Special Report on Diseases of Cattle Part 25

When the back of the calf is turned to the right side or the left the main difference is that in addition to straightening the limbs the fetus must be rotated to turn its back upward before extraction is attempted. In this case, too, it may be difficult to bring up and straighten the lower of the two limbs until the body has been rotated into its proper position. Cord the upper straightened limb and head, then rotate the body and search for the second missing limb.

_Fore limbs bent back from the shoulders._--This is an exaggeration of the condition just named, and is much more difficult to remedy, owing to the distance and inaccessibility of the missing limb. It usually happens with the proper position of the body, the back of the calf being turned toward the back of the mother. The head presents in the pa.s.sage and may even protrude from the v.u.l.v.a during an active labor pain, but it starts back like a spring when the straining ceases. Examination with the oiled hands in the intervals between the pains fails to detect the missing limbs. (Pl.

XVI, fig. 1.) If, however, the hand can be introduced during a pain it may be possible to reach the elbow or upper part of the forearm. In the absence of a pain a halter or noose on the head may be used to advance the whole body until the forearm can be seized just below the elbow. This being firmly held and the head or body pushed back into the womb, room may be obtained for bringing up the knee. The forearm is used as a lever, its upper part being strongly forced back while its lower part is pressed forward. If a pain supervenes the hold must be retained, and whatever gain has been made must be held if possible. Then during the next pain, by pushing back the body and continuing to operate the forearm as a lever, a still further advance may be made. As the knee is brought up in this way, the hand is slid down from the elbow toward the knee, which is finally brought up over the brim of the pelvis and into the pa.s.sage. It is now corded at the knee, and the subsequent procedure is as described in the last article. In a large, roomy cow with a small calf the latter may pa.s.s with one or both forelegs bent back, but this is a very exceptional case, and, as early a.s.sistance is the most successful, there should never be delay in hope of such a result.

_One fore limb crossed over the back of the neck._--This is a rare obstacle to calving, but one that not altogether unknown. The hand introduced into the pa.s.sage feels the head and one forefoot, and farther back on the same side of the other foot, from which the womb can be traced obliquely across the back of the neck. (Pl. XVI, fig. 3.) This foot, projecting transversely, is liable to bruise or tear the v.a.g.i.n.a. If still deeply engaged in the v.a.g.i.n.a, it may be seized and pushed across to the opposite side of the neck, when the presentation will be natural.

_Head bent down beneath the neck._--In this case, with drooping belly and womb allowing the brim of the pelvis to form a ridge, the advancing calf, having unduly depressed its nose, strikes it on the brim of the pelvis, and the neck advancing, the head is bent back and the poll and ears either enter the pelvis or strike against its brim. The two forefeet present, but they make no progress, and the oiled hand introduced can detect no head until the poll is felt at the entrance of the pelvis, between the forearms.

The two forefeet must be fixed with running nooses and dragged on moderately while the oiled hand seeks to bring up the head. The hand is slid down over the forehead and brim of the pelvis until the nose is reached, when it is pa.s.sed into the mouth, the muzzle resting in the palm of the hand. The legs are now pushed upon, and in the s.p.a.ce thus gained the muzzle is drawn up so as to enter it into the pelvis. In doing this the operator must carefully see that the mouth does not drop open so that the sharp, front teeth cut through the floor of the womb. Should this danger threaten, the hand should be made to cover the lower jaw as well. The lessened security of the hold is more than compensated by the safety of the procedure. With the nose in the pelvis, it has only to be drawn forward and the parturition is natural.

_Head bent down beneath the breast._--This is an exaggerated condition of that last named. The head, arrested by the brim of the pelvis and already bent back on the neck, is pressed farther with each successive throe until it has pa.s.sed between the forelegs and lodges beneath the breast bone. (Pl.

XVI, fig. 4.) On examination, the narrow upper border of the neck is felt between the forearms, but as a rule the head is out of reach below. Keeping the hand on the neck and dragging on the feet by the aid of ropes, the hand may come to touch and seize the ear, or, still better, one or two fingers may be inserted into the orbit of the eye.

