Chapter 23

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

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

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

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

When the head is bent on the shoulder the feet appear in the natural way, but no progress is made, and examination reveals the absence of the nose from between the knees, and farther back, from above and between the elbows, a smooth rounded mass is felt extending to the right or left, which further examination will identify with the neck. Following the upper border of this the hand reaches the crown of the head with the ears, and still further the eyes, or even, in a small calf, the nose.

As the bulky head of the calf can not be extracted along with the shoulders, it becomes necessary to push the body of the fetus back and straighten out the head and neck. The cow should be laid with her head downhill and with that side up toward which the head is turned. If the throes are very violent, or the womb strongly contracted on the calf, it may be best to seek relaxation by giving chloroform, or 2 ounces of laudanum, or 2 ounces of chloral hydrate. If the calf or the passages are dry, sweet oil may be injected, or the whole may be liberally smeared with fresh lard. In the absence of these, warm water rendered slightly slippery by Castile soap may be injected into the womb in quantity. Ropes with running nooses are placed on the presenting feet and the oiled hand introduced to find the head. If, now, the fingers can be passed inside the lower jawbone, and drag the head upward and toward the passage, it unwinds the spiral turn given to the neck in bending back, and greatly improves the chances of bringing forward the nose. If, at first, or if now, the lower jaw can be reached, a noose should be placed around it behind the incisor teeth and traction made upon this, so that the head may continue to be turned, forehead up, toward the spine and jaws down, thereby continuing to undo the screwlike curve of the neck. If, on the contrary, the nose is dragged upon by a cord passing over the upper border of the neck, the screwlike twist is increased and the resistance of the bones and joints of the neck prevents any straightening of the head. As soon as the lower jaw has been seized by the hand or noose, a repeller (Pl. XX, fig. 7), planted on the inside of the elbow or shoulder most distant from the head, should be used to push back the body and turn it in the womb, so that the head may be brought nearer to the outlet. In this way the head can usually be brought into position and the further course of delivery will be natural.

Sometimes, however, the lower jaw can not be reached with the hand, and then the orbit or, less desirably, the ear, may be availed of. The ear may be pulled by the hand, and by the aid of the repeller on the other shoulder the calf may be so turned that the lower jaw may be reached and availed of. Better still, a clamp (Pl. XVIII, figs. 3 and 4) is firmly fixed on the ear and pulled by a rope, while the repeller is used on the opposite shoulder, and the hand of the operator pulls on the lower border of the neck and lifts it toward the other side. To pull on the upper border of the neck is to increase the spiral twist, while to raise the lower border is to undo it. If the outer orbit can be reached, the fingers may be inserted into it so as to employ traction, or a blunt finger hook (Pl. XXI, fig. 8) may be used, or a hook with a rope attached, or, finally, a hook on the end of a long staff. Then, with the assistance of the repeller, the body may be so turned and the head advanced that the lower jaw may be reached and availed of.

In case neither the ears nor the orbit can be reached, a cord should be passed around the neck of the calf as near the head as possible, and traction made upon that while the opposite shoulder is pushed toward the opposite side by the repeller, assisted by the hand dragging on the lower border of the neck. To aid the hand in passing a rope around the neck a cord carrier (Pl. XXI, fig. 5) is in use. It fails, however, to help us in the most difficult part of the operation--the passing of the cord down on the deep or farthest side of the neck--and to remedy this I have devised a cord carrier, furnished with a ring at the end, a joint 6 or 8 inches from the end, and another ring on the handle, close to this joint. (Pl. XX, fig. 4.) A cord is passed through both rings and a knot tied on its end, just back of the terminal ring. The instrument, straightened out, is inserted until it reaches just beyond the upper border of the neck, when, by dragging on the cord, the movable segment is bent down on the farther side of the neck, and is pushed on until it can be felt at its lower border. The hand now seizes the knotted end of the cord beneath the lower border of the neck and pulls it through while the carrier is withdrawn, the cord sliding through its rings. The cord, pushed up as near to the head as possible, is furnished with a running noose by tying the knotted end round the other, or, better, the two ends are twisted around each other so as to give a firm hold on the neck without dangerously compressing the blood vessels. By pushing on the opposite shoulder with the repeller, and, assisting with the hand on shoulder, breastbone, or lower border of the neck, such a change of position will be secured as will speedily bring the head within reach. Afterwards proceed as described above.

These cases are always trying, but it is very rarely necessary to resort to embryotomy. When absolutely required, first remove one fore limb, and then, if still unsuccessful, the other, after which the head can easily be secured. (See "Embryotomy," p. 202.)

_Head turned upward and backward._--In this case the face rests upon the spine; the forefeet appear alone in the passage, but fail to advance, and on examination the rounded, inferior border of the neck can be felt, extending upward and backward beneath the spine of the dam, and if the calf is not too large the hand may reach the lower jaw or even the muzzle. (Pl. XVI, fig. 5.) A repeller is planted in the breast and the body of the calf pushed backward and downward so as to make room and bring the head nearer to the passage; or in some cases the body may be pushed back sufficiently by the use of the fore limbs alone. Meanwhile the head is seized by the ear or the eye socket, or, if it can be reached, by the lower jaw, and pulled downward into position as space is obtained for it. If the hand alone is insufficient, the blunt hooks may be inserted in the orbits or in the angle of the mouth, or a noose may be placed on the lower paw, and by traction the head will be easily advanced. In case of a large fetus, the head of which is beyond reach, even when traction is made on the limbs, a rope may be passed around the neck and pulled, while the breastbone is pressed downward and backward by the repeller, and soon the change of position will bring the orbit or lower jaw within reach. With the above-described position the standing position is most favorable for success, but if the calf is placed with its back down toward the udder, and if the head is bent down under the brim of the pelvis, the best position for the cow is on her back, with her head downhill.

In neglected cases, with death and putrefaction of the fetus and dryness of the passages, it may be necessary to extract in pieces. (See "Embryotomy," p. 202.)

_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.