Chapter XI: Part 11

CONTRACTIONS OF MUSCLES.--The foal is not always developed symmetrically, but certain groups of muscles are liable to remain short, or to shorten because of persistent spasmodic contraction, so that even the bones become distorted and twisted. This is most common in the neck. The bones of this part and even of the face are drawn to one side and shortened, the head being held firmly to the flank and the jaws being twisted to the right or left. In other cases the flexor muscles of the fore limbs are contracted so that the latter are strongly bent at the knee. In neither of these cases can the distorted part be extended and straightened, so that body or limbs must necessarily present double, and natural delivery is rendered impossible. The bent neck may sometimes be straightened after the muscles have been cut on the side to which it is turned, and the bent limbs after the tendons on the back of the shank bone have been cut across. Failing to accomplish this, the next resort is embryotomy.

INCLOSED OVUM, OR TUMORS OF THE FETUS.--Tumors or diseased growths may form on any part of the foal, internal or external, and by their size impede or hinder parturition. In some cases what appears as a tumor is an imprisoned and undeveloped ovum which has grafted itself on the fetus. These are usually sacculated, and may contain skin, hair, muscle, bone, and other natural tissues. The only course to be pursued in such cases is to excise the tumor, or, if this is not feasible, to perform embryotomy.

MONSTROSITIES.--Monstrosity in the foal is an occasional cause of difficult parturition, especially such monsters as show excessive development of some part of the body, a displacement or distortion of parts, or a redundancy of parts, as in double monsters. Monsters may be divided into--

(1) Monsters with absence of parts--absence of head, limb, or other organ.

(2) Monsters with some part abnormally small--dwarfed head, limb, trunk, etc.

(3) Monsters through unnatural division of parts--cleft head, trunk, limbs, etc.

(4) Monsters through absence of natural divisions--absence of mouth, nose, eyes, anus, confluent digits, etc.

(5) Monsters through fusion of parts--one central eye, one nasal opening, etc.

(6) Monsters through abnormal position or form of parts--curved spine, face, limb, etc.

(7) Monsters through excess of formation--enormous head, supernumerary digits, etc.

(8) Monsters through imperfect differentiation of sexual organs--hermaphrodites.

(9) Double monsters--double-headed, double-bodied, extra limbs, etc.

_Causes._--The causes of monstrosities appear to be very varied. Some monstrosities, like extra digits, absence of horns or tail, etc., run in families and are produced almost as certainly as color or form. Others are associated with too close breeding, the powers of symmetrical development being interfered with, just as in other cases a sexual incompatibility is developed, near relatives failing to breed with each other. Mere arrest of development of a part may arise from accidental disease of the embryo; hence vital organs are left out, or portions of organs, like the dividing walls of the heart, are omitted. Sometimes an older fetus is inclosed in the body of another, each having started independently from a separate ovum, but the one having become embedded in the semifluid mass of the other and having developed there simultaneously with it, but not so largely nor perfectly. In many cases of redundance of parts the extra part or member has manifestly developed from the same ovum and nutrient center with the normal member to which it remains adherent, just as a new tail will grow out in a newt when the former has been cut off. In the early embryo, with its great powers of development, this factor can operate to far greater purpose than in the adult animal. Its influence is seen in the fact pointed out by St. Hilaire that such redundant parts are nearly always connected with the corresponding portions in the normal fetus. Thus superfluous legs or digits are attached to the normal ones, double heads or tails are connected to a common neck or rump, and double bodies are attached to each other by corresponding points, navel to navel, breast to breast, back to back. All this suggests the development of extra parts from the same primary layer of the impregnated and developing ovum. The effect of disturbing conditions in giving such wrong directions to the developmental forces is well shown in the experiments of St. Hilaire and Valentine in varnishing, shaking, and otherwise breaking up the natural connections in eggs, and thereby determining the formation of monstrosities at will. So, in the mammal, blows and other injuries that detach the fetal membranes from the walls of the womb or that modify their circulation by inducing inflammation are at times followed by the development of a monster. The excitement, mental and physical, attendant on fright occasionally acts in a similar way, acting probably through the same channels.

The monstrous forms liable to interfere with parturition are such as, from contracted or twisted limbs or spine, must be presented double; where supernumerary limbs, head, or body must approach the passages with the natural ones; where a head or other member has attained to an unnatural size; where the body of one fetus has become inclosed in or attached to another, etc.

Extraction is sometimes possible by straightening the members and obtaining such a presentation as will reduce the presenting mass to its smallest and most wedgelike dimensions. To effect this it may be needful to cut the flexor tendons of bent limbs or the muscles on the side of a twisted neck or body; one or more of the manipulations necessary to secure and bring up a missing member may be required. In most cases of monstrosity by excess, however, it is needful to remove the superfluous parts, in which case the general principles employed for embryotomy must be followed. The Caesarean section, by which the fetus is extracted through an incision in the walls of the abdomen and womb, is inadmissible, as it practically entails the sacrifice of the mare, which should never be done for the sake of a monster. (See "Embryotomy," p. 202.)

