Chapter 25

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.

Fig. 1. Long embryotome with joint.

Fig. 2. Long, sharp hook. This instrument is about 3 feet in length, including the handle. Hooks of this kind, both blunt and sharp, are applied directly to the fetus to assist in delivery.

Fig. 3. G¸nther's long-handled embryotome. This instrument and that represented in Fig. 1 are of special value in cutting through muscular tissue and in separating the limbs from the trunk when the fetus can not be removed entire. These embryotomes are usually 30 inches long, but may be made either longer or shorter.

Fig. 4. Jointed cord-carrier, used in difficult parturition to carry a cord into regions which can not be reached by the arm.

Fig. 5. Instrument used to rotate or turn the fetus, known as a rotator.

Fig. 6. Dilator of the neck of the womb, used when conception can not take place owing to a contracted condition of the neck of the womb.

Fig. 7. Repeller. An instrument from 2 to 3 feet long, used to force the fetus forward into the womb. This operation is generally necessary when the presentation is abnormal and the fetus has advanced too far into the narrow inlet to the uterus to be moved.

Fig. 8. Cartwright's bone chisel. Including the handle, this instrument is about 32 inches in length; the chisel portion is a little more than 2 inches long and 1 to 1-1/2 broad. Only the middle portion is sharp, the projecting corners are blunt, and the sides rounded. This instrument is used for slitting up the skin of a limb and as a bone chisel when it is necessary to mutilate the fetus in order to effect delivery.

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PLATE XXI. Instruments used in difficult labor.

Fig. 1. Embryotome, an instrument used when it is necessary to reduce the size of the fetus by cutting away certain parts before birth can be effected. This instrument may be long or short, straight or curved.

Fig. 2. Also an embryotome. The blade can be made to slide out of or into the handle. The instrument can thus be introduced into or withdrawn from the genital passage without risk of injury to the mother.

Fig. 3. Schaack's traction cord. This is merely a cord with a running noose at one end and a piece of wood at the other, to offer a better hold for the hand.

Figs. 4_a_ and 4_b._ Reuff's head collar for securing the head of the fetus.

Fig. 5. Curved cord-carrier, used in difficult parturition to carry a cord into regions which can not be reached by the arm.

Fig. 6. Blunt hook, used in difficult parturition.

Fig. 7. Short hook forceps, used in difficult parturition.

Fig. 8. Blunt finger hook.

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DISEASES FOLLOWING PARTURITION.

By James Law, F. R. C. V. S.,

_Formerly Professor of Veterinary Science, etc., in Cornell University._

FLOODING (BLEEDING FROM THE WOMB).

Though not so common in the cow as in the human female, flooding is sufficiently frequent to demand attention. It may depend on a too rapid calving and a consequent failure of the womb to contract when the calf has been removed. The pregnant womb is extraordinarily rich in blood vessels, especially in large and tortuous veins, which become compressed and almost obliterated under contraction, but remain overfilled and often bleed into the cavity of the womb should no contraction take place. Cox records cases in which the labor pains had detached and expelled the fetal membranes, while the calf, owing to large size or wrong presentation, was detained in the womb, and the continued dilatation of the womb in the absence of the fetal membranes led to a flow of blood which accumulated in clots around the calf. Other causes are laceration of the cotyledons of the womb, or from an antecedent inflammation of the placenta, and the unnatural adhesion of the membranes to the womb, which bleeds when the two are torn apart. Weakness of the womb from overdistention, as in dropsy, twins, etc., is not without its influence. Finally, eversion of the womb (casting the withers) is an occasional cause of flooding. The trouble is only too evident when the blood flows from the external passages in drops or in a fine stream. When it is retained in the cavity of the womb, however, it may remain unsuspected until it has rendered the animal almost bloodless. The symptoms in such case are paleness of the eyes, nose, mouth, and of the lips of the vulva, a weak, rapid pulse, violent and perhaps loud beating of the heart (palpitations), sunken, staring eyes, coldness of the skin, ears, horns, and limbs, perspiration, weakness in standing, staggering gait, and, finally, inability to rise, and death in convulsions. If these symptoms are seen, the oiled hand should be introduced into the womb, which will be found open and flaccid and containing large blood clots.

_Treatment._--Treatment consists in the removal of the fetal membranes and blood clots from the womb (which will not contract while they are present), the dashing of cold water on the loins, right flank, and vulva, and if these measures fail, the injection of cold water into the womb through a rubber tube furnished with a funnel. In obstinate cases a good-sized sponge soaked in tincture of muriate of iron should be introduced into the womb and firmly squeezed, so as to bring the iron into contact with the bleeding surface. This is at once an astringent and a coagulant for the blood, besides stimulating the womb to contraction. In the absence of this agent astringents (solution of copperas, alum, tannic acid, or acetate of lead) may be thrown into the womb, and one-half-dram doses of acetate of lead may be given by the mouth, or 1 ounce powdered ergot of rye may be given in gruel. When nothing else is at hand, an injection of oil of turpentine will sometimes promptly check the bleeding.

EVERSION OF THE WOMB (CASTING THE WITHERS).

Like flooding, this is the result of failure of the womb to contract after calving. If that organ contracts naturally, the afterbirth is expelled, the internal cavity of the womb is nearly closed, and the mouth of the organ becomes so narrow that the hand can not be forced through, much less the whole mass of the matrix. When, however, it fails to contract, the closed end of one of the horns may fall into its open internal cavity, and under the compression of the adjacent intestines, and the straining and contraction of the abdominal walls, it is forced farther and farther, until the whole organ is turned outside in, slides back through the vagina, and hangs from the vulva. The womb can be instantly distinguished from the protruding vagina or bladder by the presence, over its whole surface, of 50 to 100 mushroomlike bodies (cotyledons), each 2 to 3 inches in diameter, and attached by a narrow neck. (Pls. XII, XIII.) When fully everted, it is further recognizable by a large, undivided body hanging from the vulva, and two horns or divisions which hang down toward the hocks. In the imperfect eversions the body of the womb may be present with two depressions leading into the two horns. In the cases of some standing the organ has become inflamed and gorged with blood until it is as large as a bushel basket, its surface has a dark-red, bloodlike hue, and tears and bleeds on the slightest touch. Still later lacerations, raw sores, and even gangrene are shown in the mass. At the moment of protrusion the general health is not altered, but soon the inflammation and fever with the violent and continued straining induce exhaustion, and the cow lies down, making no attempt to rise.

_Treatment._--Treatment varies somewhat, according to the degree of the eversion. In partial eversion, with the womb protruding only slightly from the vulva and the cow standing, let an assistant pinch the back to prevent straining while the operator pushes his closed fist into the center of the mass and carries it back through the vagina, assisting in returning the surrounding parts by the other hand. In more complete eversion, but with the womb as yet of its natural bulk and consistency and the cow standing, straining being checked by pinching the back, a sheet is held by two men so as to sustain the everted womb and raise it to the level of the vulva. It is now sponged clean with cold water, the cold being useful in driving out the blood and reducing the bulk, and finally it may be sponged over with laudanum or with a weak solution of carbolic acid (1 dram to 1 quart water).