Chapter X: Part 10

In obstinate cases, in which the hand can be made to pass through the neck of the womb easily, additional help may be had from the use of the instrument shown in Plate XX, figure 5. Two cords, with running nooses, are successively introduced and made fast on two limbs of the calf; the cords are then passed through the two rings on the end of the instrument, which is passed into the womb and the cords drawn tight and fixed round the handle. Then, using the handle as a lever, it is turned in the direction opposite to the twist. The hand should meanwhile be introduced into the womb and the snared limbs seized and pressed against its walls so as to secure the rotation of the uterus along with the body of the fetus. The relaxation of the constriction and the effacement of the spiral folds will show when success has been gained, and the different members at one end of the body should then be brought up so as to secure a natural presentation.

NARROW PELVIS FROM FRACTURE OR DISEASE.

In a small cow the pelvis may be too narrow to pass a calf sired by a bull of a large breed, but this is exceptional, as the fetus usually accommodates itself to the size of the dam and makes its extra growth after birth. When the pelvic bones have been fractured repair takes place with the formation of a large permanent callus, which, projecting internally, may be a serious obstacle to calving. Worse still, if the edge of the broken bone projects internally as a sharp spike or ridge, the vaginal walls are cut upon it during the passage of the calf, with serious or fatal result. In other cases, where the cow has suffered from fragility of bone (fragilitas ossium) the thickening of the bone causes narrowing of the long passage of the pelvis and the crumbling fractures poorly repaired, with an excess of brittle new material, may form an insuperable obstacle to parturition. Cows affected in any of these ways should never again be bred, but if they do get pregnant and reach full time a careful examination will be necessary to determine whether natural parturition can take place or if the calf must be extracted in pieces. (See "Embryotomy," p. 202.)

OBSTRUCTION BY MASSES OF FAT.

This is not unknown in old cows of the beef breeds, the enormous masses of fat upon and within the pelvis being associated with weakness or fatty degeneration of the muscles. If the presentation is natural, little more is wanted than a judicious traction upon the fetus to compress and overcome the soft resisting masses.

OBSTRUCTION BY A FULL BLADDER OR RECTUM OR BY STONE.

In all cases of delayed or tardy parturition the evacuation of rectum and bladder is important, and it is no less so in all difficult parturitions. Stone in the bladder is fortunately rare in the cow, but when present it should be removed to obviate crushing and perhaps perforation of the organ during calving.

CALVING RETARDED BY NERVOUSNESS.

In a public fair ground I have seen labor pains begin early in the day and keep up in a weak and insufficient manner for many hours, until the stall was thoroughly closed in and the cow secluded from the constant stream of visitors and the incessant noise, when at once the pains became strong and effective and the calf was soon born.

COAGULATED BLOOD UNDER THE VAGINAL WALLS.

This is common after calving, but sometimes occurs before, as the result of accidental injury. The mass may be recognized by its dark hue and the doughy sensation to the touch. It may be cut into and the mass turned out with the fingers, after which it should be washed frequently with an antiseptic lotion (carbolic acid 1 dram in 1 quart of water).

CONSTRICTION OF A MEMBER BY THE NAVEL STRING.

In early fetal life the winding of the navel string around a limb may cause the latter to be slowly cut off by absorption under the constricting cord. So at calving the cord wound round a presenting member may retard progress somewhat, and though the calf may still be born tardily by the unaided efforts of the mother, it is liable to come still-born, because the circulation in the cord is interrupted by compression before the offspring can reach the open air and commence to breathe. If, therefore, it is possible to anticipate and prevent this displacement and compression of the navel string it should be done, but if this is no longer possible, then the extraction of the calf should be effected as rapidly as possible, and if breathing is not at once attempted it should be started by artificial means.

WATER IN THE HEAD OF THE CALF (HYDROCEPHALUS).

