378 
UNUSUAL AND DIFFICULT PARTURITION. 
On my arrival, I found her lying down ; her pulse was small 
and accelerated, and her labour pains seemed to be gradually 
decreasing. 
On introducing my arm into the vagina, I found the neck of 
the womb was firmly closed, so that I could scarcely introduce a 
finger. By gentle manipulation, however, I by degrees introduced 
my hand. 
The anterior extremities were naturally presented, but the head 
was turned back in such a manner that the lower jaw was the 
superior one. The calf appeared to be dead. 
1 waited a little while, thinking that the dilatation would be 
presently more easily effected. She was stretched at her length 
on the litter, and from time to time some slight contractions of 
the uterus could be felt. 
At length, however, I determined to endeavour to effect the 
parturition, and, in order to rouse the powers of nature, I admi- 
nistered a bottle of wine warm and sugared. I then introduced 
my arm, covered with oil, and grasped one of the anterior extre- 
mities, and passed a rope round it, the management of which I 
entrusted to an assistant. I next searched for the other extre- 
mity, to which — having readily founcl it — I fastened another cord. 
The head remained ; but a difficulty presented itself. I could 
not without the greatest force introduce my arm, and, when I had 
done so, it was pressed upon and benumbed by the foetus, and I 
found that I must amputate one of the limbs before I could re- 
lieve the patient. 
I took a bistoury, and, drawing down the left leg, I effected a 
circular incision through the integument around the knee : I 
then effected a similar incision on the internal surface of the limb, 
which enabled me to dissect still higher, until I arrived at the 
humero-cubital articulation, and then, the lips of the vulva being 
held back, I prolonged my incision as far as I was able. Four 
assistants then began to draw the cord gradually but firmly ; and 
in an instant the muscles by which the shoulder was attached to 
the thorax were torn away, and the limb was drawn out entire. 
The same operation w T as immediately afterwards performed on the 
other limb, and with greater ease. 
By means of this, however, the head, curved in the way that 
has been described, was pushed farther backward in proportion 
as the chest of the foetus filled the passage, and, as it was be- 
yond the reach of my arm, I employed a crotchet (hook), which 
I forced between the first ribs, and, pulling with my right hand, T 
so brought down the head that I could lay hold of the lower jaw. 
After some little manipulation, I was enabled to grasp the head, 
and to bring it into the natural position, but I could not pass it 
