546 OBSTETRICAL OPERATIOXH. 



others on the outer side. On the latter there is perhaps less danger of 

 wounding the maternal organs, and it may be more convenient for the 

 operator. But this is a matter of minor importance ; it is more neces- 

 sary to be careful in incising the skin beyond the articulations, so as 

 not to divide the ligaments of these, as this might lead to the limb being 

 torn away at the wrong place ; no such precaution is necessary with the 

 muscles. 



This longitudinal incision having been made, the skin is separated 

 from the structures beneath, either by means of the fingers or the 

 spatula — pushing it up towards the shoulder as it is detached, until at 

 length, as the leg becomes stretched, the incision and the detached 

 skin are as high as the shoulder. The dissection being then deemed 

 sufficient, and the limb being only retained by the muscles which attach 

 it to the thorax, the operator, either by his hand or the crutch, makes 

 pressure on the foetus, while the assistants are ordered to pull energetic- 

 ally at the cord on the pastern, and in a kind of jerking manner. Soon 

 slight cracking sounds are heard, the muscles are rupturing and giving 

 way, and in a very short time the entire limb — ^scapula and all — is 

 removed. 



The removal of one limb usually leaves a considerable space in the 

 genital canal, and this allows delivery to be completed. Sometimes, 

 however, and particularly when the head is deviated towards the flank, 

 it is necessary to remove the other limb ; and this, when effected, 

 permits the head to be sought for and rectified, version accomplished, 

 etc., according to the requirements of the case. 



Some practitioners operate in a somewhat different manner to the 

 foregoing. Lecoq, for instance, commences his incision at the upper 

 part of the shoulder, brings it down over the head of the humerus, on 

 the side of the forearm, and as far as the middle of the cannon, where 

 he makes his circular incision ; the skin is separated from this part up- 

 wards. In some cases this procedure may be preferable to the other, 

 and it certainly is less dangerous for the parent ; but it sometimes- 

 happens that the shoulder cannot be reached. 



Giinther pushed back the fcjetus as far as possible by means of the 

 crutch, with the finger-scalpel divided the skin before and behind the 

 scapula, then across — below and above; then cutting through the pectoral 

 muscles, and extracting the limb. Cartwright operates in a similar 

 manner to Lecoq. He first has a leg drawn out, and divides the skin 

 as far as possible; or he introduces his hand, containing a knife, as high 

 as he can on the side of the scapula, and makes an incision thence- 

 down the whole length of the limb to the pastern bones ; the skin is 

 separated by the fingers or spatula as far as possible from the entire- 

 leg, and the transverse pectoral muscles cut through. The limb is then 

 disjointed, either at the pastei'n or fetlock ; the foot being left attached 

 to the skin, as it is afterwards found to be useful in the extraction of 

 the body. Cords are fastened around the limb above the fetlock-joint 

 and knee, and the Cow being firmly tied by the head, the necessary 

 force is applied, and the whole limb drawn away. He writes : "I have 

 known, in some of these cases, the limbs to separate at the shoulder 

 joints, and yet the foetus has been extracted^both from the Mare and 

 Cow — with the shoulders attached, the points of the latter having, 

 fortunately, not caught the edge of the pelvis. The great danger in 

 these cases is, that the shoulder-joints may catch against the pelvis and. 

 thus prevent extraction." 



