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 space 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 passage, 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 passed 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 passage, 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 passed 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 assist 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 passed 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 passages, 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 passed 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 passages, 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 passages 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 passages, and the head and withers being liable to arrest against
the border of the pelvis. Lubrication of the passage 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.
[Illustration: PLATE XV.
ABNORMAL PRESENTATIONS.]
[Illustration: PLATE XVI.
ABNORMAL PRESENTATIONS.]
[Illustration: PLATE XVII.
ABNORMAL PRESENTATIONS.]
[Illustration: 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 buttocks,
with the tail and anus in the center and the sharp points of the hocks
beneath. First pass a rope around each limb at the hock, then with hand
or repeller push the buttocks backward and upward, until the feet can be
brought up into the passages. 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 passed 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 passage so as to
constitute 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 passages and with all four
feet engaged in the passage. (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 passage and prevent the reentrance of the
fore limbs. If it proves difficult to push the fore limbs back, a noose
may be passed 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 passages 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 passed 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 vulva. 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 button
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 passed round
that and pulled so as to bring the point of the hock between the lips of
the vulva. 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 passage 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 passage
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 vaginal walls against injuries from bones while such part is
passing.
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 accumulates 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
vulva, 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.
If the womb fails to contract after difficult parturition, the
after-pains will sometimes lead to the fundus passing into the body of
the organ and passing through that and the vagina until the whole
inverted organ appears externally and hangs down on the thighs. The
result is rapid engorgement and swelling of the organ, impaction of the
rectum with feces, and distention of the bladder with urine, all of
which conditions seriously interfere with the return of the mass. In
returning the womb the standing is preferable to the recumbent position,
as the abdomen is more pendent and there is less obstruction to the
return. It may, however, be necessary to put hobbles on the hind limbs
to prevent the mare from kicking. A clean sheet should be held beneath
the womb, and all filth, straw, and foreign bodies washed from its
surface. Then with a broad, elastic (india-rubber) band, or in default
of that a long strip of calico 4 or 5 inches wide, wind the womb as
tightly as possible, beginning at its most dependent part (the extremity
of the horn). This serves two good ends. It squeezes out into the
general circulation the enormous mass of blood which engorged and
enlarged the organ, and it furnishes a strong protective covering for
the now delicate, friable organ, through which it may be safely
manipulated without danger of laceration. The next step may be the
pressure on the general mass while those portions next the vulva are
gradually pushed in with the hands; or the extreme lowest point (the end
of the horn) may be turned within itself and pushed forward into the
vagina by the closed fist, the return being assisted by manipulations by
the other hand, and even by those of assistants. By either mode the
manipulations may be made with almost perfect safety so long as the
organ is closely wrapped in the bandage. Once a portion has been
introduced into the vagina the rest will usually follow with increasing
ease, and the operation should be completed with the hand and arm
extended the full length within the womb and moved from point to point
so as to straighten out all parts of the organ and insure that no
portion still remain inverted within another portion. Should any such
partial inversion be left it will give rise to straining, under the
force of which it will gradually increase until the whole mass will be
protruded as before. The next step is to apply a truss as an effectual
mechanical barrier to further escape of the womb through the vulva. The
simplest is made with two 1-inch ropes, each about 18 feet long, each
doubled and interwoven at the bend, as seen in Plate XIV, figure 4. The
ring formed by the interlacing of the two ropes is adjusted around the
vulva, the two ends of the one rope are carried up on the right and left
of the tail and along the spine, being wound around each other in their
course, and are finally tied to the upper part of the collar encircling
the neck. The remaining two ends, belonging to the other rope, are
carried downward and forward between the thighs and thence forward and
upward on the sides of the belly and chest to be attached to the right
and left sides of the collar. These ropes are drawn tightly enough to
keep closely applied to the opening without chafing, and will fit still
more securely when the mare raises her back to strain. It is desirable
to tie the mare short so that she may be unable to lie down for a day or
two, and she should be kept in a stall with the hind parts higher than
the fore. Violent straining may be checked by full doses of opium
(one-half dram), and any costiveness or diarrhea should be obviated by a
suitable laxative or binding diet.
In some mares the contractions are too violent to allow of the return of
the womb, and full doses of opium one-half dram, laudanum 2 ounces, or
chloral hydrate 1 ounce, may be demanded, or the mare must be rendered
insensible by ether or chloroform.
RUPTURE, OR LACERATION, OF THE WOMB.
This may occur from the feet of the foal during parturition, or from
ill-directed efforts to assist, but it is especially liable to take
place in the everted, congested, and friable organ. The resultant
dangers are bleeding from the wound, escape of the bowels through the
opening and their fatal injury by the mare's feet or otherwise, and
peritonitis from the extension of inflammation from the wound and from
the poisonous action of the septic liquids of the womb escaping into the
abdominal cavity. The first object is to close the wound, but unless in
eversion of the womb this is practically impossible. In the last-named
condition the wound must be carefully and accurately sewed up before
the womb is returned. After its return, the womb must be injected daily
with an antiseptic solution (borax, one-half ounce, or carbolic acid, 3
drams to a quart of tepid water). If inflammation threatens, the abdomen
may be bathed continuously with hot water by means of a heavy woolen
rag, and large doses of opium (one-half dram) may be given twice or
thrice daily.
RUPTURES OF THE VAGINA.
These are attended with dangers similar to those belonging to rupture of
the womb, and in addition by the risk of protrusion of the bladder,
which appears through the lips of the vulva as a red, pyriform mass.
Sometimes such lacerations extend downward into the bladder, and in
others upward into the terminal gut (rectum). In still other cases the
anus is torn so that it forms one common orifice with the vulva.