ENTRANCE OF TWINS INTO THE PASSAGE AT ONCE.--Twins are rare in the mare, and still more rare is the impaction of both at once into the pelvis. The condition would be easily recognized by the fact that two fore limbs and two hind would occupy the passage at once, the front of the hoofs of the fore feet being turned upward and those of the hind feet downward. If both belonged to one foal, they would be turned in the same direction. Once recognized, the condition is easily remedied by passing a rope with a running noose round each foot of the foal that is furthest advanced or that promises to be most easily extracted, and to push the members of the other fetus back into the depth of the womb. As soon as the one fetus is fully engaged into the passage it will hold its place and its delivery will proceed in the natural way.

ABNORMAL PRESENTATIONS.

(Pls. XV-XVIII.)

Abnormal presentations may be tabulated as follows:

{ {Incompletely extended.
{ { Flexor tendons shortened.
{Fore limbs {Crossed over the neck.
{ {Bent back at the knee.
{ {Bent back from the shoulder.
Anterior presentations: {
{ {Bent downward on the neck.
{ {Head and neck turned back
{ { beneath the breast.
{Head {Turned to one side.
{ {Turned upward and backward
{ { on the back.
{
{Hind limbs Hind feet engaged in the pelvis.
{
{Transverse Back of foal to side of pelvis.
{
{Inverted Back of foal to floor of pelvis.

{Hind limbs {Bent on itself at the hock.
Posterior presentations { {Bent at the hip.
{
{Transverse Back of foal to side of pelvis.
{
{Inverted Back of foal to floor of pelvis.

{With back and loins presented.
Transverse presentation of body {With breast and belly presented.

FORE LIMBS INCOMPLETELY EXTENDED.--In cases of this kind, not only are the back tendons behind the knee and shank bone unduly short, but the sinew extending from the front of the shoulder blade over the front of the elbow and down to the head of the shank bone is also shortened. The result is that the fore limb is bent at the knee and the elbow is also rigidly bent. The condition obstructs parturition by the feet becoming pressed against the floor of the pelvis or by the elbow pressing on its anterior brim. Relief is to be obtained by forcible extension. A rope with a running noose is passed around each fetlock and a repeller (see Plate XIV) planted in the breast is pressed in a direction upward and backward while active traction is made on the ropes. If the feet are not thereby raised from the floor of the pelvis the palm of the hand may be placed beneath them to protect the mucous membrane until they have advanced sufficiently to obviate this danger. In the absence of a repeller, a smooth rounded fork handle may be employed. If the shortening is too great to allow of the extension of the limbs in this way, the tense tendons may be cut across behind the shank bone and in front of the elbow, and the limb will be easily straightened out. This is most easily done with an embryotomy knife furnished with a ring for the middle finger, so that the blade may be protected in the palm of the hand. (See Plate XIII, fig. 4.)

FORE LIMB CROSSED OVER BACK OF NECK.--With the long fore limbs of the foal this readily occurs, and the resulting increase in thickness, both at the head and shoulder, offers a serious obstacle to progress. (See Plate XV, fig. 2.) The hand introduced into the passage detects the head and one fore foot, and farther back on the same side of the head the second foot, from which the limb may be traced obliquely across the back of the neck.

If parturition continues to make progress the displaced foot may bruise and lacerate the vagina. By seizing the limb above the fetlock it may be easily pushed over the head to the proper side, when parturition will proceed normally.

FORE LIMB BENT AT KNEE.--The nose and one fore foot present, and on examination the knee of the missing fore limb is found farther back. (Plate XV, fig. 1.) First place a noose each on the presenting pastern and lower jaw, and push back the body of the fetus with a repeller, while the operator seizing the shank of the bent limb extends it so as to press back the knee and bring forward the fetlock and foot. As progress is made little by little the hand is slid down from the region of the knee to the fetlock, and finally that is secured and brought up into the passage, when parturition will proceed without hindrance. If both fore limbs are bent back the head must be noosed and the limbs brought up as above, one after the other. It is usually best to employ the left hand for the right fore limb, and the right hand for the left fore limb.

FORE LIMB TURNED BACK FROM SHOULDERS.--In this case, on exploration by the side of the head and presenting limb, the shoulder only can be reached at first. (Plate XV, fig 4.) By noosing the head and presenting fore limb, they may be drawn forward into the pelvis, and the oiled hand being carried along the shoulder in the direction of the missing limb is enabled to reach and seize the forearm just below the elbow. The body is now pushed back by the assistants pressing on the head and presenting limb or on a repeller planted in the breast until the knee can be brought up into the pelvis, after which the procedure is the same as described in the last paragraph.

HEAD BENT DOWN BETWEEN FORE LIMBS.--This may be so that the poll or nape of the neck, with the ears, can be felt far back between the fore limbs, or so that only the upper border of the neck can be reached, head and neck being bent back beneath the body. With the head only bent on the neck, noose the two presenting limbs, then introduce the hand between them until the nose can be seized in the palm of the hand. Next have the assistants push back the presenting limbs, while the nose is strongly lifted upward over the brim of the pelvis. This accomplished, it assumes the natural position and parturition is easy.

When both head and neck are bent downward it may be impossible to reach the nose. If, however, the labor has only commenced, the limbs may be drawn upon until the operator can reach the ear, by dragging on which the head may be so far advanced that the fingers may reach the orbit; traction upon this while the limbs are being pushed back may bring the head up so that it bends on the neck only, and the further procedure will be as described in the last paragraph.

