Special Report on Diseases of the Horse Part 23

If parturition continues to make progress the displaced foot may bruise and lacerate the v.a.g.i.n.a. By seizing the limb above the fetlock it may be easily pushed over the head to the proper side, when parturition will proceed normally.

FORE LIMB BENT AT KNEE.--The nose and one fore foot present, and on examination the knee of the missing fore limb is found farther back.

(Plate XV, fig. 1.) First place a noose each on the presenting pastern and lower jaw, and push back the body of the fetus with a repeller, while the operator seizing the shank of the bent limb extends it so as to press back the knee and bring forward the fetlock and foot. As progress is made little by little the hand is slid down from the region of the knee to the fetlock, and finally that is secured and brought up into the pa.s.sage, when parturition will proceed without hindrance. If both fore limbs are bent back the head must be noosed and the limbs brought up as above, one after the other. It is usually best to employ the left hand for the right fore limb, and the right hand for the left fore limb.

FORE LIMB TURNED BACK FROM SHOULDERS.--In this case, on exploration by the side of the head and presenting limb, the shoulder only can be reached at first. (Plate XV, fig 4.) By noosing the head and presenting fore limb, they may be drawn forward into the pelvis, and the oiled hand being carried along the shoulder in the direction of the missing limb is enabled to reach and seize the forearm just below the elbow. The body is now pushed back by the a.s.sistants pressing on the head and presenting limb or on a repeller planted in the breast until the knee can be brought up into the pelvis, after which the procedure is the same as described in the last paragraph.

HEAD BENT DOWN BETWEEN FORE LIMBS.--This may be so that the poll or nape of the neck, with the ears, can be felt far back between the fore limbs, or so that only the upper border of the neck can be reached, head and neck being bent back beneath the body. With the head only bent on the neck, noose the two presenting limbs, then introduce the hand between them until the nose can be seized in the palm of the hand. Next have the a.s.sistants push back the presenting limbs, while the nose is strongly lifted upward over the brim of the pelvis. This accomplished, it a.s.sumes the natural position and parturition is easy.

When both head and neck are bent downward it may be impossible to reach the nose. If, however, the labor has only commenced, the limbs may be drawn upon until the operator can reach the ear, by dragging on which the head may be so far advanced that the fingers may reach the orbit; traction upon this while the limbs are being pushed back may bring the head up so that it bends on the neck only, and the further procedure will be as described in the last paragraph.

If the labor has been long in progress and the fetus is jammed into the pelvis, the womb emptied of the waters, and firmly contracted on its solid contents, the case is incomparably more difficult. The mare may be chloroformed and turned on her back with hind parts elevated, and the womb may be injected with sweet oil. Then, if the ear can be reached, the correction of the malpresentation may be attempted as above described. Should this fail, one or more sharp hooks may be inserted in the neck as near the head as can be reached, and ropes attached to these may be dragged on, while the body of the foal is pushed back by the fore limbs or by a repeller. Such repulsion should be made in a direction obliquely upward toward the loins of the mother, so as to rotate the fetus in such a way as to bring the head up. As this is accomplished a hold should be secured nearer and nearer to the nose, with hand or hook, until the head can be straightened out on the neck.

All means failing; it becomes necessary to remove the fore limbs (embryotomy) so as to make more s.p.a.ce for bringing up the head. If, even then, this can not be accomplished, it may be possible to push the body backward and upward with the repeller until the hind limbs are brought to the pa.s.sage, when they may be noosed and delivery effected with the posterior presentation.

HEAD TURNED ON SHOULDERS.--In this case the fore feet present, and the oiled hand pa.s.sed along the fore arms in search of the missing head finds the side of the neck turned to one side, the head being perhaps entirely out of reach. (Plate XVIII, fig. 1.) To bring the head forward it may be desirable to lay the mare on the side opposite to that to which the head is turned, and even to give chloroform or ether. Then the feet being noosed, the body of the fetus is pushed by the hand or repeller forward and to the side opposite to that occupied by the head until the head comes within reach, near the entrance of the pelvis. If such displacement of the fetus is difficult, it may be facilitated by a free use of oil or lard. When the nose can be seized it can be brought into the pa.s.sage, as when the head is turned down. If it can not be reached, the orbit may be availed of to draw the head forward until the nose can be seized or the lower jaw noosed. In very difficult cases a rope may be pa.s.sed around the neck by the hand or with the aid of a curved carrier (Plate XIV), and traction may be made upon this while the body is being rotated to the other side. In the same way in bad cases a hook may be fixed in the orbit or even between the bones of the lower jaw to a.s.sist in bringing the head up into position. Should all fail, the amputation of the fore limbs may be resorted to, as advised under the last heading.