Then in pushing back upon the limbs, with or without the aid of a repeller applied against the shoulder, s.p.a.ce may be obtained to draw the head into a vertical position, and even to slip the hand down so as to seize the nose.

Should it prove impossible to draw the head up with the una.s.sisted fingers, a blunt hook (Pl. XXI, fig. 6) may be inserted into the orbit, on which an a.s.sistant may drag while another pushes upon the limbs or repeller.

Meanwhile the operator may secure an opportunity of reaching and seizing the nose or of pa.s.sing a blunt hook into the angle of the mouth. Success will be better a.s.sured if two hooks (Pl. XXI, fig. 7) are inserted in the two orbits, so as to draw up the head more evenly. In other cases a noose may be placed on the upper jaw, or even around both jaws, and traction made upon this and on the hooks in the orbits while the legs are pushed back, and while the operator pushes back on the poll or forehead. In still more difficult cases, in which even the orbits can not be reached, a sharp hook on the end of a straight iron rod (Pl. XX, fig. 2) may be inserted over the lower jaw as far forward as it can be reached, and by dragging upon this while the body is pushed back the head will be brought up sufficiently to allow the operator to reach the orbit or nose. If even the jaw can not be reached, the hook may be inserted in the neck as near to the head as possible and traction employed so as to bring the head within reach.

In all such cases the cow's head should be turned downhill, and in case of special difficulty she should be turned on her back and held there until the head is secured. In old-standing cases, with the womb closely clasping the body of the calf, relaxation may be sought by the use of chloroform or a full dose of chloral hydrate--2 ounces; the free injection of warm water into the womb will also be useful.

_Head turned back on the shoulder._--With a natural, anterior presentation this may happen because of the imperfect dilation of the mouth of the womb.

Under the throes of the mother the forefeet pa.s.s through the narrow opening into the v.a.g.i.n.a, while the nose, striking against it and unable to enter, is pressed backward into the womb and turns aside on the right or left shoulder. The broad muzzle of the calf forms an especial obstacle to entrance and favors this deviation of the head. The worst form of this deviation is the old-standing one with shortening of the muscles of the neck on that side, and oftentimes distortion of the face and neck bones, as noticed under "Monstrosities" (p. 182).

When the head is bent on the shoulder the feet appear in the natural way, but no progress is made, and examination reveals the absence of the nose from between the knees, and farther back, from above and between the elbows, a smooth rounded ma.s.s is felt extending to the right or left, which further examination will identify with the neck. Following the upper border of this the hand reaches the crown of the head with the ears, and still further the eyes, or even, in a small calf, the nose.

As the bulky head of the calf can not be extracted along with the shoulders, it becomes necessary to push the body of the fetus back and straighten out the head and neck. The cow should be laid with her head downhill and with that side up toward which the head is turned. If the throes are very violent, or the womb strongly contracted on the calf, it may be best to seek relaxation by giving chloroform, or 2 ounces of laudanum, or 2 ounces of chloral hydrate. If the calf or the pa.s.sages are dry, sweet oil may be injected, or the whole may be liberally smeared with fresh lard. In the absence of these, warm water rendered slightly slippery by Castile soap may be injected into the womb in quant.i.ty. Ropes with running nooses are placed on the presenting feet and the oiled hand introduced to find the head. If, now, the fingers can be pa.s.sed inside the lower jawbone, and drag the head upward and toward the pa.s.sage, it unwinds the spiral turn given to the neck in bending back, and greatly improves the chances of bringing forward the nose. If, at first, or if now, the lower jaw can be reached, a noose should be placed around it behind the incisor teeth and traction made upon this, so that the head may continue to be turned, forehead up, toward the spine and jaws down, thereby continuing to undo the screwlike curve of the neck. If, on the contrary, the nose is dragged upon by a cord pa.s.sing over the upper border of the neck, the screwlike twist is increased and the resistance of the bones and joints of the neck prevents any straightening of the head. As soon as the lower jaw has been seized by the hand or noose, a repeller (Pl. XX, fig. 7), planted on the inside of the elbow or shoulder most distant from the head, should be used to push back the body and turn it in the womb, so that the head may be brought nearer to the outlet. In this way the head can usually be brought into position and the further course of delivery will be natural.