If the labor has been long in progress and the fetus is jammed into the pelvis, the womb emptied of the waters, and firmly contracted on its solid contents, the case is incomparably more difficult. The mare may be chloroformed and turned on her back with hind parts elevated, and the womb may be injected with sweet oil. Then, if the ear can be reached, the correction of the malpresentation may be attempted as above described. Should this fail, one or more sharp hooks may be inserted in the neck as near the head as can be reached, and ropes attached to these may be dragged on, while the body of the foal is pushed back by the fore limbs or by a repeller. Such repulsion should be made in a direction obliquely upward toward the loins of the mother, so as to rotate the fetus in such a way as to bring the head up. As this is accomplished a hold should be secured nearer and nearer to the nose, with hand or hook, until the head can be straightened out on the neck.

All means failing; it becomes necessary to remove the fore limbs (embryotomy) so as to make more space for bringing up the head. If, even then, this can not be accomplished, it may be possible to push the body backward and upward with the repeller until the hind limbs are brought to the passage, when they may be noosed and delivery effected with the posterior presentation.

HEAD TURNED ON SHOULDERS.--In this case the fore feet present, and the oiled hand passed along the fore arms in search of the missing head finds the side of the neck turned to one side, the head being perhaps entirely out of reach. (Plate XVIII, fig. 1.) To bring the head forward it may be desirable to lay the mare on the side opposite to that to which the head is turned, and even to give chloroform or ether. Then the feet being noosed, the body of the fetus is pushed by the hand or repeller forward and to the side opposite to that occupied by the head until the head comes within reach, near the entrance of the pelvis. If such displacement of the fetus is difficult, it may be facilitated by a free use of oil or lard. When the nose can be seized it can be brought into the passage, as when the head is turned down. If it can not be reached, the orbit may be availed of to draw the head forward until the nose can be seized or the lower jaw noosed. In very difficult cases a rope may be passed around the neck by the hand or with the aid of a curved carrier (Plate XIV), and traction may be made upon this while the body is being rotated to the other side. In the same way in bad cases a hook may be fixed in the orbit or even between the bones of the lower jaw to assist in bringing the head up into position. Should all fail, the amputation of the fore limbs may be resorted to, as advised under the last heading.

HEAD TURNED UPWARD ON BACK.--This differs from the last malpresentation only in the direction of the head, which has to be sought above rather than at one side, and is to be secured and brought forward in a similar manner. (Plate XVIII, fig. 2.) If a rope can be passed around the neck it will prove most effectual, as it naturally slides nearer to the head as the neck is straightened and ends by bringing the head within easy reach.

HIND FEET ENGAGED IN PELVIS.--In this case fore limbs and head present naturally, but the hind limbs bent forward from the hip and the loins arched allow the hind feet also to enter the passages, and the further labor advances the more firmly does the body of the foal become wedged into the pelvis (Plate XVII, fig. 2.) The condition is to be recognized by introducing the oiled hand along the belly of the fetus, when the hind feet will be felt advancing. An attempt should at once be made to push them back, one after the other, over the brim of the pelvis. Failing in this, the mare may be turned on her back, head downhill, and the attempt renewed. If it is possible to introduce a straight rope carrier, a noose passed through this may be put on the fetlock and the repulsion thereby made more effective. In case of continued failure the anterior presenting part of the body may be skinned and cut off as far back toward the pelvis as possible (see "Embryotomy"); then nooses are placed on the hind fetlocks and traction is made upon these while the quarters are pushed back into the womb. Then the remaining portion is brought away by the posterior presentation.

ANTERIOR PRESENTATION WITH BACK TURNED TO ONE SIDE.--The diameter of the axis of the foal, like that of the pelvic passages, is from above downward, and when the fetus enters the pelvis with this greatest diameter engaged transversely or in the narrow diameter of the pelvis, parturition is rendered difficult or impossible. In such a case the pasterns and head may be noosed, and the passages and engaged portion of the foal freely lubricated with lard, the limbs may be crossed over each other and the head, and a movement of rotation effected in the fetus until its face and back are turned up toward the croup of the mother; then parturition becomes natural.

BACK OF FOAL TURNED TO FLOOR OF PELVIS.--In a roomy mare this is not an insuperable obstacle to parturition, yet it may seriously impede it, by reason of the curvature of the body of the foal being opposite to that of the passages, and the head and withers being liable to arrest against the border of the pelvis. Lubrication of the passage with lard and traction of the limbs and head will usually suffice with or without the turning of the mare on her back.

In obstinate cases two other resorts are open: First, to turn the foal, pushing back the fore parts and bringing up the hind so as to make a posterior presentation, and, second, the amputation of the fore limbs, after which extraction will usually be easy.

ABNORMAL PRESENTATIONS.]

ABNORMAL PRESENTATIONS.]

ABNORMAL PRESENTATIONS.]

ABNORMAL PRESENTATIONS.]

