Part 26

(4) Monsters through absence of natural divisions—absence of mouth, nose, eyes, anus, confluent digits, etc.

(5) Monsters through fusion of parts—one central eye, one nasal opening, etc.

(6) Monsters through abnormal position or form of parts—curved spine, face, limb, etc.

(7) Monsters through excess of formation—enormous head, supernumerary digits, etc.

(8) Monsters through imperfect differentiation of sexual organs—hermaphrodites.

(9) Double monsters—double-headed, double-bodied, extra limbs, etc.

Causes.—The causes of monstrosities appear to be very varied. Some monstrosities, like extra digits, absence of horns or tail, etc., run in families and are produced almost as certainly as color or form. Others are associated with too close breeding, the powers of symmetrical development being interfered with, just as in other cases a sexual incompatibility is developed, near relatives failing to breed with each other. Mere arrest of development of a part may arise from accidental disease of the embryo; hence vital organs are left out, or portions of organs, like the dividing walls of the heart, are omitted. Sometimes an older fetus is inclosed in the body of another, each having started independently from a separate ovum, but the one having become embedded in the semifluid mass of the other and having developed there simultaneously with it, but not so largely nor perfectly. In many cases of redundance of parts the extra part or member has manifestly developed from the same ovum and nutrient center with the normal member to which it remains adherent, just as a new tail will grow out in a newt when the former has been cut off. In the early embryo, with its great powers of development, this factor can operate to far greater purpose than in the adult animal. Its influence is seen in the fact pointed out by St. Hilaire that such redundant parts are nearly always connected with the corresponding portions in the normal fetus. Thus superfluous legs or digits are attached to the normal ones, double heads or tails are connected to a common neck or rump, and double bodies are attached to each other by corresponding points, navel to navel, breast to breast, back to back. All this suggests the development of extra parts from the same primary layer of the impregnated and developing ovum. The effect of disturbing conditions in giving such wrong directions to the developmental forces is well shown in the experiments of St. Hilaire and Valentine in varnishing, shaking, and otherwise breaking up the natural connections in eggs, and thereby determining the formation of monstrosities at will. So, in the mammal, blows and other injuries that detach the fetal membranes from the walls of the womb or that modify their circulation by inducing inflammation are at times followed by the development of a monster. The excitement, mental and physical, attendant on fright occasionally acts in a similar way, acting probably through the same channels.

The monstrous forms liable to interfere with parturition are such as, from contracted or twisted limbs or spine, must be presented double; where supernumerary limbs, head, or body must approach the passages with the natural ones; where a head or other member has attained to an unnatural size; where the body of one fetus has become inclosed in or attached to another, etc.

Extraction is sometimes possible by straightening the members and obtaining such a presentation as will reduce the presenting mass to its smallest and most wedgelike dimensions. To effect this it may be needful to cut the flexor tendons of bent limbs or the muscles on the side of a twisted neck or body; one or more of the manipulations necessary to secure and bring up a missing member may be required. In most cases of monstrosity by excess, however, it is needful to remove the superfluous parts, in which case the general principles employed for embryotomy must be followed. The Caesarean section, by which the fetus is extracted through an incision in the walls of the abdomen and womb, is inadmissible, as it practically entails the sacrifice of the mare, which should never be done for the sake of a monster. (See "Embryotomy," p. 202.)

ENTRANCE OF TWINS INTO THE PASSAGE AT ONCE.—Twins are rare in the mare, and still more rare is the impaction of both at once into the pelvis. The condition would be easily recognized by the fact that two fore limbs and two hind would occupy the passage at once, the front of the hoofs of the fore feet being turned upward and those of the hind feet downward. If both belonged to one foal, they would be turned in the same direction. Once recognized, the condition is easily remedied by passing a rope with a running noose round each foot of the foal that is furthest advanced or that promises to be most easily extracted, and to push the members of the other fetus back into the depth of the womb. As soon as the one fetus is fully engaged into the passage it will hold its place and its delivery will proceed in the natural way.

ABNORMAL PRESENTATIONS.

(Pls. XV-XVIII.)

