equally effective in the mare. The dam is placed (with her head uphill)
on her right side if the upper folds of the spiral turn toward the
right, and on her left side if they turn toward the left, and the oiled
hand is introduced through the neck of the womb and a limb or other part
of the body of the fetus is seized and pressed against the wall of the
womb, while two or three assistants turn the animal over on her back
toward the other side. The object is to keep the womb stationary while
the animal is rolling. If success attends the effort, the constriction
around the arm is suddenly relaxed, the spiral folds are effaced, and
the water bags and fetus press forward into the passage. If the first
attempt does not succeed, it may be repeated again and again until
success crowns the effort. Among my occasional causes of failure have
been the prior death and decomposition of the fetus, with the
extrication of gas and overdistention of the womb, and the supervention
of inflammation and inflammatory exudation around the neck of the womb,
which hinders untwisting. The first of these conditions occurs early in
the horse from the detachment of the fetal membranes from the wall of
the womb; and as the mare is more subject to fatal peritonitis than the
cow, it may be concluded that both these sources of failure are more
probable in the former subject.
When the case is intractable, though the hand may be easily introduced,
the instrument shown in Plate XIV, figure 7, may be used. Each hole at
the small end of the instrument has passed through it a stout cord with
a running noose, to be passed around two feet or other portion of the
fetus which it may be possible to reach. The cords are then drawn tight
and fixed around the handle of the instrument; then, by using the cross
handle as a lever, the fetus and womb may be rotated in a direction
opposite to that causing the obstruction. During this process the hand
must be introduced to feel when the twist has been undone. This method
may be supplemented, if necessary, by rolling the mare as described
above.
EFFUSION OF BLOOD IN THE VAGINAL WALLS.--This is common as a result of
difficult parturition, but it may occur from local injury before that
act, and may seriously interfere with it. This condition is easily
recognized by the soft, doughy swelling so characteristic of blood
clots, and by the dark-red color of the mucous membrane. I have laid
open such swellings with the knife as late as 10 days before
parturition, evacuated the clots, and dressed the wound daily with an
astringent lotion (sulphate of zinc 1 dram, carbolic acid 1 dram, water
1 quart). A similar resort might be had, if necessary, during
parturition.
CALCULUS (STONE) AND TUMOR IN THE BLADDER.--The pressure upon the
bladder containing a stone or a tumor may prove so painful that the mare
will voluntarily suppress the labor pains. Examination of the bladder
with the finger introduced through the urethra will detect the offending
agent. A stone should be extracted with forceps. (See "Lithotomy.") The
large papillary tumors which I have met with in the mare's bladder have
been invariably delicate in texture and could be removed piecemeal by
forceps. Fortunately, mares affected in this way rarely breed.
FECAL IMPACTION OF THE RECTUM.--In some animals, with more or less
paralysis or weakness of the tail and rectum, the rectum may become so
impacted with solid feces that the mare is unable to discharge them, and
the accumulation both by reason of the mechanical obstruction and the
pain caused by pressure upon it will impel the animal to cut short all
labor pains. The rounded swelling surrounding the anus will at once
suggest the condition, when the obstruction may be removed by the
well-oiled or well-soaped hand.
SPASM OF THE NECK OF THE WOMB.--This occurs in the mare of specially
excitable temperament, or under particular causes of irritation, local
or general. Labor pains, though continuing for some time, produce no
dilatation of the neck of the womb, which will be found firmly closed so
as to admit but one or two fingers; this, although the projection at the
mouth of the womb may have been entirely effaced, so that a simple round
opening is left, with rigid margins.
The simplest treatment consists in smearing this part with solid extract
of belladonna, and after an interval inserting the hand with fingers and
thumb drawn into the form of a cone, rupturing the membranes and
bringing the fetus into position for extraction, as advised under
"Prolonged retention of the fetus." Another mode is to insert through
the neck of the womb an ovoid rubber bag, empty, and furnished with an
elastic tube 12 feet long. Carry the free end of this tube upward to a
height of 8, 10, or 12 feet, insert a filler into it, and proceed to
distend the bag with tepid or warm water.
