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 passages 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 passages into womb, even after one-half has been born. The presenting members are dragged upon forcibly by assistants to bring as much of the body as possible outside. Then cut through the skin around the body at some distance from the vulva, and with hand, knife, and spud detach it from the trunk as far back into the passages 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 passed 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.
Removal of the contents of chest or abdomen.—If the body of the calf sticks fast in the passages by reason of the mere dryness of its skin and of the passages, the obstacle may be removed by injecting sweet oil past the fetus into the womb through a rubber or other tube, and smearing the passages 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 (Cæsarean section, or laparotomy).—This is sometimes demanded, when the distortion and narrowing of the hip bones are such as to forbid the passage of the calf, or when inflammation has practically closed the natural passages 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 passages.
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.