four feet, marking those of the fore limbs to distinguish them from those
of the hind ones. In case it is proposed to bring the anterior extremities
into the passage, a noose should also be placed on the lower jaw. Then run
the ropes attached to the two feet that are to be pushed back through the
ring of a cord carrier (Pl. XXI, fig. 5), passing the rings down to the
feet, and by the aid of the carrier push them well back into the womb and
hold them there. Meanwhile drag upon the ropes attached to the two other
feet so as to bring them into the passage (or, in case of the anterior
extremity, on the two foot ropes and the head one). The other feet must be
pushed back into the womb until the body of the calf is fully engaged in
the passages. After this they can no longer find an entrance, but must
follow as the body escapes.
NEGLECTED AND AGGRAVATED CASES.
In laying down the foregoing rules for giving assistance in critical cases
of calving it is not intimated that all cases and stages can be
successfully dealt with. Too often assistance is not sought for many hours
or even days after labor pains, and the escape of the waters intimate the
danger of delay. Not seldom the long delay has been filled up with
unintelligent and injurious attempts at rendering assistance, violent
pulling when resistance is insurmountable without change of position,
injuries to the vagina and womb by ill-considered but too forcibly executed
attempts to change the position, the repeated and long-continued contact
with rough hands and rougher ropes and hooks, the gashes with knives and
lacerations with instruments in ignorant hands, the infecting material
introduced on filthy hands and instruments, and the septic inflammations
started in the now dry and tender passages and womb. Not infrequently the
death, putrefaction, and bloating of the calf in the womb render the case
extremely unpromising and make it impossible to apply successfully many of
the measures above recommended. The labor pains of the cow may have
practically ceased from exhaustion; the passages of the vagina may be so
dry, tender, friable, red, and swollen that it requires considerable effort
even to pass the oiled hand through them, and the extraction of the calf or
any portion of it through such a channel seems a hopeless task; the womb
may be equally dry, inflamed and swollen, so that its lining membrane or
even its entire thickness is easily torn; the fetal membranes have lost
their natural, unctuous and slippery character, and cling firmly to the dry
walls of the womb, to the dry skin of the calf, or to the hands of the
operator; the dead and putrefying calf may be so bloated with gases that
the womb has been overdistended by its presence, and the two adhere so
closely that the motion of the one on the other is practically impossible.
In other cases reckless attempts to cut the calf in pieces have left raw
surfaces with projecting bones which dangerously scratch and tear the womb
and passages.
In many cases the extreme resort must be had of cutting the fetus to pieces
(embryotomy), or the still more redoubtable one of CÊsarean section
(extraction through the flank).
DISSECTION OF THE UNBORN CALF (EMBRYOTOMY).
In some cases the dissection of the calf is the only feasible means of
delivering it through the natural passages; and while it is especially
applicable to the dead calf, it is also on occasion called for in the case
of the living. As a rule, the living calf should be preserved, if possible,
but if this threatens to entail the death of the cow it is only in the case
of offspring of rare value that its preservation is to be preferred. To
those acquainted with the toil, fatigue, and discomfort of embryotomy, no
discussion is necessary so long as there is a prospect of success from the
simple and generally easier method of rectifying the faulty position of the
calf. When the correction of the position is manifestly impossible,
however, when distortions and monstrosities of the fetus successfully
obstruct delivery, when the pelvic passages are seriously contracted by
fractures and bony growths, when the passages are virtually almost closed
by swelling, or when the calf is dead and excessively swollen, no other
resort may be available. In many cases of distortion and displacement the
dismemberment of the entire calf is unnecessary, the removal of the
offending member being all that is required. It will be convenient,
therefore, to describe the various suboperations one by one and in the
order in which they are usually demanded.