FIBROUS BANDS CONSTRICTING OR CROSSING THE NECK OF THE WOMB.--These,
occurring as the result of disease, have been several times observed in
the mare. They may exist in the cavity of the abdomen and compress and
obstruct the neck of the womb, or they may extend from side to side of
the vagina across and just behind the neck of the womb. In the latter
position they may be felt and quickly remedied by cutting them across.
In the abdomen they can be reached only by incision, and two
alternatives are presented: (1) To perform embryotomy and extract the
fetus piecemeal, and (2) to make an incision into the abdomen and
extract by the Caesarean operation, or simply to cut the constricting
band and attempt delivery by the usual channel.
FIBROUS CONSTRICTION OF VAGINA OR VULVA.--This is probably always the
result of direct mechanical injury and the formation of rigid cicatrices
which fail to dilate with the remainder of the passages at the approach
of parturition. The presentation of the fetus in the natural way and the
occurrence of successive and active labor pains without any favorable
result will direct attention to the rigid and unyielding cicatrices
which may be incised at one, two, or more points to a depth of half an
inch or more, after which the natural expulsive efforts will usually
prove effective. The resulting wounds may be washed frequently with a
solution of 1 part of carbolic acid to 50 parts of water, or of 1 part
of mercuric chlorid to 1,000 parts of water.
FETUS ADHERENT TO THE WALLS OF THE WOMB.--In inflammation of the mucous
membrane lining the cavity of the womb and implicating the fetal
membranes the resulting embryonic tissue sometimes establishes a medium
of direct continuity between the womb and fetal membranes; the blood
vessels of the one communicate freely with those of the other and the
fibers of the one are prolonged into the other. This causes retention of
the membranes after birth, and a special risk of bleeding from the womb,
and of septic poisoning. In exceptional cases the adhesion is more
extensive and binds a portion of the body of the foal firmly to the
womb. In such cases it has repeatedly been found impossible to extract
the foal until such adhesions were broken down. If they can be reached
with the hand and recognized, they may be torn through with the fingers
or with a blunt hook, after which delivery may be attempted with hope of
success.
EXCESSIVE SIZE OF FETUS.--It would seem that a small mare may usually be
safely bred to a large stallion, yet this is not always the case; and
when the small size is an individual rather than a racial characteristic
or the result of being very young, the rule can not be expected to hold.
There is always great danger in breeding the young, small, and
undeveloped female, and the dwarfed representative of a larger breed, as
the offspring tend to partake of the large race characteristics and to
show them even prior to birth. When impregnation has occurred in the
very young or in the dwarfed female there are two alternatives--to
induce abortion or to wait until there are attempts at parturition and
to extract by embryotomy if impracticable otherwise.
CONSTRICTION OF A MEMBER BY THE NAVEL STRING.--In man and animals alike
the winding of the umbilical cord around a member of the fetus sometimes
leads to the amputation of the latter. It is also known to get wound
around the neck or a limb at birth, but in the mare this does not
seriously impede parturition, as the loosely attached membranes are
easily separated from the womb and no strangulation or retarding occurs.
The foal may, however, die from the cessation of the placental
circulation unless it is speedily delivered.
WATER IN THE HEAD (HYDROCEPHALUS) OF THE FOAL.--This consists in the
excessive accumulation of liquid in the ventricles of the brain so that
the cranial cavity is enlarged and constitutes a great, projecting,
rounded mass occupying the space from the eyes upward. (See Plate XIII,
fig. 3.) With an anterior presentation (fore feet and nose) this
presents an insuperable obstacle to progress, as the diseased cranium is
too large to enter the pelvis at the same time with the fore arms. With
a posterior presentation (hind feet) all goes well until the body and
shoulders have passed out, when progress is suddenly arrested by the
great bulk of the head. In the first case, the oiled hand introduced
along the face detects the enormous size of the head, which may be
diminished by puncturing it with a knife or trocar and cannula in the
median line, evacuating the water and pressing in the thin, bony walls.
