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Webster Family Li terinary Medicine

Cummings S i Veterinary Medicine at

Tutts University
200 Westboro Road
North Grafton, MA 01536

The Diseases of the Genital Organs
of Domestic Animals

BY

W. L. WILLIAMS

PROFESSOR OF OBSTETRICS AND RESEARCH PROFESSOR
IN THE DISEASES OF BREEDING CATTLE
IN THE

NEW YORK STATE VETERINARY COLLEGE AT CORNELL UNIVERSITY

WITH THE COLLABORATION OF

W. W. WILLIAMS, B.A., D.V.M.

SPRINGFIELD, MASS.

Published by the Author
ITHACA, N. Y.

1921

Copyright by

W. L. WILLIAMS

1921

Press of

ANDRUS & CHURCH

Ithaca, N. Y.

PREFACE

No attempt has been made heretofore to describe system-
atically the genital diseases of domestic animals. The path-
ologic processes acting within the genital organs and inter-
fering with the ideal production of young are chiefly hidden
from view. Only certain phenomena caused by them be-
come apparent. Of these the most striking phenomenon is
the observed expulsion of a fetal cadaver, which is desig-
nated abortion. The observer is generally forewarned of
impending death of a born animal because it is commonly
preceded by visible injury or illness, but abortion produces
a profound impression because the death of a potentially
valuable unborn animal has occurred unseen and is re-
vealed only when the cadaver is seen to be expelled. This
tends to draw a veil of mystery about the event. If the
spermatozoon, unfertilized or fertilized ovum, or the small
embryo perishes, the dead cell or body is not observed and
therefore excites little or no comment.

In the early history of medicine, certain striking phe-
nomena were regarded and described as diseases. When the
science of pathology became established, a rearrangement
of medical literature became necessary and the phenomena
became grouped about their causes, so far as known. It
followed that various phenomena which had been regarded
as distinct diseases were in some cases due to a common
cause. In other cases a phenomenon classed as a disease
has been split up because the phenomenon was inconstant
in its cause. In primitive veterinary literature glanders and
farcy were described as distinct affections, but later it be-
came known that the two supposed diseases were merely
separate phenomena resulting from one cause. Nasal gleet
occupied a prominent place in primitive veterinary litera-
ture, but as veterinary science advanced the phenomenon of
nasal discharge was split up, assigned in each case to the
disease of which it constituted one symptom, and nasal gleet
disappeared from the pages of veterinary literature.

iv Preface

The pathologic processes occurring in the genitalia of
animals have been almost wholly described under the primi-
tive method, each striking -phenomenon being elevated to
the dignity of a disease. Consequently a certain infection,
by causing a wide variety of outstanding phenomena, in-
jected into veterinary literature numerous alleged "dis-
eases" each due to a single infection. It was unavoidable
also that a given phenomenon, such as fetal death, which
may be due to numerous different infecting agents, should
be known as one disease. Thus abortion, metritis, retained
fetal membranes, epididymitis, semino-vesiculitis, and dys-
entery of the new-born, all of which in a given series of
cases may be due to an identical infection, have been de-
scribed as six distinct diseases and scattered from end to end
of veterinary literature.

The re-casting of the genital diseases of animals into a
systematic treatise is a formidable task, the first effort at
which must be very imperfect. In 1909 I published "Vet-
erinary Obstetrics; Including the Diseases of Breed-
ing Animals and of the New Born", in which many of
the diseases of the genital organs were included under the
primitive plan. It was abandoned at the exhaustion of the
first edition. In 1917 I published "Veterinary Obstet-
rics" and began the preparation of the present volume. The
two treatises have been designated "companion volumes"
because they are closely allied in subject matter and may be
profitably studied together.

The present treatise appears at a critical period in the
history of the diseases of the genital organs of animals,
when an old, firmly entrenched belief is slowly crumbling
and a modern one is struggling for recognition. Abortion
has long been regarded as a specific infectious disease, due
in a given species of animals to one bacterium and to one
only. If an exception arose and a given abortion or group
of abortions was apparently due to an infection other than
that specified for the species of animal concerned, it was not
infectious abortion but merely abortion due to infection.

The belief in a specific infectious abortion has occupied

Pre/ <n, v

the central position in the literature upon genital diseases
in animals so long, that anyone attempting to write a sys-
tematic treatise in this field must either make infectious
abortion the cornerstone or reject it wholly. While in this
treatise it is held that all abortions in animals (except those
induced surgically) are due to infection, it is denied that
such infection is specific, as that term is commonly under-
stood in medicine. It is denied as a principle in pathology
that conception, parturition, birth, or other physiologic act
draws across the path of life an impenetrable barrier to dis-
ease. It is held that any infection competent to invade a
female may likewise invade a male; if able to invade a preg-
nant animal, it may also invade the same animal when non-
pregnant ; if it can gain a habitat in the pregnant female, it
may persist after parturition ; if it can invade and imperil
the life of an embryo or fetus, it may continue through
birth and affect the new-born, or may attack the new-born
from external sources. Any infection which can invade and
injure or kill a post-natal animal, may cause the same in-
jury to it while intra-uterine, provided that contact is made.
If tuberculosis or syphilis exists in the pregnant uterus, the
infection may invade the embryo. There is no evidence to
show, and no reason to believe, that any acute infection may
not attack and destroy the embryo if the virus is brought
into contact with it. It is true that acute infections, when
attacking a pregnant female, rarely if ever pass the intact
placental filter and reach the embryo. It does not follow
that the embryo is immune to the infection, but merely that
it is in a hermetically sealed sac, so isolated that the virus
fails to acquire contact.

Although the placental isolation of the embryo is efficient
against filterable viruses, the supporters of the "specific in-
fectious abortion" theory hold that certain comparatively
large bacteria defy this important law, invade the pregnant
female, pass directly to the existing embryo, and cause its
death and expulsion. But in invading the pregnant female,
presumably through the mouth, the infection is alleged to
reach the endometrium and embryo without leaving behind

vi Preface

any lesion in its path or causing any disease or sign of dis-
ease.

This treatise is built upon the belief that abortion is only
an incident in the ravages of infections existing within the
pregnant uterus at the date of conception, or deposited with
the semen at coitus. The infection is not specific, is not
limited to one species of bacterium, invades organs other
than the uterus, and involves both sexes and all ages. This
general infection causes a long list of phenomena or lesions.
The basic conflict of view with the majority of investiga-
tors will inevitably draw much unfavorable criticism. In
order to justify the views stated, controversial matter has
been included. This is regretted because it increases the
size of the volume, and because some highly esteemed col-
leagues may erroneously regard such statements as personal
reflections.

The conflicting views have served to delay publication. A
belief so long and thoroughly entrenched as that of specific
infectious abortion can not be overthrown quickly. Neither
would the overthrow of what I believe an error be a gain
unless a foundation were ready upon which a more valuable
structure could be erected. I made the first open attack
upon the specific infectious abortion theory in 1912, and that
has been followed periodically from various angles. But
external attack has not been as effective as internal disinte-
grating forces. The champions of a specific infectious abor-
tion have admitted that at least several different species of
bacteria may and do cause abortion in a given species of
animal, and that the lesions caused by the several bacterial
forms are not differentiable clinically or macroscopically.
A most serious drawback to the theory has been its failure
in practical application. It was announced twenty-five
years ago that, since the cause of infectious abortion had
been proven, it could be controlled. The twenty-five years
which have elapsed have seen no progress in the control of
abortion based upon the specific theory. The prevalence of
abortion is greater today than at any prior date in history.
During the past decade there has been developing gradu-

Preface vii

ally another view which appears more logical, is in harmony
with the general principles of pathology, and is in full ac-
cord with all data recorded by the believers in specific in-
fectious abortion. That portion of the volume designated
"The General Genital Infections" must be regarded as the
cornerstone ; if the principles it has been attempted to estab-
lish there break down, it fails as a systematic treatise. The
principles which it is attempted to establish place the com-
mon and most destructive genital infections upon a plane
analogous to wound infection. Various bacteria exist in the
genitalia of both sexes of all ages and species. The virulence
and variety vary at different times and in different indi-
viduals. They are modified by general health, coitus, preg-
nancy, parturition and other critical incidents in life.

The belief in a specific infectious abortion logically de-
mands for the control of the disease the isolation of the
pregnant female from all possible carriers of infections ; in
this treatise it is held that physiologic reproduction is based
upon coitus between two sexually healthy animals. The first
is a hypothesis of despair, confirmed by lamentable failure
over a period of twenty -five years : the latter a doctrine of
hope, supported by success. Before publishing this treatise
it was regarded as essential that the principles should have
been tried thoroughly and proven successful in the crucible
of practical clinical application. This has been a difficult
task requiring unbounded and infinite patience under great
discouragements and against opposition.

The treatise is inevitably very imperfect in every part,
and those who are inclined to criticise will have excellent
opportunity. But the volume was not made to cause or to
avoid criticism. It is a first effort in a new field which, it is
hoped, may be helpful to some and which may serve to
awaken a new interest in the diseases interfering with re-
production in animals. The call of the hour to veterinarian
and breeder is for increased efficiency of each domestic ani-
mal. The room for animal numbers is decreasing, while the
demand for service in the production of milk, meat, labor or
other products is increasing. Most of the great animal

viii Preface

plagues which imperil the lives of adults have been brought
under measurable control, but those infections involving the
safety of the embryo are constantly gathering force. Yet it
must be remembered that the sexual health of those animals
desired for reproduction is the first basic need in animal
husbandry. Reproductive efficiency in purebred cattle,
swine, and horses, so far as can be estimated, has dropped
below 60 per cent, of the ideal and continues to descend at a
discouraging pace. The condition can be relieved only
through conscientious and skillful work by veterinarians
and breeders. The problem is difficult and the duration of
the task infinite. It calls for the adoption of a permanent
policy of guarding sexual health in animals — not of "cur-
ing" established lesions. The advancement of reproductive
efficiency in the best animals is at present the greatest eco-
nomic problem in veterinary medicine.

In a higher realm the study of genital diseases in domestic
animals may be made of incalculable value in the elucidation
of the basic principles of genital diseases in man. Aside
from the specific venereal diseases of man, the genital infec-
tions are probably analogous to, and possibly identical with,
the general genital infections of animals. What is true of
the intra-uterine infections of the embryo in domestic ani-
mals is presumably equally true in principle of the human
embryo. The veterinarian has opportunities for the study
of the infections of the genital organs and embryos of ani-
mals wholly denied to practitioners of human medicine. The
veterinarian has freely available in the abattoir the genitalia
in health and in disease of thousands and millions of freshly
slaughtered cattle, sheep, and swine of all ages and of both
sexes. The females are pregnant and non-pregnant and the
embryos are of all ages, diseased and healthy. Clinically the
veterinarian can palpate the genital organs of the cow and
mare freely per rectum and read the anatomical lesions of
ovaries, oviducts and uterus as the blind read braille. The
fetus can be manipulated, its movements in response to me-
chanical stimulation studied, and its physiologic function of
swallowing its amniotic fluid recognized.

Preface ix

The new-born animal can be studied freely regarding the
infections carried from the uterus, can be fed experimen-
tally, and may be destroyed at will for examination. If the
veterinary profession is fully to live up to its opportunities
and discharge its obligations to the state, it must contribute
its share to the advancement of the knowledge of disease.
Nowhere else can it contribute more, nor as much, of value,
as in the basic principles of the physiology, pathology and
hygiene of reproduction.

Purely a clinician, I have been dependent upon others for
bacteriologic and histologic facts. In this field Drs. W. A.
Hagan and C. M. Carpenter have rendered invaluable
aid. Working first in my department and later in the de-
partment of pathology and bacteriology, they have extended
every possible assistance. Similar help has been given by
Dr. Herbert L. Gilman, at present in my department. The
reader should undertsand the difficulty of securing knowl-
edge regarding genital infections in animals. In general
bacteriologists have not studied the genitalia of animals for
infections, but for one specific infection, and have left un-
recorded and unstudied all others. If the bacillus thought
by the investigator to be the cause of infectious abortion was
recognized, that was deemed final proof of it, and no other,
caused the disease. Drs. Hagan, Carpenter, and Gilman
have so far as practicable studied all bacteria found in the
genital organs and their significance in the problem of re-
production.

My collaborator, Dr. W. W. Williams, has contributed
greatly to the value of the treatise. Having devoted his en-
tire energy for a number of years to the handling of genital
diseases and the advancement of reproductive efficiency in
purebred cattle, he has demonstrated with unusual clearness
the value of the scientific handling of this group of infec-
tions. He has contributed especially the sections upon the
surgery of the cervix and the genital infections of bulls.

W. L. Williams.
Cornell University
Ithaca, N. Y.
April, 1921

TABLE OF CONTENTS

PART I

DISEASES AND DEFECTS NOT ATTRIBUTABLE TO

INFECTION

PAGE

CHAPTER I

THE ANATOMY AND PHYSIOLOGY OF THE GENITALIA . .

The Genital Organs of the Male ... i

The Testicles and Their Excretory Ducts ...'••.... i

The Vesicula Semiualis, Prostate, and Cowper's Glands ... 10

The Penis 14

The Sheath and Prepuce 15

The Genital Organs of the Female 18

The Ovaries 18

The Muellerian Ducts 22

The Oviducts 25

The Uterus 26

The Cervix 33

The Vagina 36

Gartner's Ducts 39

The Vulva .... 41

The Physiology of the Genitalia 44

The Ripening of the Ovisac and Ovum 44

Estrum 47

Ovulation 49

Menstruation ' ' . . . 51

The Corpus Luteuni of Estrum 52

Copulation .... 53

The Ejaculation of Semen 53

The Migration of Spermatozoa 54

Fertilization - 55

The Migration and Implantation of the Ovum 55

The Corpus Luteuni of Pregnancy 56

The Fetal Membranes 58

CHAPTER II

THE CLINICAL EXAMINATION OF THE GENITALIA 73

The Clinical Examination of the Male Genitalia ... 73

The Testicles 74

The Epididymis 75

The Seminal Vesicles, Prostate, and Cowper's Glands . . . . 76

The Semen and Spermatozoa 77

xii Contents

The Clinical Examination of the Female Genitalia ... 79

The Examination of Vulva and Vagina 84

Rectal Palpation 89

The Examination of the Cervical Canal and Douching of the

Uterus 99

The Diagnosis of Estrum in

The Diagnosis of Pregnancy 113

CHAPTER III
ARTIFICIAL INTERFERENCES WITH REPRODUCTIVE

FUNCTIONS 140

The Induction of Estrum 140

Artificial Insemination 143

Artificial Abortion 146

CHAPTER IV

ARRESTS AND ABERRATIONS IN GENITAL DEVELOPMENT 151

Asexual or Bisexual Aberrations 151

Neuters or Freemartins 151

Hermaphroditism 157

Arrests in the Development of the male Genitalia ... 160

Arrests and Aberrations in the Development of the Testes . . 160

Cryptorchidy r6o

Aberration in Position of Scrotal Testes 161

Arrest in Functional Development of Scrotal Testes, Fetal

Testes 161

Aberrations in the Development of the Penis 163

Congenital Defects of the Female Genitalia 163

Uterus Unicornis 165

Double Uterus, Double Cervix 165

Persistence of Median Walls of Muellerian Ducts in Vaginal

Area, Double Vagina 167

Imperforate Hymen, Persistent Hymen 169

CHAPTER V
MISCELLANEOUS DEFECTS AND DISEASES INTERFERING

WITH FERTILITY 172

Umbilic Hernia 172

Ventral Hernia 174

Horizontal Vulva 174

Stricture of Vagina and Vulva 175

Diseases of the Feet and Limbs 177

Paralysis, Plumbism * " 179

Torsion of the Testicle 180

Traumatic Orchitis 181

Tubal Pregnancy 185

Vaginal Hernia 185

Torsion of the Uterus 189

Pelvic Tumors and Calluses 190*

Contents

Xlll

CHAPTER VI

SYSTEMIC DISEASES AND DERANGEMENTS INTERFERING

WITH REPRODUCTION i92

Physical Overwork 192

Starvation jo-j

Obesity 194

Idleness and Overfeeding 196

Sexual Excess . . 200

Onanism or Masturbation 203

CHAPTER VII

COITAL INJURIES 205

Kicks and Fractures 206

False Copulation, Rectal Injuries ... 210

Laceration and Rupture of the Vagina 214

Coital Rupture of the Uterus 216

Coital Rupture of the Urinary Bladder 217

Vaginal Hemorrhage following Coitus 21S

Urethral Hemorrhage in Stallion 218

Contusions of Neck and Withers 219

Penial Injuries 219

Rupture of Prepuce 223

Strangulated Hernia 225

CHAPTER VIII

PARTURIENT INJURIES 228

Lacerations of Perineum '. 228

Recto-Vaginal Fistula 229

Lacerations of Cervix 229

CHAPTER IX

SODOMY AND SADISM 231

PART II
TUMORS OF THE GENITALIA

CHAPTER X

MALIGNANT NEOPLASMS 239

Malignant Tumors of the Male Genitalia 239

Amputation of the Penis 245

Malignant New-< Growths of the Female Genitalia 250

CHAPTER XI

BENIGN TUMORS OF THE GENITALIA 253

Benign Tumors of the Male Genitalia 253

Benign Tumors of the Female Genitalia 257

( ►variotomy 263

xiv Contents

PART III
INFECTIONS OF THE GENITAL ORGANS

SECTION I. THE GENITAL INFECTIONS OF CATTLE
CHAPTER XII

THE SPECIFIC VENEREAL DISEASES 27S

The Vesicular Venereal Disease of Cattle 278

The Nodular Venereal Disease 283

CHAPTER XIII
NON-VENEREAL INFECTIONS WHICH INVADE THE GENITAL

ORGANS 317

Genital Actinomycosis 317

Genital Tuberculosis 319

CHAPTER XIV

THE GENERAL INFECTIONS OF THE GENITAL ORGANS ... 356

I. INFECTIONS OF THE GENITAL ORGANS OF BULLS . . 358
Orchitis 375

Degenerative Orchitis. Destruction of Spermatogenetic Epi-
thelium in Calves 375

Orchitis in Adult Bulls. Abscessation and Necrosis of Testicles 379

Epididymitis • 385

Degenerative Epididymitis of Calves 385

Arrest in Development ... 385

Chronic Indurated Epididymal Abscesses of Calves 386

Epididymitis of Adult Bulls 388

Infections of the Glands of the Pelvic Urethra 389

Spermato-Cystitis 389

Diseases of Prostate and Cowper's Glands 393

Balantitis. Balano-Posthitis. " The Granular Venereal

Disease" 393

II. GENERAL INFECTIONS OF THE GENITAL ORGANS OF

HEIFERS AND COWS

Diseases of the Ovaries. Ovaritis 394

Atretic Follicles . 395

Cystic Degeneration of the Ovaries, Nymphomania 395

Intra-Follicular Hemorrhage 409

Post-0 vulatiou Hemorrhage into the Follicular Crater. . . . 411

Hemorrhagic Corpus Luteum 412

Cystic Degeneration of the Corpus Luteum 413

Hypertrophy of the Corpus Luteum 418

Persistent Corpus Luteum .421

Central or Embedded Corpus Luteum. The Corpus Luteum of
Pyometra and of Retained Fetal Cadaver 422

Contents xv

Abscess of Ovary 424

Corpora Nigra 425

Par-Ovarian Cysts 425

Tubal Infections 426

Salpingitis, Pavilionitis, Adherent Ovary 428

Pvosalpinx. Tubo-Ovarian Abscesses 445

Hydrosalpinx. Dropsy of the Pavilion II*

Cysts in the Mesosalpinx 452

Uterine Infections 453

The Diseases of the Uterus of the Heifer Calf and Virgin Heifer 453

Intra-Uterine Infection and Endometritis 453

Pyometra 458

The Infections of the Gravid Uterus 462

Apical Endometritis with Necrosis of the Fetal Sac 462

Diffuse Endometritis, with Atony of Uterine Walls. Dystocia 464

Cervical Endometritis 465

Uterine Gangrene 467

Placentitis 469

Peripheral Placentitis with Necrosis and Dehiscence at the

Periphery of the Cotyledons 469

Inter-Placental Hemorrhage with Desiccation of the Fetus.

Mummification 47°

Incarcerating Placentitis 474

Necrosis of Cotyledons. Necrotic Placentitis 474

Adventitious Placenta 475

Calcification of Placenta 476

The Infections of the Ovum, Embryo and Fetus i;'>

The Death of the Fertilized Ovum . 476

The Death of the Embryo, with Survival of the Embryonic Sac.

Cystic Mole 177

Death and Maceration of the Embryo or Fetus 480

The Pyometra of Fetal Decomposition \So

Abscessation of the Gravid Uterus 484

Emphysema of the Fetus 487

The Observed Expulsion of the Fetal Cadaver. Abortion . . 487

The History of Abortion 488

The Prevalence and Frequency of Abortion 491

"Accidental Abortion" 495

"Food Abortion" 496

The Biology of Abortion 49s

The Colon-Like Bacillus and the Micrococcus of Nocanl 1.98

The Nodular Venereal Disease of Iseppoui 499

The Bacterium Abortus of Bang 499

The Paratyphoid Bacillus of Moussu 511

The Spirillum of Smith and others 511

Miscellaneous Bacteria 511

Contents

The Nature of Abortion 511

The Symptoms and Diagnosis of Abortion 517

The Date of Invasion 518

The Control of Abortion 519

Diseases of the Puerperal Uterus 538

Uterine Hemorrhage. Uterine Hematoma 539

Endometritis 546

Septic Metritis 554

Placentitis, Cotvledonitis. Retained Fetal Membranes . 560

Puerperal Tetanus 584

Puerperal Lamiuitis 585

Puerperal Meningitis 585

Post-Puerperal Uterine Infections 586

Endometritis 589

Pyometra 594

Uterine Abscess 601

Abscessation of Uterine Submucosa 604

Sclerotic Metritis 605

Pelvic Adhesions. Parametritis 606

Pyemia, Pyemic Arthritis 609

Pyemic Abscesses 609

Cystic Degeneration of Uterine Walls with Hydrometra . 611

Infections of the Cervix 614

Cervicitis 614

Retention of Menstrual Debris, Cystic Uterus 640

Retention of Fetus from Cervical Adhesions 641

Retention Cysts of Cervix 642

Cervical Prolapse 642

Infections ofathe Vagina 645

Vaginitis. The Nodular Venereal Disease 645

Gangrene 647

Perivaginal Phlegmon 648

Cysts and Abscesses of Gartner's Ducts 649

The Infections of the Vulva 650

III. CONGENITAL INFECTIONS OF CAUVES
Dysentery Neonatorum, Calf Scours, White Scours, Calf

Pneumonia, Arthritis, Pyemic Abscesses 651

The Problem of the Genital Infections of Cattle as a

Whole \ 687

The Assembling of Herds and the Addition of Cattle to

Existing Herds 688

Equipment 694

The Systematic Handling of Herds for the Control of

Genital Infections 697

The Genital Infections of Cattle as an Economic Problem 708

Contents xvii

The Genital Infections of Cattle in their Relation to

Human Health 709

SECTION II. THE GENITAL INFECTIONS OF SHEEP AND GOATS

CHAPTER XV

THE SPECIFIC VENEREAL DISEASES 713

The Nodular Venereal Disease 713

CHAPTER XVI
NON-VENEREAL INFECTIONS WHICH INVADE THE GENITAL

ORGANS 713

Necrotic Disease of the Genital Organs Associated with Lip-

and-Leg Ulceration 713

CHAPTER XVII

THE GENERAL GENITAL INFECTIONS OF SHEEP AND GOATS 717

Abortion Associated with a Vibrio or Spirillum 717

Retained Placenta in Ewes 717

SECTION III. GENITAL INFECTIONS OF SWIM-:
CHAPTER XVIII

SPECIFIC VENEREAL INFECTIONS 736

The Nodular Venereal Disease 736

CHAPTER XIX
NON-VENEREAL SPECIFIC INFECTIONS INVADING THE

GENITALIA OF SWINE 736

Tuberculosis 736

CHAPTER XX
THE GENERAL INFECTIONS OF THE GENITALIA OF SWINE . 738
Metritis, Death and Maceration of Embryos, Abortion .... 738

SECTION IV GENITAL INFECTIONS OF HORSES 752

CHAPTER XXI
THE SPECIFIC VENEREAL DISEASES OF HORSES 752

DOURINE 752

Genital Horse Pox 766

CHAPTER XXII
NON-VENEREAL SPECIFIC DISEASES WHICH INVADE THE
GENITALIA OR AROUSE INFECTIONS ALREADY EXISTING

WITHIN THE GENITAL TRACT 770

Infectious Cellulitis. "Pink Eye." 770

Bursattee 775

CHAPTER XXI 1 1

THE GENERAL INFECTIONS OFTHE GENITAL TRACT. " CON-
TAGIOUS ABORTION." 778

INFECTIONS OF THE GENITAL ORGANS OF STALLIONS . . . 782

orchitis and Epididymitis 782

Diseases of Seminal Vesicles, Semino- Vesiculitis 785

xviii Contents

II. GENERAL INFECTIONS OF THE GENITAL ORGANS OF MARES

Diseases of the Ovaries. Ovaritis 788

Atretic Follicles 788

Cystic Degeneration. Nymphomania 788

Uterine Infections 793

Infections of the Gravid Uterus, Ovum, Embryo or Fetus.

Abortion 793

Diseases of the Puerperal Uterus, Retained Afterbirth, Reten-
tion of Non-Gravid Horn of Chorion, Endometritis, Puer-
peral Laminitis 799

Metritis. Metro-peritonitis 803

Post-Puerperal Infections 805

Endometritis 805

Uterine Abscess 806

Pyometra 807

Cervicitis 810

Vaginitis 811

Vulvar Gangrene 8T3

III. CONGENITAL INFECTIONS OF FOALS 814

Septicemia of the Foal - . 814

Retention of the Meconium 814

Dysentery 815

Arthritis. Pyemia 815

Re-Opening of Urachus 820

Rupture of Tendons 824

SECTION V. THE GENITAL INFECTIONS OF CARNIVORA 828
CHAPTER XXIV

SPECIFIC VENEREAL DISEASES

The Venereal Tumors of Dogs 828

CHAPTER XXV
THE GENERAL INFECTIONS OF THE GENITALIA

Prostatitis of Dogs. Abortion, etc 831

CHAPTER XXVI

VENEREAL DISEASE OF RABBITS 838

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PART I

DISEASES OF THE GENITAL ORGANS NOT
ATTRIBUTED TO INFECTION

Chapter I

THE ANATOMY AND PHYSIOLOGY OF
THE GENITAL ORGANS

A. The Male Genitalia

The male genital organs consist of the testicles, epididy-
mes, vasa deferentia, vesiculae seminales, prostate and
Cowper's glands, and the penis with its sheath and prepuce.

Prior to the disappearance of the Wolffian bodies in the
embryo, there appear near their anterior end at their median
side, two parallel thickenings in the peritoneum designated
the genital ridges, which by an elaboration of their epithel-
ium ultimately form the genital glands. At first they can-
not be differentiated, but they quickly assume definite sex
characters and can be recognized as male (testicles) or fe-
male (ovaries) glands.

1. The Testicles and their Excretory Ducts

a. The testicles at first lie against the vertebral column,
in close proximity to each other, between the anterior ends
of the Wolffian bodies. The essential structures of the
testicles, the tubuli seminiferi and the specialized cells ela-
borating the spermatozoa, are formed from the peritoneal
cells of the genital ridges. The contiguous peritoneal areas
draw over the genital ridges, perpetuating the general peri-
toneal surface while the glandular mass of the testicle lies
outside or above the peritoneal cavity.

The Wolffian bodies soon disappear as independent struc-
tures. The anterior end of each Wolffian body later forms
the head of the corresponding epididymis, becoming continu-
ous with the proximal end of the testicle, upon its lateral

2 Diseases of the Genital Orga?is

side. The Wolffian duct, after the virtual elimination of the
Wolffian body, undergoes elaboration to constitute the body
and tail of the epididymis and the vas deferens.

The artery of the testicle derived from the posterior aorta,
is at first very short, but with the descent of the gland into
the scrotum, it becomes one of the longest unbranched arter-
ies in the body. The artery with its satellite vein, nerves,
and lymphatics, and the investing peritoneum, constitutes
the vascular or spermatic cord, one of the three fundamental
connections of the testicle with the body walls.

A second attachment of the testicle to the body wall con-
sists of the fibrous, cord-like gubernaculum testis. It is
formed at about the same date as the genital ridge and ex-
tends from that part of the external integument, which is to
constitute the fundus of the scrotum through the inguinal
space, internal inguinal ring, and thence outside the peri-
toneum, upward, forward, and inward across the tail of the
epididymis to the posterior end of the testicle to which it is
attached.

As the testicle increases in volume and weight, it drops
down into the peritoneal cavity towards the internal in-
guinal ring. In its descent the three attachments of the
testicle, the vascular or spermatic cord (artery, vein, nerves,
and lymphatics), vas deferens, and gubernaculum testis,
each drags with it the peritoneum which furnishes to each
structure a double fold, thus maintaining the continuity of
the visceral with the parietal peritoneum, resulting in three
double peritoneal folds, as shown in Fig. 1. When the testi-
cle descends into the scrotum, the gubernaculum shortens
throughout its course. In solipeds the tension of the guber-
naculum, prior to the complete descent of the testicle, exerts
a degree of traction upon its scrotal attachment sufficient to
cause a depression or dimple in the scrotum. The approach
of the testicle to the internal inguinal ring is accompanied
by an evagination of peritoneum through it anterior to the
gubernaculum, to constitute the processus vaginalis, which
eventually forms the parietal peritoneum of the scrotum.
When the testicle descends, it and the spermatic cord carry

The Male Genitalia 3

down their peritoneal fold which extends from the guber-
naculum below the origin of the spermatic artery in the
lumbar region. It is attached anteriorly to the spermatic
cord and posteriorly to the scrotal wall, to form the mesor-
chium which constitutes a membranous median partition in
the posterior part of each scrotal sac from the fundus to the
internal inguinal ring, as shown in Figs. 2, 3, and 4. The
processus vaginalis, in everting, pushes before it on the
lateral side the as yet invisible cremaster which quickly de-
velops when the testicle descends into a bright red, highly
functioning muscle. The scrotal sac thus consists of two
distinct groups of tissues, the general integument composed
of the skin and dartos and the intra-abdominal portion con-
sisting of the parietal peritoneum and the cremaster muscle
with the intervening fasciae. The two groups of structures
remain easily separable throughout life. The surgeon in
performing the "covered operation," when castrating ani-
mals with scrotal hernia, avails himself of this distinction

FlG. i.— The Testicle and its Attachments.
Right inguinal region and testicle of 24 hrs. colt. P, Processus vaginalis sur-
rounded by a dotted line and containing a curved sound, 5 ; G, first portion of
gubernaclum testis ; G', second portion of gubernaculum testis extending to the
epididymis,^ ; /■:, epididymis ; G", gubernaculum extending from epididvmi's (globus
minor) to the testicle ; T, testicle; A, testicular artery ; V, V, vasa de'ferentia ■ B
urinary bladder ; UA, umbilical arteries.

4 Diseases of the Genital Organs

and readily separates the two groups between the dartos
and cremaster so that he may ligate the structures of intra-
abdominal origin just at, or near to, the internal inguinal
ring.

In domestic animals, except the elephant, the descent of
the testicles into the scrotum is a prerequisite to fertility;
otherwise, spermatozoa are not formed.

In the descent of the testicle, the gubernaculum shortens,
the pi'ocessus vaginalis develops, and the tail of the epididy-
mis with the caudal end of the testicle traverses the inguinal
ring followed by the body and head of the epididymis and
cephalic end of the testicle.

The descent of the epididymis and testicle of ruminants
is directly downward. The gland comes to rest with the tail
of the epididymis and that portion of the testicle which was,
in the embryo, the posterior end directed downward. The
long axis of the testicle is perpendicular to the spinal column.
The epididymis thus rests upon the postero-lateral face of
the testicle, its head directed toward the internal inguinal
ring, its tail at the distal end of the testicle. The vas de-
ferens passes inward across the lower margin of the mesor-
chium and turns upward on the postero-median surface of
the testicle closely applied to it. The epididymis and vas
deferens are thus parallel and separated from each other by
the mesorchium or peritoneal fold connecting the visceral
and parietal layers. It is important to remember this ar-
rangement of structures when examining clinically the testi*
cles for evidences of disease.

In solipeds the cutaneous attachment of the gubernaculum
testis is farther posterior and higher than in ruminants.
This draws the tail of the epididymis upward and backward
causing its head and the corresponding end of the testicle to
tilt forward. The gland revolves through 90 degrees on its
short axis and comes to rest with its long axis parallel to the
spinal column. The vas deferens, instead of doubling back
along the postero-median surface of the testis as in the rumi-
nant, leaves the horizontal testicle immediately at the tail
of the epididymis and passes obliquely upward and forward,
to come in contact with the vascular cord in the inguinal
canal.

The Male Genitalia

Fig. 2 — Testicles of Bull.
Section through the posterior scrotal wall of the bull. The left testicle is
fully exposed, the right is covered by the cremaster muscle and fascia and by
the- scrotal peritoneum. C, Cremaster muscle divided longitudinally ; S, sper-
matic cord ; E, head of epididymis ; E' ', body ditto ; E", tail ditto.

6 Diseases of the Genital Organs

The gubernaculum of carnivora has its cutaneous at-
tachment higher and more posteriorly than that of solipeds,
the testicles are drawn further backward and upward so that
they rest between the posterior portions of the thighs, and
the glands are tilted so that their long axes are obliquely
downward and forward from the tail of the epididymis.
Finally, in swine, the cutaneous origin of the gubernaculum
testis is located high in the perineal region just beneath the
anus, and the tail of the epididymis with the lesser extrem-
ity of the testicle is caught and held at that point with the
head of the epididymis and greater end of the testicle pre-
senting almost perpendicularly downward. Its direction in
the scrotum is almost the reverse of the testicle of the
ruminant.

b. The epididymis, Figs. 2, 3, 4, is formed in part from
the tubules of the Wolffian body and partly from the Wol-
ffian duct. That portion of the epididymis derived from the
tubules of the Wolffian body leaves the anterior or cephalic
end of the embryonic testicle as a series of greatly coiled
tubules which constitute an enlarged mass designated the
head, or globus major, of the epididymis. The tubules all
converge to become the single tubule representing the Wol-
ffian duct. The latter, greatly coiled, forms the enlongated
body of the epididymis which is equal in length to about
three-fourths of the long diameter of the testicle. At the
caudal or tail end of the testicle the single tube becomes
greatly coiled to constitute a second enlargment, the tail,
or globus minor. The tube then becomes less coiled and
finally straight to constitute the vas deferens.

The head of the epididymis, through the tubules, the vasa
deferentia, is continuous with the tubular structure of the
testicle, and through these the spermatozoa escape from the
gland and reach the single tube of the body and tail of the
epididymis which in turn is continued by the vas deferens.
Only the head of the epididymis, therefore, is continuous
with the tissues of the testicle, while the body and tail lie
closely moulded against the gland and attached to it through
the agency of peritoneum and connective tissue. The tail and

The Male Genitalia 7

body of the epididymis are, therefore, only loosely attached
to the testicle and these permit, under some circumstances,
of wide separation from the gland. Thus in cryptorchidy in
the horse, the gubernaculum, as shown in Fig. 1, crosses the
tail of the epididymis and is closely attached to it. In enter-
ing the inguinal ring, the tail of the epididymis, with the
gubernaculum, must lead and physiologically the tail of the
testicle must accompany it. But sometimes the caudal end
of the testicle becomes caught at the ring, the tail of the

Fig. 3— Cross Section through Scrotum and Testicles of Bull Calf.
/, /, Hody of epididymis ; .?, 2, vas deferens on the anterior side of the
mesorchiuin.

epididymis, followed by the body, and even the head, passes
through the ring, the testicle turns upon its transverse axis,
and its head becomes incarcerated in the inguinal ring, its
caudal end remaining within the abdomen. The inexperi-
enced surgeon attempts to castrate the cryptorchid, en-
counters the epididymis in the peritoneal pouch and am-
putates it from the testicle under the impression that he is
castrating the animal. Later a second operation is neces-
sary and within the abdomen there is found a "third testicle."

8

Diseases of the Genital Organs

A study of Fig. 1 will show that in the descent of the
testicle and attached structures, a broad peritoneal sheet,
the mesorchium, is formed, extending from the spermatic
artery, A, to the gubernaculum, G. Midway in this a sec-
ond peritoneal duplicature leaves the broad expanse to en-
velop the vas deferens, V. The ruminant testicle descends
directly and in doing so, the first section of the gubernacu-
lum, G, passes through the inguinal ring followed by the tail

Fig. 4 — Cross Section through Scrotum of Young Bull viewed from

Posterior Side.
/, /, Body of epididymis ; 2, 2, vas deferens. The right testicle has revolved on
its long axis so that the epididymis and vas diferens with the mesorchium between
them rest upon the postero-external surface of the gland.

of the epididymis, E, with the caudal end of the testicle, and
when this point reaches the fundus of the scrotum and the
basal point of the attachment of G to the dartos, the descent
is completed. The testicle of the bull descends in a direct
line and when it comes to rest upon the bottom of the scro-
tum by its caudal end, it remains upright, with the epi-
didymis lying against its median side on the outer side of
the mesorchium, and the vas deferens upon its median side.
The spermatic artery, A, instead of leaving the gland per-

'/'//<■ Male Genitalia g

pendicular to the long axis, shifts its course and leaves the
head end of the testicle in a direct line parallel to the long
axis of the gland. This causes the vas deferens to turn ab-
ruptly at E and follow the mesorchium on its median sur-
face along the testicle until at the cephalic end of the latter,
it joins the artery to contribute to the spermatic cord. In
the bull the gubernaculum is anchored in the median wall of
the scrotum with the result that both the epididymis and vas
deferens are normally applied against the postero-median
side of the testicle, as shown in Figs. 2-4, the epididymis
behind, and the vas deferens in front of the mesorchium.
The head of the epididymis of the bull begins superiorly
upon the lateral surface of the cephalic end of the testicle,
passes across the posterior surface upward, medianward,
and then downward, in the form of an arc. It is flattened
against the surface of the testicle and is not materially en-
larged to form a "globus major" as in the horse. The tail
of the epididymis, or globus minor, on the other hand, is
large and prominent. It projects definitely beyond the cau-
dal end of the testicle and lies chiefly on the postero-median
surface where it is readily palpable and visible through the
scrotum. It is the dominant seat of infection in the epi-
didymis, with or without abscessation, and as such merits
special attention.

The descent of the testicle of the horse is at first funda-
mentally the same as that of the bull but upon reaching the
scrotum, the head end tilts forward and finally comes to rest
with its long axis parallel to the spinal axis. The epi-
didymis consequently lies upon the dorsal surface of the
testicle, lateral to the mesorchium, and the vas deferens, in-
stead of turning forward along the median side of the
mesorchium, is free from the gland and upon leaving the
tail of the epididymis, passes directly upward and forward
to join the artery near the external abdominal ring. This
results in a very marked difference in relation and subjects
the testicle of the horse to the possibility of torsion.

After the vas deferens has joined the spermatic artery, its
behavior is essentially alike in all species. It accompanies

io Diseases of the Ge?iital Organs

the artery through the inguinal ring, parts there from it
and, curving upward, inward, and backward, finally ap-
proaches its fellow from the opposite side, passes above the
neck of the urinary bladder between or beneath the seminal
vesicles, and enters the urethra from above. It is reaily
palable per rectum in the horse and bull.

2. The Vesiculae Seminales, Prostate, and
Cowper's Glands

The subsidiary sex glands and appendages to the sex
organs of domestic animals show wide variations. Each
vesicula seminalis is formed as an outgrowth from the vas
deferens. In most animals the vesicle consists of a long,
intricately folded, coecal tubule which, when incised, ap-
pears like an acinous gland. In solipeds the structure as-
sumes the form of a vesicle similar in outline to the urinary
bladder. The two vesicles in the horse are oblong, about
six to eight inches long by two inches in diameter, their
anterior ends round. The posterior ends taper sharply to
their outlet. They lie side by side above the neck of the
urinary bladder and the termination of the vas deferens.
Their walls are thick and their mucosa richly supplied with
glands. The vesiculae secrete a thin mucoid fluid, presumed
to dilute the semen at the time of ejaculation. Ordinarily
the vesicle contains a small amount of this secretion, and
occasionally a few spermatozoa make their way into the
cavity, but the organ does not serve as a seminal reservoir
in any domestic animal. In the gelding the vesiculae some-
times suffer from catarrhal accumulation. When attempt-
ing to catheterize geldings, the catheter sometimes passes
into the dilated orifice of the vesicle and lodges, rendering
it difficult, and sometimes impossible, for the operator to
pass the catheter into the urinary bladder.

In ruminants the vesiculae seminales are composed of
greatly elongated tubules so coiled as to give to the structure
the appearance of an acinous gland. In the bull (See
Figs. 5, 6, 7) the seminal vesicles are two oblong, nodular
bodies varying with the size of the animal from two to three

The Vesiculae Seminales

II

Fig. 5 Fig. 6

Glands Attached to Pelvic Urethra of Bull viewed from above.

FlG. 5. A, Accelerator urinae muscle sectioned horizontally ; C, C, Cowper's
glands ; H', Wilson's muscle ; I\ body of prostrate ; S, S, seminal vesicles ; D, D,
vasa deferentia ; U, ureter ; B , urinary bladder ; /, ischio-cavernosus muscle.

FlG. 6. A transverse section has been made through the posterior part 'of Wil-
son's muscle and the urethra and a median section through the accelerator.urinae
muscle and Gowper's gland. A, Accelerator urinae muscle ; C, Cowper's' gland
just above the urethra. Other lettering same as in Fig. 5.

*3

12 Diseases of the Genital Organs

inches in length, one to one and a quarter inches in width,
and approximately one half inch in diameter from above
to below. They are readily palpated per rectum, by which
means they are recognized as oblong bodies meeting poster-
iorly on the median line where their ducts empty into the
urethra, while anteriorly they diverge and drop down upon
a level with the urethra. They can be partially picked up
and give to the examiner a sensation of a nodular, acinous
gland. In swine the seminal vesicles are very large and
similar in character to those of the bull. The structures
are absent in the dog.

Physiologically they appear to be of fundamental im-
portance in those animals where present since they ap-
parently furnish a thin, mucoid secretion which contributes
the greater volume of the seminal fluid. In those animals
where it is not present, its place appears to be taken by an
increased volume and activity of the prostate gland.

The prostate glands, lying across the urethra just behind
the posterior ends of the seminal vesicles, are small in the
horse.

The prostate of the bull is of about the same volume as
either of the seminal vesicles. The body of the prostate is
a small, yellowish, transverse band lying across the urethra
just behind the termination of the seminal vesicles and in
front of the anterior end of Wilson's muscle, as shown in
Fig. 6. Posteriorly, it extends to the vicinity of Cowper's
glands. It surrounds, but lies chiefly above, the urethra.
On cross section it shows a U-shaped structure with the
urethral canal lying in the bottom of the U. Below and
at the sides, it is heavily covered by Wilson's muscle, and
above, the aponeurosis of the muscle stretches across from
side to side so that this, the more voluminous and important
portion of the gland, is completely hidden from sight and
touch. Only the body, or that portion not covered by
Wilson's muscle, is palpable per rectum.

The gland is of moderate size in the boar. In carnivora
the prostate glands are large and apparently perform the
functions of the absent vesiculae seminales. It is virtually

1 lie Vesiculae Seminalt

'3

Fig. 7. Same as Figs. 5 and 6 with same lettering. The left hand figure is from
a hull calf. In the right figure a median section through the posterior part of the
urethra has been made exposing to clear view Cowper's gland, C.

14 Diseases of the Genital Organs

only in the dog, amongst domestic animals, that the prostate
gland assumes pathologic importance.

Cowper's glands are present in solipeds, ruminants, and
the cat. They lie on either side of the urethra in the
perineal region above the ischial arch. They have little or
no known pathologic importance. The glands are absent in
the dog.

3. The Penis

The penis of domestic animals is normally completely
hidden, when at rest, within the sheath, and the glans penis
has a second covering, the prepuce. The soliped and dog
ordinarily protrude the penis out of both prepuce and
sheath during urination. The protrusion of the penis dur-

Fig. 8— Penis of Calf with Preputial Sac Unopened.
S, Sheath ; (7, urethra ; I\ prepuce, not yet free from the glans ; G, glans. Be-
tween the prepuce and the glans is soft embryonic tissue. F, fornix ; C, C, corpus
cavernosum.

ing coitus or sexual excitement is brought about by its
erection and by the relaxation of the retractor penis muscle.
In solipeds and carnivora, the retractor muscle is closely
applied throughout its length to the ventral side of the
penis, so that the length of the retractor muscle from
the tuber ischii to its penial insertion is identical with
the length of the penis from the ischial notch to the
muscular insertion. In ruminants and swine, the muscle
is not closely applied to the ventrum of the penis but
passes directly across the postero-inferior mouth of the
curvature of that organ without following its course so
that the length of the muscle is only about one-half that of
the penis from the ischial notch to the muscular insertion.

The Pern's

15

Thus it occurs that the protrusion and retraction of the
penis are brought about in a different manner in the horse
from that observed in ruminants and swine. The penis of
the soliped is protruded chiefly through an elongation of
the organ itself in the process of erection ; the penis of the
ruminant is protruded largely through the elimination of the
S-curve and temporary lengthening of the retractor penis
muscle.

Fig. 9— Penis of Calf with. Sheath forcibly Everted showing
Unopened Preputial Sac. x 3.
Ps, Preputial sac. Other lettering same as in Fig. 8.

4. The Sheath and Prepuce

Veterinary anatomists commonly use the words "sheath"
and "prepuce" as synonomous terms. When studying the
diseases of the genital organs, it is preferable to different-
iate the sheath and prepuce as two separate structures of
different embryologic history. It will simplify the study of
the pathology of these structures if the prepuce is regarded
as that sac which reaches from the fornix, or base of the
glans, to its apex when the organ is at rest. The sheath
begins at the apex of the penis, when the organ is at rest,
and extends forward to the exterior opening where it be-
comes continuous with the general integument. The pre-

i6

Diseases of (he Genital Organs

puce is wholly free from hairs; the sheath at its external
opening contains numerous hairs. In the bull these are
greatly developed to constitute the preputial tuft. The pre-
putial sac of solipeds forms and opens early in embryonic
life, but ruminants and swine are born without this struc-
ture. The new-born male soliped can readily protrude the
penis and commonly does so when urinating. The young
ruminant and porcine male cannot protrude the penis, as
is shown in Figs. 8 and 9, and necessarily urinate in the
sheath. With the advent of puberty, the frail layer of em-
bryonic tissue, serving to bind the prepuce to the glans,

Fig. 9a— Penises of Steers showing- various degrees in the
development of the Prepuce.

The left hand figure shows in the glans a few elevations from the granular

venereal disease.

The Sheatli and Prepiicc

17

slowly yields and the preputial sac opens, after which the
penis may be protruded. If the young animal is castrated
early, the formation of the prepuce is held in abeyance at
varying stages. The animal must then urinate within the
sheath throughout life and is subject to special diseases not
observed in entire males. In the young lamb, the urethral
orifice at the tip of the vermiform appendix of the penis
opens into the fundus of the sheath, the tip of the vermiform
appendix accordingly indicating the line of demarcation be-
tween the sheath and the eventual preputial sac.

Fig. 10 — Sheath, Prepuce and Retracted Penis of Bull.
F. Fornix ; G, glans ; P, prepuce ; S, sheath.

The epithelial coverings of the glans penis and the pre-
puce of solipeds are corneous and highly protective. They
produce a moist sebum in the sinus about the urethral open-
ing, but over the rest of its surface the sebum is normally
dry and forms gross masses of crusts which are readily
detached. In ruminants, swine, and carnivora, on the con-
trary, the preputial sac and glans penis are covered by a
very delicate mucous membrane which normally secretes
sufficient mucus to keep the parts constantly moist. The
prepuce of ruminants and of swine is accordingly more
vulnerable to abrasions and infections than that of solipeds,
and affects quite profoundly the type of lesions observed in
the two classes. The preputial secretions are not as a rule
markedly odoriferous.

The sheath of all domestic animals secretes a smegma
having a specific odor. The boar has two culs-de-sac in the
superior wall of the sheath which may contain as much as a

1 8 Diseases of the Genital Orgayis

pint of highly fetid urine and smegma. In the barrow
these cavities are much smaller but contain a similar fetid
material.

When the penis is protruded as in copulation, the glans
penis pushes its way out of the prepuce and that membrane
becomes everted to constitute the covering of the penis from
the fornix backward for a distance approximately equal to

Fig. ii — Sheath, Prepuce and Protruded Penis of Bull.

Lettering same as in Fig. 10.

the length of the glans. The further protrusion of the penis
requires the eversion of the sheath by which it becomes the
visceral covering of the base of the penis. It thus transpires
that the prepuce and sheath, the epithelial surfaces of which
face inwardly while the penis is at rest with a cavity be-
tween them and the penis, become reversed when the organ
is erected and constitute its immediate covering with its epi-
thelium facing outward. The general plan is indicated in
Figs. 8-11.

B. The Female Generative Organs

The genital system of the mammalian female consists of
the ovaries, oviducts, uterus, cervix, vagina, and vulva.

1. The Ovaries

The ovaries are the essential reproductive glands of the
female. They perform the fundamental generative func-

The Ovaries 19

tion by elaborating the ovum, or egg, which, after being
discharged from the ovary and fertilized by the spermato-
zoon, becomes a distinct, but in mammalia not immediately
an independent, being. The fertilized ovum is still depend-
ent for a time upon the oviducts for its transportation to the
uterus, upon the uterus for its nutrition and protection dur-
ing pregnancy and its expulsion at fetal maturity, and upon
the milk from the udder of the mother as food immediately
after birth.

The size, form, and location of the ovaries of domestic
animals differ greatly according to species, breed, age, and
individual ; even the two glands in the same animal are not
ordinarily alike and may vary greatly in size and form. The
ovary of the mare is much the largest seen in the domestic
animals, reniform, very dense owing to its thick tunica al-
buginea, with a smooth surface which is elevated here and
there in many cases by the presence near the surface of
cysts varying from less than 0.25 inch to 2 or more inches
in diameter. The gland attains its maximum size when the
animal has reached the age of three or four years, and be-
gins to atrophy at ten to fifteen years, to become very small
and fibrous as age advances. The ovary of the young mare
is usually Z\'± to 4 inches in its greatest diameter and weighs
about 4 ounces, while in the aged it may shrink to I14 inch
in its greatest diameter and in weight to 1/2 ounce. The
ovary of the cow is much smaller than that of the mare,
varying in its greatest diameter between 0.25 and 2 inches
and weighing about 0.25 to 0.5 ounce ; it is oblong and gen-
erally regular in outline ; its tunica albuginea is only moder-
ately dense. The ovary of the sow is comparatively very
large. The numerous ovisacs appear prominently on its sur-
face in such a manner that the most superficial of them
stand out entirely beyond the general ovarian surface at-
tached to the body of the organ by a somewhat constricted
neck. The ovary of the cat is very oblong, with pointed ex-
tremities, and of a bright scarlet color, with the ovisacs
standing out thickly over the surface in a way suggesting
a mulberry.

20 Diseases of the Genital Orgaiis

The ovary of the bitch is very small, livid in color, even
in outline, and, unlike those of other domestic animals, is
completely enveloped in the pavilion of the oviduct, except
for a minute oblong opening of so small size that the gland
can not be readily exposed to plain view through it.

The location of the ovary in the adult varies much with
species. The size of the gland, when normal, has little or
no influence upon its position. It rests upon the superior
surface of the anterior border of the broad ligament of the
uterus, naked in most animals but closely invested in the
bitch by the pavilion of the oviduct. The pavilion of the
oviduct in the mare is attached by one of its fimbria to the
ovary near its hilus, and its connection with the uterus is
further maintained by the utero-ovarian ligament, com-
posed largely of connective tissue and pale muscle fibers.
In the cow one of the fimbriae of the pavilion is adherent
to the outer or lateral end of the ovary. The ovary is also
influenced in its position by the round ligament, which is
analogous to the gubernaculum testis of the male. Arising
like the latter from the skin and dartos at the point where
the fundus of the scrotum of the male normally appears in
the given species, it extends up through the inguinal ring
behind the peritoneum, to become attached to the uterine
cornu or oviduct, not far from the ovary. Its attachments
tend to cause the ovary to follow a line of descent compar-
able to that of the testicle, but normally it becomes arrested
in its migration at some point between its place of origin
and the internal inguinal ring. In the bitch, it remains
closely applied to the sub-lumbar region, immediately be-
hind the kidney, virtually at its point of origin. In the
mare, its movement is arrested early and it remains rather
firmly suspended not far behind the kidney and above the
middle of the posterior part of the abdominal cavity. The
ovary of the ruminant lies loosely in the pelvis, alongside
the cervix uteri or the base of the cornu, behind the in-
ternal inguinal ring, or just in front of the pubic brim,
somewhat below it, resting upon the abdominal floor.. The
ovary of the sow floats quite freely in the peritoneal cavity

The Ovaries 21

and abnormally at times passes out through the inguinal
ring and comes to rest in that part of the perineal region
corresponding to the scrotum of the boar. The same dis-
placement of the ovary occurs rarely in bitches. It is
possible in any species. In general it may be said that in
the elongated uteri of multiparous animals the ovaries are
situated further forward than in the uniparous or biparous
genera. The location of the ovary is further modified by
the pregnant state. The gravid uterus, in its descent,
drags the gland downward and forward. It is also drag-
ged downward and forward by any increase in weight due
to disease of the uterus, oviducts, or ovary, such as pyome-
tra, tumors of the uterus, oviducts and ovaries.

The functional activity of the ovary modifies its size and
form. During the breeding life of the animal the cortex,
or peripheral area, of the ovary is largely composed of egg
columns, or masses, consisting of germinal cells arranged
in the form of a hollow sphere. Resting upon an intruding
mass of genital cells is a specially developed cell, the ovum.
The spheroidal hollow mass of cells contains a fluid, the
follicular liquid. When an ovum, or ova, matures and an
ovisac ripens, the female is in estrum or "heat." The
ovisac becomes distended with follicular fluid, presses aside
the superposed ovarian tissues, and attenuates or destroys
the tunica albuginea at the involved point. In most ani-
mals the active ovisac pushes its way above the general
ovarian surface as a hemispherical cyst with very thin
walls. In the mare it regularly protrudes at the hilus of
the gland, where it is not readily apparent. The ripe ovisac
— or ovisacs — ruptures at the close of estrum, producing a
lesion, which usually behaves differently according to
whether the discharged ovum becomes fertilized and un-
dergoes development into a fetus or, failing of fecundation,
perishes. The crater resulting from the rupture of the sac
becomes filled with lymph, blood, or other products of the
disturbances of the tissues. Should the ovum perish, the
lesion tends to heal rapidly, the blood and lymph in the
crater are resorbed, and from its walls there forms a char-
acteristic tissue, known as the corpus luteum of estrum.

22 Diseases of the Genital Organs

In the cow and in most other animals it is identical in form,
consistence, and volume with the corpus luteum of preg-
nancy, but its color differs. In the non-pregnant cow it is
chocolate-colored. Prior to the next estrum it atrophies.

Should the ovum become fecundated and undergo normal
development, the corpus luteum forming in the crater is al-
most always markedly yellow, lemon, or orange. It pro-
jects beyond the ovarian surface. It persists regularly up
to the time of parturition or abortion and for a varying
length of time thereafter. It is known as a true corpus
luteum. Pathologically, it sometimes atrophies during
pregnancy and is one of the causes of estrum in pregnant
animals. While in unipara the corpus luteum regularly
atrophies soon after the termination of pregnancy, the
atrophy is ordinarily dependent upon the expulsion of the
uterine contents. If the fetus perishes, but is retained and
desiccates or macerates, the corpus luteum remains. In
the sow (and presumably in other multipara) the number
of corpora lutea almost always exceeds the number of
fetuses, both living and dead, registering the fact that not
all ova discharged at a given estrum successfully mature.
When very few pigs are born in a litter, it indicates that
numerous ova or embryos have perished, rather than that
few ova were discharged. The size and form of the ovary
are accordingly modified by the presence of a ripe ovisac
or ovisacs or of a corpus luteum. In the cow the corpus
luteum is frequently larger than the remainder of the
ovary — approximately % to % inch.

2. The Muellerian Ducts

The beginning of the genital canal in the embryo con-
sists of two parallel rods, which later become excavated to
form tubes — the ducts of Mueller — extending from near
the posterior body opening, upward and forward to the re-
gion of the ovary. Eventually the two ducts fuse at their
posterior ends, producing a single tube. The ducts become
differentiated, through specialization in their development,
into four essentially separate segments, each having its
distinctive function. The anterior segment constitutes the

The Muellerian Ducts 23

oviduct, or Fallopian tube, dilated at its anterior end to
form the ampulla, or pavilion. The oviduct constitutes a
conduit through which the spermatozoa of the male may
pass from the vagina and uterus to the ampulla, there to
meet and fertilize the freshly discharged ovum. It serves
later to transport the ovum, fertilized or unfertilized, to
the uterus. The second, or middle portion of the genital
tube constitutes the uterine cavity, including the cornua,
in which the fetus may find lodgment, attachment, nutri-
tion, and protection during its development. The third
segment consists of the cervix, which acts as a barrier be-
tween the uterus and the vagina. The fourth, or posterior
segment — the vagina — extending from the uterus to the
vulva, serves first as an essential copulative organ and later
as a passage for the fetus at the time of birth.

The degree of the fusion of the Muellerian ducts and the
extent of the specialization of the different areas modify
greatly the form and relations of the various segments.
The entire genital tube, having a common embryonic origin,
has a similar structure, characterized chiefly by three coats
— peritoneal, muscular, and mucous. The peritoneal layer,
which invests the genital tract almost completely, is derived
from the peritoneum of the body wall, behind which the
ducts of Mueller originate. At its anterior extremity the
genital tract opens, through the pavilion of the oviduct,
into the peritoneal cavity. The peritoneum stops at the mar-
gin of the pavilion, to be succeeded by the mucous membrane
of the oviducts

The genital tract is supported by the broad ligaments,
which consist of two peritoneal layers resulting from the
departure of the genital tube from its seat of origin behind
the peritoneum. Along the line of their attachment to the
genital tube, the peritoneal investment is interrupted to the
extent of the area between the two peritoneal folds occupied
by the vessels, nerves, pale muscle, and connective tissue
fibres constituting the body of the ligament. At the pos-
terior extremity of the genital tract, where it opens into
the cloaca of the embryo, the peritoneum is reflected upon

24 Diseases of the Genital Organs

neighboring organs and the genital tube is surrounded by
the intra-pelvic connective tissue, so that eventually the
peritoneum covers, in addition to the oviducts and uterus,
only the more anterior portions of the vagina. The fusion
of the two Muellerian ducts, to form the vagina and uterus,
destroys the contiguous median walls of the tubes as far as
they coalesce, and the adjacent tubes become a single canal.
The broad ligament of the uterus varies greatly in its form
and amplitude acording to species and the functional activity
of the genital tract. In the bitch, cat, and sow, in which the
anterior extremities of the uterine cornua remain through-
out the life of the animal about as far forward as the post-
erior border of the kidney, the broad ligament maintains its
anterior attachment to the abdominal wall at or near the
point of origin of the ovary just behind the kidney; in the
ruminant, where the ovary and the anterior ends of the
uterine cornua are turned backward to the immediate
vicinity of the internal inguinal ring, the parietal attach-
ment of the anterior border of the ligament likewise moves
backward for a considerable distance so that the middle of
the recurved cornu tends to project forward beyond the an-
terior margin of the ligamentous attachment. When the
uterus of a quadrupedal mammal becomes gravid, the weight
of the fetus drags the occupied portion downward and for-
ward until the organ comes to rest upon the abdominal floor
in front of the anterior point of fixation of the ligament to
the abdominal wall. The genital tube is further maintain-
ed in its position by its attachment posteriorly to the vulva
and also by the round ligament of the uterus.

The muscular walls of the genital tube are composed of
circular and longitudinal layers of pale fibres, varying
greatly in the different sections of the tract and also accord-
ing to whether the animal be pregnant or not.

The mucous coat of the genital tract offers the greatest
possible variations and assumes widely differing and highly
important functions, according to the particular area con-
cerned.

The Muellerian Ducts 25

a. The 0 rid nets, formed from the anterior or ovarian ex-
tremities of the Muellerian ducts, are two long, tortuous
tubes, varying in length and other characters according to
species. Their length is much greater than the distance
from the anterior extremity of the uterine cornu to the
ovary. This distance is fixed by the utero-ovarian liga-
ment. In some animals the oviducts are naked and clearly
visible. In the bitch they are hidden in the abundant fat
of the broad ligament. The utero-ovarian ligament in the
dog and cat is very short, so that the anterior end of the
uterine cornu is virtually in contact with the ovary, while
the oviduct, 3 to 4 inches in length, is thrown into numerous
folds, to terminate in the immediate region of its origin, so
that casual observation, without dissection, might lead to the
assumption that the oviduct was well-nigh absent, whereas
it is very similar in actual length to that of other species.
When divested of any concealing coverings of peritoneum,
fat, or other tissues, the oviduct appears as a very convo-
luted white cord about 0.1 inch in diameter. It is very firm
to the touch and gives a sensation much like its analogue
in the male, the vas deferens. After it is dissected out from
the surrounding tissues and its numerous abrupt curves are
carefully eliminated, a very fine sound, as one of the tail
hairs of a horse, may be inserted at one opening and passed
through its entire length. While technically the oviducts
complete a communication between the peritoneal cavity and
the exterior, the tubes are ideally impassable, except to ova
and spermatozoa. They do not under usual conditions per-
mit the forcing of liquids through their canal when intra-
uterine injections are made under comparatively high pres-
sure. Clinically, they also offer valuable resistance to the
passage of bacteria. Frequently, pathogenic organisms,
such as those involved in abortion and retained placenta in
cows and other animals, travel along the oviducts, causing
disease of them or, reaching the ovary, induce abcess or other
disease, causing sterility.

The intimacy of contact between the peritoneal covering
of the oviduct and the muscular walls varies according to

26 Diseases of the Genital Organs

species. The investment is very close in ruminants and the
sow, so that the ducts are readily seen without dissection.
In the mare the duct is surrounded by much connective
tissue, which serves to conceal it from view until the peri-
toneal and fibrous coverings are dissected away. In the
bitch the concealment is further accentuated by large
amounts of adipose tissue.

The oviduct opens anteriorly through the ostium abdomi-
nale into the pavilion of the tube and posteriorly into the
uterine cornu through the ostium uterinum, which usually
projects somewhat as a small eminence into the cavity of
the cornu.

The muscular coat of the oviducts is characterized chiefly
by its density, which gives to it an almost cartilaginous con-
sistency, and its paleness, which amounts almost to trans-
lucency. The superficial layer of the mucosa of the oviducts
consists of ciliated columnar epithelium with the cilia vi-
brating toward the uterus. The oviduct is the most rigid
and undilatable portion of the genital tube. It provides
passage for the migration of the spermatozoa of the male,
which, in spite of the movements of the cilia in the contrary
direction, advance from the uterus toward the ovary, in
virtue of their inherent power of movement, meet the ovum
in the pavilion, and fecundate it. Later the oviduct conveys
the ovum, fecundated or not, from the ovary to the uterus.
In this function the cilia play an essential part. In rare
cases the fecundated ovum lodges in the duct and under-
goes partial development, to constitute tubal pregnancy, but
the undilatability of the duct serves, as a rule, to cause a
rupture of its walls and leads to the escape of the fetus from
the duct into the peritoneal cavity, either to cause sudden
death of the mother from hemorrhage or to constitute extra-
uterine, or abdominal, pregnancy.

b. The uterus, see Figs. 12, 13, a bifurcated, musculo-
membranous sac, designed for the reception, nutrition, and
protection of the ovum, finally takes the initial part in the
expulsion of the fetus at the time of birth. The uterus
varies greatly in form and disposition, dependent partly

The Mnellerian Ducts 27

upon the degree of fusion which has occurred between the
two tubes. There are recognized in domestic animals a
uterine body and two cornua, each having essentially like
functions in varying degrees. This is in sharp contrast to
the uterus of woman, where the uterine body constitutes es-
sentially the entire functional organ and the cornua are un-
important appendages. In the rabbit there is no uterine
body, but two distinct tubular uteri opening separately into
the vagina. In the bitch, cat, and sow the uterine body is
limited in extent and physiologically unimportant, rarely
containing placental attachments and only a small portion
of one fetus except while in transit at the time of birth.
The two cornua are extensive, and in them develop the
fetuses, so that physiologically the horns represent the two
separate uteri of the rabbit. In ruminants the uterine body
is larger and assumes higher importance physiologically,
while the cornua remain relatively large. The one, two, or,
very rarely, more fetuses are habitually located almost
equally in the body and the cornua, so that they represent a
middle stage in the transition between the double uterus of
the rabbit and the single uterus of woman, physiologically
devoid of cornua. In the mare the uterine body becomes re-
latively more important than in the ruminant.

The relative sizes of the cornua and of the uterine body
bear a close relation to the number of young brought forth
at a given birth. In muciparous animals, there are two
uteri, as in the rabbit, or the two extensive cornua with
functionally unimportant uterine body, as in the bitch, cat,
and sow. In ruminants, which are largely biparous, the
uterine body and cornua become approximately equal in ex-
tent and function. In the normally uniparous mare, the
cornua are smaller than the body.

The uterus and its cornua, within the above limitations,
are uniform in their plan of structure and function. They
consist of three coats : mucous, muscular and peritoneal.

The mucous coat constitutes the essential physiologic basis
of the organ. The mucous epithelium is very elaborate, con-
sisting superficially of columnar cells, embedded deeply with-

28 Diseases of the Genital Organs

in which are numerous tubular structures of a glandular
character, the utricular glands, believed to secrete the so-
called uterine milk, which is presumed to play an important
role in the nutrition of the ovum pending the formation of
the embryo and the establishment of its intricate connection

O,

O

0

Fig. 12 — Non-gravid Uterus of Mare viewed from the Dorsal Surface.
O, O, Ovary ; Ov, oviduct ; U, uterus ; UC, uterine cornu ; BL, broad
ligament ; I\ vagina ; Vu, vulva; CI, clitoris ; H, hymen.

with the mucous membrane through the chorion. Yet more
important, it is through a special elaboration of the uterine
mucosa that the highly intricate and essential maternal
placenta is formed, to constitute a physical and physiologic

The Muellerian Duels 29

bond between the mother and fetus during the span of preg-
nancy. The uterine mucosa is presumed to exert important
bactericidal powers, but a majority of uteri of cows, both
pregnant and non-pregnant, contain bacteria, several of
which appear competent to induce important disease (steril-
ity, abortion). In the non-gravid uterus, as is common
with distensible hollow organs, the mucous membrane is
thrown into numerous longitudinal folds, which facilitate
prompt and extensive dilation of the cavity without violence.

The muscular coat consists of two somewhat differentiable
groups of longitudinal and circular pale muscle fibers which
increase during pregnancy in size, activity, and, it is be-
lieved, to some extent in number. The proportion of the
longitudinal to the circular fibres varies.

The peritoneal layer of the uterus, which is derived from
that of the abdominal walls, envelops the organ completely
except at the points of continuity with the oviducts and
vagina and the interstice between the two peritoneal sheets
of the broad ligament at their points of uterine attachment.

The uterus is retained in position by its broad ligaments
and by its continuity anteriorly with the oviducts and pos-
teriorly with the cervix. The round ligament of the uterus,
arising from the skin, or dartos, in the region normally
constituting the fundus of the scrotum in the male, and
passing up through the inguinal canal and abdominal ring
and thence to the cornu, or oviduct, is functionally of scant
interest as a ligament of fixation. The uterus is located
immediately beneath the rectum, with its two cornua pass-
ing obliquely outward and forward on either side.

The uterus of the mare, with its cornua, constitutes a
somewhat crucial organ : the horns leave the body laterally
at right angles or somewhat recurved. The uterine body
is oblong, flattened somewhat from above to below, varying
from 5 to 8 inches in length and V/% to 2V-> inches in width.
Anteriorly, the cavity of the uterine body of the mare is
continuous with that of the two cornua, without a distinct
line of demarcation beyond an abrupt turn at right angles
or slight recurvation to its long axis. Each cornu is much

3Q

Diseases of the Genital Orga?is

like the body. The cavity of each is essentially equal to
that of the body, and the combined length of the two is
greater than that of the body. They end obtusely not far
from the ovary. Each presents at its apex a conical pro-
jection in which there is an opening, the os uterinum, or
uterine orifice of the oviducts.

Fig. 13 — Ovaries, Oviducts, Uterus, and Cervix of Cow.
/, Os uteri externum ; .?, right cornu; j, ovary ; 7, ovarian ventricle ; 5, ostium
abdominale of the oviduct, 6.

The Muellerian Ducts

3i

The peculiar crucial form of the uterus of the mare — the
two ample horns with the bases of their cavities directly
opposite, so that they have a common long axis — renders

FlG. 14— Genital Organs of the Bitch.
/, T, Posterior teat ; B, urinary bfadder ; V, vagina ; Uy uterus ; LUC,\eh uterine
cornu with a portion of the broad ligament, BL, lying across it ; RUC, right uterine
comu with its broad ligament, BL', turned outward exposing the full length of the
cornu ; O, O, ovary ; A', rectum ; A', left kidney.

32 Diseases of the Genital Organs

bicornual, or transverse pregnancy so easy that it occurs
not infrequently, resulting in a variety of transverse presen-
tations and causing some of the most serious dystocias
known to the veterinary practitioner.

In ruminants the uterine body is less pronounced in size,
when viewed exteriorly, and even less upon section, while
the cornua are much longer, quite tapering, and compara-
tively more ample than in the mare. The two cornua sep-
arate at a very acute angle, for a time extend forward al-
most parallel to each other, and then, becoming somewhat
more divergent, curve downward, outward, backward, and
finally upward, to end alongside the cervix within the pelvis.
The uterine body and cornua are much denser, narrower,
and more cylindrical than in the mare. The cornua taper
gradually from their bases at the uterine body to their
apices, where they pass almost insensibly into the oviducts.

The broad ligaments of the uterus of the mare arise
from the abdominal walls in the sublumbar region, begin-
ning not far posterior to the kidneys and extending from
this point obliquely downward, backward, and medianward
into the pelvic cavity, where the two layers of peritoneum
become reflected from the vagina upon the bladder, rectum,
and pelvic walls. Compared with the broad ligaments of
other domestic animals, they are limited in extent, especial-
ly transversely, causing a comparatively rigid fixation of
the uterus, and, since their anterior attachment is approxi-
mately in a direct line with the long axis of the cornua, the
entire organ is held well forward in the abdominal cavity.

The broad ligaments of ruminants, as compared with
those of the mare, are much more ample transversely, while
antero-posteriorly they are much less extensive. Their an-
terior point of attachment to the abdominal parietes is
much farther posterior than in the mare. This variation
in disposition and relations of the broad ligament produces
two well-marked clinical differences. In the non-gravid
uterus of the cow, the anterior parietal attachment of its
broad ligament is already posterior to the anterior curva-
ture of the uterine cornua, which in the gravid uterus be-

The Muellerian Ducts 33

comes sharply accentuated, so that almost the entire organ
rests anterior to its ligamentous attachments to the ab-
dominal parietes. In the cow and ewe, the broad ligaments
become largely powerless in preventing the pregnant organ
from revolving upon its long axis, so that torsion of the
uterus becomes quite common, while in the mare the more
rigidly fixed organ, with the anterior parietal attachment
of the ligament much farther forward, serves to render the
displacement comparatively rare. In ruminants, the com-
parative amplitude of the ligaments, with their anterior
point of parietal attachment but little anterior to the pelvic
inlet, permits more readily than in other animals inversion
and prolapse of the uterus and vagina.