_Amputation of the fore limb._--In cutting off a fore limb it is the one
presenting that should be selected, since it is much more easily operated
on, and its complete removal from the side of the chest affords so much
more space for manipulation that it often makes it easy to bring the other
missing limb or the head into position. The first consideration is to skin
the limb from the fetlock up and leave the skin attached to the body. The
reasons for this are: (_a_) That the skin is the most resistant structure
of the limb, and when it has been removed the entire limb can be easily
detached; (_b_) the tough skin left from the amputated limb may be used as
a cord in subsequent traction on the body of the calf; (_c_) the dissection
and separation of the limb are far more safely accomplished under the
protection of the enveloping skin than if the operator's hands and
instruments were in direct contact with the walls of the passages or womb;
(_d_) the dissection can be much more easily effected while the skin is
stretched by the left hand, so as to form a comparatively firmer resistant
point for the knife, than when it is attempted to cut the soft, yielding,
and elastic tissues which naturally offer little solid resistance, but
constantly recede before the cutting edge of the instrument. The
preservation of the skin is therefore a cardinal principle in the
amputation of all parts in which it is at all feasible.
The presenting foot is inclosed in a noose and drawn well out of the
passages. Then a circular incision through the skin is made around the limb
just above the fetlock. From this the skin is slit up on the inner side of
the limb to the breast. Then the projecting part of the limb is skinned up
to the vulva, traction being made on the foot by an assistant so as to
expose as much as possible. The embryotomy knife may now be taken (Pl. XXI,
fig. 2), and a small hole having been cut in the free end of the detached
portion of skin, that is seized by the left hand and extended while its
firm connections with the deeper structures are cut through. The looser
connections can be more quickly torn through with the closed fist or the
tips of the four fingers held firmly together in a line or with the spud,
of which there are several kinds. Much of the upper part of the limb can be
skinned more speedily without the knife, but that must be resorted to to
cut across tough bands whenever these interrupt the progress. The skinning
should be carried upward on the outer side of the shoulder blade to the
spine or nearly so. Then with the knife the muscles attaching the elbow and
shoulder to the breastbone are cut across, together with those on the inner
side of the shoulder joint and in front and behind it as far as these can
be reached. Steady traction is now made upon the foot, the remaining
muscles attaching the shoulder blade to the trunk are torn through with a
cracking noise, and the whole limb, including the shoulder blade and its
investing muscles, comes away. If the shoulder blade is left the bulk of
the chest is not diminished, and nothing has been gained. Before going
further it is well to see whether the great additional space thus secured
in the passages will allow of the missing limb or head to be brought into
position. If not, the other presenting part, limb or head, is to be
amputated and extracted. For the limb the procedure is a repetition of that
just described.
_Amputation of the head._--The head is first seized and drawn well forward,
or even outside the vulva, by a rope with a running noose placed around the
lower jaw just behind the incisor teeth, by a sharp hook inserted in the
arch of the lower jaw behind the union of its two branches and back of the
incisor teeth, or by hooks inserted in the orbits, or, finally, in case the
whole head protrudes, by a halter. (Pl. XXI, figs 4_a_ and 4_b._) In case
the whole head protrudes, a circular incision through the skin is made just
back of the ear, and the cut edge being held firmly by the left hand, the
neck is skinned as far as it can be reached. Then the great ligamentous
cord above the spine is cut across at the farthest available point,
together with the muscles above and below the spine. Strong traction on the
head will then detach it at this point and bring it away, but should there
still be too much resistance the knife is inserted between the bodies of
two vertebrÊ just behind one of the prominent points felt in the median
line below, and their connecting fibrous cartilage is cut through, after
which comparatively moderate pulling will bring it away. The detached neck
and body at once slip back into the womb, and if the fore limbs are now
brought up and pulled they are advanced so far upon the chest that the
transverse diameter of that is greatly diminished and delivery
correspondingly facilitated.
If the head is still inclosed in the vagina two methods are available: (1)
The removal of the lower jaw and subsequent separation of the head from the
neck; (2) the skinning of the whole head and its separation from the neck.