With a posterior presentation, the same course must be followed; the
hand passed along the neck will detect the cranial swelling, which may
be punctured with a knife or trocar. Oftentimes with an anterior
presentation the great size of the head leads to its displacement
backward, and thus the fore limbs alone engage in the passages. Here the
first object is to seek and bring up the missing head, and then puncture
it as above suggested.
[Illustration: PLATE XII.
NORMAL PRESENTATIONS.]
[Illustration: PLATE XIII.
SOME FACTORS IN DIFFICULT LABOR.]
[Illustration: PLATE XIV.
INSTRUMENTS USED IN DIFFICULT LABOR.]
ASCITES, OR DROPSY OF THE ABDOMEN IN THE FOAL.--The accumulation of
liquid in the abdominal cavity of the fetus is less frequent, but when
present it may arrest parturition as completely as will hydrocephalus.
With an anterior presentation the foal may pass as far as the shoulders,
but behind this all efforts fail to effect a further advance. With a
posterior presentation the hind legs as far as the thighs may be
expelled, but at this point all progress ceases. In either case the
oiled hand, passed inward by the side of the foal, will detect the
enormous distension of the abdomen and its soft, fluctuating contents.
The only course is to puncture the cavity and evacuate the liquid. With
the anterior presentation this may be done with a long trocar and
cannula, introduced through the chest and diaphragm, or with a knife an
incision may be made between the first two ribs and the lungs and heart
cut or torn out, when the diaphragm will be felt projecting strongly
forward, and may be easily punctured. Should there not be room to
introduce the hand through the chest, the oiled hand may be passed along
beneath the breast bone and the abdomen punctured. With a posterior
presentation the abdomen must be punctured in the same way, the hand,
armed with a knife protected in its palm, being passed along the side of
the flank or between the hind limbs. It should be added that moderate
dropsy of the abdomen is not incompatible with natural delivery, the
liquid being at first crowded back into the portion of the belly still
engaged in the womb, and passing slowly from that into the advanced
portion as soon as that has cleared the narrow passage of the pelvis and
passed out where it can expand.
GENERAL DROPSY OF THE FETUS.--In this case the tissues generally are
distended with liquid, and the skin is found at all points tense and
rounded, and pitting on pressure with the fingers. In some such cases
delivery may be effected after the skin has been punctured at narrow
intervals to allow the escape of the fluid and then liberally smeared
with fresh lard. More commonly, however, it can not be reached at all
points to be so punctured nor sufficiently reduced to be extracted
whole, and resort must be had to embryotomy.
EMPHYSEMA, OR SWELLING OF THE FETUS WITH GAS.--This has been described
as occurring in a living fetus, but I have met with it only in the dead
and decomposing foal after futile efforts had been made for several days
to effect delivery. These cases are very difficult, as the foal is
inflated to such extent that it is impossible to advance it into the
passages, and the skin of the fetus and the walls of the womb and vagina
have become so dry that it is impracticable to cause the one to glide on
the other. The hair comes off any part that may be seized, and the case
is rendered the more offensive and dangerous by the very fetid liquids
and gases. The only resort is embryotomy, by which I have succeeded in
saving a valuable mare that had carried a colt in this condition for
four days.
CONTRACTIONS OF MUSCLES.--The foal is not always developed
symmetrically, but certain groups of muscles are liable to remain short,
or to shorten because of persistent spasmodic contraction, so that even
the bones become distorted and twisted. This is most common in the neck.
The bones of this part and even of the face are drawn to one side and
shortened, the head being held firmly to the flank and the jaws being
twisted to the right or left. In other cases the flexor muscles of the
fore limbs are contracted so that the latter are strongly bent at the
knee. In neither of these cases can the distorted part be extended and
straightened, so that body or limbs must necessarily present double, and
natural delivery is rendered impossible. The bent neck may sometimes be
straightened after the muscles have been cut on the side to which it is
turned, and the bent limbs after the tendons on the back of the shank
bone have been cut across. Failing to accomplish this, the next resort
is embryotomy.
