544 OBSTETFJCAL OPERATIONS. 



Traction should be made on the sternum, not the withers, as the latter 

 ought first to enter the inlet. 



A third method consists in removing the lower jaw, and excising the 

 head from below. Or this incision may be practised from the mouth, 

 the chisel being used to divide the vertebras, after the cheeks, masseter 

 muscles, and soft tissues behind the lower jaw have been cut through. 



Decapitation, under the most favourable circumstances, is often a 

 long and fatiguing operation, as the greatest care has to be observed in 

 order to avoid injuring the parent. But this fatigue and anxiety are 

 vastly increased w^hen the head is deeply buried in the passage or the 

 uterus. Then the hand — moist with the fluids of the genital organs, 

 embarrassed by shreds of the foetal envelopes, hampered by the pre- 

 sence of the limbs, compressed and paralysed by the uterine contrac- 

 tions — can scarcely hold and guide the cutting instrument, or distinguish 

 what belongs to the foetus and what to the mother, and has scarcely 

 strength to divide the tissues, which are all the more difficult to cut by 

 reason of their softness. It will readily be understood how such an 

 operation must be difficult for the operator and dangerous for the 

 mother. It might also be deemed impossible, if veterinarians had not 

 attempted it and succeeded ; though the majority of them have said 

 but little as to their mode of procedure. 



It is always preferable, if possible, to remove one of the fore-limbs, 

 as this is easier, quicker, and less dangerous. 



But decapitation must sometimes be performed, and then the above 

 instructions will be found useful. 



In the case of double-headed monstrosities, the saw^ and bone-chisel, 

 or a pair of strong bone-forceps, will be valuable. When the head of 

 the foetus is retained in the uterus, and bent back towards the shoulder 

 or flank, then it may be decided to amputate the head and a portion of 

 the neck. Disarticulation may be commenced at the most convenient 

 part of the convexity made by the bend of the neck, cutting through 

 the soft tissues down to the vertebrae on that side, then on the other ; 

 then sawing or chiselling through the bones, and afterwards using the 

 crotchets carefully. 



Amputation of the Limbs. 



When the limbs are so deviated that they cannot be straightened, or 

 when by their presence in the genital passage they prevent the neces- 

 sary manoeuvres for the adjustment of other parts of the foetus, then 

 it may be necessary to amputate or disarticulate one or more of the 

 extremities. Some of the indications for the operation have been 

 referred to on various occasions ; they include all those foetal mon- 

 strosities which have supernumerary limbs that require removal before 

 delivery can be effected ; those cases in which the foetus is exaggerated 

 in volume, either normally, or through having become emphysematous 

 after death in utero ; those complicated malpresentations — such as the 

 abdominal, hock, thigh, etc., and certain deviations of the head and 

 neck in the anterior presentation. In the latter it is well to hesitate 

 before deciding to remove the limbs ; for if it is true that their ablation 

 allows more space for manoeuvres, and more facility for adjusting the 

 head, it is not less true that, should these manauvres fail, by the loss 

 of the limbs we are deprived of a powerful means of traction when we 

 are compelled, as a last resource, to adopt forced extraction. Besides, 