Sometimes, however, the lower jaw can not be reached with the hand, and then the orbit or, less desirably, the ear, may be availed of. The ear may be pulled by the hand, and by the aid of the repeller on the other shoulder the calf may be so turned that the lower jaw may be reached and availed of.

Better still, a clamp (Pl. XVIII, figs. 3 and 4) is firmly fixed on the ear and pulled by a rope, while the repeller is used on the opposite shoulder, and the hand of the operator pulls on the lower border of the neck and lifts it toward the other side. To pull on the upper border of the neck is to increase the spiral twist, while to raise the lower border is to undo it. If the outer orbit can be reached, the fingers may be inserted into it so as to employ traction, or a blunt finger hook (Pl. XXI, fig. 8) may be used, or a hook with a rope attached, or, finally, a hook on the end of a long staff. Then, with the a.s.sistance of the repeller, the body may be so turned and the head advanced that the lower jaw may be reached and availed of.

In case neither the ears nor the orbit can be reached, a cord should be pa.s.sed around the neck of the calf as near the head as possible, and traction made upon that while the opposite shoulder is pushed toward the opposite side by the repeller, a.s.sisted by the hand dragging on the lower border of the neck. To aid the hand in pa.s.sing a rope around the neck a cord carrier (Pl. XXI, fig. 5) is in use. It fails, however, to help us in the most difficult part of the operation--the pa.s.sing of the cord down on the deep or farthest side of the neck--and to remedy this I have devised a cord carrier, furnished with a ring at the end, a joint 6 or 8 inches from the end, and another ring on the handle, close to this joint. (Pl. XX, fig.

4.) A cord is pa.s.sed through both rings and a knot tied on its end, just back of the terminal ring. The instrument, straightened out, is inserted until it reaches just beyond the upper border of the neck, when, by dragging on the cord, the movable segment is bent down on the farther side of the neck, and is pushed on until it can be felt at its lower border. The hand now seizes the knotted end of the cord beneath the lower border of the neck and pulls it through while the carrier is withdrawn, the cord sliding through its rings. The cord, pushed up as near to the head as possible, is furnished with a running noose by tying the knotted end round the other, or, better, the two ends are twisted around each other so as to give a firm hold on the neck without dangerously compressing the blood vessels. By pushing on the opposite shoulder with the repeller, and, a.s.sisting with the hand on shoulder, breastbone, or lower border of the neck, such a change of position will be secured as will speedily bring the head within reach.

Afterwards proceed as described above.

These cases are always trying, but it is very rarely necessary to resort to embryotomy. When absolutely required, first remove one fore limb, and then, if still unsuccessful, the other, after which the head can easily be secured. (See "Embryotomy," p. 202.)

_Head turned upward and backward._--In this case the face rests upon the spine; the forefeet appear alone in the pa.s.sage, but fail to advance, and on examination the rounded, inferior border of the neck can be felt, extending upward and backward beneath the spine of the dam, and if the calf is not too large the hand may reach the lower jaw or even the muzzle. (Pl.

XVI, fig. 5.) A repeller is planted in the breast and the body of the calf pushed backward and downward so as to make room and bring the head nearer to the pa.s.sage; or in some cases the body may be pushed back sufficiently by the use of the fore limbs alone. Meanwhile the head is seized by the ear or the eye socket, or, if it can be reached, by the lower jaw, and pulled downward into position as s.p.a.ce is obtained for it. If the hand alone is insufficient, the blunt hooks may be inserted in the orbits or in the angle of the mouth, or a noose may be placed on the lower paw, and by traction the head will be easily advanced. In case of a large fetus, the head of which is beyond reach, even when traction is made on the limbs, a rope may be pa.s.sed around the neck and pulled, while the breastbone is pressed downward and backward by the repeller, and soon the change of position will bring the orbit or lower jaw within reach. With the above-described position the standing position is most favorable for success, but if the calf is placed with its back down toward the udder, and if the head is bent down under the brim of the pelvis, the best position for the cow is on her back, with her head downhill.

In neglected cases, with death and putrefaction of the fetus and dryness of the pa.s.sages, it may be necessary to extract in pieces. (See "Embryotomy,"

p. 202.)

