KECriFICAriOX OF rilESKXTATIoys AM) POSIT lOXS. 493 



delivery. Very frequently traction on one or more of these cords, and 

 the manipulations of a hand in the uterus, will greatly facilitate turning. 

 As in so many other obstetrical operations, undue haste and violence 

 are to be guarded against in these mutations, and gentleness, patience, 

 and perseverance should be observed. We not unfrequently find that, 

 when the presentation is anterior or posterior, and the limbs are in a 

 favourable direction, though the body of the fa'tus may be somewhat 

 inclined to the right or left, the uterine contractions are sulhcient to 

 eftect adjustment, gradual and well-directed traction being alone re- 

 quired from the operator. 



Extension .\nd Flexion. 



Independently of the ijeneral mutations which have for their object 

 the movement of the whole mass of the foetus in the uterus, it is some- 

 times only required to resort to i^artial mutations — as in the adjustment 

 of one or more of the limbs, head, neck, etc., these consisting of extension 

 — as when the arm is extended on the shoulder, the fore-arm on the 

 arm, the head on the neck, the latter on the trunk, etc., and jlexion, in 

 bending the various articulations — as those of the limbs, in order to 

 place them or the body in a better direction ; and rotation. In all these 

 manoeuvres a rudimentary knowledge of mechanics will be of gi'eat 

 advantage, and especially that pertaining to levers, which is particu- 

 larly applicable to manipulations of the limbs that so frequently prove 

 of the greatest service in obstetrical operations. 



It only too often happens that the arm of the obstetrist is found to 

 be sadly too short in version and other manoeuvres, and these are conse- 

 quently rendered more diflicult of accomplishment. With regard to 

 this, it is well to point out — what is not always known — that the 

 obstetrist should always employ the arm corresponding to the side of the 

 foetus on which the limb, the part sought for or to be manipulated, is 

 situated. For instance, if the fcctus is in the anterior presentation and 

 dorso-sacral position, with the head bent round towards tlie left Hank, 

 or the left fore-limb (right hind-limb in a posterior presentation) doubled 

 under the body, he will use his right arm ; but the left will be employed 

 in the opposite conditions. By doing so, the operator gains in length 

 of arm, particularly towards the shoulder, and can consequently reach 

 deeper into the uterus. 



Flexion and extension of a limb are often made simultaneously, and 

 it sometimes happens that in extending such a part as the head to 

 straighten it, it effects its own rotation. Extension alone serves to 

 bring the limbs from under the chest or abdomen ; flexion is rarely re- 

 sorted to, and chiefly when it is desired to return an extended limb 

 again into the uterus. In these operations on the limlis, when the 

 weight of the fa'tus is an obstacle, the body of the creature is inclined 

 to the side opposite to that of the limb to be manipulated ; thus, if the 

 right limb is flexed under the body, and we desire to extend it, the 

 fcctus is inclined from right to left, so that the right side being raised, 

 the limb can be taken from under it. The body is turned in the way 

 indicated for rotation. 



We have casually alluded to the attitude of the larger animals during 

 version, retropulsion, and rotation, and pointed out the advantage to be 

 derived from elevating the hind-quarters, either by placing litter under 

 the hind-feet, or causing the animal, if a Cow, to kneel on its knees. 

 And we have also remarked that it is not always possible to obtain the 