In multiparous animals the broad ligaments are neces-
sarily very extensive and uniformly have their anterior
point of attachment to the abdominal walls far forward in
the post-renal region. In the bitch, the ligament at its an-
terior border is very short, so that the ovary and ovarian
end of the cornu are closely fixed in the sublumbar region,
just posterior to the kidney, tending to stretch the cornu be-
tween this anterior, sublumbar attachment and the vagina.
The ligaments are exceedingly ample, except at the anterior
border, and are much broader than the distance from the
parietal attachments to the position of the cornu, resulting
in a large antero-posterior fold in the ligament, which drops
down on the lateral side of the cornu and covers it in a
double fold of broad ligament (Fig. 14). Unlike other do-
mestic animals, the broad ligaments of the bitch are uni-
formly the seat of extensive deposits of fat, which cause
them to resemble the gastric omentum in general ap-
pearance.

c. The cervix, or neck of the uterus, consists of a power-
ful, sphincter-like segment of the genital tract, serving to
separate anatomically and physiologically the uterus from
the vagina. It is continuous anteriorly with the uterine
body and posteriorly with the vagina. It is a tubular organ
having walls very much thicker than those of the uterus or
vagina and very dense and rigid. In the cow especially the

34

Diseases of the Genital Organs

walls are intensely rigid and hard like cartilage. In rigid-
ity the cervix is closely analogous to the oviducts. In func-
tion, too, they are analogous: the one acts as a powerful
guardian of the anterior, or peritoneal opening of the
uterus; the other of the posterior, or vaginal portal. The
cervix varies in size in the different genera and in individ-
uals. The posterior end of the cervix projects into the
vagina as an obtuse cone, li/2 to 2*4 inches in the mare and

Fig. 15 — Cervices of Virgin Heifers opened from above on the
median line exposing the Annular Folds of the Mucosa.

/, First or vaginal fold ; 2, 3, j, the second, third and fourth folds respectively.

the cow. The cow has the longest and most powerful
cervix: it is 3 to 5 inches antero-posteriorly and 2 to 3
inches transversely. Its muscular walls are so rigid, and
its circular muscle fibres so contracted that it is exceedingly
difficult to dilate the canal mechanically, but it dilates freely
under the influence of estrum and parturition. The cervix
of the mare is shorter than that of the cow and the walls
far thinner and more pliable, rendering its canal readily
dilatable.

The Muellerian Ducts

35

The cervical mucosa is very complex. It is thrown into
deep and ample longitudinal folds, which upon cross section
(See Figs. 16 and 17) are seen to radiate centralward from
the basal mucosa, the summits of the rugae converging to
meet at the central axis of the cervical canal. The cervical
mucosa of the ruminant is also thrown into very ample cir-

Fig. 16 (Above) and Fig. 17 (Below).
Transverse section of the cervix between the Annular Folds

secoml 'th^^w"1 5? Uteri,f e"d- Fr°m left t0 ri*ht they ^present the first,
SScu\arwi1'of^Urth anUUlar "^ resPecti^ * Cervical canal; M.
Fig. 17— Annular folds viewed from the vaginal end.

36 Diseases of the Genital Organs

cular folds, with their summits, or free surfaces, directed
vaginalward. In the cow these circular folds measure one-
half to three-fourths of an inch from the base to the free
summit, and in disease may become elongated to several
inches and protrude into the vagina to constitute large
polypoid masses. The cervical mucosa is rich in special
mucous glands, which during pregnancy elaborate the
uterine seal — a very tough, firm, adhesive structure com-
pletely sealing the cervical canal from the uterus to the
vagina and constituting a highly elaborate and efficient bar-
rier against invasion of the pregnant uterus by infection
from the vagina. The cervical canal, elaborately barri-
caded by mucous folds and by the firm contraction of the
circular muscles, is extremely narrow, and in the ruminant
is besides exceedingly crooked (See Figs. 40, 41). This
disposition of the cervical mucosa has given rise in the past
to the fiction of "closure of the womb" and led to the belief
in "opening the womb" as a panacea in sterility. Anterior-
ly, the cervical canal opens into the uterine cavity by the os
uteri internum ; posteriorly, at the summit of the conical
projection into the vagina by the os uteri externum.

During estrum the muscular walls of the cervix relax and
the cervical canal dilates somewhat. When parturition en-
sues, the cervix, as such, becomes temporarily obliterated,
and the canal dilates sufficiently for the passage of the fetus
— that is, until its cavity is co-extensive with the pelvic cav-
ity and with the cavities of the uterus and vagina. At this
time it becomes virtually non-recognizable ; all the posterior
segments of the genital tract — uterus, cervix, and vagina
— become one continuous tube of virtually uniform calibre.
In that type of cystic disease of the ovaries causing nymph-
omania, the cervical canal undergoes pathologic dilation.
In the sow the cervix is not so well defined and no elaborate
uterine seal forms. Instead, the vagina and cervix extend
as an irregular tube up to the bifurcation of the essentially
double uterus.

d. The vagina is a musculo-membranous canal, formed
from the fusion of the posterior ends of Mueller's ducts and

The Muellerian Puds

37

FlG. is. Vulva and Vagina of Cow showing Gartner's Ducts.
. /. < »s uteri externum ; /, meatus urinarius ; 2, the outlets of the two ducts of
Gartner, rhe arrows point to small openings from the duct into the vagina
apparently from ruptures of small cysts or abscesses,

38 Diseases of the Genital Organs

extending from the cervix to the vulva. It begins at the os
uteri externum and ends posteriorly at the position of the
hymen, just anterior to the meatus urinarius, where the
vulva succeeds it. In the cow, incomplete fusion of the
Muellerian ducts in the vaginal segment is evidenced oc-
casionally by a muscular column of varying size stretching
from the roof to the floor of the vagina on the central line,
just against, but free from the vaginal end of the cervix.

The vagina of the mare is eight to twelve inches in
length and capable of lateral distension to the full size of the
pelvic cavity. It is lined with squamous epithelium. Its
mucosa is thrown into longitudinal folds, which, when at
rest, lie in contact with each other.

The mucous membrane of the vagina has in its deeper
portions numerous mucous glands which serve to keep the
surface at all times moist and which become especially ac-
tive during sexual excitement and at the close of pregnancy.
The muscular coat does not differ fundamentally in arrange-
ment from that of the uterus, though less in volume.

In the mare, the peritoneal covering extends backward
from the anterior extremity three to five inches, where it
becomes reflected upon the rectum, bladder, and pelvic walls.
In the posterior portion of its course, the vagina is sur-
rounded by the loose pelvic connective tissue, which permits
comparatively free movement.

The function of the vagina is chiefly copulative, receiving
the penis of the male during coition. During parturition,
it affords a passage for the fetus from the uterus to the
vulva.

In the mare and the cow the vagina frequently becomes
ballooned during manual exploration of the organ, owing to
an inflow of air at the moment of inspiration. During ex-
ploration the vulva is propped open by the hand or arm of
the operator, permitting the air to flow in, distending the
vagina so that it fills the pelvic cavity completely from side
to side and from roof to floor, presenting a vast cavity with
smooth, rigid walls, which are in close contact laterally with
the bony or ligamentous pelvic walls, superiorly with the

The Mucllerian Duds 39

sacrum except in the area where the rectum intervenes, and
inferiorly with the pubis except for the urinary bladder.
The ballooning of the vagina of the mare or the cow is
readily induced by intra-vaginal manipulation, by the in-
jection into the organ of bland, tepid fluids, or by various

Fie. 19. Vulva and Vagina of Cow Showing Gartner's
Ducts and Bartholin's Glands.
/, Meatus urinarius ; 2y j, cystic areas in the right duct of Gartner ; 4,
cervical canal laid open ; C, small cyst in Bartholin's gland.

other means. When the moist hand is introduced into the
organ at the time of estrum, marked inflation generally oc-
curs at once.

e. Gartner's Ducts. The Wolffian ducts of the embryo
do not wholly disappear in the female but persist in varying

40 Diseases of the Genital Organs

degrees as essentially functionless structures. The caudal
ends of the ducts persist as recognizable structures along
the floor of the vagina in the cow. They end posteriorly
just in front of the meatus urinarius where they lie near
together. They consist of very fine tubes which diverge

Fig. 20. Vulva and Vagina of Cow.
1, Meatus urinarius ; 2, 2, enlarged openings of Gartner's duct in which a
wire loop has been inserted; 3, opening of Bartholin's gland; 4, cervix.
The course of Gartner's ducts is indicated by arrows upon slight ridges.

slightly as they pass forward to disappear to the right and
left of the cervix. As a result of vaginitis, their orifices
occasionally become occluded and the structures assume the
character of cylindrical or spindle-shaped retention cysts.
(See Figs. 18, 19,20,21.)

The Vulva 4 r

3. The Vulva

The vulva, located immediately beneath the anus, consti-
tutes the posterior termination of the genital canal. In-
stead of being derived from the mesodermic Muellerian
ducts like the preceding organs, the vulvar epithelium origi-
nates from the ectoderm of the embryo.

Anteriorly, the boundary between the vagina and the vulva
is marked by the hymen, a transverse membranous expanse
stretching across the genital canal, which represents the
partition between the termination of the hind gut and the
proctodeum of the embryo, in the lower, or genito-urinary,
division of the cloaca. Generally it atrophies and almost or
wholly disappears in domestic animals before birth, but at
times it persists, either as vertical bands stretching across
from the roof to the floor of the vagina or as a circular ex-
panse largely closing the genital canal except in its center.
Rarely in domestic animals the hymen persists as an im-
pervious membrane.

The vulva opens externally by means of a vertically elong-
ated slit, bounded upon either side by the labiae vulvae,
which meet above and below to form the superior and in-
ferior vulvar commissures.

The vulvar labiae are covered externally by a very fine
skin. In the mare the growth of hairs is inconspicuous ; in
the cow, there is a prominent tuft of hairs about the in-
ferior commissure. The parts are so scantily haired that
their color, which as a rule is simply that of the adjacent
skin, becomes very conspicuous. In dark-skinned mares
with white faces, eyes, and feet, the cutaneous covering of
the vulva tends also to be devoid of pigment. The promi-
nence of the pigmentation of the skin of this part serves as
an aid in the clinical diagnosis of the venereal diseases of
horses, in which important discolorations occur.

The muscles of the vulva, which are chiefly circular, are
divided into two groups — the posterior and anterior con-
strictors. The posterior constrictor, situated within the
vulvar lips, constitutes a true sphincter, analogous to those

42

Diseases of the Genital Organs

about other body openings. Above, its fibers become lost
in the perineum and the sphincter ani ; below, some go to
the base of the clitoris and some pass downward, to become
lost in the skin and other tissues of the thighs. Their con-
traction brings about the closure of the vulvar opening.
The anterior group of muscle fibers invests the vulva in the

Fig. 21. Vulva and Vagina of Cow.
/, Meatus urinarius ; 2, 2, mouths of Bartholin's glands.

The arrows

point to very small cystic swellings in Gartner's ducts.

region of the hymen, just anterior to the meatus urinarius,
where, by their contraction, they produce a constriction on
the vulvo-vaginal border line.

Through the medium of the surrounding aponeuroses, the
vulvar muscles acquire continuity with the ischium, sacrum,

The Vulva 43

and postero-superior border of the sacro-sciatic ligament,
thus affording the vulva a secure attachment to the posterior
opening of the pelvis and furnishing a fixed base upon which
the entire genital canal may act in parturition. This fixa-
tion enables the uterus, when contracting, to force the fetus
back toward and through the cervical canal, the vagina, and
the vulva. It is this fixed base of attachment which enables
the contracting uterus at the time of parturition to dilate
and virtually efface the cervical canal, obliterating all its
mucous folds and increasing its calibre sufficiently to afford
room for the passage of the fetus.

The vulvar mucous membrane, continuous with that of
the urinary bladder and the vagina, is covered with squam-
ous epithelium and contains numerous mucous glands,
which are largely displaced near the labial margins and
about the clitoris by sebaceous follicles, the secretions from
which are odoriferous, especially during estrual periods,
when the odor becomes very marked in a manner charac-
teristic of the species.

Within the vulvar cavity are to be noted the meatus urin-
arius, clitoris, Bartholin's glands, and vaginal bulb. In the
mare the meatus urinarius, or terminal opening of the
urethra, is located along the floor of the vulva at a distance
of three to four inches from the external opening. The
urethral canal passes obliquely downward and forward
through the vaginal floor to the urinary bladder. In most
animals the meatus urinarius is comparatively small and in-
extensible. In the mare it is large and freely dilatable.
With patience, one, two or more fingers may be pressed
gradually through it into the bladder, and it is not rare to
find the opening, in heavy, coarse animals, sufficiently large
to admit without great difficulty the entire hand. The am-
plitude of the meatus urinarius in the mare is of special
significance clinically, as it favors eversion and prolapse of
the bladder, an accident not particularly rare in this ani-
mal, though extremely so in others. In the cow the narrow
meatus urinarius has beneath its vulvar opening a small
sac, or infundibulum. The supero-anterior wall of the

44 Diseases of the Genital Organs

sinus constitutes the inferior terminal wall of the ureter
causing it to act essentially as a valve, rendering cathe-
terization difficult.

Bartholin's glands, (See Figs. 18, 21) like Gartner's
ducts, are vestigial structures presumed to represent the
bulbo-urethral, or Cowper's glands, of the male. In the
cow they consist of small, glandular structures located be-
hind the vulvo-vaginal or hymeneal border, about midway
from floor to roof of the copulatory canal, backward, up-
ward and outward from the meatus urinarius. Their in-
terest lies largely in the fact that, like Gartner's ducts, their
mouths become occluded as a result of infection causing,
in the cow especially, retention cysts in the vaginal walls.

The clitoris is composed chiefly of erectile tissue like that
of the corpus cavernosum of the penis. The clitoris of the
bitch, like the penis of the dog, contains a small bone. The
functions of the clitoris are not important, although it is
alleged to exert an influence upon sexual excitement. In
observations upon a large number of sows from which
the clitoris had been removed by an empiric, the operation
had no influence upon estrum or fecundation and all bred
normally.

C. The Physiology of the Genitalia

The specific function of the generative organs is the pro-
creation of the species, including conception, the intra-
uterine nutrition and development of the fetus, and its ex-
pulsion after a certain degree of development. As the two
sexes in mammalia are wholly distinct, before conception
can take place a conjunction of the male and female —
coition, or copulation — must occur. In each individual
there are more or less apparent vestiges of each part of the
genital apparatus of the opposite sex, but these naturally
become arrested in their development in the embryonic
stage and remain wholly functionless.

Before reproduction becomes possible, the breeding ani-
mal must have reached the period of puberty, or sexual
maturity, which is marked by the advent of sexual desire.
When this period has been reached, ova mature in the ovary

The Vulva 45

of the female and spermatozoa in the testicle of the male.
Up to this time, the reproductive organs are dormant in so
far as their specific functions are concerned. Puberty, or
sexual maturity, occurs at varying ages in different species,
breeds, and individuals, depending upon the food supply
and rapidity of growth. It occurs quite uniformly in both
sexes prior to the completion of growth.

Reproduction is a complex physiologic process, accom-
panied by or associated with phenomena which bear an im-
portant relation to each other. In approximately the fol-
lowing order, there are observed the maturation of the
ovisac — or Graafian follicle — estrum, copulation, rupture of
the ovisac, fecundation, and possibly menstruation. The
chain of phenomena is finally completed by pregnancy, par-
turition, and the nutrition of the new-born.

The ovaries consist at first of a mere thickening of the
peritoneum, due to an elaboration of its epithelial cells. The
external cell layer becomes columnar. The cells of the
deeper strata assume a more or less cuboidal form, to con-
stitute the germinal cells, and certain of their number be-
come distinctly larger than the others, to form the primitive
ova. The deeper epithelial layers are broken into irregular
columnar masses, or egg columns, through the growth
among them from below of blood vessels and connective
tissue. Prior to birth, in those young which are born in a
well developed state, and shortly after birth in the imma-
ture young like that of the rabbit, some of the primitive
ova become materially changed, to constitute permanent
ova. In the cell masses the permanent ova, developed from
the primitive ova, become much larger than the others,
while the nucleus, or germinal vesicle enlarges and its en-
veloping membrane becomes distinct. The contents of the
nucleus become massed at one point and form a distinct
reticulum, in which one or more nodal points enlarge to
constitute the nucleolus, or germinal spot. The neighbor-
ing germinal cells become arranged about the ovum in such
a manner as to enclose it completely in a follicle, which has
at first a single layer of cells. Later a second layer of cells

46 Diseases of the Genital Orga?is

forms within the first, closely investing the ovum and con-
tinuous at one point with the cellular layer of the wall.
This mass of cells, bearing within it the permanent ovum,
constitutes the discus yroligerus.

The cells of the follicular walls multiply rapidly. The
external enveloping layer extends more rapidly than the
inner discus proligerus causing a separation between the
two, except at the point of attachment of the latter. A sec-
tion through the discus proligerus and follicle reveals a
crescent-shaped cavity filled with fluid. Fully developed,
this constitutes the ovisac, or Graafian follicle, which con-
sists of the outer layer of follicular cells, or tunica
granulosa, and the inner granular cells, the discus proli-
gerus, embedded within which lies the ovum. The cavity
of the follicle between the two masses of cells is occupied by
the follicular fluid. The immature egg sac usually lies
deep within the ovary. As it matures and the volume of
follicular fluid increases, it approaches the surface of the
ovary. In the cow about one-half of the ovisac protrudes
finally beyond the general ovarian surface as a hemisphere,
rhile the other half remains below the general level of the
gland. The ripe ovisac of the cow is about one-half to five-
eighths of an inch in diameter. In the sow the ovisac grows
completely beyond the ovarian surface and appears as a
pedunculated cyst one-fourth inch in diameter. In push-
ing toward and beyond the ovarian surface, the tunica al-
buginea, or ovarian capsule, atrophies and disappears at the
summit of the distended sac, and the peritoneum is pushed
outward. The follicular wall becomes very thin. During
rectal palpation in the cow, the ovisac often ruptures under
very slight pressure. During the maturation of the ovisac,
the ovum undergoes important changes. Before the ovisac
ruptures, the nucleus of the ovum passes from the center of
the egg toward its periphery ; a definite vitelline membrane
is formed within the zona radiata immediately about the
nucleus of the ovum; the nucleus becomes indistinct; and,
while the yolk retracts slightly from the vitelline membrane
at one point, the first polar body, a small mass apparently
derived from an unequal division of the nucleus, is assumed
to be extruded.

Esirum

47

When the egg has fully ripened and the ovisac has com-
pleted its growth and is fully distended with fluid, estrum,
or "heat", occurs.

2. Estrum

Preliminary to reproduction, an irresistible sexual desire
occurs, leading to coition.

Estrum finds expression in various ways in different
species of animals. In general there is a nervous excitabil-
ity, the external genitals are swollen and vascular, and there
is an increased secretion of mucus from the vulva and the

Germinal EpAketiuTn

"Primary Follicle

jitr — t- ....,, ■ / Primary hollicle

• . ■.-.. fflS

• : H <"

Fig. 22 — Section of ovary of cow showing a follicle,
0.6 mm., with ovum.

vagina. In the mare, when other horses — especially stal-
lions— are present, there are frequent emissions of urine in
small quantities, and the vulvar lips are frequently opened
and the erected clitoris protruded. In the cow and the sow,
the female imitates the copulatory act of the male by mount-

48 Diseases of the Genital Organs

ing, or standing to be mounted by, other animals of its
species. The ewe ordinarily shows little or no evidence of
estrum except in the presence of the male. In certain
pathologic cases (nymphomania) the cow especially does
not confine her expressions of sexual desire to her own
kind, but may attempt to mount other species of animals.

In all animals there is a tendency during estrum for the
female to wander from home. This is most noticeable in
the bitch and the cat, which, if not securely confined, disap-
pear, tending to wander long distances and to remain away
during a large part or all of the estrual period. The sexual
wanderings of domestic animals constitute an interesting
chapter in the dissemination of infectious diseases.

Fig. 23 — Section of ovary of cow showing a follicle ot
2 mm., with ovum.

The female exhibits sexual desire only for a compara-
tively brief time, during the existence of a ripe ovisac or
ovisacs in the ovary. The duration of the estrual period
varies widely, according to species. It is shortest in the
cow, ranging ordinarily between eighteen and twenty-four
hours, or a trifle longer. The mare is usually in estrum for
several days. The bitch is in estrum for ten to fifteen days.
In healthy females, the estrual cycle is quite uniform. In
the cow it is twenty to twenty-two days, usually twenty-one ;
in the mare 3 to 4 weeks; in the bitch ordinarily every six
months. The frequency, intensity, and duration of estrum
are profoundly modified by the state of nutrition, diseases
of the genital organs, and by serious systemic diseases.

Ovulation 49

3. Ovulation

At about the close of estrum, in those animals where the
phenomena have been studied, as in the cow, the distended
ovisac ruptures and discharges the ovum. Prior to the rup-
ture of the ovisac, preparation for the detachment of the
ovum from the enveloping and supporting cells of the dis-
cus proligerus has been made by the formation of numerous
vacuoles in the mound, as shown in Fig. 24. The attachment
of the ovum is rendered exceedingly frail, subject to de-
tachment upon the slightest disturbance. The ovum is ap-
parently maintained in situ chiefly, if not wholly, by the

Corona. vadiata.

pelluci^a.

Fig. 24 — Section of ovary of cow ■with a nearly ripe ovum in

an ovisac, 5x7 mm., showing vacuoles in the

cumulus preparatory to ovulation.

sustaining pressure of the follicular liquid. When the ovi-
sac ruptures, the ovum, the follicular fluid, and some of the
granular cells of the discus proligerus in which the ovum
was embedded are discharged into the pavilion of the ovi-
duct, which is at this epoch erected and closely applied to
the ovary at that point where the ovisac is about to rupture.
Here, if successful copulation has occurred, spermatozoa are
already present, meet the ovum and a single spermatozoon
fuses with each, to constitute fertilization.

The precise period at which ovulation occurs, as related
to estrum, has not been determined for all domestic animals.
In the rabbit, which has given birth to young, copulation

5<d Diseases of the Genital Organs

occurs immediately following parturition. Ovulation fol-
lows about twelve hours later — an interval sufficiently great
for the migration of spermatozoa from the vagina to the
ovary. In the cow, estrum persists ordinarily for but twelve
to twenty-four hours, and ovulation occurs at about the
close of this period. If copulation occurs early in estrum,
better opportunity is afforded for the arrival of spermatozoa
at the pavilion of the oviduct prior to the rupture of the
ovisac and discharge of the ovum. In swine, carnivora, and
to some degree in solipeds, the estrual period is prolonged,
extending over several days. In these there are no accurate
data of the epoch of ovulation. Probably ovulation occurs
at a time corresponding to that observed in the cow — that is,
at about the close of estrum.

Fig. 25 — Diagram of ovary of cow showing- comparative
sizes of the follicles shown in Figs. 22, 2b, 24

The number of ovisacs rupturing at a given estrual period
corresponds as a rule with the maximum number of possible
fetuses. It is said that rarely two ova are contained in one
ovisac. I have been unable to verify this statement, and
have in all cases of twins in the cow observed two corpora
lutea, sometimes both in one ovary but most frequently one
in each. Sometimes a single fertilized ovum divides to con-
stitute two embryos, which form identical twins in man,
but this is not known to occur in domestic animals, though
it probably does so. In multipara, it is assumed that there
are at least as many ova discharged, from as many ovisacs,
as there are embryos.

Ovulation 5 1

Physiologically, estrum and ovulation are inhibited by
pregnancy ; abnormally, they occur while the animal is preg-
nant and the fetus alive and well.

4. Menstruation

If a heifer or a cow fails to conceive, when estrum, copu-
lation, and ovulation have occurred, or if copulation has
failed, she regularly menstruates. If she conceives, she
does not as a rule menstruate. Evidently the engorgement
of the uterus during estrum is designed to fit the genital
tract for the protection and nutrition of the fertilized ovum.
Should fertilization fail, capillary hemorrhage from the
placental areas follows. The volume of hemorrhage is suf-
ficient that the blood is expelled through the vagina and
vulva to stain the exterior vulvar region and adjacent parts.
Upon the killing floor of the abattoir, heifers or cows having
in their ovaries ripe ovisacs have engorged uteri with special
engorgement of the placental areas. If the ripe ovisac has
ruptured, and presumably fertilization has failed, the pla-
cental areas are covered over with thin coagula of bright
red blood. Later this is expelled, to constitute the menstrual
fluid. The exact significance of menstruation is not fully
determined. By my observations I have been led to the con-
clusion that menstruation constitutes reliable evidence of a
failure to conceive, so far as the estrum just past is con-
cerned. Apparently there are exceptions to the rule.

There is much controversy amongst embryologists and
human obstetrists regarding the relationship between men-
struation, ovulation, and conception. There is no outstand-
ing estrual period in woman, and scant opportunity for the
clinical study of ovulation. The cow offers the best available
animal for such study. Her estrual period is sharp, clear,
and brief; the ovary is conveniently palpated per rectum;
the ripe ovisac is clearly recognizable by palpation ; and the
crater of the recently ruptured sac is clearly palpable. The
order of the phenomena is clearly and indisputably —
maturation of the ovisac, estrum (with copulation, if oppor-
tunity exists), ovulation, and fertilization, or, if fertilization

52 Diseases of the Genital Organs

fails, menstruation. The cow is probably representative for
mammalia in general.

5. The Corpus Luteum of Estrum

Ovulation leaves behind a crater having the same diame-
ter as the ovisac which ruptured. Into this crater, physio-
logically, a small amount of blood escapes at once and quickly
clots. The walls of the crater rapidly approach each other
and within a few hours there remains a small, deep cavity,
about one-eighth to three-sixteenths of an inch, filled with a
blood clot. Ovulation has necessarily caused a lesion, com-
parable in some respects to a wound, in which ordinarily the
wound cavity is to a greater or less extent filled with coagu-
lated blood, and like the wound in the body covering, the
lesion offers an open avenue for invasion by any bacteria
existing in the peritoneal cavity or within the oviduct. Such
infection frequently interrupts the orderly physiologic pro-
cesses and leads to a variety of pathologic lesions.

Soon after the rupture of the ovisac and discharge of the
ovum, there is elaborated from the walls of the crater a
distinctive tissue designated the corpus luteum (yellow
body) because its prevailing color in pregnant animals is
yellow. The corpus luteum consists of a network
of capillaries, some connective tissue, and essentially of
special lutein cells emanating from the membrana granu-
losa and theca interna of the ovisac. The method of growth
causes the corpus luteum to repeat at first the form of the
crater from the sides of which it originates. Originally it
is a cup-shaped structure opening upon the surface and
filled in its center by the small blood coagulum which formed
in the crater of the ruptured ovisac immediately after ovu-
lation. The corpus luteum pushes its way out somewhat
through the rupture in the ovarian tunic and projects (in
the cow) somewhat above the ovarian surface as a cylin-
drical or conical mass of granulations, one-eighth to one-
half inch in diameter. The cavity in the center of the cor-
pus luteum of the cow is gradually eliminated by the growth
of the lutein tissue and at the same time the epithelium of

The Corpus Luteum of E strum 53

the ovary draws over the naked granulating surface until
at seven to ten days, the structure, if physiologic, has lost
its central cavity, the blood coagulum has disappeared and
the epithelium of the ovary has recovered its continuity.
The corpus luteum of the cow is then five-eighths to three-
quarters of an inch in diameter, usually spherical or ovoid,
but subject to numerous variations, has an even contour
and is firm in consistence. It is readily recognized in the
cow by rectal palpation and usually easily dislodged by digi-
tal compression. If the ovum discharged is not fertilized,
or if the fertilized ovum perishes quickly, the corpus luteum
of the cow is not yellow but with great uniformity is choco-
late or liver-colored. Its size, contour, and consistence are
essentially the same as in pregnancy. The volume remains
virtually constant after its growth has been completed at
seven to ten days until at a period of about three or four
days prior to the maturation of the next ovisac, when it
commences to atrophy rapidly, and when about one-fourth
inch in diameter, a new ovisac ripens, generally in the oppo-
site ovary, the animal is again in estrum and ovulates. The
old yellow body has permanently ceased, so far as known,
to exert any influence upon the reproductive processes. It
continues to atrophy slowly. There are frequently visible
in a single section in the ovary of the cow, three to five old
corpora lutea, one-eighth inch or less in diameter, with
white strands of connective tissue scattered amongst the
nests of lemon or orange-colored lutein cells.

6. Copulation

The male ordinarily exhibits little or no sexual desire ex-
cept in the presence of a female in estrum, but the testes
function constantly. The sexual desire may be activated
at any time when a female in estrum approaches sufficiently
near to be recognized, and copulation occurs when opportu-
nity offers.

During the act of copulation, the semen from the male is
ejaculated into the vagina of the female, possibly in part
into the cervical canal. The semen has as its essential con-

54 Diseases of the Genital Orga?is

stituent the spermatozoa, or sperm cells, elaborated by the
testicles. Prior to copulation the spermatozoa lie chiefly in
the epididymis and vas deferens, being exceedingly concen-
trated in these tubules. At the moment of ejaculation,
there is thrown into the pelvic urethra the liquid secretions
from the vesiculae seminales, prostate and Cowper's glands
which serve to dilute greatly the very dense mass of sper-
matozoa and facilitate the forcible ejaculation of the semen.
Chief amongst these glands in the bull, are the seminal vesi-
cles. If these are removed, or are so diseased that their
function is impaired or in abeyance, the bull copulates with
difficulty apparently owing to the absence of the diluent
fluid from these structures. Some think that most or all of
the semen is ejaculated directly through the cervical canal
into the body of the uterus and that the urethral opening of
the male comes in direct contact with or enters the os uteri.
Harms, quoting Duranton (Journal de Lyon, 1888), cites a
case of alleged rupture in the uterine cornu of a cow during
copulation, owing to the entrance of the penis of the bull
through the cervical canal, but this must have been an error
in clinical history. A study of the cervical canal of the cow,
as delineated in figures 15, 16, 17, suffices to refute any alle-
gation of the entrance of the penis into it. It is an anatomi-
cal impossibility. In the mare, with a far more dilatable
cervical canal, copulatory injuries from an unusually long
penis occur in the vagina — not in the uterus. Male animals,
after the amputation of a considerable portion of the penis,
are quite as fertile as before, although the stump of the or-
gan can not reach the os uteri. Clinically, a large part of the
semen is ejected from the vulva of the female immediately
after copulation, -and quantities of semen are readily ob-
tained from the vagina at this time.

The condition essential to fecundation, so far as the male
is concerned, is that physiologically perfect spermatozoa
shall gain the cervical canal, traverse the uterus and ovi-
ducts, and meet the ovum in the pavilion of the oviduct. Of
the countless myriads of sperm cells in one discharge of
semen, but one can take part in the fertilization of the ovum.

The migration of the spermatozoa from the vagina to the

Fertilization 55

pavilion of the oviduct involves a period of brief duration,
probably varying in different species. Marshall estimates
that in the rabbit, the migration of the spermatozoa requires
but fifteen minutes to two hours. Copulation occurs eight
or more hours prior to ovulation so that the spermatozoa
ordinarily arrive at the pavilion of the tube six or more
hours prior to ovulation and lie in wait preparatory to im-
mediate fertilization. According to clinical observations in
cows, ovulation occurs at approximately eight to twelve
hours after the cessation of estrum. Ovulation is apparently
hastened (and estrum abbreviated) by copulation. The in-
fluence of copulation upon ovulation in higher animals ap-
pears somewhat analogous to insemination in the frog,
where the sexual embrace of the male apparently favors the
ovulation. It appears from available data that the sper-
matozoa of the bull traverse the twenty to twenty-five or
more inches of the genital tube (cervix, uterus, and ovi-
ducts) in two or three hours and are present in the pavilion
of the oviduct some time prior to ovulation. In this manner
the single ovum meets at once many spermatozoa so that
its prompt fertilization is luxuriantly provided for.

9. Fertilization

Fertilization, fecundation, or conception follows when a
healthy female copulates naturally with a healthy male.
Since copulation, in those animals in which the sequence is
known, precedes ovulation, spermatozoa have already mi-
grated through the genital tube and have reached the pa-
vilion of the oviduct, where they await the discharge of the
ovum. One spermatozoon penetrates each egg and traverses
the zona radiata to the nucleus. The nucleus of the sper-
matozoon fuses with that of the ovum. A beginning has
been made for the development of a new individual. The
animal has conceived.

10. The Migration of the Fertilized Ovum

After the ovum has been fertilized in the pavilion of the
oviduct, it must traverse the length of the tube, reach a

56 Diseases of the Genital Organs

suitable location in the uterus, and become implanted there
before it can advantageously receive ample nutriment for
needed growth and development. The migration through
the oviduct must occur with sufficient celerity that the ovum
shall enter the uterine cavity prior to any noteworthy
growth in volume for the reason that the lumen of the tube
is so small that important increase in the size of the egg
would imperil its passage. It is probably owing to patho-
logic decrease in its lumen that the ovum occasionally
lodges in the oviduct of woman (tubal pregnancy), de-
stroying the life of the embryo and greatly imperilling
the life of the mother. The migration of the ovum,
unlike that of the spermatozoa, is passive and is brought
about by the action of the cilia of the tubal epithelium which
wave toward the uterus, and probably by muscular action
in the walls of the oviduct. The time required in domestic
animals is not known but in the cow it is probably eight to
fifteen days.

11. The Corpus Luteum of Pregnancy

The formation of the corpus luteum of pregnancy is fun-
damentally like that of estrum as described above. Its
source of origin, its method of growth and its ultimate vol-
ume is the same. It presents two notable characters which
serve to distinguish it.

The color of the corpus luteum of pregnancy in the cow
is regularly of a bright lemon color, in contrast with the
chestnut or muscle-colored structure of estrum. The color
distinction is not universally present. Amongst approxi-
mately 2000 pregnant cows and heifers, I have observed two
corpora nigra, or black bodies, one normal in size, the other
about double the normal volume. The rule of chestnut color
for the corpus luteum of estrum and lemon or orange color
for the corpus luteum of pregnancy appears at times to be
reversed. Some have claimed that the corpus luteum of
estrum is often lemon or orange-colored but I believe most
of these reports are referable to error. That is, observers
not familiar with their ground see in the abattoir an empty

The Corpus Ltdeum of Pregnancy

57

53 Diseases of the Genital Organs

uterus and an orange-colored corpus luteum and consider
the structure that of estrum. But there has been pregnancy
and the corpus luteum has not yet disappeared.

The duration, or life, of the corpus luteum of pregnancy
presents a strong contrast in most domestic animals to the
corpus luteum of estrum. The corpus luteum of pregnancy
has as its minimum physiologic life the duration of preg-
nancy. The simplest cycle in ovulation, pregnancy, and
atrophy of the corpus luteum is in the rabbit where the dura-
tion of the corpus luteum and of pregnancy are identical.
The doe conceives, the corpus luteum forms, in four weeks
she gives birth to young, the corpora lutea have atrophied,
new ovisacs have matured and immediately after parturi-
tion she copulates with the male and conceives.

In the cow, the corpus luteum forms promptly after con-
ception, attains its growth in seven to ten days and physio-
logically remains static until thirty to ninety days post par-
turn, or for a period of ten to twelve calendar months.
Pathologically (retained corpus luteum, pyometra, macer-
ated or desiccated fetus, etc.), the corpus luteum of preg-
nancy may remain static indefinitely and inhibit estrum and
ovulation. In the mare it appears that the corpus luteum
of pregnancy atrophies promptly after parturition so that
she is ordinarily in estrum at seven to nine days post par-
turn, thus giving it a physiologic duration of about three
hundred fifty-five days. In those animals which have short
periods of pregnancy and are normally in estrum semi-an-
nually, like the bitch, the corpus luteum appears to persist
for a comparatively long period after parturition or estrum.

12. The Fetal Membranes

After fertilization has occurred, the ovum passes through
the oviduct, propelled largely by the cilia of the tubal epi-
thelium, and soon reaches the uterine cavity. During its
tubal migration, the ovum has undergone segmentation.
The stored food material in the ovum is insignificant, so
that it must be dependent upon the uterus for any nutrient
material for the maintenance of life and development. The
nutrition of the ovum, embryo, and fetus is throughout in-

The Fetal Membranes

59

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Diseases of the Genital Organs

direct : that is, when the ovum is discharged from the ovi-
sac, its direct connection with the tissues of the mother is
finally and permanently severed. The fertilized ovum at
first lies free upon the uterine mucosa while nutrient fluids
poured out by the endometrium are absorbed by the ovum
to provide for its development. Thus far, the life of the

Fig. 28 — Fetal Cotyledon of Cow showing primary and adventitious
Placentae. Photograph.

ovum has been supremely precarious, relying wholly upon
a delicately balanced physiologic state of the oviduct and
uterus and their contents. It has no known inherited power
to resist the attacks of any bacteria contained within the
tubo-uterine cavity and has no known power to maintain a
given location. Clinical observation leads readily to the be-
lief that the mortality of the fertilized ova during this period

The Fetal Membranes

61

is the greatest occurring at any epoch in life. The death is
unseen, and is necessarily designated sterility. The newly
created individual needs greater fixidity in its place, more
accurate protection against invasion, and especially a safe
and abundant food supply. While the ovum lies free in the
uterine cavity, any liquid nutriment available is in constant
danger of being contaminated by any bacteria or other dele-
terious substances present in the uterus. Such toxic sub-

FiG. 29 — Maternal ( bottom 1 and Fetal (top) Cotyledons of Cow
partly detached. A portion of the uterine wall seen
at bottom and of choriom at top.

stances constitute a menace by threatening to invade the
new individual mixed with nutritive substances, through a
common portal, the external layer of the morula. The nu-
trition needs to be more dependable, abundant, and imme-
diate, and guarded as far as possible against contamination
from every source. The uterine seal hermetically closes the
cervical canal to direct invasion from the vagina. Since
the ovarian end of the genital tube, though opening into the

62 Diseases of the Genital Organs

peritoneal cavity, is very narrow and the peritoneal cavity
is assumed to be physiologically sterile, the embryo lying in
the genital tube between the tubal and cervical openings,
once the uterine seal is physiologically formed, enjoys a high
degree of safety in these directions. Two vital dangers

Fig. 30 — Same as Fig-. 29, showing a different type of Placental
Crypts with thickened, fibrous partitions possibly
due to prior disease

remain. There is constant peril to the embryo from bacte-
ria, already old habitants of the utero-cervical cavity, and
there is a further threat of unknown potentiality from
micro-organisms floating in the blood of the mother, which
may invade the uterus from the blood stream. These dan-

The Fetal Membranes 63

gers are obviated in part by the formation of the placenta.
The placenta consists of two complementary parts — one
due to a special development of the whole or certain areas
of the uterine mucosa, or endometrium, of the mother, and
the other to an analogous development from the chorion of
the fetus. The embryo or embryos early become arrested
and detained for the rest of intra-uterine life in a definite
and comparatively fixed location. In unipara the rule is

Fig. 31 — Chorionic Placenta of Ewe.
The right hand figure includes a portion of the Chorion.

that the embryo becomes located partly within the cavity
of the uterine body, with the remainder of its body lying in
that horn of the uterus from the corresponding ovary of
which the ovum was derived. Pathologically, the fetus 01 a
soliped, instead of growing into the uterine body, may ex-
tend across the ovarian end of the uterine body cavity into
the opposite horn, to constitute bicornual pregnancy. In
multipara the embryos become halted at approximately

^4 Diseases of the Genital Organs

equidistant points in the cornu corresponding to the ovary
from which the ova emanated. If but one embryo is pres-
ent in a horn, it is ordinarily near its base, and very rarely
may become, as in the mare, bicornual. When near full
term, the fetuses may be very irregularly located, owing to
the fact that one or several of them has perished and later
has been absorbed.

Fig. 32 — Left. Uterine Cotyledon of Ewe,
from which Fetal Cotyledon has been removed, leaving a cavity.
Right. Median section of Maternal and Fetal Cotyledon of Ewe,
with portion of Chorion attached.

At the point where a fertilized ovum becomes located
within the uterus, the adjacent uterine walls promptly as-
sume increased functional activity, become increased in
thickness, and show heightened vascularity. The vital
changes occur in the endometrium, and particularly in the
placental areas. In ruminants with multiple cotyledonal
placentae, the placental areas are already visible in the
uterus of the female fetus as definite elevations in the uterine
mucosa. When the existing placental areas or caruncles of

The Fetal Membranes

65

the ruminant have been destroyed by disease, the former
non-placental areas develop adventitious placental struc-
tures, but in such cases want their multiple cotyledonal
character and take on the simpler structure of a diffuse
placenta.

As soon as the embryo begins to form, its enveloping
membranes commence to develop, first the amnion, followed
closely by the allantois. The external allantoic wall fuses
with the external amniotic layer (false amnnion) to con-

^tr.

Fig. 33 — Fetal and Maternal Placenta of Cow.

The chorionic or fetal placental tufts are shown above and to the left,

projecting downward, and to the right, into the placental

crypts of the uterus. X310 (Pornayer).

stitute the chorion. In all domestic animals the amnion and
allantois each constitutes a sac containing considerable vol-
umes of amniotic and allantoic fluids respectively. In uni-
para, the allantoic sac normally pushes out to the apices of
both uterine horns and to the os uteri internum, thus ac-
quiring contact with the uterine mucosa throughout. In
ruminants and swine, however, the tips of the allantoic sac
early become necrotic in varying degree, as shown in Figs.
35 and 36. The necrotic portion retracts at times from the
apex of the cornual cavity, leaving the lumen filled with pus
and debris. In extreme cases, the entire non-gravid horn of
the allantois of the cow becomes necrotic as shown in Plate

66

Diseases of the Genital Organs

III. Sometimes, also, as shown in Plate II, the chorion be-
comes necrotic where it passes across the os uteri internum.
The common, small necrotic tips, shown in Figs. 35 and 36,
are designated as "normal" by embryologists but these pass
by imperceptible gradations into the degree of necrosis
shown in Plate III which is clearly and grossly pathologic.
The allantoic sac, fully distended with fluid, fills the uterine
cavity in such a manner that violent movements of the
mother cannot readily cause any material displacement be-
tween the uterine wall and the chorion, but both are moved

0

m

%

Fig. 34. Same as Fig-. 33. x 900. (Pomayer).

as a unit, obviating largely any dragging upon the placenta
which might threaten to cause injury thereto. The fetus
floats within the amniotic fluid and the amniotic sac, in
turn, floats within the allantoic fluid. In solipeds, swine
and carnivora, the amniotic sac floats freely within the
allantoic fluid, except for the allantoic segment of the um-
bilic cord ; in ruminants, the dorsum of the amniotic sac is
intimately fused with the chorion, obliterating the allantoic
cavity in this area. The fetuses of solipeds, swine, and
carnivora may be expelled from the uterus through a rent
in the chorion, with the more or less intact amnion envel-
oping them, but in ruminants the adhesion of the amnion

-

Plate II

Fetal Sac of Cow at Aboi i too Days

A. Amnion.

Al. Allantois.

1. Necrotic tip of non-gravid horn.

2. Necrotic isthmus between gravid and non-gravid horn.

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The Fetal Membranes 67

to the allantois detains the former within the chorion, leav-
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Fig. 35— Necrotic Tips of Fetal Sac, Cow.
/, /, /, Living allantois ; 2, 2, 2, necrotic tips ; 3, chorionic placenta.

The fetal placental structures, originating as outgrowths
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vascular network of the allantois. Regardless of placental

68

Diseases of the Genital Organs

type, the fundamental structure is essentially the same in
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The Fetal Membranes 69

this filter, so long as it is healthy, no solids or other visible
substances ordinarily pass. Bacteria are not known to pass
this filter while it is healthy. Researches show further that
rarely or never do the hypothetical antibodies pass this
filter, so that a mother may be highly infected with a given
bacterium and her blood react strongly by agglutination or
complement-fixation to such organism, but the blood of her
new-born fails to react. The contact between the fetal and
the maternal epithelium is so intimate, that no infection nor
foreign substance may readily exist between them. Hence
in the placental area, so long as the structures are healthy,
so far as known, infection can not pass from the mother to
the fetus through the placental filter, nor can infection in-
vade the fetus from the uterine cavity by passing between
the two fetal structures, and thence gain the fetal cir-
culation, without having first attacked and severely dam-
aged the placental structures themselves.

The Utero-Chorionic Space. There is, however, a
more vulnerable area through which bacterial invasion of
the embryonic sac may occur. There are about one hundred
functioning cotyledons in the healthy gravid uterus of the
cow. Each of these cotyledons, in the slaughtered animal
(they are doubtless much thicker in the living animal while
they are distended with blood) is one to one and one-half
inches in its perpendicular diameter while the peduncle of
the cotyledon measures an inch or more, thus tending to
push the chorion away from the non-placental endometrium
for a distance of two inches. The one hundred cotyledons
with their stalks serve as a great colonnade producing a
vast space between the non-placental areas of the uterus and
chorion, designated the utero-chorionic space. At full term
of pregnancy, the uterine mucosa offers an area of approxi-
mately fifteen square feet. In this space, as in the non-
gravid uterus, bacteria commonly exist and need only to in-
vade successfully the thin non-placental chorion and adher-
ent amnion to gain the amniotic cavity and fluid. With the
fluid, the fetus swallows any bacteria present. But the bac-
teria have other interesting portals of entry, the importance

jo Diseases of the Genital Organs

of which is not at present known. At the apex of each
cornu, the tip of the chorion is necrotic and is commonly sur-
rounded by exudate or pus. It would appear that such an
area would offer but little resistance to invasion and once
the bacteria have reached the allantoic fluid, the very thin
amnion offers scant barrier.

Placental Hemorrhage. At the cervical end of the
uterus there also exist conditions which apparently favor
invasion of the fetal sac. Nearly always placental hemor-
rhages exist at the os uteri internum and some of the cotyle-
dons have separated. In this manner the placental areas,
denuded of protective epithelium, and with important vol-
umes of blood resting upon their surfaces, offer an inviting
field for invasion.

Uterine Sand. Such placental hemorrhages must be
of very frequent occurrence. It would be supposed that such
hemorrhage would be resorbed in a few days so that the
regular meeting with them would seem to indicate that they
occur almost constantly. The frequency of these is further
suggested by the existence in the utero-chorionic space in
essentially all cows in advanced pregnancy, of bodies I have
designated uterine sand. These are free, spherical bodies
generally about one-sixteenth inch, translucent and amber-
colored. They are very hard, are insoluble in water and
alcohol. They vary greatly in numbers and volume. By de-
taching the fetal membranes from the uterus, washing both
surfaces in a vessel of water, and then decanting it off,
there remains behind a mass of uterine sand varying from
half a dram to one ounce, feeling much like sand when
grasped between the fingers. Its exact character and origin
are unknown but it appears most probably due to disinte-
gration of red blood cells, and if so, indicates frequent and
important placental hemorrhages.

In ruminants, therefore, with the immense utero-chori-
onic space, the inter-cotyledonal area of the chorion offers
the avenue of least resistance to the invasion of the fetus.
In the soliped, where no non-placental area exists, any vul-
nerable field must be created by the invasion of the placental

The Fetal Membranes 7 r

structures. After such infection has destroyed the placental
power of resistance, it is free to invade the fetus.

The development of the placentae is a cumulative process
from the time of the formation of the fetal envelopes until
the pregnancy terminates. It has been stated that as par-
turition approaches, the placenta undergoes fatty degenera-
tion in preparation for dehiscence. That is untrue. The
embryonic sac at first lies free in the uterine or cornual
cavity without visible placental structures. Gradually the
placental structures become macroscopically apparent but
the embryonic sac can still be lifted out of the opened uterus
without resistance. Gradually the chorionic tufts lengthen,
become more branched, and sink deeper and deeper into the
maternal crypts. In the abattoir, it becomes necessary, in
separating the placenta, to use gradually increasing care
and force as the duration of pregnancy advances. Early in
pregnancy the chorionic tufts of the cow appear very much
the same as the short, simple structures of the soliped, but
they gradually become more complex as the close of preg-
nancy nears. This is essential to fetal development, which
gathers in force and rapidity from the time of fertilization
up to the end of pregnancy.

The force which maintains the contact between the fetal
and the maternal placenta is not readily defined. It might
be termed physiologic magnetism. This force continues so
long as the fetus lives and the umbilic cord is intact. When
birth occurs and the navel cord ruptures, the magnetism
ceases. The blood in the fetal placental capillaries escapes
through the broken umbilic veins. The capillaries in the
chorionic tufts collapse, automatically fall away from the
crypt walls and drop out. Thus, in preparing histologic
sections of healthy placental structures one does not see the
chorionic tufts lying in contact with the crypt walls, but
quite detached therefrom, with the fetal and maternal epi-
thelial layers widely separated, as shown in Figs. 33, 34.
If, however, disease has invaded the placental tissues, the
picture promptly changes ; the damaged fetal and maternal
epithelia or their debris lie in contact, and placentitis with

Diseases of tlie Genital Organs

retained or adherent placenta is present. The tendency to
retention of the fetal membranes, when placentitis is pres-
ent, logically increases as the size and complexity of the
chorionic tufts advance. Thus retention of the fetal mem-
branes is commonest and most severe in the cow, and in-
creases in severity with the advancement in pregnancy. It
rarely occurs during the first four months of pregnancy, but
becomes increasingly common as the duration of pregnancy
increases. The simple, short, chorionic tufts of solipeds
tend to obviate retention of fetal membranes.

Chapter II

THE CLINICAL EXAMINATION OF
THE GENITAL ORGANS

A. The Clinical Examination of the Male Genital Organs

The clinical examination of the genital organs of the stal-
lion and the bull is, as a rule, best made with the animal in
the standing position after necessary measures have been
taken for the safety of the examiner. Most stallions stand
well but exceptions are sufficiently numerous to dictate that
the animal be securely confined. A few are safe when care-
fully held by bridle or halter ; some are controlled by the ap-
plication of the twitch or by holding up a fore foot; some
are safe only when side lines or breeding hobbles are applied.
Even with these the examiner must be on his guard. The
side line interferes with examination from that side. If the
examination is made from behind, the animal may forcibly
lift his hind foot and give the examiner a bad blow with the
summit of the os calcis. The stocks make an ideal method
for confining, safe alike for examiner and patient. Very
refractory animals may need to be cast or placed upon the
operating table.

The bull is to be confined preferably in the stanchion, re-
sorting to the use of the leading or nose ring in lieu of the
twitch. Sufficient precautions should be taken against
crowding and trampling upon the examiner. Kicking with
one foot may be conveniently prevented by securing a rope
upon one metatarsus, carrying it once around the other meta-
tarsus, and having a man hold the free end. The animal can
be promptly released if he falls.

When the animal is properly secured, the testicles of both
stallion and bull are best examined from behind because
both glands can be viewed simultaneously or palpated from
the same point. The smaller ruminants are readily ex-
amined standing ; carnivora need to be securely controlled
against scratching or biting.

74 Diseases of the Genital Organs

1. The Testicles

The testicles are to be examined with reference to loca-
tion, position, volume, consistence, clearness of outline, and
evidences of heat, pain, and swelling.

It is a well established clinical principle that, in order to
be fertile, there must be one testicle in the scrotum. It is
desirable that both glands be in the scrotum because when
one is retained, owing to arrest in development, the progeny
are liable to inherit the defect. The testicles of the foal and
the calf should be in the scrotum at birth. The position of
the testicle apparently matters but little ; at least occasion-
ally the testicle of the stallion is observed to be rotated on
its transverse axis so that the tail of the epididymis presents
forward, without apparent detriment. In one bull, the tail
of the testicle was caught well up in the posterior part of the
scrotal sac and the large end of the gland tipped forward to
come to rest in the position of the stallion testicle.

In volume, the two testicles of the horse are rarely alike.
Usually the right gland is clearly the larger. In ruminants
the two glands are more nearly alike. The size varies with
the size of the animal, the breed, the age, and the individual.
It is only when the glands depart widely from the average
volume that their size becomes significant. Even then the
size needs to be considered with the consistence. They be-
come enlarged in orchitis, abscessation, etc. When arrest in
development has occurred, they are usually abnormally small.

The consistence of the testicle is highly important. Phys-
iologically the gland is very firm and tense and its contour
is clear and definite. The testicle may, from inflammation,
become hard and unyielding, or in advanced abscessation,
soft and fluctuating. In arrest in development the testicle
is generally small and flaccid. This is commonly so in the ab-
dominal testicle but is observed also in arrest in development
of scrotal testicles. Such testes do not form spermotozoa
but do (commonly, at least) induce sex reflex. If a healthy
male of similar age and size is available for comparison, the
examination mav thus be rendered more accurate.

The Epididymis 75

2. The Epididymis

The epididymis and scrotal section of the vas deferens are
also palpable. The commonest point for the lodgment of
chronic infections is in the tail of the epididymis which
should be examined accordingly with special care.

In the stallion, bull, and perhaps other males, there is a
tendency towards the obliteration of the peritoneal sac of
the scrotum due to adhesions between the parietal and vis-
ceral layers of peritoneum. This lessens or destroys the mo-
bility of the gland within its peritoneal sac but the very loose
areolar fascia between the cremaster and the dartos and
skin leave the testicle, with the adherent parietal peritoneum
and the closely applied cremaster, movable within the dartos.
The adhesions between the two peritoneal layers are not
very readily diagnosed and accordingly careful search should
be made.

The size of the penis is not generally of clinical import-
ance, but it is occasionally so large in the stallion that it im-
perils the vagina of the mare. This can be best determined
by bringing a mare into the presence of the stallion and
causing complete erection, when the examiner can make a
reasonable estimate of the safety or danger when mated
with a mare of a certain size. In some cases urethral hemor-
rhage follows coitus so that it is essential to cause the ani-
mal to copulate in order to render the examination effective.

An examination of the relaxed penis of the horse may be
made by passing the hand up through the sheath into the
prepuce and grasping the glans firmly behind the corona.
By exerting moderate traction, sometimes for several min-
utes, the retractor muscle becomes fatigued and the penis
can be completely exposed and examined. If the organ is
moist and not readily grasped with the hand, the hold may
be rendered secure by wrapping the penis in a dry towel or
a piece of gauze.

The S-curved penis of ruminants cannot ordinarily be ex-
amined satisfactorily while the patient is standing. Copula-
tion is virtually instantaneous so that only a hurried glance
can be had at such times. The sheath is so narrow that the

76 Diseases of the Genital Orga?is

glans cannot be reached and grasped with the hand. The
animal is to be confined in lateral recumbency, with the an-
terior limbs extended forward and the posterior limbs, back-
ward, thus completely exposing the ventral surface of the
body and giving the operator free and safe access to the
parts. The bull is best extended by placing him between
two strong posts or other solid points for attachment and
stretching the limbs by means of two stout ropes, one ex-
tending from the hind, and the other from the fore feet to
the corresponding posts. The penis is then to be exposed by
eliminating the S-curve and pushing the sheath backward.
The elimination of the sigmoid flexure is accomplished by
grasping the distal curve at the point of insertion of the re-
tractor muscle and, pushing firmly upward and forward,
fatigue the muscle until it finally yields and the glans penis
moves forward. The tissues about the sheath opening are
then to be pressed backward toward the scrotum, thus short-
ening the sheath ; the two movements combined serve to ex-
pose the glans. A piece of dry gauze wrapped about the
glans enables the operator to grasp it firmly, and by the ex-
ertion of moderate and prudent traction the retractor muscle
may be kept in a state of fatigue and the penis fully exposed.
It can then be examined leisurely and carefully. The com-
plete exposure of the penis also exposes fully the mucosa of
the prepuce and sheath which, as shown in Fig. 9, now con-
stitutes the covering of the body of the penis from the glans
backward.

3. The Seminal Vesicles, Prostate, and Cowper's

Glands

The abdominal vas deferens, the vesicula seminalis, and
the prostate gland may be palpated per rectum in the stal-
lion and the bull. The prostate may be palpated digitally
per anum in the dog. In the stallion and the bull the vas
deferens may be palpated as it emerges from the internal
inguinal ring and passes upward, forward, and inward to
reach the superior surface of the neck of the urinary blad-
der, where it passes backward to disappear beneath the cor-
responding vesicula seminalis.

The Semen and Spermatozoa 77

4. The Semen and Spermatozoa

The satisfactory examination of the male genitalia ordi-
narily involves an examination of the semen. This is best
accomplished by causing the male to copulate with a female
and removing immediately some of the semen from the
vagina. This may be conveniently attained by introducing
a sterile swab, like that used in diphtheria, deeply into the
vagina. Then withdraw the swab and from it make a smear
on an ordinary slide, apply a cover glass and examine under
moderate magnification. If the examination is made in a
warm room and the preparation is kept moist by adding a
few drops of physiologic salt solution, healthy spermatozoa
continue to move vigorously during a period ample for study
of the living cells. If the semen is kept warm and moist, it
may be carried some distance and examined after several
hours. It is best, however, to examine the semen as to mo-
tility soon after ejaculation.

The quantity of semen ejaculated is likewise of funda-
mental importance in judging the fertility of a sire. While
technically but one spermatozoon is necessary for the fer-
tilization of an egg, there are physiologically many millions
of spermatozoa for each ovum. The luxurious numbers
serve as a safeguard against their total destruction during
the hurried migration from the vagina to the ovary. Not
only is it important that great numbers of spermatozoa shall
be present in order to make it certain that at least one vigor-
ous cell will reach the ovum, but great numbers constitute,
under certain limitations, an indication of sexual health and
vigor. The amount of semen needs to be determined by some
form of approximate measurement. In horses and cattle
the vagina of the female may be well washed out with sterile
salt solution or with a 0.257; chlorazene solution which dis-
solves the vaginal mucus, followed by the salt solution, and
by inserting the well disinfected hand, the animal may be
caused to eject all fluid or it may be ladled out with the
hand. If the male is then caused to copulate with her, the
contents of her vagina may be at once ladled out of the

7S Diseases of the Genital Organs

vagina, measured, and a fair approximation of the volume
of semen ejaculated obtained. If the vagina has not been
cleaned out immediately prior to coitus, no accurate idea
can be had of the volume of the semen because there may be
several ounces of thin mucus or other fluid lying in the
vagina. Studied under this plan, the bull ejaculates as a
rule 6 to 8 mils of semen at a copulation. The semen con-
sists largely of the secretions from the seminal vesicles and
prostate gland in which the spermatozoa swim freely. If
the spermatozoa are dead immediately after ejaculation,
that is conclusive evidence of sterility but does not reveal
the cause of the sperm death. Living spermatozoa, how-
ever abundant, do not afford final proof of fertility. Sperm-
atozoa may be suffering from disease and their elements
undergoing disintegration and death. Or there may be
bacteria ejaculated in the semen capable of causing the
death of most or all spermatozoa. It is accordingly essential
to accurate diagnosis that the spermatozoa shall be so pre-
pared by staining and otherwise that their structural de-
tails may be carefully and effectively studied. The various
parts need to be rendered clear so that any commencing de-
generation may be detected.

The degeneration of the spermatozoa and their capacity
to fertilize is not the end of the question. There is striking
clinical evidence that stallions, apparently in good general
health, transmit venereally to mares the infection of epizoo-
tic cellulitis or "pink eye" and at the same time prohibit fer-
tilization. Some sterile bulls apparently render sterile the
females which they have unsuccessfully served.

It is important that the copulatory act be closely observed
so as to determine whether it is normal — that there is the
normal sexual desire and ejaculation, followed by normal
relaxation. Any hesitancy in copulation should be carefully
noted and its cause determined if possible. Imperfect coitus
may arise from physical difficulty in mounting the female
due to painful diseases of the hind feet or limbs, or to paral-
ysis. The difficulty may be due to mechanical interferences
with the protrusion of the penis. In other instances there is

The Semen and Spermatozoa 79

such pain in protruding the penis or in ejaculating semen,
that the animal fails to copulate properly. The examiner
must reach a proper diagnosis regarding the group of causes
under which a given case falls and search in detail for a defi-
nite solution of the problem.

B. The Clinical Examination of the
Female Genital Organs

The clinical examination of the genital organs of the mare
and the cow reveals to the veterinarian data of great eco-
nomic and scientific interest. The freedom with which the
veterinarian may palpate the entire genital system per rec-
tum in these animals gives to him a marked advantage over
his confrere in human medicine in the examination of
woman. In the small ruminants, with a rectum too small to
admit the operator's hand and a tense abdominal tunic which
well-nigh shuts out abdominal taxis, the veterinarian is
placed at a serious disadvantage. The same holds true of
the sow, with the thick skin and dense, abundant, subcu-
taneous fat. The bitch and cat, with thin, flaccid abdominal
walls, offer a moderate opportunity for palpation of the
genital organs, but far inferior to that enjoyed in the mare
and cow.

By means of clinical examination of the genitalia, espec-
ially of the cow and the mare, the veterinarian is enabled to
diagnose estrum, ovulation, pregnancy, and innumerable
genital diseases.

Most mares and cows will stand quietly for both rectal
and vaginal examination, but the prudent veterinarian will
take no unnecessary risks. The danger, usually greatest at
the commencement of the examination, is far greater in the
mare than in the cow. The chief danger is, of course, from
kicks. The greatest resistance is generally offered when the
hand is introduced through the vulva. As a rule of prac-
tice, in examining the mare, one assistant should hold the
head securely and well elevated, another should hold up one
fore foot, and a third hold the tail out of the examiner's

80 Diseases of the Genital Organs

way. Should the mare be restless, a twitch should be ap-
plied, and upon the least show of viciousness, breeding hob-
bles should be used and drawn up tight. Even then, the
veterinarian should have care that she does not give him a
blow with one or both os calces. The operator should look
carefully to having abundant room, especially that the mare
may not crowd him against a wall, and also that, when his
arm is in the rectum, she shall not be able to move violently
to the right or left and, by pressing her buttocks close to a
post, crush his arm.

The cow does not often kick during rectal or vaginal ex-
aminations, but I know to my cost that exceptionally she
kicks fiendishly and very dangerously. Next to the worst
kick in my career was from a cow while I was attempting to
examine her genital organs. Usually the cow can be con-
trolled by a strong stableman grasping her muzzle firmly, or
still better by applying a leading ring or pincers to her
muzzle and pulling firmly. However, a few vicious cows
need to be shackled by tying a rope or strap about one meta-
tarsus, giving it a turn about the other, and then having a
strong, alert man hold the end of the rope firmly, ready in
event of a fall to release her. I have encountered a number
of heifers which were exceedingly resistant to the instru-
mental examination of the cervico-uterine cavity, and have
found it necessary to lay them down and secure them. It is
inadvisable to waste time on these obstinate patients, be-
cause the longer one works the more resistant they become.
Finally they exhaust the operator and then, if ever, he is
liable under fatigue to injure the patient seriously. There-
fore it is best, when the animal cannot be controlled in a
manner to render both patient and operator safe and to
avoid fatigue, that the animal be secured in lateral recum-
bency. She may be cast in a variety of ways, but for con-
venience of securing for the operation, the best method is
that of stretching her between two posts. The head should
be tied securely to one, with a second post or other fixed
point for securing a rope about twenty feet or more behind
her. A stout rope is then tied in a running noose about one

Examination of Female Genital Organs 81

metatarsus, and a half hitch taken about the other. Two or
three strong men may then draw regularly and firmly upon
the rope, gradually stretching the animal until she finally
falls upon her side. The process is rendered easier by apply-
ing a second rope to the anterior feet and having a man
stretch these forward, but the cow may then fall harder and
should be guarded against injury by an ample bed. The
ropes drawing upon the metatarsi or metacarpi may cause
pressure injuries unless the precaution is taken to pad the
parts beneath the rope, which is conveniently done usually
by wrapping the part with a grain sack before applying the
rope. Finally the rope on the hind feet is to be secured to
the rear post and that on the fore feet to the front post. The
operator may now proceed deliberately, conveniently, and
safely with his examination. The examination of the recum-
bent heifer thus secured is easier and safer. In the well-
behaved heifer the advantage of securing in lateral recum-
bency is more than counterbalanced by the time and labor
of securing and the peril of casting injuries. I have found
it necessary to secure a heifer in lateral recumbency three
or four times in succession for examination or treatment,
until finally she yields and stands without resistance.

The preparation of a special stall or stanchion into which
all cows in an establishment may be led for examination is a
great convenience. In some herds a sort of movable stocks,
somewhat like a shipping crate, is prepared, which can be
placed anywhere according to light or other convenience, or
moved from one stable to another.

The ready introduction of the hand into the vulva or rec-
tum requires some form of lubrication. As a rule, the best
is a warm salt solution of approximately 0.7 to 1 per cent.
Many veterinarians resort to soap as a lubricant, but this is
undesirable because even very weak soapsuds almost inevi-
tably irritates both the rectal and the vaginal mucosa and
causes tenesmus — the worst foe with which the examiner
must contend. The addition of antiseptics to the water is
much worse than the use of soap. No antiseptic can be used
of such strength as to produce even very feeble disinfection

82 Diseases of the Genital Organs

without causing much irritation and straining. The opera-
tor may use antiseptics on his hands and arms to cleanse
them, and may use moderately strong antiseptic solutions,
if desired, about the exterior of the anus and vulva, but
these should not, as a rule, be carried on the hand, even in
small amount, into the rectum or vagina. Oils and fats
make good lubricants, but when used they interfere very
seriously with the sense of touch in the vagina, especially
when one wishes to palpate for the uterine seal or to deter-
mine the character of the mucus within the vagina. Some-
times, however, lubrication of the hand with oil or fat is
virtually necessary, especially when introducing it through
a very narrow vulva. Powdered elm bark suspended in
warm water has a lubricant value essentially equal to that
of fats, and has the advantage that it is readily washed
away with water without the use of soap. Vaseline and
other heavy fats make very bad lubricants because of the
difficulty of getting rid of them after using. The value of
any examination of the genital organs rests absolutely upon
the knowledge, skill, and care in every detail. The veteri-
narian needs a thorough knowledge of the anatomy of the
entire genital system. This cannot be had from books or
lectures, nor in the anatomical laboratory of a veterinary
college. These help form the foundation, but in order to
get an accurate sense of the form, size, density, and other
attributes of the living organs, the veterinarian needs to
examine them promptly after death. The abattoir offers an
ideal place for the study of the genitalia of cattle, sheep, and
swine, and no veterinarian interested in the diseases of their
genital organs should neglect to avail himself of this ideal
opportunity for study. Here he can see and handle non-
gravid uteri and uteri in every stage of pregnancy, and by
approximate measurements may learn to recognize with fair
accuracy the duration of pregnancy by the transverse dia-
meter of the distended uterus. In the abattoir, the uterine
seal, the corpus luteum, cysts, ripe and freshly ruptured
ovisacs may be recognized and their character studied by
sight and touch. No such opportunity for fundamental

Examination of Female Genital Organs

83

knowledge exists elsewhere. By availing himself of the
freshly slaughtered animal, the veterinarian makes the
closest possible approach to the next logical step, the clinical
examination.

STERILITY-ABORTION

ORIGINAL EXAMINATION

Owner. Address. •■■■

Name or Herd Number of Animal _ Date of Birth _

Has animal been pregnant? If she has bred, state number of calves produced

_ Date of termination of last pregnancy —

Duration of last pregnancy in days _ Was calf alive or dead ?

If living, was it healthy? Did cow have retained afterbirth ?.

or discharge from uterirs ?

If a heifer which is not known to have been pregnant, insert in chart the date or dates of service or
in case of estrum or "heat" and not served write date in parenthesis ( ). In animals which have
been pregnant, indicate the dates of service since calving or aborting and dates of estrum when not
served, as in the heifers.

Year

Jan.

Feb.

Mar.

Apr.

Mat

June

JULY

Aug.

Sept.

Oct.

Nov.

Dec.

1 1 1 1 1 1 1 1 1 1 1 1

Character of estrum, regular or irregular
General condition

State of lactation

Date of Examination
Right broad ligament

Vulva _

Cervix

Left broad ligament

Vagina

Uterus

Right ovary

Right oviduct

Left ovary

Left oviduct

Diagnosis
Treatment applied
Treatment advfsed
Remarks :

Prognosis

Fig. 37 — Examination Blank for Recording Findings in the
Examination of the Genitalia of Cows. Reduced.

84 Diseases of the Genital Organs

There is no field of veterinary practice where system and
detailed permanent records are so essential to efficiency.
The precise order of examination needs to be varied some-
times according to the individual, but generally a definite
order may be followed from beginning to end. I have found
the examination blank, shown in Fig. 37, convenient in mak-
ing a systematic and complete examination. After the iden-
tity and the history of the animal have been satisfactorily
recorded, any evidences of abnormality in the broad, or
sacro-sciatic ligaments, such as their sunken condition in
nymphomania, with external evidences of vulvar disease are
noted.

1. Examination of Vulva and Vagina

It is generally advisable next to insert the hand into
the vagina and carefully palpate and record findings
in the vulva, vagina, and os uteri externum. Unless
palpation reveals counter-indications, the twenty-inch
uterine forceps should be introduced alongside the hand
already within the vagina and the cervix grasped. This
is best accomplished by pushing the index finger against
or into the os uteri externum. With the forceps slightly
open, push the one jaw into the os far enough to se-
cure a firm hold upon its lip and then close and lock the
forceps. In some heifers, the vaginal portion of the cervix
forms such a sharp cone, and the cervical canal is so narrow,
that the tip of the forceps jaw cannot be inserted sufficiently
to grasp the cervix. In such cases the forceps should be
opened wide enough to grasp the cervical cone at the side
near its base.

Moderate traction upon the forceps draws the cervix,
uterus, and ovaries backward four to ten inches, stretches
the uterus in its ligaments, renders its outline clearer, and
brings the ovaries into a more accessible position. When
an ovary is unusually large and the abdomen pendulous, the
gland frequently drops forward and downward where the
examiner cannot reach it or can do so only with great diffi-
culty not devoid of peril to the rectal walls. The traction

Examination of Vulva and Vagina 85

with the forceps usually draws the uterus, the apices of the
cornua, and the ovaries up into the pelvis or against the
pubic brim, where they are readily palpated. At about the
90th to the 120th day of pregnancy, the fetus is sometimes
far forward in the gravid cornu and the uterus has fallen
down in a pendulous abdomen, where it is difficult to palpate,
making error in diagnosis easy. Here again the traction
upon the cervix tenses the genital tube so that it may be
readily followed and brings up within reach the gravid por-
tion of the horn, where its volume may be recognized and
the approximate duration of pregnancy determined.

There are some important exceptions to this order of pro-
cedure. In heifers with narrow vulvae, and perhaps with
considerable hymeneal stricture, the force necessary in order
to introduce the hand in attaching the forceps may arouse so
great an irritation as to induce severe and obstinate strain-
ing, which may render rectal palpation very tiresome, fre-
quently inaccurate, and sometimes impossible, so far as any
reliable findings go. With heifers, therefore, I generally
prefer to postpone the vulvo-vaginal palpation and omit the
application of the forceps to the cervix until after the rectal
examination has been attempted. The very frequent in-
tense straining may thus be avoided. The traction upon
the cervix is by no means so important in the heifer as
in the cow. The uterus of the non-pregnant heifer, unless
long sterile, is of good tone, firm, small, and lies in the pel-
vis within easy reach. If the heifer is pregnant, her uterus
virtually always remains firm and retains its position with
a portion of the distended organ within, or just in front of,
the pelvis, where it is readily palpated and its volume recog-
nized. In a large proportion of pregnant heifers, reliable
and satisfactory diagnosis can be made readily by rectal
palpation without applying forceps to the cervix or insert-
ing the hand into the vagina, thus rendering these super-
fluous.

If the heifer is not pregnant and after several copulations
her sterility is deemed serious or important, the vulvo-vagi-
nal and cervical canals and the uterine cavity need to be ex-

86 Diseases of the Ge?iital Organs

amined in order to arrive at a reliable diagnosis. The vulva
and vagina then need to be forcibly dilated. This is best
done with the hand. After lubricating with warm oil, fat, or
emulsion of elm bark, the fingers should be formed in a cone
and, under gradual and firm pressure, the vulva slowly di-
lated. In extreme cases the dilation may require an hour or
two, or may demand repeated efforts on successive days.
Any intelligent helper may, under proper instruction and
caution, undertake the work, but it must not be unduly
rushed. In some extreme cases I have inserted the uterine
forceps into the vagina without inserting my hand, directing
it on the median line, from side to side, inclined very slightly

Fig. 38 — BischofFs Vaginal Dilator.

downward, to the end of the vagina. Opening the forceps
moderately and pressing them forward against the cervical
end of the vagina, closing and locking them, and then apply-
ing gentle traction, I have occasionally been able to draw the
vaginal portion of the cervix back to the vulva, where it
could be palpated by inserting one or two fingers and even-
tually secured by guiding the second pair of forceps to the
part by palpation. With both forceps applied to the cervix,
the vagina may be visually inspected and the cervical canal
and uterine cavity examined instrumentally.