_Outward direction of the stifles_--_Abduction of hind limbs._--As an obstacle to parturition, this is rare in cows. It is most liable to take place in cows with narrow hip bones, and when the service has been made by a bull having great breadth across the quarter. The calf, taking after the sire, presents an obstacle to calving in the breadth of its quarters, and if at the same time the toes and stifles are turned excessively outward and the hocks inward the combined breadth of the hip bones above and the stifles below may be so great that the pelvis will not easily admit them.

After the forefeet, head, and shoulders have all pa.s.sed out through the v.u.l.v.a, further progress suddenly and unaccountably ceases, and some dragging on the parts already delivered does not serve to bring away the hind parts. The oiled hand introduced along the side of the calf will discover the obstacle in the stifle joints turned directly outward and projecting on each side beyond the bones which circ.u.mscribe laterally the front entrance of the pelvis. The evident need is to turn the stifles inward; this may be attempted by the hand introduced by the side of the calf, which is meanwhile rotated gently on its own axis to favor the change of position. To correct the deviation of the hind limb is, however, very difficult, as the limbs themselves are out of reach and can not be used as levers to a.s.sist. If nothing can be done by pushing the body of the calf back and rotating it and by pressure by the hand in the pa.s.sages, the only resort appears to be to skin the calf from the shoulder back, cut it in two as far back as can be reached, then push the b.u.t.tocks well forward into the womb, bring up the hind feet, and so deliver.

_Hind limbs excessively bent on the body and engaged in the pelvis._--In this case the presentation is apparently a normal, anterior one; fore limbs and head advanced naturally and the parturition proceeds until half the chest has pa.s.sed through the external pa.s.sages, when suddenly progress ceases and no force will effect farther advance. An examination with the oiled hand detects the presence, in the pa.s.sages, of the hind feet and usually the hind legs up to above the hocks. (Pl. XVII, fig. 1.)

The indications for treatment are to return the hind limbs into the body of the womb. If they have not advanced too far into the pelvis, this may be done as follows: A rope with running noose is pa.s.sed over each hind foot and drawn tight around the lower part of the hock; the ropes are then pa.s.sed through the two rings in the small end of the rotating instrument (Pl. XX, fig. 5) which is slid into the pa.s.sages until it reaches the hocks, when the ropes, drawn tight, are tied around the handle of the instrument. Then in the intervals between the pains the hocks are pushed forcibly back into the womb. If by this means flexion can be effected in hocks and stifles, success will follow; the hind feet will pa.s.s into the womb and clear of the brim of the pelvis and the body may now be advanced without hindrance, the hind limbs falling into place when the hip joints are extended. At the same time the pressure upon hind limbs must not be relaxed until the b.u.t.tocks are engaged in the pelvis, as otherwise the feet may again get over the brim and arrest the progress of delivery.

When the hind limbs are already so jammed into the pelvis that it is impossible to return them, the calf must be sacrificed to save the mother.

Cords with running nooses are first put on the two hind feet. The body must be skinned from the shoulders back as far as can be reached, and is to be then cut in two, if possible, back of the last rib. The remainder of the trunk is now pushed back into the body of the womb and by traction upon the cords the hind feet are brought up into the pa.s.sages and the extraction will be comparatively easy.

_Hind presentation with one or both legs bent at the hock._--After the bursting of the water bags, though labor pains continue, no part of the fetus appears at the v.u.l.v.a unless it be the end of the tail. On examination the b.u.t.tocks are felt wedged against the spine at the entrance of the pelvis and beneath them the bent hock joints resting on the brim of the pelvis below. (Pl. XVII, fig. 3.) The calf has been caught by the labor pains while the limb was bent beneath it and has been jammed into or against the rim of the pelvis, so that extension of the limb became impossible. With the thigh bent on the flank, the leg on the thigh, and the shank on the leg, and all at once wedged into the pa.s.sage, delivery is practically impossible.