HEAD TURNED UPWARD ON BACK.--This differs from the last malpresentation only in the direction of the head, which has to be sought above rather than at one side, and is to be secured and brought forward in a similar manner. (Plate XVIII, fig. 2.) If a rope can be pa.s.sed around the neck it will prove most effectual, as it naturally slides nearer to the head as the neck is straightened and ends by bringing the head within easy reach.

HIND FEET ENGAGED IN PELVIS.--In this case fore limbs and head present naturally, but the hind limbs bent forward from the hip and the loins arched allow the hind feet also to enter the pa.s.sages, and the further labor advances the more firmly does the body of the foal become wedged into the pelvis (Plate XVII, fig. 2.) The condition is to be recognized by introducing the oiled hand along the belly of the fetus, when the hind feet will be felt advancing. An attempt should at once be made to push them back, one after the other, over the brim of the pelvis.

Failing in this, the mare may be turned on her back, head downhill, and the attempt renewed. If it is possible to introduce a straight rope carrier, a noose pa.s.sed through this may be put on the fetlock and the repulsion thereby made more effective. In case of continued failure the anterior presenting part of the body may be skinned and cut off as far back toward the pelvis as possible (see "Embryotomy"); then nooses are placed on the hind fetlocks and traction is made upon these while the quarters are pushed back into the womb. Then the remaining portion is brought away by the posterior presentation.

ANTERIOR PRESENTATION WITH BACK TURNED TO ONE SIDE.--The diameter of the axis of the foal, like that of the pelvic pa.s.sages, is from above downward, and when the fetus enters the pelvis with this greatest diameter engaged transversely or in the narrow diameter of the pelvis, parturition is rendered difficult or impossible. In such a case the pasterns and head may be noosed, and the pa.s.sages and engaged portion of the foal freely lubricated with lard, the limbs may be crossed over each other and the head, and a movement of rotation effected in the fetus until its face and back are turned up toward the croup of the mother; then parturition becomes natural.

BACK OF FOAL TURNED TO FLOOR OF PELVIS.--In a roomy mare this is not an insuperable obstacle to parturition, yet it may seriously impede it, by reason of the curvature of the body of the foal being opposite to that of the pa.s.sages, and the head and withers being liable to arrest against the border of the pelvis. Lubrication of the pa.s.sage with lard and traction of the limbs and head will usually suffice with or without the turning of the mare on her back.

In obstinate cases two other resorts are open: First, to turn the foal, pushing back the fore parts and bringing up the hind so as to make a posterior presentation, and, second, the amputation of the fore limbs, after which extraction will usually be easy.

[Ill.u.s.tration: PLATE XV.

ABNORMAL PRESENTATIONS.]

[Ill.u.s.tration: PLATE XVI.

ABNORMAL PRESENTATIONS.]

[Ill.u.s.tration: PLATE XVII.

ABNORMAL PRESENTATIONS.]

[Ill.u.s.tration: PLATE XVIII.

ABNORMAL PRESENTATIONS.]

HIND PRESENTATION WITH LEG BENT AT HOCK.--In this form the quarters of the foal with the hind legs bent up beneath them present, but can not advance through the pelvis by reason of their bulk. (Plate XV, fig. 3.) The oiled hand introduced can recognize the outline of the b.u.t.tocks, with the tail and a.n.u.s in the center and the sharp points of the hocks beneath. First pa.s.s a rope around each limb at the hock, then with hand or repeller push the b.u.t.tocks backward and upward, until the feet can be brought up into the pa.s.sages. To this the great length of the shank and pastern in the foal is a serious obstacle, and in all cases the foot should be protected in the palm of the hand while being brought up over the brim of the pelvis; otherwise the womb may be torn. When the pains are too violent and constant to allow effective manipulation, some respite may be obtained by the use of chloroform or morphin and by turning the mare on her back, but too often the operator fails and the foal must be sacrificed. Two courses are still open: First, to cut through the cords behind and above the hock and extend the upper part of the limb, leaving the hock bent, and extract in this way, and, second, to amputate the hind limbs at the hip joint and remove them separately, after which the body may be extracted.

HIND PRESENTATION WITH LEGS BENT FORWARD FROM HIP.--This is merely an aggravated form of the presentation last described. (Plate XVII, fig.