In some heifers, the vulva is constricted by the presence
of a small band of connective tissue or aponeurosis, located
about one-half inch from the margin of the lips, just beneath
the vulvar mucosa. When vulvar dilation is attempted, the
veterinarian encounters this firm, small, cord-like structure,
which under the force employed cuts into his hand. I have
observed this in one family of Holstein heifers, the members
of which were unusually large and rugged, where the vulvae

Examination of Vulva and Vagina 87

were so constricted by this cord-like structure that a small
hand could not be inserted. The difficulty was overcome by
severing the cord at one or two points. I encountered one
sterile Jersey heifer of breeding age, with so small a vulva
that I could not insert my hand at all and so small an anus
that I could not palpate her genitalia, per rectum, though the
heifer herself was not extremely small. Vulvo-vaginal stric-
tures occur from disease, rendering palpation of the anterior
end of the vagina impossible. These will be considered later.

Albrechtsen makes extensive use of the vaginal speculum
in studying the vagina and cervix, but I have not found it of
great value. When one pair of the uterine forceps is at-
tached to the right and the other pair to the left lip of the
os uteri externum, traction exerted, and the forceps pressed
apart, the vulvar opening is widely dilated and in almost all
animals all parts of the vaginal mucosa and the vaginal por-
tion of the cervix are brought into view more clearly than
with the speculum. The visual examination of the vaginal
end of the cervix may be further facilitated in cases of need
by applying a third pair of forceps to the superior margin of
the cervical border. In a few instances of a very narrow
vulva or vagina, a speculum of sufficiently small size may
be of great aid. The best speculum in my experience for
this purpose is that of Bischoff's Vaginal Dilator, shown in
Fig. 38.

In the manual examination of the vulva and vagina, the
examiner should take note of all abnormal contents and of
abnormalities of the vulvo-vaginal mucosae and of the peri-
vaginal tissues and organs. Physiologically, the vagina of
the cow at estrum and when nearing parturition contains
an abundance of clear, rather fluid, highly lubricant mucus.
The vagina of the non-pregnant cow in the interval between
estrual periods contains a small amount of lubricant mucus.
The vagina of the pregnant cow, except when nearing par-
turition, contains a highly adhesive mucus. These physio-
logic variations in quantity and quality of vaginal mucus
need to be learned by actual clinical observation before the
various pathologic contents may be readily recognized.

88 Diseases of the Genital Organs

The walls of the vagina are physiologically soft, pliable,
and thin, but this is largely comparative which the examiner
must learn to appreciate by clinical study. In severe granu-
lar venereal disease and in other chronic inflammatory con-
ditions, the mucosa and entire walls become thickened and
hard. In the acute vesicular venereal disease the vulva and
vagina become highly sensitive and exceedingly painful to
the touch.

In order that these variations in the vaginal walls may be
recognized by palpation, it is essential that the organ be
flaccid. It is impossible to determine clearly the state of
the vaginal walls while the patient is straining violently.
A still greater impediment to palpation of the vaginal walls
is the ballooning or inflation of the vagina with air. During
inspiration, if the vulva, the anus, or the cervical canal is
open, air may be drawn into the vagina, rectum, or uterine
cavity respectively, and the involved organ become greatly
inflated like a balloon. These inflations appear to be wholly
involuntary, but the tendency for them to occur varies
greatly in individuals. Once the vagina becomes inflated,
the ballooned organ completely fills the pelvis ; the walls are
hard and firm; and, except for the rectum above, lie in imme-
diate contact everywhere with the pelvis. The condition of
the vaginal walls and of the surrounding tissues or organs
cannot be determined by palpation through this tightly
stretched, firm, unyielding structure. Sometimes, by mov-
ing the hand rapidly and vigorously from side to side and
slapping the tense walls, the cow or mare may be induced to
contract the vagina and expel the air. If the cervix is seized
with forceps and drawn backward, the vaginal cavity is
largely eliminated and the air forced out. The air may be
forced out of the vagina by exerting manual pressure upon
the ballooned organ from the rectum. In many cases the
evacuation of the air from the vagina is none too readily ac-
complished, but it must be done before the palpation of the
vagina and perivaginal structures can be accomplished. The
veterinarian must, therefore, be patient and persevere until
his object has been attained. Through the flaccid vaginal

Rectal Palpation 89

walls, the examiner may recognize perivaginal abscesses of
lymph glands, tumors, pelvic fractures, diseases of the uri-
nary bladder, ureters, and other organs. In advanced preg-
nancy in the cow, the head of the fetus commonly lies in the
pelvis above the vagina, as shown in Plate I, possibly mis-
leading the unwary veterinarian and causing him to suspect
extra-uterine pregnancy.

2. Rectal Palpation

The palpation of the genitalia of the cow per rectum is on
the whole the most important part of the clinical examina-
tion, because it reveals such an extended list of data. The
essential preliminaries to rectal palpation of the genitalia
are that the rectum shall be empty of feces, that it shall not
be ballooned with drawn-in air, and that straining or tenes-
mus shall not be present. Some have advised emptying the
rectum by means of an enema, but the liquid is rarely all
evacuated until after the operator inserts his hand, at which
time the liquid feces are often forced out, causing unpleasant
soiling. Hess recommends inserting the hand into the anus
in the form of a cone, spreading the fingers apart and di-
lating the anal ring enough to admit some air which is com-
monly followed by defecation. But one must wait for a
time and although defecation finally occurs, quantities of
feces usually still remain in the rectum which must be in-
vaded for successful palpation. It is essential that the rec-
tum be emptied as far as the operator wishes to insert his
hand and, in the end, this must be accomplished largely by
the manual removal of the feces.

The ballooning of the rectum is an annoying impediment
to rectal palpation, holding the examination completely in
abeyance so long as it persists. Rapid movements of the
hand, as suggested for ballooning of the vagina, frequently
suffice, causing the rectum to contract and expel the air.
The ballooning generally involves but twelve to sixteen
inches of the rectum at the anal end, and the operator may
reach beyond into an empty section of the gut, cautiously
engage his fingers in the intestinal folds, and, drawing the

9<D Diseases of the Genital Organs

anterior segment of the rectum analward, force the air out
of the ballooned portion. Patience must be exercised until
the ballooning is completely overcome. It is useless to at-
tempt palpation while it exists, because the rectal walls are
so stretched, hard, and firm that reliable operation is simply
impossible.

Tenesmus, or straining, also inhibits, so long as it lasts,
any reliable palpation of the genital organs. It has already
been remarked that soapsuds, antiseptics, etc., must not be
introduced into the rectum on the hand, arm or otherwise,
since they may cause very annoying straining. It has also
been noted that if force has been used in dilating the vulvo-
vaginal tract of a heifer just prior to rectal exploration, the
pain already caused in the genital tract will result in vio-
lent, and frequently uncontrollable straining during rectal
palpation. These causes must be avoided. But when the
hand can be readily introduced into the vagina and the for-
ceps fixed in the cervix, any moderate traction exerted tends
to prevent rather than to cause straining. Gentleness and
patience are the chief factors in controlling straining. Dur-
ing straining the operator should always let his hand lie
perfectly passive in the rectum. He must not even use
force to retain a position already reached. If his fingers
are in a saccule of the rectum and he holds his hand rigidly
in position, the cow will rupture her rectum against his
finger tips. Even with the greatest gentleness and patience,
one sometimes encounters an animal which strains persist-
ently and violently. One cow strained constantly during
efforts at rectal palpation by my colleagues and myself, and
although repeated attempts were made at different times,
accurate palpation failed. Peri-anal injections of apoth-
esene and moderate chloral enemas both failed. Not only
accurate work, but the safety and life of the patient, are
dependent upon the gentleness and prudence of the operator.

It is virtually impossible sometimes to avoid injuries suf-
ficient to cause hemorrhage from the rectal mucosa. In
small heifers the anal opening seems unduly constricted and
at some point the mucosa may tear and slight hemorrhage

Rectal Palpation 9 i

result, but this is extremely rare. Injuries to the rectal
mucosa from the palpation are far more common. Veteri-
narians with very large hands and arms should not under-
take rectal palpation of the genitalia per rectum in small
heifers. As a rule, however, bleeding from the rectal mu-
cosa is not due to a big hand, but to roughness, inexperience,
or untrimmed finger nails. The nails are to be trimmed to
the quick and carefully filed until they are as smooth as
possible, softened in warm water, and then all possible care
and gentleness must be used. Under no conditions is the
rectum to be dragged upon violently. While it is ballooned
or the cow is straining, no reliable palpation can be accom-
plished, but severe or fatal injury is always impending.

Even if the injury is not serious, hemorrhage is a dis-
credit to the examiner. When he removes his hand, covered
with blood, it looks bad to the owner, and to one who knows
the subject it shows that the examiner has failed to attain
his object, which is a reliable palpation, but has instead in-
jured the rectum. The prudent veterinarian will, therefore,
have care to reduce to a minimum the frequency and amount
of hemorrhage from the rectal mucosa, and will always feel
that he has erred whenever his hand, when withdrawn, is
stained with blood. After other precautions to prevent
straining have failed, it may sometimes be controlled by
pinching the skin of the back, pressing over the spine with a
rough stick, pinching the muzzle with the fingers and thumb
in the nostrils, or applying a leading-ring to the nose.

When the foregoing preliminary precautions against in-
jury to the intestines have been made and other preparations
for rectal palpation satisfactorily attained, the examiner is
ready to proceed with the palpation of the genital organs
per rectum. If forceps have been applied and slight trac-
tion is exerted, the cervix of the non-pregnant, adult cow
may usually be drawn back almost or quite to the vulva.

There are occasional exceptions. In Shorthorn cows, the
vagina is quite long and narrow and the uterus is held far
forward by its ligaments so that in many individuals it is
very difficult, and sometimes impossible, to draw the cervix

92 Diseases of the Genital Organs

far enough back to permit of visual examination or of de-
sired manipulations.

When the operator inserts his hand into the rectum, the
logical starting point for the palpation is the cervix. With
the forceps applied to the vaginal end, the operator may
recognize the structure by following the instrument to its
point of attachment. When the forceps have not been ap-
plied, as in heifers, the cervix must be sought and recognized
by its location, size, consistence, and attachments. Without
traction with the forceps, the vaginal end of the cervix lies
eight to twelve or more inches anterior to the vulva. In the
non-pregnant heifer, it ordinarily lies not more than eight
inches from the vulva; in old, pregnant cows, it may be
dragged far forward out of the pelvic, into the abdominal,
cavity. Similar displacement may exist in pyometra, hydro-
metra, large ovarian and uterine tumors, and other patho-
logic conditions. Not infrequently, portions of the small in-
testines are pushed back in the recto-vaginal pouch, and
must be dislodged forward before the cervix, uterus, or
ovaries may be palpated. Ordinarily it is a very easy task
to dislodge these by applying very slight intermittent pres-
sure downward and forward.

When the urinary bladder is empty, the cervix may lie
upon the empty viscus, but it is generally slightly deviated to
the right and rests upon the pelvic floor. When the urinary
bladder is distended, the cervix (and uterus) is almost al-
ways deflected to the right and lies in the furrow between
the distended viscus on its left, and the right pelvic wall.
Rarely the cervix and uterus lie upon the distended urinary
bladder or, yet more rarely, may be displaced to the left.
Sometimes the greatly distended urinary bladder, containing
four or more quarts of urine, almost fills the pelvis, the cer-
vix and uterus fall far down between the bladder and pelvis,
and the bladder rolls or extends over to the right, virtually
covering the cervix and uterus. The distended bladder then
needs to be pushed to the left in order to palpate the cervix
and uterus. Rarely I find it desirable, before satisfactory
palpation may be made, to catheterize the bladder and evacu-

Rectal Palpation 93

ate the urine. The small or extra-small Albrechtsen uterine
catheter answers the purpose satisfactorily.

Sometimes great care is necessary in order to avoid con-
fusion on account of the bladder. It may give the impression
at first of the distended pregnant uterus, and the examiner,
off his guard, may fall into a very embarrassing error. His
safety is assured only by the clear recognition of the cervix
and uterus. When the urinary bladder is empty, it forms a
flattened, pear-shaped body, palpable beneath the cervix,
about three to four inches long, rather firm in consistency,
and finely irregular, due to the wrinkling of the mucosa and
contracted muscle bands. Then follows every gradation in
size, up to four or more quarts of contents, when the dis-
tended organ may fall over the pubic brim and hang down in
the abdomen.

The cervix is recognizable by palpation as a very firm, al-
most cartilaginous, cylindrical organ, three to six inches
long, and one to three or four inches in diameter. In heifers
it is very small and firm, usually about three to three and
one-half inches long, and one to one and one-half inches in
diameter. With age, and yet more with disease, it increases
in all its diameters. In health, owing to the amplitude of its
broad ligaments, the organ may be picked up per rectum,
and virtually its entire circumference freely palpated. In
disease, it may be adherent in varying degrees and difficult
of clear identification. Behind, the cervix is continued by
the flaccid, empty vagina. Sometimes the inexperienced
practitioner may be confused on account of the ballooned
vagina, which has already been mentioned. The cervix is
then pushed forward by the ballooning and the operator
feels beneath the rectum, filling more or less completely the
pelvic cavity, a moderately tense, inflated sac, which he may
at first mistake for the urinary bladder or be otherwise mis-
led. Traction upon the cervix with the forceps pushes the
air out through the vulva, or it may be readily evacuated by
gentle pressure from the rectum.

a. The Uterus. Forward, the cervix ends in the usually
somewhat broader and markedly softer uterine body. In

94 Diseases of the Genital Orga?is

severe cervicitis, the cervix often has a far greater trans-
verse diameter than the body of the uterus.

Just in front of the cervix, the body of the bovine uterus
is small and inconspicuous when compared with the size of
the uterus as a whole. Externally it is ordinarily two to
three inches long, but the originally separate Muellerian
ducts are still faintly evident upon palpation, in the form of
a slight antero-posterior depression on the dorsal surface.
This depression gradually deepens into a distinct furrow,
soon the bifurcation is reached and the two distinct cornua
follow, constituting the chief volume of the uterus. Each
uterine horn has about sixty per cent of the transverse dia-
meter of the body.

The examiner recognizes the non-pregnant uterus by its
continuity with the cervix anteriorly, its bicornual charac-
ter, and its firmness and evenness to the touch, each cornu
forming the segment of a circle with its convex border pre-
senting dorso-anteriorly. In the healthy uterus of the heifer,
the uterine body and horns are very firm, smooth, regular,
thus serving to differentiate them clearly from all other pel-
vic or abdominal viscera. The cornu of the heifer is one-
half to three-fourths of an inch in diameter at the base, and
tapers gradually to a fine point at the ovarian end, where it
passes almost imperceptibly into the oviduct. The examiner
should trace each cornu separately, as it extends obliquely
forward to the right or left, where it soon turns downward,
thence backward and upward by a regular curved line, to
end, the right cornu on the right side, the left cornu to the
left, in close proximity to its base, thus describing an almost
complete circle. The healthy cornu of the heifer is eight to
ten inches long on its convex border, thus forming an in-
complete circle two and one-half to three inches in diameter.
The entire organ may, therefore, be picked up through the
rectal floor and held in the hollow of the hand. The uterus
of the cow is larger, is slightly uneven owing to longitudinal
wrinkles, and may be slightly sinuous because the cornua are
longer than their broad ligaments. That is, the uterus, once
pregnant, never wholly returns to the original form, outline

Rectal Palpation 95

and volume of the uterus of the heifer. Estrum, pregnancy,
and disease alter profoundly the volume, form, position, and
consistency. Whatever the changes may be, the basic prin-
ciples in recognition are the continuity with the vagina and
cervix and the fundamental position, attachments, and re-
lations.

b. The Oviduct. The healthy oviducts are difficult of rec-
ognition by rectal palpation, but under favorable conditions
are recognizable. They are less than one-eighth inch in
diameter, sinuous, very smooth and firm. Arising almost
imperceptibly from the apex of the cornu, they pass lateral-
ward, in front of and below the ovaries embedded in the
ovarian ventricle or pocket of the broad ligament, as shown
in Fig. 13.

Passing beyond the outer or lateral extremity of the
ovary, it bends inward, or medianward, so that the pavilion
of the tube presents toward the antero-lateral surface of
that gland, with one of the fimbriae of the pavilion attached
to the lateral end of the ovary. When either pyosalpinx or
hydrosalpinx is present, the tube becomes distinctly en-
larged and usually readily palpable. The distension of its
lumen or the thickening of its walls increases not only its
transverse diameter but also its length. It then becomes
readily recognizable by palpation per rectum in almost
every case. Generally the infection involves the pavilion
and also the ovarian pocket, causing them to become ad-
herent to the ovary in varying degrees.

c. The Ovary. The palpation of the ovaries per rectum
logically follows the examination of the oviducts. The
glands, which in the cow physiologically lie approximately
in the position indicated in Fig. 13, are to be recognized by
their size, form, consistence, and attachments. In the
healthy, non-pregnant heifer or cow, the ovary usually lies
lateral to and somewhat below the dorsal border of the base
of the uterine cornu, between it and the ascending, lateral
portion of the pubis. Usually it lies upon the pubic floor,
near the brim, or just beyond in the abdominal cavity, at or
slightly below the brim of the pubis. Pregnancy and dis-

96 Diseases oj the Genital Organs

ease greatly modify the position of the ovaries. Anything
which contributes a weight in excess of the physiologic, non-
gravid uterus, oviducts, or ovaries causes the latter to drop
downward and forward. The extent of the dislocation is
further influenced by the degree of pendulousness of the
abdomen.

The ovary swings freely in its attachments, may be picked
up per rectum and ordinarily moved freely for a distance of
four to six inches or more. The healthy ovary sometimes
lies hidden in the ovarian pocket (mesosalpinx), or drops
over in front of, and down beneath, the broad ligament, so
that manipulation is required in order to free it and render
accurate palpation possible. Once it is disentangled from
the pocket or other accidental covering, the outline of the
gland is very free and the examiner may recognize clearly
ripe ovisacs, the crater following the recent rupture of an
ovisac, the corpus luteum in its varying stages of growth and
decline, its abnormalities and diseases, its adhesions with the
pavilion of the tube and diseases of the ovary, with concur-
rent diseases of both ovary and oviducts.

The ripe ovisac of the cow is a thin-walled, yielding, and
readily ruptured cyst of three-eighths to one-half inch in
diameter, standing well above the ovarian surface, usually
upon the convex or greater border of the gland. The crater
resulting from the rupture of an ovisac is a deep pit with
somewhat irregular edges, three-eighths to one-fourth inch
across its mouth. The fresh, growing corpus luteum is very
soft to the touch. Its dome, which may project one-fourth
inch or more above the general ovarian surface, is about one-
fourth inch wide. Upon palpation, it feels like a small,
atonic granulations tumor. Gradually it increases in diame-
ter, becomes firm, and after about ten days has reached its
full size of three-quarters to seven-eighths of an inch. The
contiguous covering of the ovary grows over the corpus
luteum. The latter is usually spheroidal, sometimes ovoid,
with its base implanted in the body of the ovary. The yellow
body may be somewhat dumb-bell shaped owing apparently
to a constriction about its center, due to a narrow, firm open-

Rectal Palpation 97

ing of the crater when the ovisac ruptured. The two ovaries
are rarely symmetrical ; the left is usually the smaller — not
rarely, minute, — no larger than a small pea. From such a
minimum, the healthy ovary may be of any size, up to two,
or even three inches in some large cattle.

The corpus luteum modifies greatly the gross volume of the
ovary. In the very small ovary, the corpus luteum, fully de-
veloped, may increase the volume of the organ ten- to twenty-
fold, while the development of a seven-eighths inch corpus
luteum in an ovary of two inches, though actually adding the
same volume, does not cause the great comparative increase
in size.

The healthy corpus luteum of the non-pregnant heifer or
cow retains its maximum volume until about the sixteenth to
eighteenth day after ovulation, when it atrophies rapidly for
two or three days, and at twenty to twenty-two days, when
it has decreased to one-fourth or three-eighths of an inch in
diameter, estrum and ovulation recur. After the corpus
luteum has formed as a solid mass, physiologically it remains
solid throughout its history. It is solid, firm, and somewhat
elastic to the touch.

The corpus luteum of pregnancy does not differ (except in
color, which is of no concern here) from the corpus luteum
of estrum in its general characters, but in duration it phys-
iologically continues unchanged throughout pregnancy and
for thirty to sixty days thereafter, when it atrophies and
estrum and ovulation recur. Pathologically, the corpus
luteum may be grossly enlarged to even two or three inches
in diameter, may undergo cystic degeneration, and other-
wise depart from the normal volume, consistence, and char-
acter. It may undergo rapid degeneration, with abnormally
short intervals between estrual periods, may atrophy dur-
ing pregnancy and cause ovulation and estrum, may shift its
position and sink deeply into the body of the gland, and may
persist at full size for month after month, even to years, in-
hibiting estrum and ovulation. The ovary is subject to such
a wide variety of pathologic changes that the veterinarian
needs to study it carefully and abundantly both in the abat-
7

98 Diseases of the Ge?iiial Orga?is

toir and clinically by palpation in order to be able to read
every change in the gland with his finger-tips as unerringly
as a blind man reads braille.

The rectal palpation of the uterus, oviducts and ovaries of
cows and of some heifers, is greatly facilitated by the appli-
cation of the forceps to the vaginal end of the cervix and the
exertion of moderate traction thereon. The traction draws
the uterus, oviducts and ovaries backward and upward,
tenses the uterine horns and renders their outline more dis-
tinct, and enables the operator to study all parts of the geni-
tal tract at a far greater advantage. The plan avoids many
errors in diagnosis. Some veterinarians fear that the appli-
cation of the forceps to the cervix of a pregnant cow and the
exertion of traction is dangerous, but I have failed to observe
any untoward results. Without the aid of forceps, I have
seen colleagues mistake gross pyometra for pregnancy and
make other regrettable blunders. As a rule of practice,
therefore, rectal palpation of the genital organs should regu-
larly be aided by traction upon the cervix with forceps. Cer-
tain exceptions arise. It has already been noted that the
genital organs of a heifer with a small vulva may be ad-
vantageously palpated per rectum without the application
of the forceps. In pregnancy of 30 to 90 days, one may gen-
erally make a clear diagnosis without applying forceps.
But in an old cow with a pendulous belly, the uterus in early
pregnancy may be dropped too far forward and be entirely
too flaccid to admit of safe recognition. To add to the diffi-
culty, the embryo in such cows may be located in the apex of
a horn, quite out of reliable reach. Then the operator paws
about unconsciously in an effort to drag the uterus back per
rectum which is infinitely more dangerous and far less effi-
cient than traction with forceps.

The vaginal and rectal palpation, in addition to revealing
an endless category of pathologic lesions, serves almost al-
ways to determine the presence or absence of pregnancy. If
pregnancy is diagnosed, the examination is ordinarily com-
plete. If the animal is non-pregnant, instrumental search
of the cervical canal and uterine cavity is necessary for the

Examination of the Cervical Canal 99

complete assembling of available data for diagnosis and
prognosis. During vaginal palpation, the operator logi-
cally palpates the os uteri externum for the uterine seal as
an indication of pregnancy. When a healthy heifer is preg-
nant 30 days or more, if the examiner will press the tip of
his index finger, without oil, vaseline, or other lubricant,
against the os uteri externum for a short interval, and then
carefully withdraw it, he is able to recognize in the os a
small, highly adhesive seal. The seal grows and expands, be-
coming more and more recognizable throughout pregnancy.
Its presence is a warning against the invasion of the cervi-
cal canal until ample evidence is at hand that the seal is
spurious.

3. The Examination of the Cervical Canal and
Douching the Uterus

Having applied the uterine forceps either to the lips or to
the sides of the cervix, and satisfactorily determined that
the animal is not pregnant, the operator may exert traction
and draw the vaginal end of the cervix back to the vulva or
as near thereto as is safe. Continuing a safe degree of
traction and drawing the handles of the two pairs of forceps
apart, he brings the vaginal end of the cervix into view. If
there is good light from a window behind the cow, the parts
may be satisfactorily examined visually or in the absence of
efficient natural light, one may secure excellent illumination
by using a reflecting electric lamp on an extension cord, or
an ordinary flash light. The examiner should note the state
of the mucous membrane at the os uteri externum. In the
healthy heifer, the vaginal end of the cervix terminates in
a sharp cone, at the apex of which opens the very narrow
os uteri externum with its mucosa everywhere in contact.
The index finger cannot be inserted without violence. Usu-
ally it will admit for a short distance, without resorting to
force, a smooth sound, one-fourth inch in diameter. The
vaginal mucosa envelops completely the entire cone of the
vaginal portion of the cervix and invaginates slightly into
the os uteri externum.

IOO

Diseases of the Genital Organs

After a cow has been pregnant, increasing with each preg-
nancy, the relations of the cervical tissues become modified.
The second annular fold of the cervical mucosa becomes en-
larged, both elongated and thickened, and the antero-poste-

Fig. 39— Instruments for the Examination of the Genitalia of Cows.

/, 20// uterine forceps ; .?, Palmer's uterine dilator, modified ; j, Bozeman's

uterine dressing forceps ; ./, small uterine catheter.

rior grooves become comparatively deeper, cutting the ring
into a series of deep, pedunculated lobes. Eventually these
push their way out through the vaginal ring or os uteri ex-
ternum into the vagina. The vaginal ring now serves as a
band surrounding the protruding second ring. The second
ring then becomes the most posterior portion of the cervix,

Examination of the Cervical Canal 101

and in disease may project three to four inches beyond the
original os uteri externum toward the vulva. In severe dis-
ease the third annular fold may also force its way out
through the vaginal ring. In disease these everted, swollen
rings of cervical mucosa constitute large, cauliflower-like

Fig. 40 -Median Longitudinal Sections of Cervices of Cows

showing the Windings of the Cervical Canal.

/, The vagina ; 2, lip of the os uteri externum ; 3, first annular mucous fold ;

7, second annular mucous fold.

tumors. The healthy mucosa of the cervix is smooth, of a
pinkish hue, paler than the vaginal mucosa. Its surface is
moist, but should reveal no signs of pus. During estrum the
cervical canal is dilated and filled with clear, highly lubri-
cant mucus.

The deeper portions of the cervical canal may be examined

102

Diseases of the Genital Organs

Fig. 42. Rupture of Cervix by an Amateur in an effort to "Open the

Mouth of the womb" followed by Chronic Abscess of Cervix.

Cv., Cervix; A, abscess in inferior wall of cervix; O. O., approximate

location of ovaries lying above the uterine ligaments ; Oi\ Ov, cystic

oviducts (hydrosalpinx) which were causing the sterility ;

Cu., Cu., uterine cornua.

Examination of the Cervical Canal 103

by means of dilator, catheter, or sound. The dilator (Fig.
39) is usually preferable. As will be seen in Figs. 40, 41,
the cervical canal is extremely narrow, sinuous, and at times
angular, and the free margins of its annular mucous folds,
directed toward the vagina, offer serious obstacles to the
prompt passage of an instrument into the uterus. The
canal usually extends sharply downward and forward, very
slightly to the right, for one to one and one-half inch ; then
bends sharply upward and forward, and thence approxi-
mately forward, with slight divergences, to the cavity of the
uterus. The windings of the canal are difficult to follow and
the free margins of the annular folds, directed toward the
vagina, constitute deep culs-de-sac, into which the dilator
tends to pass and its progress to be thus arrested. The
operator is, therefore, to take these conditions into account
and, without violence or force, retreat and advance at vari-
ous angles, in his effort to follow the tortuous canal and
evade the barriers formed by the mucous folds. Sometimes
the free edges of the mucous folds appear to become pushed
forward by the instrument into the lumen of the canal and
occlude it, preventing for the time the passage of the instru-
ment. In disease, the annular folds often become so hyper-
trophied and their bases so sclerotic as to cause acute bend-
ings of the canal and to close quite firmly its lumen, making
it exceedingly difficult and rarely impossible at a given time
to pass an instrument through the canal into the uterus.

The operator needs to be patient here, as well as skilful.
Any undue force may rupture the cervical wall and pene-
trate the surrounding connective tissue, causing pelvic ab-
scessation, as shown in Fig. 42, with extreme peril to the
physical and breeding life of the animal. If the operation
cannot be made to succeed at first effort, it should be sus-
pended for the time and undertaken later. I have worked
for an hour or two at a time, four or five times in succession,
before finally succeeding in reaching the uterine cavity.
However, it is always infinitely better to try repeatedly, and
finally fail, than to use force and ruin the animal, not so
much because of the breeding value of such an animal, since

104 Diseases of the Genital Organs

that is always seriously impaired already, but because the
rupture of the cervical walls, with the unpleasant conse-
quences attending, leaves an ugly stain on the veterinarian's
reputation. If the passage of the canal is very difficult, one
should not, as a rule, work at it for more than an hour or an
hour and a half, since by that time he will tend to injure the

Fig. 43. Rupture of the Uterus with Uterine Catheter. Cow.
V., Vagina; /, lip of os uteri externum ; 2, first annular mucous fold;
j, instrumental rupture in the roof of the horn ; 4, instrumental rupture of
the floor of the uterine horn ; 5, mesometrium enormously thickened and
inflamed ; 6, cystic corpus luteum with adherent cystic oviduct to the left ;
7, median section through cystic oviduct. The veterinarian had killed the
cow douching the uterus when the sterility was caused by the inoperable
hydrosalpinx.

tissues unwarrantably if he continues his efforts longer,
and, still more important, he becomes fatigued. A fatigued
operator is always a dangerous operator. If prudent, he will
not accept the attendant risks which he inevitably faces
when fatigued.

When the examiner has succeeded in passing the uterine
dilator, the catheter, or other instrument into the uterine
cavity, he faces the danger of puncturing the uterine wall,

Examination of the Cervical Canal 105

as shown in Fig. 43, and invading the peritoneal cavity. In
order to avoid wounding the uterus, the operator needs to
judge well the approximate length of the cervix and when
the end of the instrument reaches the region of the os uteri
internum, it should be directed slightly downward. That is,
using a curved instrument, as is always most convenient and
safest, the operator should at this time turn the instrument
so that the concave side of the curve is directed downward.
Ordinarily no metal instrument should pass far beyond the
os uteri internum. In the ordinary empty, non-pregnant
uterus, the downward curvature of the uterus is so marked
that there is great peril of puncturing the walls if the instru-
ment is pushed more than one to two inches into the uterine
cavity. In addition to this danger, if the uterus is flaccid or
if the pushing of the instrument through the cervical canal
requires some degree of pressure, the uterus bends sharply
and the instrument catches in this and punctures the wall.

If chronic cervicitis is present, it inevitably causes scle-
rosis of the annular mucous folds of the cervix, and the hy-
pertrophy of the sclerotic areas presses across against the
opposite side of the cervical canal, bending it out of its
course and narrowing its lumen. The sharp bendings of the
canal, with the intruding sclerotic and hypertrophied masses,
so impede the passage of the instrument that once it has
entered the uterine cavity, the resistance of the uterine wall
is not clearly recognizable if the instrument is pushed into
or through it. When using the dilators, therefore, the ad-
vancement of the instrument should cease when the uterine
cavity is reached. The length of the cervix, if doubt arises,
may be learned by rectal palpation. The same means may
be used to learn when the dilator has passed the cervical
canal. In all cases where the cervical canal is not freely
open and sufficiently direct to permit the easy passage of the
uterine catheter, it is prudent and advisable to use first the
uterine dilator. I have found the Palmer uterine dilator of
the human gynecologist, modified as shown in Fig. 39, the
best instrument for this purpose. It is small and the curva-
ture of its blades corresponds fairly well with the average

106 Diseases of the Genital Organs

bendings of the cervical canal. The dilation of the cervical
canal is essentially alike for diagnosis and therapy. When
the canal is very narrow and is pressed upon by sclerotic en-
largements in the mucosa, the passage of a catheter suffi-
ciently large to permit of satisfactory douching either for
diagnosis or treatment, is both difficult and dangerous. Even
if it is accomplished, the cervical disease cannot be satisfac-
torily handled until the canal has been freely dilated.

Once the instrument has reached the os uteri internum,
the gradual dilation of the canal should be undertaken by
forcing the forceps jaws apart with the thumb screw. The
opening of the jaws should be very gradual and prudence
used in the amount of force applied. In heifers especially
which have suffered severely from cervicitis, and there is
consequently well advanced sclerosis, the tissues may fail to
relax under the strain but rupture instead. The instrument
must on no account be pushed toward the uterus while the
jaws are opened as there is great danger of pushing them
through the uterine or cervical wall. There is great danger,
while dilation is proceeding, if the operator pushes toward
the uterus when the patient strains. At such times the in-
strument must be permitted to move backward with the cer-
vix. The process of dilation should be continued for a suffi-
cient period of time to render the cervical canal of sufficient
size to admit of the ready passage of a small uterine cathe-
ter, uterine dressing forceps, or other desired instruments.
Once the forceps blades are forced apart, the operator may
cautiously exert traction upon them, eventually drawing the
forceps out with the jaws widely separated. This presses
the free borders of the annular mucous folds outward
against the cervical walls and tends to cause them to remain
out of the way temporarily while the uterine catheter may
be introduced. It is best in case of a very narrow cervical
canal to open and close the dilator alternately and while
closed to revolve the instrument in varying degrees so that
the direct pressure of the blades shall be exerted on all parts
of the cervical walls. With patience, the pale muscles of the
cervix gradually become exhausted and finally the canal at-

Examination of the Cervical Canal 107

tains a sufficient lumen so that a moderately large uterine
catheter may be passed through it without difficulty or dan-
ger. This having been attained, catheterization may be un-
dertaken. The catheter used should always be of as large
caliber as the cervical canal will readily and safely admit,
because the greater the caliber of the catheter, the more effi-
cient the douching of the uterus. If the operator has care-
fully observed the windings of the cervical canal while using
the dilator, he will better understand the direction which
the catheter must take. The catheter selected as of proper
dimensions should be introduced into the cervical canal very
gently and advanced with great care. Force is at all times
to be avoided. If the catheter will not pass without force,
it should be laid aside and the dilators again used and this
plan repeated until the dilation suffices.

The uterine catheter, like the dilator, should not be
pressed deeply into the uterus but merely far enough that
the fenestrum of the instrument is free in the cavity of the
uterus so that douching will be practicable. At the moment
of entering the uterus, the concave side of the catheter
should be directed ventralward and so maintained through-
out douching. Occasionally blood escapes through the cathe-
ter, indicating mechanical injury to the uterine mucosa, and
this should cause the operator to beware of impending
trouble. Once I misjudged the length of the cervical canal,
pushed the uterine catheter too far, and caused an extensive
antero-posterior laceration in the uterine mucosa along the
dorsal surface with copious hemorrhage. I had been careful
and could not identify the character of the injury and it was
only later when she was slaughtered as a tuberculin reactor,
that the cicatrix in the organ revealed the character of the
lesion. In this instance the blood did not escape through the
catheter but was forced out after the withdrawal of the in-
strument. The cow suffered greatly, kicked at her belly, lay
down and rose frequently, trembled, sweat, and breathed
rapidly. The hemorrhage was not of sufficient volume to
cause the symptoms directly from the loss of blood nor could
the lesion in itself cause so much pain. Apparently the dis-
tress was due to uterine colic, that is, the small, empty

108 Diseases of the Genital Organs

uterus, not recently gravid, rapidly filled with blood and the
cervix being firm, it could not readily escape but, being re-
tained, aroused violent contractions like those seen when a
volume of fluid is inadvertently left behind when douching.
The difficulty passed in an hour or two and she continued ap-
parently well. Whenever there is any question as to the
course of the catheter or other instrument, the operator
should cautiously palpate per rectum and determine if all is
well.

Not rarely, when the catheter enters the uterine cavity
there is a sudden inrush of air by which the uterus becomes
greatly ballooned, as has already been noted of the vagina
and rectum under similar conditions. The inflation of the
uterus sometimes proves annoying. It is difficult and some-
times impssible to douche the inflated organ until a very
large amount of fluid has been introduced because the liquid
drops downward and forward to the ovarian end of the
uterus while the air occupies the cervical end of the cavity
which is highest. If left in the uterus, it may cause colic. It
can be pressed out through the catheter by careful rectal
manipulation. (Gynecologists apparently encounter the
same condition in woman and some writers describe it as
"acute dilation of the uterus".)

When the catheter is accidentally pushed through the uter-
ine wall and the peritoneal cavity is entered, there is gener-
ally an inrush of air through the instrument. In this one
regard the inflation of the uterine cavity through the cathe-
ter and the flow of air into the peritoneal cavity are much
alike but in general the rate and volume of air drawn in are
greater in the latter.

When an antiseptic fluid, like a two per cent Lugol's solu-
tion, is introduced into the peritoneal cavity through the
catheter, it immediately causes marked depression and un-
easiness, with rapid breathing, trembling, sometimes lying
down, and other evidences of distress. The cow tenses her
abdominal walls, arches her back and visually appears to
be bloated. If the uterus is clean and little or no infection
is forced into the peritoneal cavity, lymph is soon thrown

Examination of the Cervical Canal 109

out, which dilutes the Lugol's solution. Rapid absorption may
follow and iodism result. The distress from the introduc-
tion of Lugol's solution into the peritoneal cavity is of short
duration and within one-half to two hours she seems as well
as before. The uterine wound heals promptly and little or
no harm follows. When coal tar disinfectants and others of
a highly irritant character, especially those not freely solu-
ble in the lymph, are introduced, the irritation is more se-
vere and prolonged, with great danger of a severe peritoni-
tis with serious peril to life. If death is avoided, the peri-
tonitis may lead to extensive adhesions destroying the value
of the patient. Some veterinarians have counseled the use
of bicarbonate or chloride of sodium solution as a douche,
but if this or other neutral fluid is used and a puncture of
the uterus occurs with the fluids entering the peritoneal
cavity, the danger is extreme because usually infection is
borne from the uterus and sets up a violent and fatal peri-
tonitis. In Fig. 43, is shown a uterus punctured by pushing
a catheter much too far, a fatal peritonitis following douch-
ing with, it was claimed, soda bicarbonate solution. Whether
the infection was due to a dirty catheter, whether it bore
infection from the cervix or uterus into the peritoneal cav-
ity, or whether the soda solution itself was septic, does not
materially alter the case. No antiseptic was present to de-
stroy the infection.

When pus is present in the uterus in large quantities and
of high virulence, as is most frequently seen in the puerperal
animal, a gross rupture of the organ is followed at once by
very alarming symptoms which frequently prove fatal
within two or three hours. The shock is especially pro-
found when it is attempted to douche a large paretic uterus
containing a great volume of virulent material and a great
amount of water is introduced to add to the mass of liquid.
A large rupture of the uterus releasing the great mass of
infected liquid, which immediately reaches the total peri-
toneal surface, produces prompt collapse. The abdominal
walls at once become tense and fixed, the breathing being
thoracic, rapid and shallow. The patient appears tympani-

i io Diseases of the Genital Organs

tic, shows intense suffering and, as a rule, quickly succumbs.
Some of them, however, after remaining in an extremely
critical state for some days slowly improve but as a rule
never regain condition and must eventually be destroyed as
useless.

Consequently in the instrumental examination of the
uterus, as in that of the cervix, ample care is always to be
taken to avoid rupture. Such care must be based upon ac-
curate anatomic knowledge, surgical skill, patience, and the
application of the invariable rule that, if the instrument can-
not be passed without the use of force, the effort must be
suspended. The cervical canal dilates during estrum, at
which time an instrument may far more readily be passed
into the uterus. If the operator desires, he may dislodge the
corpus luteum and return after three days with reasonable
assurance that he will find the patient in estrum and her
cervical canal dilated. If he will then use the dilators pru-
dently, he will leave the canal dilated and the angles modified
in a manner to render catheterization of the uterus less diffi-
cult if again undertaken in a few days. Aside from the diag-
nosis of estrum and the advantage of the dilated cervix fa-
cilitating the catheterization of the uterus, estrum is a very
poor time to examine the genitalia, because vagina, cervix,
and uterus are so filled with mucus, and the uterus so en-
larged and engorged that many pathologic conditions may
be so completely screened as to be wholly unrecognizable.

When the catheter has entered the uterine cavity, the ex-
amination is to be completed by douching. For this purpose
I prefer a one to two per cent. Lugol's solution, rather than
sterile salt solution or other neutral liquid, because, in my
judgment, the disinfectant renders the operation safer, es-
pecially when any minor injury to the cervical or uterine
mucosa has occurred. The faintly brownish and clear fluid
serves to form a contrast with pus or muco-pus rendering
them more apparent. Physiologically the douche should re-
turn clear and uniform except that in estrum there should
first escape some clear mucus, and during the one or tvvo
days following estrum, some partly clotted menstrual blood.

The Diagnosis of Estrum 1 1 1

Admitting fully the dangers incurred in the manual and
instrumental examination of the genital organs of mares
and cows, it nevertheless remains that (1) such examina-
tion is not in the ordinary sense necessarily dangerous and
(2) the examination is absolutely essential to a safe diag-
nosis. Accidental injuries to the genital organs of cows
and mares in the course of examination are happily rare in
the hands of competent veterinarians. At present there is
much activity in the handling of sterility in cows and many
veterinarians, some of whom have always blundered at each
critical step, have plunged headlong into this field with
neither the chart of anatomical knowledge nor the compass
of ordinary prudence. Naturally they make many and seri-
ous errors and bring undeserved discredit upon one of the
most valued fields of veterinary service. The veterinarian
who will not give long and conscientious study to the sub-
ject, has no moral right to attempt the work.

The physical examination of the genitalia not only serves
the necessary purpose of diagnosing disease but also serves
to identify estrum, the period of sexual rest between estrual
periods, and pregnancy.

C. The Diagnosis of Estrum

The diagnosis of estrum is of great practical importance
because in numerous instances the ordinary clinical signs
fail unless the veterinarian is able to apply a more technical
and accurate method of determination. Without technical
examination, the breeder may fail to recognize the condition
and hence omit breeding. The cow or heifer commonly re-
veals the presence of estrum by bellowing and restlessness,
whether in stable or field. In the field or paddock with other
cattle, the animal in estrum repeatedly mounts other cattle
or stands to be mounted by them. Often there is a dis-
charge of thin mucus from the vulva. In many cases cattle
are not out in paddock or field daily so that the tendency to
mount other cattle is not apparent. Some individuals show
little excitement and do not bellow enough to attract atten-
tion in the stable. Even when turned daily into the paddock

U2 Diseases of the Genital Organs

or field, as is commonly done in winter for only a brief in-
terval, a cow may pass through her active estrual period
during the interval between two periods in the paddock.
Not infrequently such unrecognized estrual periods result
in expensive delay in breeding.

The chief evidences of estrum revealed upon physical ex-
amination are :

(1) The vagina contains much thin, lubricant, clear mu-
cus. In metritis, cervicitis, and vaginitis the mucus may
contain floccules of muco-pus. The flow of the mucus of es-
trum appears in the vagina twenty-four hours or more prior
to the establishment of sexual desire and terminates about
twenty-four hours after the cessation of estrum. If fertiliza-
tion fails, the discharge of estrual mucus is displaced by the
menstrual flow.

(2) The cervix is relaxed and the canal more dilated and
dilatable than in the inter-estrual period of rest.

(3) The uterus is engorged. Prior to the full develop-
ment of estrum, the uterus may be normal to the touch at
first, but under palpation becomes engorged or erected.
When estrum is at its height, the engorgement is constant.
The diameter of the engorged uterus of estrum is increased
about one-half, is much firmer than during the inter-estrual
pause, and is smooth, even, and very firm. It is about the
same size as the pregnant uterus at thirty to forty days, but
is distinguishable by its firm, engorged character, in con-
trast with the fluctuant, tense uterus of pregnancy. It is
less hard, and smaller than the uterus of chronic sclerotic
metritis with destruction of the uterine mucosa.

(4) The corpus luteum of the preceding estrum is atro-
phied to about one-half its ordinary diameter, or about three-
eighths of an inch.

(5) There is present, generally upon the opposite ovary,
a mature ovisac, a thin-walled cyst one-half inch or a trifle
more in diameter. {See Figs. 22-25.)

If it is desired to breed the animal during the existing es-
trum, the examiner needs to be very cautious in palpating
the ripe ovisac since under very slight pressure it ruptures,

The Diagnosis of Pregnancy 1 13

the ovum escapes into the peritoneal cavity, and conception
is barred for that estrual period.
Recent estrum is recognized :

( 1) • By menstrual blood in the vagina or the soiling of the
tail and buttocks with blood, about twenty-four hours after
estrum has ceased ;

(2) By engorgement of the uterus which continues during
menstruation ;

(3) By the rapid atrophy of the corpus luteum of the pre-
ceding estrum ;

(4) By the palpation of the crater of the ruptured ovisac.
The diagnosis of estrum may be rendered more certain by

concentrating the observations to a brief period. Thus,
when the soiling of the tail and buttocks with menstrual
blood is observed, if the breeder will watch the animal closely
from the eighteenth to the twentieth day thereafter and.
take occasion to place the cow in paddock or field with the
bull or other cattle, estrum will in all probability be recog-
nized. The time during which close watch is to be kept may
be even further concentrated by dislodging the corpus lu-
teum when it is well formed and watching the patient from
the third to the fifth day thereafter.

D. The Diagnosis of Pregnancy

The accurate diagnosis of pregnancy in the cow is a fun-
damental necessity in the handling of diseases of the genital
organs. The gravest and most embarrassing errors made
in dealing with the genital organs are the failure to diag-
nose an existing pregnancy and the erroneous diagnosis of
pregnancy when the animal is sterile. The failure to recog-
nize an existing pregnancy frequently leads to instrumental
abortion or to the slaughter of a valuable pregnant animal
which is wrongly believed to be sterile. The diagnosis of
pregnancy, when the animal is sterile, leads often to months
of expensive delay in breeding. The examination for preg-
nancy of valuable animals which are for sale is gradually
assuming scientific and economic importance. In some
large herds placed in dispersal sales, all the cattle are ex-

H4 Diseases of the Ge?iital Organs

amined in detail and certificates of pregnancy or non-preg-
nancy by a skilled veterinarian issued for each female.
Eventually, probably before most veterinary practitioners
are ready to render highly efficient service, buyers of ex-
pensive breeding cattle will demand reliable veterinary ex-
aminations as to sexual soundness. In the female assumed
to be pregnant, the prudent buyer will place first reliance
upon the judgment of an expert veterinarian.

The signs of pregnancy are many. Each has its value
and each is subject to certain limitations :

1. The Failure of Menstruation After Copulation

When conception follows coition, estrum is rarely followed
by menstruation. If menstruation follows coition after 24
to 48 hours, the cow is probably non-pregnant.

2. The Cessation of Estrum

If a cow or heifer has been regular in her estrual periods,
and estrum fails to recur at the normal date, the animal is
quite probably pregnant. The probability is accentuated if
menstruation following coitus failed. The sign is of little
value in irregular estrum. The estrual period may be com-
paratively short or long, but in order to be of value in judg-
ing conception, the periods need to be alike. That is, one
animal may have an estrual cycle of eighteen, and another of
twenty-two, days but an animal having once an interval of
eighteen days and at another time a cycle of twenty-two
days offers suspicion of ovarian disease. The failure of an
estrual period in such an animal is not a good index of con-
ception. In healthy cows and heifers there is little varia-
tion in the estrual cycle in the individual ; the variation rarely
exceeds twenty-four hours. It is important alike for the
breeder and the veterinarian that accurate records be kept
for each heifer and cow.

Estrum does not always cease with conception. In my
judgment, one to two per cent, of pregnant cows and heifers
show estrum. In some of these, the estrum recurs at vary-
ing intervals up to the seventh or eighth month, but as a rule

The Cessation of Est rum 115

it ceases to recur after the third or fourth month of preg-
nancy. Sometimes the recurrence of estrum is regular, re-
peating the cycle prevailing in the individual prior to con-
ception, but usually the cycle is irregular. So far as I have
observed, the estrum of pregnancy is not followed by men-
struation. In fact, menstruation is not ordinarily possible,
owing to the uterine seal blocking the cervical canal and
preventing exit.

Estrum not infrequently fails to recur after copulation
although conception did not follow. Sometimes the failure
of estrum to recur is due to retained corpus luteum, some-
times pyometra (without discharge) follows estrum and
coitus, inhibits estrum and misleads the caretaker. Poverty
serves to prevent alike ovulation and estrum. The failure
of estrum to recur in non-pregnant, and the recurrence of
estrum in pregnant animals render it clear that the pres-
ence or absence of estrum does not furnish secure ground
for diagnosis relative to pregnancy. The evidence must be
supported by other facts in order to be reliable.

The estrum of pregnancy has been little studied. In one
case which I had the good fortune to examine while the ani-
mal was in estrum, the corpus luteum of pregnancy had
atrophied and a ripe ovisac was present on the non-gravid
side. I think it more than possible that the estrum of preg-
nancy is generally due to this cause. The corpus luteum of
pregnancy, for some unknown reason, atrophies, loses its
inhibitory power upon the maturation of ovisacs, and es-
trum, so far as the ovaries are concerned, appears in the or-
dinary manner.

It is of scientific interest to note here also that the estrum
of pregnancy, with the atrophy of the corpus luteum and the
ripening of an ovisac upon the opposite ovary, is the possible
foundation for numerous errors regarding the migration of
the ovum. It has been claimed that finding a fetus in one
horn and the corpus luteum in the alternate ovary is proof
of the migration of the ovum, and that the fertilized ovum
has dropped into the peritoneal cavity, been transported to
the pavilion of the opposite oviduct and penetrated it, or that

n6

Diseases of the Genital Organs

the ovum has passed down the horn corresponding to the
ovary from which it emanated, thence across the uterine
body cavity and up the opposite horn. My observation
makes it perfectly clear that the alternating of the fetus and
the corpus luteum is not proof of migration.

The abnormality of estrum (and coitus) appears to have
no serious peril for either the pregnant animal or the fetus.
It is clear evidence of a pathologic state, but many cows and
heifers show frequent estrum and copulate freely without
showing any marked tendency to abort or for the pregnancy
to terminate unfavorably in any marked respect. Some of
them abort, it is true, but I have been unable to learn that
their tendency to abort is greater than in pregnant cows
which do not show estrum. A few cases have occurred under
conditions which have led some to believe that coitus caused
abortion almost immediately. Thus I recall one cow which
came in estrum in the sixth month of pregnancy, copulated,
and the next day aborted. In other instances, a cow carry-
ing a desiccated fetus develops estrum, copulates, and a
few hours later expels the mummy. I think it reasonably
certain that the facts have been misinterpreted, and that,
instead of the coitus causing the expulsion of the fetus, the
corpus luteum has atrophied, an ovisac has ripened, estrum
and coitus have occurred, and because of the atrophy of the
corpus luteum, not because of coitus, the uterus contracts
and expels the fetus. That is, instead of the estrum and
copulation causing the abortion, the disease has brought
about the changes in the ovary, the estrum, the copulation,
and the expulsion of the fetus. The problem merits further
study.

Menstruation following estrum in pregnancy is incom-
patible with the life of the fetus, because the menstrual
blood consists of a hemorrhage emanating from the pla-
cental areas (cotyledons) of the uterus. Menstruation
would, therefore, result first of all in a hemorrhage between
the maternal and fetal structures which would force the two
structures asunder (compare "Desiccation of the Fetus").

The Uterine Seal

117

3. The Uterine Seal

If the vagina and cervix are healthy, the cervical canal is
well sealed at from thirty to forty days after conception and
it may be felt clearly upon palpation per vaginam. In order
to recognize this, the finger tip must be pressed carefully
and gently against the external os uteri and then cautiously
withdrawn ; if the seal is present, it is readily revealed by
its adhesiveness. In the earlier stages the seal is very small,
only one-eighth to one-fourth inch across, and does not pro-

Fig. 44 — The Uterine Seal in Early Pregnancy in Heifer.
F, Embryo % inch long in the embryonic sac ; 5", uterine seal in cross sec-
tion ; O, ovary with corpus lutein of pregnancy ; A, uterine seal
protruding from the vaginal end of the cervix.

ject into the vagina. It is distinct, however, and adheres
clearly to the finger tips. It continues to grow and soon
bulges out into the vagina. The uterine seal involves the
cervical mucosa only. As stated earlier, however, the annu-
lar folds of the cervical mucosa push out into the vagina in
the cow which has calved and especially when she has suf-
fered from cervicitis. The protruding portions of the cervical

1 1 8 Diseases of the Ge?iital Organs

mucosa function as though they remained in the canal so
that in such animals the uterine seal proceeds from, and
covers over, the mucosa protruding into the vagina. In the
mare, in advanced pregnancy, the uterine seal projects into

Fig. 45 — The Uterine Seal of an Adult Cow in Advanced Pregnancy.

Cross sections through the cervix at various points. The larger

seals are near the vaginal end.

the vagina as an adhesive, somewhat cylindrical body, one,
two, or more inches in length. Its size and protrusion in-
crease until just before the close of pregnancy, when it
softens, changes to lubricant mucus, and strings from the
vulva. During pregnancy the mucus secreted by the vagina
becomes exceedingly sticky, having much the same charac-
ter as the uterine seal.

The Uteri?ie Seal

119

Sometimes a false uterine seal forms, as a result of dis-
ease, as in retained corpus luteum and in cervicitis. The
uterine seal persists when the fetus dies and desiccates, and
when the embryo dies and the embryonic sac remains to con-
stitute a "mole".

The uterine seal may fail to form or it may break down
when the cervix is badly diseased and abortion is imminent.
Consequently the presence of the typical seal not only gives
reliable evidence of pregnancy, but adds to that a certain
feeling of security, suggesting not only that the animal is

Fig. 45a— The Uterine Seal in Longitudinal Section. Cow.
/, Os uteri externum ; 2, os uteri internum ; 3, base of second annular cervi-
cal fold ; 4, uterine seal extending throughout the length of the canal.

pregnant, but perhaps safely so. In severe purulent vagini-
tis or purulent cervicitis of the vaginal portion, the uterine
seal may exist in the uterine end of the cervical canal and be
displaced by pus in the vaginal portion. The seal may then
be recognized by palpating it with a metallic sound, uterine
catheter, or dilator introduced cautiously along the cervical
canal. While the uterine seal is one of the most important
evidences of pregnancy, it has its limitations in diagnosis
and, like most signs, needs to be considered in conjunction
with other findings.

120 Diseases of the Ge?iital Orga?is

4. The Corpus Luteum of Pregnancy
(See Fig. 26)

Physiologically, a corpus luteum develops after each es-
trum, and is of the same form, size, and consistency, whether
the animal be pregnant or not. In sterility, however, the
corpus luteum is one of the most common sufferers from
pathologic changes. The bovine corpus luteum of preg-
nancy is normally five-eighths to three-quarters of an inch
in diameter, somewhat oval in form, usually even in con-
tour, and firm in consistency. Forming, as it does, within
the crater left behind when the ovisac ruptures, it is at first
naked. That is, it is not covered by the tunic of the ovary
and it protrudes somewhat beyond the surface of the gland.
If the animal conceives, the tunic of the ovary soon draws
over the surface of the yellow body and leaves it smooth
and firm. The wound is healed. Sometimes a considerable
projection remains, even though the tunic has drawn over
the yellow body. In sterility, however, the wound in the
ovisac frequently fails to heal and the yellow body remains
for a long period of time protruding and naked. The pro-
truding dome feels soft upon palpation, like the exuberant
granulation of an unhealthy ulcer. The corpus luteum of
sterility frequently undergoes cystic degeneration in its
center. It becomes soft and more or less fluctuant, accord-
ing to the degree of degeneration. Finally, as the degenera-
tion extends, the lutein tissue disappears and a cyst remains.
When one can recognize these conditions in the ovary, he
can with very rare exceptions rest assured that pregnancy
has not occurred through fertilization of the ovum which
was discharged from the ovisac in which the diseased yellow
body develops. He must not be deceived, however, because
of the presence of a cyst or cysts in an ovary. The typical
corpus luteum of pregnancy almost always exists in a preg-
nant animal, but cysts may co-exist. Accordingly, while the
absence of a corpus luteum of a normal type is fairly con-
clusive evidence that the animal is not pregnant, the co-
existence of a large cyst in the same or other ovary is not
final proof, though it is strong evidence that the animal is

The Corpus Luteum of Pregnancy 121

non-pregnant. When a typical corpus luteum of pregnancy
is present and other findings are in accord, the evidence it
affords is of the greatest possible value. Amongst thousands
of ovaries which I have examined, I have seen but one cor-
pus luteum of pregnancy which departed markedly in volume
from the normal. The one exception was more than one inch
in diameter. In cows which, though pregnant, nevertheless
show estrum, the corpus luteum disappears, at least some-
times. Hence a cow may be pregnant and no corpus luteum
present.

The corpus luteum of pregnancy persists throughout
pregnancy and for thirty to sixty days after its close. The
corpus luteum of estrum is a temporary structure, which be-
gins to disappear rapidly at about eighteen days after es-
trum, so that at the average period of twenty-one days it has
become so far resorbed that it no longer inhibits the matur-
ing of a fresh ovisac.

It is at this period that the corpus luteum becomes of
special significance in the diagnosis of very early pregnancy.
If estrum has been regular and the animal is not pregnant,
it is very certain that at about twenty-one days the animal
will again be in estrum and that the corpus luteum of the
previous estrum will have decreased to a small size. At the
same time, if estrum is near, the uterus is engorged, the
cervical canal is dilated, and the vagina contains the lubri-
cant mucus of estrum. Hence, if the practitioner examines
a cow at about eighteen to twenty-one days after breeding,
if she is pregnant, there is almost invariably a typical corpus
luteum ; if she is not pregnant, the corpus luteum is definitely
atrophied. This is one of the best times for making a diag-
nosis, and a highly important date, because if the animal is
not pregnant, immediate measures may be taken, such as
disinfecting the uterine cavity, preparatory to breeding
when the approaching estrum has become established.

5. The Uterine Arteries

The uterine arteries afford definite evidences of preg-
nancy. As soon as the fertilized ovum has become implanted

122 Diseases of the Genital Organs

in the uterus, all vessels leading to that organ awaken to a
wholly new activity. There are three pairs of arteries con-
cerned, the utero-ovarian, the uterine, and the vaginal. In
the healthy non-pregnant cow or mare each of these is
clearly palpable per rectum, approximately one-eighth inch
in diameter and, being but lightly covered, yields a clear,
though not strong, pulsation.

The utero-ovarian artery, analogue of the chief artery of
the testicle in the male, arises from the aorta near the ori-
gin of the small mesenteric, and, passing downward, back-
ward and inward between the peritoneal layers of the broad
ligament, divides near the ovary into two branches, one go-
ing to the ovary, the other supplying the oviduct and the
apex of the uterine horn. Readily palpable in the non-gravid
animal, it is soon dragged so far forward that rectal palpa-
tion is rendered inconvenient. The two other pairs, which
are readily reached, suffice in virtually all cases, and conse-
quently the utero-ovarian artery is commonly ignored. Its
palpation becomes of great importance in the diagnosis of
ovarian tumors.

The middle or chief uterine artery arises usually from
the posterior aorta near its division into the iliacs, or from
one of these, and is easily recognized as it leaves the arterial
trunk, at almost right angles, in the region of the anterior
border of the shaft of the ilium. It curves backward, me-
dianward, and finally, in the form of an arc, forward, to dis-
appear in the uterine walls at or near to the base of the
uterine horn. During this course it lies between the two
peritoneal layers of the broad ligament of the uterus, is
much longer than the broad ligament and is thrown into nu-
merous S-shaped coils. It is readily picked up per rectum
and palpated in the non-pregnant animal and in all stages
of pregnancy. With the advent of pregnancy, the artery
quickly enlarges and the pulsation becomes strong and
bounding. The arterial stream feels as if impeded and there
is a sensation of grating not encountered in other healthy
arteries. The artery is about one-quarter of an inch in
diameter at 120 to 150 days ; at eight months it is one-half

Palpation of the Uterus per Rectum 123

inch or over; and in a large cow closely approaching full
term it may be nearly three-quarters inch, full and bounding.

The posterior uterine or vaginal artery is given off from
the internal pudic, approximately opposite the apex of the
angle between the sacro-sciatic ligament and its point of at-
tachment to the sacrum, and passes across the pelvic cavity
in the broad ligament of the vagina to the vagina and cervix.
In the healthy non-pregnant cow it is almost as large as the
main uterine artery. It is easily picked up per rectum and
palpated. Like the middle uterine artery, it enlarges very
rapidly as soon as pregnancy is established but attains no
such great dimensions as the former. It reaches ordinarily
the size of a lead pencil.

The examiner, in the course of his work, should acquaint
himself with these various changes by studying animals
pregnant for a known period. In this manner he becomes
familiar with the clinical findings and is able to reach a
closer approximation of the date of pregnancy of females
whose history of conception is wanting.

6. Palpation of the Uterus per Rectum

The palpation of the uterus of the cow and mare per rec-
tum affords the most valuable means which we possess for
the diagnosis of pregnancy. After conception the uterus
undergoes prompt and marked changes in volume, form,
consistence, and location. When estrum occurs, there is a
marked engorgement. The organ is hard, tense, and smooth.
The condition is most notable in heifers. If conception oc-
curs, the engorged, undulatory character continues for a
time and in heifers the organ remains almost static in size
for fifteen to twenty days, after which it gradually en-
larges. In cows which have calved previously, these symp-
toms do not become so apparent and the enlargement is not
pronounced until thirty to sixty, or even seventy days. Then
the uterus becomes larger, most markedly in the gravid horn.

Owing to the great variations of the size of the uterus in
adult cows and mares, due partly to individual peculiarities
and partly to the health or disease of the organ, one has

124 Diseases of the Ge?iital Organs

sometimes to await a quite definite increase in volume before
this becomes of distinct value in determining pregnancy.
The same may be true of heifers which have been sterile for
a long period and in which the uterus has undergone en-
largement because of chronic endometritis.

As a general rule, however, heifers which have conceived
at all promptly show distinct and characteristic enlargement
of the uterus within twenty to thirty days after conception,
and cows at any time from thirty to sixty or seventy days.
The enlargement of the uterus as a result of conception is
very characteristic. The organ may be enlarged from a
great variety of causes, but the enlargement due to other in-
fluences than pregnancy differs materially and clearly in al-
most every case. In pregnancy the uterus is smooth and even
in outline, firm, tense, and fluctuating. Except in case of
twin pregnancy, the pregnant horn is much larger than the
other and regularly corresponds with the corpus luteum of
pregnancy. While the corpus luteum is regularly palpable
in early pregnancy in the cow, it is not so in the mare be-
cause it is hidden deeply in the hilus of her ovary. At the
region of the internal os uteri, the superior uterine wall of
the pregnant cow rises up suddenly like a terrace instead of
sloping forward gradually as is observed when pus or lymph
distends the organ. The firmness of the uterine wall is in
marked contrast also to its character when the organ is dis-
tended with pus or lymph. In pregnancy the uterus is dis-
tinctly firm and exhibits to the touch a sense of vigor and
life. When lymph distends the uterus, the walls may be thin
as in pregnancy but they are almost always soft and flaccid
and the horns are usually somewhat equally filled. In rare
instances, owing to compression of the cervical canal due to
sclerotic swellings in the cervical walls associated with cer-
vicitis, menstrual debris is retained, distending the uterus
quite firmly and giving a tension much like that of preg-
nancy, but the two horns are alike and there is but one cor-
pus luteum. Usually in such cases no uterine seal is pres-
ent. When the organ is distended with pus, the contents do
not move as freely as the fetal liquids. The uterine walls

Palpation of the Uterus per Rectum 125

are soft and flabby with a moderate amount of thickening,
or they are tense and at some place an abscess may point, or
the organ is very dense, with thick, hard walls.

As pregnancy advances, additional evidences appear. The
uterus becomes very greatly enlarged, the walls are tense,
and the fetal fluids are quite readily recognized as such.
Later, cotyledons are palpable through the uterine wall and
when pregnancy has reached four to five months one will
occasionally recognize the fetus itself floating in its fluids.
The fetus becomes increasingly easy of recognition as preg-
nancy advances. In some cases, however, both fetus and
uterus fall forward into the abdomen and may be beyond
the reach of the examiner. In such cases there is still good
evidence of pregnancy. The vagina is drawn far forward,
the cervix has been dragged anterior to the pubis, and the
vaginal end of the uterus constitutes a large, thick, firmly
stretched band passing downward and forward beyond the
examiner's reach. This of itself does not indicate preg-
nancy with absolute certainty, because the same displace-
ment of the uterus also occurs from the presence of large
uterine or ovarian tumors, from extensive pyometra, Or from
other pathologic conditions which would cause an increased
weight of the organ. The application of the uterine forceps
to the cervix, followed by traction on these, thus drawing
the uterus upward and backward, to or into the pelvis, as
already advised, is of supreme importance in making an
accurate diagnosis in these cases. No other means alone
can afford so great assistance and security. In this emer-
gency, however, other signs appear to aid the examiner in
making his diagnosis. As a general rule, the diagnosis can
be verified by the presence of the uterine seal, by abdomi-
nal ballottement, or by palpation of the enormously en-
larged uterine arteries. In some instances it is practicable
to diagnose the physical well-being of the pregnancy. It is
easy to diagnose desiccation of the fetus from the time
when the interplacental hemorrhage occurs. When the
metritis of pregnancy is so far advanced that abortion is
not very distant, it may be diagnosed by vaginal and rectal

126 Diseases of the Genital Organs

palpation, even though the fetus be yet alive, but this is not
as easy in the cow as in the mare. In the latter I have been
able to pass my finger through the wide, short cervical
canal, from which the uterine seal had disappeared, palpate
the suppurating, necrotic area of the chorion about the os
uteri internum, and, beyond, touch the active fetus. In the
cow this is impracticable, but one may recognize by vaginal
examination the disease or destruction of the uterine seal
or portions of necrotic chorion in the cervical canal or pro-
truding into the vagina. By rectal examination, one may
recognize clearly the paretic uterus of metritis, its want of
tone, its flaccidity at the cervical end, and the thickened
wall. By these means I have been able to make the diag-
nosis "Pregnant, but unsafe" and, to the astonishment of
the breeder, have my diagnosis verified in a few weeks by
the cow aborting. The dead and macerating or emphyse-
matous fetus and such displacements as torsion of the uterus
without clinical symptoms are clearly diagnosed by rectal
palpation. The palpation of the pregnant uterus per rec-
tum has, therefore, a very wide range of usefulness and
is capable of important advancement by further study.

Much fiction has been indulged in regarding the dangers
from palpation of the gravid uterus per rectum. While
some persons are bungling enough to rupture the rectum in
this procedure, that is not the fault of the operation, but
merely the ignorance, stupidity, or carelessness of the ex-
aminer. The idea that abortion may be caused by a pru-
dent rectal palpation is no better founded, if as well, than
the unavoidability of rupturing the rectum. A stupid ex-
aminer might rupture the gravid uterus, or possibly roll it
over and cause torsion, but that is not abortion, and does
not lead to abortion. I might illustrate the safety of the
examination by a typical incident to which reference will be
made later. I was examining for pregnancy a cow which
had been bred 145 days previously. The findings were ex-
ceedingly confusing. I palpated the uterus for one-half
hour before I finally recognized the presence of torsion.
The cow was left for about twenty hours, then was cast,

The Diagnosis of Twin Pregnancy 127

rolled over several times, released and caused to get up,
then thrown and rolled again. In all, she was rolled com-
pletely over six times, thrown twice, and the gravid uterus
palpated with considerable vigor. She calved easily and
without assistance, at 280 days. Both mother and calf were
healthy. Thus, she endured severe uterine torsion, violent
rolling, and prolonged palpation per rectum, without visible
disturbance of the course of pregnancy.

Some veterinarians are afraid to apply forceps to the
cervix of a pregnant cow or mare and exert traction. The
proper application of the uterine forceps to the cervix does
not cause any material disturbance to the uterine seal and
causes only the most trivial wound of the cervix. The trac-
tion applied to the cervix by any veterinarian of very ordi-
nary prudence is not so great as the tension caused upon
the same parts when the animal is lying down or getting up.

Generally life can be recognized in the fetus by rectal ex-
ploration long before it can be by auscultation of the heart
or by other means. When the cow has been pregnant four
or five months, the fetus, eight to twelve inches long, when
touched, generally reacts to the impact and moves in a
clearly recognizable manner.

7. The Diagnosis of Twin Pregnancy

The diagnosis of twin pregnancy can be made only by
rectal examination and is especially easy in the cow at 90 to
120 days, when the entire uterus may generally be palpated,
as well as the ovaries. At this time, if the twins are bicor-
nual, as is the rule, the diagnosis is very simple. The two
horns are equal in size, and, as discussed in the following
paragraph, there is a corpus luteum of pregnancy in each
ovary. With all cardinal symptoms of pregnancy present,
the two elements mentioned make the diagnosis very reli-
able. Later, when the uterus becomes greatly enlarged and
passes far forward in the abdomen, the diagnosis is more
difficult and less secure. The corpora lutea cannot then be
felt, as the ovaries are out of reach and the uterine horns
cannot be well compared. The diagnosis of twins must then

128 Diseases of the Genital Organs

rest upon the palpation of two fetuses, and there is no cer-
tainty whether they are to present alike or alternately.
Generally they alternate ; one presents cephalically and the
other caudally. In eampylorrhachis and schistocormus re-
flexus, however, we meet with a single fetus presenting
both by its cephalic and caudal ends. Double monsters may
also be met, confusing the examiner. In unicornual twins,
the examiner faces great difficulty. Almost, if not always,
they lie end to end — either head to head or tail to tail — caus-
ing an enormous elongation of the gravid horn which
reaches, at the close of pregnancy, double the length of the
antero-posterior diameter of the abdominal cavity, necessi-
tating the doubling of the uterus upon itself, as in the bitch.
Then the fetuses lie side by side, with two uterine walls be-
tween them and their contact ends lying against the dia-
phragm of the mother. Their free ends — two heads or two
tails — lying side by side, are directed toward the pelvis.
The basal fetus presents on a line with the long axis of the
cervix ; the fetus occupying the ovarian end of the horn lies
lateral to the basal fetus, on the side of the ovary of preg-
nancy. That is, if unicornual twins are in the right horn,
the basal fetus presents with its head or tail towards the
cervix, and on the right of this lies the other fetus, present-
ing by the same part but lying to the right of the cervix.
The ovary may now be pushed toward the pelvis and its two
corpora lutea should be palpable. On the left the non-
gravid horn would be palpable. In one cow about 60 days
pregnant, unicornual twins were quite securely diagnosable
by the presence of two typical corpora lutea in the ovary on
the pregnant side. That does not make twin birth neces-
sary. One embryo may perish and be absorbed but the diag-
nosis is still important because the other embryo may be a
"freemartin", or neuter, though born singly. If a good
diagnosis of twin pregnancy has been made, a single birth
follows, and the offspring is apparently a female, its sex
may well be doubted.

Diagnosis of the Duration of Pregnancy 129

8. Diagnosis of the Duration of Pregnancy

It is highly important that the veterinarian shall be able
to diagnose with reasonable accuracy the duration of an ex-
isting pregnancy. As already related, the heifer or cow
sometimes comes in estrum and is re-bred perhaps repeat-
edly after conception. It is then desirable to be able to
state, approximately, the stage of pregnancy in order that
it may be determined at about what period parturition may
be anticipated. When heifers or cows are bred in pasture
so that the date of conception is practically unknown, the
determination of the duration of pregnancy is at times
sought by the owner. In pedigreed cattle, when pregnant
females come in estrum, the bull is sometimes changed and
confusion of pedigree results, which may often be satisfac-
torily solved by physical examination to determine the dura-
tion. Sometimes conception occurs unexpectedly and a de-
termination of the stage of pregnancy aids in determining
how it occurred. Thus in one instance, in a cow supposed
to be non-pregnant which showed no estrum, examination
led me to say that she was pregnant four months. The
owner was certain she had not been served, but it was
finally recalled that four months previously a bull, supposed
to be too young to copulate, had been with her at pasture.
In another instance a pure-bred Holstein cow purchased a
year previously as pregnant six months, had not calved, had
not been in estrum so far as known, and, according to his-
tory, had at no time been where a bull could copulate with
her unknown to the custodian. In addition, her vagina con-
tained a quart or more of highly fetid pus. In spite of such
a history, I pronounced her pregnant six months and the
fetus alive. She calved true to diagnosis. When the custo-
dian saw clearly that the cow was to calve soon, he recalled
that she had, at the date indicated, escaped to the premises
of a Shorthorn breeder, though it was not known that she
had copulated with the Shorthorn bull.

