opened on the left side. In the uterus the fetus is surrounded by several
membranes which are known as the amnion or inner layer, the allantois or
central layer, and the chorion or outer layer. The amnion is nearest the
fetus and forms a closed sac around it filled with a fluid known as liquor
amnii, in which the fetus floats. The allantois is composed of two layers,
which form a closed sac in connection with the urachus, or the tube which
extends from the fetal bladder through the umbilical cord. The one layer of
the allantois is spread over the outer surface of the amnion and the other
over the inner surface of chorion. The allantois also contains a fluid
which is known as the allantoid liquid. The chorion is the outer envelope
or membrane of the fetus, completely inclosing the fetus with its other
membranes. On the outer surface of this membrane are found the fetal
placentulÊ, or cotyledons, which, through their attachment to the maternal
cotyledons, furnish the fetus with the means of sustaining life. The
relation of the fetal and maternal cotyledons to each other is illustrated
on the following plate.
PLATE XIII. Pregnant uterus with cotyledons.
Fig. 1. Uterus of the cow during pregnancy, laid open to show the
cotyledons (_d_) on the internal surface of uterus (_c_). The ovary (_a_)
is shown cut across, and the two halves are laid open to show the position
of the discharged ovum at _a_'.
Fig. 2 illustrates the relation of the fetal and maternal parts of a
cotyledon. A portion of the uterus (_A_) is shown with the maternal
cotyledon (_BB_) attached to it. The fetal portion (_D_) consists of a mass
of very minute hairlike processes on the chorion (_E_), which fit into
corresponding depressions or pits of the maternal portion. Each portion is
abundantly supplied with blood vessels, so that a ready interchange of
nutritive fluid may take place between mother and fetus.
PLATE XIV. Vessels of umbilical cord.
Fig. 1. Fetal calf with a portion of the wall of the abdominal cavity of
the right side and the stomach and intestines removed to illustrate the
nature of the umbilical or navel cord. It consists of a tube (1-1') into
which pass the two umbilical arteries (3) carrying blood to the placenta in
the uterus or womb and the umbilical vein (4) bringing the blood back and
carrying it into the liver. The cord also contains the urachus (2') which
carries urine from the bladder (2) through the cord. These vessels are all
obliterated at birth. 5, liver; 5', lobe of same, known as the lobus
Spigelii; 5'', gall bladder; 6, right kidney; 6', left kidney; 6'',
ureters, or the tubes conducting the urine from the kidneys to the bladder;
7, rectum, where it has been severed in removing the intestines; 8, uterus
of the fetus, cut off at the anterior extremity; 9, aorta; 10, posterior
vena cava. (From _F¸rstenberg-Leisering, Anatomie und Physiologie des
Rindes._)
Fig. 2. Blood vessels passing through the umbilical cord in a human fetus.
(From Quain's Anatomy, vol. 2.) _L_, liver; _K_, kidney; _I_, intestines;
_U C_, umbilical cord; _Ua_, umbilical arteries. The posterior aorta coming
from the heart passes backward and gives rise to the internal iliac
arteries, and of these the umbilical arteries are branches. _Uv_, umbilical
vein; this joins the portal vein, passes onward to the liver, breaks up
into smaller vessels, which reunite in the hepatic vein; this empties into
the posterior vena cava, which carries the blood back to the heart.
* * * * *
[Illustration: PLATE XII.
FETAL CALF WITHIN ITS MEMBRANES.]
[Illustration: PLATE XIII.
PREGNANT UTERUS WITH COTYLEDONS.]
[Illustration: PLATE XIV.
VESSELS OF UMBILICAL CORD.]
[Illustration: PLATE XV.]
[Illustration: PLATE XVI.]
[Illustration: PLATE XV.
NORMAL POSITION OF CALF IN UTERO.]
[Illustration: PLATE XVI.
ABNORMAL POSITIONS OF CALF IN UTERO.]
[Illustration: PLATE XVII.
ABNORMAL POSITIONS OF CALF IN UTERO.]
* * * * *
PLATE XV. Normal position of calf in utero. This is the most favorable
position of the calf or fetus in the womb at birth, and the position in
which it is most frequently found. This is known as the normal anterior
position. The back of the fetus is directly toward that of the mother, the
forelegs are extended back toward the vulva of the mother, and the head
rests between them. The birth of the calf in this position usually takes
place without artificial assistance.