Abnormal presentations may be tabulated as follows:

{ {Incompletely extended. { { Flexor tendons shortened. {Fore limbs {Crossed over the neck. { {Bent back at the knee. { {Bent back from the shoulder. Anterior presentations: { { {Bent downward on the neck. { {Head and neck turned back { { beneath the breast. {Head {Turned to one side. { {Turned upward and backward { { on the back. { {Hind limbs Hind feet engaged in the pelvis. { {Transverse Back of foal to side of pelvis. { {Inverted Back of foal to floor of pelvis.

{Hind limbs {Bent on itself at the hock. Posterior presentations { {Bent at the hip. { {Transverse Back of foal to side of pelvis. { {Inverted Back of foal to floor of pelvis.

{With back and loins presented. Transverse presentation of body {With breast and belly presented.

FORE LIMBS INCOMPLETELY EXTENDED.—In cases of this kind, not only are the back tendons behind the knee and shank bone unduly short, but the sinew extending from the front of the shoulder blade over the front of the elbow and down to the head of the shank bone is also shortened. The result is that the fore limb is bent at the knee and the elbow is also rigidly bent. The condition obstructs parturition by the feet becoming pressed against the floor of the pelvis or by the elbow pressing on its anterior brim. Relief is to be obtained by forcible extension. A rope with a running noose is passed around each fetlock and a repeller (see Plate XIV) planted in the breast is pressed in a direction upward and backward while active traction is made on the ropes. If the feet are not thereby raised from the floor of the pelvis the palm of the hand may be placed beneath them to protect the mucous membrane until they have advanced sufficiently to obviate this danger. In the absence of a repeller, a smooth rounded fork handle may be employed. If the shortening is too great to allow of the extension of the limbs in this way, the tense tendons may be cut across behind the shank bone and in front of the elbow, and the limb will be easily straightened out. This is most easily done with an embryotomy knife furnished with a ring for the middle finger, so that the blade may be protected in the palm of the hand. (See Plate XIII, fig. 4.)

FORE LIMB CROSSED OVER BACK OF NECK.—With the long fore limbs of the foal this readily occurs, and the resulting increase in thickness, both at the head and shoulder, offers a serious obstacle to progress. (See Plate XV, fig. 2.) The hand introduced into the passage detects the head and one fore foot, and farther back on the same side of the head the second foot, from which the limb may be traced obliquely across the back of the neck.

If parturition continues to make progress the displaced foot may bruise and lacerate the vagina. By seizing the limb above the fetlock it may be easily pushed over the head to the proper side, when parturition will proceed normally.

FORE LIMB BENT AT KNEE.—The nose and one fore foot present, and on examination the knee of the missing fore limb is found farther back. (Plate XV, fig. 1.) First place a noose each on the presenting pastern and lower jaw, and push back the body of the fetus with a repeller, while the operator seizing the shank of the bent limb extends it so as to press back the knee and bring forward the fetlock and foot. As progress is made little by little the hand is slid down from the region of the knee to the fetlock, and finally that is secured and brought up into the passage, when parturition will proceed without hindrance. If both fore limbs are bent back the head must be noosed and the limbs brought up as above, one after the other. It is usually best to employ the left hand for the right fore limb, and the right hand for the left fore limb.

FORE LIMB TURNED BACK FROM SHOULDERS.—In this case, on exploration by the side of the head and presenting limb, the shoulder only can be reached at first. (Plate XV, fig 4.) By noosing the head and presenting fore limb, they may be drawn forward into the pelvis, and the oiled hand being carried along the shoulder in the direction of the missing limb is enabled to reach and seize the forearm just below the elbow. The body is now pushed back by the assistants pressing on the head and presenting limb or on a repeller planted in the breast until the knee can be brought up into the pelvis, after which the procedure is the same as described in the last paragraph.

HEAD BENT DOWN BETWEEN FORE LIMBS.—This may be so that the poll or nape of the neck, with the ears, can be felt far back between the fore limbs, or so that only the upper border of the neck can be reached, head and neck being bent back beneath the body. With the head only bent on the neck, noose the two presenting limbs, then introduce the hand between them until the nose can be seized in the palm of the hand. Next have the assistants push back the presenting limbs, while the nose is strongly lifted upward over the brim of the pelvis. This accomplished, it assumes the natural position and parturition is easy.

