_Amputation of the head._--The head is first seized and drawn well forward, or even outside the v.u.l.v.a, by a rope with a running noose placed around the lower jaw just behind the incisor teeth, by a sharp hook inserted in the arch of the lower jaw behind the union of its two branches and back of the incisor teeth, or by hooks inserted in the orbits, or, finally, in case the whole head protrudes, by a halter. (Pl. XXI, figs 4_a_ and 4_b._) In case the whole head protrudes, a circular incision through the skin is made just back of the ear, and the cut edge being held firmly by the left hand, the neck is skinned as far as it can be reached. Then the great ligamentous cord above the spine is cut across at the farthest available point, together with the muscles above and below the spine. Strong traction on the head will then detach it at this point and bring it away, but should there still be too much resistance the knife is inserted between the bodies of two vertebrae just behind one of the prominent points felt in the median line below, and their connecting fibrous cartilage is cut through, after which comparatively moderate pulling will bring it away. The detached neck and body at once slip back into the womb, and if the fore limbs are now brought up and pulled they are advanced so far upon the chest that the transverse diameter of that is greatly diminished and delivery correspondingly facilitated.

If the head is still inclosed in the v.a.g.i.n.a two methods are available: (1) The removal of the lower jaw and subsequent separation of the head from the neck; (2) the skinning of the whole head and its separation from the neck.

To remove the lower jaw the skin is dissected away from it until the throat is reached. Then the muscles of the cheeks and side of the jaw (ma.s.seters) are cut through and those connecting the jaw with the neck. When traction is made on the rope around the lower jaw it will usually come away with little trouble. Should it resist, its posterior extremity on each side (behind the grinding teeth) may be cut through with bone forceps or with a guarded bone chisel. (Pl. XX, fig. 8.) After the removal of the lower jaw the way will be open to separate the head from the neck, the knife being used to cut into the first or second joint from below, or the bone forceps or chisel being employed to cut through the bones of the neck. Then traction is made on the head by means of hooks in the orbits, and the hand, armed with an embryotomy knife, is introduced to cut through the tense resisting ligament, and muscles above the bones. The skin and the strong ligamentous cord attached to the poll are the essential things to cut, as the muscles can easily be torn across. Unless there are great difficulties in the way it is well to skin the head from the eyes back, and on reaching the poll to cut through the ligament and then bring the head away by pulling.

If it is decided to remove the entire head at once, it may be skinned from the front of the eyes back to behind the lower jaw below and the poll above, then cut through the muscles and ligaments around the first joint and pull the head away, a.s.sisting, if need be, in the separation of the head by using the knife on the ligament of the joint.

If the calf is a double-headed monster, the skinning of the head must be carried backward until the point has been reached where both heads branch from the single neck, and the separation must be made at that point. The muscles and ligaments are first to be cut through; and if the part can not then be detached by pulling, the bodies of the vertebrae may be separated by pa.s.sing the knife through the joint. The second head may now be secured by a noose around the lower jaw or hooks in the orbits and brought up into place, the body being pushed back toward the other side by a repeller, so as to make room.

It should be added that, except in the case of a double-headed monster, or in case of the head protruding or nearly so, and one or both fore limbs presenting, it is rarely desirable to undertake amputation of the head. The s.p.a.ce desirable in the pa.s.sages can usually be obtained by the much simpler and easier procedure of removing one or both fore limbs.

_Amputation of the hind limbs._--This is sometimes demanded on the one extended limb when the other can not be brought up and delivery can not be effected; also in case of monsters having extra hind limbs; when the calf is dead, putrid, and bloated with gas; and in some cases of breech presentation, as described under that head.

When the limb is extended the guiding principles are as in the case of the fore limbs. The skin is cut through circularly above the fetlock and slit up to beneath the pelvic bones on the inner side of the thigh. It is then dissected from the other parts as high as it has been slit on the inner side and to above the prominence (_trochanter major_) on the upper end of the thigh bone on the outer side of the joint. In this procedure the hands and spud can do much, but owing to the firmer connections the knife will be more frequently required than in the case of the fore limb. The muscles are now cut through all around the hip joint, and strong traction is made by two or three men on the limb. If there is still too much resistance, a knife is inserted into the joint on the inner side and its round ligament cut through, after which extraction will be comparatively easy. This accomplished, it will often be possible to extract the fetus with the other leg turned forward into the womb. If the calf is bloated with gas, it may be necessary to remove the other leg in the same way, and even to cut open the chest and abdomen and remove their contents before extraction can be effected. In the case of extra limbs it may be possible to bring them up into the pa.s.sages after the presenting hind limbs have been removed. If this is not practicable, they may be detached by cutting them through at the hip joint, as described under "Breech presentation," page 197.

Another method of removing the hind limb is, after having skinned it over the quarter, to cut through the pelvic bones from before backward, in the median line below, by knife, saw, or long embryotome (Pl. XX, fig. 1), and then disjoint the bones of the spine (sacrum) and the hip bone (ilium) on that side with embryotome, knife, or saw, and then drag away the entire limb, along with all the hip bones on that side. This has the advantage of securing more room and thereby facilitating subsequent operations. Both limbs may be removed in this way, but on the removal of the second the operator is without any solid point to drag upon in bringing away the remainder of the fetus.