The obvious remedy is to push the croup upward and forward and extend the hind legs, and in the early stages this can usually be accomplished in the cow. A repeller (Pl. XX, fig. 7) is planted across the thighs and pointed upward toward the spine of the cow and pushed forcibly in this direction during the intervals between labor pains. Meanwhile the oiled hand seizes the shank just below the hock and uses it as a lever, pushing the body back and drawing the foot forward, thus effectually seconding the action of the repeller. Soon a distinct gain is manifest, and as soon as the foot can be reached it is bent back strongly at the fetlock, held in the palm of the hand, and pulled up, while the repeller, pressing on the b.u.t.tocks, a.s.sists to make room for it. In this way the foot may be brought safely and easily over the brim of the pelvis without any risk of laceration of the womb of the foot. After the foot has been lifted over the brim, the whole limb can be promptly and easily extended. In cases presenting special difficulty in raising the foot over the brim, help may be had by traction on a rope pa.s.sed around in front of the hock, and later still by a rope with a noose fastened to the pastern. In the worst cases, with the b.u.t.tocks and hocks wedged deeply into the pa.s.sages, it may prove difficult or impossible to push the b.u.t.tocks back into the abdomen, and in such case the extension of the hind limb is practically impossible without mutilation. In some roomy cows a calf may be dragged through the pa.s.sages by ropes attached to the bent hocks, but even when this is possible there is great risk of laceration of the floor of the v.a.g.i.n.a by the feet. The next resort is to cut the hamstring just above the point of the hock and the tendon on the front of the limb (flexor metatarsi) just above the hock, and even the sinews behind the shank bone just below the hock. This allows the stifle and hock to move independently of each other, the one undergoing extension without entailing the extension of the other; it also allows both joints to flex completely, so that the impacted ma.s.s can pa.s.s through a narrower channel. If now, by dragging on the hocks and operating with the repeller on the b.u.t.tocks, the latter can be tilted forward sufficiently to allow of the extension of the stifle, the jam will be at once overcome, and the calf may be extracted with the hock bent, but the stifle extended. If even this can not be accomplished, it may now be possible to extract the whole ma.s.s with both hocks and stifles fully bent. To attempt this, traction may be made on the rope around the hocks and on a sharp hook (Pl. XX, fig. 2) pa.s.sed forward between the thighs and hooked on to the brim of the pelvis.

Everything else failing, the offending limb or limbs may be cut off at the hip joint and extracted, after which extraction may proceed by dragging on the remaining limb, or by hooks on the hip bones. Very little is to be gained by cutting off the limb at the hock, and the stifle is less accessible than the hip, and amputation of the stifle gives much poorer results.

_Hind limbs bent forward from the hip_--_Breech presentation._--This is an exaggeration of the condition last described, only the hocks and stifles are fully extended and the whole limb carried forward beneath the belly.

(Pl. XVII, fig. 2.) The water bags appear and burst, but nothing presents unless it may be the tail. Examination in this case detects the outline of the b.u.t.tocks, with the tail and a.n.u.s at its upper part.

The remedy, as in the case last described, consists in pushing the b.u.t.tock upward and forward with a repeller, the cow being kept standing and headed downhill until the thigh bone can be reached and used as a lever. Its upper end is pushed forward and its lower end raised until, the joints becoming fully flexed, the point of the hock can be raised above the brim of the pelvis. If necessary a noose may be pa.s.sed around the leg as far down toward the hock as possible and pulled on forcibly, while the hand presses forward strongly on the back of the leg above. When both hocks have been lodged above the brim of the pelvis the further procedure is as described under the last heading.

If, however, the case is advanced and the b.u.t.tocks wedged firmly into the pa.s.sages, it may be impossible safely to push the fetus back into the womb, and the calf must either be dragged through the pa.s.sage as it is or the limbs or the pelvis must be cut off. To extract successfully with a breech presentation the cow must be large and roomy and the calf not too large.

The first step in this case is to separate the pelvic bones on the two sides by cutting from before backward, exactly in the median line below and where the thighs come together above. This may be done with a strong embryotomy knife, but is most easily accomplished with the long embryotome (Pl. XX, fig. 3). The form which I have designed (Pl. XX, fig. 1), with a short cutting branch jointed to the main stem, is to be preferred, as the short cutting piece may be folded on the main stem so that its cutting edge will be covered, and it can be introduced and extracted without danger.