To remove the lower jaw the skin is dissected away from it until the throat
is reached. Then the muscles of the cheeks and side of the jaw (masseters)
are cut through and those connecting the jaw with the neck. When traction
is made on the rope around the lower jaw it will usually come away with
little trouble. Should it resist, its posterior extremity on each side
(behind the grinding teeth) may be cut through with bone forceps or with a
guarded bone chisel. (Pl. XX, fig. 8.) After the removal of the lower jaw
the way will be open to separate the head from the neck, the knife being
used to cut into the first or second joint from below, or the bone forceps
or chisel being employed to cut through the bones of the neck. Then
traction is made on the head by means of hooks in the orbits, and the hand,
armed with an embryotomy knife, is introduced to cut through the tense
resisting ligament, and muscles above the bones. The skin and the strong
ligamentous cord attached to the poll are the essential things to cut, as
the muscles can easily be torn across. Unless there are great difficulties
in the way it is well to skin the head from the eyes back, and on reaching
the poll to cut through the ligament and then bring the head away by
pulling.
If it is decided to remove the entire head at once, it may be skinned from
the front of the eyes back to behind the lower jaw below and the poll
above, then cut through the muscles and ligaments around the first joint
and pull the head away, assisting, if need be, in the separation of the
head by using the knife on the ligament of the joint.
If the calf is a double-headed monster, the skinning of the head must be
carried backward until the point has been reached where both heads branch
from the single neck, and the separation must be made at that point. The
muscles and ligaments are first to be cut through; and if the part can not
then be detached by pulling, the bodies of the vertebrÊ may be separated by
passing the knife through the joint. The second head may now be secured by
a noose around the lower jaw or hooks in the orbits and brought up into
place, the body being pushed back toward the other side by a repeller, so
as to make room.
It should be added that, except in the case of a double-headed monster, or
in case of the head protruding or nearly so, and one or both fore limbs
presenting, it is rarely desirable to undertake amputation of the head. The
space desirable in the passages can usually be obtained by the much simpler
and easier procedure of removing one or both fore limbs.
_Amputation of the hind limbs._--This is sometimes demanded on the one
extended limb when the other can not be brought up and delivery can not be
effected; also in case of monsters having extra hind limbs; when the calf
is dead, putrid, and bloated with gas; and in some cases of breech
presentation, as described under that head.
When the limb is extended the guiding principles are as in the case of the
fore limbs. The skin is cut through circularly above the fetlock and slit
up to beneath the pelvic bones on the inner side of the thigh. It is then
dissected from the other parts as high as it has been slit on the inner
side and to above the prominence (_trochanter major_) on the upper end of
the thigh bone on the outer side of the joint. In this procedure the hands
and spud can do much, but owing to the firmer connections the knife will be
more frequently required than in the case of the fore limb. The muscles are
now cut through all around the hip joint, and strong traction is made by
two or three men on the limb. If there is still too much resistance, a
knife is inserted into the joint on the inner side and its round ligament
cut through, after which extraction will be comparatively easy. This
accomplished, it will often be possible to extract the fetus with the other
leg turned forward into the womb. If the calf is bloated with gas, it may
be necessary to remove the other leg in the same way, and even to cut open
the chest and abdomen and remove their contents before extraction can be
effected. In the case of extra limbs it may be possible to bring them up
into the passages after the presenting hind limbs have been removed. If
this is not practicable, they may be detached by cutting them through at
the hip joint, as described under "Breech presentation," page 197.
Another method of removing the hind limb is, after having skinned it over
the quarter, to cut through the pelvic bones from before backward, in the
median line below, by knife, saw, or long embryotome (Pl. XX, fig. 1), and
then disjoint the bones of the spine (sacrum) and the hip bone (ilium) on
that side with embryotome, knife, or saw, and then drag away the entire
limb, along with all the hip bones on that side. This has the advantage of
securing more room and thereby facilitating subsequent operations. Both
limbs may be removed in this way, but on the removal of the second the
operator is without any solid point to drag upon in bringing away the
remainder of the fetus.