This is an enormous distention of the cavity holding the brain, by reason of the accumulation of liquid in the internal cavities (ventricles) of the brain substance. The head back of the eyes rises into a great rounded ball (Pl. XIX, figs. 4 and 5), which proves an insuperable obstacle to parturition. The fore feet and nose being the parts presented, no progress can be made, and even if the feet are pulled upon the nose can not by any means be made to appear. The oiled hand introduced into the passages will feel the nose presenting between the fore limbs, and on passing the hand back over the face the hard rounded mass of the cranium is met with. A sharp-pointed knife or a cannula and trocar should be introduced in the palm of the hand and pushed into the center of the rounded mass so as to evacuate the water. The hand is now used to press together the hitherto distended but thin and fragile walls, and the calf may be delivered in the natural way. If the enlarged head is turned backward it must still be reached and punctured, after which it must be brought up into position and the calf delivered.

If the hind feet present first, all may go well until the body and shoulders have passed out, when further progress is suddenly arrested by the great bulk of the head. If possible, the hand, armed with a knife or trocar, must be passed along the side of the shoulder or neck so as to reach and puncture the distended head. Failing in this, the body may be skinned up from the belly and cut in two at the shoulder or neck, after which the head can easily be reached and punctured. If in such case the fore limbs have been left in the womb, they may now be brought up into the passage, and when dragged upon the collapsed head will follow.

If the distention is not sufficient to have rendered the bony walls of the cranium thin and fragile, so that they can be compressed with the hand after puncture, a special method may be necessary. A long incision should be made from behind forward in the median line of the cranium with an embryotomy knife (Pl. XXI, fig. 1) or with a long embryotome (Pl. XX, fig. 3). By this means the bones on the one side are completely separated from those on the other and may be made to overlap and perhaps to flatten down. If this fails they may be cut from the head all around the base of the rounded cranial swelling by means of a guarded chisel (Pl. XX, fig. 8) and mallet, after which there will be no difficulty in causing them to collapse.

DROPSY OF THE ABDOMEN OF THE CALF (ASCITES).

This is less frequent than hydrocephalus, but no less difficult to deal with. With an anterior presentation the fore limbs and head may come away easily enough, but no effort will advance the calf beyond the shoulders. The first thought should be dropsy of the belly, and the oiled hand introduced by the side of the chest will detect the soft and fluctuating yet tense sac of the abdomen. If there is space to allow of the introduction of an embryotomy knife, the abdomen may be freely cut with this, when the fluid will escape into the womb and parturition may proceed naturally. If this can not be effected, a long trocar and cannula may be passed between the first two ribs and straight on beneath the spine until it punctures the abdomen. (Pl. XVIII, fig. 2.) Then the trocar is to be withdrawn and the liquid will flow through the cannula and will be hastened by traction on the fore limbs. In the absence of the trocar and cannula, two or three of the first ribs may be cut from the breastbone, so that the hand may be introduced through the chest to puncture the diaphragm with an embryotomy knife and allow an escape of the water. In some slighter cases a tardy delivery may take place without puncture, the liquid bulging forward into the chest as the abdomen is compressed in the pelvic passages. With a posterior presentation the abdomen may be punctured more easily either in the flank or with a trocar and cannula through the anus.

GENERAL DROPSY OF THE CALF.

This occurs from watery blood or disease of some internal organ, like the liver or kidney, and is recognized by the general puffed-up and rounded condition of the body, which pits everywhere on pressure but without crackling. If not too extreme a case, the calf may be extracted after it has been very generally punctured over the body, but usually the only resort is to extract it in pieces. (See "Embryotomy," p. 202.)

SWELLING OF THE CALF WITH GAS.

This is usually the result of the death and decomposition of the fetus when extraction has been delayed for a day or more after the escape of the waters. It is impossible to extract it whole, owing to its large size and the dry state of the skin of the calf, the membranes, and the wall of the womb. These dry surfaces stick with such tenacity that no attempt at traction leads to any advance of the calf out of the womb or into the passages. When the fetus is advanced the adherent womb advances with it, and when the strain is relaxed both recede to where they were at first. The condition may be helped somewhat by the free injection of oil into the womb, but it remains impossible to extract the enormously bloated body, and the only resort is to cut it in pieces and extract it by degrees. (See "Embryotomy," p. 202.)

RIGID CONTRACTIONS OF MUSCLES.

