide them, in order to allow the hand to explore the interior of 

 the foetus. If the obstacle is due to ascites, the convex condition of 

 the diaphragm, and the fluctuation of the fluid on the abdominal side 

 of it, will be remarked. 



When the dystokia is owing to anasarca, this will be distinguished 

 by the general roundness of the surface of the body, owing to the 

 presence of the subcutaneous fluid — which effaces all the prominences, 

 and to the oedematous sensation communicated to the fingers by 

 pressure. 



Indications. 



When the condition of the foetus is once ascertained, the principal 

 indication, if delivery by traction cannot be effected, is to diminish its 

 volume by producing the evacuation of the fluid which distends it, as 

 promptly and effectually as possible. 



In ascites, puncture of the abdomen through the parietes of that 

 cavity, if they can be reached, or puncturing the diaphragm through 

 the chest, if they cannot, must be practised. In the first, a bistoury 

 or anjr kind of convenient knife, or a trocar, will suffice ; in the second, 

 a long trocar or long-bladed knife, wrapped round with tow to near the 

 point, will answer the same purpose ; or if the hand can be introduced 

 into the thorax, the fingers alone will rupture the diaphragm. As the 

 fluid escapes, the abdomen collapses, and delivery is then easy. 



When anasarca is present, the fluid must be got rid of by deep 

 incisions through the skin wherever the hand can reach. The 

 mechanical extraction of the foetus should then be easy. In a case 

 reported by Anacker,i however, the foetus was so large that it had to 

 be removed by gastro-hysterotomy. 



An extremely rare cause of dystokia is due to congenital occlusion of 

 the urachus, which leads to great accumulation of urine in the bladder, 

 and consequent distention of the abdomen. A very good example is 

 given in the yearly report of the Veterinary School of Hanover for 1872. 



This condition will be diagnosed in the same way as ascites, and the 

 same indications for extraction of the foetus are to be observed. 

 ^ Der Thierarzt, 1868, p. 85. 