During the first five or six months, the stage of preg-
nancy in cattle is to be determined by the transverse diame-
ter of the pregnant horn of the uterus. During the latter
9

130 Diseases of the Genital Organs

stages, the duration is to be determined by the volume of
the palpable part or parts of the fetus, the volume of the
uterine arteries, and to some extent by the volume of the
uterine seal, the dilation of the cervical canal, the enlarge-
ment of the udder, and the sinking of the pelvic ligaments.
In a heifer of medium size, pregnant thirty days, the gravid
horn is about one to one and one-quarter inches in diame-
ter. When forty-five days pregnant, the gravid horn has
increased to one and one-quarter or one and one-half inches.
At sixty days, it has reached about one and three-quarters
inches ; at ninety days, two to two and one-half inches ; at
one hundred to one hundred and twenty days, three to three
and one-half inches. At one hundred and fifty days, the
gravid horn is four and one-half to six inches, and at one
hundred eighty days, seven to eight inches. In the cow,
during the first sixty days, the uterus is somewhat larger
than in the heifer, and later is not quite as tense as in the
latter, but there is no recognizable difference in size.

At about one hundred fifty to one hundred eighty days,
the fetus is generally palpable. Frequently it is palpable at
a much earlier date even when only six to eight inches long,
but recognition of the fetus at this time is not at all certain
in any given case. Even when the fetus is recognized at
this early date, it is of little or no advantage, as a means for
determining the stage of pregnancy, over the transverse di-
ameter of the gravid horn.

Once the fetus is palpable, its age is to be judged by the
volume of the extremity palpated. The length of the fetus
cannot be determined. The parts usually palpated are the
head or the anterior feet when in the anterior presentation,
or buttocks when in posterior presentation. The size of
these will vary with the size and age of the pregnant animal
and with breed. The Holstein fetus is the largest commonly
encountered and has large head and feet. The Jersey pre-
sents the other extreme. The examiner is to bear in mind
individual variations in size of fetuses also. The determina-
tion of the stage of pregnancy by physical examination is
evidently only approximation but, with the breeding history,

Diagnosis of the Duration of Pregnancy 131

may be rendered very exact. Thus when a cow or mare has
been bred but twice with an interval of two to four months
between and the two dates definitely known, the veterinarian
can then positively state by which service the animal is
pregnant.

Depending upon the value of the animal and the skill of
the veterinarian, the rectal palpation of pregnant animals
may be made of wider use to breeders. The trained human
obstetrist examines his patient at intervals during her preg-
nancy in order to determine if all is well and, if possible, to
recognize any impending danger to mother or fetus. So in
animals there is an interesting and useful opportunity for
service. Thus in the cow with torsion of the uterus, to
which reference was made above, the statement is quite jus-
tified that this examination of an apparently well cow saved
the lives of herself and fetus. In mares and cows the pos-
terior presentation of the fetus is as a rule a definite peril.
In many instances definite assistance is required during par-
turition. If the presentation were known in advance, close
watch might be kept and veterinary aid more promptly sum-
moned. Perhaps one of the most striking instances where
the diagnosis of the presentation of the fetus would prove of
tremendous value to the breeder, is in the transverse or bi-
cornual development of the fetus in the uterus of the mare.
In the commonest of these, the ventral transverse presenta-
tion, virtually every foal is lost, since the sacrifice of its life
in the performance of embryotomy is essential to any hope
for the life of the mare. Nevertheless, the mortality in
mares from this presentation is appalling. When the con-
dition which I have described in Veterinary Obstetrics as
"compound rotated bicornual pregnancy" is encountered,
no foal or mare, so far as recorded, has emerged from the
ordeal alive. It seems to me that the most hopeful outlook
for such cases would be to diagnose them as early as mid-
term, and either bring about artificial delivery while the
fetus is yet small, or resort to Caesarian section some time
during the eleventh month.

132 Diseases of the Genital Organs

There lies before the veterinarian an interesting, and as
yet wholly undeveloped field of usefulness in watching preg-
nant animals and guarding them against important perils.

9. Palpation of the Fetus per Vaginam

Palpation of the fetus per vaginam generally succeeds
only during the last months of pregnancy. At this time, in
many cases, some portions of the fetal body, usually the
head and two anterior feet, rest upon the vagina posterior
to the os uteri externum, occasionally giving the inexperi-
enced examiner the impression of extra-uterine pregnancy.

10. Abdominal Ballottement

After the sixth month of pregnancy, in the cow, the but-
tocks or other portions of the fetus usually lie in close con-
tact with the abdominal floor of the lower right flank re-
gion. If the hand is placed firmly against the abdominal
wall, a somewhat vigorous thrust made upward, and then
suddenly the force released, but the hand kept in contact
with the parts, the adjacent portion of the fetus is pushed
upward in its fluids, floats for a moment, and then drops
back against the examiner's hand with a recognizable im-
pact. This is a good sign of pregnancy, but not always re-
liable. Sometimes no portion of the fetus chances to lie in
sufficiently close contact with the abdominal wall to render
the test efficient. On the other hand, a tumor or a very
large and heavy intestinal calculus might mislead the ex-
aminer when the animal is actually sterile.

11. Auscultation of the Fetal Heart

In the advanced stages of pregnancy it is frequently possi-
ble, by careful auscultation of the abdominal walls over the
region of the fetus, to detect the beat of the fetal heart,
which is usually at least twice as rapid as the beat of the
maternal heart.

The abdominal ballottement and the auscultation of the
fetal heart are of minor value to the skilled veterinarian, be-
cause when these can be successfully applied the other signs

The Abderhalden Reaction 133

which have been enumerated should have decided the ques-
tion long before.

12. The Abderhalden Reaction

Abderhalden (') announced in 1912 the discovery of a
highly interesting method for diagnosing pregnancy by a
laboratory test. A test fluid is made from placental tissues,
to which is added serum from the animal to be tested, and
the mixture is placed in a dialyzing tube. If the animal is
pregnant, portions of the ferments existing within the blood
serum dialyze into surrounding distilled water, in which
they may be recognized by a delicate purple coloring, upon
the addition of ninhydrin followed by heat. It is claimed
that the placental ferments appear in the blood as early as
eight days after conception and disappear within fourteen
to twenty-one days after the expulsion of the placenta. In
the larger domestic animals it is more than eight days be-
fore any placental tissue commences to form. It is not easy
to understand how a test for placental elements can act until
placental tissues exist. The statement that a reaction may
occur as early as at eight days is probably based upon re-
searches upon some small rodent, where the placenta de-
velops much earlier.

Since the preparation of the test material and the test it-
self are very complex, requiring delicate laboratory appara-
tus and highly technical skill, the test is expensive as com-
pared to its value in the veterinary field. Even in human
obstetrics and gynecology, where the cost is not as great
an element and where an accurate physical examination is
not nearly as practicable as in the mare and cow, the test
is not regarded by many of the foremost authorities as effi-
cient. J. Whitridge Williams (-) states, "While I consider
that the method should be regarded as one of the important
recent contributions to medicine, I do not believe that it is
destined to come into extensive practical use for several
reasons : First, its technic is so complicated that it can be

1 Die Serodiagnostik der Schwangerschaft, Deutsche med. Wochenschr.,
1912, No. 46.

1 Obstetrics, 191 7.

134 Diseases of the Genital Organs

satisfactorily employed only by especially trained labora-
tory workers. Second, even its most enthusiastic advo-
cates admit that the results fail to correspond with the clini-
cal finding's in 5 to 10 per cent, of cases, and thirdly, that it
is available only in normal pregnancy, as it gives uncertain
results in inflammatory conditions and uterine myomata,
or when the pregnancy is complicated by nephritis or tox-
aemia."

Graves (]), speaking of this test, states, "Opinions dif-
fer as to the present value of the Abderhalden test for preg-
nancy, some regarding it as too inaccurate to be of much
clinical value, while others consider it reliable and practical
(McCord). The test requires much skill and care, there be-
ing numerous chances for error. For that reason it has not
yet come into general practical use."

Thus for woman, where accurate diagnosis is most im-
portant, leading authors either condemn the test as unre-
liable or seriously question its value in the present state of
knowledge concerning it.

Zell(-) concludes that the test is very reliable, but when
questioned admits that the serum of a cow may react for
twenty or more days after abortion, that many tests are
valueless because of slight errors in drawing the blood or
decanting the serum, and that various diseases nullify the
value of the test. Finally, he admits that the test is not at
all sufficient or complete within itself and must always be
considered in conjunction with — not as a substitute for —
physical examination. In 78 clinical cases summarized, the
test was erroneous in 5 animals — or 6.4 per cent. Any
fairly good diagnostician can be more accurate by physical
examination. Some have claimed a place for the Abder-
halden test on the ground that, in the cow and the mare,
physical diagnosis is impracticable in the first half of preg-
nancy and in the second half physical examination imperils
the pregnancy. Neither of these assumptions is true
Should the test become simplified and its accuracy be ad-

1 Gynecology, Graves, Win. P., 1917.

2C. A. Zell, The Abderhalden Test for Pregnancy in Animals, Jour. Am.
Vet. Med. Assn., Oct., 1917. New Series Vol. 5, No. 1, page 39.

The Abdcrhalden Reaction 135

vanced, it may prove valuable in sheep, goats, swine, and
carnivora, where rectal palpation is not practicable, but in
these a diagnosis is rarely of sufficient importance to war-
rant the cost.

It is claimed that the test is highly valuable in cases of
sale and warranty, but at the same time it is admitted that
the blood of a cow which has recently calved, and presuma-
bly also of one which has recently aborted, gives a positive
reaction for a somewhat indefinite period. Accordingly,
even though a test is positive and no error in technic has
been made, the Abderhalden test can at best show only an
alternative result — that is, the animal either is or has re-
cently been pregnant. Just how recently, we do not know.
In this respect it is inferior to physical diagnosis, because
the latter shows that the animal is actually pregnant at the
time of examination and in many cases gives valuable in-
formation as to the safety of the pregnancy.

In another direction the Abderhalden test is very de-
fective. In examining cows for sterility, the examiner
must decide upon the spot whether a cow is pregnant. In
many cases the whole value of his work in relation to ster-
ility depends upon a prompt and accurate diagnosis without
resort to laboratory methods, with the accompanying de-
lays and difficulties. For example, when called to examine
a cow which has proven sterile, at about the time for a re-
turn of the estrual period, the practitioner needs to make a
prompt and accurate diagnosis and apply the proper handl-
ing immediately. If he cannot make a diagnosis and take
prompt action, if the cow is nearing estrum, he must lose
one period without having made any material progress. At
present it seems highly improbable that the Abderhalden
test for pregnancy is destined to attain a prominent place
in veterinary medicine.

The physical diagnosis of pregnancy is not dependent
upon any one sign, but rather upon a summary of all signs,
all of which are in close accord and are available to the
careful examiner. We have dealt with these individually.
They should always be considered individually, and later

136 Diseases of the Genital Organs

collectively. For example, if an animal has been bred for
thirty days, if estrum has not recurred, if the uterine seal
is present and definite, if one of the horns is larger than the
other, and on the same side with the enlarged horn there is
a typical corpus luteum of pregnancy, the cow is pregnant,
and the diagnosis is as accurate and secure as any diagnosis
which we can make. Other signs exist which may aid us
and add to the security when any one of these fundamental
signs is absent or in some manner clouded. With experi-
ence and care, any veterinarian can learn to make a safe
and accurate diagnosis of pregnancy by physical examina-
tion.

Certain other signs of pregnancy frequently relied upon
have a minor value. One of the commonest physical signs
of pregnancy is a change in the volume and form of the ab-
domen. However, this is not in itself dependable. Many
non-pregnant animals have greatly enlarged abdomens, and
many in advanced pregnancy show but little enlargement of
the abdomen. In a heifer, gaunt from advanced tuberculo-
sis and believed non-pregnant, I diagnosed twins, to which
she gave birth a few weeks later.

The enlargement of the mammae is generally a reliable
sign of advanced pregnancy, but some cows do not show
marked enlargement. In other cases sterile heifers lactate
freely. I saw one, which was not and had not been preg-
nant, yield twenty pounds of milk daily.

13. Confusing Findings in Examination for Pregnancy

While engaged in rectal palpation, one sometimes en-
counters conditions which confuse the examiner, at least
temporarily.

a. The left kidney, in all cows, is displaced somewhat to
the right and appears quite pendulous. It is much larger in
the living than in the dead animal. It contains a great vol-
ume of blood. In some cases, it hangs very pendant, and an
inexperienced veterinarian, coming in contact with it for the
first time, may for a moment think it a tumor.

Confusing Findings in Examination for Pregnancy 137

Fig. 46. Lipoma of Mesenteric Fat of Large Intestine. Cow.

/,/,/, Lar^e intestine ; 2, 2, 2, cross sections of loops of large

intestine, surrounded by fat tumor.

138 Diseases of the Genital Organs

b. Mesenteric fat tumors of immense size occur now and
then, chiefly in the mesentery of the large intestines, as seen
in Fig. 46. I have seen these mostly in Guernseys and Jer-
seys. They consist of great masses of necrotic fat, hard,
marbled, and iridescent on section. They are quite movable
in the abdomen. In my first case, I was greatly confused,
and suspected that I had to do with an extra-uterine fetus.
It was too far forward to permit of complete palpation.
There is no occasion for such error. In extra-uterine preg-
nancy the fetus is firmly moored by adhesions to the abdomi-
nal floor. While I have no definite history, my museum speci-
mens show the fetus, or fetuses, to be firmly encapsuled by
adhesions, so that they are compressed into the narrowest
space possible, but where and how they were attached I
have no history. When the examiner is on his guard, the
mesenteric fat tumors have in my experience admitted of
ready diagnosis. Their relation to the intestines constitutes
the chief guide. I have seen them in old, or at least adult,
cows only. They may be of any size. In one case the entire
abdomen appeared to be filled with these.

c. Dislocation of the rumen is also a very disconcerting
condition when first met. In one cow, to all external ap-
pearances in perfect health, the rumen was extremely dis-
located. The right sac had glided across the abdominal floor
and had come to rest against the right abdominal wall, above
the level of the pubis. The left sac of the rumen had de-
parted from the left sub-lumbar region and dropped down
until it lay only slightly above the pubis. The massive or-
gan thus lay on the abdominal floor. Its normal left wall
had become its floor; its right wall faced upward. The
rumen occupied the entire abdominal floor in front of the
pubis, and projected somewhat above it. The soft, pulta-
ceous rumenal contents were readily recognizable. The or-
gan could be clearly distinguished and traced. The genital
organs, uterus, and ovaries passed directly forward and lay
upon the dislocated rumen. The dislocation is apparently
of no consequence, except for the confusion it may cause
during rectal palpation.

Confusing Findings in Examination for Pregnancy 139

d. Extensive pyometra has caused colleagues of consid-
erable experience to diagnose pregnancy. In one instance,
pregnancy had been diagnosed in a well-bred cow. She was
sold at a high figure and shipped a long distance. She was
finally returned by the purchaser at heavy cost. When I ex-
amined her, I siphoned out 3 to 4 gallons of a thin, very
fetid pus. In another instance, a heifer purchased as preg-
nant, having gone beyond her supposed duration of preg-
nancy, was examined and a macerating fetus diagnosed. I
siphoned out about 13 liters of a very thin, odorless, yellow
pus. In each case there was no observable purulent dis-
charge, though the cervical canal was freely open. The
uterus lay far forward (neither colleague had applied for-
ceps and drawn the uterus back) and, finding it distended to
the volume of six months or more pregnant, the colleague in
each case erred and diagnosed pregnancy. The uterus was
too flaccid for pregnancy and its walls were too thick. When
traction was applied and the uterus drawn backward and
upward until the entire organ was in reach, it was per-
fectly clear no large fetus or fetal cadaver was present.

It is true that often the gravid uterus drops far downward
and forward, especially in old cows with pendant bellies,
but fetal cotyledons are in reach even if the fetus is not.
The veterinarian should also seek evidence from the uterine
arteries. Pyometra cannot cause an enlargement of the
arteries at all comparable with the enlargement of preg-
nancy.

e. Cystic Uterus. The uterus of the cow occasionally be-
comes cystic and causes the veterinarian to err in diagnos-
ing pregnancy. There may be five to ten gallons of lymph
or thin mucus in the uterine cavity, the organ dropped far
forward and very flaccid. There is no recognizable dis-
charge. The cervical canal is usually free.

In another group of cases, there is a blocking of the cervi-
cal canal owing to one of the annular mucous folds acting
as a valve to retain menstrual debris. This causes a tense
filling of the uterus which is much like pregnancy, but the
uterine seal is ordinarily absent, there is probably no corpus
luteum typical of pregnancy, the arteries are not enlarged,
and the two uterine horns are distended alike.

Chapter III

ARTIFICIAL INTERFERENCES WITH
REPRODUCTIVE FUNCTIONS

A. The Artificial Induction of Estrum

The artificial induction of estrum has a wide application
in cattle breeding and in dairying, but has not been rendered
available in other species of animals.

Aphrodisiacs. Yohimbin Spiegel. For many years nu-
merous drugs have been credited with the power of arousing
the sexual appetite and powers. Among these are canthar-
ides, turpentine and the balsams and resins and, more re-
cently, a new drug, yohimbin, has been introduced to over-
come sterility. In large doses, these drugs induce more or
less irritation of the urino-genital tract and, apparently,
stimulation of the sexual desire.

It has not been shown that aphrodisiacs stimulate ovula-
tion and spermatogenesis. From all data at hand, they
merely arouse the sexual appetite without increasing the re-
productive powers. In the minds of some, vigorous sexual
desire signifies exalted breeding powers, but this is a false
assumption. In nymphomania, for example, the sexual ap-
petite is intense and the breeding power nil. Sexual appe-
tite, without normal ovulation in the female and the forma-
tion of normal spermatozoa in the male, has no value, but is
rather a harm, frequently leading the owner astray and di-
minishing the value of the patient for other purposes.

A few years ago vigorous propaganda brought into notice
yohimbin spiegel as a magical sex tonic and a great weapon
against sterility. The pathology of the cases where it was
alleged to give relief was not recorded. It was used almost
wholly in females which failed to come in estrum, but why
they failed no intimation was given.

Holterbach (Berlin Tierarztliche Wochenscrift, No. 9,
1908), in an exhaustive article, champions the use of the
drug. He used it in 37 cases of absence of sexual desire —

The Artificial Induction of Estrum 141

22 cows, 9 bitches, 3 bulls, and 3 sows. In his observation,
the drug has a greater affinity for the female than for the
male genitalia. A five-year-old Simmerthal cow calved nor-
mally in June, 1906, but estrum did not follow. All other
drugs, including cantharides, proved useless. In August,
1907, fourteen months after calving, 16 tablets of yohimbin
chloride, each containing 0.1 gram of the alkaloid, were pre-
scribed, one tablet to be given three times daily in the drink-
ing water. On the third day there was excitement, bellow-
ing, uneasy stepping about, frequent urination and de-
creased milk flow. On the fourth day there was a muco-
sanguineous discharge from the vulva (menstruation?) and
on the fifth day the owner noted expulsive efforts resembling
labor pains. The external genitals were swollen and hyper-
aemic, but no estrum was present. The uterus was large.
The ovaries were enlarged, but not cystic. Six weeks later,
the cow, showing violent estrum, was bred and the owner
"believed" her in calf.

Another cow, nine months post partum ,without estrum,
and having cystic ovaries, was treated in the same way, de-
veloped estrum ten weeks later and was bred. The owner
"believed" her to be pregnant.

So far as can be seen from Holterbach's reports, the evi-
dence is not convincing. In no case was the cause of non-
estrum explained, and no proof was submitted that the es-
trum, following the use of yohimbin, was due to the drug.

Frubinger (D. M. W. No. 7, 1907) condemns the drug as
worthless and attributes the alleged cures in man to sug-
gestion.

Miiller (Arch. Internat. Phar. et de Therap., Vol. XVII,
p. 81) considers it an erratic aphrodisiac, acting differently
on different individuals. Daels, quoted by Holterbach, ex-
perimentally caused menstruation in bitches already in es-
trum, but bitches usually menstruate at this time anyhow.
In another, not in estrum, but date of probable normal es-
trum not named, menstruation occurred in four days. A
third bitch showed a mucous discharge. Later, bloody feces
were voided and the animal died from the toxic effects of

142 Diseases of the Ge?iital Organs

the drug. Autopsy showed enlarged, congested genital
canal, prominent ripe ova, etc.

In experiments on young bitches less than nine months
old, the drug, in fatal toxic doses, failed to cause reaction in
the genital organs.

I used the drug experimentally upon several cows in
which I had otherwise failed to induce estrum, but, like
other efforts, it was without avail. In one cow there were
ovarian adhesions ; in another, cystic degeneration of the
ovaries, etc. The drug has dropped out of notice except for
an occasional medicine vendor who adheres to "patent medi-
cine" ideals. The failure of an adult, non-pregnant female
to come in estrum at the proper time is due to some patho-
logic condition, the removal of which is followed by estrum.
But the removal of the cause of non-estrum must be the
basis for action in each case. These pathologic conditions
will be discussed in their proper places. In some cows es-
trum is not very evident, or the keeper fails to recognize it.
The animal may be healthy or unhealthy. It is important
in some healthy cows to get definite track of the estrum. If,
upon the examination of an animal in which estrum is not
observed, the general health is good, the genital organs nor-
mal, and a corpus luteum present, it is sufficiently clear that
at some former date the animal had been in estrum and had
ovulated. If the corpus luteum is dislodged by compressing
it per rectum, the animal will quite certainly be in estrum
in three or four days.

In some cases it is desirable to interrupt the estrual cycle
because several females are in estrum simultaneously and
the service of all would overwork the herd bull. The vet-
erinarian can, by dislodging the corpus luteum, adjust the
estrual cycle at will.

Healthy cows sometimes fail to ovulate promptly after
parturition, thereby causing a delay in re-breeding. When
a cow does not show estrum within sixty days after par-
turition, if she is healthy, the corpus luteum of pregnancy
is probably tardy in disappearing. It then becomes of im-
portance to the dairyman that the yellow body shall be dis-
lodged and the cow caused to come in estrum.

Artificial Insemination 143

The veterinarian should constantly remember that es-
trum and ovulation come as a matter of course in healthy
females of breeding age and that when estrum fails it is
because of general ill health or some other restraining
cause. No drug has yet been discovered which can di-
rectly cause estrum or ovulation. The restoration of the
general health, relief from distinctively genital diseases,
and the surgical dislodgment of the inhibiting corpus lu-
teum, when present, constitute the fundamental principles
in regulating estrum and ovulation.

B. Artificial Insemination. Artificial Impregnation

Artificial insemination or impregnation has been advo-
cated by a limited number of veterinarians and breeders.
The advocacy has been based upon various hypotheses and
facts, but the operation has not come into extended use. At
present there are no indications that the scheme will ever
occupy an important place in livestock husbandry.

Artificial insemination is not difficult and there can be no
question of its efficacy in fertilization. It has been advo-
cated in two distinct fields — to conserve the sexual powers
of valuable sires by causing numerous fertilizations from a
single coitus and also to insure fertilization in a female
otherwise sterile.

The fertilizing of many females by a single coitus is of
course technically possible, and has appealed very strongly
to some owners of fashionable sires. Technically, in all ani-
mals there are millions of spermatozoa ejaculated at each
coitus, of which but one can take part in the fertilization of
an egg, and the millions of others must perish. Any at-
tempt to conserve these millions of spermatozoa, when from
a valuable sire, has much in it to appeal to some owners,
and comparatively simple means are at hand for carrying
out the operation. The prime essentials to possible arti-
ficial fertilization are that the spermatozoa shall be obtained
promptly after ejaculation by the male, kept moist, the tem-
perature maintained at approximately that of the body
(100 to 105 degrees, F.), and introduced into the genital

144 Diseases of the Genital Orga?is

canal of the female with sufficient promptness that the
spermatozoa shall have lost none of their vigor. In large
animals (horse and cow) semen may be collected immedi-
ately after coitus by introducing the hand into the vagina,
using it as a ladle to gather up and withdraw the contents,
and may then be placed in a wide-mouthed bottle or other
vessel, immersed in water at a temperature of 100° to 105°
F. The semen may then be diluted, if required, by adding
sterile physiologic salt solution of body temperature. Di-
luted or undiluted, the semen may be introduced into the
vagina, cervical canal or uterine cavity of another female
which it is desired to fertilize. The introduction may be
made with a syringe, a funnel fitted with a tube, or other
apparatus.

Spermatozoa have been kept artificially in a motile state
for many hours. In the healthy genital tract they presuma-
bly retain their motility for days. Motility of the sperma-
tozoa is not proof of fertilizing power, and no satisfactory
data are at hand indicating how long after ejaculation sper-
matozoa retain vigorous fertility. It is probably for a few
hours only when in the healthy genital tract, where the
spermatozoa unquestionably live longer than when kept out-
side the body. In mares and cows, rape is occasionally in-
duced by the breeder, under the belief that it will cause es-
trum to appear soon. In other cases, the female has been in
estrum, which, before opportunity for coitus has occurred,
ceases and the owner hopes by belated coitus, under com-
pulsion, to secure fertilization. Rape virtually always, if
not always, fails of results. It is reasonable to assume that
artificial insemination can be no more productive of results
than rape. Mule breeding is based upon approximate rape,
but the resistance of the mare is not because she is not in
estrum but owing to her repulsion to coitus with the ass.
It appears that artificial insemination must, therefore, ap-
proximate the essentials of physiologic coitus. The sperma-
tozoa need to be transferred promptly, during estrum. The
suggestion that semen may be transported long distances
and used successfully should be discounted liberally until

A rtificial Insem ination 1 45

further evidence is adduced. The allegations of some en-
thusiasts that artificial insemination succeeds whether the
female is in estrum or not is without supporting evidence
and appears absurd.

Artificial insemination has numerous objectionable feat-
ures. So far as I am aware, no livestock association offi-
cially recognizes such fertilization for purposes of record of
pedigree. The moral hazard in recording pedigrees is al-
ready great and artificial insemination would open a new
avenue to fraud.

While the millions of spermatozoa ejaculated at each
coitus are technically capable of infinite fertilizations, some
are dead and some defective from the first, and most of
them succumb to bacterial or other injury while en route
from the vagina to the ovary, so that their numbers are
greatly reduced before they have reached the pavilion of
the oviduct. As soon as the spermatozoa are apportioned
between two or more animals, the certainty of fertilization
decreases. It is clearly impossible to keep the spermatozoa
as well outside the body as within the genital tract, and
slight error in technic may destroy completely the fertiliz-
ing power.

The chief menace from artificial insemination is the trans-
fer of infection. In natural coitus, when the semen is ejacu-
lated into the vagina, there may be present infection from
both the male and the female genital organs. Most infec-
tions, so far as known, are non-motile. This affords oppor-
tunity for the vigorously motile spermatozoa to move away
from the infection, elude the dangers ,and effect fertiliza-
tion. Semen taken from the vagina of one female contains
the bacteria from herself and the male and, when introduced
into the vagina of a second female, carries for her a double
danger. If, as is generally advocated, the insemination is
made intra-uterine, the danger from infection is greatly in-
creased.

Artificial insemination has also been advocated as a
remedy for sterility. When first proposed, atresia of the
cervical canal was considered one of the chief causes of
10

146 Diseases of the Genital Organs

sterility. Had that been true, the plan would have had
merit. Later developments show clearly that cervical
atresia is essentially negligible as a cause of sterility. Ar-
tificial insemination has, therefore, only a very limited and
questionable place in the treatment of sterility. Diseases of
the vagina, cervix, and uterus which might cause sterility
are more readily remedied by other means than by artificial
insemination. Diseases of the oviducts and ovaries cannot
be favorably affected by the operation. Artificial insemina-
tion may have some value under exceptional conditions in
extending the breeding range of highly valued sires, and in
very rare cases may possibly have value in sterile females.

Artificial Abortion

Occasionally artificial abortion in animals becomes desir-
able in the economic interests of the owner. When highly
pedigreed females are accidentally permitted to copulate
with common males or with pedigreed males of a different
breed, the progeny is valueless and the span of the pregnancy
becomes a loss to the owner in so far as the production of
valuable progeny is concerned. Sometimes, also, a heifer
calf of five to ten months unexpectedly comes in estrum,
copulates with a bull, conceives, and, unless the pregnancy
is artificially interrupted, is much damaged by repression
of growth and development.

No drug is known which is capable of causing a pregnant
animal to abort. Ergot and other drugs have been cited as
ecbolics or abortifacients, but there is no reliable evidence
that any one of them is competent to cause abortion di-
rectly. Ergot, given repeatedly and in large doses, finally
poisons the pregnant animal, which, just prior to death, may
abort. Such abortion is probably indirect; the toxic effect
of the drug, by lowering the resistance of the body, may
enable the infection present in the uterus to acquire new
power and precipitate abortion.

It is not known that any form of bacteria, living or dead,
or any of their toxins or other products, possesses any di-
rect ecbolic power, if by this term is meant an inherent

A rtificial A bortion 1 47

power to cause contraction of the uterus with the expulsion
of its contents.

Many veterinarians and research workers with the B.
abortus of Bang believed for some years that this organism
had the power to act directly as an abortifacient. Professor
Bang made no such claim, so far as I have found, but in-
stead contended that the abortion was the result of an endo-
metritis for which he believed the B. abortus responsible.
If the B. abortus could cause abortion by directly acting
upon the central nervous system, it should be able to do so
when the bacillus is multiplying elsewhere than in the
uterus or fetus, but in all cases, when the aborter is promptly
destroyed, metritis is present and bacteria are recognized
as the cause of the metritis. Hence, so far as known, abor-
tion can not be caused artificially by means of toxins or
other bacterial poisons.

Artificial abortion is quite certainly induced by breaking
down the uterine seal, invading the uterus, and douching
the cavity. The earliest date after copulation at which abor-
tion can be induced by uterine douching is undetermined.
Douching the uterus with a disinfectant immediately after
copulation is quite certain to destroy all spermatozoa and
prevent fertilization, but after the lapse of a brief time,
certainly less than an hour in the cow, the spermatozoa,
having passed into the oviducts, are beyond reach. Mar-
shall, citing Hensen, states that in the rabbit the spermato-
zoa travel from the vagina to the ovary in from fifteen min-
utes to two hours. If that be correct, it is well-nigh im-
possible to douche the uterus early enough after copula-
tion to prevent fertilization. Marshall states that the fer-
tilized ovum of the rabbit enters the uterus at about three
days after fertilization. During this interval uterine
douching can not interrupt pregnancy. In the larger domes-
tic animals, the migration of the fertilized ovum from the
pavilion of the oviduct into the uterus is believed to be
slower than in the rabbit. Marshall (') gives the duration
of migration in the dog as eight to ten days. During this

1 Marshall, A. Milnes, Vertebrate Embryology, 1893, p. 471.

148 Diseases of the Genital Organs

interval, or about 16 per cent, of her span of pregnancy,
the bitch can not be aborted by uterine douching.

Bonnet believes that in domestic animals generally the
tubal migration of the fertilized ovum requires eight to ten
days. The period is certainly no less, and I suspect that in
the cow it is longer. In one cow, which had long been ster-
ile, I douched the uterus freely with 2 per cent. Lugol's so-
lution thirteen days after conception, without inducing
abortion. There was moderate cervicitis present, and I
douched from the cervical end of the uterus some mils, of
pus, so that I possibly prevented, instead of caused, abor-
tion. So far as known, artificial abortion in the cow can
not be brought about by uterine douching until at least eight
to ten days after conception, or, judging from my single
experience, not until an even later date. There is greater
assurance of success if douching is deferred until about the
twentieth day.

In douching the pregnant uterus, the veterinarian needs
to be quite cautious. The catheter must be introduced very
gradually and carefully through the cervical canal, since
the very adhesive uterine seal dulls the sense of touch and
renders mechanical injury possible. When the catheter has
entered the uterus and douching is attempted, the instru-
ment generally becomes blocked with portions of the uter-
ine seal and no safe distension of the uterus with fluid will
force out the sticky mass. The connecting screw between
the outer and inner tubes needs to be loosened and the inner
tube drawn back and forth until the plug of the uterine seal
is dislodged and washed away.

The amount of fluid introduced should be noted very care-
fully, and great care taken not to use too much, because the
pregnant uterus is very easily ruptured. In a recent publi-
cation, a veterinarian records a case of "extra-uterine preg-
nancy" in a cow, the uterus of which he had recently douched
and ruptured, thus causing the fetus to become extra-uter-
ine. It is to be remembered, since up to the fourth month
the embryonic sac in the cow lies very loosely in the uterus,
that the douching fluid pushes the maternal and fetal pla-
centae apart. Then the detached sac, sucked into the fenes-

Artificial Abortion 149

tra of the catheter, prevents the return of the fluid. If the
catheter is removed, the detached embryonic sac blocks the
cervical canal, the distended uterine walls contract, rup-
ture takes place, and the fetus drops into the peritoneal cav-
ity. Therefore it is safer to introduce a few ounces of fluid
only, thus avoiding the peril of rupture. The fluid should
be antiseptic, because, as a rule, the uterine cavity is septic
and a neutral fluid stimulates the bacteria present. The
fluid introduced must not be highly irritant.

While the induction of abortion by means of the uterine
douche is quite reliable in bringing about the expulsion of
the uterine contents, it is neither the safest nor the best
plan. Hess(!) was first to draw attention to the reliability
with which abortion may be induced in heifers and cows by
dislodging the corpus luteum of pregnancy. This operation
possesses the great advantage over the preceding plan of
causing the abortion in an approximately physiologic man-
ner. That is, it acts directly, by removing the inhibiting
power of the corpus luteum, and establishes uterine con-
tractions closely simulating those of parturition and men-
struation, without the intervention of any mechanical insult
to the cervix and uterus. The abortion follows in one to
three days.

The operation is easy and safe in early pregnancy. As
late as ninety to one hundred and twenty days, the operator
can pick up the ovary of pregnancy per rectum with one
hand, carry it back over the vagina, introduce the other
hand into the vagina, grasp the ovary through its roof, and
compress the base of the corpus luteum firmly between the
thumb and fingers until the body is wholly dislodged.
Sometimes the yellow body breaks up under pressure, so
that only a portion is dislodged. The operator should be
careful to press it all out. Later in pregnancy, the ovary
can not be carried back over the vagina. In small heifers,
the vulva may not permit the passage of the hand. Then it
is essential to dislodge the corpus luteum by compression
from the rectum. This must be done cautiously, since the

1 Hess, Professor E., Schweitzer Archives fur Tierheilkunde, No. 6, 1906
P- 351-

150 Diseases of the Genital Organs

rectal walls are but feebly resistant and are readily in-
jured. With patience and care, the dislodgement can be
carried out per rectum though not so safely as per vaginam.
Artificial abortion is rarely advisable after the sixth
month, especially for the purpose of terminating a funda-
mentally undesirable pregnancy. It is safer in such cases,
and the loss of time is little, if any, greater to allow the
pregnancy to go full term and end in parturition. Should
occasion arise for inducing abortion late in pregnancy, it
would be necessary to resort either to breaking down the
uterine seal and douching the uterus, or to performing lapa-
rotomy, if the ovary of pregnancy has been dragged beyond
reach per rectum. If the vagina is clean, vaginectomy may
be performed as in spaying, the hand and arm inserted, and
the ovary thus reached. However abortion is induced, once
it has been completed, it is desirable to watch the progress
of the case and determine by examination of the genital or-
gans, including uterine douching, whether all is going well.

Chapter IV

ARRESTS AND ABERRATIONS IN
GENITAL DEVELOPMENT

A. Asexual or Bisexual Aberrations

1. Neuters, Freemartins

So far as known, cattle lead in the production of asexual,
or neuter individuals. This may be only apparent, since in
cattle, more than in any other animal, the value of the fe-
male of breeding age rests almost wholly upon its reproduc-
tive powers, and any failure to breed attracts definite atten-
tion. It may be that sheep and goats are as frequently neu-
ter but that the condition is overlooked. In cattle the neuter
is ordinarily one of a pair of twins, of which the other is a
male and commonly fertile. The condition, so far as I
know, has not been observed when the other twin is a female.
Numerous theories have been advanced in an effort to ex-
plain the origin of freemartins, or neuters, but the cause of
the phenomenon has not been made clear. While ordinarily
the neuter is twin to a male, I am unable to verify the gen-
eral belief that this is universal. It has been my privilege
to examine clinically several neuters which had been regu-
larly registered in official herd books and sold as heifers.
The rules of breeders' associations forbid the registration
of an apparent female which is twin to a bull until the ani-
mal has conceived. In some instances where the animal has
not been sold, but has been bred by the party for whom the
examination was made, I have had personal assurances that
it was a single. Some of these cases may be due to fraud
upon the part of the breeder. Other animals may be truly
singles in so far as birth is concerned, but the conception
may have been twin and one embryo may have perished and
disappeared. I am inclined to believe that neuters rarely
come from a single conception. Accordingly, when examin-
ing a neuter which has been registered and sold as a breeder,

152

Diseases of the Genital Organs

I always feel that fraud has probably been committed,
though I believe that exceptions exist.

In the most typical individuals, no distinctively genital
organs exist, but traces of both Wolffian and Mueller's ducts
are present and may be clearly traced. No ovaries or testes
are present, but very tiny undifferentiated sex glands may
be recognizable.

Every gradation of development is encountered, from ab-
solute neuter to complete female, but the direction of devel-
opment in cattle, so far as I have observed, is always toward
the female — never toward the male or toward hermaphrod-
itism. Hermaphroditism, so far as I have noticed, is rarer
in cattle than in any other species of domestic animal, but

0CL

Fig. 47 — Arrested Development of the Genital Tract. Bovine.

MU, Meatus urinarius ; V, vulva ; H, hymen ; Va, vagina ; U, cordiform

Muellerian ducts representing the uterus ; UC, uterine cornu, excavated

and filled with fluid (menstrual debris) ; CL, corpus luteum ; O, ovary.

cattle furnish by far the greatest number of asexual indi-
viduals.

The development of the genital organs in the embryo be-
gins at the anterior, or ovarian end and progresses toward
the vulva. In the typical asexual individual, the genital
glands are represented by indifferent nodes, yellow in color,
about the size of an ordinary grain of wheat. Both the
Muellerian and Wolffian ducts are present and have attained
considerable size. They do not become tubular, but persist
as solid, fibrous cords. All four structures lie on a common
plane, the Wolffian lateral to the Muellerian ducts and in
close contact with them. The ducts of Mueller do not fuse

Asexual or Bisexual Aberrations

*53

in any portion of their length, but persist as contiguous,
solid cords. The first suggestion of sex specialization is
generally an excavation of the Muellerian ducts at the
apices of the uterine horns, as shown in Figs. 51, 52. Paral-
lel with this there may be some suggestion of ovarian de-
velopment. The next observed stage of excavation of the
apices of the uterine horns is the fusion and the excavation
of the Muellerian ducts in the area of the uterine body. The
cavity of the excavated uterine horns or body sometimes be-
comes distended with lymph, usually thin and clear.

Fig. 48— Arrested Development of Bovine Genital Tract (Freemartin. )
MU, Meatus urinarius ; H, hymen; WD, Wolffian ducts; DM, ducts of
Mueller ; DAP cross section of Mueller's ducts ; GG, undifferentiated
genital gland. The anterior ends of the Muellerian Ducts, DM, between
the genital glands, GG, are excavated and distended with fluid.

154

Diseases of the Genital Organs

Finally, in the individuals most advanced in development,
the posterior portions of the cervico-vaginal segments show
definite advances toward physiologic development. When
this occurs, there is parallel development of the ovaries and
the genital system functions more or less normally. Thus
all conceivable gradations occur between the absolute neu-
ter and the fully developed female sex system.

L

/j

Fig. 49 — Same as Fig. 48, with further Development of the Muellerian
Ducts. Lettering same as in Fig. 4S, except BL indicates broad ligament
of the uterus and just above BL at DM, the ducts of Mueller are excavated
and distended.

Asexual and Bisexual Aberrations 155

The vulva of the neuter frequently shows at birth a highly
marked tuft of vulvar hairs, strongly suggestive of the pre-
putial tuft of the bull. In the typical neuter no sexual de-
sire develops : there is no estrum. The head and neck fail
to develop that fineness of lines characteristic of the heifer
and the body is generally somewhat gross. It has been
stated that the head and neck are like those of the bull, but
I have been unable to verify this. To me they seem more
like those of a steer — a surgically made neuter. The horns
are rather gross, straight, and thick.

As soon as the rectum of the animal is large enough to
admit the operator's hand, a reliable diagnosis is available.
Upon rectal palpation, the urinary bladder is prominent, as
in the bull ; there is no vagina or cervix, but instead there
are two hard, fibrous cords the size of lead pencils or
smaller, sometimes so closely bound together that they feel
as one. In other cases careful palpation may identify all
four cords, Wolffian and Muellerian ducts. The length of
these cords varies greatly. Sometimes they are as long as
a normal genital tract ; sometimes very short and blunt.
Frequently they end anteriorly in cystic dilations given off
at almost right angles. Beyond the ends of these dilations,
the operator may or may not be able to distinguish the un-
differentiated tiny sex glands. In typical cases, the diag-
nosis is easy, and fortunately most cases are typical. In
some of the atypical cases, where the sex development has
progressed to a considerable degree, the diagnosis may prove
very difficult. Confusion is most probable in those cases
where a large proportion or all of the uterine horns and body
have become excavated but the cervix remains imperforate.
The uterus and horns are then distended with lymph, sim-
ulating pregnancy. As a rule, however, the examiner can
recognize by palpation some fundamental defect in vagina,
cervix, or ovaries which will make the diagnosis clear. The
character of the distension itself, as I have observed it,
serves readily to differentiate the condition from preg-
nancy. The uterus is flaccid and the contents mobile. The
horns are irregularly distended, broad at one point and

156 Diseases of the Genital Organs

quite narrow at another. The fluid may sometimes be
pressed from one horn to the other through the uterine
body. This is in sharp contrast to the distended uterus of
pregnancy, in which, if the pregnancy is healthy, the dis-
tension is firm and the contained fluids fixed in the fetal
membranes. If a careful record is made of the volume of
the uterus, and it is re-examined thirty days later, the uterus
of pregnancy will have enlarged markedly; distension of a
uterus arrested in development would have remained essen-
tially static.

Fig. 50 — Same as Figs. 48, 49. /, Meatus uriuarius ; 2, 2, Wolffian ducts ;

3. Muellerian ducts ; 4, 4, excavated and distended anterior

(ovarian) ends of Muellerian ducts.

The mole, or uterine cyst, may also confuse. Like the
uterus of arrested development, the mole may remain static
for months and the uterus may be flaccid. In this instance,
however, the genital organs are anatomically sound, there
is a corpus luteum of pregnancy, probably a typical uterine
seal, and a distended uterus, static in size. It can finally be
differentiated by sounding the cervical canal. The condi-
tion is discussed later.

As soon as the neuter character of the animal is recog-
nized, it should be designated for slaughter, but whether the
animal shall be kept until further grown, fattened, or slaugh-
tered immediately will depend upon conditions.

HertnapJiroditism 157

Forensically, if the animal has been sold as a female, the
recognition of its asexual character arouses a suspicion of
fraud, but by no means proves it because, as previously
stated, single births are sometimes neuters, though possibly
due to twin conception, the other twin having perished and
been absorbed. Ethically, however, the result is the same.
The animal is not a heifer or a female. Accordingly it has
been sold for what it is not. If the purchaser has paid for
a breeding female, he is ethically entitled to reimbursement.

2. Hermaphroditism

Hermaphroditism, in which organs of both sexes are
found in one individual, is observed in all domestic animals.
Some have claimed that freemartins, or what I have desig-
nated as "neuters", are in fact a type of hermaphrodite,
but with this view I am unable to agree. Neuters, as they
grade up toward sexuality, tend always toward the female
— never toward the male or toward both. Hermaphrodites
incline to assume prevailing types according to species.

In the horse, hermaphroditism tends generally toward
the development of testicles which are largely retained
within the abdomen and attached and located the same as
the ovaries, but may descend into an imperfect scrotum.
The vulva, vagina, and uterus may develop almost per-
fectly, as in one case occurring in my clinic where the vulva
and vagina were sufficiently developed that I castrated the
animal through the vagina in the same manner as mares are
spayed. The rudimentary penis, or enlarged clitoris, usu-
ally ends either in the vulva or in the vicinity of the ischial
arch, with the urethral opening directed backward. Some-
times it is directed backward at its extremity. The mam-
mae are usually moderately developed and upon casual ex-
amination, have the appearance of those of the mare. In
one case upon which I operated there were, just above these
rudimentary glands, small scrotal pouches containing the
imperfectly developed testes.

These animals present chiefly the characters of the crypt-
orchid horse with all his deranged sexual desire and ten-

158

Diseases of the Genital Organs

dency to viciousness. In the case illustrated by Fig. 52, the
head, neck, voice, and disposition were those of a cryptor-
chid horse, and the vulva, vagina, uterus, and udder were
those of a normal mare. The erectile organ occupied a mid-
dle place between the clitoris of the mare and the penis of
the horse.

In Fig. 51 is shown the generative apparatus of a pig, in
which the hermaphroditism is of quite a different character ;

Fig. 51 — Hermaphroditism. Swine.
T, Testicle ; O, ovary ; P, penis ; UC, uterine cornu ; V, vas deferens.

one of the glands developed into a typical ovary and the
other into a testicle, so that the two sides of the genital ap-
paratus represented the two sexes.

Sections of these genital glands show one to be a typical
cryptorchid testicle with tubuli seminiferi and the other a
primitive ovary with scattering Graafian follicles contain-
ing ova. The Muellerian ducts have developed into typical
oviducts, uterus, and vagina. From the Wolffian ducts have
formed typical vasa deferentia. The penis is normal in
form and extent.

Horn aphroditism

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160 Diseases of the Genital Organs

I have found no records of fertility in hermaphrodites of
the equine or other species.

B. Arrests in the Development of the Male Genitalia

1. Arrests and Aberrations in the Development
of the Testes

Anorchidy, or complete absence of the testicles, except in
neuters as described above, is exceedingly rare in domestic
animals. That is, if some other portions of the male genital
system are present in approximately normal development,
the testicles, however aberrant or arrested in development,
are regularly present. Anorchidy is repeatedly mentioned
in veterinary literature, but the basis for the assertion is
not quite clear. I have observed one horse, sold as a colt
for breeding purposes, which showed no testicles or scro-
tum, had no sexual desire, and lacked the form and voice of
the stallion. The penis, prepuce, and sheath were fully de-
veloped. Since no rectal or post-mortem examination was
made, a positive diagnosis of anorchidy was not practicable.
I doubt its occurrence. The testis is so fundamental in the
genital system that, in its absence, I am inclined to doubt
the formation of such accessories as penis, prepuce and
sheath.

Practical anorchidy does, however, occur, as in the horse
just described. In castrating a cryptorchid colt, the hidden
testis was represented by a small, calcareous node, render-
ing him to all practical purposes a true monorchid.

2. Cryptorchidy

Cryptorchidy, or the retention of one or both testes within
the abdominal cavity, is common in domestic animals. It
is commonest in horses and boars. As a rule — surely in 98
per cent. — cryptorchidy is due to simple arrest in develop-
ment. Occasionally a dermoid cyst is at fault. I have seen
a pig in which the cryptorchid testicle was the seat of ma-
lignant growth. These new-growths will be considered un-
der tumors of the genitalia. The typical cryptorchid tes-
ticle is small, soft, and fetal in type, anatomically and his-
tologically.

Cryptorchidy 161

The cryptorchid testis does not produce spermatozoa.
When one testis has descended into the scrotum, it under-
goes compensatorial hypertrophy and functions freely.
Monorchids, though the scrotal testicle functions freely, are
not desirable as sires, because of the constant peril of the
transmission of the defect to the progeny. The condition
is beyond remedy in a breeding sense, since the involved
testicle can not be induced to function.

As a rule of practice, cryptorchid animals designed for
meat should be slaughtered before sex maturity, if it can be
done economically. If desired for work (horse) or as a
pet (dog or cat) or if it is to be grown to maturity for meat,
castration is indicated. In all domestic animals, cryptor-
chidy constantly tends to produce nymphomania. The
cryptorchid horse tends strongly to become dangerously
vicious when four or five years old, and the viciousness
grows with years. In the boar, since the cryptorchid tes-
ticle, as soon as the animal reaches sex maturity, taints the
meat beyond endurance for human food, castration is essen-
tial. The operation of castration, falling within the do-
main of ordinary surgery, need not be described here.

3. Aberration in the Position of the Testis in the

Scrotum

In one case I have observed the testicle of a bull caught in
its descent before reaching the bottom of the scrotum, ap-
parently because the gubernaculum became adherent two or
three inches above the fundus of the scrotum or because of a
shortness of the mesorchium. The result was that the testis
tipped forward at its upper end, coming to rest with its
long axis horizontal instead of perpendicular. Thus it lay
in the same position as the testicle of the horse. The tes-
ticle appeared in every respect physiological. It was of the
same size and consistence as its fellow. The bull was fer-
tile. No interference was believed desirable.

4. Arrest in Functional Development of Scrotal

Testes. Fetal Testis

An arrest in the development of scrotal testicles some-
times occurs, in which they fail to acquire the fundamental

1 62 Diseases of the Genital Organs

functional power of secreting spermatozoa. When the tes-
ticles descend into the scrotum, they are normal in size and
consistency. As the age of sexual function approaches, the
testicles fail to grow to full size and remain soft. So far as
I have observed, the sexual desire is normal, or perhaps
slightly subnormal. The animal mounts the female
promptly and apparently copulates naturally. Search for
spermatozoa in the vagina, immediately following copula-
tion, is negative. Physical examination shows the testicles
to be not more than one-half to two-thirds the volume of
testes of normal animals of the same age, size, and breed.
Even more marked, in my experience, is the soft, flaccid
character of the glands. In all cases observed by me, the di-
minutive, flaccid testes have been symmetrical in size and
form. The defect appears to be congenital or to originate
while the male is yet a nursling. I have observed it only in
young animals which were absolutely sterile from the first.
The sterility has always been uniform and permanent. At
first some of this type of testicles revealed upon histologic
examination what was looked upon as a true arrest in devel-
opment, like the typical cryptorchid testes. Later, in some
cases, I have been surprised to find that the epithelium of
the epididymal tubules has been destroyed and their lumen
filled with cell debris instead of spermatozoa, the semeni-
ferous tubules have largely lost their epithelium, spermato-
zoa rare, and probably at no time viable. This leads to the
conclusion that in such cases the condition is due to a highly
destructive invasion of the epididymis and testicle by an in-
fection which falls short of abscessation or suppuration but
absolutely and permanently destroys the physiologic func-
tion of the organ. The condition will therefore be more
fully discussed under "Infections of the Genital Tract of
the Bull."

Forensically, I know of no instance which has been de-
cided in a law court in case of sale. The" sale of such an ani-
mal for breeding purposes is rarely, if ever, fraudulent.
The breeder, selling his young males usually without having
used them for breeding purposes, does not discern the ster-

Congenital Defects of the Female Genitalia 163

ility and takes no note of the diminutive size and flaccidity
of the testes. Ethically, the buyer, having paid for a breed-
ing bull, is entitled to remuneration, and in my experience
most breeders very promptly reimburse the buyer. The
condition is apparently hopeless ; no form of handling sug-
gests itself.

6. Aberrations in the Development of the Penis

In rare cases aberrations in the development of the penis
incapacitate the male for copulation. I attended one young
bull in which the penis was somewhat chisel-shaped and di-
rected upward when protruded, instead of being acutely
conical and directed slightly downward. A loose, baggy
fold of skin about the umbilicus, caught by the penis,
formed a pocket in which the glans lodged and prevented
copulation. I removed a transverse gored piece of skin,
about three by five inches, and drew the wound margins
together by sutures. This overcame the mechanical diffi-
culty.

C. Congenital Defects of the Female Genitalia

The occurrence of asexual individuals and the impercep-
tible gradations between the neuter and the female have al-
ready been described. Independent of these, brief reference
was made to the non-development or aberrant development
of certain portions of the genital system.

The failure of one ovary to develop and function is ex-
ceedingly rare, except in conjunction with other abnormali-
ties. Usually the two ovaries are not equal in volume. The
greatest disparity in size is seen in the cow, in which the
left is almost always smaller than the right, frequently less
than one-fourth the volume, but the small ovary neverthe-
less functions. It has been claimed that the right ovary of
the cow functions far more frequently than the left. I have
the abattoir records on 1700 pregnant females, of which 55
per cent, were pregnant in the right horn and 45 per cent,
in the left. In heifers, especially in Channel Island breeds,
which regularly have very small ovaries, the left gland is

164

Diseases of the Genital Organs

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Uterus Unicornis 165

frequently no more than one-quarter inch in diameter, but
it is anatomically perfect and of the adult type. Such an
ovary functions. I recall meeting clinically with but one
ovary of fetal type where the corresponding uterine cornu
was developed; this ovary was paired with the angio-car-
cinoma shown in Fig. 66. In most cases of unicornual uteri
which I have seen the ovary was of normal, adult type on
the side where the uterine horn was absent.

The absence of one ovary, or the fact that one is of fetal
type, is of little consequence except that a second ovary
serves as a reserve or alternate. So long as one good ovary
is present and the corresponding oviduct and cornu are
physiologic, the animal is fertile.

1. Uterus Unicornis

Arrest in the development of one uterine cornu is not
rare in cattle. In the abattoir I encountered six instances
amongst a few more than three thousand females — nearly
two per thousand. Five of them were, or had been, preg-
nant; one was a heifer. The defect is apparently of little
or no significance, except, as in the ovaries, the second
cornu provides a reserve, in case of disaster to the other
side. It is readily recognized by rectal palpation. The
single horn projects directly forward from the anterior end
of the cervix. No uterine body is recognizable. In the ex-
amination of pure-bred animals for sale, the unicornual
uterus should be classed as sound but defective, and the
value of the animal as a breeder somewhat discounted.

2. Double Uterus. Double Cervix

Double uterus is extremely rare in domestic animals. I
have no specimen in my collection. In consultation with a
colleague, I have seen one cow, which, so far as I was able
to determine clinically, had two complete uteri and cer-
vices but there may have been a communication (uterine
body) at the anterior end of the two cervical canals. The
two cervical canals were perfect and readily recognized.
The cow was fertile.

i68

Diseases of the Genital Orga?is

FlGS. 56, 57— Persistent Median Walls of Mueller's Ducts.
Pig. 56 (above). View of cervix from Vagina. The persistent wall, /,
gives an appearance of a double cervix which Fig 57 (below) shows, in
horizontal section, is false. The depression on the right is the mouth of the
single cervix, while that on the left constitutes acul-de-sac Had the open-
ing on the left joined the true cervical canal, just in front of /, it would
have hft the usual perdendicular muscular column. Had the persistent
partition extended to the uterine cavity, i '. ;i double cervix would have re-
sulted. C, False os uteri. C , True os uteri.

Persistent Hymen 169

severed it with a scalpel or with scissors. An insignificant
hemorrhage follows. There is virtually no sensation in the
structure and no material evidence of pain when it is
severed.

4. Persistent Hymen

In the development of the female embryo of cattle, the
hymen regularly disappears as a complete membrane, but a
series of fragmentary projections remains, marking the
vulvo-vaginal boundary line. Upon the floor of the genital
passage this line is located just in front (the ovarian side)
of the urethral opening. The vestiges of the hymen consti-
tute a well defined stricture between the vulva and the va-
gina. In the manual examination of heifers, passing this
stricture with the hand frequently causes a slight tearing
accompanied by hemorrhage. In numerous cases, remnants
of the hymen persist as fleshy cords, sometimes the dimen-
sions of a lead pencil, extending perpendicularly from the
floor to the roof of the passage, sometimes on the median
line, but generally to the right or left of the centre. Sel-
dom, if ever, do they cause difficulty of any consequence,
but they should be cut or ruptured when encountered.

Rarely, the hymeneal constriction forms a slight cul-de-
sac in the vaginal floor, where debris accumulates and de-
composes, to imperil conception. Sometimes the cul-de-sac
may be overcome by dividing the stricture along the floor.
Otherwise, the peril is to be obviated by frequent vaginal
douches until conception occurs. Parturition will ordinarily
eliminate the defect.

The hymen sometimes persists as an imperforate mem-
brane. I have observed but two cases, one in a heifer, the
other in a ewe. In Great Britain, I am told, it is common in
a certain strain of white cattle, so that it has become known
as "the white heifer disease". I have been unable to get
particulars about it. In any animal, imperforate hymen in-
evitably leads to the accumulation of menstrual and other
debris in the vagina, which becomes a great retention cyst.
Estrum may be regular, but copulation is impossible, be-
cause the penis of the male is prevented from entering the

i68

Diseases of the Genital Organs

]■ i.-.s s6 ST-Persistent Median Walls of Mueller's Ducts.
Fig 56 (above). View of cervix from Vagina. The persistent wall, /.
gives an appearanceof a double cervix which Fig 57. (below) rijo«t,u
Horizontal section, is false The depression on the right is the : mouth of the
single cervix, while that on the left constitutes acul-de-aac Had the open-
ing on the left joined the true cervical canal, just in front of /. it would
have left the usual perdendicular muscular column. Had the persistent
partition extended to the uterine cavity, r. a double cervix would have re-
sulted. C, False OS uteri. C , True os uteri.

Persistent Hymen i6g

severed it with a scalpel or with scissors. An insignificant
hemorrhage follows. There is virtually no sensation in the
structure and no material evidence of pain when it is
severed.

4. Persistent Hymen

In the development of the female embryo of cattle, the
hymen regularly disappears as a complete membrane, but a
series of fragmentary projections remains, marking the
vulvo-vaginal boundary line. Upon the floor of the genital
passage this line is located just in front (the ovarian side)
of the urethral opening. The vestiges of the hymen consti-
tute a well defined stricture between the vulva and the va-
gina. In the manual examination of heifers, passing this
stricture with the hand frequently causes a slight tearing
accompanied by hemorrhage. In numerous cases, remnants
of the hymen persist as fleshy cords, sometimes the dimen-
sions of a lead pencil, extending perpendicularly from the
floor to the roof of the passage, sometimes on the median
line, but generally to the right or left of the centre. Sel-
dom, if ever, do they cause difficulty of any consequence,
but they should be cut or ruptured when encountered.

Rarely, the hymeneal constriction forms a slight cul-de-
sac in the vaginal floor, where debris accumulates and de-
composes, to imperil conception. Sometimes the cul-de-sac
may be overcome by dividing the stricture along the floor.
Otherwise, the peril is to be obviated by frequent vaginal
douches until conception occurs. Parturition will ordinarily
eliminate the defect.

The hymen sometimes persists as an imperforate mem-
brane. I have observed but two cases, one in a heifer, the
other in a ewe. In Great Britain, I am told, it is common in
a certain strain of white cattle, so that it has become known
as "the white heifer disease". I have been unable to get
particulars about it. In any animal, imperforate hymen in-
evitably leads to the accumulation of menstrual and other
debris in the vagina, which becomes a great retention cyst.
Estrum may be regular, but copulation is impossible, be-
cause the penis of the male is prevented from entering the

iyo Diseases of the Genital Organs

vagina. As soon as the vagina becomes fully distended,
discomfort and pain result, causing colicky symptoms and
expulsive efforts. During the expulsive efforts the hymen
may be forced back into the vulva and become visible be-
tween the vulvar lips. Palpation reveals a tense, mem-
branous wall retaining a liquid beyond. On the floor of the
passage, the membrane is attached just anterior to (on the
ovarian side of) the meatus urinarius. The attachment of
the membrane to the walls can be traced completely around
the genital passage. Per rectum, the vagina is readily pal-
pable as an elongated sac firmly distended with fluid. In
the one heifer which I observed, both uterus and vagina
were distended greatly with thin pus. This caused much
pain, with constant straining and loss of flesh. It is quite
probable that the infection was carried to the genital tract
by the blood early in the heifer's life and remained dormant
until menstrual debris collected, when suppuration promptly
ensued. The handling consists of the surgical destruction
of the membrane, which should be punctured approximately
in the center with a scalpel and the opening thus made ex-
tended by cutting or tearing to a sufficient degree. It is
especially important to extend the opening in the membrane
downward to the floor of the passage, since otherwise it
may serve to form a cul-de-sac leading to the retention and
decomposition of discharges, thus keeping a pool of in-
fected debris about the os uteri externum, interfering with
conception.

When persistent hymen becomes a race characteristic, as
in the "white heifer disease" of England, it would appear
best to eliminate the defect by careful selection.

Imperforate hymen in the mare is apparently very rare.
There occur a few rather vague descriptions of imperforate
hymen in the mare from which the actual facts are unob-
tainable. There occur in literature statements that in the
pregnant heifer and filly imperforate hymen may exist at
the time of parturition. Evidently that is impossible. A
remnant of the hymen sufficient to complicate parturition
may persist, but copulation cannot occur and leave the mem-
brane imperforate. When imperforate, a distension of the

Persistent Hymen 1 7 1

vagina with menstrual debris is inevitable. So far as I
have observed, the imperforate hymen can not be ruptured
by the male. It is imperforate and persistent because ab-
normally thick and tough.

I have observed in a filly a persistence of the lower por-
tion of the hymen, constituting a cul-de-sac which ended at
the anterior margin of the urethra and sloped upward and
backward as a crescent-shaped partition open at the top.
It was attempted to breed her to a very large stallion. After
several unsuccessful efforts my advice was sought.

Upon introducing my hand, I promptly encountered a
broad band stretched transversely and sloping forward and
downward. Pushing my hand along the lower surface of
the membranous partition, I found that the urethral open-
ing formed the fundus of a great cul-de-sac. The urethra
was so greatly dilated that it readily admitted my hand.
Apparently it had been dilated by the penis of the stallion.
Searching higher up, I found the hymen was not imperfor-
ate; there was a large opening at the vaginal roof. The
groom was advised to be on the alert at the next effort at
coitus and push the penis of the stallion upward just at it
entered the vulva. The filly conceived.

The case reports of persistent hymen which have inter-
fered with parturition are probably largely based upon di-
agnostic error. Instead of persistent hymen there was
probably a persistent portion of the median walls of the
ducts of Mueller, a condition just short of a double vagina.
Such remnant is resistant enough to readily cause dystocia.
Many appear to think erroneously of any band passing
across the vagina as "persistent hymen". The persistent
median wall is far more common than the persistent hymen.
The condition has been discussed above.

The persistent hymen which is perforate usually has but
little significance. The imperforate hymen has little peril
for the life and general health of the patient unless over-
looked until the vagina is tensely filled with menstrual de-
bris. When, as in the heifer described above, both vagina
and uterus are greatly distended with pus, there is ground
for serious fear that breeding life is at an end.

Chapter V

MISCELLANEOUS DEFECTS AND DISEASES
INTERFERING WITH FERTILITY

There are many defects and diseases of other than the
genital organs which may render coitus physically difficult
or impossible, although the animal is fundamentally fertile.

Much has been said of the physical difficulty of coitus be-
tween individuals representing extremes in size. This oc-
curs only when the disparity in size is so great that mating
is as a rule imprudent for other reasons. Extreme varia-
tion in size may render coitus difficult or dangerous. In
both horses and cattle it is not rare to observe successful
coitus of a large male with a female 30 to 40 per cent, of
his weight. The danger from such disparity is not great,
but when a stallion has an extra large penis this may have
great peril for the vagina of the mare. These injuries will
be discussed later. When a very small male attempts coitus
with a large female, failure is dependent ordinarily upon
the shortness of the hind legs of the male, making it impossi-
ble for him to reach the vulva. As a rule, however, the male
of a given breed of animals is able, not long after he reaches
puberty, to copulate with an adult female of his breed. In
horses and dogs, where giant and pigmy breeds have been
developed, coitus between these extremes is virtually im-
possible. The variations in weight between Clydesdale
horses and Shetland ponies, for instance, may be from 2400
to 200 pounds — or 12 to 1. In dogs the extremes reach
nearly 100 to 1. Disparity in size does not enter prominently
into the question of the physical possibility of copulating.

A. Umbilic Hernia

Umbilic hernia, especially in the bull, whenever of ma-
terial size, inhibits copulation by deflecting the penis as it
is being protruded. The defect is ordinarily not brought to

Umbilic Hernia 173

the attention of the veterinarian, except in young bulls of
high pedigree. If the bull is an ordinary grade, or of low
pedigree, he is usually, and quite properly, sent to slaughter.
However, when a bull is of high pedigree and potentially of
great value, the owner often becomes anxious to have the
difficulty overcome by surgical interference.

Umbilic hernia is a congenital defect due to an arrest in
the normal closure of the umbilic ring. As an arrest in
fetal development, it has the same significance for the breed
or family as other teratological defects. It signifies a fun-
damental organic weakness always threatening to be trans-
mitted to the progeny. Umbilic hernia is very difficult to
handle in the bull. The breeder usually defers the operation
until the rumen has attained a great weight. Then the sur-
geon is faced with a weight, which it is virtually impossible
to support by means of surgical appliances, bearing imme-
diately upon the operative area. In umbilic hernia of the
bull, the surgeon is denied his chief mechanical means of
support — the bandage — because the opening of the sheath
is immediately at the umbilicus, so that the bandage can not
be effectively applied without involving and obstructing the
sheath opening. As a result, when attempting to suture an
umbilic hernia in a bull, the bandage must be omitted or in-
effectually applied, and before healing occurs the sutures
usually tear away and carry with them portions of the her-
nial ring, making the opening larger than before. If the
surgeon undertakes to clamp or ligate the hernial sac, by
the time the incarcerated mass has sloughed away, the pres-
sure from above has stretched the tissues and formed a
new sac. If the hernia is operated on when the calf is but a
few days old, before the viscera acquire insupportable
weight, the surgeon may more readily succeed. Even then,
however, the fundamental weakness of structure is there,
and in my judgment the animal should not be used as a
sire.

174

Diseases of the Genital Organs

B. Ventral Hernia

Large ventral herniae, such as indicated in Fig. 58, also
inhibit copulation, rendering the bull worthless as a sire.

■

PlG. 58— Large Ventral Hernia preventing Coitus.

C. Horizontal Vulva

Horizontal vulva in the cow sometimes serves to render
copulation difficult or impossible. In aged cows with pen-
dulous abdomen and low back (lordosis, or sway-back) the
superior commissure of the vulva is depressed and dragged
downward and forward by the descent of the rectum and
anus, so that the vulvar opening is directed upward. More
rarely, the vulvar opening is directed upward in otherwise
well-formed heifers, as a peculiarity in conformation. When
the bull attempts to copulate with such an animal, the penis
tends to glide over the vulva and strike against the anal re-
gion. This is best avoided by causing the female to stand
with her hind feet in a pit or depression, with the fore feet

Strictures of \Tagina and Vulva 175

high, thus bringing the vulvar opening toward the perpen-
dicular. Horizontal vulva also follows perineal laceration
at the superior vulvar commissure. This is described under
"Parturient Injuries".

D. Strictures of Vagina and Vulva

Strictures of the vagina, and more rarely of the vulva,
are occasionally encountered in domestic animals, chiefly
in the mare and the cow. They always result, so far as
known, from some prior inflammation of these parts, but
frequently the history of the disease is not available and the
veterinarian encounters simply the result of the disease.

In a mare which came under my observation, there was
difficulty in parturition due to an anterior presentation in
the dorso-sacral position, with the two hind feet pushed
forward beneath the fold into the pelvis. The difficulty, oc-
curring during the night, was not observed until morning.
Delivery was promptly and readily accomplished by em-
bryotomy, but the vulva had been so badly contused that
more than half of its circumference became necrotic and
sloughed away. The resulting constriction was such that
the animal could not copulate. She might have been arti-
ficially fertilized without material difficulty but, as she prob-
ably would have been unable to give birth to young, no at-
tempt was made to cause her to breed. I could see no pros-
pect for success by any operation. The mare was conse-
quently used for work.

I observed one instance of severe stricture of the vagina
in a mare, the origin of which was unknown. Without
knowledge of the presence of the lesion, the owner attempted
to breed her. This caused extensive lacerations of the va-
gina with great pain and straining. She was placed under
my care. The straining caused an eversion of the floor of
the vagina and the urinary bladder (vesico-vaginocele) . I
attempted to keep the vagina and bladder in position with a
truss, and later with vulvar sutures, but failed. Finally I
controlled the straining and eversion by producing profound
and prolonged chloral narcosis.

176 Diseases of the Genital Organs

Stricture of the vagina in the cow is comparatively com-
mon and of varying degrees. Occasionally one meets cases
in which it is impossible to reach the cervix. Frequently
the stricture is associated with long-standing sterility,
where it is highly desirable to reach the cervix and handle
the uterus.

In my experience, stricture of the vagina has occurred
most frequently in herds where the vagina has been douched
with potassium permanganate. It is not certain that there
is any connection between the potassium permanganate
douching and the stricture. Stricture is very liable to fol-
low douching with any powerful antiseptic, and very natu-
rally might follow the use of a too highly concentrated per-
manganate solution. There is another possibility with the
potassium permanganate. As it is very heavy and dissolves
rather slowly, laymen or careless veterinarians may inad-
vertently introduce some crystals into the vagina. The
liquid would be largely thrown out, and the heavy crystals
remain behind. These would cause profound irritation with
necrosis of the mucosa and stricture would naturally follow.
Stricture is likely to follow any case of severe vaginitis, re-
gardless of the cause.

If the stricture is not too severe, the prognosis is good.
If the condition of the vagina is such that copulation may
be safely performed and there is not too great hardening,
the vagina may largely recover its normal elasticity during
the rest of pregnancy, so that the animal may go through
parturition safely. If the uterus requires handling, it may
be possible to pass the uterine forceps through the stricture
and grasp the cervix without inserting the hand, or the for-
ceps may be guided with one hand in the rectum. In other
cases, one may be able to introduce the vaginal dilator (Fig.
37) and distend the passage sufficiently that the cervix may
be seen and grasped. Whenever I have been able to grasp
the cervix, it has been possible to draw it out through the
constricted vagina and give to the cervix and uterus any at-
tention desired.

Diseases of the Feet and Limbs

E. Diseases of the Feet and Limbs

177

Breeding bulls and, to a lesser degree, cows which are
kept constantly stabled tend to become disabled owing to
the fact that the growth of the hoofs is not counterbalanced
by the normal wear of travel. The margins of the lateral
and median walls tend to converge and, as they become elon-
gated, to bend beneath, the soles, approaching each other as

Fig. 59 —Overgrown Hoofs interfering with Coitus. Bull.
S, Sole, which has been largely overgrown by the wall, IV, growing for-
ward from the heel. /, A shallow groove showing approximately the
normal location of the margin of the wall.

12

178 Diseases of the Genital Organs

shown in Fig. 59. The heel portion of the wall is directed
acutely downward and forward, and, as this is not worn
away by the idle animal, the superposed weight bends the
free margin forward and inward until it lies flat against
the sole, and continues to grow forward until the posterior,
or heel wall finally reaches the toe, completely covering the
sole. The bull then walks upon the elongated heel wall, be-
tween which and the sole is a space, opening at the toe, in
which gravel, dirt, etc., become impacted. Then follows un-
equal pressure (by gravel, etc.) upon the sole, contusions
of the sensitive parts, pressure necrosis, and other lesions.
The bull soon becomes lame, and, unless the difficulty is
promptly recognized, may be crippled permanently. Fre-
quently I have seen bulls rendered incapable of copulation
from this cause. The condition is best prevented by care-
fully trimming the feet of all breeding bulls kept in stan-
chions or stalls, at least twice annually. Once the difficulty
has become established, the walls are permanently deformed
and constantly turn in. Then the trouble can be palliated
only by the frequent trimming of the feet and by keeping
the bull well bedded on a clay or board floor. Stone, con-
crete and gravel floors should be avoided.

The trimming of the feet may generally be accomplished
with hoof-cutting pincers, with the animal standing. When
the bull is secured in a stanchion, two strong men can gen-
erally hold up one of his hind feet and extend it backward
while the operator trims it. The men should take a stout,
smooth beam, preferably a round piece about six feet long,
pass it between the hind legs in front of the tarsus of the
foot to be raised, and, firmly grasping each end of the beam,
lift it upward and draw it sharply backward, so that the
flexure of the hock rests upon the middle of the beam.
Most animals will struggle but little and the trimming of
the hoof can be performed readily. If the animal is too re-
sistant, he should be cast and secured the same as already
recommended for examining the penis.

Painful diseases of the posterior feet and limbs occa-
sionally render a male incompetent or unwilling to mount

Diseases of the Feet and Limbs 179

the female, thus throwing increased weight upon his hind
limbs. Obviously any attempt at copulation aggravates the
local disease. The male should, therefore, be held out of
breeding until he has recovered. Sometimes it is wished
to breed a female suffering from some local, non-genital
disease which renders copulation difficult or dangerous for
her because of the weight of the male which she is called
upon to bear. Partial relief from the excessive weight may
be secured in cows and mares by using a breeding rack so
constructed that the female stands between two broad,
sloping shelves of such height that, when the male mounts
her, his fore feet rest upon the shelves and his weight is
more or less completely borne by these. The shelves must
fit closely against the sides of the female, in order to ob-
viate the danger of the male's getting his foot between the
shelf and the female, and should slope downward from the
head of the female. The breeding rack does more than
partly or wholly support the weight of the male. When it
fits closely and a beam is placed securely in front of her
sternum, her equilibrium is maintained and she can sup-
port without increased danger probably twice the weight of
which she would be capable otherwise. This is especially
true of the violent copulatory thrust of the bull. Not in-
frequently, when a cow is weakened and unsteady, or when
a small heifer is mounted by a large bull, the thrust causes
the cow or heifer to crumple up and fall headlong.