HIND PRESENTATION WITH LEG BENT AT HOCK.--In this form the quarters of the foal with the hind legs bent up beneath them present, but can not advance through the pelvis by reason of their bulk. (Plate XV, fig. 3.) The oiled hand introduced can recognize the outline of the buttocks, with the tail and anus in the center and the sharp points of the hocks beneath. First pass a rope around each limb at the hock, then with hand or repeller push the buttocks backward and upward, until the feet can be brought up into the passages. To this the great length of the shank and pastern in the foal is a serious obstacle, and in all cases the foot should be protected in the palm of the hand while being brought up over the brim of the pelvis; otherwise the womb may be torn. When the pains are too violent and constant to allow effective manipulation, some respite may be obtained by the use of chloroform or morphin and by turning the mare on her back, but too often the operator fails and the foal must be sacrificed. Two courses are still open: First, to cut through the cords behind and above the hock and extend the upper part of the limb, leaving the hock bent, and extract in this way, and, second, to amputate the hind limbs at the hip joint and remove them separately, after which the body may be extracted.

HIND PRESENTATION WITH LEGS BENT FORWARD FROM HIP.--This is merely an aggravated form of the presentation last described. (Plate XVII, fig. 1.) If the mare is roomy, a rope may be passed around each thigh and the body pushed upward and forward, so as to bring the hocks and heels upward. If this can be accomplished, nooses are placed on the limb further and further down until the fetlock is reached and brought into position. If failure is met with, then amputation at the hips is the last resort.

HIND PRESENTATIONS WITH BACK TURNED SIDEWAYS OR DOWNWARD.--These are the counterparts of similar anterior presentations and are to be managed in the same way.

PRESENTATION OF THE BACK.--This is rare, yet not unknown, the foal being bent upon itself with the back, recognizable by its sharp row of spines, presented at the entrance of the pelvis and the head and all four feet turned back into the womb. (Plate XVI, fig. 1.) The body of the fetus may be extended across the opening transversely, so that the head corresponds to one side (right or left), or it may be vertical, with the head above or below.

In any such position the object should be to push the body of the fetus forward and upward or to one side, as may best promise to bring up the fore or hind extremities, and bring the latter into the passage so as to constitute a normal anterior or posterior presentation. This turning of the fetus may be favored by a given position of the mother, by the free use of oil or lard on the surface of the fetus, and by the use of a propeller.

PRESENTATION OF BREAST AND ABDOMEN.--This is the reverse of the back presentation, the foal being extended across in front of the pelvic opening, but with the belly turned toward the passages and with all four feet engaged in the passage. (Plate XVI, fig. 2.) The most promising course is to secure the hind feet with nooses and then push the fore feet forward into the womb. As soon as the fore feet are pushed forward clear of the brim of the pelvis, traction is made on the hind feet so as to bring the thighs into the passage and prevent the reentrance of the fore limbs. If it proves difficult to push the fore limbs back, a noose may be passed around the fetlock of each and the cord drawn through the eye of a rope carrier, by means of which the members may be easily pushed back.

EMBRYOTOMY.

Embryotomy consists in the dissection of the fetus, so as to reduce its bulk and allow of its exit through the pelvis. The indications for its adoption have been furnished in the foregoing pages. The operation will vary in different cases according to the necessity for the removal of one or more parts in order to secure the requisite reduction in size. Thus it may be needful to remove head and neck, one fore limb or both, one hind limb or both, to remove different parts of the trunk, or to remove superfluous (monstrous) parts. Some of the simplest operations in embryotomy (incision of the head in hydrocephalus, incision of the belly in dropsy) have already been described. It remains to notice the more difficult procedures which can be best undertaken by the skilled anatomist.

AMPUTATION OF THE HEAD.--This is easy when both fore limbs are turned back and the head alone has made its exit in part. It is more difficult when the head is still retained in the passages or womb, as in double-headed monsters. The head is secured by a hook in the lower jaw, or in the orbit, or by a halter, and the skin is divided circularly around the lower part of the face or at the front of the ears, according to the amount of head protruding. Then an incision is made backward along the line of the throat, and the skin dissected from the neck as far back as possible. Then the muscles and other soft parts of the neck are cut across, and the bodies of two vertebra (neck bones) are severed by cutting completely across the cartilage of the joint. The bulging of the ends of the bones will serve to indicate the seat of the joint. The head and detached portion of the neck may now be removed by steady pulling. If there is still an obstacle, the knife may be again used to sever any obstinate connections. In the case of a double-headed monster, the whole of the second neck must be removed with the head. When the head has been detached, a rope should be passed through the eyeholes, or through an artificial opening in the skin, and tied firmly around the skin, to be employed as a means of traction when the missing limbs or the second head have been brought up into position.

AMPUTATION OF THE HIND LIMB.--This may be required when there are extra hind limbs or when the hind limbs are bent forward at hock or hip joint. In the former condition the procedure resembles that for removal of a fore limb, but requires more anatomical knowledge. Having noosed the pastern, a circular incision is made through the skin around the fetlock, and a longitudinal one from that up to the groin, and the skin is dissected from the limb as high up as can be reached, over the croup, if possible. Then cut through the muscles around the hip joint, and, if possible, the two interarticular ligaments of the joint (pubofemoral and round), and extract the limb by strong dragging.