INCLOSED OVUM, OR TUMORS OF THE FETUS.--Tumors or diseased growths may
form on any part of the foal, internal or external, and by their size
impede or hinder parturition. In some cases what appears as a tumor is
an imprisoned and undeveloped ovum which has grafted itself on the
fetus. These are usually sacculated, and may contain skin, hair, muscle,
bone, and other natural tissues. The only course to be pursued in such
cases is to excise the tumor, or, if this is not feasible, to perform
embryotomy.
MONSTROSITIES.--Monstrosity in the foal is an occasional cause of
difficult parturition, especially such monsters as show excessive
development of some part of the body, a displacement or distortion of
parts, or a redundancy of parts, as in double monsters. Monsters may be
divided into--
(1) Monsters with absence of parts--absence of head, limb, or other
organ.
(2) Monsters with some part abnormally small--dwarfed head, limb, trunk,
etc.
(3) Monsters through unnatural division of parts--cleft head, trunk,
limbs, etc.
(4) Monsters through absence of natural divisions--absence of mouth,
nose, eyes, anus, confluent digits, etc.
(5) Monsters through fusion of parts--one central eye, one nasal
opening, etc.
(6) Monsters through abnormal position or form of parts--curved spine,
face, limb, etc.
(7) Monsters through excess of formation--enormous head, supernumerary
digits, etc.
(8) Monsters through imperfect differentiation of sexual
organs--hermaphrodites.
(9) Double monsters--double-headed, double-bodied, extra limbs, etc.
_Causes._--The causes of monstrosities appear to be very varied. Some
monstrosities, like extra digits, absence of horns or tail, etc., run in
families and are produced almost as certainly as color or form. Others
are associated with too close breeding, the powers of symmetrical
development being interfered with, just as in other cases a sexual
incompatibility is developed, near relatives failing to breed with each
other. Mere arrest of development of a part may arise from accidental
disease of the embryo; hence vital organs are left out, or portions of
organs, like the dividing walls of the heart, are omitted. Sometimes an
older fetus is inclosed in the body of another, each having started
independently from a separate ovum, but the one having become embedded
in the semifluid mass of the other and having developed there
simultaneously with it, but not so largely nor perfectly. In many cases
of redundance of parts the extra part or member has manifestly developed
from the same ovum and nutrient center with the normal member to which
it remains adherent, just as a new tail will grow out in a newt when the
former has been cut off. In the early embryo, with its great powers of
development, this factor can operate to far greater purpose than in the
adult animal. Its influence is seen in the fact pointed out by St.
Hilaire that such redundant parts are nearly always connected with the
corresponding portions in the normal fetus. Thus superfluous legs or
digits are attached to the normal ones, double heads or tails are
connected to a common neck or rump, and double bodies are attached to
each other by corresponding points, navel to navel, breast to breast,
back to back. All this suggests the development of extra parts from the
same primary layer of the impregnated and developing ovum. The effect of
disturbing conditions in giving such wrong directions to the
developmental forces is well shown in the experiments of St. Hilaire and
Valentine in varnishing, shaking, and otherwise breaking up the natural
connections in eggs, and thereby determining the formation of
monstrosities at will. So, in the mammal, blows and other injuries that
detach the fetal membranes from the walls of the womb or that modify
their circulation by inducing inflammation are at times followed by the
development of a monster. The excitement, mental and physical, attendant
on fright occasionally acts in a similar way, acting probably through
the same channels.
The monstrous forms liable to interfere with parturition are such as,
from contracted or twisted limbs or spine, must be presented double;
where supernumerary limbs, head, or body must approach the passages with
the natural ones; where a head or other member has attained to an
unnatural size; where the body of one fetus has become inclosed in or
attached to another, etc.