PLATE XVI. Abnormal positions of calf in utero. (Figs. 1, 2, 3, and 5 from
Fleming's Veterinary Obstetrics; fig. 4 after St. Cyr, from Hill's Bovine
Medicine and Surgery; fig. 6 from D'Arboval, Dictionaire de MÈdecine et de
Chirurgie.)
Fig. 1. Anterior presentation; one fore limb completely retained. The
retained limb must be reached if possible and brought forward joint by
joint and the fetus then extracted.
Fig. 2. Anterior presentation; fore limbs bent at knee. The limbs must be
extended before delivery can be accomplished.
Fig. 3. Anterior presentation; fore limb crossed over neck. The leg should
be grasped a little above the fetlock, raised, drawn to its proper side,
and extended in genital canal.
Fig. 4. Anterior presentation; downward deviation of head. The head must be
brought into position seen in Plate XV before delivery can take place.
Fig. 5. Anterior presentation; deviation of the head upward and backward.
Retropulsion is the first indication, and will often bring the head into
its normal position.
Fig. 6. Anterior presentation; head presented with back down. The fetus
should be turned by pushing back the fore parts and bringing up the hind so
as to make a posterior presentation.
PLATE XVII. Abnormal positions of calf in utero. (Figs. 2 and 3 from
Fleming; figs. 4, 5, and 6 from D'Arboval.)
Fig. 1. Anterior presentation, with hind feet engaged in pelvis. A very
serious malpresentation, in which it is generally impossible to save the
fetus if delivery is far advanced. The indications are to force back the
hind feet.
Fig. 2. Thigh and croup presentation, showing the fetus corded. The cord
has a ring or noose at one end. The two ends of the cord are passed between
the thighs, brought out at the flanks, and the plain end passed through the
noose at the top of the back and brought outside the vulva. The fetus must
be pushed back and an attempt made to bring the limbs properly into the
genital passage.
Fig. 3. Croup and hock presentation. The indications in this abnormal
presentation are the same as described for Fig. 2.
Fig. 4. Posterior presentation; the fetus on its back. Turn the fetus so as
to make a normal anterior presentation.
Fig. 5. Sterno-abdominal presentation. The fetus is on its side with limbs
crossing and presenting. The limbs least eligible for extraction should be
forced back into the uterus.
Fig. 6. Dorso-lumbar presentation; the back presenting. The fetus must be
turned so that one or the other extremity can enter the passage.
PLATE XVIII. Abnormal positions of the calf in utero. Surgical instruments
and sutures.
Fig. 1. Twin pregnancy, showing the normal anterior and posterior
presentations. (From Fleming.)
Fig. 2. Abdominal dropsy of the fetus; normal presentation; fore limbs
corded. (After Armatage.) The drawing illustrates the method of puncturing
the abdomen through the chest with a long trocar and cannula. The fluid is
represented escaping from the cannula after the withdrawal of the trocar.
Fig. 3. Tallich's short, bent, crotchet forceps. The forceps have bent and
toothed jaws, which are intended to take hold of the fetus where neither
cords nor hooks can be applied, as the ear, nose, or skin of cheek.
Fig. 4. Clamp for ear, skin, etc.: 1-1, blades with hooks and corresponding
holes; 2, ring to close the blades; 3, stem with female screw for handle;
4, handle, which may be either straight or jointed and flexible.
PLATE XIX. Monstrosities. This plate illustrates various malformations and
diseases of the fetus which act as the cause of difficult parturition.
Figs. 1, 2, 3. Fetuses with portions of their bodies double. Fig. 1 (from
Fleming), double head, neck, and fore limbs. Fig. 2 (from Encyclop. der
Gesam. Thierheilkunde, 1886), double head, neck, fore limbs, and body. Fig.
3 (from Fleming), double faced.
Fig. 4. Fetus with head very much enlarged. (From Fleming.) This affection
is known as hydrocephalus, or dropsy of the brain, and is due to a more or
less considerable quantity of fluid in the cranial cavity of the fetus.
Fig. 5. Skull of the calf represented in Fig. 4. The roof of the skull is
absent. (From Fleming.)
PLATE XX. Instruments used in difficult labor.
Fig. 1. Long embryotome with joint.
Fig. 2. Long, sharp hook. This instrument is about 3 feet in length,
including the handle. Hooks of this kind, both blunt and sharp, are applied
directly to the fetus to assist in delivery.
