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.