This is pushed forward beneath the calf's belly, and the cutting arm opened, inserted in front of the brim of the pelvis and pulled forcibly back through the whole length of the pelvic bones. The divided edges are now made to overlap each other and the breadth of the haunch is materially reduced. One end of the cord may then be pa.s.sed forward by means of a cord carrier (Pl. XXI, fig. 5) on the inner side of one thigh until it can be seized at the stifle by the hand pa.s.sed forward on the outer side of that thigh. This end is now pulled back through the v.a.g.i.n.a, the other end pa.s.sed through the cord carrier and pa.s.sed forward on the inner side of the other thigh until it can be seized at the stifle by the hand pa.s.sed forward outside that thigh. This end is drawn back through the v.a.g.i.n.a like the first, and is tied around the other so as to form a running noose. The rope is now drawn through the ring until it forms a tight loop, encircling the belly just in front of the hind limbs. On this strong traction can be made without interfering with the full flexion of the limbs on the body, and if the case is a suitable one, and the body of the fetus and the pa.s.sages are both well lubricated with oil or lard, a successful parturition may be accomplished. A less desirable method is to put a rope around one thigh or a rope around each and drag upon these, but manifestly the strain is not so directly on the spine, and the limbs may be somewhat hampered in flexion.

This method being inapplicable, the next resort is to cut off one or both hind limbs at the hip joint. Free incisions are made on the side of the haunch so as to expose the hip joint, and the muscles are cut away from the head of the thigh bone down to its narrow neck, around which a rope is pa.s.sed and firmly fixed with a running noose. The joint is now cut into all around, and while traction is made on the cord the knife is inserted into the inner side of the joint and the round ligament severed. The cord may now be dragged upon forcibly, and the muscles and other parts cut through as they are drawn tense, until finally the whole member has been extracted.

Traction on the rope round the other thigh will now suffice to extract, in most cases, but if it should fail the other limb may be cut off in the same manner, and then hooks inserted in front of the brim of the pelvis or in the openings in the bones of its floor (obturator foramina) will give sufficient purchase for extraction. Another method is to insert a knife between the bone of the rump (sacrum) and the hip bone and sever their connections; then cut through the joint (symphysis) between the two hip bones in the median line of the floor of the pelvis, and then with a hook in the opening on the pelvic bones (obturator foramen) drag upon the limb and cut the tense soft parts until the limb is freed and extracted.

_Presentation of the back._--In this presentation straining may be active, but after the rupture of the water bags no progress is made, and the hand introduced will recognize the back with its row of spinous processes and the springing ribs at each side pressed against the entrance to the pelvis.

(Pl. XVII, fig. 6.) The presence or absence of the ribs will show whether it is the region of the chest or the loins. By feeling along the line of spines until the ribs are met with we shall learn that the head lies in that direction. If, on the contrary, we follow the ribs until they disappear, and a blank s.p.a.ce is succeeded by hip bones, it shows that we are approaching the tail. The head may be turned upward, downward, to the right side, or to the left.

The object must be to turn the fetus so that one extremity or the other can enter the pa.s.sage, and the choice of which end to bring forward will depend on various considerations. If one end is much nearer the outlet than the other, that would naturally be selected for extraction, but if they are equidistant the choice would fall on the hind end, as having only the two limbs to deal with without any risk of complication from the head. When the head is turned upward and forward it will usually be preferable to bring up the hind limb, as, owing to the drooping of the womb into the abdomen, rotation of the fetus will usually be easier in that direction, and if successful the resulting position will be a natural posterior presentation, with the back of the calf turned toward the rump of the cow. Similarly with the croup turned upward and forward, that should be pushed on forward, and if the forefeet and head can be secured it will be a natural anterior presentation, with the back of the calf turned upward toward the rump of the cow.

The womb should be injected with warm water or oil, and the turning of the calf will demand the combined action of the repeller and the hand, but in all such cases the operator has an advantage that the body of the fetus is wholly within the body of the womb, and therefore movable with comparative ease. No part is wedged into the pelvic pa.s.sages as a complication. The general principles are the same as in faulty presentation fore and hind, and no time should be lost in making the manipulations necessary to bring the feet into the pelvis, lest they get inbent or otherwise displaced and add unnecessary complications.