Fig. 3. G¸nther's long-handled embryotome. This instrument and that
represented in Fig. 1 are of special value in cutting through muscular
tissue and in separating the limbs from the trunk when the fetus can not be
removed entire. These embryotomes are usually 30 inches long, but may be
made either longer or shorter.
Fig. 4. Jointed cord-carrier, used in difficult parturition to carry a cord
into regions which can not be reached by the arm.
Fig. 5. Instrument used to rotate or turn the fetus, known as a rotator.
Fig. 6. Dilator of the neck of the womb, used when conception can not take
place owing to a contracted condition of the neck of the womb.
Fig. 7. Repeller. An instrument from 2 to 3 feet long, used to force the
fetus forward into the womb. This operation is generally necessary when the
presentation is abnormal and the fetus has advanced too far into the narrow
inlet to the uterus to be moved.
Fig. 8. Cartwright's bone chisel. Including the handle, this instrument is
about 32 inches in length; the chisel portion is a little more than 2
inches long and 1 to 1-1/2 broad. Only the middle portion is sharp, the
projecting corners are blunt, and the sides rounded. This instrument is
used for slitting up the skin of a limb and as a bone chisel when it is
necessary to mutilate the fetus in order to effect delivery.
* * * * *
[Illustration: PLATE XVIII.
ABNORMAL POSITION OF CALF IN UTERO.
SURGICAL INSTRUMENTS AND SUTURES.]
[Illustration: PLATE XIX.
MONSTROSITIES.]
[Illustration: PLATE XX.
INSTRUMENTS USED IN DIFFICULT LABOR.]
[Illustration: PLATE XXI.
INSTRUMENTS USED IN DIFFICULT LABOR.]
* * * * *
PLATE XXI. Instruments used in difficult labor.
Fig. 1. Embryotome, an instrument used when it is necessary to reduce the
size of the fetus by cutting away certain parts before birth can be
effected. This instrument may be long or short, straight or curved.
Fig. 2. Also an embryotome. The blade can be made to slide out of or into
the handle. The instrument can thus be introduced into or withdrawn from
the genital passage without risk of injury to the mother.
Fig. 3. Schaack's traction cord. This is merely a cord with a running noose
at one end and a piece of wood at the other, to offer a better hold for the
hand.
Figs. 4_a_ and 4_b._ Reuff's head collar for securing the head of the
fetus.
Fig. 5. Curved cord-carrier, used in difficult parturition to carry a cord
into regions which can not be reached by the arm.
Fig. 6. Blunt hook, used in difficult parturition.
Fig. 7. Short hook forceps, used in difficult parturition.
Fig. 8. Blunt finger hook.
* * * * *
DISEASES FOLLOWING PARTURITION.
By James Law, F. R. C. V. S.,
_Formerly Professor of Veterinary Science, etc., in Cornell University._
FLOODING (BLEEDING FROM THE WOMB).
Though not so common in the cow as in the human female, flooding is
sufficiently frequent to demand attention. It may depend on a too rapid
calving and a consequent failure of the womb to contract when the calf has
been removed. The pregnant womb is extraordinarily rich in blood vessels,
especially in large and tortuous veins, which become compressed and almost
obliterated under contraction, but remain overfilled and often bleed into
the cavity of the womb should no contraction take place. Cox records cases
in which the labor pains had detached and expelled the fetal membranes,
while the calf, owing to large size or wrong presentation, was detained in
the womb, and the continued dilatation of the womb in the absence of the
fetal membranes led to a flow of blood which accumulated in clots around
the calf. Other causes are laceration of the cotyledons of the womb, or
from an antecedent inflammation of the placenta, and the unnatural adhesion
of the membranes to the womb, which bleeds when the two are torn apart.
Weakness of the womb from overdistention, as in dropsy, twins, etc., is not
without its influence. Finally, eversion of the womb (casting the withers)
is an occasional cause of flooding. The trouble is only too evident when
the blood flows from the external passages in drops or in a fine stream.
When it is retained in the cavity of the womb, however, it may remain
unsuspected until it has rendered the animal almost bloodless. The symptoms
in such case are paleness of the eyes, nose, mouth, and of the lips of the
vulva, a weak, rapid pulse, violent and perhaps loud beating of the heart
(palpitations), sunken, staring eyes, coldness of the skin, ears, horns,
and limbs, perspiration, weakness in standing, staggering gait, and,
finally, inability to rise, and death in convulsions. If these symptoms are
seen, the oiled hand should be introduced into the womb, which will be
found open and flaccid and containing large blood clots.