1.) If the mare is roomy, a rope may be pa.s.sed around each thigh and the body pushed upward and forward, so as to bring the hocks and heels upward. If this can be accomplished, nooses are placed on the limb further and further down until the fetlock is reached and brought into position. If failure is met with, then amputation at the hips is the last resort.

HIND PRESENTATIONS WITH BACK TURNED SIDEWAYS OR DOWNWARD.--These are the counterparts of similar anterior presentations and are to be managed in the same way.

PRESENTATION OF THE BACK.--This is rare, yet not unknown, the foal being bent upon itself with the back, recognizable by its sharp row of spines, presented at the entrance of the pelvis and the head and all four feet turned back into the womb. (Plate XVI, fig. 1.) The body of the fetus may be extended across the opening transversely, so that the head corresponds to one side (right or left), or it may be vertical, with the head above or below.

In any such position the object should be to push the body of the fetus forward and upward or to one side, as may best promise to bring up the fore or hind extremities, and bring the latter into the pa.s.sage so as to const.i.tute a normal anterior or posterior presentation. This turning of the fetus may be favored by a given position of the mother, by the free use of oil or lard on the surface of the fetus, and by the use of a propeller.

PRESENTATION OF BREAST AND ABDOMEN.--This is the reverse of the back presentation, the foal being extended across in front of the pelvic opening, but with the belly turned toward the pa.s.sages and with all four feet engaged in the pa.s.sage. (Plate XVI, fig. 2.) The most promising course is to secure the hind feet with nooses and then push the fore feet forward into the womb. As soon as the fore feet are pushed forward clear of the brim of the pelvis, traction is made on the hind feet so as to bring the thighs into the pa.s.sage and prevent the reentrance of the fore limbs. If it proves difficult to push the fore limbs back, a noose may be pa.s.sed around the fetlock of each and the cord drawn through the eye of a rope carrier, by means of which the members may be easily pushed back.

EMBRYOTOMY.

Embryotomy consists in the dissection of the fetus, so as to reduce its bulk and allow of its exit through the pelvis. The indications for its adoption have been furnished in the foregoing pages. The operation will vary in different cases according to the necessity for the removal of one or more parts in order to secure the requisite reduction in size.

Thus it may be needful to remove head and neck, one fore limb or both, one hind limb or both, to remove different parts of the trunk, or to remove superfluous (monstrous) parts. Some of the simplest operations in embryotomy (incision of the head in hydrocephalus, incision of the belly in dropsy) have already been described. It remains to notice the more difficult procedures which can be best undertaken by the skilled anatomist.

AMPUTATION OF THE HEAD.--This is easy when both fore limbs are turned back and the head alone has made its exit in part. It is more difficult when the head is still retained in the pa.s.sages or womb, as in double-headed monsters. The head is secured by a hook in the lower jaw, or in the orbit, or by a halter, and the skin is divided circularly around the lower part of the face or at the front of the ears, according to the amount of head protruding. Then an incision is made backward along the line of the throat, and the skin dissected from the neck as far back as possible. Then the muscles and other soft parts of the neck are cut across, and the bodies of two vertebra (neck bones) are severed by cutting completely across the cartilage of the joint. The bulging of the ends of the bones will serve to indicate the seat of the joint. The head and detached portion of the neck may now be removed by steady pulling. If there is still an obstacle, the knife may be again used to sever any obstinate connections. In the case of a double-headed monster, the whole of the second neck must be removed with the head. When the head has been detached, a rope should be pa.s.sed through the eyeholes, or through an artificial opening in the skin, and tied firmly around the skin, to be employed as a means of traction when the missing limbs or the second head have been brought up into position.

AMPUTATION OF THE HIND LIMB.--This may be required when there are extra hind limbs or when the hind limbs are bent forward at hock or hip joint.

In the former condition the procedure resembles that for removal of a fore limb, but requires more anatomical knowledge. Having noosed the pastern, a circular incision is made through the skin around the fetlock, and a longitudinal one from that up to the groin, and the skin is dissected from the limb as high up as can be reached, over the croup, if possible. Then cut through the muscles around the hip joint, and, if possible, the two interarticular ligaments of the joint (pubofemoral and round), and extract the limb by strong dragging.

AMPUTATION OF THE FORE LIMBS.--This may usually be begun on the fetlock of the limb projecting from the v.u.l.v.a. An embryotomy knife is desirable.

This knife consists of a blade with a sharp, slightly hooked point, and one or two rings in the back of the blade large enough to fit on the middle finger, while the blade is protected in the palm of the hand.