In the development of the calf, as in after life, the muscles are subject to cramps, and in certain cases given groups of muscles remain unnaturally short, so that even the bones grow in a twisted and distorted way. In one case the head and neck are drawn round to one side and can not be straightened out, even the bones of the face and the nose being curved around to that side. In other cases the flexor muscles of the fore legs are so shortened that the knees are kept constantly bent and can not be extended by force. The bent neck may sometimes be sufficiently straightened for extraction by cutting across the muscles on the side to which it is turned, and the bent knees by cutting the cords on the back of the shank bones just below the knees. If this fails, there remains the resort of cutting off the distorted limbs or head. (See "Embryotomy," p. 202.)

TUMORS OF THE CALF (INCLOSED OVUM).

Tumors or new growths grow on the unborn calf as on the mature animal, and by increasing the diameter of the body render its progress through the passage of the pelvis impossible. In my experience with large, fleshy tumors of the abdomen, I have cut open the chest, removed the lungs and heart, cut through the diaphragm with the knife, and removed the tumor piecemeal by alternate tearing and cutting until the volume of the body was sufficiently reduced to pass through. Where this failed it would remain to cut off the anterior part of the body, removing as much of the chest as possible, and cutting freely through the diaphragm; then, pushing back the remainder of the body, the hind limbs may be seized and brought into the passages and the residue thus extracted. The tumor, unless very large, will get displaced backward so as not to prove an insuperable obstacle.

In many cases the apparent tumor is a blighted ovum which has failed to develop, but has grafted itself on its more fortunate twin and from it has drawn its nourishment. These are usually sacs containing hair, skin, muscle, bone, or other natural tissues, and only exceptionally do they show the distinct outline of the animal.

MONSTROSITY IN THE CALF.

As a monstrous development in the calf may hinder calving, it is well to consider shortly the different directions in which these deviations from the natural form appear. Their origin and significance will be rendered clearer if we divide them according to the fault of development in individual cases. Monsters are such--

(1) From absence of parts--absence of head, limb, or other organ--arrested development.

(2) From some organ being unnaturally small, as a dwarfed head, limb, trunk, etc.--arrested development.

(3) From unnatural division of parts--cleft lips, palate, head, trunk, limbs, etc.--abnormal growth.

(4) From the absence of natural divisions--absence of mouth, nose, eye, anus; the cloven foot of ox or pig becomes solid, like that of the horse, etc.--confluence of parts which are rightfully separate.

(5) From the fusion of parts--both eyes replaced by central one, both nostrils merged into one central opening, etc.--confluence of parts.

(6) From unnatural position or form of parts--curved nose, neck, back, limbs, etc.--lack of balance in the growth of muscles during development.

(7) From excessive growth of one or more organs--enormous size of head, double penis, superfluous digits, etc.--redundancy of growth at given points.

(8) From imperfect differentiation of the sexual organs--hermaphrodites (organs intermediate between male and female), male organs with certain feminine characters, female organs with certain well-marked male characters.

(9) From the doubling of parts or of the entire body--double monsters, doubled heads, doubled bodies, extra limbs, etc.--redundant development. (Pl. XIX, figs. 1, 2, 3.)

_Causes._--The causes of monstrosities are varied. Some, like extra digits, lack of horns, etc., run in families, which produce them with absolute certainty when bred in the direct line, although they were originally acquired peculiarities which have merely been fixed by long habit in successive generations. The earliest horse had five toes, and even the most recent fossil horse had three toes, of which the two lateral ones are still represented in the modern animal by the two splint bones. Yet if our horse develops an extra toe it is pronounced a monstrosity. A more genuine monstrosity is the solid-hoofed pig, in which two toes have been merged into one. Another of the same kind is the solid shank bone of the ox, which consists of two bones united into one, but which are still found apart in the early fetus. Though originally acquired peculiarities, they now breed as invariably as color or form.

Other monstrosities seem to have begun in too close breeding, by which the powers of symmetrical development are impaired, just as the procreative power weakens under continuous breeding from the closest blood relations. A monstrosity consisting in the absence of an organ often depends on a simple lack of development, the result of disease or injury, as a young bone is permanently shortened by being broken across the soft part between the shaft and the end, the only part where increase in length can take place. As the result of the injury the soft, growing layer becomes prematurely hard and all increase in length at that end of the bone ceases. This will account for some cases of absence of eye, limb, or other organ.