When both head and neck are bent downward it may be impossible to reach the nose. If, however, the labor has only commenced, the limbs may be drawn upon until the operator can reach the ear, by dragging on which the head may be so far advanced that the fingers may reach the orbit; traction upon this while the limbs are being pushed back may bring the head up so that it bends on the neck only, and the further procedure will be as described in the last paragraph.

If the labor has been long in progress and the fetus is jammed into the pelvis, the womb emptied of the waters, and firmly contracted on its solid contents, the case is incomparably more difficult. The mare may be chloroformed and turned on her back with hind parts elevated, and the womb may be injected with sweet oil. Then, if the ear can be reached, the correction of the malpresentation may be attempted as above described. Should this fail, one or more sharp hooks may be inserted in the neck as near the head as can be reached, and ropes attached to these may be dragged on, while the body of the foal is pushed back by the fore limbs or by a repeller. Such repulsion should be made in a direction obliquely upward toward the loins of the mother, so as to rotate the fetus in such a way as to bring the head up. As this is accomplished a hold should be secured nearer and nearer to the nose, with hand or hook, until the head can be straightened out on the neck.

All means failing; it becomes necessary to remove the fore limbs (embryotomy) so as to make more space for bringing up the head. If, even then, this can not be accomplished, it may be possible to push the body backward and upward with the repeller until the hind limbs are brought to the passage, when they may be noosed and delivery effected with the posterior presentation.

HEAD TURNED ON SHOULDERS.—In this case the fore feet present, and the oiled hand passed along the fore arms in search of the missing head finds the side of the neck turned to one side, the head being perhaps entirely out of reach. (Plate XVIII, fig. 1.) To bring the head forward it may be desirable to lay the mare on the side opposite to that to which the head is turned, and even to give chloroform or ether. Then the feet being noosed, the body of the fetus is pushed by the hand or repeller forward and to the side opposite to that occupied by the head until the head comes within reach, near the entrance of the pelvis. If such displacement of the fetus is difficult, it may be facilitated by a free use of oil or lard. When the nose can be seized it can be brought into the passage, as when the head is turned down. If it can not be reached, the orbit may be availed of to draw the head forward until the nose can be seized or the lower jaw noosed. In very difficult cases a rope may be passed around the neck by the hand or with the aid of a curved carrier (Plate XIV), and traction may be made upon this while the body is being rotated to the other side. In the same way in bad cases a hook may be fixed in the orbit or even between the bones of the lower jaw to assist in bringing the head up into position. Should all fail, the amputation of the fore limbs may be resorted to, as advised under the last heading.

HEAD TURNED UPWARD ON BACK.—This differs from the last malpresentation only in the direction of the head, which has to be sought above rather than at one side, and is to be secured and brought forward in a similar manner. (Plate XVIII, fig. 2.) If a rope can be passed around the neck it will prove most effectual, as it naturally slides nearer to the head as the neck is straightened and ends by bringing the head within easy reach.

HIND FEET ENGAGED IN PELVIS.—In this case fore limbs and head present naturally, but the hind limbs bent forward from the hip and the loins arched allow the hind feet also to enter the passages, and the further labor advances the more firmly does the body of the foal become wedged into the pelvis (Plate XVII, fig. 2.) The condition is to be recognized by introducing the oiled hand along the belly of the fetus, when the hind feet will be felt advancing. An attempt should at once be made to push them back, one after the other, over the brim of the pelvis. Failing in this, the mare may be turned on her back, head downhill, and the attempt renewed. If it is possible to introduce a straight rope carrier, a noose passed through this may be put on the fetlock and the repulsion thereby made more effective. In case of continued failure the anterior presenting part of the body may be skinned and cut off as far back toward the pelvis as possible (see "Embryotomy"); then nooses are placed on the hind fetlocks and traction is made upon these while the quarters are pushed back into the womb. Then the remaining portion is brought away by the posterior presentation.