With a transverse direction of the calf, the head being turned to one side, the pressure must be directed laterally, so that the body will glide around on one side of the womb, and the extremities when reached must be promptly seized and brought into the pa.s.sages. Sometimes a fortunate struggle of a live fetus will greatly aid in rectifying the position.

_Breast and abdomen presented._--All four feet in the pa.s.sages._--In this form the calf lies across the womb with its roached back turned forward and its belly toward the pelvis. All four feet may be extended and engaged in the pa.s.sages, or one or more may be bent on themselves so as to lie in front of the pelvis. The head, too, may usually be felt on the right side or the left, and if detected it serves to identify the exact position of the fetus. The position may further be decided upon by examination of the feet and limbs. With the limbs extended the front of the hoofs and the convex aspect of the bent pasterns and fetlocks will look toward that flank in which lie the head and shoulders. On examination still higher the smooth, even outline of the knee and its bend, looking toward the hind parts, characterize the fore limb, while the sharp prominence of the point of the hock and the bend on the opposite side of the joint, looking toward the head, indicate the hind limb. (Pl. XVII, fig. 5.)

The remedy of this condition is to be sought in repelling into the womb those limbs that are least eligible for extraction, and bringing into the pa.s.sages the most eligible extremities. The most eligible will usually be those which project farthest into the pa.s.sages, indicating the nearer proximity of that end of the calf. An exception may, however, be made in favor of that extremity which will give the most natural presentation. Thus if, owing to obliquity in the position of the fetus, the hind extremities promised a presentation with the back of the fetus turned down toward the udder, and the anterior extremities one with the back turned up toward the spine, the latter should be selected. Again, if the choice for the two extremities is evenly balanced, the hind may be chosen as offering less risk of complication, there being no head to get displaced.

The first step in the treatment is to place a running noose on each of the four feet, marking those of the fore limbs to distinguish them from those of the hind ones. In case it is proposed to bring the anterior extremities into the pa.s.sage, a noose should also be placed on the lower jaw. Then run the ropes attached to the two feet that are to be pushed back through the ring of a cord carrier (Pl. XXI, fig. 5), pa.s.sing the rings down to the feet, and by the aid of the carrier push them well back into the womb and hold them there. Meanwhile drag upon the ropes attached to the two other feet so as to bring them into the pa.s.sage (or, in case of the anterior extremity, on the two foot ropes and the head one). The other feet must be pushed back into the womb until the body of the calf is fully engaged in the pa.s.sages. After this they can no longer find an entrance, but must follow as the body escapes.

NEGLECTED AND AGGRAVATED CASES.

In laying down the foregoing rules for giving a.s.sistance in critical cases of calving it is not intimated that all cases and stages can be successfully dealt with. Too often a.s.sistance is not sought for many hours or even days after labor pains, and the escape of the waters intimate the danger of delay. Not seldom the long delay has been filled up with unintelligent and injurious attempts at rendering a.s.sistance, violent pulling when resistance is insurmountable without change of position, injuries to the v.a.g.i.n.a and womb by ill-considered but too forcibly executed attempts to change the position, the repeated and long-continued contact with rough hands and rougher ropes and hooks, the gashes with knives and lacerations with instruments in ignorant hands, the infecting material introduced on filthy hands and instruments, and the septic inflammations started in the now dry and tender pa.s.sages and womb. Not infrequently the death, putrefaction, and bloating of the calf in the womb render the case extremely unpromising and make it impossible to apply successfully many of the measures above recommended. The labor pains of the cow may have practically ceased from exhaustion; the pa.s.sages of the v.a.g.i.n.a may be so dry, tender, friable, red, and swollen that it requires considerable effort even to pa.s.s the oiled hand through them, and the extraction of the calf or any portion of it through such a channel seems a hopeless task; the womb may be equally dry, inflamed and swollen, so that its lining membrane or even its entire thickness is easily torn; the fetal membranes have lost their natural, unctuous and slippery character, and cling firmly to the dry walls of the womb, to the dry skin of the calf, or to the hands of the operator; the dead and putrefying calf may be so bloated with gases that the womb has been overdistended by its presence, and the two adhere so closely that the motion of the one on the other is practically impossible.