Sometimes a monstrosity is owing to the inclosure of one ovum in another while the latter is still but a soft mass of cells and can easily close around the first. Here each ovum has an independent life; they develop simultaneously, only the outer one having direct connection with the womb and being furnished with abundant nourishment advances most rapidly and perfectly, while the inclosed and starved ovum is dwarfed and imperfect often to the last degree.

In many cases of excess of parts the extra part or member is manifestly derived from the same ovum, and even the same part of the ovum, being merely the effect of a redundancy and vagary of growth. Such cases include most instances of extra digits or other organs, and even of double monsters, as manifested by the fact that such extra organs grow from the normal identical organs. Hence the extra digit is attached to the normal digit, the extra head to the one neck, the extra tail to the croup, extra teeth to the existing teeth, and even two similarly formed bodies are attached by some point common to both, as the navels, breastbones, backs, etc. (Pl. XIX, figs. 1, 2, 3.) This shows that both have been derived from the same primitive layer of the embryo, which possessed the plastic power of building up a given structure or set of organs. An inclosed ovum, on the other hand, has no such identity or similarity of structure to the part with which it is connected, showing an evident primary independence of both life and the power of building tissues and organs. The power of determining extra growth along a given natural line is very highly developed in the early embryo and is equally manifest in the mature examples of some of the lower forms of animal life. Thus a newt will grow a new tail when that member has been cut off, and a starfish will develop as many new starfishes as the pieces made by cutting up the original one. This power of growth in the embryo and in the lower form of animals is comparable to the branching out again of a tree at the places from which branches have been lopped. The presence of this vegetablelike power of growth in the embryo accounts for most double monsters.

The influence of disease in modifying growth in the early embryo, increasing, decreasing, distorting, etc., is well illustrated in the experiments of St. Hilaire and Valentine in varnishing, shaking, or otherwise disturbing the connections of eggs and thereby producing monstrosities. One can easily understand how inflammations and other causes of disturbed circulation in the womb, fetal membranes, or fetus would cause similar distortions and variations in the growing fetus. It is doubtless largely in the same way that certain mental disturbances of a very susceptible dam affect the appearance of the progeny. The monstrosities which seriously interfere with calving are mainly such as consist in extra members or head, which can not be admitted into the passages at the same time, where some organ of the body has attained extra size, where a blighted ovum has been inclosed in the body of a more perfect one, or where the body or limbs are so contracted or twisted that the calf must enter the passages doubled up.

_Treatment._--Extraction is sometimes possible by straightening the distorted members by the force of traction; in other cases the muscles or tendons must be cut across on the side to which the body or limbs are bent to allow of such straightening. Thus, the muscles on the concave side of a wry neck or the cords behind the shank bones of a contracted limb may be cut to allow of these parts being brought into the passages, and there will still be wanting the methods demanded for bringing up missing limbs or head, for which see paragraphs below. In most cases of monstrosity by excess of overgrowth it becomes necessary to cut off the supernumerary or overdeveloped parts, and the same general principles must be followed as laid down in "Embryotomy" (p. 202).

WRONG PRESENTATIONS OF THE CALF.

The following is a list of abnormal presentations of the calf:

Simultaneous presentation of twins.

A { {Limbs curved at the knee. Flexor tendons shortened.
n {Fore Limbs{Limb crossed over the back of the neck.
t { {Limb bent back at the knee.
e { {Limb bent back from the shoulder.
r {
i { {Head bent downward on the neck.
o P { {Head and neck turned downward beneath the breast.
r r {Head {Head turned to one side upon the side of the neck.
e { {Head and neck turned back on the side of the chest and
s { { abdomen.
e { {Head turned upward and backward on the back.
n {
t { {Hind limbs rotated outward. Toes and stifles turned
a { { outward.
t {Hind Limbs{Hind limbs bent forward, their feet resting in the pelvis.
i {
o {Transverse{Back of the calf turned to the right or left side.
n {
s {Inverted {Back of the calf turned to the floor of the pelvis and
{ { udder.