_Division across the middle of the body._--In cases of extra size, monstrosity, or distortion of one end of the body it may be requisite to cut the body in two and return the half from the pa.s.sages into womb, even after one-half has been born. The presenting members are dragged upon forcibly by a.s.sistants to bring as much of the body as possible outside.

Then cut through the skin around the body at some distance from the v.u.l.v.a, and with hand, knife, and spud detach it from the trunk as far back into the pa.s.sages as can be reached. Next cut across the body at the point reached, beginning at the lower part (breast, belly) and proceeding up toward the spine. This greatly favors the separation of the backbone when reached, and further allows of its being extended so that it can be divided higher up. When the backbone is reached, the knife is pa.s.sed between the two bones, the prominent ridges across their ends acting as guides, and by dragging and twisting the one is easily detached from the other. With an anterior presentation the separation should, if possible, be made behind the last rib, while with a posterior presentation as many of the ribs should be brought away as can be accomplished. Having removed one half of the body, the remaining half is to be pushed back into the womb, the feet sought and secured with nooses, and the second half removed in one piece if possible; and if not, then after the removal of the extra limb or other cause of obstruction.

_Removed of the contents of chest or abdomen._--If the body of the calf sticks fast in the pa.s.sages by reason of the mere dryness of its skin and of the pa.s.sages, the obstacle may be removed by injecting sweet oil past the fetus into the womb through a rubber or other tube, and smearing the pa.s.sages freely with lard. When the obstruction depends on excess of size of the chest or abdomen or thickening of the body from distorted spine, much advantage may be derived from the removal of the contents of these great cavities of the trunk. We have already seen how the haunches may be narrowed by cutting the bones apart in the median line below and causing their free edges to overlap each other. The abdomen can be cut open by the embryotomy knife or the long embryotome in the median line, or at any point, and the contents pulled out with the hand, the knife being used in any case when especial resistance is encountered. If the abdomen is so firmly impacted that it can not be dealt within this way, one hind limb and the hip bone on the same side may be removed as described under "Amputation of the hind limbs," page 205. This will allow the introduction of the hand into the abdomen from behind, so as to pull out the contents. By introducing an embryotomy knife in the palm of the hand and cutting through the muscle of the diaphragm the interior of the chest can be reached in the same way and the heart and lungs removed.

When, in dealing with an anterior presentation, it becomes necessary to remove the contents of the chest, the usual course is to cut through the connections of the ribs with the breastbone (the costal cartilages) close to the breastbone on each side, and from the abdomen forward to the neck.

Then cut through the muscles connecting the front of the breastbone with the neck and its hinder end with the belly, and pull out the entire breastbone. Having torn out the heart and lungs with the hand, make the rib cartilages on the one side overlap those on the other, so as to lessen the thickness of the chest, and proceed to extract the body. If it seems needful to empty the abdomen as well, it is easy to reach it by cutting through the diaphragm, which separates it from the chest.

_Delivery through the flank_ (_Caesarean section, or laparotomy_).--This is sometimes demanded, when the distortion and narrowing of the hip bones are such as to forbid the pa.s.sage of the calf, or when inflammation has practically closed the natural pa.s.sages and the progeny is more valuable and worthy of being saved than the dam; also in cases in which the cow has been fatally injured, or is ill beyond possibility of recovery and yet carries a living calf. It is too often a last resort after long and fruitless efforts to deliver by the natural channels, and in such cases the saving of the calf is all that can be expected, the exhausted cow, already the subject of active inflammation and too often also of putrid poisoning, is virtually beyond hope. The hope of saving the dam is greatest if she is in good health and not fatigued, in cases, for example, in which the operation is resorted to on account of broken hip bones or abnormally narrow pa.s.sages.

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 a.s.sistant, 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 a.s.sistants, 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 ma.s.ses 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 st.i.tches 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 st.i.tches, to be placed at intervals of 2 inches, is pa.s.sed 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 st.i.tches are put in every half inch and pa.s.sed 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.

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 placentulae, 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 ill.u.s.trated 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 ill.u.s.trates 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 ma.s.s 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 ill.u.s.trate the nature of the umbilical or navel cord. It consists of a tube (1-1') into which pa.s.s 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, r.e.c.t.u.m, 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 _Furstenberg-Leisering, Anatomie und Physiologie des Rindes._)

Fig. 2. Blood vessels pa.s.sing 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 pa.s.ses 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, pa.s.ses 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.

[Ill.u.s.tration: PLATE XII.

FETAL CALF WITHIN ITS MEMBRANES.]

[Ill.u.s.tration: PLATE XIII.

PREGNANT UTERUS WITH COTYLEDONS.]

[Ill.u.s.tration: PLATE XIV.

VESSELS OF UMBILICAL CORD.]

[Ill.u.s.tration: PLATE XV.]

[Ill.u.s.tration: PLATE XVI.]

[Ill.u.s.tration: PLATE XV.

NORMAL POSITION OF CALF IN UTERO.]

[Ill.u.s.tration: PLATE XVI.

ABNORMAL POSITIONS OF CALF IN UTERO.]

[Ill.u.s.tration: PLATE XVII.

ABNORMAL POSITIONS OF CALF IN UTERO.]

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 v.u.l.v.a of the mother, and the head rests between them. The birth of the calf in this position usually takes place without artificial a.s.sistance.

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 Medecine 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 ca.n.a.l.

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.