_Treatment._--Treatment consists in the removal of the fetal membranes and
blood clots from the womb (which will not contract while they are present),
the dashing of cold water on the loins, right flank, and vulva, and if
these measures fail, the injection of cold water into the womb through a
rubber tube furnished with a funnel. In obstinate cases a good-sized sponge
soaked in tincture of muriate of iron should be introduced into the womb
and firmly squeezed, so as to bring the iron into contact with the bleeding
surface. This is at once an astringent and a coagulant for the blood,
besides stimulating the womb to contraction. In the absence of this agent
astringents (solution of copperas, alum, tannic acid, or acetate of lead)
may be thrown into the womb, and one-half-dram doses of acetate of lead may
be given by the mouth, or 1 ounce powdered ergot of rye may be given in
gruel. When nothing else is at hand, an injection of oil of turpentine will
sometimes promptly check the bleeding.
EVERSION OF THE WOMB (CASTING THE WITHERS).
Like flooding, this is the result of failure of the womb to contract after
calving. If that organ contracts naturally, the afterbirth is expelled, the
internal cavity of the womb is nearly closed, and the mouth of the organ
becomes so narrow that the hand can not be forced through, much less the
whole mass of the matrix. When, however, it fails to contract, the closed
end of one of the horns may fall into its open internal cavity, and under
the compression of the adjacent intestines, and the straining and
contraction of the abdominal walls, it is forced farther and farther, until
the whole organ is turned outside in, slides back through the vagina, and
hangs from the vulva. The womb can be instantly distinguished from the
protruding vagina or bladder by the presence, over its whole surface, of 50
to 100 mushroomlike bodies (cotyledons), each 2 to 3 inches in diameter,
and attached by a narrow neck. (Pls. XII, XIII.) When fully everted, it is
further recognizable by a large, undivided body hanging from the vulva, and
two horns or divisions which hang down toward the hocks. In the imperfect
eversions the body of the womb may be present with two depressions leading
into the two horns. In the cases of some standing the organ has become
inflamed and gorged with blood until it is as large as a bushel basket, its
surface has a dark-red, bloodlike hue, and tears and bleeds on the
slightest touch. Still later lacerations, raw sores, and even gangrene are
shown in the mass. At the moment of protrusion the general health is not
altered, but soon the inflammation and fever with the violent and continued
straining induce exhaustion, and the cow lies down, making no attempt to
rise.
_Treatment._--Treatment varies somewhat, according to the degree of the
eversion. In partial eversion, with the womb protruding only slightly from
the vulva and the cow standing, let an assistant pinch the back to prevent
straining while the operator pushes his closed fist into the center of the
mass and carries it back through the vagina, assisting in returning the
surrounding parts by the other hand. In more complete eversion, but with
the womb as yet of its natural bulk and consistency and the cow standing,
straining being checked by pinching the back, a sheet is held by two men so
as to sustain the everted womb and raise it to the level of the vulva. It
is now sponged clean with cold water, the cold being useful in driving out
the blood and reducing the bulk, and finally it may be sponged over with
laudanum or with a weak solution of carbolic acid (1 dram to 1 quart
water).
The closed fist may now be planted in the rounded end of the largest horn
and pushed on so as to turn it back within itself and carry it on through
the vagina, the other hand being used meanwhile to assist in the inversion
and in pushing the different masses in succession within the lips of the
vulva. In case of failure, resort should be had at once to a plan which I
have successfully followed for many years. Take a long linen or cotton
bandage, 5 or 6 inches wide, and wind it around the protruding womb as
tightly as it can be drawn, beginning at the free end and gradually
covering the entire mass up to the vulva. By this means the greater part of
the blood will be forced out of the organ and its bulk greatly reduced, so
that its reduction is much facilitated. An additional advantage is found in
the protection given to the womb by its investing bandage while it is being
pushed forward into the vagina and abdomen. In manipulating the exposed
womb there is always danger of laceration, but when the organ is covered
with a sheet it is next to impossible to tear it. The subsequent
manipulation is as in the other case, by pushing the blind end forward
within itself with the closed fist and carrying this on through the vagina
into the abdomen with the constant assistance of the other hand. Often it
will be found convenient to use the edge of the left hand to push the outer
part of the protruding mass inside the lips of the vulva, while the right
hand and arm are carrying the central portions forward through the vagina.