P P {
o r { {Hind limb bent on itself at the hock. Hock and buttocks
s e {Hind Limbs{ present.
t s { {Hind limb bent at the hips. Buttocks present.
e e {
r n {Transverse{Back of calf turned to the right or left side.
i t {
o a {Inverted {Back of calf turned to the floor of the pelvis and udder.
r t {
i {
o {
n {
{Head up toward the spine, croup
{Position of calf vertical { toward udder.
T { { {Head down toward udder, croup
r {Back { { toward spine.
u P {and {
n r {loins { {Head toward the right side,
k e {presented.{Position of calf transverse{ croup toward the left.
s { {
e { { {Head toward the left side,
n { { { croup toward the right.
t { {
a { {
t {Breast { {Head toward right side, croup
i {and {Position of calf transverse{ toward left.
o {abdomen { {Head toward left side, croup
n {presented.{ { toward right.
s {

These include all general presentations, yet other subsidiary ones will at once occur to the attentive reader. Thus, in each anterior or posterior presentation, with the back of the calf turned downward or to one side, the case may be complicated by the bending back of one or more members as a whole or at the joint just above the shank bones (knee or hock). So also in such anterior presentation the head may be turned back.

_Head and fore feet presented--Back turned to one side._--The calf has a greater diameter from above down (spine to breastbone) than it has from side to side, and the same is true of the passage of the pelvis of the cow, which measures, on an average, 8-7/10 inches from above downward and 7-9/10 inches from side to side. Hence the calf passes most easily with its back upward, and when turned with its back to one side calving is always tardy and may be difficult or impossible. The obvious remedy is to rotate the calf on its own axis until its spine turns toward the spine of the cow. The operation is not difficult if the body of the calf is not yet fixed in the passages. The presenting feet are twisted over each other in the direction desired, and this is continued until the head and spine have assumed their proper place. If the body is firmly engaged in the passages the skin of the whole engaged portion should be freely lubricated with lard, and the limbs and head twisted over each other as above. The limbs may be twisted by an assistant when the head is manipulated by the operator, who drags on the rope turned halfway round the limbs and assists in the rotation with his other hand in the passages.

_Head and fore feet presented--Back turned down toward the udder._--This position (Pl. XVI, fig. 6) is unnatural, and the parturition is difficult for two reasons: First, the natural curvature of the fetus is opposed to the natural curvature of the passages; and, second, the thickest part of the body of the calf (the upper) is engaged in the narrowest part of the passage of the pelvis (the lower). Yet unless the calf is especially large and the pelvis of the cow narrow, parturition may usually be accomplished in this way spontaneously or with very little assistance in the way of traction on the limbs. If this can not be accomplished, two courses are open: First, to rotate the calf as when the back is turned to one side; second, to push back the presenting fore limbs and head and search for and bring up the hind limbs, when the presentation will be a natural, posterior one.

_Presentation of the hind feet with the back turned to one side or downward._--These are the exact counterparts of the two conditions last described, are beset with similar drawbacks, and are to be dealt with on the same general principles. (Pl. XVII, fig. 4.) With the back turned to one side the body should be rotated until the back turns toward the spine of the dam, and with the back turned down it must be extracted in that position (care being taken that the feet do not perforate the roof of the vagina) or it must be rotated on its own axis until the back turns upward, or the hind limbs must be pushed back and the fore limbs and head advanced, when the presentation will be a natural anterior one.

_Impaction of twins in the passage._--It is very rare to have twins enter the passages together so as to become firmly impacted. As a rule, each of the twins has its own separate membranes, and as the water bags of one will naturally first enter and be the first to burst, so the calf which occupied those membranes will be the first to enter the passage and the other will be thereby excluded. When the membranes of both have burst without either calf having become engaged in the pelvis, it becomes possible for the fore legs of one and the hind legs of the other to enter at one time, and if the straining is very violent they may become firmly impacted. (Pl. XVIII, fig. 1.) The condition may be recognized by the fact that two of the presenting feet have their fronts turned forward, while the two others have their fronts turned backward. If the four feet belonged to one natural calf, they would all have the same direction. By means of this difference in direction we can easily select the two feet of one calf, place running nooses upon them just above the hoofs or fetlocks, and have an assistant drag upon the ropes while the feet of the other calf are pushed back. In selecting one of the twins to come first several considerations should have weight. The one that is most advanced in the passage is, of course, the first choice. Though the fore feet of one are presented, yet if the head is not in place the calf presenting by its hind feet is to be chosen as being less liable to obstruct. Again, if for either calf one limb only is presented and the other missing, the one presenting two feet should be selected to come first. As soon as one calf has been advanced so as to occupy the pelvis the other will be crowded back so that it will not seriously obstruct.

