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 mass 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 passages 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 quantity. 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 passed inside the
lower jawbone, and drag the head upward and toward the passage, 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 passing 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 assistance 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
passed 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, assisted by the hand dragging on the lower
border of the neck. To aid the hand in passing 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 passing 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 passed 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, assisting 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 passage, 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 passage; 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 space 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 passed 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 passages, 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 passed out through the
vulva, 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 circumscribe 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 assist. If nothing can be done by pushing the body of the calf
back and rotating it and by pressure by the hand in the passages, 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 buttocks 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 passed through the external passages, when suddenly progress
ceases and no force will effect farther advance. An examination with the
oiled hand detects the presence, in the passages, 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 passed over each hind foot
and drawn tight around the lower part of the hock; the ropes are then
passed through the two rings in the small end of the rotating instrument
(Pl. XX, fig. 5) which is slid into the passages 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 pass 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 buttocks 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 passages 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 vulva unless it be the end of the tail. On examination
the buttocks 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 passage, 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 buttocks, assists
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
passed 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 buttocks and hocks
wedged deeply into the passages, it may prove difficult or impossible to
push the buttocks 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 passages by ropes attached to the
bent hocks, but even when this is possible there is great risk of
laceration of the floor of the vagina 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 mass can pass through a narrower
channel. If now, by dragging on the hocks and operating with the repeller
on the buttocks, 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 mass
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)
passed 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 buttocks, with the tail and anus at its upper part.
The remedy, as in the case last described, consists in pushing the buttock
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 passed 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 buttocks wedged firmly into the
passages, it may be impossible safely to push the fetus back into the womb,
and the calf must either be dragged through the passage 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 passed 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 passed forward on the outer side of that
thigh. This end is now pulled back through the vagina, the other end passed
through the cord carrier and passed forward on the inner side of the other
thigh until it can be seized at the stifle by the hand passed forward
outside that thigh. This end is drawn back through the vagina 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 passages 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
passed 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 space 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 passage, 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 passages 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 passages. Sometimes a fortunate struggle of a
live fetus will greatly aid in rectifying the position.
_Breast and abdomen presented._--All four feet in the passages._--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 passages, 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
passages the most eligible extremities. The most eligible will usually be
those which project farthest into the passages, 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.