AMPUTATION OF THE FORE LIMBS.--This may usually be begun on the fetlock of the limb projecting from the vulva. An embryotomy knife is desirable. This knife consists of a blade with a sharp, slightly hooked point, and one or two rings in the back of the blade large enough to fit on the middle finger, while the blade is protected in the palm of the hand. (See Plate XIII, fig. 4.) Another form has the blade inserted in a mortise in the handle, from which it is pushed out by a movable button when wanted. First place a noose around the fetlock of the limb to be amputated, cut the skin circularly entirely around the fetlock, then make an incision on the inner side of the limb from the fetlock up to the breastbone. Next dissect the skin from the limb, from the fetlock up to the breastbone on the inner side, and as far up on the shoulder blade as possible on the outer side. Finally, cut through the muscles attaching the limb to the breastbone, and employ strong traction on the limb, so as to drag out the whole limb, shoulder blade included. The muscles around the upper part of the shoulder blade are easily torn through and need not be cut, even if that were possible. In no case should the fore limb be removed unless the shoulder blade is taken with it, as that furnishes the greatest obstruction to delivery, above all when it is no longer advanced by the extension of the fore limb, but is pressed back so as to increase the already thickest posterior portion of the chest. The preservation of the skin from the whole limb is advantageous in various ways; it is easier to cut it circularly at the fetlock than at the shoulder; it covers the hand and knife in making the needful incisions, thus acting as a protection to the womb; and it affords a means of traction on the body after the limb has been removed. In dissecting the skin from the limb the knife is not needful at all points; much of it may be stripped off with the fingers or knuckles, or by a blunt, iron spud, pushed up inside the hide, which is meanwhile held tense to render the spud effective.

In case the limb is bent forward at the hock, a rope is passed round that and pulled so as to bring the point of the hock between the lips of the vulva. The hamstring and the lateral ligaments of the hock are now cut through, and the limbs extended by a rope tied round the lower end of the long bone above (tibia). In case it is still needful to remove the upper part of the limb, the further procedure is the same as described in the last paragraph.

In case the limb is turned forward from the hip, and the fetus so wedged into the passage that turning is impossible, the case is very difficult. I have repeatedly succeeded by cutting in on the hip joint and disarticulating it, then dissecting the muscles back from the upper end of the thigh bone. A noose was placed around the neck of the bone and pulled on forcibly, while any unduly resisting structures were cut with the knife.

Cartwright recommends to make free incisions round the hip joints and tear through the muscles when they can not be cut; then with cords round the pelvic bones, and hooks inserted in the openings in the floor of the pelvis to drag out the pelvic bones; then put cords around the heads of the thigh bones and extract them; then remove the intestines; finally, by means of the loose, detached skin, draw out the body with the remainder of the hind limbs bent forward beneath it.

Reuff cuts his way into the pelvis of the foal, and with a knife separates the pelvic bones from the loins, then skinning the quarter draws out these pelvic bones by means of ropes and hooks, and along with them the hind limbs.

The hind limbs having been removed by one or the other of these procedures, the loose skin detached from the pelvis is used as a means of traction and delivery is effected. In case of a monstrosity with extra hind limbs, it may be possible to bring these up into the passage and utilize them for traction.

_Removal of the abdominal viscera._--In case the belly is unduly large, from decomposition, tumors, or otherwise, it may be needful to lay it open with the knife and cut or tear out the contents.

_Removal of the thoracic viscera._--To diminish the bulk of the chest it has been found advisable to cut out the breastbone, remove the heart and lungs, and allow the ribs to collapse with the lower free ends overlapping each other.

_Dissection of the trunk._--In case it becomes necessary to remove other portions of the trunk, we should follow the general rule of preserving the skin so that all manipulations can be made inside this as a protector, that it may remain available as a means of exercising traction on the remaining part of the body, and as a covering to protect the vaginal walls against injuries from bones while such part is passing.

FLOODING, OR BLEEDING FROM THE WOMB.

This is rare in the mare, but not unknown, in connection with a failure of the womb to contract on itself after parturition, or with eversion of the womb (casting the withers), and congestion or laceration. If the blood accumulates in the flaccid womb, the condition may be suspected only by reason of the rapidly advancing weakness, swaying, unsteady gait, hanging head, paleness of the eyes and other mucous membranes, and weak, small, failing pulse. The hand introduced into the womb detects the presence of the blood partly clotted. If the blood escapes by the vulva, the condition is evident.

_Treatment_ consists in evacuating the womb of its blood clots, giving a large dose of powdered ergot of rye, and in the application of cold water or ice to the loins and external generative organs. Besides this, a sponge impregnated with a strong solution of alum, or, still better, with tincture of muriate of iron, may be introduced into the womb and squeezed so as to bring the liquid in contact with the walls generally.

EVERSION OF THE WOMB.