_Fore limbs curved at the knee--Limbs sprawling outward._--In this case not only are the knees somewhat bent in a curve, but the calf has a position as if it rested on its breastbone, while the legs were drawn apart and directed to the right and left. The shoulder blades being drawn outward from the chest and the elbows turned out, the muscles extending from the trunk to the limb are unduly stretched and keep the knees bent and the feet directed outward so as to press on the sides of the passages. They become retarded in their progress as compared with the more rapidly advancing head, and may bruise or even lacerate the walls of the vagina. It would seem easy to rectify this by extending the legs, but the already tense and overstretched muscles operate against extension in the present position, and it is not easy to rotate the limbs so as to apply the shoulder flat against the side of the chest. Under these circumstances a repeller (Pl. XX, fig. 7) may be planted in the breast and the body of the calf pushed backward into the womb, when the limbs will extend easily under traction and the presentation becomes at once natural.

_Fore limbs curved at knee--Flexor tendons shortening._--In this case the feet will press against the floor of the pelvis though the limb has no outward direction, and the shoulder meanwhile presses against the roof of the same passage. Unless the knees can be sufficiently straightened by force a knife must be used to cut across the cords behind the knee, when the limbs may be straightened sufficiently.

_Fore limbs flexed at knee--Flexor tendons unshortened._--This is mostly seen in cases in which the body of the calf is in the proper position, its back being turned up toward the back of the dam, and in cows with a drooping abdomen. The feet have been supposed to catch beneath the brim of the pelvis, and being retarded while the head advances into the passages, they get bent at the knee and the nose and knees present. (Pl. XVI, fig. 2.) The calf, however, is not an inanimate body advanced by the mere contraction of the womb, but it moves its limbs freely under the stimulus of the unwonted compression, and in moving the feet as they are advanced they slip down over the pelvic brim and finding no other firm support they bend back until, under the impulsion, they can no longer straighten out again. The knees, therefore, advance with the neck and head, but the feet remain bent back. The result is that the upper part of the limb is also flexed, and the shoulder blade and arm bone with their masses of investing muscles are carried backward and applied on the side of the chest, greatly increasing the bulk of this already bulky part. As the elbow is carried back on the side of the chest, the forearm from elbow to knee further increases the superadded masses of the shoulder and renders it difficult or impossible to drag the mass through the passages. When the fore limbs are fully extended, on the contrary, the shoulder blade is extended forward on the smallest and narrowest part of the chest, the arm bone with its muscles is in great part applied against the side of the back part of the neck, and the forearm is continued forward by the side of the head so that the nose lies between the knees. In this natural presentation the presenting body of the calf forms a long wedge or cone, the increase of which is slow and gradual until it reaches the middle of the chest.

The difficulty of extending the fore limbs will be in proportion to the advance of the head through the pelvic cavity. In the early stage all that is necessary may be to introduce the oiled hand, the left one for the right leg or the right one for the left, and passing the hand from the knee on to the foot to seize the foot in the palm, bend it forcibly on the fetlock, and lift it up over the brim of the pelvis, the knee being, of course, pressed upward against the spine. As soon as the foot has been raised above the brim of the pelvis (into the passage) the limb can be straightened out with the greatest ease.

