Chapter XI: Part 11

_Outward direction of the stifles_--_Abduction of hind limbs._--As an obstacle to parturition, this is rare in cows. It is most liable to take place in cows with narrow hip bones, and when the service has been made by a bull having great breadth across the quarter. The calf, taking after the sire, presents an obstacle to calving in the breadth of its quarters, and if at the same time the toes and stifles are turned excessively outward and the hocks inward the combined breadth of the hip bones above and the stifles below may be so great that the pelvis will not easily admit them. After the forefeet, head, and shoulders have all passed out through the vulva, further progress suddenly and unaccountably ceases, and some dragging on the parts already delivered does not serve to bring away the hind parts. The oiled hand introduced along the side of the calf will discover the obstacle in the stifle joints turned directly outward and projecting on each side beyond the bones which circumscribe laterally the front entrance of the pelvis. The evident need is to turn the stifles inward; this may be attempted by the hand introduced by the side of the calf, which is meanwhile rotated gently on its own axis to favor the change of position. To correct the deviation of the hind limb is, however, very difficult, as the limbs themselves are out of reach and can not be used as levers to assist. If nothing can be done by pushing the body of the calf back and rotating it and by pressure by the hand in the passages, the only resort appears to be to skin the calf from the shoulder back, cut it in two as far back as can be reached, then push the buttocks well forward into the womb, bring up the hind feet, and so deliver.

_Hind limbs excessively bent on the body and engaged in the pelvis._--In this case the presentation is apparently a normal, anterior one; fore limbs and head advanced naturally and the parturition proceeds until half the chest has passed through the external passages, when suddenly progress ceases and no force will effect farther advance. An examination with the oiled hand detects the presence, in the passages, of the hind feet and usually the hind legs up to above the hocks. (Pl. XVII, fig. 1.)

The indications for treatment are to return the hind limbs into the body of the womb. If they have not advanced too far into the pelvis, this may be done as follows: A rope with running noose is passed over each hind foot and drawn tight around the lower part of the hock; the ropes are then passed through the two rings in the small end of the rotating instrument (Pl. XX, fig. 5) which is slid into the passages until it reaches the hocks, when the ropes, drawn tight, are tied around the handle of the instrument. Then in the intervals between the pains the hocks are pushed forcibly back into the womb. If by this means flexion can be effected in hocks and stifles, success will follow; the hind feet will pass into the womb and clear of the brim of the pelvis and the body may now be advanced without hindrance, the hind limbs falling into place when the hip joints are extended. At the same time the pressure upon hind limbs must not be relaxed until the buttocks are engaged in the pelvis, as otherwise the feet may again get over the brim and arrest the progress of delivery.

When the hind limbs are already so jammed into the pelvis that it is impossible to return them, the calf must be sacrificed to save the mother. Cords with running nooses are first put on the two hind feet. The body must be skinned from the shoulders back as far as can be reached, and is to be then cut in two, if possible, back of the last rib. The remainder of the trunk is now pushed back into the body of the womb and by traction upon the cords the hind feet are brought up into the passages and the extraction will be comparatively easy.

_Hind presentation with one or both legs bent at the hock._--After the bursting of the water bags, though labor pains continue, no part of the fetus appears at the vulva unless it be the end of the tail. On examination the buttocks are felt wedged against the spine at the entrance of the pelvis and beneath them the bent hock joints resting on the brim of the pelvis below. (Pl. XVII, fig. 3.) The calf has been caught by the labor pains while the limb was bent beneath it and has been jammed into or against the rim of the pelvis, so that extension of the limb became impossible. With the thigh bent on the flank, the leg on the thigh, and the shank on the leg, and all at once wedged into the passage, delivery is practically impossible.