(See Plate XIII, fig. 4.) Another form has the blade inserted in a mortise in the handle, from which it is pushed out by a movable b.u.t.ton when wanted. First place a noose around the fetlock of the limb to be amputated, cut the skin circularly entirely around the fetlock, then make an incision on the inner side of the limb from the fetlock up to the breastbone. Next dissect the skin from the limb, from the fetlock up to the breastbone on the inner side, and as far up on the shoulder blade as possible on the outer side. Finally, cut through the muscles attaching the limb to the breastbone, and employ strong traction on the limb, so as to drag out the whole limb, shoulder blade included. The muscles around the upper part of the shoulder blade are easily torn through and need not be cut, even if that were possible. In no case should the fore limb be removed unless the shoulder blade is taken with it, as that furnishes the greatest obstruction to delivery, above all when it is no longer advanced by the extension of the fore limb, but is pressed back so as to increase the already thickest posterior portion of the chest. The preservation of the skin from the whole limb is advantageous in various ways; it is easier to cut it circularly at the fetlock than at the shoulder; it covers the hand and knife in making the needful incisions, thus acting as a protection to the womb; and it affords a means of traction on the body after the limb has been removed.

In dissecting the skin from the limb the knife is not needful at all points; much of it may be stripped off with the fingers or knuckles, or by a blunt, iron spud, pushed up inside the hide, which is meanwhile held tense to render the spud effective.

In case the limb is bent forward at the hock, a rope is pa.s.sed round that and pulled so as to bring the point of the hock between the lips of the v.u.l.v.a. The hamstring and the lateral ligaments of the hock are now cut through, and the limbs extended by a rope tied round the lower end of the long bone above (tibia). In case it is still needful to remove the upper part of the limb, the further procedure is the same as described in the last paragraph.

In case the limb is turned forward from the hip, and the fetus so wedged into the pa.s.sage that turning is impossible, the case is very difficult.

I have repeatedly succeeded by cutting in on the hip joint and disarticulating it, then dissecting the muscles back from the upper end of the thigh bone. A noose was placed around the neck of the bone and pulled on forcibly, while any unduly resisting structures were cut with the knife.

Cartwright recommends to make free incisions round the hip joints and tear through the muscles when they can not be cut; then with cords round the pelvic bones, and hooks inserted in the openings in the floor of the pelvis to drag out the pelvic bones; then put cords around the heads of the thigh bones and extract them; then remove the intestines; finally, by means of the loose, detached skin, draw out the body with the remainder of the hind limbs bent forward beneath it.

Reuff cuts his way into the pelvis of the foal, and with a knife separates the pelvic bones from the loins, then skinning the quarter draws out these pelvic bones by means of ropes and hooks, and along with them the hind limbs.

The hind limbs having been removed by one or the other of these procedures, the loose skin detached from the pelvis is used as a means of traction and delivery is effected. In case of a monstrosity with extra hind limbs, it may be possible to bring these up into the pa.s.sage and utilize them for traction.

_Removal of the abdominal viscera._--In case the belly is unduly large, from decomposition, tumors, or otherwise, it may be needful to lay it open with the knife and cut or tear out the contents.

_Removal of the thoracic viscera._--To diminish the bulk of the chest it has been found advisable to cut out the breastbone, remove the heart and lungs, and allow the ribs to collapse with the lower free ends overlapping each other.

_Dissection of the trunk._--In case it becomes necessary to remove other portions of the trunk, we should follow the general rule of preserving the skin so that all manipulations can be made inside this as a protector, that it may remain available as a means of exercising traction on the remaining part of the body, and as a covering to protect the v.a.g.i.n.al walls against injuries from bones while such part is pa.s.sing.

FLOODING, OR BLEEDING FROM THE WOMB.

This is rare in the mare, but not unknown, in connection with a failure of the womb to contract on itself after parturition, or with eversion of the womb (casting the withers), and congestion or laceration. If the blood acc.u.mulates in the flaccid womb, the condition may be suspected only by reason of the rapidly advancing weakness, swaying, unsteady gait, hanging head, paleness of the eyes and other mucous membranes, and weak, small, failing pulse. The hand introduced into the womb detects the presence of the blood partly clotted. If the blood escapes by the v.u.l.v.a, the condition is evident.

_Treatment_ consists in evacuating the womb of its blood clots, giving a large dose of powdered ergot of rye, and in the application of cold water or ice to the loins and external generative organs. Besides this, a sponge impregnated with a strong solution of alum, or, still better, with tincture of muriate of iron, may be introduced into the womb and squeezed so as to bring the liquid in contact with the walls generally.

EVERSION OF THE WOMB.