496 OBSTETRICAL OPERATIONS. 



brought straight by first cording the fore-limbs, then reaching the neck 

 of the lower jaw over the shoulder, and cording that also — retropulsion 

 and manipulation, with traction in the intervals of the straining, will 

 effect the rest. The case is very different, however, when the head is 

 carried as far back as the flank or hind-quarter, and especially if the 

 uterus is retracted on the foetus, and the interior is dry and adhesive. 

 In the Mare this is always a most formidable affair to deal with. Here 

 the mucilaginous and emollient injections are indispensable, and should 

 be at once resorted to. Then the fore-limbs must be corded, and 

 pushed into the uterus if they are in the way (using Darreau's porte- 

 cord if necessary), the hand passed along the convexity of the neck, 

 and between it and the uterine wall, until the lower jaw is seized and 

 corded. Pressure is now made on the breast of the foetus, so as to 

 push it away from the pelvic brim and towards the side of the uterus 

 opposite to that on which the head lies, so as to bring this nearer to 

 the inlet. Then the hand turns the lower jaw upwards by placing the 

 fingers in the submaxillary space, and pulling the head round by means 

 of the cord, the hand in the uterus keeping the body away from the 

 pelvis and to the opposite side, as well as protecting the uterus from 

 injury by the incisors. If there is a tendency to twisting of the neck, 

 this must be overcome by manipulation of the head, which must be 

 brought gradually and carefully round. 



But it only too frequently happens that the hand cannot reach the 

 head, or can only touch the ear-tips, and then the difficulty is very 

 great — it may even be insurmountable. Various plans have been tried, 

 such as exciting the foetus to move if it be alive ; raising the abdomen 

 of the mother, elevating the front part of the body or placing her in 

 the dorsal position ; or implanting hooks in the foetal orbits. But there 

 is no certainty in any or all of these methods, and the only one which 

 has hitherto been most successfully employed is that introduced by 

 Delafoy, more than sixty years ago. Having satisfied himself as to the 

 state of affairs, he passed the end of a strong rope, about twelve feet 

 long, with a knot at the end to prevent it slipping from his hand, 

 between the neck and chest of the foetus ; this end he passed down- 

 wards, seized it at the lower side of the neck, and brought it out of the 

 vaginal canal, so that the middle of the cord was inside the bend in the 

 neck. Again introducing his hand into the uterus, he pushed the loop 

 of cord by the tips of his fingers as near to the head as possible, 

 when he directed an assistant who held the two ends to twist them 

 round and round each other, until the cord was quite tight around the 

 part on which it was placed ; at the same time his hand prevented any 

 of the placenta or cotyledons from getting into the twists. This having 

 been accomplished, the hand was placed on the breast or one of the 

 shoulders of the foetus, and while he pushed it towards the fundus of 

 the uterus the assistant exercised steady traction on the cord. In this 

 way, by good management the head was brought towards the cervix 

 uteri, where it was immediately accessible, and could be placed in its 

 normal position. A small weight of any kind attached to the end of 

 the cord, instead of the knot, would carry it more readily between the 

 neck and shoulder or chest, and the porte-cord might also be used to 

 pass the cord if the hand could not be extended sufficiently far (see 

 Binz's porte-cord). 



Extension of the Limbs. — The limbs are not unfrequently a cause of 

 difficulty in parturition, and have to be adjusted before delivery can be 