_Division across the middle of the body._--In cases of extra size,
monstrosity, or distortion of one end of the body it may be requisite to
cut the body in two and return the half from the passages into womb, even
after one-half has been born. The presenting members are dragged upon
forcibly by assistants to bring as much of the body as possible outside.
Then cut through the skin around the body at some distance from the vulva,
and with hand, knife, and spud detach it from the trunk as far back into
the passages as can be reached. Next cut across the body at the point
reached, beginning at the lower part (breast, belly) and proceeding up
toward the spine. This greatly favors the separation of the backbone when
reached, and further allows of its being extended so that it can be divided
higher up. When the backbone is reached, the knife is passed between the
two bones, the prominent ridges across their ends acting as guides, and by
dragging and twisting the one is easily detached from the other. With an
anterior presentation the separation should, if possible, be made behind
the last rib, while with a posterior presentation as many of the ribs
should be brought away as can be accomplished. Having removed one half of
the body, the remaining half is to be pushed back into the womb, the feet
sought and secured with nooses, and the second half removed in one piece if
possible; and if not, then after the removal of the extra limb or other
cause of obstruction.
_Removed of the contents of chest or abdomen._--If the body of the calf
sticks fast in the passages by reason of the mere dryness of its skin and
of the passages, the obstacle may be removed by injecting sweet oil past
the fetus into the womb through a rubber or other tube, and smearing the
passages freely with lard. When the obstruction depends on excess of size
of the chest or abdomen or thickening of the body from distorted spine,
much advantage may be derived from the removal of the contents of these
great cavities of the trunk. We have already seen how the haunches may be
narrowed by cutting the bones apart in the median line below and causing
their free edges to overlap each other. The abdomen can be cut open by the
embryotomy knife or the long embryotome in the median line, or at any
point, and the contents pulled out with the hand, the knife being used in
any case when especial resistance is encountered. If the abdomen is so
firmly impacted that it can not be dealt within this way, one hind limb and
the hip bone on the same side may be removed as described under "Amputation
of the hind limbs," page 205. This will allow the introduction of the hand
into the abdomen from behind, so as to pull out the contents. By
introducing an embryotomy knife in the palm of the hand and cutting through
the muscle of the diaphragm the interior of the chest can be reached in the
same way and the heart and lungs removed.
When, in dealing with an anterior presentation, it becomes necessary to
remove the contents of the chest, the usual course is to cut through the
connections of the ribs with the breastbone (the costal cartilages) close
to the breastbone on each side, and from the abdomen forward to the neck.
Then cut through the muscles connecting the front of the breastbone with
the neck and its hinder end with the belly, and pull out the entire
breastbone. Having torn out the heart and lungs with the hand, make the rib
cartilages on the one side overlap those on the other, so as to lessen the
thickness of the chest, and proceed to extract the body. If it seems
needful to empty the abdomen as well, it is easy to reach it by cutting
through the diaphragm, which separates it from the chest.
_Delivery through the flank_ (_CÊsarean section, or laparotomy_).--This is
sometimes demanded, when the distortion and narrowing of the hip bones are
such as to forbid the passage of the calf, or when inflammation has
practically closed the natural passages and the progeny is more valuable
and worthy of being saved than the dam; also in cases in which the cow has
been fatally injured, or is ill beyond possibility of recovery and yet
carries a living calf. It is too often a last resort after long and
fruitless efforts to deliver by the natural channels, and in such cases the
saving of the calf is all that can be expected, the exhausted cow, already
the subject of active inflammation and too often also of putrid poisoning,
is virtually beyond hope. The hope of saving the dam is greatest if she is
in good health and not fatigued, in cases, for example, in which the
operation is resorted to on account of broken hip bones or abnormally
narrow passages.
