460 FCETAL DYSTOKIA. 



corded, placed straight in the genital passage, and traction made on 

 them by the cords and the hand ; if there is difficulty in moving the 

 foetus, traction should be made on one side, then on the other, by which 

 means progress will be made, and delivery ultimately completed. 



Fore-Limhs. 



In the posterior presentation it may happen that the fore-limbs olTer 

 an obstacle to birth, by entering the inlet along with the chest of the 

 foetus. Donnarieix alludes to this accident in a presentation which 

 he designates as mixed, and characterised by the entrance into the os 

 of the four legs at the same time ; this may occur in the anterior pre- 

 sentation, when the hind extremities are flexed beneath the abdomen 

 and jammed in the pelvis, as well as when these are the first to enter 

 the OS. Other authorities also speak of this accident, which is not 

 frequent. Sometimes the two hind-limbs and a fore one are found in 

 the passage. It is probable that the presentation is secondary, and 

 probably it was originally sterno-abdominal, with the feet engaged in 

 the canal. 



The hind-legs are found in the passage, perhaps projecting from the 

 vulva, one or both of the fore ones being in the vagina, and probably 

 towards the maternal sacrum ; while the body of the foetus may be 

 parallel to that of the mother, but more frequently it is oblique. 



Indications. — According to Donnarieix, retropulsion is impracticable 

 in the Mare in this difficulty, as the limbs are jammed against the 

 maternal pubis, ihums, or sacrum, and traction will lead to rupture of 

 the uterus. He therefore advises amputation of the fore-limb or limbs 

 at the humero-radial joint, after they have been withdrawn to near the 

 vulva ; he has always been successful in his cases by such treatment. 

 With the Cow, however, he admits that the fore-limbs may be pushed 

 forward into the uterus, and delivery then effected. 



Dieterich and Darreau advise retropulsion of the fore-limb or limbs 

 by means of the repeller. 



Amputation of these limbs being a long and troublesome operation, 

 Donnarieix's advice should not be followed until other measures have 

 been tried. These should be : propelling the fore-limbs into the uterus, 

 and if this cannot be effected, pushing the upper joints beyond the 

 inlet. Canu recommends cording the hind extremities, grasping the 

 fore ones above the knee and carrying them into the uterus, while the 

 assistants pull the cords. If these attempts fail, then the fore-legs can 

 be drawn as near the vulva as possible, and amputated either at the 

 shoulder or scapula. 



B. Abnormal Posterior Presentations. 



The abnormal posterior presentations are chiefly due to deviation in 

 the direction of the hind-limbs, and this is, in many instances, a very 

 serious complication. Instead of being extended backwards into the 

 passage, one or both may be bent at the fetlocks or the hocks — the leg 

 against the thigh, these joints presenting ; or they may be carried 

 straight forward under the body, the buttocks alone resting against the 

 inlet. So that, instead of a wedge-shaped mass offering its thinnest 

 portion to gradually dilate the genital canal, the foetus presents a large 

 rounded mass — the croup and thighs — which is not at all adapted for 