The obvious remedy is to push the croup upward and forward and extend the hind legs, and in the early stages this can usually be accomplished in the cow. A repeller (Pl. XX, fig. 7) is planted across the thighs and pointed upward toward the spine of the cow and pushed forcibly in this direction during the intervals between labor pains. Meanwhile the oiled hand seizes the shank just below the hock and uses it as a lever, pushing the body back and drawing the foot forward, thus effectually seconding the action of the repeller. Soon a distinct gain is manifest, and as soon as the foot can be reached it is bent back strongly at the fetlock, held in the palm of the hand, and pulled up, while the repeller, pressing on the buttocks, assists to make room for it. In this way the foot may be brought safely and easily over the brim of the pelvis without any risk of laceration of the womb of the foot. After the foot has been lifted over the brim, the whole limb can be promptly and easily extended. In cases presenting special difficulty in raising the foot over the brim, help may be had by traction on a rope passed around in front of the hock, and later still by a rope with a noose fastened to the pastern. In the worst cases, with the buttocks and hocks wedged deeply into the passages, it may prove difficult or impossible to push the buttocks back into the abdomen, and in such case the extension of the hind limb is practically impossible without mutilation. In some roomy cows a calf may be dragged through the passages by ropes attached to the bent hocks, but even when this is possible there is great risk of laceration of the floor of the vagina by the feet. The next resort is to cut the hamstring just above the point of the hock and the tendon on the front of the limb (flexor metatarsi) just above the hock, and even the sinews behind the shank bone just below the hock. This allows the stifle and hock to move independently of each other, the one undergoing extension without entailing the extension of the other; it also allows both joints to flex completely, so that the impacted mass can pass through a narrower channel. If now, by dragging on the hocks and operating with the repeller on the buttocks, the latter can be tilted forward sufficiently to allow of the extension of the stifle, the jam will be at once overcome, and the calf may be extracted with the hock bent, but the stifle extended. If even this can not be accomplished, it may now be possible to extract the whole mass with both hocks and stifles fully bent. To attempt this, traction may be made on the rope around the hocks and on a sharp hook (Pl. XX, fig. 2) passed forward between the thighs and hooked on to the brim of the pelvis. Everything else failing, the offending limb or limbs may be cut off at the hip joint and extracted, after which extraction may proceed by dragging on the remaining limb, or by hooks on the hip bones. Very little is to be gained by cutting off the limb at the hock, and the stifle is less accessible than the hip, and amputation of the stifle gives much poorer results.

_Hind limbs bent forward from the hip_--_Breech presentation._--This is an exaggeration of the condition last described, only the hocks and stifles are fully extended and the whole limb carried forward beneath the belly. (Pl. XVII, fig. 2.) The water bags appear and burst, but nothing presents unless it may be the tail. Examination in this case detects the outline of the buttocks, with the tail and anus at its upper part.

The remedy, as in the case last described, consists in pushing the buttock upward and forward with a repeller, the cow being kept standing and headed downhill until the thigh bone can be reached and used as a lever. Its upper end is pushed forward and its lower end raised until, the joints becoming fully flexed, the point of the hock can be raised above the brim of the pelvis. If necessary a noose may be passed around the leg as far down toward the hock as possible and pulled on forcibly, while the hand presses forward strongly on the back of the leg above. When both hocks have been lodged above the brim of the pelvis the further procedure is as described under the last heading.

If, however, the case is advanced and the buttocks wedged firmly into the passages, it may be impossible safely to push the fetus back into the womb, and the calf must either be dragged through the passage as it is or the limbs or the pelvis must be cut off. To extract successfully with a breech presentation the cow must be large and roomy and the calf not too large. The first step in this case is to separate the pelvic bones on the two sides by cutting from before backward, exactly in the median line below and where the thighs come together above. This may be done with a strong embryotomy knife, but is most easily accomplished with the long embryotome (Pl. XX, fig. 3). The form which I have designed (Pl. XX, fig. 1), with a short cutting branch jointed to the main stem, is to be preferred, as the short cutting piece may be folded on the main stem so that its cutting edge will be covered, and it can be introduced and extracted without danger. This is pushed forward beneath the calf's belly, and the cutting arm opened, inserted in front of the brim of the pelvis and pulled forcibly back through the whole length of the pelvic bones. The divided edges are now made to overlap each other and the breadth of the haunch is materially reduced. One end of the cord may then be passed forward by means of a cord carrier (Pl. XXI, fig. 5) on the inner side of one thigh until it can be seized at the stifle by the hand passed forward on the outer side of that thigh. This end is now pulled back through the vagina, the other end passed through the cord carrier and passed forward on the inner side of the other thigh until it can be seized at the stifle by the hand passed forward outside that thigh. This end is drawn back through the vagina like the first, and is tied around the other so as to form a running noose. The rope is now drawn through the ring until it forms a tight loop, encircling the belly just in front of the hind limbs. On this strong traction can be made without interfering with the full flexion of the limbs on the body, and if the case is a suitable one, and the body of the fetus and the passages are both well lubricated with oil or lard, a successful parturition may be accomplished. A less desirable method is to put a rope around one thigh or a rope around each and drag upon these, but manifestly the strain is not so directly on the spine, and the limbs may be somewhat hampered in flexion.