In other cases reckless attempts to cut the calf in pieces have left raw surfaces with projecting bones which dangerously scratch and tear the womb and pa.s.sages.

In many cases the extreme resort must be had of cutting the fetus to pieces (embryotomy), or the still more redoubtable one of Caesarean section (extraction through the flank).

DISSECTION OF THE UNBORN CALF (EMBRYOTOMY).

In some cases the dissection of the calf is the only feasible means of delivering it through the natural pa.s.sages; and while it is especially applicable to the dead calf, it is also on occasion called for in the case of the living. As a rule, the living calf should be preserved, if possible, but if this threatens to entail the death of the cow it is only in the case of offspring of rare value that its preservation is to be preferred. To those acquainted with the toil, fatigue, and discomfort of embryotomy, no discussion is necessary so long as there is a prospect of success from the simple and generally easier method of rectifying the faulty position of the calf. When the correction of the position is manifestly impossible, however, when distortions and monstrosities of the fetus successfully obstruct delivery, when the pelvic pa.s.sages are seriously contracted by fractures and bony growths, when the pa.s.sages are virtually almost closed by swelling, or when the calf is dead and excessively swollen, no other resort may be available. In many cases of distortion and displacement the dismemberment of the entire calf is unnecessary, the removal of the offending member being all that is required. It will be convenient, therefore, to describe the various suboperations one by one and in the order in which they are usually demanded.

_Amputation of the fore limb._--In cutting off a fore limb it is the one presenting that should be selected, since it is much more easily operated on, and its complete removal from the side of the chest affords so much more s.p.a.ce for manipulation that it often makes it easy to bring the other missing limb or the head into position. The first consideration is to skin the limb from the fetlock up and leave the skin attached to the body. The reasons for this are: (_a_) That the skin is the most resistant structure of the limb, and when it has been removed the entire limb can be easily detached; (_b_) the tough skin left from the amputated limb may be used as a cord in subsequent traction on the body of the calf; (_c_) the dissection and separation of the limb are far more safely accomplished under the protection of the enveloping skin than if the operator's hands and instruments were in direct contact with the walls of the pa.s.sages or womb; (_d_) the dissection can be much more easily effected while the skin is stretched by the left hand, so as to form a comparatively firmer resistant point for the knife, than when it is attempted to cut the soft, yielding, and elastic tissues which naturally offer little solid resistance, but constantly recede before the cutting edge of the instrument. The preservation of the skin is therefore a cardinal principle in the amputation of all parts in which it is at all feasible.

The presenting foot is inclosed in a noose and drawn well out of the pa.s.sages. Then a circular incision through the skin is made around the limb just above the fetlock. From this the skin is slit up on the inner side of the limb to the breast. Then the projecting part of the limb is skinned up to the v.u.l.v.a, traction being made on the foot by an a.s.sistant so as to expose as much as possible. The embryotomy knife may now be taken (Pl. XXI, fig. 2), and a small hole having been cut in the free end of the detached portion of skin, that is seized by the left hand and extended while its firm connections with the deeper structures are cut through. The looser connections can be more quickly torn through with the closed fist or the tips of the four fingers held firmly together in a line or with the spud, of which there are several kinds. Much of the upper part of the limb can be skinned more speedily without the knife, but that must be resorted to to cut across tough bands whenever these interrupt the progress. The skinning should be carried upward on the outer side of the shoulder blade to the spine or nearly so. Then with the knife the muscles attaching the elbow and shoulder to the breastbone are cut across, together with those on the inner side of the shoulder joint and in front and behind it as far as these can be reached. Steady traction is now made upon the foot, the remaining muscles attaching the shoulder blade to the trunk are torn through with a cracking noise, and the whole limb, including the shoulder blade and its investing muscles, comes away. If the shoulder blade is left the bulk of the chest is not diminished, and nothing has been gained. Before going further it is well to see whether the great additional s.p.a.ce thus secured in the pa.s.sages will allow of the missing limb or head to be brought into position. If not, the other presenting part, limb or head, is to be amputated and extracted. For the limb the procedure is a repet.i.tion of that just described.