If the womb fails to contract after difficult parturition, the after-pains will sometimes lead to the fundus passing into the body of the organ and passing through that and the vagina until the whole inverted organ appears externally and hangs down on the thighs. The result is rapid engorgement and swelling of the organ, impaction of the rectum with feces, and distention of the bladder with urine, all of which conditions seriously interfere with the return of the mass. In returning the womb the standing is preferable to the recumbent position, as the abdomen is more pendent and there is less obstruction to the return. It may, however, be necessary to put hobbles on the hind limbs to prevent the mare from kicking. A clean sheet should be held beneath the womb, and all filth, straw, and foreign bodies washed from its surface. Then with a broad, elastic (india-rubber) band, or in default of that a long strip of calico 4 or 5 inches wide, wind the womb as tightly as possible, beginning at its most dependent part (the extremity of the horn). This serves two good ends. It squeezes out into the general circulation the enormous mass of blood which engorged and enlarged the organ, and it furnishes a strong protective covering for the now delicate, friable organ, through which it may be safely manipulated without danger of laceration. The next step may be the pressure on the general mass while those portions next the vulva are gradually pushed in with the hands; or the extreme lowest point (the end of the horn) may be turned within itself and pushed forward into the vagina by the closed fist, the return being assisted by manipulations by the other hand, and even by those of assistants. By either mode the manipulations may be made with almost perfect safety so long as the organ is closely wrapped in the bandage. Once a portion has been introduced into the vagina the rest will usually follow with increasing ease, and the operation should be completed with the hand and arm extended the full length within the womb and moved from point to point so as to straighten out all parts of the organ and insure that no portion still remain inverted within another portion. Should any such partial inversion be left it will give rise to straining, under the force of which it will gradually increase until the whole mass will be protruded as before. The next step is to apply a truss as an effectual mechanical barrier to further escape of the womb through the vulva. The simplest is made with two 1-inch ropes, each about 18 feet long, each doubled and interwoven at the bend, as seen in Plate XIV, figure 4. The ring formed by the interlacing of the two ropes is adjusted around the vulva, the two ends of the one rope are carried up on the right and left of the tail and along the spine, being wound around each other in their course, and are finally tied to the upper part of the collar encircling the neck. The remaining two ends, belonging to the other rope, are carried downward and forward between the thighs and thence forward and upward on the sides of the belly and chest to be attached to the right and left sides of the collar. These ropes are drawn tightly enough to keep closely applied to the opening without chafing, and will fit still more securely when the mare raises her back to strain. It is desirable to tie the mare short so that she may be unable to lie down for a day or two, and she should be kept in a stall with the hind parts higher than the fore. Violent straining may be checked by full doses of opium (one-half dram), and any costiveness or diarrhea should be obviated by a suitable laxative or binding diet.

In some mares the contractions are too violent to allow of the return of the womb, and full doses of opium one-half dram, laudanum 2 ounces, or chloral hydrate 1 ounce, may be demanded, or the mare must be rendered insensible by ether or chloroform.

RUPTURE, OR LACERATION, OF THE WOMB.

This may occur from the feet of the foal during parturition, or from ill-directed efforts to assist, but it is especially liable to take place in the everted, congested, and friable organ. The resultant dangers are bleeding from the wound, escape of the bowels through the opening and their fatal injury by the mare's feet or otherwise, and peritonitis from the extension of inflammation from the wound and from the poisonous action of the septic liquids of the womb escaping into the abdominal cavity. The first object is to close the wound, but unless in eversion of the womb this is practically impossible. In the last-named condition the wound must be carefully and accurately sewed up before the womb is returned. After its return, the womb must be injected daily with an antiseptic solution (borax, one-half ounce, or carbolic acid, 3 drams to a quart of tepid water). If inflammation threatens, the abdomen may be bathed continuously with hot water by means of a heavy woolen rag, and large doses of opium (one-half dram) may be given twice or thrice daily.

RUPTURES OF THE VAGINA.

These are attended with dangers similar to those belonging to rupture of the womb, and in addition by the risk of protrusion of the bladder, which appears through the lips of the vulva as a red, pyriform mass. Sometimes such lacerations extend downward into the bladder, and in others upward into the terminal gut (rectum). In still other cases the anus is torn so that it forms one common orifice with the vulva.

Too often such cases prove fatal, or at least a recovery is not attained, and urine or feces or both escape freely into the vagina. The simple laceration of the anus is easily sewed up, but the ends of the muscular fibers do not reunite and the control over the lower bowel is never fully reacquired. The successful stitching up of the wound communicating with the bladder or the rectum requires unusual skill and care, and though I have succeeded in a case of the latter kind, I can not advise the attempt by unprofessional persons.

BLOOD CLOTS IN THE WALLS OF THE VAGINA.

(See "Effusion of blood in the vaginal walls," p. 190.)

LAMINITIS, OR FOUNDER, FOLLOWING PARTURITION.

This sometimes follows on inflammation of the womb, as it frequently does on disorder of the stomach. Its symptoms agree with those of the common form of founder, and treatment need not differ.

INFLAMMATION OF THE WOMB AND PERITONEUM.

These may result from injuries sustained by the womb during or after parturition, from exposure to cold or wet, or from the irritant infective action of putrid products within the womb. Under the inflammation the womb remains dilated and flaccid, and decomposition of its secretions almost always occurs, so that the inflammation tends to assume a putrid character and general septic infection is likely to occur.

_Symptoms._--The symptoms are ushered in by shivering, staring coat, small, rapid pulse, elevated temperature, accelerated breathing, loss of appetite, with arched back, stiff movement of the body, looking back at the flanks, and uneasy motions of the hind limbs, discharge from the vulva of a liquid at first watery, reddish, or yellowish, and later it may be whitish or glairy, and fetid or not in different cases. Tenderness of the abdomen shown on pressure is especially characteristic of cases affecting the peritoneum or lining of the belly, and is more marked lower down. If the animal survives, the inflammation tends to become chronic and attended by a whitish mucopurulent discharge. If, on the contrary, it proves fatal, death is preceded by extreme prostration and weakness from the general septic poisoning.

