DYSTOKIA ItlK Tn THE FnllKlAMliS. 



437 



the latter against the thorax, and prevent their being lo(l{::;ed in the 

 depression at the base of the neck — thus augnientin<^ the vertical and 

 transverse diameter of the chest, while at the same time the projecting 

 elbows press against the border of the pelvis. 



It may happen tliat only one limb is tlexed at the knee, and then, of 

 course, the case is not so serious. 



Indications. — The indications are in this case also obvious : Find 

 the retained limbs, extentl the fore-arm of each on the arm, and ex- 

 tend them in the pelvic cavity, as in normal parturition. 



These indications are not so ditticult to carry out when the obstetrist 

 is called in sutliciently early, and the head has made but little advance 

 into the pelvis. 



We will suppose both fore-legs partially retained in the abdomen. 



Fig. 128. 

 .A.NTEBIOR Presentation, Dorso-Sacral Position : FoiiKLisiits klexku at the Knee.s. 



and flexed at the knees. The exploration which has led to this discovery 

 has perhaps also indicated that one limb is not so much flexed as, or is 

 more accessible than, the other. If this is the left limb, then the left 

 hand and arm must be employed ; if it is the right leg, then the right 

 hand and arm will be most convenient ; but if both limbs are alike 

 implicated and accessible, then it is immaterial which is first manipu- 

 lated, so long as the corresponding hand and arm are employed. The 

 same directions are applicable to both, keeping in mind that the right 

 and left hands are opposite. The object is to adjust the direction of the 

 fore-limbs, so that delivery can be accomplished. This adjustment is 

 effected in four movements : — 1. The hand is passed alongside the neck 

 of the fcctus, the fore-arm is seized in the middle, the radial border of 

 the hand being upwards, the cubital downwards ; then bending the hand. 