An intelligent assistant, pushing with the palms of both hands on the outer
portion of the mass, will also afford material assistance. As the womb is
turned within itself the wrapping bandage will gradually loosen, but once
the great mass has entered the passages it is easy to compel the rest to
follow, and the compression by the bandage is no longer so important. When
the womb is fully replaced the bandage is left in its interior in a series
of loose folds, and can be easily withdrawn. It is well to move the hand
from side to side to insure that the two horns of the womb are fully
extended and on about the same level before withdrawing the arm and
applying a truss.
When the womb has been long everted and is gorged with blood, inflamed, and
friable there is often the additional disadvantage that the animal is
unable or unwilling to rise. When lying down the straining can not be
controlled so effectually, and, even in the absence of straining, the
compression of the belly is so great as to prove a serious obstacle to
reduction. The straining may be checked by 2 or 3 ounces of laudanum or 2
ounces of chloral hydrate, or by inhalation of chloroform to insensibility,
and then by raising the hind parts on straw bundles the gravitation of the
abdominal organs forward may be made to lessen the resistance. If not
successful in this way, the cow may be further turned on her back, and if
return is still impossible, the hind limbs may be tied together and drawn
up to a beam overhead by the aid of a pulley. In this position, in place of
the pressure backward of the bowels proving a hindrance, their gravitation
forward proves a most material help to reduction. In seeking to return the
womb the sponging with ice-cold water, raising on a sheet, and wrapping in
a tight bandage should be resorted to. Another method which is especially
commendable in these inflamed conditions of the womb is to bring a piece of
linen sheet, 30 by 36 inches, under the womb, with its anterior border
close up to the vulva, then turn the posterior border upward and forward
over the organ, and cross the two ends over this and over each other above.
The ends of the sheet are steadily drawn, so as to tighten its hold on the
womb, which is thus held on the level of the vulva or above, and cold water
is constantly poured upon the mass. The reduction is further sought by
compression of the mass with the palms applied outside the sheet. Fifteen
or twenty minutes are usually sufficient to cause the return of the womb,
provided straining is prevented by pinching the back, or otherwise.
In old and aggravated cases, with the womb torn, bruised, or even
gangrenous, the only resort is to amputate the entire mass. This is done by
tying a strong, waxed cord around the protruding mass close to the vulva,
winding the cord around pieces of wood, so as to draw it as tightly as
possible, cutting off the organ below this ligature, tying a thread on any
artery that may still bleed, and returning the stump well into the vagina.
Retention of the returned womb is the next point, and is most easily
accomplished by a rope truss. Take two ropes, each about 18 feet long and
an inch in thickness. Double each rope at its middle, and lay the one above
the other at the bend, so as to form an ovoid of about 8 inches in its long
diameter. Twist each end of the one rope twice around the other, so that
this ovoid will remain when they are drawn tight. (Pls. XXII and XXIII.)
Tie a strap or rope around the back part of the neck and a surcingle around
the body. Place the rope truss on the animal so that the ovoid ring will
surround the vulva, the two ascending ropes on the right and left of the
tail and the two descending ones down inside the thighs on the right and
left of the udder. These descending ropes are carried forward on the sides
of the body and tied to the surcingle and to the neck collar. The ascending
ropes proceed forward on the middle of the back, twisting over each other,
and are tied to the surcingle and collar. The upper and lower ropes are
drawn so tightly that the rope ring is made to press firmly all around the
vulva without risk of displacement. This should be worn for several days,
until the womb shall have closed and all risk of further eversion is at an
end. Variations of this device are found in the use of a narrow triangle of
iron applied around the vulva and fixed by a similar arrangement of ropes,
surcingle, and collar (Pl. XXIII, fig. 3), a common crupper similarly held
around the vulva (Pl. XXII, fig. 1), stitches through the vulva, and wire
inserted through the skin on the two hips (Pl. XXIII, fig. 2), so that they
will cross behind the vulva; also pessaries of various kinds should be
inserted into the vagina. None of these devices, however, present any
advantage over the simple and comparatively painless rope truss described
above. Such additional precautions as keeping the cow in a stall higher
behind than in front, and seeing that the diet is slightly laxative and
nonstimulating may be named. If straining is persistent, ounce doses of
laudanum may be used twice a day, and the same may be injected into the
vagina.
If the womb has been cut off, injections of a solution of a teaspoonful of
carbolic acid in a quart of water should be used daily, or more frequently,
until the discharge ceases.
EVERSION OF THE BLADDER.