_Treatment._--In treatment the first thing to be sought is the removal of all offensive and irritant matters from the womb through a caoutchouc tube introduced into the womb, and into which a funnel is fitted. Warm water should be passed until it comes away clear. To insure that all the womb has been washed out, the oiled hand may be introduced to carry the end of the tube into the two horns successively. When the offensive contents have been thus removed, the womb should be injected with a quart of water holding in solution 1 dram permanganate of potash, or, in the absence of the latter, 2 teaspoonfuls of carbolic acid, twice daily. Fomentation of the abdomen, or the application of a warm flaxseed poultice, may greatly relieve. Acetanilid, in doses of half an ounce, twice or thrice a day, or sulphate of quinia in doses of one-third ounce, may be employed to reduce the fever. If the great prostration indicates septic poisoning, large doses (one-half ounce) bisulphite of soda, or salicylate of soda, or sulphate of quinin may be resorted to.

LEUCORRHEA.

This is a white, glutinous, chronic discharge, the result of a continued, subacute inflammation of the mucous membrane of the womb. Like the discharge of acute inflammation, it contains many forms of bacteria, by some of which it is manifestly inoculable on the penis of the stallion, producing ulcers and a specific, gonorrheal discharge.

_Treatment_ may consist in the internal use of tonics (sulphate of iron, 3 drams, daily) and the washing out of the womb, as described under the last heading, followed by an astringent antiseptic injection (carbolic acid, 2 teaspoonfuls; tannic acid, 1/2 dram; water, 1 quart). This may be given two or three times a day.

DISEASES OF THE UDDER AND TEATS.

CONGESTION AND INFLAMMATION OF THE UDDER.

This is comparatively rare in the mare, though in some cases the udder becomes painfully engorged before parturition, and a doughy swelling, pitting on pressure, extends forward on the lower surface of the abdomen. When this goes on to active inflammation, one or both of the glands becomes enlarged, hot, tense, and painful; the milk is dried up or replaced by a watery or reddish, serous fluid, which at times becomes fetid; the animal walks lame, loses appetite, and shows general disorder and fever. The condition may end in recovery, in abscess, induration, or gangrene, and, in some cases, may lay the foundation for a tumor of the gland.

_Treatment._--The treatment is simple so long as there is only congestion. Active rubbing with lard or oil, or, better, camphorated oil, and the frequent drawing off of the milk, by the foal or with the hand, will usually bring about a rapid improvement. When active inflammation is present, fomentation with warm water may be kept up for an hour and followed by the application of the camphorated oil, to which has been added some carbonate of soda and extract of belladonna. A dose of laxative medicine (4 drams Barbados aloes) will be of service in reducing fever, and one-half ounce saltpeter daily will serve a similar end. In case the milk coagulates in the udder and can not be withdrawn, or when the liquid becomes fetid, a solution of 20 grains carbonate of soda and 10 drops carbolic acid dissolved in an ounce of water should be injected into the teat. In doing this it must be noted that the mare has three separate ducts opening on the summit of each teat and each must be carefully injected. To draw off the fetid product it may be needful to use a small milking tube, or spring teat dilator designed by the writer. (Plate XIV, figs. 2 and 3.) When pus forms and points externally and can not find a free escape by the teat, the spot where it fluctuates must be opened freely with the knife and the cavity injected daily with the carbolic-acid lotion. When the gland becomes hard and indolent, it may be rubbed daily with iodin ointment 1 part, vaseline 6 parts.

TUMORS OF THE UDDER.

As the result of inflammation of the udder it may become the seat of an indurated diseased growth, which may go on growing and seriously interfere with the movement of the hind limbs. If such swellings do not give way in their early stages to treatment by iodin, the only resort is to cut them out with a knife. As the gland is often implicated and has to be removed, such mares can not in the future suckle their colts and therefore should not be bred.

SORE TEATS, SCABS, CRACKS, WARTS.

By the act of sucking, especially in cold weather, the teats are subject to abrasions, cracks, and scabs, and as the result of such irritation, or independently, warts sometimes grow and prove troublesome. The warts should be clipped off with sharp scissors and their roots burned with a solid pencil of lunar caustic. This is best done before parturition to secure healing before suckling begins. For sore teats use an ointment of vaseline 1 ounce, balsam of tolu 5 grains, and sulphate of zinc 5 grains.

DISEASES OF THE NERVOUS SYSTEM.

By M. R. TRUMBOWER, V. S.

[Revised by John R. Mohler, A. M., V. M. D.]

ANATOMY AND PHYSIOLOGY OF THE BRAIN AND NERVOUS SYSTEM.

(Pl. XIX.)

The nervous system may be regarded as consisting of two sets of organs, peripheral and central, the function of one being to establish a communication between the centers and the different parts of the body, and that of the other to generate nervous force. The whole may be arranged under two divisions: First, the cerebrospinal system; second, the sympathetic or ganglionic system. Each is possessed of its own central and peripheral organs.

In the first, the center is made up of two portions--one large and expanded (the brain) placed in the cranial cavity; the other elongated (spinal cord), continuous with the brain, and lodged in the canal of the vertebral column. The peripheral portion of this system consists of the cerebrospinal nerves, which leave the axis in symmetrical pairs and are distributed to the skin, the voluntary muscles, and the organs.