The stock owner will not attempt such a serious operation as this. Yet, if
the mother has just died or is to be immediately sacrificed, no one should
hesitate to resort to it in order to save the calf. If alive, it is
important to have the cow perfectly still. Her left fore leg being bent at
the knee by one person, another may seize the left horn and nose and turn
the head to the right until the nose rests on the spine just above the
shoulder. The cow will sink down gently on her left side without shock or
struggle. One may now hold the head firmly to the ground, while a second,
carrying the end of the tail from behind forward on the inside of the right
thigh, pulls upon it so as to keep the right hind limb well raised from the
ground. If time presses she may be operated on in this position, or if the
cow is to be sacrificed a blow on the head with an ax will produce
quietude. Then the prompt cutting into the abdomen and womb and the
extraction of the calf requires no skill. If, however, the cow is to be
preserved, her two forefeet and the lower hind one should be safely
fastened together and the upper hind one drawn back. Two ounces chloral
hydrate, given by injection, should induce sleep in 20 minutes, and the
operation may proceed. In case the cow is to be preserved, wash the right
flank and apply a solution of 4 grains of corrosive sublimate in a pint of
water.
Then, with an ordinary scalpel or knife, dipped in the above-mentioned
solution, make an incision from 2 inches below and in front of the outer
angle of the hip bone in a direction downward and slightly forward to a
distance of 12 inches. Cut through the muscles, and more carefully through
the transparent lining membrane of the abdomen (peritoneum), letting the
point of the knife lie in the groove between the first two fingers of the
left hand as they are slid down inside the membrane and with their back to
the intestines. An assistant, whose hands, like those of the operator, have
been dipped in the sublimate solution, may press his hands on the wound
behind the knife to prevent the protrusion of the intestines. The operator
now feels for and brings up to the wound the gravid womb, allowing it to
bulge well through the abdominal wound, so as to keep back the bowels and
prevent any escape of water into the abdomen. This is seconded by two
assistants, who press the lips of the wound against the womb. Then an
incision 12 inches long is made into the womb at its most prominent point,
deep enough to penetrate its walls, but not so as to cut into the water
bags. In cutting, carefully avoid the cotyledons, which may be felt as hard
masses inside. By pressure the water bags may be made to bulge out as in
natural parturition, and this projecting portion may be torn or cut so as
to let the liquid flow down outside of the belly. The operator now plunges
his hand into the womb, seizes the fore or hind limbs, and quickly extracts
the calf and gives it to an attendant to convey to a safe place. The womb
may be drawn out, but not until all the liquid has flowed out, and the
fetal membranes must be separated from the natural cotyledons, one by one,
and the membranes removed. The womb is now emptied with a sponge, which has
been boiled or squeezed out of a sublimate solution, and if any liquid has
fallen into the abdomen it may be removed in the same way. A few stitches
are now placed in the wound in the womb, using carbolized catgut. They need
not be very close together, as the wound will diminish greatly when the
womb contracts. Should the womb not contract at once it may have applied
against it a sponge squeezed out of a cold sublimate solution, or it may be
drawn out of the abdominal wound and exposed to the cold air until it
contracts. Its contraction is necessary to prevent bleeding from its
enormous network of veins. When contracted, the womb is returned into the
abdomen and the abdominal wound sewed up. One set of stitches, to be placed
at intervals of 2 inches, is passed through the entire thickness of skin
and muscles and tied around two quills or little rollers resting on the
skin. (Pl. XXVII, fig. 7.) These should be of silver, and may be cut at one
end and pulled out after the wound has healed. The superficial stitches are
put in every half inch and passed through the skin only. They, too, may be
of silver, or pins may be inserted through the lips and a fine cord twisted
round their ends like a figure 8. (Pl. XXVII, fig. 9.) The points of the
pins may be snipped off with pliers. The edges may be still further held
together by the application of Venice turpentine, melted so as to become
firmly adherent, and covered with a layer of sterilized cotton wool. Then
the whole should be supported by a bandage fixed around the loins and
abdomen.
* * * * *
DISEASES OF THE GENERATIVE ORGANS.
DESCRIPTION OF PLATES.