Extraction is sometimes possible by straightening the members and
obtaining such a presentation as will reduce the presenting mass to its
smallest and most wedgelike dimensions. To effect this it may be needful
to cut the flexor tendons of bent limbs or the muscles on the side of a
twisted neck or body; one or more of the manipulations necessary to
secure and bring up a missing member may be required. In most cases of
monstrosity by excess, however, it is needful to remove the superfluous
parts, in which case the general principles employed for embryotomy must
be followed. The Caesarean section, by which the fetus is extracted
through an incision in the walls of the abdomen and womb, is
inadmissible, as it practically entails the sacrifice of the mare, which
should never be done for the sake of a monster. (See "Embryotomy," p.
202.)
ENTRANCE OF TWINS INTO THE PASSAGE AT ONCE.--Twins are rare in the mare,
and still more rare is the impaction of both at once into the pelvis.
The condition would be easily recognized by the fact that two fore limbs
and two hind would occupy the passage at once, the front of the hoofs of
the fore feet being turned upward and those of the hind feet downward.
If both belonged to one foal, they would be turned in the same
direction. Once recognized, the condition is easily remedied by passing
a rope with a running noose round each foot of the foal that is furthest
advanced or that promises to be most easily extracted, and to push the
members of the other fetus back into the depth of the womb. As soon as
the one fetus is fully engaged into the passage it will hold its place
and its delivery will proceed in the natural way.
ABNORMAL PRESENTATIONS.
(Pls. XV-XVIII.)
Abnormal presentations may be tabulated as follows:
{ {Incompletely extended.
{ { Flexor tendons shortened.
{Fore limbs {Crossed over the neck.
{ {Bent back at the knee.
{ {Bent back from the shoulder.
Anterior presentations: {
{ {Bent downward on the neck.
{ {Head and neck turned back
{ { beneath the breast.
{Head {Turned to one side.
{ {Turned upward and backward
{ { on the back.
{
{Hind limbs Hind feet engaged in the pelvis.
{
{Transverse Back of foal to side of pelvis.
{
{Inverted Back of foal to floor of pelvis.
{Hind limbs {Bent on itself at the hock.
Posterior presentations { {Bent at the hip.
{
{Transverse Back of foal to side of pelvis.
{
{Inverted Back of foal to floor of pelvis.
{With back and loins presented.
Transverse presentation of body {With breast and belly presented.
FORE LIMBS INCOMPLETELY EXTENDED.--In cases of this kind, not only are
the back tendons behind the knee and shank bone unduly short, but the
sinew extending from the front of the shoulder blade over the front of
the elbow and down to the head of the shank bone is also shortened. The
result is that the fore limb is bent at the knee and the elbow is also
rigidly bent. The condition obstructs parturition by the feet becoming
pressed against the floor of the pelvis or by the elbow pressing on its
anterior brim. Relief is to be obtained by forcible extension. A rope
with a running noose is passed around each fetlock and a repeller (see
Plate XIV) planted in the breast is pressed in a direction upward and
backward while active traction is made on the ropes. If the feet are not
thereby raised from the floor of the pelvis the palm of the hand may be
placed beneath them to protect the mucous membrane until they have
advanced sufficiently to obviate this danger. In the absence of a
repeller, a smooth rounded fork handle may be employed. If the
shortening is too great to allow of the extension of the limbs in this
way, the tense tendons may be cut across behind the shank bone and in
front of the elbow, and the limb will be easily straightened out. This
is most easily done with an embryotomy knife furnished with a ring for
the middle finger, so that the blade may be protected in the palm of the
hand. (See Plate XIII, fig. 4.)
FORE LIMB CROSSED OVER BACK OF NECK.--With the long fore limbs of the
foal this readily occurs, and the resulting increase in thickness, both
at the head and shoulder, offers a serious obstacle to progress. (See
Plate XV, fig. 2.) The hand introduced into the passage detects the head
and one fore foot, and farther back on the same side of the head the
second foot, from which the limb may be traced obliquely across the back
of the neck.
If parturition continues to make progress the displaced foot may bruise
and lacerate the vagina. 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 passage, 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 assistants 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
assistants push back the presenting limbs, while the nose is strongly
lifted upward over the brim of the pelvis. This accomplished, it assumes
the natural position and parturition is easy.