When, however, the shoulders are already engaging in the pelvis the feet can not thus be lifted up, and to gain room a repeller (Pl. XX, fig. 7) must be used to push back the body of the calf. This is an instrument with a long, straight stem, divided at the end into two short branches (2 to 3 inches long) united to the stem by hinges so that they can be brought into a line with the stem for introduction into the womb and then spread to be implanted in the breast. In the absence of a repeller a smooth, round, fork handle may be used, the prongs having been removed from the other end. A third device is to have an assistant strip his arm to the shoulder and, standing back to back with the operator, to introduce his right arm into the passages along with the operator's left (or vice versa) and push back the body of the calf while the operator seeks to bring up a limb. The repeller or staff having been planted safely in the breast of the calf, an assistant pushes upon it in a direction either forward or slightly upward, so as not only to follow the natural curve of the body and favor its turning in the line of that curve within the womb, but also to carry the shoulders upward toward the spine and obtain more room for bringing up the missing feet. It is good policy, first, to put a halter (Pl. XXI, figs. 4_a_ and 4_b_) on the head or a noose (Pl. XXI, fig. 3) on the lower jaw and a rope round each limb at the knee, so as to provide against the loss of any of these parts when the body is pushed back into the womb. This offers the further advantage that by dragging upon these ropes the body can be advanced in the passage until the foot is reached, when the rope must be slackened and the repeller used to get room for bringing up the foot. If the cow is lying, the operator should first secure the foot on the upper side and then, if necessary, turn the cow on its opposite side so as to bring up the other.

In using the instruments some precautions are demanded. They must be invariably warmed before they are introduced, and they should be smeared with lard or oil to make them pass easily and without friction. The assistant who is pushing on the instrument must be warned to stop if at any time resistance gives way. This may mean the turning of the fetus, in which case the object of repulsion has been accomplished, but much more probably it implies the displacement of the instrument from the body of the fetus, and unguarded pressure may drive it through the walls of the womb.

When the calf enters the passage with its back turned down toward the belly and udder, the bending back of the fore limbs is rare, probably because the feet can find a straighter and more nearly uniform surface of resistance in the upper wall of the womb and the backbone, and do not slide over a crest into an open cavity, as they do over the brim of the pelvis. The weight of the calf, too, gravitating downward, leaves more room for the straightening of the bent limbs, so that the desired relief is much more easily secured. The manipulation is the same in principle, only one must add the precaution of a steady traction on the feet in extraction, lest, owing to the adverse curvature of the fetus, the hoofs are suddenly forced through the roof of the vagina, and, perhaps, the rectum as well, during a specially powerful labor pain.

When the back of the calf is turned to the right side or the left the main difference is that in addition to straightening the limbs the fetus must be rotated to turn its back upward before extraction is attempted. In this case, too, it may be difficult to bring up and straighten the lower of the two limbs until the body has been rotated into its proper position. Cord the upper straightened limb and head, then rotate the body and search for the second missing limb.

_Fore limbs bent back from the shoulders._--This is an exaggeration of the condition just named, and is much more difficult to remedy, owing to the distance and inaccessibility of the missing limb. It usually happens with the proper position of the body, the back of the calf being turned toward the back of the mother. The head presents in the passage and may even protrude from the vulva during an active labor pain, but it starts back like a spring when the straining ceases. Examination with the oiled hands in the intervals between the pains fails to detect the missing limbs. (Pl. XVI, fig. 1.) If, however, the hand can be introduced during a pain it may be possible to reach the elbow or upper part of the forearm. In the absence of a pain a halter or noose on the head may be used to advance the whole body until the forearm can be seized just below the elbow. This being firmly held and the head or body pushed back into the womb, room may be obtained for bringing up the knee. The forearm is used as a lever, its upper part being strongly forced back while its lower part is pressed forward. If a pain supervenes the hold must be retained, and whatever gain has been made must be held if possible. Then during the next pain, by pushing back the body and continuing to operate the forearm as a lever, a still further advance may be made. As the knee is brought up in this way, the hand is slid down from the elbow toward the knee, which is finally brought up over the brim of the pelvis and into the passage. It is now corded at the knee, and the subsequent procedure is as described in the last article. In a large, roomy cow with a small calf the latter may pass with one or both forelegs bent back, but this is a very exceptional case, and, as early assistance is the most successful, there should never be delay in hope of such a result.