It is unwise to breed a crippled or weak female unless it
can be reasonably determined that the patient will promptly
recover from the local disease. Otherwise, as soon as the
increased weight of pregnancy has to be borne by the weak
member, a new peril is encountered in the aggravation of
the disease. Pregnancy may occur and parturition may be
safely passed, but the progeny is rarely well nourished or
valuable.

F. Paralysis and Plumbism

Paralysis sufficient to interfere with copulation may oc-
cur in any animal, and from a great variety of causes. In

180 Diseases of the Genital Organs

the stallion there occurs sometimes a paralysis of the pos-
terior limbs. In one bull in my experiment herd, paralysis
was due to lead poisoning caused by licking a painted board
when but a few days old. He was completely paralyzed
and unconscious for a number of days. For months he was
quite severely paralyzed in his posterior parts, with some
swelling of the joints and bones. He attained medium size,
and was normally fertile, but was quite awkward and copu-
lated with some difficulty.

Stallions suffer occasionally from paralysis of the penis,
the cause of which is generally unknown, largely associated
with partial paralysis of the posterior limbs and not ordi-
narily subject to remedy.

G. Torsion of the Testicle

Torsion of the spermatic cord, it is claimed, sometimes
causes atrophy of the testicles and inhibits the formation
of spermatozoa because of interruption of the nutritive sup-
ply. It is well known that emasculation can be produced in
ruminants by the process designated double subcutaneous
torsion, in which the testicles are twisted and inverted in
such a manner as to interrupt their vascular supply and in-
duce atrophy, with disappearance of sexual desire and
power.

Occasionally in man torsion of the testicle appears to pro-
duce painful and serious symptoms simulating incarcerated
hernia with vomition. O'Connor (') describes two cases
and states that one hundred twenty-four cases have been
recorded in man. I am not aware that disease has been
traced to torsion of the spermatic cord in animals. In the
stallion, with horizontal testes, the gland is frequently re-
volved upon its transverse axis through 180 degrees, but
this appears to be of no consequence. The horizontal posi-
tion of the testicle permits it to revolve upon its transverse
axis below the mesorchium. The displacement involves
very slight damage to the spermatic cord. The freedom of

'Vincent J. O'Connor, Torsion of the Spermatic Cord. Surg. Gyn. and
< itist.. Dec, 1 9 1 9. ]). 580.

Torsion of the Testicle I Si

the spermatic cord in the inguinal canal permits part of the
torsion to occur within the abdomen, so that the twist need
not be great at any one point. In man the torsion is said
to occur frequently where the gland is caught in the inguinal
canal. Just how it can revolve in the inguinal canal, I fail
to understand. Inguinal cryptorchidy is familiar to veteri-
narians, but torsion is rarely, if ever, recognized in these
cases. I have observed but one instance of torsion which
was of consequence. In an adult cryptorchid presented for
castration, I quickly recognized a state of affairs new to
me, finally recognized what I believed to be the vas deferens,
traced this to what appeared to be the testicle, and then ap-
plied traction in an effort to bring the gland out through the
wound. Finally an attachment unexpectedly parted, and a
large, livid-colored testicle was brought out. The spermatic
cord was spiral, the circulation had been barred, and the
cord and testicle were necrotic. The cord was so weakened
at the chief point of torsion that it gave way at that point.
O'Connor, cited above, believes the chief cause of torsion to
be the irregular contraction of muscle bundles in the cre-
master, but, in my case with the testicle in the abdomen,
such an explanation can not be accepted, as the cremaster
does not come into play or become visibly developed until
the testicle descends into the scrotum. A study of Fig. 1
will show how a cryptorchid testicle could readily revolve
upon its transverse axis. The testicle of the ruminant,
moored throughout by the mesorchium to the wall of the
scrotum, can not possibly, so far as I can see, revolve upon
either of its axes. The possibility of serious torsion of the
spermatic cord should be borne in mind.

H. Traumatic Orchitis

According to many veterinary authors, orchitis in animals
is due largely to traumatism. Professor Hendricks1 empha-
sizes the belief in trauma as a cause of orchitis and considers
that most cases of inflammation of the testicles are due to
mechanical injuries. It is an open question, however, to

1 Handbuch der tierartzl. Chirurgie u. Geburtshilfe, III Band.

1 82 Diseases of the Genital Organs

what extent such an opinion is based on experience and to
what extent, upon legend. Personally I have not observed
orchitis in any domestic animal where it was plainly due to
traumatism except in one instance of an abattoir bull which
had suffered from gunshot wound in the scrotum, two of the
shot having lodged, one in the epididymis and the other in
the testicle. This case is illustrated in Fig. 59a.

Cinically orchitis is most common in the stallion, in which
animal the testicles are unusually well protected against
traumatism when compared with those of other domestic
animals. The pendent testicles of ruminants are exposed
preeminently to mechanical injury. In the ram and the he-
goat, the testicles hang so low that in moving rapidly over
rough ground, especially where there are stumps and high-
projecting stones, the testicles frequently come in rather vio-
lent contact with these foreign objects. In all ruminants
the pendent testicles are thrown against the thighs repeat-
edly whenever the animal is in rapid locomotion, and yet I
have not observed orchitis as a result of this. In trotting
stallions there is a general belief that, unless a suspensorium
is used, orchitis may result from the constant striking of
the testicles against the thighs during rapid locomotion,
but I find nothing in veterinary literature to indicate that
orchitis arises in this way.

While it must be freely admitted that orchitis may arise
in any animal because of traumatism, careful clinical ex-
amination would indicate that the affection is very rare.
It is difficult to determine clearly just what type of orchitis
a mechanical injury may induce. It cannot by any con-
ceivable means cause an abscess of the testicle unless there
is first a destructive injury to the skin or a penetrant wound
so that the trauma serves merely to open an avenue of in-
fection rather than to directly cause orchitis. In Chapter
XIV of this treatise, the question of orchitis as a result of
infection is discussed at some length. By referring to this
chapter, it will be observed that in nearly all cases of orchi-
tis and epididymitis the disease is bilateral, which would in-
dicate very strongly that it is due to some systemic infection

Traumatic Orchitis

1S3

Fig. 59a— Gunshot Wounds of Testicles. Bull.
S", Gunshot embedded in right epididymis ; S2, gunshot embedded in left
testis ; //, globus major of epididymis ; T, globus minor, do ; A, rough-
ened surface from inflammatory thickenings. The orchitic peritoneum is
generally roughened on account of traumatic peritonitis.

184 Diseases of the Genital Organs

arising from the presence in the blood stream of pathogenic
organisms having a distinct affinity for the genital organs.
The lesions figured and described are distinctly those of in-
fection and not of traumatism.

Before diagnosing traumatic orchitis in any animal, one
should give ample consideration to the facts as stated and
should in addition know that there has been a severe trau-
matism of the gland or glands.

It is quite possible that mechanical injury plays a very
important part in bringing about a crisis when infection is
already present within the gland. That is the general rule
in the etiology of disease in any organ of the body, and ap-
parently applies with special force to the diseases of the
genital organs. Thus Hendricks, to whom reference has
been made above, states that excessive coitus serves as a
fertile cause of this disease. Excessive coitus, however,
cannot be regarded as traumatism. It must, instead, be
looked upon as an overworking of a gland by which it be-
comes weakened and its tissues lose their power of resis-
tance toward disease-producing microorganisms which are
already present in the part.

When the veterinarian feels justified in diagnosing trau-
matic orchitis, the prognosis will of course depend upon the
nature of the trauma. The treatment also needs to be ad-
justed to the general principles of surgery in harmony with
the character of the injury. Speaking generally, care should
be taken to obviate, as far as possible, the invasion of the
gland by bacteria because of injury to the skin and other
coverings. It is likewise important that the interferences
with the circulation in the testicles should be anticipated
and prevented, if possible, by the careful application of a
suspensorium. In ruminants, in addition to the suspenso-
rium, the testicles can be inclosed in a bandage of adhesive
tape in such a manner as to exert uniform and gentle pres-
sure upon the glands and thereby maintain the efficiency of
the circulation. Sexual excitement should be strictly avoided.
The bowels should be kept freely open as in any case of dis-
ease where fever is likely to occur, and the diet should be
properly adjusted.

Tubal Pregnancy 185

I. Tubal Pregnancy

Tubal pregnancy, comparatively common in woman, has
not, so far as I know, been recorded in any domestic ani-
mal, but it is quite possible and may be encountered by the
veterinarian when he is examining the genitalia. The fact
that extra-uterine pregnancy is now and then encountered
in the abattoir renders it highly probable that tubal preg-
nancy does at times occur in animals. The veterinarian
does not have the means for diagnosis afforded in woman
by the regular occurrence of hemorrhage from the uterus,
since the cervix is too securely sealed, but he has a distinct
advantage over the human obstetrist in the facility with
which palpation per rectum may be applied. The condition
would necessarily give rise to a cystic enlargement in the
oviduct, associated with a typical corpus luteum of preg-
nancy in the corresponding ovary, a typical uterine seal, en-
largement of the ovarian artery, and an absence of estrum.
If tubal pregnancy is diagnosed, the peril from rupture of
the oviduct should be promptly removed by performing
laparotomy in the upper flank on the involved side, followed
by the amputation of the tube and ovary. If the other side
of the reproductive tract is sound, the fertility of the ani-
mal is not disturbed.

After the oviduct has ruptured and the ovum has escaped
into the peritoneal cavity, if the accident is discovered
early and there are evidences of serious internal hemor-
rhage, the animal, if (5f a species used for food and other-
wise fit, should be slaughtered immediately. Should the
veterinarian by chance diagnose an old-standing extra-
uterine pregnancy, with the fetus securely anchored and
enveloped, the fact is to be wholly disregarded, except that
the animal is probably permanently sterile on the side where
the pregnancy originated.

J. Vaginal Hernia

Vaginal hernia, or hernia through the vulvo-vaginal mus-
cular wall, is not infrequent in cows. In the cases I have
observed there was a rent in the lateral wall of the vagina

1 86 Diseases of the Gc?iital Organs

at the hymeneal ring. The symptoms consist of the ap-
pearance between the vulvar lips, or projecting beyond
them, when the patient is lying down, of a fluctuant, globu-
lar mass, covered by the vaginal mucosa. When the cow is
caused to stand, the hernial mass usually disappears spon-
taneously, or, if it does not, readily disappears under gentle
manual compression. Then the veterinarian can readily
recognize a well defined hernial ring of variable size, ad-
mitting the insertion of two fingers or the entire hand. The
veterinarian should constantly be on the alert not to confuse
vaginal hernia with prolapse. Prolapse of the vagina is not
so frequent as vaginal hernia. I have seen colleagues err
in diagnosis. The size of the hernial mass increases as
pregnancy advances. The mucosa of the hernial sac be-
comes somewhat befouled and inflamed by constant ex-
posure to filth when the animal is lying down, but in the
cases I have observed there has been no recognizable incon-
venience. The hernia constitutes a repulsive defect not
wholly devoid of peril to the animal. I have observed five
cases of this hernia, all in pedigreed cows. With one ex-
ception, all had been purchased as presumably sound by
the parties owning them at the time of examination. The
one owned by her breeder had developed a fibroma at the
hymeneal ring, which protruded beyond the vulva. The
veterinarian removed the tumor by ecrasement. Evidently
the chain of the ecraseur included a portion of the muscu-
lar wall of the vagina, thus causing an opening into the
pelvic connective tissue, behind the peritoneum. The intra-
abdominal pressure pushed portions of the small intestine
against the peritoneum and forced it out through the vent
in the vulvo-vaginal wall, to constitute a hernia. It is not
impossible that the other cases I observed were caused in
the same way, since the vestiges of the hymen are fre-
quently the seat of fibroid tumors and the veterinarian,
when called to remove them, resorts to the ecraseur, with-
out thinking of the consequences. The tumors will be dis-
cussed later. As I now recall, the hernia has been on the

Vaginal Hernia

187

right side in most of my cases. The initial injury must be
as frequent on the left as on the right side, but the intra-
pelvic content of the small intestine is greater on the right
and would tend rather to develop a hernia in a weakened
area.

Fig. 60 — Sutures For Vaginal Hernia.
The insert below at the left shows details of suture.

Although I have not had an opportunity to operate upon
a case, and thus can not speak from experience, the condi-
tion should be amenable to surgical interference. The oper-
ation could be done best upon the non-pregnant animal, al-
lowed only a small volume of food in order to lower the in-

1 88 Diseases of the Ge?iital Organs

tra-pelvic pressure upon the operative area. It would be
practicable to operate upon most cows under local anaes-
thesia in the standing position. After carefully cleansing
the vulva and vagina, an incision may be made through the
vulvar mucosa of the hernial sac, down to the pelvic fascia.
An index finger can be inserted through the incision and,
palpating the hernial ring, act as a guide in suturing. A
half-curve needle armed with strong silk should then be in-
serted at a point on a level with the superior border of the
hernial ring and about one-half inch posterior to the mar-
gin. The needle is to be passed through the vulvar mucosa
and the muscular wall ; carried forward, carefully guarded,
across the hernial opening on the ovarian side of the ante-
rior margin of the hernial ring ; and finally brought out into
the vagina, through the muscular and mucous coats. Then
the needle is to be reversed, carried downward about one-
fourth inch, inserted, and a suture laid parallel to the first,
emerging about one-fourth inch below the point of starting.
The free ends of the suture are then brought together and
tied tightly, with a view to inducing pressure necrosis in
the tissues incarcerated in the loop. The sutures should be
repeated every quarter of an inch, from the upper to the
lower margin of the hernial ring. The ring will then be
obliterated, and adhesion occur between the incarcerated
tissues. The portions of tissue lying between the incar-
cerated areas in the sutures serve to maintain function in
the hernial sac, preventing it from sloughing away, and the
possibility of prolapse of the intestine through the slough.
When circumstances render it desirable to apply pallia-
tive measures to ventral hernia pending parturition, the
object is readily accomplished by means of vulvar sutures,
as shown in Fig. 60. In the illustration, tape has been used
for sutures. A loop has been tied near the middle of the
suture, after which the needle is inserted about one inch
lateral to the vulvar opening, somewhat below the superior
commissure, carried downward nearly to the inferior com-
missure, and brought out. The ends are then tied together

Torsion of the Uterus 189

firmly, leaving sufficient free tape to reach across the vulva
to the suture of the other side, to which it is tied by a bow-
knot. The sutures can be untied at will while the vulva,
vagina, and sutures are cleansed.

The suture is better when made of heavy silver wire. It
irritates the tissues less than the tape and is cleaner. It
has the great advantage, also, that the ends of the wires
crossing over the vulva may be fastened by merely bending
them over the suture, so that, if parturition commences in
the absence of an attendant the force will cause the wire
hook to unbend and the vulvar lips to part. Similar pro-
vision may be made with tape by using for the cross liga-
tures, tape or cord of low tensile strength which, in case of
labor pains, will break. Otherwise, there is danger of in-
terference with parturition and special danger of lacera-
tions of the vulva owing to pressure upon the sutures.

K. Torsion of the Uterus

Torsion of the uterus is generally considered only as a
cause of dystocia at or near the full term of pregnancy. It
has been quite fully discussed in the companion volume
upon Veterinary Obstetrics. It is well to add that uterine
torsion occurs quite independently from the near approach
of parturition. In the cow it may be encountered when
palpating the genitalia at least as early as the 145th day of
pregnancy. It may cause colicky pains, or merely dullness,
or for a time no symptoms at all. Therefore the practi-
tioner may be called to examine the cow because she has
shown signs of disease, or he may detect the torsion in the
course of an examination of the genitalia as a part of the
control of sterility and abortion.

When a veterinarian is called to attend a cow showing oc-
cult evidences of disease, he should always have in mind the
important role played by the genital organs and make a
careful examination. When the displacement occurs early,
as in the cow already cited, there may be no manifestations
of disease or discomfort. The torsion in the small and not

190 Diseases of the Genital Organs

fully distended uterus may occur so far forward that the
usual spiral folding of the vaginal walls may be wanting.
Therefore it may be stated as a law that rectal palpation is
essential to a proper determination of the state of the uterus.
When the uterus which has undergone torsion is palpated
per rectum, it offers certain definite characteristics :

1. The posterior portion of the uterus can not be clearly
palpated, because one of the broad ligaments is tightly
stretched across the organ, completely covering it. Far for-
ward, in front of the broad ligament, the examiner may di-
rectly palpate the gravid uterus and the contained fetus. If
the uterus has revolved to the left — that is, if in the begin-
ning of the displacement the dorsal wall of the uterus has
moved to the left, while the ventral or lower wall moves to
the right — the right broad ligament passes over the vagina
and uterus to the left, while the left broad ligament passes
beneath the vagina and uterus to the right. Both ligaments
are tensely stretched.

2. The chief uterine artery inevitably moves with the
broad ligament, and is readily felt. In left torsion, the
right uterine artery, tightly stretched, passes over the
uterus to the left side, while the right artery is forced
down along the pelvic floor and passes beneath the uterus
and vagina, to the right. The torsion constitutes a for-
midable obstacle to the circulation in the entire genital
tract anterior to the turn, causing the arteries to become
distended and the pulsation in them to be unusually full
and bounding. These findings serve to identify the char-
acter of the displacement. Moderate uterine torsion, with-
out transverse rupture of the uterus or vagina, recognized
in time, warrants a highly favorable prognosis. The chief
indication is the rolling process already fully described in
the companion volume, Veterinary Obstetrics.

L. Pelvic Tumors and Calluses

Occasionally, when examining the genital organs of
mares or cows, one finds tumors in the pelvis between the

Pelvic Tumors and Calluses 191

pelvic walls and the vagina, which may interfere with fer-
tility— not so frequently with fertilization as with parturi-
tion. These should always be observed carefully and pre-
cautions taken against impending difficulty. If the tumors
are irremovable, the animal should not be bred ; if she is
pregnant, artificial abortion may be performed, in the early
stages, or, if the fetus is of value, pregnancy may be per-
mitted to continue to full term and the young removed by
hysterotomy.

A commoner interference with reproduction consists of
calluses resulting from fractures or other injuries to the
bony girdle of the pelvis. Pelvic fractures with large cal-
luses are especially common in nymphomaniac cows, and
sometimes unfit them for breeding. Even if the nympho-
mania can be overcome, where such injuries are encoun-
tered during examination, the veterinarian should judge
carefully of their importance and act accordingly. If they
are of such a character as to prevent parturition, the ani-
mal should not be treated for the disease of the genital or-
gans, but be sent to slaughter. Exceptions might be made
in highly valuable cows, which, if the nymphomania or other
disease is curable, might be bred and delivered at full term
by hysterotomy.

Chapter VI

SYSTEMIC DISEASES AND DERANGEMENTS
INTERFERING WITH REPRODUCTION

Reproduction is the culminating function of animal life.
The fundamental demand of the individual is the mainte-
nance of life, and it is only when this has been reasonably
assured that any additional power may be directed to the
reproduction of the species. During the most active stages
of growth, most animals do not breed. When old age comes,
and the maintenance of nutrition is difficult, reproduction
becomes uncertain or ceases. Throughout adult life, any
element which interferes seriously with nutrition promptly
imperils reproduction.

During the course of acute infectious diseases, with rare
exceptions, male animals do not elaborate spermatozoa and
females do not ovulate. At the same time, sexual desire
ceases. In the pregnant female such diseases imperil the
life of the fetus. So it is frequently said of cows that foot-
and-mouth disease, pleuro-pneumonia, and similar fevers
tend to cause abortion. This does not imply that the in-
fectious fever directly causes the abortion, but rather that
the infection present within the pregnant uterus, capable
under favorable conditions of causing the death and expul-
sion of the fetus, is rendered virulent by the general de-
pression of the system due to infectious fever. Such chronic,
debilitating affections as the bone diseases — osteoporosis,
rickets, spavin, ringbone, and others — commonly lead to
sterility through their devigorating influence.

A. Overwork
Animals subjected to severe work are strongly inclined
to be sterile for the time. In stallions which are being
trained for the turf, there is usually temporary sterility,
without any evidence of disease or degeneration of the
glands. The resources of the animal are wholly consumed
in the physical work which is demanded, and there remains
no reserve force to provide reproductive energy during this
period.

Starvation 193

B. Starvation

Starvation exerts an influence parallel to that of acute
disease. In the young animal the development of the sex
functions is advanced or delayed according to the state of
nutrition. In highly fed, vigorous heifer calves, ovulation
and estrum may occur at six months, or even earlier. In
countries where cattle are reared in a semi-wild state, con-
stantly running at large where herbage is scanty, they
rarely ovulate until nearly two years old, so that, although
the bulls run in the herd, the heifers do not conceive until
well grown. The nutritive supply beyond the necessities of
the individual do not suffice for reproduction. In cattle
more highly domesticated, if they are underfed or otherwise
badly handled, ovulation or estrum frequently fails. I have
observed two-year-old heifers, badly kept, though not ex-
tremely poor, which failed to come in estrum because of
poverty, but bred promptly when the food supply was in-
creased. Semi-wild cattle generally conceive in early sum-
mer, at the time when grazing is at its best and the animal
has recovered its vigor after the privations of winter. The
same rule applies to cattle stabled in winter and grazed
during the summer. Animals which do not come in estrum
in the stable or, doing so, do not conceive, frequently breed
when increased vigor has been gained after grazing on
good pasture.

A high state of nutrition does not necessarily accompany
an abundance of food. Any food may be so damaged that
its nutritive value may be lowered or destroyed, or, con-
taminated by various bacteria or fungi, it may become toxic.
Mere quantity of food, and even of technical nutritive ele-
ments in the food, does not mean good nutrition. I observed
a stable of cows and heifers which were getting an abun-
dance of hay and grain of excellent quality, but all were un-
thrifty and emaciated. The non-pregnant animals did not
come in estrum. One cow could scarcely get up when down.
They were in charge of a lazy attendant, who gave them
plenty of food with fair regularity, but did not keep them

13

194 Diseases of the Genital Orga?is

clean. So far as I could learn, the foundation for the de-
bility was his failure to carry a reasonable supply of water
a few paces. A change of caretakers promptly relieved the
condition, and within a month cows began to show estrum
and conceived promptly.

C. Obesity

Abundant food and a high state of nutrition must not be
confused with obesity. Obesity is not vigor, but may be the
reverse. Vigor and an abundance of fat may coexist and
are not incompatible. While obesity may sometimes cause
sterility, it is far more frequently true that sterility causes
obesity. That is, if a cow or heifer is sterile, she does no
work, has abundant food, and is perhaps closely confined in
the stanchion. No special functional activities are present,
such as the secretion of butter fat or other product, which
would consume the extra nutrient materials taken in the
food. Consequently the animal takes on an abnormal quan-
tity of fat.

In many cases the obesity of sterility apparently has a
more interesting significance than the mere conversion of
redundant nutritive material into fat. This is preeminently
notable in cattle. The sterile heifer or cow frequently has
irregular, lumpy deposits of fat, especially great, irregular
lumps about the external iliac and ischiatic tuberosities.
The hair becomes rough and lustreless. The form of the
body becomes coarse and uncouth. If the genital organs are
examined, no great departure from the normal is found.
Perhaps the ovaries are rather small and the genital system
is wanting in tone. The animal may be dull and estrum ca-
pricious.

The cause appears to be a disturbance of endocrine secre-
tions, probably a faulty secretion of the ovaries themselves,
which so modifies the nutritive system as a whole that fat
deposits are made in a manner quite in conflict with the gen-
eral physiologic laws of nutrition. Physiologic heifers or
cows may carry quite as much fat as the obese, sterile ani-
mal, but it is more evenly distributed, the coat retains its

Obesity 1 95

lustre, the animal is bright and alert, and is fertile. I think
that obesity as a cause of sterility in cattle has been over-
emphasized, though I admit the importance of controlling it
by properly adjusted rations, combined with exercise.

A distinction needs to be made between obesity and over-
feeding. While obesity is sometimes due to overfeeding,
especially when combined with idleness, overfeeding may
cause a serious impediment to sex functions without pro-
ducing marked obesity. I have seen bulls which were fed
an excessively large amount of very poor, hard, woody hay.
The manager, wishing to prevent them from getting over-
fat, was feeding coarse hay in the dairy. After the cows
had picked out the best portions, the refuse, consisting of
weeds and very coarse stems of hay, was fed to the bulls,
with a view to affording an abundant bulk of food having a
very low nutritive value. The abdomen of each bull,
though they were in moderate flesh, became excessively
large. Some individuals lost almost completely their sexual
desire. While ruminants are adapted to using large vol-
umes of dry fodder, the hygienic maximum is readily ex-
ceeded, especially in herd bulls closely confined.

Even when such overfeeding with a poor quality of fod-
der does not seriously depress the sexual functions, it not
infrequently interferes with the physical ability to copulate.
The immense weight of the load in the rumen, with its pres-
sure against the diaphragm and lungs, renders the bull
slow, awkward, and short of breath. I have seen such bulls
fail utterly to copulate. The great intra-abdominal weight
and tension made mounting very difficult, and the enormous
belly served to prevent coitus, since the pressure of the tense
abdomen upon the rump of the cow forced the abdominal
viscera against the diaphragm so that the bull was quickly
out of breath and exhausted.

A breeding male should be fed like any other animal which
one desires to keep in vigorous condition. The bulk of the
food and the amount of nutriment contained should be ad-
justed to the needs of the individual, having due respect for
size, age, and the exercise or work provided.

196 Diseases of the Genital Organs

The direct influence of certain foods upon fertility has
frequently been asserted but is difficult to trace. It is a
favorite habit of the breeder and dairyman, when his herd
shows a low rate of reproduction, to attribute it directly to
food — ensilage, alfalfa, clover, cottonseed meal, and well-
nigh every food. Indirectly, foods modify reproduction
greatly because the general vigor depends more upon the
quantity and quality of food than upon any other one ele-
ment.

D. Idleness and Overfeeding

Impotence of the male is sometimes expressed chiefly by
an absence of sexual desire in the presence of females prop-
erly in estrum, without any visible changes of the reproduc-
tive organs. Sometimes he may pay attention to the female,
with more or less complete erection of the penis, then desist
in his attentions, and turn away. When the next female is
presented, he may show normal sexual vigor.

In some cases, there is said to be an individual psychic in-
fluence which prevents the male from copulating with a cer-
tain female. This is alleged to be especially true of individ-
ual stallions, to which certain mares seem to be repulsive, so
that they refuse to copulate with them. The presence of
young at the side of the dam is sometimes alleged to repress
the sexual appetite of the male. This is usually seen, however,
only in those males depressed in their vitality. It is almost,
if not always, erroneous to attribute absence of sexual de-
sire to the caprice or idiosyncracies of the male, by which
a female of a certain type or color becomes repulsive to
him and fails to arouse his sexual appetite ; the real cause
lies in bad management or in disease.

The tendency to loss of vigor on this account is usually
not noticeable in the young, but, as soon as the animal has
become mature and grown quite fat, the disposition becomes
marked. This form of impotence is seen almost exclusively
in those animals which are closely confined, highly fed, and
not properly exercised. It is commonest in draft stallions,
but is observed in bulls, especially of the beef breeds, and in
male breeding animals of all species. It tends to disappear

Idleness and Overfeeding 197

promptly upon a correction of the method of keeping, pro-
viding that it be applied sufficiently early.

The difficulty should be prevented by not forcing the
young male designed for breeding purposes too rapidly in
his development. He should be allowed only a moderate
diet, with plenty of exercise and freedom, or be given actual
work.

Upon the appearance of these defects in the mature ani-
mal, much can be done, if handled opportunely, by restrict-
ing the diet and causing an abundance of exercise. A
healthy young draft stallion belonging to one of my clients
refused almost wholly to serve mares. He was being highly
fed and was getting a very limited amount of exercise, at a
slow walk. Being appealed to for advice, I reduced his
food ration one-half and prescribed eight miles exercise
daily, at a brisk walk. Within a few days, his sexual de-
sire had fully returned. He finished his season's work in
good form, and was effective as a sire. The same general
principles apply to other breeding males. In countries
where cattle are habitually worked, the bulls are kept in
breeding condition by moderate draft service. It would be
well to imitate this plan in America, where bulls and stal-
lions are not habitually used for work, but could readily
render valuable service while being greatly benefited by
the vigorous exercise secured. Under general conditions,
it is perhaps the best possible and most economic manner
by which sufficient exercise for these animals can be as-
sured. Incidentally, it should be noted that such exercise
or work tends very strongly to prevent that viciousness in
bulls and stallions which renders them dangerous to their
keepers.

Zschokke emphasizes the value of the proper selection of
food for the purpose of arousing sexual desire, and insists
especially that the hay should be aromatic, as should also
the oats. Not only should they be well cured and sweet-
smelling, but he believes that the admixture of certain
stimulants, such as calamus, pepper, powdered mustard,
and even powdered cantharides, are advantageous. He

198 Diseases of the Genital Organs

recommends that these remedies be fed with cut hay and
that they be allowed for two or three days in succession and
then omitted for the same length of time, when they may
be given again. I doubt very greatly the value of aphrodisi-
acs, or sexual stimulants, in breeding animals. Sexual in-
stinct is normal and so universal in animals of breeding
age and in proper health that I fail to see the value of ex-
citing sexual desire artificially. If sexual instinct is ab-
sent, it is because of some disease of, or depression in the
general vigor of the animal, which can not readily be re-
moved by aphrodisiacs. It has not been shown that the
arousal of sexual appetite by means of these drugs insures
or even favors fertility. A constant and wide distinction
must be drawn between copulation and fecundation. The
fundamental function of the male is the elaboration of virile
spermatozoa, or male cells, and of the female to produce
healthy ova. Copulation serves merely to transfer these
fecunding cells from the testes of the male to the vagina of
the female. Copulation is in vain without vigorous sper-
matozoa and healthy ova, and no data exist to show or sug-
gest that any drug may directly cause or favor their devel-
opment.

Certainly it must be admitted that tonics, alteratives, or
other drugs capable of influencing favorably the restoration
of a diseased animal to a state of health must also improve
its reproductive powers, by restoring the equilibrium of the
body and enabling it to perform better all its normal func-
tions, among which is reproduction . The highest state of
the general vigor of the body is, consequently, the most
favorable condition for the production of virile spermatozoa
and ova, which constitute the first essential in fertility .

Sometimes there is an apparent absence of sexual desire
in young males when first brought in contact with estrual
females for purposes of coitus. If such animals are turned
loose with the females, the difficulty is generally overcome
very promptly.

The preparation of breeding animals for the show is al-
ways dangerous for their sexual vitality. In order to get

Idleness and Overfeeding 199

them in high condition, they are frequently closely confined
and fed in such a manner as to produce the greatest amount
of fat, in the hope that they may make a better showing and
more certainly win a prize. It is an unfortunate fact that
many of the most richly bred animals, designed for breeding
purposes, which capture the most coveted prizes at the
livestock fairs, have their breeding powers either tempo-
rarily or permanently destroyed in the process of feeding
them for the show. There is no effective method for over-
coming this except by the exercise of greater intelligence
on the part of the owners of show animals, which may be
furthered by judges in livestock exhibitions paying less at-
tention to the amount of fat and more to the form and gen-
eral vigor of the animal, in the allotment of premiums. In
order to show breeding animals with safety, it is absolutely
essential that abundant exercise should accompany the pre-
paring process, if the sexual vigor of the animal is to be
safely preserved.

The result is not the same with all individuals. There
are some which can withstand almost unlimited abuse in
this direction and continue to breed regularly, while others
are very susceptible and soon become temporarily or per-
manently sterile. Once this sterility is established, the only
thing that can be done is to correct errors in care by moder-
ating the diet and enforcing vigorous exercise, which will
sometimes, though not always, restore the sexual powers.

In a general way, the food of a breeding male needs to
be rich in protein, as compared with the amount of hydro-
carbons and carbohydrates. The commonest foods, when
well grown and cured, are the best for the breeding animal,
such as bright, aromatic hay and clean, well developed oats,
along with grass, to which may be added, in the winter,
roots and tubers. Rarely, if ever, is it necessary or even
advisable or permissible to add to the food any sexual stimu-
lant like pepper or mustard.

It should be observed that interferences with reproduc-
tion by confinement, overwork, overfeeding, starvation, and
other imprudent details of handling exert their pernicious

200 Diseases of the Genital Organs

influence through two separate channels. In the first place,
overwork or starvation, by lowering nutrition of mature
genital cells, directly inhibits reproduction. The functions
of the sex glands are such that neither the physical over-
exertion of the animal nor starvation can extend its influ-
ence beyond the duration of the abuse. The function re-
turns with restoration of bodily vigor.

The indirect effects of these errors are far more serious
and enduring. In all animals the genital organs commonly
contain bacteria which, so long as the animal is healthy,
may insidiously multiply at a rate barely to maintain their
status. When for any reason the vigor of the animal is
lowered, the genital tract participates in the depression and
bacteria multiply and rapidly increase in virulence. Soon
permanent injury of essential structures may occur, and
reproduction becomes difficult or impossible. At one time
there was much said about "fatty degeneration" of the
genital organs as a bar to reproduction in fat animals. I
know of no adequate ground for such an assertion. In most
animals the genital organs are among the last to act as de-
positories for fat. A notable exception is the bitch, in
which the uterine ligaments are loaded with fat, but these
are not essential and the fundamental organs are not visibly
involved.

As knowledge of the diseases of the genital organs ad-
vances, the belief in the direct influence of food, work, and
housing recedes, but their indirect influence, through the
general lowering of vigor and a correlatively increased viru-
lence of bacteria present, comes into greater prominence.
The proper nutrition, housing, and physical exercise of
breeding animals is one of the great fundamentals in the
problem of reproduction, because the vigor which these in-
duce constitutes an invaluable armor against the extension
of infection.

E. Excessive Sexual Use

The number of copulations which a male animal can effec-
tively perform is an important question for the breeder. It

Excessive Sexual Use 20 1

probably varies greatly with different individuals. Natu-
rally, the power of a male does not depend so much upon
the number of females with which he is expected to copu-
late as upon the number of copulations essential to produce
fertilization. It has been determined by careful investiga-
tion that, when the number of copulations during a given
day is increased, the abundance of spermatozoa in the semen
rapidly decreases and, if this service is pushed too far, the
spermatozoa fail almost entirely, causing an interruption
of the fertility of the animal. Much will depend upon the
age and vigor of the male animal.

Zschokke states that 80 to 100 cows may be bred to a
single bull when the animal is kept confined and his service
somewhat regulated by the breeder but, if allowed to con-
sort with the cows at pasture, not more than 50 should be
allowed. In the western range country of America, the al-
lotment is very much smaller and it is considered safer that
there be one bull to each 20 or 25 cows. This is necessitated
largely by the fact that, during the principal breeding sea-
son, the bulls have not yet fully recovered their vigor from
the long and trying winter with scant food supply. Zschokke
further holds that the bull should not be allowed to serve
more than three cows in any one day and that, under such
conditions, there should be one or two days per week of
complete rest.

Many horse-breeders apply a similar standard in the use
of stallions. The total number of females, however, may
be greatly increased if the service is distributed throughout
the year. Noted stallions, it is claimed, have served suc-
cessfully, and without apparent injury, two or three hun-
dred mares during the year, but in such cases the service was
evenly distributed over the entire period.

Zschokke draws attention to the erroneous belief that a
long abstinence from coition serves to store up a large
amount of semen, which will answer for a series of copula-
tions. There is no reservoir for such purpose, and all sper-
matozoa which may be formed and not used in copulation
soon disintegrate and are expelled or absorbed.

Excessive sexual use is largely a comparative term, in-

203 Diseases of the Genital Organs

dicative of a relative over-use under existing environment.
There is no question but that a breeding male may be readily
over-used and that such is a frequent occurrence, but more
commonly the use is relatively excessive because of bad man-
agement, where proper handling of the male would enable
him to make the number of services demanded, safely and
efficiently.

My belief is that most males are called upon to copulate
too frequently. The most hygienic rule for reproduction in
the higher mammals is monogamy, and any departure from
that ideal is necessarily at some peril. Since great sires
which have cost heavily are expected to repay their owner
by begetting a large number of highly valuable young, poly-
gamy is crowded to its limit, and beyond. There are two
fundamental facts bearing upon sex hygiene which every
breeder should know and heed. Most breeding animals of
both sexes carry important infections in their genital tracts,
and coitus stimulates and heightens genital infections. The
number of copulations which a bull or stallion may safely
perform depends first upon the degree of infection or dis-
ease in his genital organs, and, second, upon his general
health and vigor. While many accounts are published of
the great numbers of copulations made by various bulls or
stallions, or the large number of progeny to their credit,
they constitute an infinitesimal proportion of the total.
Clinically we observe bull after bull breaking down genitally
under what would appear to be very moderate use. Ad-
mittedly the infection was probably there already but the
repeated copulations served to vitalize it and establish seri-
ous disease, precisely as coitus intensifies syphilis and gonor-
rhea. Moderate work of the male during the breeding sea-
son is not injurious, but favorable. It is a constant observa-
tion that a male breeding animal which is regularly exer-
cised or moderately worked is capable of rendering a greater
number of effective services than one which is closely con-
fined.

Some writers condemn such foods as oil cake and malted

Onanism, or Masturbation 203

grain for the male and prefer the various grains, especially
oats, barley, peas and beans in moderate quantity. To these
should be added hay and grass in sufficient amount. Roots,
tubers, meal and molasses are not considered essential as a
part of the food supply for breeding males, but may, by aid-
ing in the maintenance of a good state of digestion, con-
tribute to the general vigor.

The feeding of salt has long been regarded as important
for maintaining fertility, and some have superstitiously ac-
corded it a prominent place, but it can not act directly and
serves merely to favor fertility indirectly by aiding diges-
tion and assimilation.

Apparently some believe that a male breeding animal re-
quires a different kind of food from the female. Funda-
mentally that is absurd, but when a bull is kept absolutely
confined and is wholly idle physically, he requires less food
per unit of body weight than a cow which is yielding a lib-
eral quantity of milk and probably gets some exercise daily
in the open field or paddock. The feeding needs to be ad-
justed the same as it would be between a cow which is milk-
ing heavily and another which is dry.

F. Onanism, or Masturbation

Masturbation, as a cause of sterility, is mentioned chiefly
in the stallion and the bull. It is said to be very common in
improperly kept stallions. Spinola (Handbuch der spec.
Pathol. 1858, II Bd.) records this vice in the bull.

In the stallion there is an erection, the penis is moved up
and down, imitating coitus, and finally ejaculation occurs.
In the bull, the ejaculation is induced by an erection and
the alternate protrusion and withdrawal of the penis. This
is generally seen in idle males which are closely confined,
over-fed, and sparingly used for breeding, and in racing
stallions when sexual debility is brought about by hard
work. It is undetermined whether the vice causes the im-
potence or the sexual weakness induces the masturbation.

Correction may be brought about by such feeding, exer-
cise and other care as will maintain the general vigor of the

204 Diseases of the Genital Organs

animal. Moderate work or exercise and judicious feeding,
or, in animals which can not be worked or artificially exer-
cised, the allowance of freedom in a commodious paddock —
still better, in a properly enclosed pasture — tends largely
to prevent or cure the vice. Once the habit has become fixed,
it should be prevented by a shield so arranged as to cause
pain whenever the penis is protruded. It is a vice of idle-
ness and debility, and any and all remedies must fail in
their aim until the return to normal vigor is attained.

Chapter VII
COITAL INJURIES

In the wild state, severe and fatal battles between rival
males are not infrequent and the same prevails to some de-
gree among domesticated animals, although, as a general
rule, if several males are kept together they lose much of
their combativeness. I have seen an instance of a fatal
fray between two rams which had been regularly kept to-
gether.

When a strange male wanders into a herd or group of fe-
males with which a male is regularly consorting, there is at
once a determined fight between the two, which ends only
with one or the other becoming vanquished. In these bat-
tles, injuries of the most diverse character occur, according
to species and chance. The only method of prevention is the
proper confinement of male animals. In most countries
there are laws against the running at large of male animals
but these are not enforced against carnivora. This excep-
tion should be overcome by the confinement of all females.

There is further danger to the male, especially horses and
cattle, of injuries in attempting to escape from or break
into enclosures in order to reach females. The appearance
of a female in estrum near the enclosure of a male causes
him to make violent attempts to escape from his confinement
and reach the female. Consequently it is important that en-
closures intended for the confinement of male breeding ani-
mals should be especially secure and, as far as possible, all
elements avoided in their construction which would endan-
ger the animal in an effort to escape.

In the preparations for copulation there is little danger
except in case of horses. Breeding customs and conven-
ience bring into the procedure a period of "trying" or "teas-
ing" of the mare by the stallion, to determine the existence
of estrum and bring about the desired degree of sexual ex-
citement before permitting an attempt at copulation. In
this act there are numerous dangers, especially to the stal-
lion.

206 Diseases of the Genital Organs

It is desirable, if not frequently essential to safety, that
special conveniences for restraint be provided for this pur-
pose. They should consist ordinarily of a strong, solid wall
about three feet high and ten to twelve feet long, with a
rather broad and rounded top. The chief object of the struc-
ture is the avoidance of kick wounds which may be inflicted
upon the stallion by the mare. To this end it should be
merely of sufficient height to guard against such an acci-
dent and sufficiently resistant that the mare can not kick
through it. A single pole to separate the stallion and the
mare is insecure and hazardous, as either may kick through
beneath it and injure the other.

It is highly essential that the top of the structure be
rounded, smooth, and free from projections. Either the
mare or stallion may get beyond the control of the groom
and kick or leap upon the structure. The wall should be low
enough that either animal, getting upon it by rearing or
kicking, may readily free itself without injury. I once at-
tended a stallion, which, having passed beyond the control
of the groom, reared to mount the mare and became im-
paled upon a projecting post at one end of the structure,
causing a serious hernia and almost eventration. Posts
should not extend above the top of the structure or, doing
so, should continue so high as to make injury in this manner
impossible.

A. Kicks and Fractures

When this preparatory period has been passed and copula-
tion has been decided upon, there arise fresh dangers to the
stallion from kicks by the mare while approaching her or in
the act of mounting. Two methods of avoiding accidents
at this point are used — without and with hobbles. In the
first method, when both stallion and mare are well broken
and controllable and competent grooms have each well in
hand, the stallion should be caused to approach the mare's
head, and then allowed to mount from the side instead of
from the rear. If both are kept well in hand, any attempt
to kick on the part of the mare should be at once counter-

Kicks and Fractures 207

acted by vigorously drawing her head toward the stallion,
thus turning her heels from him. When coition has been
completed and the stallion is dismounting, the same rule
should constantly be applied and the mare at once caused to
face the stallion in order to avoid kicks.

Owners of valuable stallions generally prefer to obtain
yet greater security by the application of hobbles. Two
forms are used, of which there are numerous varieties. By
one plan, a hobble is buckled about each hind pastern and
to each hobble is attached a rope of sufficient length, the two
free ends of which are carried forward between the fore-
legs and securely tied to a strong collar or carried upward
on either side of the neck and tied on the top sufficiently
tightly to prevent the mare from kicking backward any ap-
preciable distance. By the second plan, the hobbles are at-
tached to the hocks instead of the pasterns. In this case,
each hobble is branched ; one portion of each is attached
above and the other below the hock of each hind leg, and by
ropes or straps fixed forward the same as in the first. The
latter plan possesses some points of superiority : the mare is
not so liable to injure herself by becoming entangled in the
ropes, and the stallion is probably also exposed to less dan-
ger of getting his foot caught in the securing apparatus.
Whatever the form of breeding hobbles or other confining
apparatus, they should be secure and strong. Nothing can
well be more dangerous for the breeding stallion than weak
hobbles which lead to a false feeling of security and throw
the otherwise careful groom off his guard. I was called to
attend a valuable stallion suffering from a compound tibial
fracture, the result of a kick during attempted copulation.
Because the mare was not properly in estrum, or for other
reason, she was unexpectedly ill-natured. When the stal-
lion was attempting to mount she commenced to kick, the
old hobbles, in which the owner of the stallion had trusted,
gave way, and the fatal accident at once followed. The
breeder should never trust partly to hobbles and partly to
the gentleness of the mare or good luck. If hobbles are to
be trusted at all, the breeder should know that they are so

2o8 Diseases of the Genital Organs

strong that no mare can break them, always allowing a safe
margin of strength beyond that considered essential, and
that the fastenings are secure in every detail, making slip-
ping or accidental detachment impossible.

If accidents are to be avoided, it is highly important that
the mare is properly in estrum and that she is not frightened
or angered. Gentleness and patience in the handling of both
stallion and mare and postponing copulation until the proper
moment are always essential elements of safety in breeding.
Some breeders place a twitch upon the mare's nose until the
stallion has safely mounted her. Much of the danger arises
through the lack of ability upon the part of the groom to
diagnose estrum. Some grooms think when a mare crowds
against the teasing-pole and urinates, she is in estrum, when
as a matter of fact she is angry. A groom should learn
that a mare, not in estrum at all, when confined to be
teased by a stallion and unable to get away, will crowd to-
ward him, squat, and expel small quantities of urine simply
as an expression of anger (a gelding, when tightly confined,
occasionally gives vent to his anger by a characteristic
neigh and the expulsion of urine in small quantities). If
opportunity offers, such a mare will kick viciously. Some
stallions are so poorly broken that they rush at a mare vio-
lently and, if opportunity is given her, she will kick from
fright in self-defense. The proper knowledge on the part
of the groom, enabling him to diagnose estrum, and the
proper control of the stallion, are prime essentials to safety.

In breeding mares to jacks, it is customary to place the
mare in a pit where she is closely confined and rests upon a
plane a foot or more lower than that upon which the jack
stands. This not only gives an advantage to the compara-
tively small male by affording him an elevation, but also
secures him against kicks from the mare, a highly essential
precaution because, since the mare ordinarily resents copula-
tion with the ass, the act is largely in the nature of rape.

Disparity in size is a common cause of fractures in cattle
of both sexes. When a young bull attempts to copulate with
a large cow, he is liable, at the moment of the sudden copu-

Kicks and Fractures 209

latory thrust, to lift his feet entirely from the ground, so
that they glide forward, he falls backward, and may break
his spine in either dorsal, lumbar, or sacral region. In one
case brought to my attention, a similar accident occurred to
a cow which, being in heat, mounted one of her mates,
slipped, fell, and fractured her spine so that she had to be
destroyed. The danger of falling when the ground is slip-
pery or copulation is undertaken upon a concrete or other
smooth floor, is to be obviated by the removal of the causes.
In females mated with too large a male, fractures of the
spine, pelvis, and limbs occur. The danger is greatly ag-
gravated by slippery or uneven ground or by other unfavor-
able surroundings. Injuries to the female because of the
great weight of the male are not rare though far less com-
mon than one would be inclined to expect when the disparity
in size is considered. It is not rare to see females served by
males two, three, or more times as heavy, and yet escape in-
jury. In the smaller species, as the pig and dog, the female
can quite readily drop to the ground under excessive weight
and escape injury, but in the cow and mare there is danger
of serious injury when the weight of the male becomes too
great. Fractures from this source are most common in
cattle and generally the result of a fall at the moment the
bull makes the violent copulatory thrust. Some breeders
overcome this danger by using a breeding rack or cage, as
described above, so that the heifer can not be forced for-
ward and down. Each side of the rack presents a shelf
upon which the fore feet of the bull rest, preventing his en-
tire weight from falling upon the heifer. Sometimes an
awkward helper holds the head of the cow to one side and,
when she moves forward, draws firmly on the halter, bend-
ing her head sharply to one side and causing her to fall.
Either she should be left free or any restraint should be ex-
erted by two men, one on either side, thus pushing directly
backward. Nymphomaniac cows suffer frequently from pel-
vic fractures, which will be discussed under Cystic Degen-
eration of the Ovaries. In one instance a heifer of about
five months and weighing about 400 pounds was served by

210 Diseases of the Genital Organs

a bull weighing 2000 pounds and suffered a fracture of the
pelvis. The injury was not sufficiently serious to prevent
her giving birth in due time to a calf. In another instance,
a sucking filly was mounted by a large stallion which had
accidentally broken into a field with her, causing dislocation
of the sacro-iliac articulation on one side and fracture of
the iliac shaft on the other, rendering her useless for labor.
She was bred at two years, and destroyed at three years,
because of irremediable dystocia.

It is desirable that young females which come in estrum
very early in life should be securely segregated from mature
males, not alone because of the undesirability of very early
breeding, but in order to avoid serious injuries from dis-
parity in size. It is also essential to remember that a male
breeding animal regularly confined, in case of accidental
escape, will attempt rape upon the most immature young,
as in the foregoing case, with serious or fatal results.

The violent copulatory thrust of the bull occasionally
causes a fracture of the base of the tail or the caudal end of
the sacrum. I have observed it most frequently in Jerseys,
perhaps because the sacrum is relatively smaller and less
resistant than in other breeds. It seems to occur at the mo-
ment of the copulatory thrust. So far as known, it is not
subject to remedy. The result is usually caudal paralysis,
with a lateral curvature of the tail and caudal end of the
sacrum, disfiguring the cow and destroying the protective
value of the tail against flies, without otherwise injuring
the animal.

B. False Copulation

False copulation, or entrance of the penis into the anus
instead of the vulva, is possible in most domestic animals.
Harms records it as occurring in the mare, cow and sow. 1
have observed it only in the mare and, in all, four times,
though I have known of numerous other instances. It is by
no means rare and is highly dangerous. Its causes are va-
rious, but it is probably due largely to resistance on the part
of the female. Sometimes a female is thought to be in es-

False Copulation 211

trum when she is not. Perhaps she has been in estrum an
hour or two before and the owner or person in charge be-
lieves it best to use forcible restraint in order that copula-
tion may occur. Some, erroneously believing that, when
estrum fails to appear at the expected date, it may be
brought about by rape, proceed to force coitus. Coition is
safe only when estrum is present in the proper degree. The
mare has ample power to close the vulva against the ready
entrance of the penis, thus causing it to glide upward and
forward against and into the anus, which opening may be
more readily forced.

The accident is also invited in aged cows or mares with
pendulous abdomen in which the tension upon the rectum
draws the anus and superior commissure of the vulva down-
ward and forward, thereby causing the vulvar opening to
approach the horizontal instead of the perpendicular. The
penis then tends to glide forward and slightly upward over
the oblique vulvar opening, to strike against the inferior
surface of the tail and become deflected into the anus. It
may be purely accidental. Harms thinks it may result from
smallness of the female. All cases I have observed have
been in mares of medium or large size.

The extent of the injury varies. Apparently, the acci-
dent may cause little or no injury in some cases, though, of
those which are brought to the attention of the veterinarian,
a large proportion are fatal. The extent of the lesions will
vary according to the size of the penis, the violence of the
copulatory act, and the quantity and character of the feces
in the posterior portion of the rectum. Should the rectum
be quite empty or filled only with pultaceous feces, as in a
cow, or in a mare on green food, the penis may force its
way along in the bowel unless it is caught in the folds. If
the rectum is impacted with dry feces, as is usually the case
in the mare, the penis is deflected and tends to pass through
the rectal walls. The rupture may occur either into the
peritoneal cavity or into the periproctal connective tissue.
In the former case, in the mare, the opening is so great that
feces drop at once into the peritoneal cavity and cause pro-

212 Diseases of the Genital Orga?is

found irritation. No sooner has the stallion dismounted
than the mare trembles, looks anxiously at her sides, may
pass some feces and blood, moves uneasily, and may lie
down, but does not roll violently. The pulse is rapid and
weak, the breathing is shallow and quickened, the abdomen
is held rigid, and the patient looks tympanitic. The symp-
toms resemble in many particulars those of rupture of the
stomach. The diagnosis is readily made by manual explora-
tion per rectum, since the hand passes easily out through
the rupture into the peritoneal cavity. In one of my cases
of rupture into the peritoneal cavity, the mare lived some
eight hours ; in another, less than four hours.

Not all cases lead to rupture into the peritoneal cavity. In
one instance under my observation, in an old brood mare,
no history of injury was obtainable, and apparently the rup-
ture had not occurred during the several years of ownership
by her last proprietor. She died under symptoms of colic.
Autopsy revealed a large intra-pelvic sac, opening into the
rectum, which had been habitually filled with feces but, be-
coming over-distended, had obstructed the bowel and caused
a rupture of the sac into the peritoneal cavity. It was al-
most certainly the result of an old penial wound.

In another case I recognized the accident at the time of its
occurrence. Blood and feces were voided, and the perineal
region was swollen. Manual exploration revealed a large
rent through the rectal walls into the periproctal connective
tissue, six to eight inches from the anus. The resulting sac
contained about two liters of feces impacted into the readily
distensible wound. The feces occupying the sac and those
from the rectum immediately anterior to the rupture were
carefully removed by the hand, and the sac was cautiously
flushed out with an antiseptic solution. This method of
handling, repeated twice daily, along with restricted, laxa-
tive diet and complete rest, brought about a prompt recov-
ery with little sacculation.

According to Harms, false copulation in the sow is usu-
ally followed by no more serious consequences than a swollen
anus, accompanied by a bloody discharge.

False Coptilation 213

In the mare the accident is preventable by ordinary pre-
cautions on the part of the stallion groom. Service should
not be attempted in case of a mare not certainly in proper
estrum. It is the duty of the groom to see that the penis of
the stallion is properly entering the vulva of the mare. If
the mare is kicking or otherwise violently resisting the stal-
lion, he should be promptly withdrawn, since copulation un-
der such circumstances is unwarrantedly dangerous for
both animals. Such violent resistance of the mare is some-
times cited by the groom as an excuse for his failure to
know that the penis of the stallion was being properly en-
tered in the vulva, but it is not valid. The mare or cow
with retracted anus should be placed with her hind feet on a
lower level than her anterior members, leaving the ground
upon which the male is to stand at a higher level and thus
bringing the vulvar opening more nearly perpendicular. In
the cow and sow, the accident is not usually preventable.

The prognosis of penial injuries to the rectum must be
based largely upon their position and extent. When the
lacerations perforate the peritoneum, allowing feces to es-
cape into the peritoneal cavity, the injury is essentially
fatal : veterinarians have not yet succeeded in successfully
handling such lesions. When the rupture of the rectal wall
occurs behind the peritoneum or, occurring more anteriorly,
does not perforate it, the prognosis is good, if timely surgi-
cal aid is given, though, after a long time, serious or fatal
results may follow the impaction of feces in the sac formed
in the pelvic connective tissue. The pressure of the feces es-
caping from the rectum tends constantly to push the loose
connective tissue aside and, eventually, to form a large sac,
which is constantly filled with fecal masses.

The handling in such cases consists of gently removing
the feces from the sacculated wound cavity in the pelvic con-
nective tissue and cautiously flushing it out at least twice
daily with a mild antiseptic solution. At the same time, the
rectum should be manually emptied as far as the attendant
can reach and the feces thus prevented from dropping into
the sac. The patient should be kept at rest on a very scant,

214 Diseases of the Ge?iital Organs

laxative diet during the treatment, until the rupture is
quite healed, as it is highly important to guard against ex-
tensive sacculation in the part, which can be done only by
avoiding the accumulation of feces in it.

In some instances, the injuries to the rectum from the en-
trance into it of the penis are comparatively trivial — merely
wounds of the mucosa and part of the muscular walls,
with the passage of bloody feces, some swelling about the
anus, and other slight symptoms of injury, which readily
pass away under repeated antiseptic enemata.

From a forensic standpoint, the owner of the stallion is
probably always responsible, since the accident is preventa-
ble with proper care upon the part of the groom. Such were
the findings in the only case which I have seen tested in the
courts.

C. Laceration and Rupture of the Vagina

The vagina, especially of the mare, is not infrequently
lacerated or ruptured by the penis of the male. The size of
the penis of the stallion does not bear a constant ratio to
that of the body, but is comparatively excessive in coarsely
bred animals with long legs and large heads. Such stallions,
copulating with small mares, constantly tend to produce
vaginal injuries. Sometimes it is merely a slight laceration
in the mucous membrane, which may cause limited hemor-
rhage and some straining; sometimes the lacerations in the
mucous and muscular walls are extensive and induce marked
symptoms of wound infection in the vagina, with tumefac-
tion, discharge and straining; sometimes the vaginal walls
are completely ruptured, with great danger of fatal perito-
nitis.

In one instance I investigated, a series of injuries was
caused by a recently introduced stallion, which had been put
to service among comparatively small mares. Almost every
mare served by him exhibited signs of vaginal injury: some
were severely lacerated ; in one there was a fatal rupture.
The horse was found to be an overgrown, coarse, leggy grade
draft stallion about eighteen hands high, with an enormous

Laceration and Rupture of the Vagina 215

penis which would have been dangerous with heavy draft
mares, while in his neighborhood most animals were of small
roadster or common stock.

When such injuries occur, there is observed an abnormal
amount of straining immediately after copulation, with, per-
haps, some discharge of blood from the vulva. Later, swell-
ing of the vulva and a muco-purulent discharge may occur.

If the wound penetrates the peritoneal cavity, septic peri-
tonitis is highly probable, with early collapse and death.

Injuries to the mare from this cause should be obviated
by means of a roll or padded surcingle encircling the body
of the stallion and passing just in front of the sheath in a
manner to prevent the penis from entering the vagina to its
full length, the pad or roll being adjusted in size according
to the case. The diameter of the roll should always be ample,
since little fear need be entertained that preventing the en-
trance of the entire length of the penis will unfavorably af-
fect the results of copulation, as general observations show
to the contrary. In constructing this roll or pad, an ordi-
nary surcingle may be used and a tube made of sheeting or
other sufficiently strong material, open at each end, which is
slipped over the surcingle. Padding of cotton, oakum, or
other material is then to be inserted into the tubular cover-
ing until it is tightly filled so that it presents a diameter of
4 to 8 inches in that part of the surcingle to come in contact
with the abdominal floor, after which the open ends of the
tube are to be secured to the surcingle and closed by tying.
When the stallion is ready for service, the surcingle is passed
around his body just in front of the opening of the sheath,
and secured by buckling. In copulation, only that portion of
the penis projecting beyond the roll can enter the vagina.

Non-fatal laceration of the vagina should be handled
along general antiseptic lines. The practitioner should re-
member that this organ reacts strongly to irritants and that
thorough disinfection should be brought about largely by
mechanical flushing rather than by heroic attempts to de-
stroy the micro-organisms in position. ,
Coital injuries to the vaginae of cows have not come un-

216 Diseases of the Genital Organs

der my observation. I am of the opinion that they are very
rare. The vagina of the cow is very long and elastic. Dur-
ing estrum it is highly lubricated with an abundant, thin
mucus, rendering it virtually impossible for the penis of the
bull to become caught in the lateral walls. If the heifer or
cow were not in estrum and the vagina were dry, the case
would be quite different.

I have seen a number of cows which could not copulate
without great peril because of severe vaginal stricture. Per-
haps that is the explanation of the cited instances of vagi-
nal injury by the penis.

Lacerations of the vagina by the penis are also liable to
occur in other domestic animals, though less probable than
in the mare. Their symptoms, prognosis, and treatment
are essentially the same.

D. Rupture of the Uterus by the Penis of the Bull

DurantonO) states that in one instance the penis of the
bull passed through the cervical canal and ruptured one of
the uterine cornua. This is highly improbable, if not abso-
lutely impossible. It is almost certain that the real culprit
was a man, who had either committed sadism or had at-
tempted to "open the womb".

Veterinarians should be always on their guard in accept-
ing accounts of injuries to the vagina or uterus of the cow
by the penis of the bull. Many owners and caretakers have
an abiding faith in the efficacy of "opening the womb" just
before coitus, as a remedy for sterility, and not infrequently
are not publicly proud of their faith. As a consequence,
the operation is often kept secret, especially if the layman
has become frightened because hemorrhage has followed
his efforts. Later, if disaster follows, the true history is
not given the veterinarian. Often a workman will under-
take such an operation without the knowledge of the owner,
and. suspecting he has injured the animal, quite naturally
keeps his bungling work a secret, so that the bull is blamed
with having caused the lesions.
'Journal de Lyon, [888.

Alleged Rupture of the Urinary Bladder by the Pe?iis 217

In examining a sterile heifer, I encountered a chronic,
indurated, cervical abscess, which is shown in Fig. 39. The
origin appeared perfectly clear to me. Upon inquiry, it
was at once admitted that a man had attempted to "open"
her to cure the sterility. Repeatedly I have observed in-
juries to cervix and uterus by veterinarians.

E. Alleged Rupture of the Urinary Bladder
by the Penis

Uebele, cited by Harms, reports that a heifer died from
rupture of the urinary bladder a few days after coitus.
Any veterinarian who has passed a catheter through the
urethra of a cow should appreciate the difficulty of the pas-
sage of the penis of the bull through that narrow canal, ob-
structed at the beginning by the valve-like cul-de-sac. An
ignorant meddler, mistaking the urethra for the cervical
canal, might cause such injury. The veterinarian should
take every possible precaution against being deceived,
whenever the lesions appear so removed from the ordinary.
Under certain abnormal anatomic conditions, the urethra
might well suffer severe lesions during attempted coitus,
especially when the lower portion of the hymen persists.
The hymeneal remnant slopes somewhat upward and back-
ward, forming a sort of pouch in the floor of the vulva,
with the urethra at its bottom. The membrane, catching
the penis, may deflect it downward into the urethra, and
either the penis or the urethra and bladder, or all, may suf-
fer injury. But that is aside from the point. The healthy
normal genital tract of the heifer or cow is not readily
damaged by the penis of the bull during coitus. When such
post-coital injuries are recognized, the diagnosis as to
cause should be very guarded. Under certain conditions, a
false diagnosis might well lead to litigation, especially when
a bull belonging to one man breaks into an enclosure where
cows belonging to another are kept.

In all such injuries the veterinarian should not fail to give
consideration to two other possibilities, each of which is
more probable than penial injury — sadism (which see) and

218 Diseases of the Genital Organs

meddling by incompetent persons in an effort to "open the
womb".

In the mare, this accident would seem more possible be-
cause of the very wide, valveless meatus, through which
several fingers may be passed, but the penis of the stallion
is large and the glans very broad. Elsewhere I have de-
scribed a filly with a persistent, though perforate hymen,
which deflected the penis of the stallion downward and ap-
parently caused a wide dilation of the urethra but no harm
to the bladder.

F. Vaginal Hemorrhage Following Coitus

Hemorrhage following coitus is not rare. It often follows
copulation of a virgin female, owing to slight lacerations
of remnants of the hymen. In cattle, when the granular
venereal disease is very severe, hemorrhage in both sexes
often follows coitus. This will be discussed in a succeed-
ing chapter. If stricture of the vagina is present, coitus is
always liable to cause hemorrhage. Often lacerations of the
vagina during coitus, already cited, cause more or less hem-
orrhage. Tumors of the genitalia which are lacerated by
coitus may bleed quite profusely.

G. Urethral Hemorrhage in Stallions

Hemorrhage from the urethra following coitus was ob-
served by me in a valuable racing stallion. The patient, a
famous imported thoroughbred in fine physical condition,
had been a successful sire. He was very vigorous in copu-
lating. Without warning, he suddenly began to bleed pro-
fusely from the urethra after each coitus. The act of copu-
lation appeared normal, and was completed promptly and
naturally. A moment after dismounting, before the penis
had retracted, there was a sudden gush of bright red blood,
estimated at about one pint, after each copulation.

The source of the hemorrhage could not be determined,
though it probably emanated from the pelvic urethra, vesi-
culae seminales, prostate, or Cowper's glands. Its cause was

Contusions of the Neck ajid Withers from Bites 219

not learned. He was withdrawn from the stud, kept sexu-
ally quiet, exercised freely, and fed lightly. Later he was
returned to the stud. He had been kept in sight of the mare
while the breeding hobbles were being applied, during which
time he became highly excited. This was changed so that
the mare was properly shackled before he was brought into
her presence. He was then allowed to copulate promptly,
before excessive erection could occur. The difficulty ceased.

H. Contusions of the Neck and Withers from Bites

In the mare, injuries to the neck and withers are liable to
occur from bites by the stallion during coitus. This is proba-
bly most common among heavy draft stallions, some of which
are very rough and cause more or less serious lacerations or
contusions, at times leading to fistulous withers. There
seems to be no means for breaking the stallion of the vice.
The only effective method of control is the application of a
muzzle prior to coition.

I. Penial Injuries

Injuries to the penis of the male just before, during, or
after copulation are by no means rare. The penis of the
stallion is most liable to injury from kicks by the mare just
as he mounts or dismounts. The prevention of such injuries
has been discussed above. Such contusions of the penis dur-
ing its great vascularity in the breeding season are very
difficult to handle. The stallion needs to be kept quiet and
free from sexual excitement. The penis should be retained
at rest within the sheath, by means of a suspensorium, and
the resulting local inflammation ameliorated by the applica-
ton of cooling astringents such as lead acetate, hamamelis,
tannin, belladonna, etc., combined if necessary with anti-
septics. Generally the patient may have quiet walking ex-
ercise, a restricted laxative diet, saline laxatives, or in case
of serious disturbance, prompt cathartics of the hypodermic
alkaloidal group (eserin, arecolin, etc.).

220

Diseases of the Genital Organs

Lesser injuries to the penis of the stallion are caused by
the tail hairs of the mare, pushed into the vagina by the
glans, which, being drawn tightly across the penis, cut the
organ. This is to be prevented by the stallion groom, who
should draw the tail of the mare aside at the commencement
of the copulatory act ; apply a bandage about the base of the
tail extending low enough to secure any hairs that might be
caught by the glans penis ; or braid the hairs of the tail upon
its dorsal surface.

The danger of injury to the penis of the bull is increased
when a large male attempts to copulate with a small heifer,
with a very narrow vulva and perhaps important remnants
of the hymen. The presence of severe granular venereal
disease lessens the caliber of the vulva and the roughness
caused by the nodules increases materially the resistance to
the entrance and the two combined, with the pain caused by
the forcible contact, render injury more probable. Some-
times the penis of the bull withstands violence surprisingly
well. I examined a neuter, or freemartin, with severe lacer-
ations of the vulva and periproctal tissues. The owner re-
lated that, as the "heifer" would not come in estrum, he de-
cided to stimulate its appearance by causing the animal to
be raped by the bull. (The practice of raping females which
fail to come in estrum is not rare amongst a careless, ignor-
ant class of breeders.) The penis of the bull had caused
serious injury to the neuter, compelling prompt slaughter.
The penis of the bull escaped known injury.

Coital injuries to the penis and prepuce of the bull are
probably more common and vital than those occurring to
the genital canal of the cow. Exposure to minor injuries
is constant. In cattle the universal presence of the granu-
lar venereal disease causes a constant genital catarrh, which,
escaping at the inferor vulvar commissure, befouls the vul-
val- tuft of hairs. The muco-pus forms hard, dry crusts
upon the tuft. The sticky muco-pus also catches up and in-
corporates in the crusts various foreign bodies. The en-
crusted vulvar tuft is liable to become caught and forced

Pen ia I Inju rics 2 2 1

into the vulva alongside the penis, abrading it and threaten-
ing to transfer to the abraded parts any infection included
within its mass. The injury can and should be prevented
by keeping the vulvar tuft clean by washing.

In abattoir bulls, the penis is often found eroded, owing
to the withdrawal into the prepuce of loose, dirty hairs from
the preputial tuft, but I have not observed this in breeding
bulls. Some breeders attempt to prevent the pulling of
hairs into the prepuce by clipping away the preputial tuft.
This invites another, and equally important danger from
the multiple minute abrasions of the prepuce and glans
from the short hair stubs.

"Broken penis" in the bull is often reported. It is be-
lieved that the penis becomes caught against the side of the
vulva or elsewhere and the animal at the moment of making
the violent copulatory thrust, doubles the organ sharply
upon itself, "breaking" it or otherwise causing serious in-
jury. Sudden and violent bending of the erected penis
causes such injuries to its tissues that the "broken" organ
remains curved or bent at an angle. That portion beyond
the point of injury does not become erected. Thus the ani-
mal is rendered useless as a breeder or the injury causes
severe balanitis or inflammation of the prepuce, leading to
adhesions so that the organ can not be protruded. Clini-
cally I have observed the injury following, and apparently
due to coitus by a large bull with a heifer. In one instance,
the breeder believed the penis of the bull had been injured
in casting him by the compression method, in which the
noose about the flank crosses the penis just in front of the
scrotum. I have cast bulls so frequently by this method,
without observing injury, that I could not accept his con-
clusions regarding the cause without important reserva-
tions. The injury is liable to pass unnoted for several days,
. until the bull is brought out for breeding and is found to be
incapable of copulating, or capable only with difficulty. A
narrow vulva, sometimes accentuated by great swelling of
the vulvar mucosa because of severe granular venereal dis-

222 Diseases of the Genital Organs

ease, important hymeneal remnants, vaginal stricture, or
other obstacles to the passage of the penis into the vagina,
tends constantly to cause the penis to be violently bent, most
readily at the base of the glans, where the encircling pre-
puce is attached. At the same moment the prepuce is per-
haps overstretched.

Both penis and prepuce become inflamed, swollen, and
sensitive. Protrusion of the penis becomes very difficult or
impossible. Frequently the pain is too great to permit copu-
lation. The swelling and the pain about the base of the
glans are very marked.

The prognosis is good. The bull usually recovers anato-
mically and functionally. Exceptions may occur, owing to
chronic irregular induration of the corpus cavernosum,
which causes the penis to become bent in such a manner
that copulation becomes difficult or impossible. Such in-
juries to the penis are preventable where the causes are
recognizable in advance. Once they have occurred, the
handling consists fundamentally of sexual rest and anti-
sepsis. The sexual rest should be as complete as practicable
without unnecessarily curtailing physical exercise. On no
account should attempts at copulation be permitted until re-
covery appears to be complete. Since in the bull the pre-
puce is nearly always involved, it should be kept clean. In
addition, warm douches exert a favorable action upon the
inflamed penis. The douche should consist of warm physi-
ologic salt solution or a very weak, warm, antiseptic liquid,
as a 0.25 per cent. Lugol's solution. The salt solution douche
may be repeated twice daily, or as frequently as may be de-
sired in an individual case. The Lugol's solution can not as
a rule be applied more than once, or at most twice daily,
without causing irritation. If the parts are very irritable,
iodoform suspended in oil may be used instead of the
douches.

The best instrument for applying the douche is the soft
rubber catheter seven feet in length, designed specially for
this purpose. Or one may substitute for this the rubber

Rupture of the Prepuce 223

horse catheter, the length of which is to be supplemented by
splicing with two or three feet of ordinary tubing, attached
to a hospital irrigator. The catheter should be cautiously
pushed through the sheath into the prepuce, the irrigator
elevated one to two feet above the bull's back, the sheath
opening compressed about the catheter with the hand, and
the douching fluid caused to flow into the sheath and pre-
puce until they are fully distended, when it should be al-
lowed to escape, and the process repeated as often as con-
sidered expedient.

J. Rupture of the Prepuce

Rupture of the prepuce sometimes occurs, as shown in
Fig. 60, presumably due to the violence of the copulatory
thrust, associated with a narrow vulva, hymeneal stricture,
or possibly other unfavorable anatomical condition. How
common it may be, I am unable to state. My one example,
Fig. 61, is from the abattoir, and hence without clinical his-
tory. Clinically, rupture of the prepuce is subject to defi-
nite diagnosis only by the forcible protrusion of the penis,
as already described. It may be suspected by a history of
marked hemorrhage following the coitus during which the
lesion has occurred.

A slight rupture may perhaps recover without impair-
ment of breeding efficiency, but severe or extensive rupture
probably closes the breeding career of the animal, because
the ruptured parts may, in healing, become adherent to the
surrounding framework of the sheath, incarcerating the
glans penis and causing permanent and irremediable phi-
mosis.

The prevention of such injuries is more important and
practicable than their handling. They are most liable to
occur in confined males which are suddenly brought in con-
tact with females, not always in a proper state for coition.
The female may be nervous or timid at the approach of a
strange male or, still worse, estrum may not have reached
its fullness or may have begun to decline so that she will not

224 Diseases of the Genital Organs

stand well, and owing to her resistance the accident may
occur. Slippery or uneven ground may also render the act
insecure and lead to injuries to the penis.