In the second, the central organ consists of a chain of ganglia, connected by nerve cords, which extends on each side of the spine from the head to the rump. The nerves of this system are distributed to the involuntary muscles, mucous membrane, viscera, and blood vessels.

The two systems have free intercommunication, ganglia being at the junctions.

Two substances, distinguishable by their color, namely, the white or medullary and the gray or cortical substance, enter into the formation of nervous matter. Both are soft, fragile, and easily injured, in consequence of which the principal nervous centers are well protected by bony coverings. The nervous substances present two distinct forms--nerve fibers and nerve cells. An aggregation of nerve cells constitutes a nerve ganglion.

The nerve fibers represent a conducting apparatus and serve to place the central nervous organs in connection with peripheral end organs. The nerve cells, however, besides transmitting impulses, act as physiological centers for automatic, or reflex, movements, and also for the sensory, perceptive, trophic, and secretory functions. A nerve consists of a bundle of tubular fibers, held together by a dense areolar tissue, and inclosed in a membranous sheath--the neurilemma. Nerve fibers possess no elasticity, but are very strong. Divided nerves do not retract.

Nerves are thrown into a state of excitement when stimulated, and are, therefore, said to possess excitable or irritable properties. The stimuli may be applied to, or may act upon, any part of the nerve. Nerves may be paralyzed by continuous pressure being applied. When the nerves divide into branches, there is never any splitting up of their ultimate fibers, nor yet is there ever any coalescing of them; they retain their individuality from their source to their termination.

Nerves which convey impressions to the centers are termed sensory, or centripetal, and those which transmit stimulus from the centers to organs of motion are termed motor, or centrifugal. The function of the nervous system may, therefore, be defined in the simplest terms, as follows: It is intended to associate the different parts of the body in such a manner that stimulus applied to one organ may excite or depress the activity of another.

The brain is that portion of the cerebrospinal axis within the cranium, which may be divided into four parts--the medulla oblongata, the cerebellum, the pons Varolii, and the cerebrum--and it is covered by three membranes, called the meninges. The outer of these membranes, the dura mater, is a thick, white, fibrous membrane which lines the cavity of the cranium, forming the internal periosteum of the bones; it is continuous with the spinal cord to the extremity of the canal. The second, the arachnoid, is a delicate serous membrane, and loosely envelops the brain and spinal cord; it forms two layers, having between them the arachnoid space which contains the cerebrospinal fluid, the use of which is to protect the spinal cord and brain from pressure. The third, or inner, the pia mater, is closely adherent to the entire surface of the brain, but is much thinner and more vascular than when it reaches the spinal cord, which it also envelops, and is continued to form the sheaths of the spinal nerves.

The medulla oblongata is the prolongation of the spinal cord, extending to the pons Varolii. This portion of the brain is very large in the horse: it is pyramidal in shape, the narrowest part joining the cord.

The pons Varolii is the transverse projection on the base of the brain, between the medulla oblongata and the peduncles of the cerebrum.

The cerebellum is lodged in the posterior part of the cranial cavity, immediately above the medulla oblongata; it is globular or elliptical in shape, the transverse diameter being greatest. The body of the cerebellum is composed of gray matter externally and of white matter in the center. The cerebellum has the function of co-ordinating movements; that is, of so associating them as to cause them to accomplish a definite purpose. Injuries to the cerebellum cause disturbances of the equilibrium but do not interfere with the will power or intelligence.

The cerebrum, or brain proper, occupies the anterior portion of the cranial cavity. It is ovoid in shape, with an irregular, flattened base, and consists of lateral halves or hemispheres. The greater part of the cerebrum is composed of white matter. The hemispheres of the cerebrum are usually said to be the seat of all psychical activities. Only when they are intact are the process of feeling, thinking, and willing possible. After they are destroyed the organism comes to be like a complicated machine, and its activity is only the expression of the internal and external stimuli which act upon it.

The spinal cord, or spinal marrow, is that part of the cerebrospinal system which is contained in the spinal canal of the backbone, and extends from the medulla oblongata to a short distance behind the loins. It is an irregularly cylindrical structure, divided into two lateral, symmetrical halves by fissures. The spinal cord terminates posteriorly in a pointed extremity, which is continued by a mass of nerve trunks--cauda equinae. A transverse section of the cord reveals that it is composed of white matter externally and of gray matter internally. The spinal cord does not fill the whole spinal canal. The latter contains, besides, a large venous sinus, fatty matter, the membranes of the cord, and the cerebrospinal fluid.

The spinal nerves, forty-two or forty-three in number, arise each by two roots, a superior or sensory, and an inferior or motor. The nerves originating from the brain are twenty-four in number, and arranged in pairs, which are named first, second, third, etc., counting from before backward. They also receive special names, according to their functions or the parts to which they are distributed, viz:

1. Olfactory.
2. Optic.
3. Oculo-motor.
4. Pathetic.
5. Trifacial.
6. Abducens.
7. Facial.
8. Auditory.
9. Glossopharyngeal.
10. Pneumogastric.
11. Spinal accessory.
12. Hypoglossal.

Inflammation of the Brain and its Membranes (Encephalitis, Meningitis, Cerebritis).