_One fore limb crossed over the back of the neck._--This is a rare obstacle to calving, but one that not altogether unknown. The hand introduced into the passage feels the head and one forefoot, and farther back on the same side of the other foot, from which the womb can be traced obliquely across the back of the neck. (Pl. XVI, fig. 3.) This foot, projecting transversely, is liable to bruise or tear the vagina. If still deeply engaged in the vagina, it may be seized and pushed across to the opposite side of the neck, when the presentation will be natural.

_Head bent down beneath the neck._--In this case, with drooping belly and womb allowing the brim of the pelvis to form a ridge, the advancing calf, having unduly depressed its nose, strikes it on the brim of the pelvis, and the neck advancing, the head is bent back and the poll and ears either enter the pelvis or strike against its brim. The two forefeet present, but they make no progress, and the oiled hand introduced can detect no head until the poll is felt at the entrance of the pelvis, between the forearms. The two forefeet must be fixed with running nooses and dragged on moderately while the oiled hand seeks to bring up the head. The hand is slid down over the forehead and brim of the pelvis until the nose is reached, when it is passed into the mouth, the muzzle resting in the palm of the hand. The legs are now pushed upon, and in the space thus gained the muzzle is drawn up so as to enter it into the pelvis. In doing this the operator must carefully see that the mouth does not drop open so that the sharp, front teeth cut through the floor of the womb. Should this danger threaten, the hand should be made to cover the lower jaw as well. The lessened security of the hold is more than compensated by the safety of the procedure. With the nose in the pelvis, it has only to be drawn forward and the parturition is natural.

_Head bent down beneath the breast._--This is an exaggerated condition of that last named. The head, arrested by the brim of the pelvis and already bent back on the neck, is pressed farther with each successive throe until it has passed between the forelegs and lodges beneath the breast bone. (Pl. XVI, fig. 4.) On examination, the narrow upper border of the neck is felt between the forearms, but as a rule the head is out of reach below. Keeping the hand on the neck and dragging on the feet by the aid of ropes, the hand may come to touch and seize the ear, or, still better, one or two fingers may be inserted into the orbit of the eye.

Then in pushing back upon the limbs, with or without the aid of a repeller applied against the shoulder, space may be obtained to draw the head into a vertical position, and even to slip the hand down so as to seize the nose. Should it prove impossible to draw the head up with the unassisted fingers, a blunt hook (Pl. XXI, fig. 6) may be inserted into the orbit, on which an assistant may drag while another pushes upon the limbs or repeller. Meanwhile the operator may secure an opportunity of reaching and seizing the nose or of passing a blunt hook into the angle of the mouth. Success will be better assured if two hooks (Pl. XXI, fig. 7) are inserted in the two orbits, so as to draw up the head more evenly. In other cases a noose may be placed on the upper jaw, or even around both jaws, and traction made upon this and on the hooks in the orbits while the legs are pushed back, and while the operator pushes back on the poll or forehead. In still more difficult cases, in which even the orbits can not be reached, a sharp hook on the end of a straight iron rod (Pl. XX, fig. 2) may be inserted over the lower jaw as far forward as it can be reached, and by dragging upon this while the body is pushed back the head will be brought up sufficiently to allow the operator to reach the orbit or nose. If even the jaw can not be reached, the hook may be inserted in the neck as near to the head as possible and traction employed so as to bring the head within reach.

In all such cases the cow's head should be turned downhill, and in case of special difficulty she should be turned on her back and held there until the head is secured. In old-standing cases, with the womb closely clasping the body of the calf, relaxation may be sought by the use of chloroform or a full dose of chloral hydrate--2 ounces; the free injection of warm water into the womb will also be useful.

_Head turned back on the shoulder._--With a natural, anterior presentation this may happen because of the imperfect dilation of the mouth of the womb. Under the throes of the mother the forefeet pass through the narrow opening into the vagina, while the nose, striking against it and unable to enter, is pressed backward into the womb and turns aside on the right or left shoulder. The broad muzzle of the calf forms an especial obstacle to entrance and favors this deviation of the head. The worst form of this deviation is the old-standing one with shortening of the muscles of the neck on that side, and oftentimes distortion of the face and neck bones, as noticed under "Monstrosities" (p. 182).

When the head is bent on the shoulder the feet appear in the natural way, 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.)