Prevention should be based chiefly upon the avoidance of
these and other dangers. With cattle especially, it is im-
portant that the female be properly in estrum, and that the

Fig. 6i — Rupture of Prepuce. Bull.

G, Glaus ; F, fornix ; ft R, rupture of the prepuce near its juncture

with the sheath.

ground or floor of the enclosure in which copulation is to
occur be reasonably even. Zschokke commends (Der Un-
fruchtbarkeit des Rindes, page 66) service stocks consist-
ing of five posts upon which are fixed two beams which meet
in front to constitute an acute triangle, open at the base,
into which the cow is led and from which she can not readily
escape or make any extensive movements.

In the handling of such injuries to the penis, little can be
done beyond the allaying of infection by means of antisep-
tic douches and the avoidance of sexual excitement, com-

Strangulated Hernia 225

bined with such local and general treatment as would tend
to control inflammation.

In the dog, in which, during copulation, the prominent
glans penis becomes tightly fixed in the vulva of the bitch,
the male may dismount and turn in the opposite direction,
thus bending the penis abruptly. If disturbed by other
dogs or in any other manner, violent dragging upon the
penis follows, which leads to injuries of a more or less seri-
ous character, chiefly to swelling and inflammation of the
parts, occasionally followed by paraphimosis. These in-
juries are not usually observed under proper breeding ar-
rangements, but are generally seen where bitches are per-
mitted to run loose and a large number of dogs congregate,
with the resultant fighting.

The handling of such injuries to dogs consists of essen-
tially the same methods as in the bull, chiefly disinfection.
If paraphimosis results, it should be overcome. A local an-
aesthetic, with perhaps some adrenalin, may be applied to
the swollen glans penis, after which, with the aid of digital
compression or by means of an elastic bandage, the size of
the congested organ may be so reduced that it can be pressed
back into the prepuce. If not, the margin of the prepuce is
to be enlarged by incision sufficiently to permit the penis to
return.

K. Strangulated Hernia

Copulation is one of the commonest causes of strangu-
lated inguinal hernia in the stallion, and occasionally in
other male animals. When the stallion mounts the mare,
the inguinal region is subjected to increased pressure from
the weight of the abdominal viscera. The position of the
abdomen is changed from horizontal, or a declination down-
ward and forward from the inguinal ring towards the dia-
phragm, to almost the perpendicular, with the entire weight
of the abdominal viscera pressing downwards upon the pel-
vic inlet and inguinal opening. The pressure is further
augmented by the abdomen of the stallion becoming forcibly
15

226 Diseases of the Getiital Organs

compressed against the buttocks of the mare, as well as by
the vigorous contraction of the abdominal muscles during
the act, all of which combine to increase the intra-abdominal
pressure and tend to force a small section of intestine
through the inguinal ring, where it quickly becomes strangu-
lated unless it promptly returns to its proper position when
the stallion dismounts.

In such case, soon after dismounting, in fifteen to thirty
minutes, or even earlier, the stallion exhibits symptoms of
colic, kicks at his belly, looks at his flank, breathes rapidly,
sweats profusely and rolls violently. The agony is excru-
ciating and constant, increasing in intensity, the sweat be-
coming more profuse until, after ten to twelve hours in very
acute and unrelieved cases, the violence abates, the body
surface, bedewed with sweat, becomes cold, and the pulse
rapid and weak or imperceptible, indicating gangrene of
the incarcerated bowel, to be soon followed by death.

If the inguinal region is carefully examined, a tense fluc-
tuating swelling may be recognized, but in many cases the
incarcerated intestinal loop is so small that its presence can
be determined only by very careful palpation. Examina-
tion per rectum usually gives more definite results : the in-
carcerated intestine can be felt and grasped, making the
diagnosis definite and final.

The handling needs to be prompt, and usually radical, if
the life of the patient is to be saved, although spontaneous
recovery occurs in some cases. If the agony of the patient
does not prohibit the attempt, the operator may insert his
hand per rectum, grasp the incarcerated intestine, and, drag-
ging gently and cautiously upon it, attempt its replacement.
At times this succeeds.

Should this fail, the animal is to be cast in dorsal recum-
bency, with the hind legs sharply abducted, and the inguinal
region freely opened. He should at once be placed under
complete anaesthesia. The dragging on the incarcerated
bowel per rectum may now be repeated, accompanied by
digital manipulation or compression externally with the
other hand or bv an assistant.

Stra ngulated Hern ia 227

Failing in these efforts, herniotomy should be performed
with the least possible delay. After thorough disinfection
of the region, proper sterilization of hands and instruments,
and covering the adjacent parts, including the hind feet and
legs, with aseptic or antiseptic towels or napkins, the scro-
tum is to be freely and cautiously incised down to the in-
carcerated intestine, after which the carefully disinfected
and moistened index finger is to be passed up along the an-
terior side of the herniated bowel to the point of incarcera-
tion in the internal ring. Using the finger as a guide, a
herniotome, probe-pointed bistoury, scalpel, or such other
instrument as the exigencies of the situation demand, is in-
troduced through the ring at its antero-external angle and
the tissues are sufficiently divided, forward and outward, to
permit the incarcerated intestine to return. Sterile or anti-
septic gauze is then introduced into the wound and packed
closely against the internal ring in a manner to avoid all
danger of a recurrence of the hernia, and the scrotal wound
is closed by sutures. The tampon may be omitted and deep
sutures taken in the internal ring, closing it against future
hernia.

Twenty-four to forty-eight hours later the antiseptic
gauze may be removed, and the wound disinfected, closed,
and thereafter left undisturbed or handled according to in-
dications. If the strangulation of the intestine has already
led to the necrosis of the incarcerated loop, resection of the
intestine should be promptly performed. When herniotomy
is performed, if there is doubt concerning the viability of the
incarcerated loop, after the inguinal ring has been freely
dilated, additional intestine may be drawn out and the parts
carefully examined. The intestine should be kept moist with
physiologic salt solution. The operation of resection, be-
longing to surgery, need not be described here. The prog-
nosis in herniotomy is good in properly selected cases.

Chapter VIII
PARTURIENT INJURIES

A. Lacerations of the Perineum

Lacerations of the perineum occur in two distinct ways,
and almost exclusively in mares. The more important type
of laceration of the perineum is due to one of the extremi-
ties of the fetus, generally a foot, becoming misdirected
during parturition, being forced up through the roof of the
vagina and floor of the rectum, and protruding from the
anus. The violent expulsive efforts of the mother drive the
fetus along and tear asunder the entire partition between
the rectum and the anus above and the vagina and vulva
below, converting the two posterior openings into a common
cloaca. The accident and its handling have been fully de-
scribed in the companion volume, Veterinary Obstetrics.
It is referred to here because, as a general rule, if not prop-
erly handled, it closes the breeding life of the animal. The
unhealed tear permits feces to drop into the vagina, keep-
ing up a constant irritation and fecal infection. It also
renders copulation virtually impossible. If the cervix and
uterus are healthy, artificial insemination may succeed, and
if pregnancy ensues the injury will offer no impediment to
parturition.

The second type of laceration of the perineum may occur
in any animal, though most frequently in the mare. In this
type of laceration, the injury is due to overstretching of the
vulva by the volume of the fetus. In almost all cases the in-
jury occurs at the superior commissure of the vulva and ex-
tends obliquely upward to the right or to the left outside the
anal sphincter. Such lacerations are of importance princi-
pally because they permit the superior commissure of the
vulva to drop forward, rendering the vulvar opening hori-
zontal and interfering with copulation. Still more impor-
tant, they destroy the physiologic function of the vulva as a
sphincter and as a barrier to infection, so that the vagina

Recto- Vaginal Fistula 229

tends to become more intensely infected than usual, and
this infection may extend through the cervical canal into
the uterine cavity and beyond.

Consequently it is of importance that such lacerations be
repaired as promptly as possible. Owing to the constant
tension of the muscles and fascia extending from the vulva
to the ischial tuberosity, the margin of the sacro-sciatic liga-
ment, and the sacrum, it is difficult to retain the parts in
apposition while healing. Therefore it may be advisable to
isolate largely, upon one or both sides, the anus and vulva
from the adjacent structures by making two approximately
parallel incisions from above to below on either side of the
anus and vulva, extending through the skin and subcuta-
neous tissues, so that outward tension upon these can no
longer exist. After the injury has been repaired, the in-
cision will heal and the function of the parts be restored.

B. Recto-Vaginal Fistula

Recto-vaginal fistula, like the first type of ruptured peri-
neum, belongs virtually exclusively to the mare. Its origin
is the same. An extremity of the fetus, almost always a
hoof, pushes up through the roof of the vagina and rectal
floor into the rectum. The position of the deviated member
then becomes corrected, and birth is completed without the
tissues posterior to the puncture becoming divided. As a
rule, the erroneous position of the foot is probably corrected
by an attendant who, realizing the peril, quickly pushes the
foot from the anus and rectum back down into the vagina.
The opening persists. The result is analogous to the com-
plete rupture of the perineum. Feces drop through the fis-
tula and cause fecal infection.

The prognosis and handling are the same as for complete
rupture of the perineum.

C. Lacerations of the Cervix

Lacerations of the cervix have been generally ignored.
Not alone have the parturient lacerations of the organ been

230 Diseases of the Genital Organs

disregarded, but there has been a very general disregard
for surgical invasion of the cervix in a manner equivalent
to laceration. There has come down to the present day a
legend of frequent stricture and induration of the cervix,
of a character to prevent parturition, which may be relieved
by a free and careless dilation of the canal by incision. Ow-
ing to a gross and common misconception with reference to
the non-dilation of the bovine cervix at the time of parturi-
tion, it is quite habitual to dilate a perfectly normal cervix
by cutting, when, as a matter of fact, the whole fault lies in
a paretic uterus. The cervix has no inherent power to di-
late, but is dilated passively by the contraction of the uter-
ine walls upon the fetus and its fluids. Adhesions, or in-
durated thickenings, in the cervix occur with such frequency
as to constitute a basis for the fiction of the frequency of
induration. Practitioners should be on the alert and re-
member the three salient facts — that the cervix of the cow
is physiologically very rigid, that its non-dilation at time of
parturition is almost always due to atony of the uterus from
intra-uterine infection, and that the part played by the cer-
vix is essentially passive. If this is fully understood, dila-
tion of the cervix by incision will not be rashly applied.

In whatever manner the laceration or division of the cer-
vical wall occurs, the fissure heals neither perfectly nor
readily and the vaginal opening of the cervical canal gapes.
Naturally infection of the cervix follows and a pernicious
interference with fertility results.

Lacerations of the cervix should be repaired as promptly
and accurately as possible. If recognized at first, they
should be carefully sutured with slow-dissolving catgut un-
der the best available asepsis. When a persistent fissure in-
terferes with fertility, the vaginal end of the cervix had best
be amputated as far forward as the fissure extends. The
technic of trachelectomy is described later under "Cervici-
tis".

Chapter IX

SODOMY AND SADISM

Injuries to the Genital and Neighboring Organs of
Animals by Sexually Psychopathic Men

It is of fundamental importance that veterinarians shall
have in mind the extremely variable injuries which may be
caused to animals by sexual perverts. Failure to diagnose
these injuries has been the common lot of veterinary prac-
titioners. The errors in the diagnosis of such injuries mis-
lead the public, tend to cause a repetition of the acts upon
other animals, and result in extensive losses to owners, be-
cause under the shadow of error the culprit is not detected,
nor is any intelligent effort made at detection. Finally, the
error is deeply humiliating to the erring veterinarian.

Veterinary literature is very poor in this field. The prin-
cipal contributors to our knowledge have been Guillebeau1,
Cadiot-, and Eggimann!. The following includes the more
important portions of the contribution of Guillebeau.

The injuries may be placed under two headings — sodomy
and sadism. Sodomy, or carnal intercourse between man
and the lower animals, while highly repulsive to moral stand-
ards and in sharp conflict with statutory laws, is generally
of but scant interest to veterinarians, as Guillebeau points
out, because no physical injury follows in the large domestic
animals and the specific venereal infections of man are not
transmissible to animals.

Guillebeau relates that in a remote suburb several neigh-
bors, upon separate mornings, each found a dead hen which
had been left apparently well the evening before. The
fourth hen was presented for autopsy.

1 Ueber Verletzungen der Haustiere durch sexuell psycopathic Menschen.
Von Alfred Guillebeau in Bern. Schweizer Archiv. fiir Tierheilkuude.
XLI Band, 1899, page r.

2 Cadiot, P. J. Bulletin d. 1. Soc. Ceutr. de Med. Vet. vol. 50, page 257.

3 Eggiinan, F., Schweizer Archiv. f. Tierheilkuude. Band 35 (1893)
page 103.

232 Disea ses of tlic Genital Organs

The well-filled crop and well-developed egg in the oviduct
indicated sudden death. The liver presented several lacera-
tions covered with blood, and on its caudal side between the
intestinal loops an extensive hematom. The connective tis-
sue of the groin was infiltrated. The egg tube contained a
hard-shelled egg. The cloaca was gaping and dilated to
21 -_> cm., much larger than normal. Four days later another
dead hen was brought for autopsy by another neighbor. The
cadaver presented the same lesions, with the addition that
the left tibia was broken and, yet more important, two
mammalian spermatoza were found in the cloaca. The liver
rupture was apparently due to the violent holding of the
hen to prevent her escape. Later, in another locality, an
owner lost a number of hens, one at a time, at intervals of
one to a few days, and finally a sick bird was brought Guille-
beau for observation. Eight days later it was necessary to
kill her. The autopsy revealed bloody serum and fibrin
clots in the body cavity, the liver greatly enlarged and con-
taining large cavities filled with blood serum, the intestines
adherent. Apparently the wounds were essentially like the
foregoing, but not so severe as to cause immediate death.

The incentives to such an offense lie in a great sexual
craving with a low moral sense, while in other respects the
person may be normal or even bright.

The subject is without material veterinary interest be-
yond diagnosis, and through this means to enable the owner
to secure police protection.

Sadism, or that type of sexual perversion which leads per-
sons to mutilate the genital and neighboring organs, is of
far more frequent interest to veterinarians and, owing to
the endless variety of mutilations, offers extraordinary diffi-
cult ics in diagnosis. Many of the mutilations prove fatal,
and the pervert is so persistent in the perpetration of the
offense that delay in diagnosis may cause great economic
. as well as serious embarrassment to the veterinarian.
Errors in diagnosis have certainly injected into our litera-
me very mysterious and illogical accounts of coital
injuries. Quite naturally a sex pervert is equally or more
liable to commit the offense upon an animal in estrum. at

Sodomy and Sadism 233

which time also the female copulates if opportunity is of-
fered. The coincidence of physiologic copulation with a
male of the same species and sadism by a psychopathic man
may, and undoubtedly does, lead veterinarians to attribute
to coitus injuries which are highly improbable or impossible
from that act.

In one instance cited by Guillebeau, recorded by Eggi-
mann, five cows and two heifers in one establishment were
mutilated in the vagina and rectum, and four of them died.
Two aborted putrid fetuses. The seven animals had re-
ceived a total of over thirty punctured wounds, one animal
alone having fifteen punctures. The wounds were of various
depths, about the diameter of a goose quill, and surrounded
by necrotic tissue. The wounds penetrated the peritoneal
cavity, the uterus, the rectum, and the pelvic connective tis-
sues and mutilated the urethra, bladder, and the urethral
valve. Extensive and fatal hemorrhages ensued, as well as
metritis, vaginitis, peritonitis, etc. The culprit was not dis-
covered and no legal action taken.

Guillebeau records that in 1896, in Obersteg near Bern, in
an isolated establishment far back in the mountains, ten
cattle and ten goats were injured, mostly fatally. The depre-
dations began in January, when the father of the culprit
lost two cows, two goats, and later two cattle. In March
two cattle and six goats were mutilated, in April three cattle
and two goats, and in May one heifer. In June two cattle
belonging to neighbors were injured. The monetary loss
was $720, one-half of which fell upon the father of the of-
fender. The last animal of the group was destroyed ten
days after mutilation and an autopsy made. The vagina
contained a large volume of red, stinking exudate. Fistulae
extended from the vagina forward. Two of these were ten
cm. long. One was fifty-five cm. long, involving wounds of
the liver, spleen, diaphragm, and lung, and reaching the
region of the eighth rib, or about the middle of the chest.
The frightful injuries revealed by the autopsy made it
clear that the culprit had accomplished his designs with a

234 Diseases of the Genital Organs

stick. The extraordinary resemblance between these in-
juries and those recorded above in Langnau was apparent.
The symptoms, in the cases not immediately fatal, con-
sisted of straining, bloody discharge from the vagina, swell-
ing of the vulva, and general weakness. Six months later
the investigation was taken up by Professor E. Hess and
the culprit detected. He was a large, nineteen-year-old
man, bent somewhat forward, with a handsome face, downy
beard, and dangling arms. He had suffered from inflamma-
tion of the brain at four years. His cranium was small,
and he was regarded as idiotic. In school he could not
learn and when grown was incapable of work except as an
assistant in caring for cattle. Taken into custody, he con-
fessed his guilt several times and later withdrew his con-
fession. He went about his misdeeds so craftily that he had
never been caught.
The Cases in Wolfikon, Schivartzenbach, and Rickenbach.
In March, 1894, in a stable containing fifteen cattle,
eight — all in one row of stanchions — became ill. Amongst
them were three calves, one only a few days old. There was
a bloody vaginal discharge, depression, and peritonitis.
Some showed crepitant swelling of the loins and croup.
Within a week four animals had died and four had been
killed. All were buried with their hides on. Fifteen hun-
dred kilos of hay was burned for fear of bad contamination.
The guilty caretaker and his clothes were carefully disin-
fected. The cattle which had escaped mutilation were dis-
infected and removed to other quarters. In two weeks, two
of the remaining seven animals became affected, one of
which died and the other was slaughtered. The remaining
five head were slaughtered in order to escape, partially, the
impending loss. After about two months, the tenant pur-
chased two cows, but in a short time he buried one and re-
turned the other to the seller. The same caretaker of the
cattle was still in charge. He purchased goats, which re-
mained well. It was soon hoped that the ban which had
hung over the place had disappeared. The tenant bought

Sodorny and Sadism 235

three goats, which promptly died under the same conditions
as the cattle. He became discouraged, sold his hay to be
fed to horses only, and sold his farm.

The servant found employment with another party in
Schwartzenbach. Here, as in the preceding place, a heifer,
a goat, four oxen, and a cow soon became ill. Three oxen
were buried. The flesh of the other cattle was used for food.
The investigator was struck with the similarity of the mu-
tilations of the sexual organs with those observed in Wolf-
ikon. A Capuchin monk, evidently a good judge of men,
when consulted, advised the discharge of the servant. The
losses became noised about the neighborhood and were at-
tributed to the young man who had cared for the cattle. On
November 12, 1895, he obtained a new position in Ricken-
bach, not far away from his previous place. Fourteen days
later, a cow cared for by this man sickened like the preceding
and had to be destroyed. Autopsy revealed a finger-sized
fistulous wound in the rectum, two blood-covered lacerations
in the vagina, and hemorrhage into the peritoneal cavity.
On the next day a cow died suddenly from symptoms of
vaginal and rectal hemorrhage. A third animal had to be
destroyed on November 29. In the vagina only one perfor-
ating wound was found, but in the rectum thirty-five, six of
which were perforating. A fourth animal injured would
probably recover. The servant was discharged and a few
days later arrested. At first he denied his guilt, but later
confessed that he had caused the injuries by forcing a stick
into the rectum and vagina and pushing it back and forth
until the animal bled. The culprit was twenty-four years
old and a capable worker in stable and field. He was good-
natured but represented as wanting in judgment. In Wolf-
ikon, the scene of his first crimes, he was three years in one
position, but apparently he had come to sexual maturity
very late and part of the period of service preceded this.
His teacher, the local pastor, and the alienist who observed
him after arrest regarded him as of very low intelligence.
The size of the cranium was below normal. In the hearing,

236 Diseases of the Genital Organs

the young man showed some of the talents of a trader. He
had at his command about 5000 francs and criticized the
reckoning of damages. In recent years, while feeding, milk-
ing, and grooming the cows, he had had frequent erections,
fits of excitement, and delusions. At first he merely forced
his hand into the posterior body openings of his charges ;
later he used a stick, always, according to his statement,
under the pressure of a dark, powerful, inner craving at
times when he also suffered from sleeplessness, sweating,
dysuria, and erections. He seemed conscious of the wrong,
but powerless to resist his cravings. He was adjudged ir-
responsible, but made to pay as far as possible for the losses
caused. This simpleton had led the veterinary diagnosti-
cians a merry chase. According to the official report of the
first cases in Wolfikon, the animals had died of an undeter-
mined epizootic, probably anthrax. The second outbreak,
in Schwartzenbach, was diagnosed as "intestinal diph-
theria", especially a localization of malignant, catarrhal
fever of rectum and vagina. In both places elaborate pre-
cautions against the spread of the malady were taken by
thorough disinfection.

Second Outbreak in Rickenbach

In the same stable in Rickenbach, in which in November,
1895, the acts described above were committed, an ox had to
be destroyed in April, 1897, because of rectal hemorrhage.
The illness lasted four days. After twelve hours there were
symptoms of colpitis. After four days there escaped from
the rectum four liters of blood. The animal was weak.
Peritonitis was apparent. Autopsy revealed bloody infiltra-
tion of the pelvic organs, kidneys, and adrenals. The veteri-
narian found numerous injuries in the rectal mucosa, five
of which were penetrant. The culprit was an eighteen-year-
old caretaker of the animal. Apparently he was not as
stupid as his renowned predecessor, but, according to his
story, the master had related the misdeeds of the other, and
seeing in the stable day after day the short stick previously

Sodomy and Sadism 237

used, finally awakened in him a desire for the same experi-
ence.

The Occurrence in Le Menil-aux-Cerfs

When the trauma is induced by less violent means than
those already described, the difficulties of diagnosis increase.
In a stable of about ten cows, there occurred, within three
weeks after a change in caretakers, vaginitis in all the ani-
mals. Ten new cows added later soon developed the vagini-
tis. The heifers, when they reached sexual maturity, also
suffered. With the advent of estrum the vaginitis became
worse, and at the same time the disease increased in in-
tensity in the cows near the one in estrum, even though cas-
trated. The symptoms began with swelling of the perineum,
then a discharge of clear, tough mucus, which later became
thick and purulent. Once colic followed estrum for several
days. The general health, nutrition, and lactation suffered
little. Pregnant animals generally did not abort. The local
handling had little effect : some cows conceived again ; sev-
eral remained sterile and had to be discarded. The owner
was compelled to sell the sterile animals for less than the
cost of new ones. He was tormented with the fear that they
had been inoculated with syphilis. Investigations were
finally made by Schwartz of Bern. Four cows were visibly
diseased ; all showed colpitis, and two of them severe annular
vaginal stricture. Five other cattle offered nothing re-
markable. The cows had been bred to two public bulls
which had also been used for numerous other cows. Neither
the cows nor the bulls suffered from any visible genital dis-
ease. The conclusion was finally reached that the injuries
were due to rough handling by some evil-disposed person
but it appeared very difficult to so much as suspect the cul-
prit. Several weeks had elapsed when by accident it was
discovered that the caretaker of the cows was the culprit.
Aside from this the man was a model : he was a quiet, punc-
tual, thorough worker, and, until the accidental revelation,
beyond suspicion. The identification of the culprit revealed

238 Diseases 0/ the Genital Orga?is

also his method. It consisted of pushing a fork handle into
the vagina and rapidly turning it in a wide circle. This
special form of sadism served to explain the strictures of
the vaginae. No punishment of the offender was under-
taken, because it was feared it would lead to endless trouble,
and the model servant was permitted to go his way unmo-
lested.

I have found no account of this type of injuries in this
country. They probably occur and escape diagnosis. In
connection with public institutions for mental defectives we
have many valuable dairy herds in which the cattle are
largely placed in charge of "trusties". Since such mental
defectives might resort to such practices, veterinarians hav-
ing charge of such herds would do well to keep this possi-
bility in mind and not be led too far afield in diagnosis.

PART II

TUMORS OF THE GENITAL ORGANS

The fundamental nature of tumors is essentially undeter-
mined. Clinically, many of the benign tumors of animals
bear strong evidences of transmissibility. They appear un-
expectedly in a stable or herd, or in a group of animals
within a herd, and involve simultaneously a large percentage
of the group. At present the general concensus of scientific
opinion appears to be that malign tumors are due to infec-
tion. Certain new-growths formerly regarded as true tu-
mors, like actinomycosis and botryomycosis, are now defi-
nitely classed as infections. In the dog, there occurs a
clearly defined venereal tumor definitely ascribed to infec-
tion, which is included among venereal infections instead of
among tumors.

Chapter X

A. MALIGNANT TUMORS

1. Malignant Tumors of the Male Genitalia

Herbivora, and especially ruminants, are apparently
highly resistant to malignant neoplasms. This may be ap-
parent only because most domestic ruminants are slaugh-
tered early in life for food. More than fifty per cent, of all
dairy calves born are slaughtered for veal. More than
ninety per cent, of male cattle of beef breeds are castrated
and are slaughtered at three to four years of age. The aver-
age age of dairy cows is below six years, though occasionally
they live to fifteen, eighteen or more.

Malignant neoplasms affect chiefly adult or old animals.
Naturally it follows that they would be rare in species where
the technically normal duration of life is greatly abbreviated
by artificial means.

Malignant neoplasms in domestic animals are most fre-
quent in dogs and horses, both of which are largely kept

2.4 o Diseases of the Genital Organs

until old age. In the dog, the animal which suffers most
frequently from malignant tumors, the normal span of life
is but ten to twelve years, the briefest among domestic ani-
mals.

Malignant new-growths may invade any portion of the
genital system, of either sex and in all species, and may
vary greatly in histologic type.

Malignant tumors of the genital organs of bulls (as well
as of rams and he-goats) are exceedingly rare. I have not
observed a well defined clinical case and have no clearly
identified specimen in my collection. Possibly I am in error.
Young bulls very frequently have angry-looking, highly
vascular tumors on the glans penis which, examined histo-
logically, are found to be epithelial. They are commonly
described as carcinomata, but histologists are not wholly
agreed upon this point. So far as I have observed clinically,
they are usually not malign, however suggestive their ap-
pearance may be. When carefully excised, they show little
tendency to recur ; when neglected, they cause no daughter
tumors in the peri-penial lymph glands.

The diagnosis and handling of malign tumors of the geni-
tal organs of bulls (and of rams and he-goats) must be
based upon general principles. When involving the glans
penis in a valuable bull, liberal amputation may be applied,
which, if timely, may eliminate the tumor and preserve the
procreative powers of the animal. The amputation should be
made under the technic described later for the amputation
of the penis of the stallion.

At one time I doubted the ability of a bull to copulate
readily after the amputation of the glans penis. I attended
one famous sire which had suffered from a tumor on the
glans. Sections of the tumor had been examined by a
pathologist and pronounced carcinomatous. The glans had
been amputated. The stump refused to heal, and was in-
tensely inflamed and angry. After long and patient hand-
ling, the stump healed and the bull returned successfully to
breeding.

Malignant Tumors 241

When amputating the penis of a bull (or ram or boar) it
must be recalled that these animals are always affected with
the granular venereal disease, which retards healing and
aggravates the wound. Prior to amputation it is therefore
advisable to disinfect the glans, prepuce, and sheath by-
douching the parts daily for five to eight days with a 0.25
to 0.5 per cent. Lugol's solution, or other safe antiseptic.
After the penis has been amputated, it is desirable to con-
tinue the douching until the healing is complete.

The bull should be kept apart from cows in estrum, and
otherwise handled in a manner to obviate sexual excitement,
because erection inevitably aggravates any penial disease.
It is bad policy generally to cause the bull to become sexu-
ally excited in order to have him protrude the penis for
visual examination in case of disease. It is better, and far
more satisfactory from every standpoint, to cast the bull
and expose the penis by eliminating the S-curve, as de-
scribed in Chapter II.

If the ordinary douching of the sheath and prepuce fails
to hold in check the infection and inflammation in the stump,
the animal should be cast, the penial stump exposed, and
the inflamed' areas pencilled over with silver nitrate or
dressed with a strong solution of the same. It should be
remembered that the conditions are inimical to prompt
healing and that it is far better to hasten the healing pro-
cess to the maximum by giving concentrated attention at
the beginning, thus obviating the necessity for prolonged
handling which will in the end greatly exceed the total care
required if minute details are faithfully followed at first.

Hendryckx1 states that in the course of malignant disease
of the testicle the organ may undergo necrosis and open
upon the exterior of the scrotum and the new-growth as-
sume the clinical characters of external cancer. > .

When malignant neoplasm of the testicle is diagnosed or
seriously feared, the gland should promptly be removed. A

1 Bayer and Frolmer. Handbuch der tierarztliche Chirurgie und Geburts-
hilfe, Vol. Ill, Part 2, Page 439, 1899.
16

242 Diseases of the Genital Organs

positive diagnosis of malignancy, with all the risks of ex-
tension and of daughter tumors, should not be awaited.
Any chronic tumefaction of the testicle sufficient to arouse
fear of malignancy should be treated decisively and
promptly as malignant. In any case, the function of the
testicle is almost certainly destroyed and the ablation of the
hopelessly diseased gland is the prudent course to pursue.
The removal of one testicle neither destroys nor curtails
the reproductive power of the animal.

The removal of a testicle which is presumably affected
with a malignant new-growth should preferably be effected
by the covered operation. The skin and dartos are freely
incised down to the cremaster muscle or its fascia. The
cremaster, its fascia, and the peritoneal layer of the scro-
tum are kept intact and a separation made between the cre-
master and dartos up to the external inguinal ring. The
spermatic cord, covered by the cremaster muscle and the
scrotal peritoneum, is then securely ligated at a point as high
as is convenient or required. It is best to arm a heavy needle
with a strong thread and pass it through the cremaster
muscle, scrotal peritoneum, and spermatic cord. The needle
is removed and the ligature tied about the spermatic cord
and cremaster very tightly, in order to make inevitable the
immediate necrosis of all included tissues. The included
mass is then excised on the distal side of the ligature at a
distance sufficient to guard securely against its slipping,
generally about one inch. The cavity in the scrotum should
then be tamponned with antiseptic gauze and the cutaneous
wound closed by sutures. The gauze should be allowed to
protrude at the lowest part of the wound, in order to permit
drainage.

Malignant tumors of other portions of the genital tract
of the bull are not as amenable to handling as are those of
the glans penis and the testicle. They need to be handled
according to general principles.

Malignant tumors of the genital organs of horses are not
at all rare. According to my observation, they are com-

Malignant Tumors 243

moner in geldings than in stallions. This relates especially
to the penis. Clinically, also, I have seen more malignant
neoplasms in the stumps of the spermatic cords of geldings
than in the testicles of stallions. It is possible that the es-
sentially dormant genitalia of emasculated animals are more
vulnerable to malignant new-growths.

The testicle and epididymis of the stallion is only very
rarely the seat of malignant tumors. In one stallion I diag-
nosed clinically malignant disease of the testicle, but had
no opportunity to verify my diagnosis by direct examina-
tion of the gland. In the college collection there are no
specimens of malignant disease of the testicles of the horse.
When cryptorchidy occurs in man, it commonly raises the
question of malignant disease of the testicle. Although
cryptorchidy is very common in horses, the condition is
rarely, if ever, attributable to malignant disease. The clini-
cal diagnosis of malignant disease of the testicles is to be
made upon the same general basis as the diagnosis of malig-
nant tumors of other organs.

When malignant disease of the testicle in the horse is se-
riously feared, the gland should be promptly removed for
the same reasons and in the same manner as already de-
scribed for the bull.

Malignant disease of the testicles and epididymis in other
domestic animals is rarely reported. Clinically I removed
successfully a cryptorchid, cancerous testicle from a pig.
It was adherent over its entire surface to the adjacent in-
testines and mesentery, so that it had to be dissected away
carefully.

Malignant disease of the penis, sheath, and prepuce in the
stallion is generally supposed to be common. At least,
writers upon veterinary surgery, as Cadiot1, Bayer and
Frohner-, and others, would lead the reader to believe so.
I have not observed a case in either penis, prepuce, or
sheath in a stallion, and my collection contains no specimen.

1 Traite de Therap. Chir. d. Animaux Douiestiques, 1898, p. 674.

2 Handbuch d. Tier. Chir. u. Geburtsh., 1899, vol. iii, Part II, p. 345.

244 Diseases of the Genital Organs

On the other hand, the occurrence in geldings has been rela-
tively common. This may be apparent only. Since in
America essentially all colts not desired for breeding pur-
poses are castrated, the ratio of stallions to geldings is less
than five per cent. Consequently one would logically expect
to see at least twenty to twenty-five malignant new-growths
in geldings to one in stallions. The malignant tumors of
these parts may be sarcomatous but are most frequently
carcinomatous. Their character is generally diagnosable
by clinical examination. Usually there is abundant necro-
sis of the diseased parts and rapid growth and in all re-
spects they show typical malignancy. As in malignant dis-
ease generally, there is rarely any early trace of cancer
cachexy. The general health of the animal remains as a
rule unimpaired for several months, unless the disease in-
terferes with some vital function either by mechanical im-
pediment or by invading a vital organ (liver, lungs). Ma-
lignant disease of the penis, sheath, and prepuce ordinarily
proves fatal indirectly, through daughter tumors in a vital
organ. Thus, in one case in my clinic, carcinoma of the
sheath caused death through the breaking down of a daugh-
ter tumor in the lungs.

The clinician should not err in diagnosing benign tumors
of the penis as malign. The ordinary benign epithelioma
of the equine penis is highly vascular and undergoes pres-
sure and attrition necrosis. The necrotic tissues and the
sebum produce much highly fetid pus containing tissue de-
bris, and often blood. That should not be accepted as evi-
dence of malignancy. The necrosis of malignant neoplasms
is fundamental and inherent, and not attributable to pres-
sure or attrition. When essential, the diagnosis may be
safeguarded by the removal of a portion of the tissue for
pathologic study.

The veterinarian should also be on the alert in diagnosis
not to mistake bursattee of the penis and prepuce for ma-
lignant neoplasms. The necrosis of bursattee is funda-
mental, like cancer, but its other characters serve to differ-

Amputation of the Penis 245

entiate it. This will be discussed while dealing with the in-
fections of the genitalia of horses.

The handling of malignant disease of prepuce, sheath,
and penis of the breeding stallion calls for prompt and
skillful measures. The early ablation of the neoplasm is
the only course known which offers hope . Even then the
hope is based upon the complete extirpation of the growth,
in such a manner as not to interfere with the power to copu-
late. When involving the sheath only, complete removal
may be possible, but there is danger of such deformation
of the parts as will cause faulty direction of the erected
penis. If the prepuce is involved, a greater danger faces
the surgeon because adhesions between the direct and re-
curved portions may bar the protrusion of the penis.

When the penis itself is involved, the amputation of a
part or all of the glans does not disable the animal, but if
the amputation needs to be on the proximal side of the pre-
putial ring, the breeding capacity of the animal is probably
ruined. I find no conclusive data on this point, but it has
been proven clinically that the glans can be amputated with-
out serious interference. In the present state of our knowl-
edge, when the malignant growth has extended beyond the
glans into the penial body, no hope should be given of re-
storing the breeding powers. In a gelding I have seen the
cancerous growth involving the entire penis from the glans
to the attachments of the crura to the ischial tuberosities.

2. Amputation of the Penis

Almost, if not all cases of malignant tumors of the glans
penis should be handled by the amputation of a portion or
all of the glans. The amputation should be carried out by
the following technic, which affords ample security against
urethral stricture and provides a tapering stump which can
most readily enter the vulva in copulation. The amputation
of the penis of the stallion affords a technic equally applica-
ble to that of other species.

246

Diseases of the Genital Organs

Instruments. Scalpel, elastic ligature, strong silk suture,
strong piece of tape 1 m. long, artery and compression for-
ceps.

Technic. The operation is carried out on the recumbent

FlG. 62 Amputation of Penis.
First stage of operation. T, Elastic ligature used as tourniquet ; CS, cor-
pus spongiosum of urethra ; S, skin ; CC, corpus cavernosum ;
( , urethra; /. . ligature ; C, catheter.

animal, under local or general anaesthesia. The upper hind
foot is drawn backward or upward or otherwise so fixed as
not to obstruct the field of operation. The point of opera-
tion is determined by the character of the disease and the

Amputation of the Penis

247

object to be attained. It may be made at any point from
the glans penis to the attachment of the corpus cavernosum
to the ischium, but if possible in front of the preputial ring.
After the penis has been drawn out, and the preputial re-
gion carefully cleansed and disinfected, an assistant grasps
the organ just behind the preputial ring and holds it firmly.
A catheter is then introduced into the urethra and pushed
upward beyond the point where it is designed to amputate

FIG. 63 — Amputation of the penis showing needle inserted

for a suture.

V, Dorsal vessels of penis ; A, fibrous tunic of the corpus cavernosum ;

S, skin ; CC, corpus cavernosum ; CS, corpus spongiosum

of urethra ; U, urethra.

the organ. A temporary elastic ligature, T, is then applied
above the assistant's hand around the penis, or a piece of
tape is looped around it above the hand and is made to serve
both as a tourniquet and as a means for holding the penis,
or the penis may be grasped in front of the ligature with
double tenaculum forceps and held.

!48

Diseases of the Genital Organs

A small cord is applied just behind the glans penis, L, Fig.
62, and a triangular incision is made on the ventral surface
of the organ about 4 cm. long by 3 cm. wide, the base of the
triangle being forward as shown in the figure ; this incision
is carried through the skin, S, the corpus spongiosum, CS,
and along the corpus cavernosum, CC, down to the urethra,

nT

Pig. 64 —Amputation of the Penis.
Completed operation showing sutures. U, Urethra. T, Elastic Ligature.

U. In the triangular area the tissues are dissected away
without opening or wounding the urethra and then a longi-
tudinal incision is made from near the apex of the triangle
to its base through the urethral walls to the catheter. Be-
ginning at the apex of the triangular wound, a series of in-
terrupted sutures is inserted, as shown in Fig. 64, in such a
manner that they pass through the urethral wall and the
skin, so that when tied the wounded surfaces are completely

Amputation of the Penis 249

hidden and the urethral mucous membrane is brought into
apposition with the integument. These sutures are contin-
ued down to the base of the triangle, the catheter is removed
and the organ is excised by a cut extending in a slightly
oblique direction from below upward and forward. A
straight needle armed with a silk suture is passed through
the margin of the urethral wound, the adjacent fibrous cap-
sule of the corpus cavernosum, and across but not through
the erectile tissue, inserted again into the superior portion
of the fibrous capsule and carried out through the adjacent
dorsal vessels and the skin, as shown in Fig. 63, and, bring-
ing the ends of the sutures together, tied in such a way that
the urethral mucous membrane and the margin of the skin
are brought into immediate contact and the blood vessels se-
curely closed in such a manner as to guard against hemor-
rhage. By this plan when the sutures are tied, the cut bor-
ders of the fibrous envelope are brought together over the
erectile tissue, thus preventing hemorrhage from that tissue
also. As many sutures are inserted as may be required to
close the wound securely and finally leave every part wholly
covered with epithelium. By this plan stricture of the ure-
thra in the process of healing is avoided. The tourniquet is
removed and the patient released.

The principles here laid down are applicable and advisa-
ble in the amputation of the penis in all domestic animals.
In the dog, the point of amputation should be above the
penial bone.

Once the amputation has been successfully completed, the
healing of the stump should be favored by keeping the parts
scrupulously clean with frequent douchings. The patient
is much better if given abundant exercise, avoiding con-
stantly, as far as may be practicable, any sexual excitation
because erection strains the sutures, engorges the wound
area, and seriously impedes the healing process. The diet
should be scant and laxative.

250

Diseases of the Geyiital Organs

3. Malignant New-Growths of the Female Genitalia

Malignant tumors of the female genital organs, generally
very rare, are most often seen in the vulva and ovary. I
have observed but one case of malignant tumor of the
uterus — that one case in the bitch (see Fig. 65). The
malignant growth involved the entire genital tube, but
was apparently most advanced in the uterus. The symp-
toms consisted of a profuse, fetid, purulent discharge from
the vulva, with swelling and obstruction of the lumen of the
genital passage. When discovered, it was inoperable.

FlG. 65 Sarcoma of Genital Tract. Bitch.

/, Rectum ; z, left oviduct ; ,\ ovary ; /. uterus ; 5, vagina ;

c>, urinary bladder.

I have seen two clinical cases of ovarian carcinoma
of the cow. The first (see Fig. 67) was in a pedigreed
Holstein heifer which had proven sterile. Upon rectal pal-
pation the right ovary was found to be enormously enlarged.

Malignant Ne~n'- Growths or the Female Genitalia 251

Fig. 67— Angio-Sarcom of Ovary, Heifer.
/, Left cornu ; 2, enlarged right ovarian artery ; 3, minor. Below, section

of tumor.

2.52

Diseases of the Genital Orga7is

about four inches in diameter. The right uterine artery,
enlarged to many times its size, as indicated in Fig. 67,
pulsated with great force. The left ovary was minute and
non-functional. Slaughter was advised, since the examina-
tion indicated clearly that surgical interference would be
highly perilous because of the enormously enlarged ovarian
artery. The removal of the ovary, also, would leave the left
gland, which would probably not function. The clinical
diagnosis was angioma. Upon slaughter it was found that
the ovary had ruptured at one point, causing profuse hemor-

I ■'!<•,. 69 -Cyst-Adenoma of Ovary. Sow. Weight of tumor 38 lbs.
/, Necrotic area ; 2, 2, cystic areas.

rhage. The entire peritoneal surface was thickly studded
over with tufts of yellowish new-growth. Histologically,
the tumor proved to be a carcinoma, or rather angiocar-
cinoma.

Benign Tumors of the Genital Orga?is 253

My second clinical case was in an aged Guernsey cow.
The ovary was about five or six inches in diameter, spheri-
cal, tense, and smooth. It was diagnosed as a thick-walled
cyst of the non-nymphomaniac type. It was considered both
impossible and imprudent to rupture the cyst. Ovariotomy
was performed through a flank incision. Histologic exami-
nation showed the tumor to be a carcinoma.

I have not observed clinically in other animals than the
cow an instance of malignant disease in the ovaries, and
have but one specimen of malign tumor of the ovary other
than those mentioned above. This is a multilocular ovarian
tumor from a sow, shown in Fig. 69. The sow weighed
about three hundred pounds, and the ovary thirty-eight.
Clinically it would have been difficult or impossible to diag-
nose. Inevitably the abdomen of the sow was greatly en-
larged, but that might have been from hydronephrosis or
many other conditions. In this fat sow, the discovery was
made after slaughter.

Carcinoma of the vulva is not at all rare in the cow. It
presents highly distinctive clinical characters which render
a reliable diagnosis comparatively easy. When reported to
the veterinarian, it is not ordinarily subject to surgical in-
terference.

As a rule, when the genital organs of a meat animal are
invaded by malignant new-growths, if they are still local-
ized, the general condition good, and the subject not of great
breeding value, the animal should be sent to slaughter.

B. Benign Tumors of the Genital Organs

1. Benign Tumors of the Male Genitalia

Benign tumors are very common upon the penis, sheath,
and prepuce of horses and cattle. These two species are
very prone to growths of benign epithelial tumors, or
"warts", about the face and lips and upon the external geni-
tal organs. They are observed almost entirely in young
animals. Generally they are papillomatous in type and tend
to become polypoid or pedunculated. This is especially true

254 Diseases of the Genital Organs

when they are located upon the glans penis or within the
sheath, where constant compression acts to modify their
form. The attrition caused by protruding and retracting
the penis tends to abrade the epithelium covering the tumor.
The mucus, sebum, and sometimes urine, tend to macerate
and irritate the new-growth. As a consequence of these
conditions, ulceration, superficial necrosis, and suppuration,
with highly repulsive odor, are frequent and not rarely lead
to error in diagnosis.

It is only rarely that this type of tumor attains such size
as to cause phimosis or paraphimosis. Possibly one reason
for this is that, with the small peduncle, when the tumor be-
comes sufficiently large to retard the movements of the
penis, the stalk divides and the tumor drops away. I have
had them drop off in my hand when attempting to make a
physical examination. They are readily observed during
copulation. The copulatory attrition and great vascularity
of erection commonly cause hemorrhage. Such tumors call
for early excision. Benign penial tumors, if not promptly
removed, may extend and eventually call for amputation of
the penis, though, had opportune attention been given, mere
excision of the tumor would have sufficed.

The animal should be cast for the operation, with all four
limbs extended, or may be secured upon the operating table.
The penis, whether of stallion, bull, or other male, should be
exposed and secured as advised in Chapter II, and either
general or local anaesthesia applied, as conditions may dic-
tate. When the peduncle is small and superficially attached,
it should be excised, removing a liberal amount of normal
tissue with it in order to have assurance that all the neo-
plasm is included. Care should be taken not to remove an
unnecessarily large amount of tissue, because the contrac-
tion of the cicatrix is liable to bend the penis at an angle
and make copulation difficult or impossible. The invasion
of the penial tissue had best not be circular nor transverse,
but preferably the base of the peduncle should be removed
by making two incisions beginning above or on the proximal

Benign Tumors of the Genital Organs

255

side of the base of the peduncle, diverging sufficiently to
pass on either side of it, and then converging to meet at an
equal distance on the distal side of the base, making a
wedge-shaped incision extending into the penial tissues, so
that the wound may be closed with chromatized catgut. In
this manner deformation of the penis will be avoided as far
as practicable. A careless transverse incision is more liable
to invade an important nerve or arterial trunk and inter-

Fig. 70— Dermoid Cyst. Cryptorchid Stallion.

/, Glandular tissue ; 2, osseous tissue ; j, cavity in the bony structure ;

4, epididymis ; 5, spermatic cord.

fere with the erection of the tissues supplied by the vessel.
If, in spite of such precautions, deformation occurs which
prevents copulation, or if the base of the tumor is too ex-
tensive to permit excision without serious deformation, re-
course must be had to amputation, as already described.

Many other types of benign tumors involve the male geni-
tal organs, but they occur very rarely and offer nothing of
special importance in handling with reference to breeding.

256

Diseases oj the Genital Organs

Fig. 70a — Dermoid Cyst of Ovary. Mare.

/, Cystic ovary, the cyst being filled with long, matted hairs

C, cartilage ; 2, normal ovary from same animal.

FlO. 7"l> - Cystic Ovary of Mare. Divided.
The cyst was about 8 inches in diameter with very thick, resistant walls.
/, Exterior of cyst, showing at P, the pavilion of the oviduct flattened
inst the cyst ; 2, the interior of the cyst, showing the thick walls.

Benign Tumors of the Female Genitalia 257

Dermoid cysts of the testicle occur now and then, contain-
ing bones, teeth, hair, or all three (see Fig. 70). Such tes-
ticles occur almost wholly in the horse, are generally crypt-
orchid, and are beyond remedy as to breeding, but should
be removed in order to eliminate the sex desire, frequently
perverted, which they cause. If the other testicle is sound,
the animal is fertile. No data exist to indicate that such an
aberration in development does or does not tend to recur in
the progeny of such a male, but, since arrests in develop-
ment generally tend to be transmitted to the offspring, it is
well to be on guard and view with distrust the use, as a sire,,
of an animal so affected. Cysts of the testicle, epididymis,
and spermatic cord are recorded.

2. Benign Tumors of the Female Genitalia

Benign tumors of the ovaries proper are exceedingly
rare. I have no well-marked example in my collection, al-
though they are recorded in great variety. Since, when
they involve one ovary only, fertility is unimpaired, they
are not sought in connection with sterility. They are but
rarely of such volume as to change the appearance of the
animal. Most frequently they attract clinical attention by
causing incarceration colic, the tumor having fallen over an
intestine so that its long peduncle becomes wrapped about it
in a manner to prevent the free passage of feces along the
canal. Generally the bodies leading to such incarceration
colic are not true tumors. Most frequently they are ovarian
(Fig 71) or par-ovarian (Figs. 72-74) cysts of large size.
There are at least four distinct types of ovarian cysts in
cows, and probably an equal number in other species :

1. There are generally present a large number of small
cysts, from 1/20 to 1/10 of an inch, apparently atretic folli-
cles. They have no known relation to breeding efficiency or
to the general well-being of the animal.

2. The moderate-sized cysts of nymphomania, apparently
resulting from the death of the ovum, as a result of ovarian
infection associated with an increased volume of follicular
fluid.

Diseases of the Genital Organs

PIG -.-Large ovarian cyst of pregnant COW (above] with P air of
normal ovaries (below), showing corpus luteum of pregnancy.

Benign Tumors of the Female Genitalia

259

3. Cystic degeneration of the corpus luteum.

4. Large, single, thick-walled cysts which may reach an
indefinite volume and are of unknown origin.

The fourth type described commonly bars functional ac-
tivity in the involved organ, but does not interfere with the
reproductive powers of the other gland. The chief interest
in such cysts is their volume and their power, in common
with par-ovarian cysts, to cause incarceration of the intes-

Fig. 72— Parovarian Tumor of Mare, Incarcerating Rectum.

View from right side with the tumor, T, almost hidden by the

constriction caused by the pedicle.

Lettering same as Fig. 74

tines. The diagnosis of large ovarian or par-ovarian cysts
must, as a rule, be tentative only. One large and somewhat
cystic, malignant, ovarian neoplasm in a cow was diagnosed
by a colleague as an "abscess in the uterine ligament". I
diagnosed it as a large ovarian cyst. This also was erro-
neous. It was indeed somewhat cystic, but the error would
have been very important had an attempt been made to rup-
ture or puncture the malignant growth within the peritoneal

26o

Diseases qf the Genital Organs

cavity. Therefore it is best to use caution in diagnosis,
when the ovary is extremely large. However confident one
may feel that he is dealing with a benign cyst, he should re-
member that it may be malignant and in operating proceed
upon a safe course by performing laparotomy and, if pos-
sible, removing the gland intact.

Fig 73 — View of Fig. 72 from left side, the tumor exposed l>y
cutting away part of mesentery.
Lettering same as Pig. 74

In mares and cows the diagnosis of uncomplicated cases
is to be made by rectal palpation, with the uterus and ova-
ries drawn back as far as prudent by fixing uterine forceps
upon the cervix and exerting traction. If the cyst is very
large, the ovarian ligament and the oviduct may be much
elongated, so that the ovary may lie far ahead of its normal

Benign Tumors of the Female Genitalia

261

location, anterior to the apex of the uterine cornu When
large ovarian tumors cause incarceration colic, the diagno-
sis is not always easy. If the incarceration involves the pel-
vic portion of the rectum, the veterinarian faces a rather
delicate problem in diagnosis. He can not palpate the uterus
and ovaries per vaginam, and he may find palpation per
rectum barred by incarceration. The principal question
lies between a stricture of the rectum and a mechanical con-
striction investing the gut from within the pelvic cavity.
The investment of the rectum by means of the peduncle of

Fig. 74 — Schematic illustration of method of incarceration.

/, Intestine ; M, mesentery ; O, ovary ; T, parovarian tumor or cyst ;

P, pedicle of tumor ; R, rectum ; R/, rectum posterior

to point of strangulation.

an ovarian or other tumor produces no changes in the walls
of the rectum such as those encountered in actual stricture.
There is no inflammation, no sclerosis, and no edema of the
rectal walls, if they have not been neglected nor tampered
with. The hand may pass freely along the rectum until it
comes suddenly upon the constricted portion, when further
progress is more or less completely barred. In the incarcera-
tion colic caused by the parovarian cyst illustrated in Figs.
72, 73 and 74, the clinical features were identical with those
due to ovarian incarceration of the intestine. I found that
anteriorly a finger could be passed through the constriction
into the free portion. The constriction was necessarily lim-
ited in area to the diameter of the peduncle of the cyst. The

262 Diseases of the Genital Organs

distinguishing element in the case should have been (my
colleagues and I each failed in diagnosis) that the constric-
tion was not in the rectal wall but was due to an investing
cord outside the intestine. The history aids in diagnosis.
True stricture usually develops gradually, and commonly
has a history of prior injury. Perirectal abscesses or tu-
mors develop slowly, and the symptoms of colic come on
gradually. Ovarian and parovarian pedunculated tumors
cause no clinical manifestations until some accidental dis-
placement of the tumor causes a sudden incarceration of the
intestine by the tumor peduncle and violent colic quickly
ensues.

In the diagnosis of this type of intestinal incarceration,
it is not essential that the histologic character be deter-
mined. It is of little surgical consequence, for the moment,
whether the tumor be ovarian or par-ovarian, cystic or
solid. It calls for prompt relief by surgical means.

These tumors attain a diameter of four to twelve or more
inches. Owing to their weight they drop forward and
downward in the abdomen and their attachments become
greatly elongated. They consist of a single cyst, generally
showing traces of ovarian tissue, flattened out on one side
of the spherical cyst. I have seen one in a mare presented
in my clinic because of recurrent severe colics. Rectal ex-
amination revealed an ovarian tumor, regular in outline,
about ten inches in diameter. Its cystic character was as-
sumed, but could not be definitely ascertained. The ovary
(left) was successfully removed through an incision in the
left flank by my colleague, Frost, and myself. The cyst was
punctured with a trocar after it had been brought into the
laparotomy wound. This permitted it to be removed
through a moderate-sized opening. Similar ovarian cysts
occur in the cow, but so far as known do not so frequently
incarcerate the intestines. They have the general clinical
importance of benign ovarian tumors and demand surgical
removal merely because of their physical menace to the
health and life of the patient. Since they tend to cause in-
creased size of the ovarian artery care is necessary in their

Vagina/ Ovariotomy in the Mare 263

removal to avoid danger from hemorrhage. The arteries
had best be ligated with chromatized catgut. Sometimes
vaginal ovariotomy is practicable. Usually it is best to re-
sort to laparotomy in the upper or middle flank region.
When considered prudent to operate through the vagina,
the technic should be essentially that for ordinary ovario-
tomy.

Vaginal Ovariotomy in the Mare

Instruments. Colin's scalpel, ratchet ecraseur 55 cm.
long, vaginal tensor.

Preparation of patient. It is best to keep the animal on a
scant laxative diet for at least 24 hours, and preferably
longer, prior to the operation, so that the alimentary canal
shall be somewhat empty, thus decreasing the intra-ab-
dominal tension and relieving the operator from much an-
noyance due to the pressure of the viscera. When incar-
ceration colic is present, there is of course no opportunity
to await the general preparation of the patient. Before
commencing the operation, it is best to have an assistant
empty the rectum manually. Enemas should not be em-
ployed, because there is danger from the expulsion of liquid
feces during the operation. It is best, also, to empty the
bladder before operating; otherwise the animal is quite sure
to urinate during the operation.

Technic. The introduction of the hand into the vagina of
the non-anaesthetized mare causes the admission of air
along the hand and arm. The vulvar lips fail to envelop
the hand and arm closely and the irritation or shock causes
the animal to draw air alongside the arm into the vagina,
fully ballooning it. The movements of the diaphragm and
chest walls tend to cause a vacuum of both chest and ab-
domen during inspiration, and, if the vulva is partly propped
open and the abdominal walls are fixed, air rushes in. The
vagina may also be distended by filling it with warm water.
Under these conditions the vaginal walls become hard, and
stand apart from each other, closely applied against the
pelvic walls at every part except at the points where the

264 Diseases of the Genital Organs

bladder and rectum intervene. These organs, pressed out
flat, occupy a minimum amount of space. In the quiescent
state the vaginal walls are in contact. From the perineum
forward to within about 10 cm. of the uterine os, the vulva
and vagina are connected above with the rectum by the pel-
vic connective tissue. Anterior to this point, the vagina is
covered by peritoneum. It is in this area that the incision
needs to be made in the operation. The ballooning of the
vagina profoundly alters the relation of this operative area,
changing it from the horizontal in the quiescent organ to
the perpendicular in the ballooned condition. These varia-
tions permit of two methods of operating: (1) On the bal-
looned organ without anaesthesia and with animal confined

Fig. 75 — Special spaying- ecraseur, 55 cm. long-.

in the standing position. (2) On the quiescent organ in the
recumbent position under anaesthesia :

1. Without anaesthesia. Secure in the stocks with the
head elevated, a rope over the back to prevent rearing,
straps beneath the body to prevent lying down, straps or
ropes before and behind the animal to prevent backward
and forward movements, all four feet pinioned to the floor,
and the tail firmly secured and stretched to a beam above.
Apply a bandage to the tail extending 12 to 15 inches from
its base, in order to secure the tail hairs out of the way of
the operator.

With soap, water, and brush cleanse the tail, perineum
and vulva thoroughly, being especially careful to remove all
detachable masses of sebum; 50 per cent, alcohol or gaso-
line may be used sparingly to aid in removing this. Too
free a use of alcohol excoriates the delicate skin. Cleanse
the clitoris carefully. Follow the washing with a free gp-

Vaginal Ovariotomy in the Mare 265

plication of 1:1000 aqueous sublimate solution to the exter-
nal parts and for a short distance inside the vulvar lips and
to the clitoris. Do not introduce irritant disinfectants into
the healthy vagina nor deeply into the vulva, as they may
cause severe straining during and subsequent to the opera-
tion and, by injuring the vulvo-vaginal mucosa, favor subse-
quent infection of the vaginal wound. The vagina may
with benefit be flushed out mechanically with 0.6 per cent,
salt or soda solution.

Wash away the sublimate solution with a tepid 0.6 per
cent, soda bicarbonate solution, and fill the vulvo-vaginal
canal with the same. After thorough disinfection of the
hands and arms, remove the disinfectants by washing in
sterile soda solution, which at the same time renders the

Fig. 76 — Colin's scalpel.

hand unctuous and readily introduced through the vulva.
Armed with the guarded sterilized scalpel, Fig. 76, intro-
duce the hand into the vagina promptly and when the organ
is well "ballooned," unsheath the knife. Place it just above
the os uteri, parallel to the long axis of the uterus, a few
mm. to the right or left of the median line in order to avoid
a loose fold of mucous membrane generally existing there.
Hold the blade vertical — that is, with the cutting surface
parallel to the longitudinal muscular fibers of the vagina —
and, guarding the possible extent of its introduction with
the thumb and fingers, push it directly forward with a
quick thrust through the vaginal mucosa, the muscular walls,
and the peritoneum, until the disappearance of resistance
indicates that the latter has been penetrated. This is the
most critical step in the operation.

If the hand is introduced into the vagina immediately
after the injection of the sterile saline solution, the vagina

266 Diseases of the Genital Organs

will generally be found "ballooned" or will quickly become
inflated under manual movements. If the solution is thrown
out, the vagina may collapse and closely invest the hand. In
this case more of the liquid should be injected, and it will
again dilate. If the hand is introduced without the knife,
withdrawn, and then introduced with it, it will frequently
be found that the vagina has collapsed and needs a second
filling with the fluid. Patience until dilation is accomplished
and promptness to act when it is attained are prime requi-
sites to success.

The knife should be pushed through the vagina quickly,
making a clean wound the width of the blade, and the latter
withdrawn and laid aside. It should be remembered that in
this "ballooned" state, the anterior wall of the vagina is but
2 or 3 mm. thick and easily penetrated. Introduce the hand
again, push one finger into the incision, then a second and
third, and eventually, holding all the fingers in the form of a
cone, push the entire hand into the peritoneal cavity. Im-
mediately below the incision and continuous with the tissues
involved in the wound, lies the uterus, with a transverse di-
ameter of 4 to 6 cm. With the palm of the hand downward,
trace the uterus forward 15 to 18 cm., where it ends abruptly
in two cornua of about the same size as the body, which are
given off horizontally at almost right angles. Trace these to
the right and left for 14 or 15 cm., where they end obtusely,
and 3 or 4 cm. beyond this in a direct line, resting upon the
anterior border of the broad ligament is the ovary, varying
in size according to the degree of disease.

Prepare the ecraseur for use by withdrawing the chain
until the loop is barely of sufficient size to admit of its being
readily slipped over the ovary (or par-ovarian cyst as de-
scribed below) . Grasp this loop and the end of the ecraseur
tube in the hand, carry the instrument to the ovary or tu-
mor, and drop the loop over it from above. Pass some of
the fingers beneath the ovary or tumor, push it up through
the chain loop, and grasp it there with the thumb and index
finger. Holding the ovary with one hand, tighten the chain
quickly with the other, examine to make sure that a loop of
intestine is not caught, draw the ovary well through the

Vaginal Ovariotomy in the Mare 267

loop, include a large portion of the oviduct, and crush off
promptly, holding to the gland until carried out through the
vulva. If the tumor or cyst is very large it may not be
practicable to remove it through the vaginal incision. The
incision may be enlarged six to ten inches, but after such
enlargement suturing is necessary in order to avoid pro-
lapse of the intestines. The suturing of the vaginal in-
cision is not, however, a serious task. The lips of the wound
may be grasped by means of long dressing forceps and held
firmly while the operator with a short, curved needle closes
the incision by means of a continuous suture beginning at
the anterior end. When the ovary is cystic or the surgeon
is dealing with a large parovarian cyst, the cyst may be
grasped by its peduncle and engaged in the vaginal in-
cision. The cyst may then be punctured with a trocar or
scalpel and the liquid contents permitted to escape into the
vagina or through the canula of the trocar, beyond the
vulva. Wash away any blood from the external parts. Apply
sublimate solution freely to the vulva, perineum and tail.
Keep the patient quiet for five or six days, and feed lightly
on a laxative diet.

2. In operating under anaesthesia, the animal should be
cast or confined upon the operating table in lateral recum-
bency, preferably with the posterior part of the body some-
what higher than the anterior in order to avoid visceral
pressure in the pelvic cavity. Place the animal under com-
plete anaesthesia. Prepare the parts as already described.
Carry the knife into the vagina as directed previously and
render the roof of that organ tense by pushing the os uteri
downward and forward with the hand or by means of the
vaginal tensor or speculum. It is important that the vagina
be held well down toward the floor of the pelvis, so as to
carry it away from the rectum, posterior aorta, and iliac
arteries while the incision is being made. The incision is
now to be made just above and behind and a trifle to one side
of the os uteri, in essentially the same manner as under 1,
except that when the vaginal tensor is used, the cut is made
upward and backward instead of directly forward. The

268 Diseases of the Genital Organs

remainder of the operation is identical with what we have
described under 1. Under anaesthesia the vagina is flaccid
and cannot be made to "balloon" but may be distended with
sterile soda or salt solution.

Dangers. Wounding of the rectum is scarcely possible un-
der the first method, if it has been emptied as advised above,
if care is taken not to attempt the incision until the vagina
is well "ballooned," and the stab wound is made directly
forward. If made upward when the organ is so tensed, the
accident is highly probable, and with the undilated vagina,
where it is necessary to cut upward, the danger is ever
present. In order to avoid this danger, when operating by
the lirst method, the operator should await the complete
"ballooning" and then make his incision as directed. In the
second method, the accident is to be prevented by being care-
ful to push the vagina down away from the rectum and hold
it away while the incision is being made. If the wound in
the rectum passes through the pelvic connective tissue be-
hind the peritoneum, it is of little consequence, but the oper-
ation should be abandoned ; if the bowel is opened into the
peritoneal cavity, the accident is generally, though not al-
ways fatal. The vaginal incision may be enlarged and the
wounded portion of the rectum drawn out through the vulva.
The wound may then be closed by sutures.

Wounding of the iliac arteries, which generally produces
prompt death from hemorrhage, results from the incision
being made upward instead of forward when the vagina is
"ballooned" or from a failure to hold the roof of the vagina
down and away from the part while making the incision in
the flaccid organ, as is the case with the recumbent animal
under anaesthesia. It is most likely to occur with timid
operators who become nervous, especially when the vagina
does not "balloon" promptly or the mare is not well se-
cured. The accident is wholly unnecessary if the operator
will await the "ballooning" in the first operation, while by
the second method it is prevented by proper care in holding
the vagina downward and forward during the incision.
When it has occurred, it is generally beyond remedy, though

Vaginal Ovariotomy in the Mare 269

in some cases the prompt intravenous injection of adrenalin
chloride may stay the hemorrhage and save the life of the
patient.

Wounding of the uterus may occur when the incision is
directed downward and may greatly embarrass the operator
and confuse him because his fingers or hand may pass
through the incision into the uterine cavity. It is to be
avoided in the first operation (without anaesthesia) by care-
fully directing the incision straight forward. When the
accident occurs, it is of little consequence beyond the em-
barrassment and may be overcome by again dilating the
vagina with fresh injections of the soda solution and mak-
ing a new incision. If preferred, the first cut may be cor-
rected by placing an index finger against the peritoneum at
the upper part of the wound, and, with a sudden and vigor-
ous thrust, breaking through into the peritoneal cavity, or
by again using the scalpel and directing the incision prop-
erly. If it is attempted to rupture the peritoneum with the
finger, this must be done by a sharp thrust, since otherwise
a large section of the membrane will be pushed away from
the subjacent tissues.

Incomplete penetration of the vaginal wall is liable to oc-
cur if the scalpel is dull, if the vagina is imperfectly "bal-
looned" and flaccid, or if the operator is unduly timid. It
is best prevented by avoiding the causes mentioned. Once it
has occurred, it is generally best, in the operation without
anaesthesia, to again "balloon" the organ and make a new
incision either to the right or left of the first. It may be
overcome also by thrusting the index finger through the
peritoneum as described in the preceding paragraph or by
completing the cut with the scalpel.

The mistaking of a ball of feces for the ovary or tumor
has occurred to inexperienced operators and the fatal error
of removing the portion of the rectum surrounding the fecal
pellet committed. The blunder is uncalled for : the fecal
ball is movable in the bowel, the intestine is far more mas-
sive than the broad ligament, and the ovary is to be definitely
identified by its being lodged in the broad ligament just be-

270 Diseases of the Genital Organs

yond the end of the cornua, which is continuous with the
uterus. If, therefore, one traces the uterus forward to the
cornua, and thence along each of these to their extremities
and along the borders of the broad ligament to the ovary, as
above directed, the error will not occur.

The vaginal incision may be made too loiv and pass be-
neath the broad ligament. This is to be avoided by being
careful to keep close to the median line and above the os
uteri. If it occurs, the operation may be completed from be-
neath without very great difficulty, only that the ovary now
lies above the hand and must be drawn down from above
the broad ligament in order to fix the ecraseur upon it.

Infection, which always constitutes the most serious dan-
ger, is to be avoided by properly securing the animal, by the
avoidance of irritant antiseptics in the vagina, by rigid
asepsis at every stage, and by carrying out the mechanical
parts of the operation deliberately, vigorously, and neatly.
If infection should occur, it will generally take the form of
pelvic cellulitis with abscesses and rectal stricture. Enemas
of normal salt or soda solution afford the surest relief of the
stricture and impaction in front of it. The abscesses must
be watched and opened early into the vagina or rectum, and
the case treated internally and locally according to general
surgical principles.

Vaginal Ovariotomy in the Cow

While vaginal ovariotomy is the common method used in
the cow and mare for the simple purpose of removing
healthy ovaries in castration, or of ovaries aberrant in
function as in nymphomania, it is not of great value in the
removal of ovarian tumors, since as a rule they are too large
for removal by this route. Neither does the vaginal opera-
tion afford satisfactory opportunity for controlling hemor-
rhage if increased vascularity exists.

Instruments. Colin's scalpel, vaginal dilator, spaying
ecraseur, or emasculator.

Tecfuiic. Confine the cow in the standing position in the
stocks, secure the head firmly, and pass two boards beneath

Vaginal Ovariotomy in the Cow 271

the abdomen and sternum to prevent lying down, and a rope
over the middle of the back to prevent arching of the spinal
column and straining.

Wash and disinfect the tail and the perineum and flush
out the vagina with a 0.5 per cent, solution of carbolic acid
or lysol at a temperature of about 100° F. Insert the vagi-
nal dilator with one hand and push the prolongation at the
anterior end into the os uteri. With the other hand, elevate
the handle of the dilator, and depress and push forward the
uterus, thus rendering the roof of the vagina tense and push-
ing it downward away from the rectum. Carry the scalpel
into the vagina with the right hand and, resting it in the
oval of the dilator, make an incision through the roof of the
vagina, beginning at a point 8 to 10 cm. posterior to the os
uteri and extending backward on the median line for a dis-
tance of 2 or 3 cm. Be careful to make the incision entirely
through the mucosa, muscle and peritoneum at the first cut,
since any failure to complete it tends to cause the perito-
neum to separate from the muscular coat and form a pocket
between them, while the serous membrane, being very elas-
tic, renders it difficult to complete the incision. Introduce
two fingers through the incision, if the ovary is not greatly
enlarged, and, reaching over the side of the vagina to the
right or the left, the right or left ovary respectively is recog-
nized, when normal in volume, lying immediately against
the lower part of the base of the uterine horn, just at the
anterior border of the pubis, in a mass consisting of the
cord-like Fallopian tube and the fimbriae of its pavilion.
When the seat of an extensive tumor or cyst, it shifts its lo-
cation downward and forward a variable distance according
to its weight. The normal ovary may be distinguished as a
firm oval mass 2 to 4 cm. in length and 1 to 2 cm. in its lesser
diameter attached to the broad ligament. If not promptly
recognized by the sense of touch, trace the vagina and uterus
forward with the fingers from the vaginal incision to the
cornua and follow them as they bend forward and down-
ward, and then backward and upward to the oviducts, until
the ovary is reached where it is attached to the broad liga-
ment, just beyond the fimbriated end.

272 Diseases of the Genital Organs

Grasp the ovary between the fingers and, if not too large,
draw it through the incision into the vagina. Introduce the
emasculator with the o.ther hand, and, when the ovary is
reached, open the instrument far enough to admit the ova-
rian attachments between the jaws, push the ligament be-
tween the jaws, close the forceps and sever the ovary. Or
introduce the ecraseur, draw the ovary through the loop of
the chain and, holding it securely until the instrument is
tightened, crush it off. If the ovary is the seat of an exten-
sive tumor, the hemostatic power of the ecraseur or emascu-
lator must not be relied upon. The same is true in a lesser
degree of nymphomaniac ovaries. In such cases it is far
more prudent to ligate the artery with large chromatized
catgut, passed through the ovarian ligament by means of a
needle. For this purpose the ovary is drawn into the vagina
and its ligament engaged securely in a long pair of forceps.
The ligature is passed through the pedicle of the tumor and
tied tightly outside the forceps. The attachments are then
divided between the ovary and the ligature, care being taken
to leave a sufficiently long stump to give ample safety
against slipping.

It is essential that plenty of the broad ligament and ovi-
duct be excised with the ovary to insure the entire removal
of the gland, because the accidental leaving of the smallest
particle of ovarian tissue may cause a development of this
into abnormally large cystic ovisacs, tending to increase in-
stead of decrease nymphomania. Generally no after care is
necessary.

The dangers are similar to those in the mare. The iliac
arteries may be wounded in the same manner. The accident
is preventable by being careful to push the vaginal roof
well downward away from the rectum and sacrum.

Another danger appears in the presence of the rumen,
the supero-posterior portion of which, when filled with
fond, projects into the pelvic cavity so that, if the cut is
directed forward, a stab wound readily penetrates its walls
with fatal results. Make the cut upward and backward.

Ovariotomy in the Cow and Mare by the Fla?ik 273

Ovariotomy in the Cow and Mare by the Flank

Instruments. Clipping shears, convex scalpel, spraying
emasculator or ecraseur, heavy needle and thread.

The animal may be secured as in the preceding or con-
fined in lateral recumbency with the hind legs extended
backward and the anterior limbs forward. To accomplish
this, loop a rope about the two fore feet, another about the
two hind feet, and, drawing upon these, cast the animal and
secure it in recumbency with the legs extended and body
stretched by fastening the ropes to two strong posts about
8 to 10 m. apart. The operation may be performed in either
flank. The recumbent animal should lie with the diseased
ovary uppermost.

Clip the hair from the upper part of the flank and
shave the operative area, disinfect an area 15 to 25
cm. square, make an incision about 12 cm. long be-
ginning at a point equidistant from the anterior tu-
berosity of the ilium, the ends of the transverse processes
of the lumbar vertebrae and the last rib, and extend it
downward perpendicularly, severing the skin and subcu-
taneous muscle. If the attachments of the tumor are short,
it may be impossible to bring it out through an incision in
the upper flank. In such cases the laparotomy should be
performed in the middle or lower flank region. Divide the
external oblique muscle in the direction of its fibres by
means of the scalpel handle or the fingers, and repeat the
process upon the internal oblique, after which puncture the
peritoneum with the scalpel. By thus dividing the external
and internal oblique muscles, an X-shaped opening through
the abdominal walls results, which closes automatically and
obviates the need for peritoneal and muscular sutures. It
also conserves in the highest measure the integrity of the
muscular walls.