ANTERIOR PRESENTATION WITH BACK TURNED TO ONE SIDE.—The diameter of the axis of the foal, like that of the pelvic passages, is from above downward, and when the fetus enters the pelvis with this greatest diameter engaged transversely or in the narrow diameter of the pelvis, parturition is rendered difficult or impossible. In such a case the pasterns and head may be noosed, and the passages and engaged portion of the foal freely lubricated with lard, the limbs may be crossed over each other and the head, and a movement of rotation effected in the fetus until its face and back are turned up toward the croup of the mother; then parturition becomes natural.

BACK OF FOAL TURNED TO FLOOR OF PELVIS.—In a roomy mare this is not an insuperable obstacle to parturition, yet it may seriously impede it, by reason of the curvature of the body of the foal being opposite to that of the passages, and the head and withers being liable to arrest against the border of the pelvis. Lubrication of the passage with lard and traction of the limbs and head will usually suffice with or without the turning of the mare on her back.

In obstinate cases two other resorts are open: First, to turn the foal, pushing back the fore parts and bringing up the hind so as to make a posterior presentation, and, second, the amputation of the fore limbs, after which extraction will usually be easy.

HIND PRESENTATION WITH LEG BENT AT HOCK.—In this form the quarters of the foal with the hind legs bent up beneath them present, but can not advance through the pelvis by reason of their bulk. (Plate XV, fig. 3.) The oiled hand introduced can recognize the outline of the buttocks, with the tail and anus in the center and the sharp points of the hocks beneath. First pass a rope around each limb at the hock, then with hand or repeller push the buttocks backward and upward, until the feet can be brought up into the passages. To this the great length of the shank and pastern in the foal is a serious obstacle, and in all cases the foot should be protected in the palm of the hand while being brought up over the brim of the pelvis; otherwise the womb may be torn. When the pains are too violent and constant to allow effective manipulation, some respite may be obtained by the use of chloroform or morphin and by turning the mare on her back, but too often the operator fails and the foal must be sacrificed. Two courses are still open: First, to cut through the cords behind and above the hock and extend the upper part of the limb, leaving the hock bent, and extract in this way, and, second, to amputate the hind limbs at the hip joint and remove them separately, after which the body may be extracted.

HIND PRESENTATION WITH LEGS BENT FORWARD FROM HIP.—This is merely an aggravated form of the presentation last described. (Plate XVII, fig. 1.) If the mare is roomy, a rope may be passed around each thigh and the body pushed upward and forward, so as to bring the hocks and heels upward. If this can be accomplished, nooses are placed on the limb further and further down until the fetlock is reached and brought into position. If failure is met with, then amputation at the hips is the last resort.

HIND PRESENTATIONS WITH BACK TURNED SIDEWAYS OR DOWNWARD.—These are the counterparts of similar anterior presentations and are to be managed in the same way.

PRESENTATION OF THE BACK.—This is rare, yet not unknown, the foal being bent upon itself with the back, recognizable by its sharp row of spines, presented at the entrance of the pelvis and the head and all four feet turned back into the womb. (Plate XVI, fig. 1.) The body of the fetus may be extended across the opening transversely, so that the head corresponds to one side (right or left), or it may be vertical, with the head above or below.

In any such position the object should be to push the body of the fetus forward and upward or to one side, as may best promise to bring up the fore or hind extremities, and bring the latter into the passage so as to constitute a normal anterior or posterior presentation. This turning of the fetus may be favored by a given position of the mother, by the free use of oil or lard on the surface of the fetus, and by the use of a propeller.

PRESENTATION OF BREAST AND ABDOMEN.—This is the reverse of the back presentation, the foal being extended across in front of the pelvic opening, but with the belly turned toward the passages and with all four feet engaged in the passage. (Plate XVI, fig. 2.) The most promising course is to secure the hind feet with nooses and then push the fore feet forward into the womb. As soon as the fore feet are pushed forward clear of the brim of the pelvis, traction is made on the hind feet so as to bring the thighs into the passage and prevent the reentrance of the fore limbs. If it proves difficult to push the fore limbs back, a noose may be passed around the fetlock of each and the cord drawn through the eye of a rope carrier, by means of which the members may be easily pushed back.