DYSTOKIA ]>VE To THE HEAD. 445 



uterine contractions, pushing on the body, propel the fore-hmbs, if they 

 are in a favourable direction, into the genital canal. Thus it will be 

 understood that, if the expulsive efforts continue, the head becomes 

 more and more tlexcd as the fietal mass is carried towards the vulva (as 

 is delineated in the shaded and unshaded fcetuses in Fig. 132), until, 

 from vortical and oblique, the face becomes horizontal, and rests on 

 the floor of the pelvis of the mother, the lower jaw against the trachea ; 

 the neck becomes proportionately flexed, and as laliour goes on the 

 head is retained, as well as the cervical portion of the former ; so that 

 when the obstetrist introduces his hand into the genital canal, the feet 

 are found presenting towards the vulva, but far in front of them (or 

 behind them, as the explorer stands) ; this may be designated a neck or 

 poll presentation {unshaded fcetus in Fig. 132). 



The diagnosis of this deviation is not ditlicult. When the anterior 

 limbs are in a proper direction, the feet and upper part of them are 

 readily found, and their inclination should be noted ; but in a slight 

 complication the whole of the head cannot be discovered — only the ears, 

 eyes, nape of the neck, and the forelock and mane if a Foal. With the 

 Calf, which has a shorter neck, it may be possible to reach the head 

 or nose. The upper ridge of the neck is always a safe guide to follow 

 in discovering the direction of the head. 



Indications. — There is no difViculty in adjusting the head, if the ob- 

 stetrist is called in time, and it is movable towards the pelvic inlet, but 

 not engaged in that opening. It is merely necessary to glide the hand 

 along the floor of the vagina into the uterus, pass it between the maternal 

 pubis and the forehead of the foetus, downwards to the nose, which is 

 to be received into the hollowed palm and raised above the pubic brim, 

 by flexing the wrist and drawing it towards the vulva. When the nose is 

 brought into the genital canal, nothing more is to be done than to pull 

 the head into the passage and complete delivery in the usual way. 

 W'ith the Calf, whose muffle is wider and cannot be so readily received 

 into the palm of the hand, it is better to introduce the lingers into its 

 mouth, using them like a blunt hook, or to seize the nose l)y pushing 

 the index finger and thumb into the nostrils, so as to throw the lower 

 part of the head upwards. 



When, however, through delay or unskilful attempts at delivery, the 

 nape of the neck is firmly engaged in the inlet, there is no room to 

 adjust the head, the lower part of which is jammed against the mater- 

 nal pubis below, and the vertex against the sacrum above. In such a 

 case delivery has been etTected by passing the running noose of a cord 

 round the nose or the upper jaw of the fa^tus, and while an assistant 

 pulled at this, the operator, by pressing strongly against the top of the 

 head, made this swing backwards, the nose rising into the passage ; 

 birth was then accomplished in a few minutes. 



.\nd even with this degree of head deviation, delivery of the Foal 

 without adjustment is not impossible ; for Lecoq gives an instance in 

 which the upper part of the head and poll were so firmly fixed in the 

 pelvis, that it was impossible to push the fcctus into the uterus. This 

 was attempted, however, by squeezing the head closer to the neck, the 

 hand being passed alongside the cheek and the nose gradually raised ; 

 at the same moment the Mare strained doubly hard, and gentle traction 

 being applied, the Foal was expelled with its head in this position, but 

 without injuring the perinicum of the mother. The latter soon recovered, 