Force one hand through the opening into the peritoneal
cavity and search for the ovary or tumor at the same point
and by the same method as in the preceding operation : that
is, locate the uterus within the pelvic cavity, between the
rectum and bladder, and trace it, the cornu, and broad liga-
18

2j4 Diseases of the Genital Organs

ment to the ovary. Then draw out the diseased ovary
through the abdominal incision and remove it under ample
safeguards against hemorrhage. Cleanse the wound and
close the skin incision with continuous sutures.

Benign Tumors of Oviducts, Uterus and Cervix

Benign tumors of the oviducts, uterus, and cervix are ex-
tremely rare. I have in my collection no tumors of oviduct
or cervix and but two of the uterus — one a fibroid from a
cow. the other a myom from a mare. The tumor from the
cow (Fig. 77) is from the abattoir, and hence without his-
tory. It is oblong, of even contour, measures 4x7 inches,
and is located near the apex of the cornu. The uterine walls
show no changes from its presence.

The myom from the mare (Fig. 78) was unobserved until,
while at work, the tumor, which weighed eleven pounds,
became dislocated, and caused pain with expulsive efforts
of such violence that the tumor was forced out through the
vulva and could not be returned. The dragging upon the
uterus and its ligaments caused great suffering. The case
was entered in the clinic of my colleague. Frost. The tumor
was removed, the uterine wound sutured, and the uterus
returned to its position. The mare died a few hours later
of hemorrhage from the uterine artery, which was ruptured
by the violent dragging of the expelled tumor. The tumor
measures .", x 11 inches.

In one ease of tumor of the uterus, diagnosed clinically as
a fibroid, the cow bred several times in the opposite horn.
but after the tumor had reached a diameter of 10 to 1'2
inches, she became sterile, probably owing to the presence
of the neoplasm.

Benign uterine tumors may generally lie diagnosed clini-
cally with reasonable assurance. Ordinarily the tumor
grows slowly, causes no discharge or irritation, is not pain-
ful upon manipulation, is usually very firm, and presents an
contour. The malign tumor would generally give evi-
dence of its presence by the discharge of pus and necrotic
debris. The macerating fetus gives an irregular swelling.

Benign Tumors of Oviducts, Uterus and Cervix 275

Fig. 77 — "Uterine Fibroid. Cow.
C, Cervix ; T, Tumor.

Fig. 78 — Uterine Fibroid. Mare.

The dark periphery is due to profuse hemorrhage, apparently the result of

contusions and the incarceration of arteries during prolapse

of the tumor and uterus through vulva.

276 Diseases of the Genital Organs

the fetal bones are commonly palpable, and there is a very
fetid discharge. The desiccating uterine hematoma and the
desiccating fetus in its early stages are less firm than the
fibroid and fill one horn and uterine body from the cervix
to the ovarian end of the cornu. The tumor, on the other
hand, occupies but a part of the total length of the uterus.

When clinically recognized in valuable breeding animals,
uterine tumors should be removed after performing laparo-
tomy, as indicated for spaying through the flank. If the
tumor can be removed without destroying completely a
transverse section of one cornu, the cornu and ovary should
be preserved, but if the removal of the base of the tumor
will lead to the occlusion of the lumen of the horn, the en-
tire cornu on the ovarian side of the tumor, with the ovi-
duct and ovary, should be removed. The hysterotomy in-
cision should be closed by intestinal sutures.

Tumors, usually fibroids, occur not rarely at the hymeneal
ring, emanating apparently from the vestiges of the hymen.
They are largely pedunculated. They have already been
referred to incidentally while considering vaginal hernia.
When recognized, they should be removed by incarcerating
the pedicle in a suture or ligature. It is best to arm a needle
with a strong suture and, exerting moderate traction upon
the tumor, pass the needle deeply through the vulvo-vaginal
wall in a manner to include the entire base of the new-
growth. Tie the suture very firmly, incarcerating the en-
tire base of the pedicle and causing prompt necrosis of the
tumor. The body of the tumor may then be excised, leaving
enough of the pedicle to insure the safety of the ligature.
Do not attempt ecrasement or plain incision because of the
great danger of vaginal hernia.

I have observed two instances of apparently infectious
vulva)- benign epithelioma, both in heifers. In one instance,
two heifera in contiguous stanchions developed epithelial
tumors, or "warts." in the vulva. The tumors were uneven
and highly vascular. They were three inches or more in
diameter. In the other instance, in a group of 26 heifers
in one lot, none of which had copulated. 15 developed vulvar

Be?iign Tumors of Oviducts, Uterus and Cervix 2jj

tumors. The tumors were confined, so far as could be de-
termined, to the interior of the vulva, largely at the superior
commissure and about the meatus urinarius. The tumors
were of every size up to four inches in diameter. In two or
three of the heifers where the tumors were very large, the
growths protruded from the vulva, especially when the ani-
mal was recumbent. The tumors caused no visible distress
or injury to the animals. Some of the larger tumors were
removed after transfixing and ligating their bases with
strong sutures. Much care was necessary in one or two
cases to avoid invading the meatus urinarius. The tumors
had developed during the winter months while the heifers
had been confined largely to the stable. With the advent of
spring, with grazing, the new-growths disappeared spon-
taneously. They behaved clinically much like the common
"warts" and the ringworm of the head and face of young
cattle.

PART III

INFECTIONS OF THE GENITAL ORGANS
SECTION I. THE GENITAL INFECTIONS OF CATTLE

CHAPTER XII

THE SPECIFIC VENEREAL DISEASES

1. The Vesicular Venereal Disease of Cattle. Vesi-
cular Exanthem. Aphthous Venereal
Disease. Blaschenausschlag

The vesicular venereal disease of cattle is widespread in
continental Europe, and occurs somewhat rarely in the
United States. It is highly contagious. Ordinarily it is
transmitted by copulation. After handling diseased ani-
mals, it is readily transmitted by careless manipulations of
the genitalia of healthy animals, and by grooming apparatus,
such as brushes, currycombs, and sponges. It is yet more
certainly carried by means of douching apparatus or other
instruments used in handling the diseased animal and thence
brought into contact with the sound genital mucosa of an-
other. It is one of the most intensely contagious diseases
known to veterinarians. Whenever genital contact occurs,
whether directly through coitus, or indirectly by such means
as suggested above, infection is practically certain. A dis-
eased cow may transmit the infection to her neighbor by
switching her tail.

The vesicular venereal disease is analogous to the genital
horse pox, or vesicular exanthem of horses, though they are
not known to be related. It bears some resemblance to the
chancroid of man.

The symptoms are very acute and marked. In the fe-
male the disease appears suddenly as an intense vulvo-
vaginitis. The vulvo-vaginal mucosa becomes greatly in-
d and swollen. It soon shows numerous dark red pe-
techiae, which quickly develop vesicles. The vesicles, which

The Vesicular Venereal Disease 279

are of short duration, either rupture as vesicles or become
pustular and rupture, in each case leaving an ulcer. The
ulcers, which are one-eighth to three-sixteenths of an inch
or more in diameter, very shallow, and exceedingly angry
in appearance, give rise to an abundant muco-purulent dis-
charge which, issuing from the vulva, soils the vulvar labiae,
the tail, and the adjoining parts. The vesicles and ulcers
continue to develop in successive crops for a number of days.
The ulcers heal with only a very slight, temporary scar.
Much pain is present. The ulcerating mucosa is intensely
sensitive. Any attempt at manipulation causes very great
resistance. The ulcers bleed freely upon touch. When un-
disturbed, the cow is uneasy, as shown chiefly by frequent
switching of the tail and more or less stamping of the hind
feet. When urination occurs, the urine, coming into con-
tact with the highly inflamed ulcers, causes very marked
and intense pain. The animal switches her tail violently
and stamps the hind feet in rapid succession. Whenever
the animal defecates, the mechanical pressure unavoidably
causes pain, because of the extreme tenderness of the vulva
and vagina. The pain is not as acute "as that observed in
urination. Whenever the animal moves, the muscles of the
limbs which come in close contact with the vulva naturally
drag upon the inflamed organ, causing pain, which is re-
vealed by a stiffness of gait.

The infection does not necessarily prevent impregnation.
If the cow becomes pregnant, there seems to be no unfavor-
able influence upon the life of the embryo. It is stated that
in some cases the disease results in chronic catarrh of the
vagina. A commoner, and apparently more threatening
termination is adhesions between the walls of the vagina,
which may cause more or less constriction of that canal.

In the bull the symptoms of the disease are analogous to
those observed in the cow. The mucous membrane of the
penis, prepuce and sheath becomes inflamed, swollen and
tender. The eruptions in the mucosa of the genital organs
are identical with those observed in the cow. The urethra
may also become involved, giving rise to a muco-purulent

280 Diseases of the Genital Organs

discharge therefrom. Urination causes pain of the same
general character as that observed in the cow. The swelling
of the penis and the sheath may be so great as to cause phi-
mosis. Erection of the penis causes bleeding. This is fur-
ther emphasized by copulation. Kampmann records a case
of extensive necrosis, with permanent deformity of the
penis, due to this disease.

So far as known, the disease does not affect other species
of animals. The period of incubation is brief. The course
of the disease is brief and stormy. Spontaneous recovery
generally occurs in from ten to thirty days. It is said that
no enduring or valuable immunity is acquired, and that an
animal may readily become re-infected by copulation.

The pathogenic organism which causes the disease, as is
common in diseases associated with vesicles, is unknown.
Ordinarily an outbreak of the disease appears suddenly and
can not be traced to other herds. Like genital horse pox,
it appears to develop spontaneously. No suggestion of any
exposure from strange cattle exists. Suddenly the out-
break is present in the stable in its most acute and highly
contagious form. Several or many animals are already
infected. Once established, the infection is readily traced
from animal to animal. It may then spread to a few neigh-
boring herds through the agency of the bull, but it is so evi-
dent that it is quickly observed by the layman, who natu-
rally takes measures to control it. The disease then dis-
appears, until suddenly it reappears in some other area
without any connection whatever being traceable between
one outbreak and another.

Ordinarily the differential diagnosis of the vesicular ve-
nereal disease is easy. At times there has been confusion
with the nodular venereal disease, but this is unnecessary.
The former is characterized by vesicles and ulcers ; the lat-
ter by nodules or granules, which may be translucent, but
are hard and solid throughout. The nodular venereal dis-
ia chronic. While there may be a copious muco-puru-
ltut discharge and the affected parts may be sensitive, the
tenderness is not as marked as in the vesicular venereal

The Vesicular Venereal Disease 281

disease. The very rapid spread of the vesicular disease
serves also to distinguish it from the virtually omnipresent
nodular venereal disease.

The prognosis is highly favorable. Recovery from the
disease is prompt, and almost always complete. It causes
small loss to the dairyman. The cow retains her appetite,
she does not lose perceptibly in flesh, and the milk supply
is not seriously disturbed. Rarely, especially following the
use of strong antiseptics, constriction or atresia of the va-
gina may follow, which may interfere later with copulation
or parturition.

The control of the disease must rest fundamentally upon
isolation, especially sexual isolation. Since the disease is
preeminently venereal in character, breeding should be
completely suspended until all signs of the disease in the
herd have disappeared. Even steers or oxen should not be
permitted to run in pasture or in paddocks with cows, be-
cause in attempts at copulation they might transmit the
disease. It is not necessary to separate the diseased from
the healthy by any great distance. Close proximity should
of course be avoided, because the disease might be trans-
mitted from animal to animal through the medium of the
tail or soiled bedding. Diseased animals should on no ac-
count be bred until they have thoroughly recovered, and
even then it is well to use antiseptic precautions just before
and after breeding. For this purpose, both the vagina of
the cow and the sheath of the bull should be thoroughly
disinfected prior to permitting copulation. The disinfection
of the sheath of the bull should be repeated immediately
after copulation, and the douching of the vagina of the cow
may be carried out within five or six hours after copulation
and repeated occasionally until the attending veterinarian
believes than any possible danger has been eliminated. The
thorough disinfection of the stalls and of the soiled parts
of the animals contributes materially to the control of an
outbreak.

The treatment of the disease consists of the disinfection
of the copulative organs and of those parts of the animal

282 Diseases of the Genital Organs

which have become soiled from the venereal discharges.
Disinfection is a difficult problem and must be conducted
with caution. The genital mucosa is in such a highly irri-
table state that one can not with success employ any strong
disinfectant. It must constantly be borne in mind that a
mucous membrane can not be definitely disinfected and that
any radical effort to disinfect will serve only to irritate and
destroy the genital epithelium and intensify the disease.
Something must be used which is non-irritant. It will be
found that a mechanical cleansing of the parts with a physi-
ologic salt solution will best answer the purpose. In this
way the tissue debris and pus may be washed away and the
highly sensitive ulcers cleansed without inducing any ma-
terial pain. On the other hand, the douching actually tends
to soothe. If the animal will bear it without pain, very mild
antiseptic solutions may be used as a douche, such as 4 per
cent, boric acid. Whatever antiseptic is selected, its action
should be carefully noted, and whenever it causes straining
its use should at once be discontinued. If the cow is not in
milk or if the milk is not to be used for human consumption,
one may use a dressing of 10 per cent, iodoform in oil in-
troduced through a catheter or tube. If the cow is being
milked, the use of iodoform inevitably taints the milk in
such a manner as to render it obnoxious.

In some continental European states, the disease is re-
portable as a dangerous contagion, subject to legal regula-
tions. I have observed several outbreaks, all handled by
voluntary personal quarantine. The symptoms are so strik-
ing that any intelligent breeder should realize that his in-
terests dictate adequate control measures. Under the spe-
cific laws for the control of contagious diseases in most
states, it may very properly be reported, and should be, if
the attitude of the custodian threatens the extension of the
disease. I have not known of an outbreak reported to the
sanitary authorities in America.

The Nodular Venereal Disease 283

2. The Nodular Venereal Disease. Infectious Vagi-
nitis. Vaginitis Verrucosa, Metritis et Vaginitis

Infectiosus. Ansteckende Scheidenkatarrh, Etc.

The classification of the nodular venereal disease as a
specific infectious malady is not free from objection. Isep-
poni of Chur (Switzerland) was the first writer to bring
the disease (or the lesions) notably before the veterinary
profession as a distinct, specific malady. He was promptly
followed by numerous veterinarians. His views were en-
dorsed first by his Swiss colleagues, and later by Austrian,
German, French and other Continental European veterina-
rians. Leading European authors — Friedberger and Froh-
ner, Hutyra and Marek, and others— assigned it a definite
place amongst infectious diseases of cattle. The lesions
characterizing the condition are so nearly universal that,
soon after the publication of Isepponi's observations, a few
veterinarians, instead of considering it specific, held that it
is in fact a physiologic condition and that the absence of
the granules or nodules indicates disease. The dissenters
were not men of authority or prominence in the profession.
The vast majority of veterinarians in the front rank ac-
cepted and supported the teachings of Isepponi.

The prominence of the nodular venereal disease was
based chiefly upon the belief of Isepponi and his followers
that it was responsible for most, or much, of the sterility
and abortion of cattle. Although sterility and abortion have
been recognized throughout history as a cause of serious
losses among animals, the interferences with reproduction
had reached a phase in the time of Isepponi where they
were causing greatly increased concern to individuals and
to the state. The views regarding the causes of abortion
were chaotic and the people were so anxious to find some
rallying point that they eagerly grasped the first plausible
explanation, hoping that behind the recognition of the
cause lay a remedy. For about ten years the belief in the
importance of the nodular venereal disease spread. This
belief rested upon clinical observations. It was held, by
those who studied the problem, that the amount of sterility

284 Diseases of the Genital Organs

and abortion in a herd was parallel to the virulence of the
nodular venereal disease. All deductions were based upon
the presence or absence of given lesions.

Bacteriology was making enormous strides. Wherever
a distinct lesion was recognized, search was made for a
bacterial invader as a cause and efforts were directed to-
ward the experimental transmission of the disease. Oster-
tag, after a brief bacterial study of the disease, reached the
conclusion that it was due to a streptococcus. No one seri-
ously attempted to cause sterility or abortion experimentally
by the artificial transmission of the disease. Wider ob-
servation showed the lesions to be essentially omnipresent.
Many began to doubt that these lesions could be the cause of
sterility and abortion, since in that case the bovine species
would be wiped out. Many were not ready to believe
(though abundant examples exist) that an infection can ex-
ist generally and only now and then prove serious.

Ten years after the interesting observations of Isepponi,
Bang made his famous discovery of the B. abortus and sur-
passed in the plausibility of his teachings by experimentally
inoculating pregnant animals which were assumed to be
free from the B. abortus infection. Some of the experiment
animals aborted and from the uterus of the cow or the
stomach of the abort Bang recovered a bacterium which, it
was assumed, was the lineal descendant of the bacteria in-
troduced. The teachings of Bang quickly gained a promi-
nent place. In the enthusiasm which grew up, sterility was
essentially forgotten or assigned a secondary place. The
nodular venereal disease was promptly overshadowed as an
important genital infection. The B. abortus occupied the
field of thought in connection with genital diseases, and all
else was consigned to oblivion.

During the two past decades little has appeared in veteri-
nary literature concerning the nodular venereal disease,
and that little has been generally ignored or roundly con-
demned. The disease is still described in recurring edi-
tions of the foremost treatises upon veterinary medicine,
rather as a matter of habit than because of any living in-

The Nodular Venereal Disease 285

terest in the subject. It has never received, and is not re-
ceiving serious study at the hands of pathologists and bac-
teriologists. The disease is accordingly a difficult subject
with which to deal. It may be said to be a lesion without a
known cause and regarding the effect of which there is very
scant knowledge. I feel that the disease should be recog-
nized as holding a definite place amongst the genital infec-
tions, but do not believe that at present it should have as-
cribed to it that importance with which Isepponi and his
followers clothed it nor that it should be so utterly ignored
as it has been recently.

The nodular venereal disease may be described as a vir-
tually universal, chronic infection affecting the mucosa of
the copulatory area of the genitalia. It involves both sexes
and all ages of ruminants and swine. It expresses itself
clinically in the form of granular or nodular elevations in
the mucosa of those parts participating in coitus (vulva,
vagina, sheath, prepuce, and glans penis).

The essential clinical symptom is the appearance in the
genital mucosa, protruding above the surface, of nodular,
conical, or spheroidal elevations, usually 1 to 2 mm. in di-
ameter. (See Figs. 79, 80.) In the female they are best
observed clinically by holding the vulvar lips apart and
causing a strong light to enter obliquely. The examina-
tion may be conducted advantageously in a well-lighted
stable, by having the animal placed with her posterior parts
presenting toward a window somewhat above the level of
her back. The examiner grasps each vulvar lip between
the thumb and fingers and, drawing the lips backward and
outward, exposes the interior of the vulva to vision. The
light, falling obliquely into the vulvar cavity, by refraction
brings the nodules clearly into view. In order to examine
every part, the examiner should shift his position again
and again, that he may view each area at the proper angle.
In order to examine satisfactorily the roof of the vulva, the
eye of the examiner should be on an approximately hori-
zontal line with the mucosa. Highly satisfactory examina-
tions may be made in dark stables or at night with the aid
of a good reflecting lamp or an electric flash light.

286

Diseases of the Genital Organs

/I

j "f?

*1

;

v*\

I'n. 79 The Nodular Venereal Disease.
Vulva aixl Vulvar End of Vagina. Cow. [Hutyra and Marek).

The Nodular Venereal Pisease

287

The nodules are also recognizable upon digital palpation,
since the elevations are very evident to the sense of touch.
At times digital palpation may have an advantage over
vision, because the mucosa may be edematous to such a de-
gree that, even when the nodules are abundant, they are
rendered invisible.

Fig. So— Mild Nodular Venereal Disease. Heifer.
/, Vulva; 2, clitoris surrounded bv nodules ; j, hymeneal scar ; /, vagina.

Under the prevailing conditions in American dairy herds,
and presumably in the dairy herds of the world, calves usu-
ally develop clinical signs of the disease at from four to
twelve weeks of age, and from that time through adult life
to old age present a series of interesting vacillations of in-
tensity, so great that various writers have designated the
disease as acute, subacute, chronic, cured, sound, etc.

In the newborn heifer calf, the vulvar mucosa is usually

288 Diseases of the Genital Organs

smooth, moist, and pale rose-colored for a period varying
from four to twelve weeks, or even longer. Finally, visual
inspection reveals the presence of several or many spheroido-
conical nodules in the vulvar mucosa, 1 to 2 mm. in diameter.
Usually they are colorless or faintly yellowish in the center
and present the appearance of small, tense vesicles, but
close examination reveals the fact that they are hard to
the touch and contain no fluid. Encircling the base of each
nodule, there is usually a pale or bright red area due to in-
creased vascularity, giving the lesion the appearance of a
minute vesicle, with a vascular girdle. The nodules are
scattered here and there, frequently along the floor of the
vulva in the clitorial region, but quite as often on the sides
or roof of the vulva. Except for the nodules and the vascu-
lar girdle about the base of each, the surface of the mucosa
in the early stage is smooth, pale rose-colored, and normal.
There is no swelling, no inflammation, no discoloration of
the vulvar mucosa not occupied by the nodules, and no
marked mucous or muco-purulent discharge.

Slowly and insidiously the disease appears in calves
which have hitherto seemed free, so that, the older the
heifers, the larger the percentage showing evidences of the
infection. The rapidity and uniformity of the development
of the malady depend largely upon environment. Usually,
in the closely housed heifer calves in large dairies, fed
carelessly upon raw, mixed milk, more than 90 per cent,
show the disease at four months, and before they are one
year old the visible infection reaches 100 per cent. If by
any chance an individual escapes infection until breed i ng
age, the first copulation conveys the disease. In heifer
calves of the beef breeds, which nurse their dams, the in-
fection develops much more slowly. In experimental heifer
calves, 1 have k*i»t individuals up to six months, and even
to one year old, without any visible trace of infection.

The influence of environment upon the spread of the in-
fection in heifer cakes is further shown in Table I. wherein
the L22 veal heifers observed showed an average infection
of 61 per cent. The percentage of infection among these

The Nodular Venereal Disease

289

-j)

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J S5 05 .

d <; a< 5

Q « t, *

55 Hi

0 a
a p

-t 3
o0

«

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s

0

tZ)

W

C/l

a

HI

a

-J

B

£>

■<

Q

*

0

O

'4,

■<

NODULES Ol

Granules
Present

O <o

•q- rO

^

vO CO

>

I 3^

CO <N CT* f/CO
1^ 10 ON On <N
UC «-, LO - tO

M«2

,5 ~ ra jj o

tj 0 W R fe

« z

w w
a tfi

P W
Z 05
< Ph

-

^

a £

D <

2 05

:o0

-G CO CO VO tH

J a

en a

a a

a z

D <

Q 05

«;

-Ci 0s r-» On UO

s

O rO C I - I - On
~ 1^. -f r, — —

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r.'- - zt cu »—

J"* S atJ

la S * <u 0
u O M Q ft

19

290 Diseases of the Genital Organs

calves is markedly below the average among heifer calves
of corresponding ages in eastern dairy herds. Western veal
calves largely run at liberty in the open, exposed only to the
infection from their dams.

When the nodules are quite numerous, they tend to be-
come arranged in longitudinal, parallel rows corresponding

lie, Si Vulva of Heifer Grown Experimentally upon Boiled Milk.
The vulvar tuft of hairs is unstained and free from muco pus.

to the longitudinal folds of the vulvar mucosa, as shown in
Fig. 79. The nodules are located upon the summits of the
rugae, emphasized and rendered more distinct by the in-
flammation of the mucosa, which causes it to swell, harden
and thicken, and forces it into marked folds. The individual
noduli b rhange in appearance. They increase little in size
and projection. The vascular areas about their bases be-
come more deeply injected and the vascularity may extend

The Nodular Venereal Disease

291

more or less completely over the surface of the nodules, so
that some of them appear as bright red elevations or as
petechiae on the vulvar mucosa.

The mucosa itself, between the nodules, becomes involved
and is injected, red, and swollen. With the advent of defi-
nite irritation of the vulvar mucosa, a slight muco-purulent,

FlG. 82 — Vulva of Heifer fed in ordinary manner as a Calf,
Showing Matting and Staining of Vulvar Tuft.

vulvar discharge ensues. It is not at first marked. Many
say it is not present, or rather that the discharge noted is
normal. There is, however, a visible discharge which so
mats together the vulvar tuft and surrounding hairs in the
heifer calf that, in opening the vulva for inspection, the ex-
aminer must frequently break down the adhesions between
the surrounding hairs before the vulvar lips may be parted.
Some contend that this is normal, but in experiment heifer

292 Diseases of the (ienital Organs

calves such vulvar discharge has not appeared until after
visible infection.

Up to the date of puberty, or estrum, the nodular venereal
disease of heifer calves generally behaves essentially as a
dormant malady, without material significance for the im-
mediate welfare of the animal (See Fig. 80). Various ob-
servers may and do hold divergent views. Numerous cases
are viewed by veterinarians as sound because of the mild-
ness of the symptoms, but the nodules are there, and, so long
as they are admitted as the deciding lesion of the malady,
the heifer must be regarded as infected.

Copulation is the signal for the awakening of the dormant
infection, which then behaves like venereal disorders in ani-
mals and in man under the stimulus of sexual contact.
Within twenty-four hours after copulation, the evidences
of sexual irritation are marked. The mucosa becomes scar-
let, swollen and tender, and in a large proportion of cases
there is a very notable muco-purulent discharge, which ad-
heres 'to the vulvar tuft "and soils the under surface of the
tail, the skin of the buttocks, and the perineum. Fre-
quently the vulvar lips become markedly swollen and edema-
tous. If the vulvar lips are parted, the mucosa is seen to
be covered with masses of stringy, semi-opaque mucus, or
small flakes of muco-pus may be seen resting upon the
mucosa.

After copulation the nodules multiply with astonishing
rapidity. Their arrangement in parallel longitudinal rows
becomes well marked. They are crowded into close contact
with each other upon the summits of the swollen, hypertro-
phied, mucous rugae. Frequently they lose their trans-
parency and assume a deep red color. In every way the
malady assumes a more decisive clinical aspect of important
disease. Still, the general health of the heifer is not low-
ered.

The intensity of the symptoms increases for a few days.
remains static for a time, and may then recede slightly,
but the improvement does not approach the status main-
tained prior to copulal ion.

The Nodular Venereal Disease 293

Should the heifer become pregnant at the first service,
the irritation may for a time abate slightly and slowly, but
the nodules remain prominent and approximately as numer-
ous as ever, and the clinical evidences of disease remain
essentially static, at one period apparently improved, at an-
other worse, until near the time for parturition, when the
vulvar mucosa becomes more reddened. A marked edema
(parturient edema) then appears: the nodules are covered
over and are no longer visible. Usually they may still be
felt upon careful palpation. In many cases of abortion the
edema of the vulvar mucosa is essentially the same as if
parturition had occurred. If parturition or abortion is fol-
lowed by retained placenta and chronic metritis or pyome-
tra, the nodules continue masked by the persisting edema
so long as serious uterine or vaginal disease continues.
Otherwise, with the gradual disappearance of the edema of
the mucosa, the nodules slowly come again into view.

If the heifer fails to conceive at the first copulation, when
the next estrual period arrives and copulation occurs,
should the sterility be refractory, the symptoms tend to
increase, so that sterile heifers are quite generally among
the worst clinical cases in a herd. During the second and
third pregnancies the symptoms of the disease retain ap-
proximately the average intensity acquired during the first
pregnancy. Then the severity of the malady generally
abates.

When the cow reaches eight to nine years of age and her
sixth or seventh pregnancy, the decrease in the intensity
of the disease generally becomes quite marked : the nod-
ules are fewer, less prominent, and more transparent ; the
irritation and injection of the vaginal mucosa are definitely
decreased ; and the muco-purulent discharge has largely
abated. With advancing age, the vulvar mucosa becomes
pale yellowish or bluish-yellow, the nodules disappear, and
the clinical evidences of the disease commonly vanish from
the vulva when the cow is twelve to fifteen years old.

Such is a brief outline of the course of the malady as ob-
served in a majority of cases, but the course is vascillating

2g4 Diseases of the Genital Organs

and erratic in individuals and in herds. Copulation always
intensifies the symptoms, especially in heifers, and one can
generally distinguish by the clinical examination of the
vulva practically every heifer which has copulated from
those which have not. In some heifers, after repeated copu-
lations, the granules become so numerous and highly in-
flamed that coitus causes pain and hemorrhage, followed
by abundant vaginal discharge for several days.

The use of antiseptics in the vulvo-vaginal tract alters the
clinical appearance profoundly. Daily washing of the va-
gina with non-irritant, warm, antiseptic solutions causes
the symptoms of the malady to decrease rapidly in intensity,
and in a few weeks the nodules may largely disappear, the
mucosa become smoother and softer, and the color change
to a pale rose-red. It looks as if the continuance of the
handling would soon eliminate the disease, but in the end
some nodules remain, and, with a cessation of handling un-
accompanied by copulation, the symptoms remain static.
On the other hand, when powerful antiseptics are intro-
duced into the vagina, the mucosa becomes irritated, swollen,
and edematous, and the nodules thereby become veiled.

Thus the clinical signs of the malady appear insidiously,
usually when the heifer is but a few weeks old. The disease
pursues a comparatively uneventful course up to breeding
age, then becomes suddenly intensified after coitus, and
quickly reaches its zenith, where it maintains, with certain
vacillations, an approximately horizontal course for three or
four years, when it begins to abate slowly in intensity and
with the advent of old age more or less completely disap-
pears clinically.

It will be seen by a study of the preceding table thai
-payed range heifers of the beef breeds show the disease in
a lower ratio than other animals, but the ratio does not give
a clear view of the facts. The intensity of the disease de-
pends very largely upon the frequency of copulation. The
spaying of range heifers was generally done very carelessly
and hastily. The operator thrust his hand through the
wound, grasping the ovaries and stripping them from the

The Nodular Venereal Disease 295

broad ligament between the thumb and fingers. The re-
sult was that in 50 to 60 per cent, of the animals some
ovarian tissues were left, which developed ovisacs and
cysts. The heifers came in estrum or were nymphomaniac
and copulated freely with range bulls. In such imperfectly
spayed animals the lesions, which were always seen, showed
considerable intensity. In the perfectly spayed heifers
the vulvar mucosa was generally normal, smooth, and pale
rose-red, with but few if any visible nodules.

Another striking illustration of the influence of coitus
upon the intensity of the disease was observed in a lot of
270 two-year-old range Hereford heifers which had evi-
dently been kept away from the bull, except in the case of
one individual which had copulated and become pregnant.
In the 269 non-pregnant animals, the disease was quite uni-
formly present, but only a few nodules were seen in each
individual. Careful inspection was required lest they be
passed over. The vulvar mucosa of the one pregnant heifer,
however, bore more of the nodules than the other 269 to-
gether. In this one heifer the entire mucosa was swollen
and red, and dense masses of nodules crowded thickly upon
each other.

Throughout its long course, the intensity of the infection
rises and falls, sometimes in obedience to known causes, as
copulation, sometimes for reasons not yet understood. Dur-
ing the period at which the disease is at its zenith, few ani-
mals fail to show the clinical evidences of its presence, as
shown by Table I, according to which the evidences of the
disease were apparent in 95 per cent. This is no higher
than regularly observed in dairy herds.

The Nodular Venereal Disease in Bulls. Balanitis.
Balano-Posthitis

The nodular venereal disease is the basic cause of balani-
tis, balano-posthitis, or akrobustitis, in the bull. There can be
no distinction of value between infections of the sheath, the
prepuce, and the mucosa of the glans. The continuity and
contiguity of the three areas render inevitable the extension

296

Diseases of the (icnital Organs

w

o

The Nodular Venereal Disease

297

of any ordinary infection from one to the other. Various
mechanical injuries may occur, and an indefinite variety of
infections may invade the area, but the nodules, which are
already present, either complicate or are complicated by
them. Consequently it appears desirable to deal with bal-
anitis as being ordinarily identical with the nodular vene-

Fig. 84— Bull Calf of same age as Fig-. 83.
Grown in ordinary manner on Raw Milk, showing Matted and Stained Pre-
putial Tuft. The body hair is also shown to be harsh and rough.

real disease. This does not prevent or complicate separate
consideration of rupture of the prepuce or other mechanical
injuries, or of such localized specific infections as actinomy-
cosis or tuberculosis, which have already been discussed.

The inflammation of the sheath, prepuce and mucosa of
the glans, due to the nodular venereal disease, is practically
universal in bulls, but the degree of inflammation varies
widely. The ordinary degree plays no visible part in the

Diseases of the Genital Organs

The Nodular Venereal Disease

299

Fig. 86— Penis of Bull showing the Nodular Venereal Disease.

(From same bull as Figs. 126, 127.) /, Glaus showing confluent nodules;

2, fornix ; j, the prepuce reflected, showing solitary nodules;

/, the sheath reflected.

3oo

Diseases of the Genital Organs

problem of reproduction. It existence is evidenced by a
discharge of muco-pus, which flows from the sheath open-
ing and mats together the preputial tuft of hairs, at the
same time staining them a dark, dirty, brownish-black.
(See Figs. 83, 84.) This occurs early in the life of the ani-
mal, but the time of its advent varies largely according to
the environment and health of the calf. In large dairy
herds, where sterility, abortion, calf scours, and pneumonia
are severe, the evidences of balanitis occur with great uni-
formity when the bull calf is twenty to sixty days old, but

FlG. s; Glans of Bull Showing Severe i confluent)
Nodular Venereal Diseases.

in the calves of grade beef cows, which nurse their young
and live in the open, the evidences of genital catarrh appear
tardily and the bull calf may reach four to ten months of
age without showing very marked evidences of matting and
discoloration. Between these extremes, every possible grad-
ation occurs, and wide variations are observed in individu-
als confined in the same stable Once the matting and
ling have developed, they remain permanent throughout
the litV of the bull. The staining of the hairs is "fast" and
can not lie washed out by any ordinary means.

The Nodular Venereal Disease

301

Inspection of the mucosa of the glans, prepuce and sheath
reveals the presence of a few or many small nodules, as in-
dicated in Figs. 85, 86, 87. The number and appearance re-
main static in the calf up to breeding age. Coitus greatly
increases the number of granules, which tend to become
confluent, causing an enormously thickened, roughened con-
dition of the mucosa of the parts. Even with this increase

Fig. 88— Section of a Single Nodule from the Vestibule of the Vagina.
Showing an Elevation in the Mucosa. (Thorns).

of the infection, there is ordinarily no notable interference
with coitus or fertility. Now and then, however, the parts
become so intensely inflamed that the bull hesitates to copu-
late. The attrition of coitus removes the epithelium from
the summits of some of the nodules, creating minute abra-
sions and inducing hemorrhage. In still more severe cases,
the involved mucosa becomes so swollen that the penis can
no longer be protruded, and phimosis becomes established.

302 Diseases of the Genital Organs

The history of the nodules has been studied chiefly by
Thorns. He found them to consist of clumps of cells encap-
suled within the mucous membrane. The cells, which are
mononuclear, can not be differentiated microscopically from
ordinary lymphocytes. The capsule surrounding the cell
mass is not dense, but is well defined and furnishes no
stroma. So far as observed, no capillaries enter the cellular

lii.. 89 Section through four contiguous nodules which cause a
single, rather flat elevation of the surface. (Thorns.

mass, but are confined to the peripheral zone, where they
are large and prominent. (See Figs. 88, 89, 90. 91.)

When the nodules are very numerous and the mucous
membrane is thrown into folds, the nodules projecting above
the surface of one fold may come into contact with those
from the contiguous ridge, and, by attrition, the superficial
of epithelium may be worn away. It is very largely
duo to this secondary lesion that a considerable amount of

The Nodular Venereal Disease 303

muco-pus is formed in many severe cases. These attrition
lesions are also responsible for frequent hemorrhages.

The biology of the nodular venereal disease has not been
satisfactorily determined. Ostertag discovered, in the
muco-pus of the vulvae of cows, a streptococcus which he
believed to be the essential cause of the disease. He intro-
duced the organism, which he had grown experimentally,

Fig. 90 — A knob-like elevation of the mucosa due to several
contiguous nodules. (Thorns.)

into the vulvae of supposedly sound heifers, and believed
that he produced the disease. It is a notable fact that in
Ostertag's experiments, while he believed he had trans-
mitted the disease to cows and heifers by means of pure
cultures, he failed to transmit it to sheep, goats, and swine,
although they regularly suffer from it. It is not clear,
however, just what he accomplished. Doubt is thrown upon

304 Diseases of i lie Genital Organs

his findings by the symptoms and course of the experi-
mental disease which he records, since they are not the
symptoms seen in the first stages of the disease as I have
seen it in hundreds of heifer calves from two to six months
old, as well as in a number of experimental calves. Oster-
tag says : "The first symptoms of infectious vaginal ca-
tarrh are swelling of the vulva, redness, swelling and sensi-

.1 -A section from roof of the Vagina showing marked nodule-
formation without macroscopically visible elevation
of the mucosa. (Thorns.)

tiveness of the vaginal mucosa with a muco-purulent de-
posit." In the earlier stages of the malady, as I have ob-
served it. there arc present none of the symptoms empha-
sized by Ostertag. On the contrary, the disease comes on
insidiously. The first sign is the appearance of a few nod-
ules in the vulvar mucosa, sharply defined above the sur-
rouding epithelium, as pale yellow or colorless transparent
elevations having a vascular girdle about their bases. Some

The Nodular Venereal Disease 305

would call such heifer calves sound, but, if two or three
typical nodules do not indicate the nodular venereal dis-
ease, it would be difficult to understand how two hundred
or three hundred nodules can assure us of the existence of
the malady. In other words, Ostertag describes, not the be-
ginning of the disease, but an "explosion" of the existing
malady under profound irritation. It is not strange that
virulent streptococci induced the symptoms he describes, nor
that he was able to recover from his experimental animals
pure cultures of the microorganism.

The disease is so universal that an investigator is not
warranted in assuming that a given heifer or heifer calf is
not affected. Calves born during severe outbreaks are fre-
quently so badly diseased that they die. Therefore, it is not
unreasonable to assume that in some cases at least calves
are born with the nodular venereal disease. Extended ob-
servations upon the genital organs of veal calves upon the
killing floors of abattoirs show that almost all of them de-
velop clearly and positively the symptoms of the disease at
a very early age, usually within sixty days after birth. It
is not known, however, when the infection really became
established, but only when the clinical evidences became
visible to the naked eye. Recent investigations indicate
that, assuming that the calf is sound when born, which is
not the general rule, it remains free from the nodular ve-
nereal disease if fed upon boiled milk. Such being the
case, it would appear that the infection may enter the or-
gans of new-born calves with the first milk consumed, and
that the appearance of visible lesions in the genital tract
merely marks the duration of time between the ingestion of
the infection and the establishment of the clinical evidences
of its presence. Accordingly, any calf which may be se-
lected for experimental purposes, with a view to determin-
ing the transmissibility of the nodular venereal disease or
the power of any known organism to cause it, can scarcely
be accepted as sound, because it is not known how thor-
oughly the calf is already infected and upon what day the
evidence of such infection would ordinarily appear in the

306 Diseases of the Genital Organs

genital tract. It is not known that these lesions in the geni-
tal tract are the sole or primary lesions of the disease. Va-
rious writers have asserted that these lesions have been dis-
covered in the uterine mucosa, and that the streptococci have
even been found in the ovaries. Streptococci are common in
the genital tracts of animals. The streptococcus which Os-
tertag has described does not differ materially, so far as
may be learned from his description, either in staining or in
cultural behavior, from other streptococci. On the whole,
therefore, the evidence relating to the biology wants some
of the essentials for arriving at a safe conclusion. When
the nodules increase they do so numerically, and when first
observed are of full size. When they disappear, they van-
ish numerically, but those which remain are essentially as
large as ever.

The Relationship of the Nodular Venereal Disease to
Steiilit)/ and Abortion. Isepponi, Zschokke, Hess, and many
others were thoroughly convinced that this infection was
the cause of abortion, sterility, and other diseases of the
genital organs of cows. The evidence which they submit is
clinical, and in large measure circumstantial. When abor-
tion breaks out in a serious form, veterinarians, seeking for
an explanation, tend always to search for any evidence
which may offer an acceptable hypothesis for the occurrence
of the disaster. If the nodular venereal disease has been
accepted at a given time or in a given country as the re-
sponsible cause of abortion and allied disasters, the exam-
iner is very liable to look closely for these lesions, and when-
ever he does so he is certain to find them. He then as-
sumes that the cause of the disaster is revealed, and does
not investigate carefully the character of his evidence. In
fact, the definition of nodular venereal disease, as given by
various observers, differs widely. As a general rule the
diagnosis is not based upon the appearance of nodules in
the vulvar mucosa, but rather upon the number of nodules
and their clinical appearance. Hess, for example, says that
an animal has the nodular venereal disease when there is a
large number of the nodules present in the vulvar mucosa

The Nodular VenerealDisea.se 307

and muco-pus upon the inflamed mucosa. The number of
nodules necessary to warrant the term "numerous," the
amount of inflammation necessary to warrant the diagno-
sis of inflammation, or the amount of muco-pus necessary
for recognition as such, varies with each observer. In
Bulletin 106 of the United States Department of Agricul-
ture, I took as my basis for diagnosis the visible existence
of nodules in the vulvar mucosa. If nodules were present,
were they two or three or even only one, if they were typi-
cal, I classed the individual as infected ; if I failed to recog-
nize any of the lesions, I classed it negative.

Whenever sterility and abortion are highly virulent in a
herd, the nodular venereal disease is intense ; whenever the
rate of abortion is very low, there is a correspondingly low
intensity of the nodular venereal disease. This parallelism
is very striking and suggestive. It constitutes evidence of
a possible relationship between this infection and the breed-
ing disasters, which should not be ignored. However, it is
merely a bit of interesting evidence — not proof.

It has been stated by some observers that, with the ad-
vent of the disease in a herd of cows, abortion broke loose
as a storm. The truth of the matter is that the infection
was discovered after the outbreak of the abortion. There
is no good reason to assume that it had not existed in the
herd from the very beginning. No search was made for it
until the abortion storm broke ; then observation revealed
its presence, and the disease was attributed to it.

Some observers have recorded that in outbreaks of abor-
tion in sows a clinical examination revealed the presence of
the nodular venereal disease. Hence it was said that the
disease had been transmitted from cows to sows and that
thereupon "contagious abortion" broke out. Thus it has
been claimed that, wherever the nodular venereal disease
appears, extensive losses from abortion must follow. Had
the observers taken the precaution to examine the genital
organs of supposedly healthy sows in herds where abortion
did not prevail, there also the disease would have been
found.

308 Diseases of the Genital Organs

Under the circumstances, it seems perfectly clear that
the nodular venereal disease has not been proven to be the
direct cause of sterility or abortion in cattle or in other do-
mestic animals. Whether it does or does not directly cause
sterility or abortion, clinical evidence indicates clearly that
it is a disease which merits the respectful attention of in-
vestigator, practitioner, and breeder.

The avenue and date of infection are not clear. In large
dairies, rich in genital infections, the evidences of the pres-
ence of the nodular venereal disease are well established at
thirty to sixty days after birth. This shows clearly that the
primary infection is not due to coitus. Careful observa-
tion also indicates that the infection is not generally refer-
able to intermediary bearers such as attendants or stable
equipment. Neither can it be ascribed to ordinary cohabi-
tation with other calves or cattle, since calves confined in
isolated stalls suffer the same as other animals. Experi-
mentally I have kept calves in close proximity to diseased
cattle, all cared for by the same attendant, with no special
precautions, without any evidence of transmission. My
experiments indicate with great emphasis that the infec-
tion which appears so uniformly in the young calf is blood-
borne from the alimentary or pulmonary tract, and its de-
velopment may be accelerated, controlled, or prevented at
will by the method of feeding. When the grade beef cow
nurses her calf in the open field, it does not so promptly
nor so markedly develop evidences of infection. The higher
the intensity of calf scours and pneumonia in a stable, the
more prompt and intense are the evidences of the nodular
venereal disease. When the health of the calf is better, but
there are adhesive feces, a rough lustreless coat, pot-belly,
and a hacking cough, the advent of the genital catarrh is
later and less marked. If the calf Is born in good health,
and diarrhea, indigestion, hacking cough and general un-
thrift are avoided, the evidences of the disease do not ap-
pear for several months.

While it has not been proven that the nodular venereal
disease is the cause, or an important cause, of sterility or

The Nodular Venereal Disease 309

abortion, it is still true that sterility, abortion and calf dys-
entery run parallel with the nodular venereal disease.
Calves thirty to sixty days old do not suffer from dysentery
or pneumonia if they are free from the clinical evidences of
the nodular venereal disease. New-born calves break down
with dysentery before the signs of the nodular venereal dis-
ease are established. If the evidences of the disease are
present, the calf exhibits one or several of the following
symptoms : dysentery, torpidity of the bowels alternating
with diarrhea, sticky feces adhering to the hairs of the tail
and buttocks, pneumonia, a hacking cough, lustreless coat,
and pot-belly. When such a calf reaches breeding age, its
fertility is uncertain.

It is highly interesting to observe that, in applying the
agglutination test for B. abortus to the blood of calves, the
reactions are parallel to the manifestations of the nodular
venereal disease : the blood of calves severely infected re-
acts highly to the B. abortus test, and vice versa. The sig-
nificance of this parallelism is undetermined. By no means
does it show that the B. abortus is or is not the cause of these
lesions. It is not known to what degree blood samples from
the same animals may react to the agglutination test for the
streptococci, colon-like bacilli, micrococci, and other bacte-
ria commonly recognized in the genitalia of cattle.

The most important consideration regarding the nodular
venereal disease, pending scientific study of the problem, is
that it causes important disease of the copulatory mucosa
(balanitis, posthitis, colpitis, vaginitis) which produces def-
inite injury. Frequently the disease is so severe that it
causes recognizable pain in coitus, followed by hemorrhage
owing to the summits of the nodules becoming removed by
attrition. Each of the multiple small abrasions constitutes
an open and inviting avenue for infection by any agent pres-
ent. In the bull the mucosa may be so severely swollen that
phimosis is established and coitus is barred. The vulva of
the heifer is frequently so inflamed that it bleeds under
gentle digital palpation, and the vulvo-vaginal mucosa is
covered over with much stringy, tough muco-pus. What-

310 Diseases of the Genital Orgayis

ever may be the final decision as to the significance of the
nodular venereal disease, these definite injuries should be
recognized and preventive or ameliorative measures applied.

The prognosis of the nodular venereal disease is good. It
can not be definitely cured by any known means, but it may
be controlled and its power for harm mitigated. It is im-
practicable at present to prevent it wholly, but the proper
handling of new-born calves does, for all practical purposes,
render it harmless so far as now known. The handling of
the nodular venereal disease is based upon application of
adequate measures for the healthy rearing of calves and for
sex hygiene in adults.

Considering the nodular venereal disease as one which at-
tacks the new-born calf and continues throughout the ani-
mal's life, the most fundamental necessity is to grow the
calf so that the infection will not develop in a serious form.
This can be done only by strict attention to the feeding and
other hygienic questions, which will be more thoroughly
discussed in Section 3 of Part III, under "Congenital In-
fections of Calves." Here the invasion may be controlled
in such a manner that it tends to protect the animal against
the more severe type of the disease during its adult life.

The disease is so highly infectious, however, that the ul-
timate control must include proper sex hygiene in the adult
of each sex. In the bull the handling of the nodular vene-
real disease resolves itself into the control of balanitis, or
balano-posthitis. Here handling should be preventive or
controlling rather than curative. It is just as necessary to
control the disease from the standpoint of secondary as from
that of the primary disease itself. If the disease is per-
mitted to acquire great intensity, so that the summits of
the nodules become denuded of their epithelium, a gateway
fin- various in feet ions is opened, imperiling the sex health
of the animal. The breeding bull should always be viewed
from the standpoint of a male which is expected to copulate
with an indefinite number of females, each of which, since
she may bear infections within her genital tract, is a poten-
tial danger for the male. He in turn, after such exposure,
carries an equal peril for the female.

The Nodular Venereal Disease 3 1 1

The handling of balanitis consists essentially of cleanli-
ness. It has been stated that genital catarrh is essentially
universal in bulls. While its presence has been ignored
generally, there should be no doubt regarding its importance
in relation to the reproductive functions. Whenever the ca-
tarrh becomes at all advanced, the epithelium upon the sum-
mits of the granules or nodules becomes damaged and af-
fords an avenue for the entrance of other infections. It is
probably largely through these lesions that primary genital
tuberculosis is established, as has already been stated in
Chapter XIII. Consequently it is important, for the sexual
health of both the bull and the cows with which he copu-
lates, that the genital catarrh shall be held in abeyance at
all times and not permitted to become so exaggerated as to
interfere with coitus. According to present knowledge, it
seems highly probable that, when the genital catarrh of the
bull becomes severe, its existence must be inimical to the
welfare of the female with which he copulates. The infec-
tion, introduced deeply into the vagina, necessarily remains
behind, adding to the infection already present. While we
do not know the exact significance of the infection, it is im-
possible to conclude otherwise than that it is detrimental.

The best method at present available for maintaining the
health of the prepuce, sheath and glans is by douching the
parts at frequent intervals, say two or three times a week,
when the bull is at rest, and thoroughly douching the parts
just prior to and immediately following each service. The
best apparatus for carrying out the douching plan is an or-
dinary agate hospital irrigator of one gallon capacity, to
which a pure gum douching catheter is attached. This in-
strument, the diameter of the ordinary horse catheter and
seven feet long, has the end rounded so that it may be intro-
duced freely and safely into the sheath and prepuce. It is
made of pure soft rubber, which is smooth, pliable, and re-
sistant to hot water, so that it may be repeatedly boiled for
purposes of sterilization'.

1 Upon my request, the firm of Sharp & Smith, Chicago, have placed in
stock a catheter of the dimensions stated. It is of sufficient length that,
when the irrigator is suspended above the bull, it is abundantly long for in-
sertion into the sheath.

312 Diseases of the Genital Organs

The technic of douching is very simple. The irrigator is
filled with a warm physiological salt solution ( 1 oz. common
salt to 1 gal. water) to which may be added with benefit 14
of 1 per cent, of Lugol's solution. The irrigator is then sus-
pended two or three feet above the back of the bull and the
catheter gently inserted through the sheath into the prepuce.
The insertion is facilitated by the application of a small
amount of lard or oil. The douching fluid should be allowed
to flow slowly from the catheter before it is inserted into
the sheath, in order that all air bubbles shall be forced out.
Once introduced, the fluid is permitted to flow freely into
the sheath and prepuce. At the same time, the operator
should grasp the opening of the sheath and compress it so
that the fluid may not escape. This causes the sheath and
prepuce to become thoroughly distended, the many complex
longitudinal folds of the mucous membrane to become ob-
literated, and the fluid to come in contact with every part.
When the sheath has become thoroughly distended, the
operator should suddenly release the compression on the
sheath opening and permit the fluid to escape. As soon as it
has all escaped, he should again compress the mouth of the
sheath and repeat the operation several times, in order to
insure thorough mechanical washing.

In numerous publications from apparently authentic-
sources, directions are given for douching the sheath and
prepuce of bulls, of which it is impossible for me to approve.
Writers frequently state that the douching can be carried
out successfully by using a piece of ordinary rubber tubing.
In my judgmenl this is not true. The ordinary rubber tub-
ing is mixed with lead and other diluents which render it
very rigid and harsh. Since the end is cut squarely, and
frequently roughly, any attempt to push the tubing into the
upper part of the sheath and into the prepuce inevitably
abrades the inucosa. I think the use of a piece of ordinary
rubber tubing can not be too strongly condemned. If the
work is worth doing at all. it should be done in a surgical
manner with an appliance suitable for the task.

Another very common error, according to my view, is the

The Nodular Venereal Disease 313

advice of some writers that a force pump should be used for
douching. A pump is exceedingly difficult to keep clean.
It almost inevitably becomes dirty. Most pumps are not
subject to disinfection or to sterilization by boiling. With a
pump there is always danger of including in the douching
fluid air bubbles, which may flow into the sheath and pre-
puce under great force, giving the animal a shock which
causes him to move suddenly with danger of injuring both
himself and the operator. The pump is also an extravagant
appliance. With the irrigator, the douhcing can be carried
out readily by one man, whereas with the force pump two
men are necessary. Ordinarily a bull is well accustomed to
one man, and that one can manage him better alone than in
the presence of others.

It is frequently asserted that certain bulls will not permit
the douching without violent and stubborn resistance. I
have not found this to be true. Repeatedly, caretakers have
been exceedingly dubious about their ability to douche the
bull, but with such an apparatus as I have described, and
with ordinary prudence in handling the animal, I have
found that the douching can be carried out without violence
on the part of the animal. He will stand for the douching
as well as for grooming. The success of the douching de-
pends upon gentleness and tact on the part of the operator
and his having at hand suitable equipment for the work.
Failures in douching, so far as I have known, have always
been due to lack of proper apparatus or to faulty method,
or in some cases to faulty solutions used. The douching
fluid should always be warm — not hot — and should be
wholly free from irritation. Some writers advise a strong
disinfectant. These always prove highly irritant and serve
to infect instead of disinfect. That is, an irritant disinfect-
ant introduced into the sheath and prepuce destroys the
protective epithelium of the part, and the dead cells re-
maining supply a new and fertile field for the multiplication
of bacteria. It is impossible to disinfect wholly the genital
mucosa, and no such vain attempt should be made. Instead,
a high degree of mechanical disinfection should be obtained
by using a neutral or slightly bactericidal douche.

314 Diseases of tlie Genital Organs

When the balanitis becomes severe and coitus becomes
difficult or impossible, the douching should be carried out
diligently, once or twice a day, according to conditions.
Great care should be taken not to use an irritant douche.
There is a great tendency among some veterinary practi-
tioners, when the infection of the sheath and prepuce be-
comes marked, to attempt to disinfect with some very pow-
erful solution. These only intensify the disease present. In
one case where I was consulted, the attending veterinarian
had used 10 per cent, silver nitrate, 5 per cent, compound
cresol, a strong solution of lysol, and other disinfectants.
Each change was for the worse and the highly valuable bull
had been pronounced incurable and slaughter advised. A
mild douche, such as advised above, ameliorated the symp-
toms very promptly. Within fifteen days the bull was back
at work in prime condition, and remained competent and
fertile.

Whenever balanitis is severe, a bull should be taken out of
service and kept as free from sexual excitement as possible
until the severe symptoms have abated.

The general principles in controlling the disease in the
female are essentially the same as in the male. In breeding
heifers for the first time, it is important and prudent to ex-
amine the vulva and vagina carefully, in order to determine
the intensity of the disease. Frequently it is found to be so
intense that there is considerable muco-pus present before
coitus has occurred. If such be the case, it is important that
the intensity should be ameliorated by flushing the vagina
three or four times a week with a warm, physiologic salt
solution, to which has been added 1 \ to ' •> per cent, of Lu-
gol's solution or of chlorazene.

After coitus has occurred and time has been given for the
spermatozoa to pass out of the vagina and through the cer-
vical canal on their way to the oviducts, the vagina should
!•<■ douched in order to overcome the irritation of coitus. It
lias already been stated that tin's irritation is very profound
and causes a tremendous increase in the number of nodules,
in the inflammation of the mucosa, and in the amount of

The Nodular Venereal Disease 315

muco-pus present, so that the vulva of the heifer presents
an appearance which shows very definitely the fact that she
has copulated. By timely douching, this irritation and ex-
plosion of the infection may be obviated. It is quite safe to
douche within four or five hours after coitus. The evil ef-
fects of coitus may be controlled by douching at any time
after the period named up to about twenty-four hours. The
control may be rendered more complete by repeating the
douche at intervals of twenty-four hours for three or four
times. It may then be omitted. The control of the disease
at any period in the sexual life of the animal may be brought
about in a similar manner. Whenever the irritation is
marked, the vagina may be douched with a very mild anti-
septic two or three times a week, and such douching may be
continued indefinitely. There is an old prejudice, sometimes
still revived, against douching the vagina for fear of causing
abortion. No reason exists, so far as I know, why such re-
sult should follow a vaginal douche. Clinically I have seen
no tendency whatever for the douching to produce any ill
effects. It is a valuable hygienic and economic measure,
when properlly carried out, especially upon cows which are
constantly confined in the stable. While douching the va-
gina, the operator also washes the exterior of the vulva and
keeps the parts clean.

In douching the vaginae of cows, one must take care not
to transmit from one to another some important form of in-
fection. Under proper precautions as to cleanliness, no such
danger ordinarily exists. Since the infections in a given
herd are fairly uniform, there is very little danger that one
female has a more serious genital infection than her neigh-
bor. There are, however, important exceptions. In a herd
where tuberculosis exists and an animal chances to have
genital tuberculosis, douching her vagina and then the va-
ginae of other females without thoroughly disinfecting
would be highly perilous. However, as, under proper veteri-
nary supervision, no cow with genital tuberculosis should
exist in the herd, such an exposure is unjustifiable. The
same conditions apply to the vesicular venereal disease,

3 16 Diseases of the Genital Organs

which has been described previously. Careless douching
would spread this infection rapidly throughout the entire
herd. As with tuberculosis, this is wholly unjustified, be-
cause the animal with vesicular venereal disease should be
in strict quarantine.

Perhaps the greatest danger involved in the general
douching of a herd is from those animals which may have a
very virulent infection of the genital organs, as retained
afterbirth or pyometra. Here again the prudent veteri-
narian places the seriously infected animal under efficient
quarantine and before an apparatus is used for douching
virtually sound animals, except for moderate nodular vene-
real disease, it is to be thoroughly disinfected by boiling.

The best method for douching the vagina and washing
the exterior of the vulva is by means of a gravity apparatus
suspended from an elevated track behind the row of cows.
Depending upon the size of the herd and the surroundings,
one may use a five-gallon pail with a faucet or a barrel of
the most convenient size, attaching to it a soft rubber horse
stomach tube. The vessel is filled with the desired solution
and elevated upon the track approximately two or three
feet above the backs of the cows, the tube is inserted into
the vagina for a sufficient distance, and the fluid is per-
mitted to flow in rapidly until the vagina fills and the wall
contracts and expels the fluid. Before inserting the tube
into the vagina, the exterior of the vulva should be washed
with sufficient care to avoid dragging any large particles of
dirt into the vagina. By such a plan, the breeder or dairy-
man has it in his power to mitigate and control the severity
of the nodular venereal disease. With proper equipment,
the application of these hygienic measures is neither diffi-
cult nor expensive. One man can readily douche the vagi-
nae of forty to sixty cows an hour, and do it reasonably well.

CHAPTER XIII

NON-VENEREAL INFECTIONS WHICH INVADE
THE GENITALIA

1. Genital Actinomycosis

Although actinomycosis may invade any organ in the
body, it rarely involves the genital system. Apparently
this is not due to any notable resistance of the genital or-
gans against this- infection, but rather to the comparative
infrequency of exposure. Actinomycosis of the genital or-
gans of cattle does occur, possibly with greater frequency
than recorded diagnoses would indicate. Clinically. I have
observed actinomycosis of the prepuce, sheath, and inguinal
lymphatics in a bull. There was present in the prepuce an
actinomycotic mass five or six inches in diameter and in the
peripenial and inguinal lymph glands several actinomycotic
masses. One instance of penial actinomycosis in the bull
has been brought to my attention, in which there was upon
the glans an actinomycotic tumor about one inch in diame-
ter. The veterinarian under whose observation the case oc-
curred very naturally diagnosed penial tuberculosis.

I have seen two clinical cases of genital actinomycosis in
cows. In my first case there was merely the history of ster-
ility in a highly valued pedigreed cow regarding which a
colleague called me in consultation. There were extensive
pelvic adhesions, with indistinct outlines of the genitalia
and large, indurated abscesses in the mesometrium. Since
the animal was evidently incurable, she was slaughtered.
Autopsy revealed several sclerotic abscesses, three to four
inches in diameter, located in the mesometrium, with other
abscesses in the liver. Histologic search showed that the
abscesses were actinomycotic in origin. No definite avenue
of invasion was determined.

My second case of genital actinomycosis was in a cow that
had calved and had suffered from retained placenta. I at-
tended her and removed the placenta manually. Apparently
she did well for a time but after a few months, as she failed
to breed or to show estrum, she was again examined. I

3i3

Diseases of the Genital Organs

PlG. 92 Genital Actinomycosis. Cow.

Above, dorsal view of genito-urinary tract showing irregular enlarge-
ment and extensive pelvic adhesions; below, median longitudinal section
through genito-urinary tract. /, Vagina ; j, os uteri externum ; 3, base of
left uterine horn ; 7, apex do; 5, actinomycotic uterine body; 6, actino-
mycotic al in uterine horns; -, \ cross sections of actinomycotic
oviducts; <j. actinomycotic abscess m ovary; /o, corpus luteum ( var.
nigrum) ; //, //. actinomycotic invasion of urinary bladder.

Non- Venereal Infections which Invade the Geniia/ia 319

found complete pelvic adhesions and a greatly enlarged
sclerotic, and irregular uterus. I diagnosed tuberculosis
and advised immediate slaughter. Inspection revealed that
the disease was confined wholly to the genito-urinary organs
and that the lesions were actinomycotic. The general ap-
pearances are illustrated in Fig. 92.

Accurate clinical diagnosis of genital actinomycosis is dif-
ficult. Sometimes it closely simulates tuberculosis. Here the
tuberculin test may greatly aid, but tuberculosis may exist
in other organs and cause a reaction although the genital
disease is actinomycotic. In some advanced cases of tuber-
culosis with involvement of the genitalia, tuberculin causes
no reaction. There occur also in sclerotic metritis due to
common pyogenic invasions pelvic adhesions with abscesses
closely resembling genital actinomycosis. Ordinarily an
accurate clinical diagnosis as to species of infection is not
demanded. The lesions render the case hopeless and dic-
tate slaughter. Then should follow accurate post-mortem
diagnosis, in the interest of contact animals.

Rarely the disease may be. amenable to treatment, but for
this purpose needs to be diagnosed early and surgical and
medicinal interference promptly put into effect according
to the general plan for handling actinomycosis of other or-
gans : the seriously diseased tissues should be surgically re-
moved and potassium iodide administered internally. When
the disease involves the glans penis of the bull, the affected
part may be successfully amputated, as described for ma-
lignant neoplasms of the penis.

2. Genital Tuberculosis

Tuberculosis of the genitalia of cattle has generally been
considered as rare and of scant scientific and economic im-
portance. William Williams1 states, "If the cow be in calf,
abortion is apt to occur; if not pregnant, the condition
called nymphomania is frequently present." Law- states,
"The generative organs also occasionally suffer (from tu-

1 Principles and Practice of Veterinary Medicine, 1875, p. 347.

2 Vet. Med., Vol. IV, 1902, pp. 44S, 449.

320 Diseases of the Genital Organs

berculosis), in which case an early and rather persistent
symptom is sterility, with a too frequent, or it may be per-
sistent desire for the bull (nymphomania). * * * In
cases of uterine tuberculosis, the nymphomania may be
supplemented by a purulent discharge. * * * Genital
tuberculosis in the bull is associated with nodular swelling
of the testicle, epididymis, or cord, hydrocele, and excep-
tionally tubercle on the penis or in the prostatic sac."
Friedberger und Frohner1 state that genital tuberculosis
occurs rarely in both sexes and may invade any portion of
the genital system. Hutyra und Marek- mention the occur-
rence of tuberculous epididymitis and orchitis, sometimes
accompanied by tuberculous abscessation of the testis, with
a consequent fistula. They consider penial tuberculosis as
extremely rare, and claim that when it occurs the glans
penis becomes studded over with tubercles. Quoting Hess,
they regard uterine and tubal tuberculosis as rare and as
causing sterility and nymphomania. Vulvo-vaginal tuber-
culosis is mentioned as a rare possibility. Hoare : describes
genital tuberculosis very briefly, without according it an
important place. He admits the possibility of transmission
by copulation. He mentions a single case of primary penial
tuberculosis.

Most veterinary literature concerning genital tuberculo-
sis is in sharp contrast with my personal observations. The
difference in view is possibly due to a variation in the di-
rection of study. Veterinarians rarely look for genital tu-
berculosis, since ordinarily it does not affect the general
well-being of the patient. Clinically, it is only when one
concentrates his observations upon the diseases of the geni-
tal organs in connection with sterility that he recognizes
genital tuberculosis and realizes its importance. The geni-
talia are not inspected frequently in the abattoir. They are
not used as human food. When they are tuberculous, the
lesions possess little or no importance in relation to the
1 Speciellen Pathologle and Therapie.

Spezielle Pathologie und Therapie der Haustiere.
tern of Veterinary Mi-dicine.

Non- Venereal Infections which Invade the Genitalia 321

value of other tissues for food. Hence, much genital tuber-
culosis may pass unnoted.

The genital mucosa offers a highly vulnerable field for
tuberculous invasion, but genital exposure to tuberculosis
is rare as compared with exposure through contaminated
food. That is, when open pulmonary tuberculosis exists,
the patient is constantly contaminating mangers, food, and
water by means of her sputum, so that companions are ex-
posed daily and hourly. When genital tuberculosis exists,
the exposure may be identical, because of the genital dis-
charges contaminating food and water, but the special ve-
nereal exposure occurs only during the very brief period of
copulation.

I have not observed tuberculous orchitis or epididymitis.
There is no example of either in my pathologic collection of
genitalia, and no specimen in the collection of any depart-
ment of the college. The scattered records in veterinary
literature of tuberculous orchitis and epididymitis do not
serve as a very accurate basis for outlining the clinical
symptoms. In a general way, it is stated that the epididymis
and testes show painless enlargement and hardening. The
demarcation between the epididymis and the testis gradu-
ally becomes clouded, and finally is lost. Apparently the
epididymis usually becomes involved first, and the disease
extends thence to the gland. The tuberculous process is
said to be located usually in the parenchyma, having its
basis in the mucosa of the epididymis and testis. In this
manner the disease may be well advanced before peripheral
inflammation or tuberculous extension involves the peri-
toneal coverings, to cause adhesions and hydrocele. Rarely,
abscessation is said to ensue, resulting in a fistula.

The clinical diagnosis of tuberculous epididymitis and
orchitis is difficult. Painless tumefaction of the testis is not
characteristic of tuberculosis, but may ensue from various
pyogenic infections. Peritoneal adhesions, hydrocele, and
abscessation are quite as probable, if not more so, from other
infections than from tuberculosis. Next to the excision of
the testis and its examination, tuberculin offers the best

322 Diseases of the Genital Organs

means for diagnosis. As is well known, tuberculin has its
limitations, and may fail. If the patient responds to tuber-
culin, the evidence of tuberculous epididymitis or orchitis
is not complete. There may be tuberculous lesions in other
organs, causing the response to tuberculin, while the lesions
in the epididymis and testis may be non-tuberculous. When
but one testicle is involved, its removal and histo-biologic ex-
amination offers by far the most reliable means for diag-
nosis. If the disease has existed for some time, the re-
moval of the testis is in no case an economic waste, because
as a general rule chronic epididymitis or orchitis signifies
permanent loss of function of the involved gland. Its re-
moval is the best curative measure and the greatest avail-
able protection for the other testicle and for the breeding
life of the bull.

The path of tuberculous invasion of the epididymis and
testis has not been clearly learned. The infection is not
primary. It does not seem to be secondary to penial infec-
tion. While I have observed several cases of primary penial
tuberculosis, I have not noted subsequent tuberculous epidi-
dymitis or orchitis. It appears highly improbable that the
tubercle bacilli would traverse the long urethra and vas
deferens and reach the epididymis without leaving behind
evidences of its passage in the form of penial or urethral
tuberculosis. When the infection is wholly within the tu-
bules of the epidymis or testis, as appears usually to be the
case, the invasion is apparently not direct from the perito-
neum. When the scrotal peritoneum is first involved, it
would appear probable that the invasion occurred from the
peritoneal cavity through the open inguinal ring. Appar-
ently most instances of tuberculous epididymitis and or-
chitis are referable to hematogenic sources and constitute a
part of generalized tuberculosis.

The prognosis for the involved gland is hopeless. If only
one gland is involved, it may be successfully removed, leav-
ing the bull perfectly fertile. The difficulty is that, since
the tuberculous epididymitis or orchitis is usually a second-
ary rather than a primary lesion, the basic lesion remains

Non- Venereal Infections which Invade the Genitalia 323

and probably unfits the bull for breeding except when mated
with infected cows held under the Bang plan. Even in such
cases, it needs to be determined that the vas deferens, vesi-
culae seminales, prostate gland, and penis are free, or the
bull becomes a serious menace even to tuberculous cows, be-
cause when such parts are involved tubercle bacilli may be

Fig. 93— Tuberculosis of Sheath and Prepuce of Bull.

S, Sheath ; U, urethra ; G, glans ; F, fornix ; CC, corpus cavernosuni,

/, /, fissure extending into tubercular mass.

ejaculated with the semen from the sound testicle, inducing
primary genital (venereal) tuberculosis in the cow, which
may promptly bring her breeding life to a close.

Tuberculosis of the vas deferens, seminal vesicle, and
prostate is possible, but apparently too rare to be of great

324 Diseases of the Genital Organs

economic importance. Tuberculosis of the vesiculae semi-
nales or prostate would tend to interfere with urination and
copulation (ejaculation). The diagnosis of tuberculosis of
these parts would be based necessarily upon rectal palpation.

Penial Tuberculosis. Penial tuberculosis is comparatively
common in the bull. The corpus cavernosum, urethra, and
urethral mucosa are not involved as frequently as the sub-
mucosa of the glans, prepuce and sheath, and the adjacent
penial lymphatics.

Tuberculosis invades any organ far more readily when
the protective epithelium is wounded. The anatomy of the
copulatory apparatus of the bull and the mechanism of copu-
lation render epithelial injuries more probable elsewhere
than in the mucosa of the glans penis itself. The penis of
the bull (and of ruminants generally) is very firm. The
transverse diameter and the rigidity of the penis are but
slightly modified by erection. The protrusion of the penis
during copulation is brought about almost wholly by the
elimination of the sigmoid flexure (See Fig. 99), the ac-
complishment of which requires the relaxation of the re-
tractor penis muscle. When at rest, the penis lies within
the prepuce, above the sheath. As a rule, no distinction is
drawn between the mucosa of the sheath and that of the
prepuce, although they have a wholly different embryologic
history. The sheath exists as a distinct structure at the
time of birth ; the prepuce does not. In the new-born rumi-
nant and porcine male, the sheath constitutes a compara-
tively short infundibulum, terminating at the bottom in the
meatus urinarius (Fig. 8, page 14, and Fig. 9, page 15).
No pari of the glans penis is exposed. At the time of birth,
the two layers of mucosa, one of which is later to form the
mucosa of the glans penis and the other the mucous mem-
brane of the prepuce, are firmly adherent to each other.
Later, when sexual maturity approaches, the tissue between
the two layers of mucous membrane, which serves to bind
them together, slowly gives way, and the preputial sac
finally becomes established. In the abattoir, one may ob-
in veal calves every gradation of the development of

Non- Venereal Infections which Invade the Genitalia 325

the prepuce. The gradations may be seen also in castrated
males (Fig. 9a, page 16). The preputial sac may be totally
absent, or there may be any degree of development, accord-
ing to the stage of sexual development at the time of castra-
tion. The anatomy and the mode of protruding the penis
during coitus have been described on page 14. The coital

Fig. 94 — Rupture of Prepuce From Coital Violence.

CC, Corpus cavernosum : F, fornix ; P, prepuce ; G, glans ; U, urethra ;

R, coital rupture. At the right end of the rupture the ruptured

border of the prepuce is folded upon itself.

thrust of the bull is vigorous, or sometimes so violent that
the prepuce is torn or ruptured, as shown in Figs. 61 and 94.
The abraded or ruptured portion is withdrawn at once, with
the retraction of the penis, and any infection which has en-
tered the wound is carried along.

pIG- 95 — Tuberculosis of Glans and Prepuce.
G, Glans ; P, prepuce ; F, fornix ; / ', urethra ; CC, corpus
cavernosum ; Tb, tubercle in tip of glans ; A, tuber-
cular abscess in prepuce.

326 Diseases of the Genital Organs

The superficial genital mucosa of the bull, as well as that
of the ram and the boar, is further exposed to abrasions and
consequent infection by the presence of the granules or
nodules of the granular venereal disease — a chronic infec-
tion which is essentially universal. The granules or nodules
frequently become inflamed, especially from excessive coitus,
the epithelium at the summits of the granules becomes
abraded, and hemorrhage ensues. It is not rare to see the
granular venereal disease so severe that the parts bleed
after each coitus, if the bull will copulate. Sometimes the
pain is so great that he refuses to copulate; sometimes the
swelling of the sheath is so great that the penis can not be
protruded — the bull has phimosis.