This method being inapplicable, the next resort is to cut off one or both hind limbs at the hip joint. Free incisions are made on the side of the haunch so as to expose the hip joint, and the muscles are cut away from the head of the thigh bone down to its narrow neck, around which a rope is passed and firmly fixed with a running noose. The joint is now cut into all around, and while traction is made on the cord the knife is inserted into the inner side of the joint and the round ligament severed. The cord may now be dragged upon forcibly, and the muscles and other parts cut through as they are drawn tense, until finally the whole member has been extracted. Traction on the rope round the other thigh will now suffice to extract, in most cases, but if it should fail the other limb may be cut off in the same manner, and then hooks inserted in front of the brim of the pelvis or in the openings in the bones of its floor (obturator foramina) will give sufficient purchase for extraction. Another method is to insert a knife between the bone of the rump (sacrum) and the hip bone and sever their connections; then cut through the joint (symphysis) between the two hip bones in the median line of the floor of the pelvis, and then with a hook in the opening on the pelvic bones (obturator foramen) drag upon the limb and cut the tense soft parts until the limb is freed and extracted.

_Presentation of the back._--In this presentation straining may be active, but after the rupture of the water bags no progress is made, and the hand introduced will recognize the back with its row of spinous processes and the springing ribs at each side pressed against the entrance to the pelvis. (Pl. XVII, fig. 6.) The presence or absence of the ribs will show whether it is the region of the chest or the loins. By feeling along the line of spines until the ribs are met with we shall learn that the head lies in that direction. If, on the contrary, we follow the ribs until they disappear, and a blank space is succeeded by hip bones, it shows that we are approaching the tail. The head may be turned upward, downward, to the right side, or to the left.

The object must be to turn the fetus so that one extremity or the other can enter the passage, and the choice of which end to bring forward will depend on various considerations. If one end is much nearer the outlet than the other, that would naturally be selected for extraction, but if they are equidistant the choice would fall on the hind end, as having only the two limbs to deal with without any risk of complication from the head. When the head is turned upward and forward it will usually be preferable to bring up the hind limb, as, owing to the drooping of the womb into the abdomen, rotation of the fetus will usually be easier in that direction, and if successful the resulting position will be a natural posterior presentation, with the back of the calf turned toward the rump of the cow. Similarly with the croup turned upward and forward, that should be pushed on forward, and if the forefeet and head can be secured it will be a natural anterior presentation, with the back of the calf turned upward toward the rump of the cow.

The womb should be injected with warm water or oil, and the turning of the calf will demand the combined action of the repeller and the hand, but in all such cases the operator has an advantage that the body of the fetus is wholly within the body of the womb, and therefore movable with comparative ease. No part is wedged into the pelvic passages as a complication. The general principles are the same as in faulty presentation fore and hind, and no time should be lost in making the manipulations necessary to bring the feet into the pelvis, lest they get inbent or otherwise displaced and add unnecessary complications.

With a transverse direction of the calf, the head being turned to one side, the pressure must be directed laterally, so that the body will glide around on one side of the womb, and the extremities when reached must be promptly seized and brought into the passages. Sometimes a fortunate struggle of a live fetus will greatly aid in rectifying the position.

_Breast and abdomen presented._--All four feet in the passages._--In this form the calf lies across the womb with its roached back turned forward and its belly toward the pelvis. All four feet may be extended and engaged in the passages, or one or more may be bent on themselves so as to lie in front of the pelvis. The head, too, may usually be felt on the right side or the left, and if detected it serves to identify the exact position of the fetus. The position may further be decided upon by examination of the feet and limbs. With the limbs extended the front of the hoofs and the convex aspect of the bent pasterns and fetlocks will look toward that flank in which lie the head and shoulders. On examination still higher the smooth, even outline of the knee and its bend, looking toward the hind parts, characterize the fore limb, while the sharp prominence of the point of the hock and the bend on the opposite side of the joint, looking toward the head, indicate the hind limb. (Pl. XVII, fig. 5.)

The remedy of this condition is to be sought in repelling into the womb those limbs that are least eligible for extraction, and bringing into the passages the most eligible extremities. The most eligible will usually be those which project farthest into the passages, indicating the nearer proximity of that end of the calf. An exception may, however, be made in favor of that extremity which will give the most natural presentation. Thus if, owing to obliquity in the position of the fetus, the hind extremities promised a presentation with the back of the fetus turned down toward the udder, and the anterior extremities one with the back turned up toward the spine, the latter should be selected. Again, if the choice for the two extremities is evenly balanced, the hind may be chosen as offering less risk of complication, there being no head to get displaced.

The first step in the treatment is to place a running noose on each of the 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.

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DISEASES OF THE GENERATIVE ORGANS. DESCRIPTION OF PLATES.

PLATE XII. Fetal calf within its membranes (at mid term). The uterus is 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.

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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.