Therefore, in addition to the very delicate epithelium of
the genital mucosa, the prepuce itself may be ruptured, or
a multitude of minute abrasions may occur at the summits
of the granules regularly present. These abrasions offer
special facility for invasion by pathogenic bacteria. If the
cow is afflicted with tuberculous genital catarrh, any abra-
sions existing upon the penis, prepuce, or sheath of the bull,
or occurring at the time of copulation, invite tuberculous
infection. The entire group of such tuberculous infections
may be classed as primary venereal or coital tuberculosis.
Primary tuberculosis of the copulatory organs of the bull
may involve any tissue or part contributing to the copula-
tory apparatus. The principal types I have observed are:

(1) Tuberculosis of the glans penis,

(2) Sheath tuberculosis,

(3) Preputial tuberculosis,

(4) Tuberculosis of the penial lymph glands.

(1) Tuberculosis of the glans penis is not very rare. I
have observed two cases clinically, and others in the abat-
toir. One clinical case was in a large Holstein herd bull.
For some months, he had been unable to copulate with small
or medium-sized cows, but could do so successfully with
large cows with commodious vulvae. Attempts at copula-
tion were generally followed by a limited amount of hemor-
rhage. The glans penis was enlarged, especially at its apex.

Noyi- Venereal Infections -which Invade the Genitalia

327

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328 Diseases of the Genital Organs

The surface was dark-colored, congested, somewhat eroded,
and suppurating slightly. Inability to copulate was appar-
ently referable to the combination of four factors — the en-
largement of the glans; the roughening of its surface, due
chiefly to the destruction of the epithelium, thus hindering
the introduction of the glans into the vulva ; the pain ; and
the flaccidity of the diseased area. The penis was protruded
readily. When the bull was confined upon the operating
table, the penis could be pushed out of the sheath and pre-
puce by forcibly effacing the sigmoid flexure. When thus
forced out and securely grasped so that the part could be
closely inspected, it was seen that the apex of the glans for
a distance of about 3 inches was much inflamed and en-
larged, and bled readily upon touch. The diseased tip was
dark livid, the epithelium largely destroyed, and the surface
contaminated by purulent exudate. The appearances were
strongly suggestive of tuberculosis. The diseased tip of the
glans was amputated. The histologic appearances were
those of tuberculous lesions, and stained smears showed
tubercle bacilli. The operative wound progressed very fav-
orably for a time, and the bull was promptly discharged
from the clinic, apparently on the safe road to recovery.

The patient belonged to a breeder devoid of serious regard
for the control of tuberculosis. It was understood that the
disease was rampant in his herd and that he was more con-
cerned about concealment than about control. I was unable
to follow the case. Apparently the patient, valued at about
ten thousand dollars, had contracted the infection by copu-
lating with a cow having genital tuberculosis. After becom-
ing infected, he was evidently a very serious menace to any
healthy cow with which he might copulate. The venereal
peril was limited chiefly by the fact already related, that he
could not copulate with most cows and heifers, but only with
those having commodious vulvae. The attitude of the owner
prevented any investigation of the herd in an effort to learn
whether any harm had come to cows from copulation with
this animal. So far as I have observed, he was one of the
most dangerous bulls I have seen with genital tuberculosis,

Non- Venereal Injections which Invade the Genitalia, 329

because in most cases copulation is promptly and absolutely
excluded and venereal transmission thereby avoided.

A very interesting abattoir specimen is illustrated in
Fig. 61, in which there has been a rupture of the prepuce
and also tubercular infection at the tip of the glans penis.
The rupture of the prepuce probably furnished the avenue
for the tuberculous invasion.

Tuberculosis of the submucosa of the glans is illustrated
in Fig. 96. This specimen shows numerous tubercles in
the submucosa. They were not recognizable clinically. The
disease was brought to a crisis by the larger tuberculous
abscesses in the prepuce and about the base of the glans,
which rendered protrusion of the penis impossible.

(2) Tuberculosis of the penial sheath is presumably rare.
In my collection I have but one well defined specimen. It
was obtained from the abattoir and is without clinical his-
tory. Fig. 93 indicates that penial incarceration occurred
early, rendering the animal impotent and causing him to
be sent to the shambles. Clinically, the condition could not
well have been differentiated, upon ordinary examination,
from other infections of the sheath wall, especially actino-
mycosis. Amongst chronic infections, however, tuberculo-
sis is by far the most probable, and a provisional diagnosis
of tuberculosis should be made. The tuberculin test may
serve as an aid, but is subject to severe limitations. If it is
reasonably certain that the bull was tubercle-free prior to
the development of the lesion, the test possesses great value.
Exploratory incision through the external skin, and the re-
moval of material for bacterial and inoculation studies, is
of great diagnostic value.

So long as the bull can protrude the penis and copulate,
he constitutes a serious menace. Since the infection is pri-
mary, and the fundamental lesion in the mucosa is natu-
rally open, any tuberculous excretions occur within the
sheath. The glans penis inevitably becomes contaminated,
but not necessarily infected. In copulation, however, the
surface contamination is carried into the vulva and vagina
of the female. In protruding the penis, as will be under-

33°

Diseases of the Genital Organs

stood by studying Figures 10, page 17, and 11, page 18,
until the swelling becomes too great for copulation to occur,
the sheath mucosa is reflected, and when the penis is fully
protruded the tuberculous membrane itself, constituting the
covering of the penial base, enters the vulva of the cow dur-
ing coitus.

Fig. <■)-, —Tuberculosis of the Glans and Prepuce.
P, Prepuce; F, fornix ; '/'/>, tubercular masses.

Accordingly it is essential that great care be exercised in
making a diagnosis when inflammatory conditions of the
sheath exist, and that every available means be taken to
eliminate the question of tuberculous infection. However,
one must not carelessly incise the sheath deeply, for diag-
nostic or other reasons, lest the resultant cicatrix incarcer-
ate the penis. If tuberculosis is diagnosed, the bull should
be excluded from service, even to reacting cows, and
promptly sent to slaughter.

el) J'ri initial tuberculosis is apparently less common

Non- Venereal Infections which Invade the Genitalia 331

than tuberculosis of the glans or of the sheath. The prepu-
tial membrane, which is far more delicate than that of the
sheath, is exposed during copulation to special injury at
the base of the glans. At this point the epithelium of the
glans becomes reflected, to constitute the lining epithelium
of the preputial sac. At the moment of the copulatory
thrust, the parietal, or outer preputial membrane is sud-
denly and violently reversed, to constitute the covering of
the penis from the base of the glans backwards for a dis-
tance approximately equal to the length of the glans itself.
Further back, the sheath mucous membrane succeeds, the
prepuce as the mucous covering of the protruded penial
body. The prepuce and the sheath mucosa become completely
reversed. That end of the sheath mucosa which, while the
penis was at rest, was situated most anteriorly now be-
comes most posterior. The mucosa of the sheath and of the
prepuce become reversed in relation to each other. When
the penis is at rest, the prepuce is behind the sheath, but
when the penis is protruded the prepuce is in front of the
reversed sheath mucosa. Accordingly the prepuce, at the
point of its attachment to the base of the glans, is one of
the most vulnerable areas at which tuberculosis and other
infections may effect an entrance. When infection occurs,
it usually leaves scant trace in the epithelium of the glans,
but involves chiefly the lymph glands of the submucosa.

As soon as infection occurs and inflammation is estab-
lished, the loose areolar tissue between the prepuce and the
external dartoid sheath becomes involved, adhesions occur,
and the penis is incarcerated. By studying Figures 8-11,
pp. 14-18, it will be seen that as soon as such inflammatory
adhesions become established copulation is at an end, be-
cause the preputial wall can not become reflected upon the
body of the penis. The adhesion of the outer with the inner
layer at the base of the glans serves to hold the penis firmly
in its retracted position.

Clinically, the lesion is probably not usually observed un-
til well established. That is, the infection probably goes
unobserved even though several copulations are made dur-

332

Diseases of the Genital Organs

ytf^-7 '

Non- Venereal Infections which Invade the Genitalia 333

ing the few succeeding days. When the lesion has reached
a certain development, a given copulation, especially with a
heifer, irritating the lesion severely, sets aflame the estab-
lished infection. Then the lesion is observed, and is natu-
rally attributed to mechanical injury referable to the last
copulation, though this is only partly true. Then swelling
in the preputial region becomes evident, incarceration of
the penis follows quickly, and copulation can no longer occur.

The diagnosis is fundamentally dependent upon symp-
toms essentially identical with those seen in sheath tubercu-
losis, except that the lesion is located further backward,
just anterior to the scrotum. It can not be differentiated
from other infections by an ordinary physical examination.
Before a technical diagnosis can be made, it is essential to
include the tuberculin test and bacterial search. In a breed-
ing sense, the lesion is not subject to cure.

(4) Tuberculosis of the penial lymph glands is by far the
most commonly observed type of genital tuberculosis in
bulls. Apparently entering through a lesion, either recog-
nizable or unrecognizable, of the glans, sheath, or prepuce,
it may involve the lymph glands at any point from the mar-
gin of the sheath, along the prepuce, and up to and above
the sigmoid flexure. Clinically, in opening the small peri-
penial abscesses, I find that they contain thick pus, and that
the abscess walls are dark, angry red, without calcification.
The lymph glands lie chiefly along the sides of the penis.
When involving the small glands outside the mucous mem-
branes of the sheath and prepuce, the inflammatory adhe-
sions soon prevent the reflection of these membranes upon
the exterior of the penis, make its protrusion impossible,
and exclude copulation. Swellings in the region, usually
well defined and painless, are evident. Abscessation gradu-
ally develops, but the abscesses are small and their walls
sclerotic, non-fluctuant, and without a tendency to "point"
or break. The lesions are well illustrated in Figures 96, 97,
98 and 99.

Sometimes the sigmoid lymph glands are involved, while
those of the sheath and prepuce are slightly or not at all

334 Diseases of the Genital Orga?is

affected. In such cases, as shown in Figures 98 and 99, the
chief clinical phenomenon is inability to protrude the penis
and copulate. The inflamed glands induce adhesions which
inhibit the elimination of the sigmoid flexure. Palpation
of the region readily enables the veterinarian to detect the
enlarged glands.

The enlargement of the lymph glands of the sheath, pre-
puce, or sigmoid flexure constitutes strong evidence of pri-
mary venereal tuberculosis. Other infections may induce
similar adenitis, but commonly the veterinarian is justified
in provisionally diagnosing such lesions as tuberculosis. He
may, should circumstances demand, search for bacterial or
other evidence. On the whole, any chronic adenitis of these
glands ruins the breeding value of the bull and dictates
slaughter. A positive diagnosis is highly important, even
when made post mortem. If it is tuberculosis — and that is
the rule — there must be highly dangerous cows in the herd,
the genitalia of which should be subjected to very rigid
search for tuberculosis. While a bull may become infected
in copulating with a cow when the exterior of the vulva is
contaminated with tubercle-bearing fecal excreta, this is
improbable. The assumption should generally be that the
infection has arisen from copulating with a female having
tuberculous genital catarrh. Such an offender should be
detected and eliminated. She is almost always incurably
sterile. She constitutes a great peril to any breeding sire,
and is one of the worst "spreaders" of tuberculous infection.

Tuberculosis of the Female Genitalia

Every part of the genital organs of the cow is subject to
invasion. My collection contains examples of ovarian, tubal,
uterine, cervical, and vaginal tuberculosis, and I have ob-
served clinically vulvar tuberculosis.

(1) Ovarian tuberculosis is very rare, but is far more
common than orchitic tuberculosis. The ovary is more ex-
posed to the infection than the testicle, especially in the
presence of extensive peritoneal lesions. I have obtained
but two good examples. One of these, Fig. 100, is highly

Tuberculosis of the Female Genitalia

335

interesting, because casual examination suggests that the
avenue of invasion of the ovary was through the physiologic
lesion, the crater of a ruptured ovisac. The dense invest-
ing tunic of both the testis and the ovary appears to offer a
highly effective barrier against tuberculous invasion, with
the important difference that in the ovary there occur in-
tervals (ovulation) when the tunic is ruptured and its con-
tinuity temporarily in abeyance. Viewed in this light, more

3
Tb

Cl

Fig. ioo— Tuberculosis of Ovary and Oviduct.

/, Section through oviduct ; 2, oviduct thrown into coils by elongation ;

j, ovary showing a corpus luteum, Cl, and a tubercular mass,

To, in crater of a ruptured ovisac.

ovarian than orchitic tuberculosis might be expected. Ap-
parently this is true. Nevertheless, the ovary is highly re-
sistant to the infection, as compared with other portions of
the female genitalia. Frequently the uterus and oviducts
are highly tuberculous, while the ovary remains normal. In
the second example of ovarian tuberculosis in my collection,
shown in Fig. 101, the ovaries and oviducts have largely
undergone tuberculous necrosis. Generally, when the ovi-
ducts are involved, the pavilion is adherent to the ovary,
and the peritoneal side of the pavilion is studded over with

336

Diseases of the Genital Organs

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Tuberculosis of the Female Genitalia 337

tubercles, as shown in Figures 102, 103, 105 and 106, but the
adherent, encapsulated gland resists invasion.

Ovarian tuberculosis can not, in my experience, be directly
and positively diagnosed clinically. Clinical diagnosis is not
highly important, since ovarian invasion rarely, if ever, oc-
curs without tubal and uterine tuberculosis, each of which
is open to reasonably safe clinical diagnosis. So far as I
am aware, ovarian tuberculosis induces no clinical symp-
toms. There is a definite impression given in veterinary
literature that ovarian tuberculosis sometimes causes ster-
ility, but there is no evidence submitted. So far as I have
seen, it is the coexisting or preexisting tubal and uter-
ine tuberculosis which causes the sterility. Statements oc-
cur also (Huytra and Marek, Law) that genital tuberculo-
sis, either through the invasion of the ovaries or otherwise,
induces nymphomania. No evidence is submitted upon the
point. The power of tuberculosis of any portion of the
genital tract to cause nymphomania is probably pure legend.
A careful study of nymphomania shows it to be due to a
definite type of cystic degeneration of the ovary, wholly de-
void of any trace of relation to tuberculosis. Genital tuber-
culosis and the nymphomaniacal type of ovarian cyst may
coexist, but that is not evidence of either identity or rela-
tionship.

(2) Tubal tuberculosis is, next to uterine tuberculosis,
the commonest type observed in the genitalia of cattle. In
many specimens, the appearances suggest that the infection
has invaded the oviducts centrifugally from the peritoneal
cavity through the pavilion. In other instances of even
severe uterine tuberculosis, the oviducts are free. Tuber-
culous oviducts are usually recognizable by rectal palpation.
They become enlarged and very hard. Generally they are
adherent and studded over with large tubercles. The tuber-
culous tubes vary in transverse diameter up to 0.5 inches or
over. When much enlarged, they become elongated and
thrown into folds lying in front of and lateral to the ovary,
as shown in Figures 103-106 inclusive. The disease may be

22

338

Diseases of the Ge?iital Organs

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Tuberculosis of the Female Genitalia

339

confused with ordinary pyosalpinx or hydrosalpinx. In
ordinary pyosalpinx, there are two types. In the first and
commonest, there is not much pus and the oviducts are not
greatly enlarged, but are very firm and of even contour; in
the second, the pus is voluminous and the oviduct walls at-
tenuated, giving a soft fluctuating tube, with thin, atonic

Fig. 103 — Tuberculosis of Ovary and Oviduct..
The Oviducts are very Nodular and Enlarged, the Ovary Adherent
in the Pavilion and Broad Ligament. Ov, Oviduct lying
lateral to the ovary ; O, ovary ; UC, uterine cornu.

lymph, firm and fluctuant. Tuberculous salpingitis is, in
my experience, always nodular, the tubes very hard, ad-
herent, and quite large.

walls. In hydrosalpinx, the oviduct is distended with
Tuberculosis of the oviduct is almost, if not always bi-

34Q

Diseases of the Genital Organs

I ..j Dorsal Surface of Tuberculous Oviducts, Uterus, and
Vagina, Showing- extensive Pelvic Adhesions and Adhesions of
Ovaries in Pavilion of Oviduct and Broad Ligament.
■ ary ; I '(.', uterine cornu ; Ov, oviduct extending laterally
to the ovary ; L ', uterus ; / '. vagina.

Tuberculosis of the Female Genitalia 341

lateral, rendering the animal incurably sterile as well as a
peril in a breeding or milking herd. The pus from tuber-
culous pyosalpinx escapes through the uterus and cervix to
the vagina, to constitute a very serious menace to the bull,
(3) Uterine tuberculosis is the commonest and most dan-
gerous type of genital tuberculosis. It is supremely dan-
gerous to the bull when copulating with the affected animal.
The discharges resulting from the tuberculous uterine ca-
tarrh soil the vulva, tail, thighs, and ultimately the udder,
and contaminate the milk. Thus the milk becomes intensely
dangerous for calves, for other animals, and for man. In
its peril to animal and human health, uterine tuberculosis
vies with tuberculosis of any other organ. Uterine tuber-
culosis is quite variable, showing three somewhat separable
types :

(a) Peritoneal uterine tuberculosis with extensive pelvic
adhesions, as shown in Figures 104, 105, 106.

(b) Tuberculosis of the glandular structure of the uterine
mucosa, as shown in Figures 105, 106, 107, 108, 109.

(c) Tuberculosis of the epithelial layer of the mucous
membrane, as shown in Fig. 110.

No clear line of demarcation can be drawn between the
three types, but in most cases one of the three groups of
lesions predominates.

In uterine tuberculosis there is generally a persistent, ob-
stinate uterine catarrh. In some cases the catarrhal dis-
charge is inconspicuous. Douching the uterus may reveal
very little pus. In some cases of tuberculous uterine ca-
tarrh, uterine douches affect the catarrh favorably for a
time, but permanent relief I have not observed. Where
there have been apparently favorable results from douch-
ing, misleading the practitioner as to the nature of the
malady, limited observation indicates that copulation sets
the infection aflame. In such cases as illustrated by Fig-
ures 108 and 109, the catarrh is profuse, but not generally
fetid. Like tuberculosis of the oviducts, uterine tuberculo-
sis is usually, if not always, symmetrical, or bicornual.
Generally the uterus contracts extensive pelvic adhesions.

342

Diseases of the Genital Organs

t

,

• UC

Ov

c-

r

l-CC

K

Tb

Fig.

Horizontal section through <l<>r>.il surface of uterus, cornua, ovaries, and

oviducts of Fig. 104. V% Vagina ; Tb, tubercular nodules in right vaginal

walls (below) ; C. cervical wall ; CC, cervical canal ; U, uterus; Tb, tuber-

-. cornua above) ; 0,0, ovaries; ('/.. corpus luteum in right ovary;

ibercular oviduct greatly enlarged and elongated, pushed laterally far

beyond the ovary ; L/C, uterine cornu.

Tuberculosis of the Fema/e Genitalia 343

In many cases the peritoneum is so involved that ovaries,
oviducts, uterus, and broad ligaments constitute a complex
adherent mass, as in Figures 104 and 106, where it is diffi-
cult, though generally possible, to identify the various parts
by rectal palpation. Pelvic adhesions due to genital tuber-
culosis resemble those caused by other infections. The ad-
hesions due to tuberculosis are often accompanied by palpa-
ble tubercles. Their recognition aids materially in diagno-
sis. Non-tuberculous pelvic adhesions are frequently ac-
companied by sclerotic abscesses of an ovary, oviduct, uter-
ine horn, or the three areas combined. In my collection, no
abscesses exist in any case of tubo-uterine tuberculosis, not
even abscesses of the lymph glands in the broad ligaments
of the uterus. Tuberculous pyosalpinx and pyometra, with
necrosis of the uterine mucosa, as indicated in Figures 96
and 97, is common enough. There is one important differ-
ence in the clinical history of tuberculous and non-tubercu-
lous pelvic adhesions. The non-tuberculous adhesions are
commonly preceded by acute metritis, largely with placen-
titis and retained fetal membranes ; tuberculous pelvic ad-
hesions ordinarily arise independently of acute metritis.

The cow from which Figures 104 and 105 were taken was
entered in our clinic for sterility. There was slight uterine
catarrh (tuberculosis of the uterine mucosa) which abated
under antiseptic douches. The ovaries, oviducts, and uterus
were normal by rectal palpation. She appeared so well that
she was mated with a valuable herd sire. Soon afterward,
she broke down, and upon re-examination genital tubercu-
losis was evident. When destroyed, extensive generalized
tuberculosis was revealed. She entered our clinic without a
history, but upon the assumption of freedom from tubercu-
losis, and no careful search was made in that direction. Ap-
parently the disease was forced to its crisis by copulation,
the patient gave way to the infection, and a diagnosis of
genital tuberculosis became practicable. Fortunately the
sire escaped, largely perhaps because the cow was douched
just prior to copulation. The case illustrates vividly the in-
sidious and subtle manner in which genital tuberculosis in

344 Diseases of the Genital Organs

the cow may develop, and how the veterinarian needs to be
on his guard.

In some cases the tuberculous uterus remains to the end
free from adhesions, as in Figures 107, 108 and 109. In
my collection some of the uteri in which the mucosa is most
extensively involved and which have undergone the maxi-
mum increase in size have suffered least from pelvic adhe-

! K3 i' 6— Tubercular Genital Tract from a Non-Reacting Cow in
Advanced Tuberculosis.

lion baa been removed from the dorsal surface exposing the interior
of uterine body and horns, r, Cervix; p.cornuaof uterus showing tuber-
cular masses : ,-. j, ,-. j, sections through the oviducts; ./, ./, ovaries. The
left o\ ■ was buried beneath the adjacent cornu, j, so it has been

1 and carried out where it conies into view.

Tuberculosis of the Female Genitalia

345

.

HS£

346 Diseases of the Genital Organs

sions. Is this because in such cases as Figures 107 and 109
the infection of the uterine cavity has been primary (vene-
real) and in those cases with extensive adhesions, as in
Figures 104 and 106, the infection has invaded the tract by
continuity from the general peritoneum? The freedom of
the oviducts in Figure 107 appears to emphasize this sug-
gestion.

^^

cc <r

■

'j^^'1

1

lie. ro8 -Uterine Tuberculosis Involving chiefly the Uterine Glands, the
peritoneum being- free. Longitudinal Section of Fig. 107.
CC, Cervical canal ; /, pus in cavity of cornu ; 2, pus in apux of cornu.

When the uterus is enlarged, sclerotic and comparatively
free from adhesions, the tuberculous character is difficult
of clinical recognition. One may meet with similar sclero-
tic hypertrophy in actinomycosis (primary genital) and in
chronic purulent sclerotic metritis with destruction of the

Tuberculosis of the Female Genitalia

347

gk]

Fjg. 109— Advanced Tubo-Uterine Tuberculosis, with Necrosis of

Mucosa and Pyometra.

Ov, Oviduct, greatly enlarged and consisting of a mass of tubercles ;

C, cervical canal.

348 Diseases of the Gefiital Organs

uterine mucosa. In such cases, however, the outlook for the
breeding life of the patient is hopeless and an accurate clini-
cal diagnosis is not imperative. In some cases of uterine
tuberculosis, the masses of tubercles are so voluminous that
they throw the uterine walls into great transverse folds
which may be palpated per rectum. When such folds are
present, they have a distinct diagnostic value. Usually in
chronic abscessation of the uterus due to ordinary pyogenic
bacteria or to actinomycosis, while the uterus is enlarged
and hard, it is very irregular in outline. At one point there
may be little or no enlargement. In actinomycosis and in
pyogenic abscessation of the genitalia, some one part usually
contains a great abscess or abscesses quite overshadowing
other lesions, but in tuberculosis there is a strong tendency
to symmetrical enlargement. The two horns are approxi-
mately alike in volume, form, and consistence. This is im-
portant to remember in making a diagnosis. In one cow of
great breeding value, a reactor to tuberculin, which had not
calved for two years and had long suffered from an abun-
dant, fetid, highly repulsive genital discharge, I found one
uterine horn much enlarged, three to four inches in its
transverse diameter, very hard, and irregular in contour.
The other horn was approximately normal. The findings
by palpation, in conjunction with her reaction to tuberculin,
led me to diagnose uterine tuberculosis. The autopsy re-
vealed, instead, a macerating fetus, the bones of which
caused the irregular bulging of the cornu. Had I recog-
nized the fact that in uterine tuberculosis the enlargement
of the horns is usually symmetrical and that the pus from
the tuberculous uterus is not usually fetid, the error would
probably have been avoided. In those cases of uterine tu-
berculosis where only the superficial mucous layer is in-
volved, as in Fig. 110, the diagnosis by ordinary clinical ex-
amination fails. The ovaries, oviducts, and uterus are nor-
mal to palpation, the uterine catarrh is scant, and no out-
standing clinical evidences of genital tuberculosis are
present.

The outstanding elements in the differentiation of utero-

Tuberculosis of the Fe?na/e Genitalia 349

tubal tuberculosis are the pelvic adhesions, the tubercles in
the genital peritoneum, the symmetrical enlargement of the
uterus, and the obstinate uterine catarrh. No one of these

Fig. no — Miliary Tuberculosis of the Superficial Uterine Mucosa

of a Virgin Heifer.

V, Vagina ; C, cervix ; L/C, uterine cornu ; Ov, oviduct. The uterine

horns are laid open to show the numerous small tubercles

upon the mucous surface

symptoms, alone, is sufficient for a positive diagnosis. If
the patient reacts to tuberculin, the probability of genital
tuberculosis is increased. No data are at hand regarding
bacterial search of the genital discharges. Such search

350 Diseases of the Ge?iital Orga?is

would probably aid materially in diagnosis. A negative
tuberculin test is not conclusive evidence that genital tuber-
culosis is not present. The very valuable herd bull, from
which Figure 96 was made, quite certainly contracted the
infection from a cow which had successfully passed several
tuberculin tests, in spite of severe generalized, utero-tubal
tuberculosis, and marked uterine catarrh. While in many
cases, such as delineated in Figure 104, quite an accurate
physical diagnosis of genital tuberculosis may be made, not
all cases may be detected. The important point is that
utero-tubal tuberculosis may almost always be tentatively
diagnosed by rectal palpation and the veterinarian and
owner placed on guard. So long as the symptoms named
are present, the tentative diagnosis of utero-tubal tubercu-
losis is not only justified, but obligatory, from the sanitary
standpoint. When uterine catarrh is present, copulation is
contra-indicated by every consideration of hygiene. Fer-
tilization can not occur; coitus aggravates the catarrh and
imperils the bull. The retention in a dairy of a cow with
obstinate uterine catarrh is unjustified by every considera-
tion of health and decency. The afflicted animal is unfit to
associate with others in such a manner that their food may
become contaminated with the genital discharges.

A tentative diagnosis of utero-tubal tuberculosis works no
serious injury. If the cow recovers, as a rule the recovery
automatically corrects the diagnosis ; if she fails to recover,
she is worthless for breeding or dairying, and fit only for
slaughter, whether the infection be tuberculous or not.

(4) Tuberculosis of the cervix is presumably rare. I
have but one specimen (Figures 111 and 112) derived from
the abattoir, and hence without a clinical history. In this
rase, the uterus and oviducts are also involved. The illus-
trations suggest the probable clinical features. The greatly
swollen, hard, smooth lips of the cervix could not well be
missed by an expert examining the genitalia clinically.
While uterine catarrh was evidently present in this animal,
it presumably had nothing to do with the cervical lesion.
The lesion was apparently closed and caused no discharge.

Ttcberadosis of the Female Genitalia

35i

The surgeon, meeting with such condition, would logically
incise the tumor, revealing the nature of the lesion. I have
repeatedly opened cysts in these parts. In so doing, I al-
ways draw the cervix back into the vulva before operating,
so that the field is freely open to view and the contents
which may be released are readily seen. If purulent, they
at once raise the question of tuberculosis, which, once raised,

Fig. hi — Tuberculosis of the Vaginal Portion of the Cervix

/, Greatly enlarged tubercular lip of os uteri externum ; 2, a second, lesser

tubercular tumefaction of lip ; j, mucous folds of the first annular

cervical fold. Between it and / is the os uteri externum.

should not be dismissed until the diagnosis has been made
perfectly clear. On no account should a cow be permitted
to copulate when a cervical lesion exists, unless it is clearly
shown to be non-tuberculous. Even harmless-appearing
cysts should not be passed over carelessly. Like vulvar
cysts, discussed below, they may be tuberculous. The cervi-

352 Diseases of the Genital Organs

cal lesion, when open, is evidently extremely dangerous.
These cysts, usually found laterally from the os uteri ex-
ternum, presumably consist of retention cysts in the ducts
of Gartner (See page 39).

(5) Vaginal tuberculosis is apparently very rare. Fig-
ure 105 illustrates the only specimen in my collection. It
was not recognized clinically, although I examined the pa-
tient several times. However, I did not search for vaginal
tuberculosis. Possibly it was of recent origin.

It is important for the veterinarian, in dealing instru-
mentally with diseases of the genitalia, to bear in mind that
he may, by the careless use of the uterine forceps, implant
the infection in the cervix, or in the vagina at its point of
continuity with the cervix. He may re-infect these parts,
through instrumental lesion, with the discharges from the
patient's uterus. If careless in his methods, he may carry
the infection from a tuberculous cow to a healthy one. Un-
der reasonable precautions, the danger is quite negligible.
Figure 105 shows the tuberculous lesions within the vaginal
wall, closed. If open, the lesion would have the same danger
as an open lesion of the cervix.

(6) Vulvar tuberculosis has occurred twice in my prac-
tice, each time readily diagnosed, though in one case the
nature of the lesion was at first misleading. In this case,
at the first examination, a cyst one inch in diameter, located
apparently in Bartholin's gland (See page 44), was incised,
and a small amount of sero-purulent content escaped. Prior
to my next examination, the patient had reacted to the tu-
berculin test. When I examined her, the lesion presented
the typical characters of a tuberculous ulcer. My second
case was more readily diagnosed. The vulvar lip. which
was swollen and sclerotic, presented an old fistulous open-
ing, from which small volumes of thick pus could be pressed
out. Centripetally, a tuberculous gland, two to three inches
in diameter, lay alongside the vagina. In addition, both
supramammary glands were greatly enlarged, and at each
internal inguinal ring glands three inches in diameter were
palpable. Autopsy showed extensive generalized tubercu-
losis.

Tuberculosis of the Female Genitalia

353

Vulvar tuberculosis is evidently a very dangerous type for
the bull. In my second case, the cow had been bred only a
few days before my examination to the herd bull, valued at
more than ten thousand dollars. Fortunately he escaped
infection.

Fig. ii2— Sagittal Section, of Fig. in.
Os, Os uteri externum ; C, cervical canal ; Tb tubercles in lip of os uteri :
A, A, tubercular abscesses.

The importance of genital tuberculosis in cattle calls for
much greater interest upon the part of the veterinarian.
In dairies and pedigreed breeding herds, tubercular uterine
catarrh is one of the most dangerous and repulsive types of
tuberculosis. The search is generally limited to the tuber-
culin test, which too often fails to detect the disease. The
cow whose uterus is shown in Fig. 94 belonged in a small,

354 Diseases of the Genital Organs

high-class Guernsey herd which had been tested semi-annu-
ally for several years. This cow passed each test satisfac-
torily. Each test revealed reactors, which upon slaughter
showed recent lesions only. It was evident that lurking
somewhere in the herd was a non-reacting spreader of a
dangerous type. In making a survey of the genital organs
of the herd, with reference to breeding, I designated this
animal as the non-reacting spreader.

When diseases of the genitalia occur, closing the breeding
career of an animal, a definite diagnosis is of great im-
portance. If tuberculosis is the probable or possible cause
of sterility, but can not be clearly diagnosed clinically,
slaughter without accurate post-mortem diagnosis is wholly
unjustifiable. If a cow is sterile because of genital tuber-
culosis, she has almost certainly seriously endangered the
bull and other cattle. If a bull becomes disabled for coitus
because of genital tuberculosis, it is not enough to send him
to the shambles because he can no longer be used for breed-
ing. Somewhere there is almost certainly a cow with geni-
tal tuberculosis which transmitted the infection to him dur-
ing coitus. She is liable to transmit the infection to another
bull and is highly dangerous to other cows. The diagnosis
of tuberculosis in the bull is therefore highly necessary for
the control of the disease in contact animals. For this pur-
pose post-mortem is as valuable as clinical diagnosis.

The control of these dangers evidently depends chiefly
upon the more general and accurate diagnosis of genital le-
sions m both sexes and the more general adoption of efficient
sex hygiene in breeding cattle. The lesions are to be de-
tected through two chief agencies — dairy inspection and in-
spection of the genitalia in connection with sterility. At
present, dairy inspection fails utterly in most cases in rela-
tion to genital disorders. Repeatedly I find, in regularly in-
spected herds, and even in certified dairies, cows with
quarts or gallons of fetid pus in the uterine cavity, large
volumes of which are pressed out from time to time while
the cows arc lying down. Advancement in this field is one
of the most urgently needed reforms in dairy inspection.

Tuberculosis of the Female Genitalia 355

The greatest weapon for the control of the danger lies in
the more general inspection of the genitalia of cattle, as a
safeguard against sterility and abortion. It is becoming
more and more apparent that a careful physical examina-
tion of the genitalia of cows, prior to breeding, is a wise
precaution of distinct scientific and economic importance,
and that the breeder should take far greater care in the sex
hygiene of the bull. If penial injuries and infections are to
be averted, having first ascertained that the genital organs
of the cow are healthy, the external genitalia of both cow
and bull should be carefully washed before permitting copu-
lation. It is highly important, in the prevention of penial
lesions, which may serve as infection avenues, that the
crusts of pus in the vulvar tuft of hairs of the cow be re-
moved by washing. Otherwise, these crusts of pus may be
caught and forced into the vulvar opening, to abrade the
penial mucosa. After copulation, the penis, prepuce, and
sheath of the bull should again be carefully and efficiently
douched. These precautions go hand in hand with those
designed to control sterility and abortion.

CHAPTER XIV

THE GENERAL INFECTIONS OF THE GENITAL
ORGANS OF CATTLE

The mammalian genital tract opens freely upon the ex-
terior, rendering it possible for any infection upon the ad-
jacent body surface, capable of growing within the genital
tract, to invade it, either actively or passively through the
agency of a bearer (copulatory organs of the opposite sex
during coitus, surgical instruments, hands of operator).
Vastly more important, as far as at present known, is the
transmission of important infections from the alimentary
and pulmonary tracts, through the blood stream, to the geni-
tal tract. Thence the infection is carried, in the female,
back to the alimentary tract of the fetus. That is, as will be
more fully discussed when considering fetal infections, if
there is infection in the uterus of the pregnant female
(which is the rule) it tends to penetrate the thin chorion
and amnion and to be swallowed promptly by the fetus,
along with the amniotic fluid. If the fetus has sufficient
vigor, the bacteria are harmlessly included as a component
part of the meconium, to be expelled soon after birth ; if dis-
ease of the fetus occurs before birth, and the gastrointes-
tinal epithelium is destroyed or devitalized, infection ensues.
The bacteria may then enter the blood stream, to be lodged
later in the articulations (arthritis) but, since they were
originally derived from the genital tract of the mother, tend
logically to return to the genitalia. If the infections within
the uterus of the pregnant cow commonly invade the ali-
mentary tract of the fetus, it follows that subsequent to
birth the same infections may be expelled from the diseased
uterus, contaminate the milk, be swallowed by the calf, and
cause disease having the same peril for it as if the infection
had been swallowed prior to birth.

Each year adds to the number of known species of micro-
organisms capable of invading the genital tract of cattle
and of other domestic animals and, according to the best

The General Infections of the Genital Organs of Cattle 357

available evidence, capable of attaining such intensity as to
interfere seriously with the reproductive functions. They
may reside indefinitely in the genital tract without causing
disaster but ready at any time, taking advantage of an in-
jury to, or loss of vigor in, the area occupied, to cause seri-
ous harm. Their method of injury, however, is less definite
in character for each recognizable organism than the patho-
logic processes described in the preceding sections. The
vesicular venereal disease stands out definitely, by its symp-
toms and clinical history of transmission, as a specific con-
tagion. The nodular venereal disease offers a distinct and
characteristic lesion, although its cause it not definitely de-
termined and its importance is largely a matter of opinion.
Actinomycosis and tuberculosis are fully recognized as spe-
cific diseases causing genital injuries identical with well
recognized lesions in other organs, each of which is due to
a recognized species of organism.

In the following section there will be discussed, as general
infections, an extensive group of lesions due to, or believed
to be due to, infection which far surpasses, in its peril to
the reproductive organs, the four preceding diseases. Each
may severally or jointly produce a variety of lesions, but no
one lesion can with confidence be attributed clinically to any
one organism. Several or many different bacteria or other
organisms may cause ovaritis, salpingitis, metritis, or cervi-
citis, and these lesions may prevent, interrupt, or imperil
reproduction. Moreover, it is difficult or impossible to dif-
ferentiate clinically between them. If salpingitis is present
and diagnosable, it may be due to a streptococcus, a bacillus,
or a micrococcus, or to a combination of the three, but the
exact status can be determined only by a bacterial study of
the diseased tube after its removal from the abdominal cav-
ity. They will be discussed, therefore, as a group having a
common tendency to cause an extensive list of pathologic
changes with serious injury to the reproductive functions.
The lesions produced by the infection — not the identity of
the infecting agent — will constitute the basis for classifica-
tion.

358 Diseases of the Genital Organs

I. THE GENERAL INFECTIONS OF THE GENITAL
ORGANS OF BULLS

The diseases of the genital organs of bulls, as a factor in
the problem of reproduction, have received scant attention
from veterinarians. A belief had grown up and held the
undivided attention of veterinarian, dairyman, and breeder,
that the great and only important menace to reproduction
in cattle was a specific infectious disease of the pregnant
female, designated "contagious abortion." During the past
few years that belief has been undergoing disintegration,
until very few veterinarians now cling unreservedly to the
tradition. There has been much unintelligent controversy
over the part played by the bull in genital diseases of cattle,
because consideration has been largely restricted to the
question of the part played by the bull in transmitting to
cows the bacillus discovered by Professor Bang, which was
regarded as the specific cause of the abortions occurring in
cattle. The attitude assumed was that the only infection of
interest which, attacking the genital organs of a bull, might
possess danger for a cow with which he might copulate was
the B. abortus. If, therefore, a bull was not ejaculating with
his semen the B. abortus, he was assumed to be virtually be-
yond criticism from the standpoint of infection. The study
of the semen of bulls and the bacteriology of the genital or-
gans and of the semen, except for a few searches made for
the B. abortus, have been of no consequence. Little or noth-
ing was known of the diseases of the testicles, unless they
became enormously enlarged or underwent abscessation.
The subsidiary structures — the epididymis, vas deferens,
vesiculae seminales, prostate and Cowper's glands — were ig-
nored. These facts show the strangling grip so long held
by "contagious abortion" upon the study of the infections
of the genital organs.

The time has arrived for a frank recognition by breeder
and veterinarian that the bull is one-half the breeding herd,
that the other half is valuless unless he is genitally sound,
and that, speaking in percentages, he is probably as great an
offender as the cow. In other words, probably as large a

The General Infections of the Genital Organs of Cattle 359

proportion of bulls as of cows go to slaughter on account of
sterility or low fertility.

A general outline for the clinical examination of the geni-
tal organs and the semen of bulls has been given in Chapter
II. It remains to describe more fully the examination of
the semen in the course of genital diseases and to point out
as far as possible the relation of changes in the semen, and
especially in the spermatozoa, to clinical manifestations of
genital disease.

xThe technique which I have pursued in collecting and
examining semen from bulls is as follows :

The bull's sheath is first douched with Yi Per cent. Lugol's
solution or !/•> per cent, chlorazene. The cow's buttocks are
thoroughly cleansed with a disinfectant and washed with a
V-i Per cent, chlorazene solution, and the vaginal mucus is
removed manually. If a bacteriological examination of the
semen is desired, the vagina should be thoroughly cleansed
with a douche of V2 per cent, chlorazene, which must be com-
pletely removed several minutes before copulation. As only
a slight trace of chlorine or other disinfectant will cause im-
mobility of the sperm cell, it is desirable that cleansing of
the parts for studying the motility of the spermatozoa be
done with sterile water or a normal saline solution. In
either case, all possible vaginal mucus should be removed,
just prior to service, with the well disinfected hand which
has been washed with sterile water. The method is not en-
tirely satisfactory from the bacteriological standpoint. Two
sources of bacterial contamination must be considered :
first, extraneous, and second, the vaginal flora. Contamina-
tion from the first source may be largely prevented by care-
fully cleansing the parts immediately prior to inserting the
hand for the sample, but, owing to the almost constant fecal
contamination of the vulva and the adjacent parts, it is well-
nigh impossible wholly to prevent contamination during

1 The results of clinical examinations of bulls, with directions for the ex-
amination of semen and spermatozoa from diseased or suspected bulls, are
by W. W. Williams ; the micro-photographs of the preparations are by
Professor B. F. Kingsbury.

360 Diseases of the Genital Organs

coitus. The danger of contamination of the semen from the
vaginal flora, although undoubtedly lessened by the above
method, can not be said to be nullified. Some other technique
may lessen the contamination from each source.

Recently I have used a common sputum cup for the with-
drawal of samples from the vagina. This method has con-
siderable advantage in the prevention of contamination. An
examination of the vaginal mucus taken prior to service
may serve as a check on the vaginal flora. With careful
disinfection, it seems that many samples may be taken free
from fecal flora, as only a few give a growth of the colon
group. If the sample is to undergo a bacteriological ex-
amination, it should be placed in a sterile vial, cooled im-
mediately, and cultured at the earliest possible date. Semen
for clinical and histological examination must be placed in
a warm vial, kept at a temperature ranging from 100° to
104c F., and examined under the microscope within thirty
to forty-five minutes after sampling.

First, the physical characters of the semen are noted, in-
cluding the quantity, color, consistency, and coagulability.
A drop of semen is then placed on a warm microscope slide
and covered with a thin cover glass. Under a low-power
lens, the relative abundance of the spermatozoa is noted.
The semen is then placed under an oil immersion lens in
order that the degree of motility and the percentage of cells
which are motile may be observed. When possible, the
length of time which the motility continues should be re-
corded. I have observed motility as much as four hours
after taking a sample, and it is probable that, in a specimen
kept under proper conditions, the motility outside of the
female genital tract continues even longer. Much of the
cellular morphology can be determined by examining the
fresh specimen under the oil immersion lens, and the rela-
tionship between the non-motility and the morphological
imperfection can be established.

For the determination of the finer morphological details,
a stained preparation is best. The film should be made
from a strictly fresh sample of semen, fixed with heat, and

The General Infections of the Genital Organs of Cattle 361

the mucus removed by placing it in a 0.5 per cent, chlora-
zene solution for eight to ten minutes. The slide is then
washed with clear water, to remove all traces of chlorine,
and stained with carbol-fuchsin with heat for one to two
minutes. The carbol-fuchsin is washed off with water.
The film is stained for eight minutes with alkaline methy-
lene blue. Then the methylene blue is washed off and the
film is dried with filter paper. The head of the healthy cell
should be brought out in clear detail. The neck granule, the
cell membrane, and the nuclear membrane should stain very
dark. The nucleus should stain slightly darker than the
cytoplasm. If the counterstaining with methylene blue is
continued only about five seconds, the nucleus remains
bright red and the cytoplasm stains light blue, but the nu-
clear membrane is left indistinct. The nucleus itself retains
an alcoholic eosin stain better than carbol-fuchsin, but after
the use of eosin it is difficult to counterstain so as to bring
out the details. Recently, I have used acid stain consisting
of alcohol two parts, carbol-fuchsin two parts and eosin one
part. Staining is carried on one and one-half minutes, and
the cells then counterstained with a fifty per cent. Loeffler's
methylene blue for three to five seconds. By this method,
an exceptionally clear detail is obtained. Various stains
may be used, but eosin and carbol-fuchsin as acid stains and
Loeffler's methylene blue as a basic stain have been found
more satisfactory because their stability makes them better
for field use than many of the aniline stains. Considerable
experience is required for proficiency in the proper prepa-
ration and interpretation of stained specimens.

For fecundation it is necessary that a healthy sperm cell
unite with the ovum. Ostensibly the spermatozoon, as is
the case with other cells of the body, may undergo certain
destructive or degenerative changes affecting its physiologi-
cal function. This may occur during the process of sperma-
togenesis, in which case the immature cells are eliminated,
or degenerative changes may take place after the cells have
reached maturity and while they lie in the seminiferous tu-
bules or epididymis. If the sperm cell be arrested in de-

362 Diseases of the Genital Organs

velopment, defective or weakened, either it loses its ability
to unite with the egg, or, if union takes place, the fertilized
ovum undergoes an early death or develops a constitution-
ally weak embryo. Thus Adami and Nicholas state :

"What is true regarding infectious diseases must to some
extent hold also regarding chronic intoxications of various
orders. The results of constitutional disease in either parent
may be the following, according, on the one hand, to the ex-
tent of the influence of the disease, or intoxication, upon
the germ plasm of that parent, and on the other, to the ac-
tivity or potency of the germinal matter contributed by the
other parent :

1. Sterility. The germ cells being so profoundly modi-
fied that either (a) they are destroyed, (b) their develop-
ment is arrested, or, (c) being developed (ova or sperma-
tozoa) , are imperfect and incapable of fusing with the germ
cells of the other parent.

2. Imperfect development of offspring, (a) Of such ex-
tent as to lead to intra-uterine death and abortion; (b) of
less extent, a viable individual being produced presenting
either —

(1) Gross anatomical defects.

(2) No gross anatomical defects, but lowered vitality,
presenting itself either in the form of weakened powers of
resistance against disease in general, or (?) proneness to
develop the same disease as the parent."

The spermatozoa which I have studied are frequently
characterized by definite morphological changes in the cells.
In order to understand fully these changes, it is essential
that the normal spermatozoon shall be known and the eye
trained to differentiate between the normal and the ab-
normal.

The cell is divided into four main parts — head, neck, body
and tail.

The head, oval in contour, is encompassed by a thin line,
the cell membrane, which takes an acid stain more deeply
than other portions. The head is divided into two portions
— the cytoplasmic and nuclear elements — by a semi-ellipti-

The General Infections of the Genital Organs of Cattle 363

cal line, the nuclear membrane. The nucleus, of full oval
contour except at its base, occupies normally a little more
than one-third of the basal area of the head. Its sides con-
form to the general contour of the cell membrane. The
chromasomic material does not occur in this cell as definite
granules, but is disseminated throughout the nucleus. The
nuclear element in a healthy cell takes a basic stain, and
when stained with methylene blue appears very slightly
granular and darker than the cytoplasmic portion.

The cytoplasmic portion of the head, anteriorly and later-
ally, corresponds in contour with the general oval outline of
the cell membrane. Caudally, it lies against the nucleus,
whose convex face is directed into the base of the cytoplasm,
forming a shallow cup or fovea in the latter. The cytoplasm
of the head takes carbol-fuchsin very faintly, which, when
counterstained with methylene blue, is entirely replaced by
the latter.

The neck parts in the bovine spermatozoon are very small
and not defined except under a very high magnification. In
the human spermatozoon two neck granules are described.
In spermatogenesis they arise from a single granule, which
in the last stages of development divides. One granule
passes to the caudal end of the neck and remains there in
close relation to the connecting piece or body ; the other
granule passes to the anterior end to become fused with the
base of the head. If such separation of the neck granules
occurs in the bovine spermatozoon, it is not brought out by
my present method of staining. The neck granule appears
as a single bar, fused to the base of the head. Apparently
there is a slight concavity at the base, into which the neck
is inserted, obscuring most of it from view. The granule,
fused into this concavity, appears therefore to be located
within the nuclear material; this is undoubtedly never the
case. Aside from this granule, the neck remains unstained
under the methods which I have employed.

By the embryologist it is held that, when fecundation
takes place, the sperm head enters the cell membrane of the
ovum. The sperm then loses its tail, which separates be-

364 Diseases of the Genital Organs

tween the neck and connecting piece. It appears then that
the head, which has up to now faced the center of the cell,
becomes reversed and faces the cell wall. From the neck
granules, which migrate toward the center of the cell, are
formed the centrasomes, or polar bodies, which play such an
important part in the mitotic process.

It is quite clear that an arrest in the development of the
centrosmic precursor may be a potent cause of sterility.
Judging from some stained preparations on hand, it appears
quite certain that this arrest in development occurs to a
greater or less degree.

The body, cylindrical in form, about one and one-third
times the length of the head, takes readily either acid or
basic stain, and reveals in the properly stained preparation
a spiral filament encircling its entire length. The body is
succeeded by the tail, of slightly smaller diameter and about
four times as long. The tail, tapering posteriorly, ends as a
very fine filament. As the body and tail function only in a
locomotive capacity, I shall not deal further with them, but
shall study the pathologic changes in the heads of various
samples of spermatozoa, and the accompanying gross anato-
mical and functional changes in the genital apparatus of the
bull.

Bull U, Figs. 113, 114. Eleven years old. For three years
was used as sire in a herd of about one hundred mature fe-
males. Served sixty-three cows, with two hundred and
fifty-one copulations, seventy-five (29.8 per cent.) of which
resulted in conception. In 1916, ten cows were served, of
which twenty per cent, failed to conceive and twenty-five
per cent, of those conceiving aborted. In 1917, thirty-six
cows were bred, of which 11.1 per cent, failed to conceive
and 21.95 per cent, of those conceiving aborted. In 1918,
forty cows were bred, of which 35.6 per cent, failed to con-
ceive and 27 per cent, of those conceiving aborted. In 1919,
thirty-eight cows were bred, of which 79 per cent, failed to
conceive and 40 per cent, of those conceiving aborted.

After about three or four months in the herd, the bull's
fertility became lessened. Since May 1, 1919, he has been

1 he General Infections of the Genital Organs of Cattle 365

used frequently, with no conceptions. The sudden sterility
of about 75 per cent, of the herd had been thought to be due
wholly to the condition of the cows. A large proportion of
the cows (36.5 per cent, of those served) showed macro-
scopic pathologic changes, especially cervicitis, but only in
a few cases of sufficient severity to account for sterility on
such a large scale.

Fig. 113 — Spermatozoa from Bull No. 4.

Number comparatively low. Cells non-motile when ejaculated.

Many Tailless Spermatozoa.

On Dec. 5, physical examination revealed a severe balano-
posthitis and testicles slightly atrophied, with slightly di-
minished tone. Coitus was normal. About 7 mils, of semen
were obtained, which was very viscid, of a light straw
color, and more translucent than normal.

The spermatozoa were non-motile. About fifty per cent,
of the normal number were present. In fresh specimens,
many spermatozoa lay upon their sides, giving the appear-
ance of extremely narrow heads. In stained preparations

366

Diseases of the (Genital Orga?is

many detached tails were present. The head stained as a
homogeneous mass instead of showing its component parts
as in the healthy cell. In this specimen of spermatozoa
there appeared to be a total absence of the nuclear mem-
brane, and in many cells the upper granules were missing.
There was an almost total disintegration or arrest in devel-
opment of the integral cellular elements — the nucleus and

FlG. mi — Spermatozoa obtained from Bull No. 4.

Taken 25 days after those shown i n Fig. 113, during which period the bull

had complete sexual rest. Spermatozoa were still non-motile.

hut showed better staining qualities.

neck granule. On Dec. 5th, 1919, this bull was ordered
withdrawn from service.

On Dec. 30th, after twenty-five days of complete sexual
rest, another sample (Fig. 114) was obtained, which
shown I a remarkable improvement in the staining qualities.
The cell was not normal, though the head stained much bet-
ter. The connecting piece appeared enlarged and was con-
torted by the presence of a much enlarged spiral filament.

The General Infections of the Genital Organs of Cattle 367

Ordinarily the filament is so small that special staining is
required to show it. The nuclear portions of the heads were
uniformly undersized. It was ordered that this bull should
have complete sexual rest until further study should deter-
mine a more normal condition of the semen and sperma-
tozoa.

Jan. 29, 1920. Motility still absent and fewer spermato-

Fig. 115 — Spermatozoa from Bull No. 5.
Spermatozoa motile, but heads abnormally narrow and nuclei very small.

zoa. About fifty per cent, of the spermatozoa were tailless.
Many of the heads had a very narrow tapering basal por-
tion, running to a point at its juncture with the neck. The
nuclear portion was generally differentiated, but not as dis-
tinct as normal. The neck granules were very small and
generally imperceptible.

Mar. 6, 1920. Physical examination revealed no changes.
Twenty mils, of semen were obtained, containing considera-
ble vaginal mucus. The semen was very viscid, and at first

368

Diseases of the Genital Organs

slightly turbid. Firm coagulum formed within thirty min-
utes. The sperm cells were decreased in numbers and non-
motile. There was a slight microcephalia and many loos-
ened heads throughout the sample.

April 5, 1920. Physical examination revealed no new
macroscopic changes. About twenty mils, of turbid, semi-
translucent semen were obtained, containing considerable

Fig. i i 6— Spermatozoa from Bull No. 7.
Many with small heads and atrophic nucleus.

epithelial debris. A firm coagulum appeared almost imme-
diately after obtained, leaving the main part of the mucus
colorless and translucent. Sperm cells, entirely non-motile,
were present in numbers not to exceed twenty-five to fifty
per cent, of normal. Fifty per cent, of the spermatozoa
were without tails. Almost all were microcephalic, espe-
cially those which were tailless. In these there was a very
marked diminution in size and uniform tapering of the
basal portion of the head. In most heads the nuclear por-

The Genera/ Infections of the Genital Organs of Cattle 369

tion was clearly defined. The neck granule was either ab-
sent or very small and stained faintly.

Bull 5, Fig. 115. Eighteen months old. Served twelve
cows, with but one conception. The seminal vesicles ap-
peared slightly arrested in development and the left gland
was inflamed. Four to seven mils, of seminal fluid were ob-
tained, containing motile atypical spermatozoa. The head

Fig. 117. Spermatozoa from Bull No. 8.

Cells show degeneration, as indicated by want of definition of the nucleus.

Some cells are abnormally large.

was narrower than normal and the nucleus constricted,
causing a marked decrease, not only in the breadth, but in
the total volume of the cell. The component parts were clear
in detail, but arrested in development. Streptococcus viri-
dans and staphylococcus albus and aureus appeared in cul-
ture from this sample.

Bull 1. Imported. About five years old. Served seven
heifers, one or two of them twice, with no conceptions. All
seven conceived from first service by another bull.

24

370 Diseases of the Genital Organs

Examination revealed granular balanitis. On the left side
there was orchitis, epididymitis, and spermatocystitis. Both
vesicles were enlarged. So far I have been unable to get a
sample of semen from this bull. More recently fluid of
lymph-like consistency has been palpated in the left seminal
vesicle. (See Figs. 86, 126, 127.)

Bull 7, Fig. 116. Out of a total of sixty-three cows served
in the past three years, there have been forty (66 per cent.)
conceptions, nine (22.5 per cent.) of which have resulted in
abortion. This bull is not the chief sire of the herd. Al-
most all repetitions of service in the herd are with cows on
which this bull has been used. Only two abortions have oc-
curred amongst cows bred to other bulls. Cows bred to
other bulls have almost invariably conceived at first service,
but repetitions are frequent with Bull 7. The vitality of his
progeny is generally below normal.

Physical examination showed all genital parts apparently
normal. Coitus was normal. Ten mils, of macroscopically
normal semen were obtained. Smears showed cocci which
failed to grow in cultures. There were also present large
Gram positive rods. Paracolon bacilli were obtained on
culture. Motility of spermatozoa normal. The heads were
slightly smaller than normal, with a very evident arrest in
development, affecting principally the nucleus and causing
many of them to appear pear-shaped.

Bull 8, Fig. 117. Two-year-old. Since first used, June
15, 1919, has shown poor fertility. Has served twenty-seven
cows, with thirty-six copulations. This resulted in six
(23.2 per cent, of cows bred, 16.7 per cent, of copulations)
conceptions, none of which has terminated. Physical ex-
amination revealed a slight granular balanitis and small
vesiculae seminales, which were apparently slightly ar-
rested in development. Three to five mils, (which is less
than normal yield) of normal-appearing semen were ob-
tained on two occasions. Degeneration of the cell was in-
dicated by a lack of definition between the cytoplasmic and
nuclear elements. In some cells, the nuclear membrane
presented a concavity instead of the normal convexity pro-

The General Infections of the Genital Organs of Cattle 37 1

jecting into the cytoplasmic portion. Many of the cells ap-
peared about normal. Some of the cells were too large ;
they might be termed megalocephalic.

Bull 9, Fig. 118. Seven-year-old. Has served twenty-
seven cows — twenty-nine recorded copulations with eight
(29.6 per cent.) conceptions resulting. Physical examina-
tion revealed bilateral seminal vesiculitis. Ten to twelve
mils, of semen of normal appearance were obtained. It con-
tained numerous short-chained streptococci on smear. The
spermatozoa, all parts of which showed in clear detail, were
apparently normal.

Fig. 118 — Spermatozoa from Bull No. 9.
Cells apparently normal, but semen contained short streptococci.

Bull 10. Three-year-old. Has been in present herd two
and one-half years. Total number of cows served, fifty,
with ninety-one copulations resulting in thirty-four concep-
tions in twenty-nine cows (two conceptions each in five
cows), of which six aborted. Since October 22, 1919, there
have been eleven copulations with eight cows, and no concep-

372

Diseases of the Genital Organs

tions. Twenty-one of the cows (42 per cent.) served did
not conceive. Examination of cows revealed little cause for
sterility. Examination of bull revealed presence of seminal
vesiculitis on left side. Organs and erection normal but,
owing to the custom of placing cows for service with their
hind parts raised, half an hour to an hour was often re-
quired to serve a cow, leading to an increased strain on the
genital apparatus, which may have been a potent factor in

Fig. 119. — Spermatozoa from Bull No. 11.
Cell heads stained poorly, because the nuclear membrane "was imperfect.

the production of the spermato-cystitis and decreased fer-
tility. Owing to unfavorable conditions for coitus, I was
unable to get a sample of semen.

Bull 11, Fig. 119. Four-year-old. Has served sixty-two
cows, with a total of one hundred and seven copulations,
resulting in twenty-nine conceptions and eleven (37.9 per
cent.) abortions. From the first his fertility has been low.
Twenty-eight cows served by this bull (45.1 per cent.) sub-
sequently conceived from service by another bull.

77/<? General Infections of the Genital Organs of Cattle 373

Examination revealed bilateral spermatocystitis, with
other portions of the genital apparatus normal. Organs
excellent but copulation interfered with by considerable
pain on erection, evidently due to the sensitiveness of the
seminal vesicles. About ten mils, of apparently normal
semen were obtained, containing sperm cells of low motility.
Firm coagulum appeared within a few minutes. The head
parts did not stain well. The nucleus stained poorly. The
nuclear membrane was not well defined.

The inefficiency of Bull 11 was so marked, especially in
contrast to other sires used in the herd, that his slaughter
was found advisable. Laboratory examination of the or-
gans, including testicles, epididymes and seminal vesicles,
revealed no macroscopical lesions. Cultures and smears
from these organs were negative. The sterility appeared
entirely referable to the changes occurring in the germinal
cells. The infection in the female was probably not specific,
but merely the result of lowered resistance or a predisposi-
tion on the part of the embryo to those organisms of low
vitality which ordinarily inhabit the female genital tract.

Sterility of the bull may be directly due to conditions af-
fecting his general health, but is more frequently referable
to demonstrable pathologic conditions occurring either in
the germinal cells or in the glandular structures of the geni-
tal system. These changes may or may not be accompanied
by recognizable infection. The diversity of the bacteriologi-
cal findings of the genital glands and of the semen do not
clearly indicate the presence of a specific type of infection.
A streptococcus of the viridans type is most frequently
found. In the female genital organs of one herd which has
been subjected to numerous bacteriological studies, appar-
ently this organism predominates. In this herd the ovi-
ducts are most seriously involved. This usually follows
cervicitis which yields to treatment, while the tubal disease
defies all efforts at control. The bull is apparently an im-
portant, if not the chief factor in bringing about these con-
ditions.

It is common to find morphological changes in the sperma-

274 Diseases of the Genital Organs

tozoa. These occur mainly as abnormal development or ar-
rest in development. Quite frequently I have seen extremely
large spermatozoan heads (megalocephalia) which so far as
determined are otherwise normal. Abnormally small heads
appear with much greater frequency. Morphological altera-
tion in any considerable proportion of the spermatozoa defi-
nitely decreases the procreative capacity of the bull. The
germinal cell may also be of low vitality without showing
morphological deviations. It is a well demonstrated fact
that the vitality of some bulls is so lowered that a healthy
vigorous calf is rarely produced. The cause for this may
be an inherent weakness, the devitalizing effect of a general
constitutional disturbance, or a local inflammation of the
germinal epithelium.

My studies of numerous herd sires bring out many in-
teresting problems. Since it has become my regular prac-
tice to examine the semen of bulls in herds where there is
a high rate of abortion, I have been interested to find that
the spermatozoa almost always show marked pathologic
changes. I have not as yet been able to correlate such
changes with any specific infection. From results thus far
obtained, it appears unsafe to conclude that abortions oc-
curring in a herd are due to a specific disease of the female,
chiefly or alone, if the sire is not first subjected to a thor-
ough examination.

Although it has been impossible to work out all data on
bulls examined up to the present time, the results so far in-
dicate:

(1) that sterility of varying degrees in bulls is very com-
mon,

(2) that such sterility is associated commonly either with
an arrest in the development of the sperm cell or with dis-
integration after reaching maturity,

(3) that, as the sterility is accompanied, in a large pro-
portion of the cases so far studied, by spermato-cystitis,
with no atrophic orchitis, it appears that the destruction or
devitalization of the spermatozoa is due to the toxic sub-
stances derived from bacterial infection,

Degenerative Orchitis of Calves 375

(4) that such infection is present, not only in the semi-
nal vesicles, but also in the seminiferous tubules and epidi-
dymes,

(5) that the determination of the motility of spermato-
zoa does not constitute a reliable standard for the measure-
ment of their vitality and powers of fecundation,

(6) that some outbreaks at least of the so-called contag-
ious abortion are entirely referable to a lessened vitality of
the spermatozoa.

A. Orchitis

1. Degenerative Orchitis of Calves. Destruction of

Spermatogenetic Epithelium in Calves. Arrest

in Development of Scrotal Testes.

Desquamative Orchitis

There occur not infrequently cases of absolute sterility in
young bulls, which reveals itself immediately when the ani-
mal is put into service. The general condition of the bull
may be beyond criticism. He is distinctly masculine in his
head, neck, and voice and shows normal sexual desire. He
copulates comparatively promptly but, observed closely, is
seen to ejaculate slowly and in a manner to raise doubt.
After copulation, little or no semen can be recovered from
the vagina. Microscopic search shows the total absence of
spermatozoa.

Clinical examination of the testicles shows them to be
small and flaccid. The two glands are symmetrical and one-
fourth to three-fourths the normal volume.

Histologically, the epithelium of the tubuli seminiferi has
disintegrated and the tubuli contain detritis. Spermatozoa
are absent. Ordinarily there remains but a single epithelial
layer on the basement membrane of the tubule. A few im-
perfect spermatozoa or spermatoids may be present in the
cellular debris in the lumen of the tubules. The tubules of
the epididymis participate in the epithelial destruction.

The degenerative changes are evidently of bacterial ori-
gin, but the form of bacteria has not been studied. The de-
structive changes appear to be quite analogous to those oc-
curring in the oviducts, in which streptococci of the veri-

376 Diseases of the Genital Organs

dans type predominate. The B. abortus of Bang is not
known to participate in the destruction.

The clinical diagnosis appears to be simple and clear, but
the subject deserves further study. When discussing "Ar-
rests in Development of Scrotal Testes," I have referred to

FlG. i2i— Degenerative, or Desquamative Orchitis in Young Bull.

./. Normal testis of bull ; />', degenerative testis of sterile bull ; /, testis;

2t head of epididymis ; ,-, body of epididymis ; f, globus minor.

the clinical characters here described. The glands have
much the consistency of cryptorchid testicles, in which the
arrest in development is assumed to be purely embryologic,
unassociated with infection. Possibly such arrests occur in
scrotal testes without infection, but this is improbable.

Dege?ierative Orchitis of Calves 377

Cryptorchid testicles based upon embryologic arrest are al-
most invariably much smaller in volume than in the condi-
tion under discussion. It appears highly probable that in
all, or virtually all scrotal testicles of the type described the
changes are referable to bacterial invasion. The period of
invasion appears to be that of the nursery. At least the era
of invasion precedes puberty, so that from the first copula-

Fig. 122— Degenerative (Atrophic) Orchitis in Young- Bull.

/, Normal testis ; 2, atrophic degenerate testes ; 3, body of atrophic gland ;

4, head and, 5, tail of epididymis ; 6, scrotal peritoneum turned back,

showing adhesions to testicular peritoneum.

tion the animal is absolutely unfertile. The invasion may
be intra-uterine, but this appears doubtful. The bacterial
invasion of living bovine fetuses is commonly restricted, so
far as determined, to the alimentary tract. Perhaps it
would be more accurate to term the presence of bacteria in
the fetal alimentary canal as bacterial "inclusion" rather
than "invasion." That is, the bacteria from the utero-
chorionic cavity of the cow invade the amniotic fluid by

378 Diseases of the Genital Organs

penetrating the chorion and are then swallowed by the em-
bryo in the constant physiologic process by which the fetus
swallows its amniotic fluid. When the ingested amniotic
fluid is absorbed, the contained bacteria, with cellular de-
bris, remains as a filtrate to constitute the meconium. Nor-
mally the bacteria, once imprisoned in the meconium, re-
main so permanently and are expelled as a component part
of it by the new-born calf. Aborts, which commonly suf-
fer from dysentery prior to their death and expulsion, are
subject to general bacterial invasion. The heart blood of
the fetus may contain the same bacteria as the utero-chori-
onic space of the mother. This also appears to be true at
times of prematurely born calves or of very sick calves born
at the completion of the normal duration of pregnancy, but
these ordinarily succumb to disease (calf sepsis, calf scours,
calf pneumonia). The infection probably occurs most fre-
quently soon after birth, while the digestive or respiratory
epithelium is damaged or destroyed as a result of dysentery
or pneumonia, or in the presence of a lesser degree of diges-
tive or pulmonary disturbance.

The condition presents an interesting problem in the
ethics of the sale of pedigreed bull calves for breeding pur-
poses. I have not known a breeder to recognize the defect
prior to sale and believe that he would not ordinarily see it
until his attention is attracted to the condition by the ster-
ility. The sale of such animals is, therefore, usually honor-
able. When the bull fails to breed and the disease is recog-
nized, the breeder is usually equally honorable in making
prompt retribution. In one instance, however, where a
young bull was sold at a very high, perhaps exorbitant
price, the seller refused to make restitution. The case was
brought into court. There was no written warranty, but
the statutes of the state where the sale was made hold that
the purpose for which an article is sold carries with it an
implied warranty of fitness for the use for which the article
is purchased. The contention of the defendant was that the
shipment of the bull from the Atlantic to the Pacific Coast
in a common box-car had caused a degeneration of the tes-

Orchitis in Adult Bulls 379

tides as a result of the vibration of the car. He supported
the plea by the evidence of numerous veterinarians with
such success as to cause a mis-trial of the case.

The condition, once established, is evidently beyond rem-
edy. If my view of its origin is correct, it can generally, if
not always, be prevented by the proper handling of young
calves.

2. Orchitis in Adult Bulls

I have not observed, and have not found described in adult
bulls a degenerative orchitis with desquamation of the
spermatogenetic epithelium with flaccidity of the testicle,
as described above in bull calves. This is probably, if not
certainly, due to the absence of careful study. It would be
difficult to assume that bacteria causing the destruction of
the spermatogenetic cells in calves may not also invade and
cause similar injury to the adult testicles. There would be
differences, however, in the results from the invasions at
two separate epochs. Doubtless there is a difference of re-
sistance. The essentials are, that there shall be a type of
organism which may invade the tubuli seminiferi and cause
a slow disintegration of their lining cells without arousing
the classic signs of inflammation, "heat, pain, redness and
swelling," and impotent to cause abscessation or total ne-
crosis.

Clinical data are at hand which warrant the tentative
conclusion that such degenerative or desquamative orchitis
exists frequently and is serious. Some bulls demonstrate
moderate fertility at the commencement of their breeding
career, but show upon close study a slowly advancing, in-
sidious sterility. At first the difficulty is ascribed to the
cows. The bull appears well, has normal sexual desire, and
copulates eagerly. In large herds where several sires are
kept, a comparative study of his breeding shows him to be
less fertile than other bulls under analogous conditions.
Further study reveals the fact that his pregnancies are less
secure, so that, while the general rate of observed expulsion
of fetal cadavers is, for example, 10 per cent., his rate is 20

380 Diseases 0/ the Genital Organs

or 25 per cent. In many cases the fertility appears inter-
mittent. For a brief period all copulations fail; then follows
a period of fair fertility. If the semen is examined, inter-
esting changes are found in the spermatozoa.

In this inadequately studied field, the best that can at
present be done is to study the spermatozoa, their degree of

FlG. 123 — Purulent Periorchitis ( Empyema of Scrotum) with
Necrosis and Atrophy of Testes.
/, Vestige of testis sectioned, showing <>n the right remnant of paren-
chyma ; j, epididymis ; ,\ vas deferens : ./, scrotal wall turned hack. On
the right <>f the right-hand figure the broad white streak between 2 and ./
i-> a deep incision made to keep specimen open:

the sperm heads. If spermatozoa are abundant but all
dead, the tubuli seminiferi must be comparatively sound
and death has occurred somewhere in the excretory appara-
motility, the frequency of the separation of heads and
bodies, and the staining characteristics, size, and form of
tus. If the spermatozoa are scant and marked disintegra-
tion has occurred, it would appear that the damage may

Orchitis in Adult Dulls

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382 Diseases of the Genital Orga?is

have taken place within the tubuli seminiferi. If no sper-
matozoa are present in the semen, it follows that the excre-
tory ducts are blocked or that the spermatogenetic epithe-
lial cells are destroyed. So far as known, the blocking of
the excretory ducts, as in cases of epididymitis or epididy-
mal abscess, is recognizable upon physical examination.

Severe orchitis, not common in bulls, ordinarily termi-
nates in abscessation. Very rarely it appears as an en-
zootic.

Wallraff (Repertorium der Tierheilkunde, 1846, p. 219)
records an outbreak of purulent orchitis in horses, cattle
and goats. The disease had existed in his locality in Freu-
denstadt for a number of years. At least it was known in
1832, fourteen years prior to the date of his contribution.
For a year prior to his report, the disease had been very
common and caused a very considerable loss among breed-
ing bulls. It involved animals of all ages, attacking many
calves when only 10 to 20 days old. The disease began with
light fever and loss of appetite. The animals stamped their
hind feet as if afflicted with colic. Presently the testicles
became more or less swollen, the scrotum red, hot, and
painful upon manipulation. This condition continued from
three to five days. Then, upon one or both sides of the scro-
tum, a small opening appeared, from which at first a stink-
ing discharge, mixed with blood, escaped. After one or two
days this discharge was superseded by ordinary pus. This
continued for five to fourteen days, until the testicle was
wholly destroyed. Wallraff uniformly observed the swell-
ing and suppuration in the left testicle first. As a general
rule, after one testicle was destroyed, the other also under-
went destruction later, though in some cases one of the tes-
ticles escaped.

The disease had little danger for the life of the animal.
Alter the destruction of the testicle, the animal recovered
without any very great enlargement of the scrotum. In
ase, when the abscess in the testicle ruptured, the bull
almost bled to death. Wallraff failed to recognize the
cause. For a time he thought it was hereditary, and con-

Orchitis in Adult Bulls 383

tinued to believe that it might be so. However, he found
that sound males introduced from other sections, where the
disease was unknown, contracted the malady, and conse-
quently felt that there must be a local infection of some
kind.

While there seemed to be no great danger to the life of
the patient, there was very serious loss in condition and also,
in all or nearly all the cases, the breeding life of the animal
was brought to a close. Consequently, as a rule, when the
disease was observed early, the animal was sent to the
butcher as the most economic course. Once the disease was
established, castration apparently proved the most direct
method of handling.

There is no very clear line of demarcation clinically be-
tween orchitis and epididymitis. The symptoms are funda-
mentally alike. The tumefaction of one structure quickly
encroaches upon the other and the two organs blend. Com-
monly also the disease processes in orchitis and epididymitis
blend, so that one is rarely present without the other.

Orchitis ordinarily reveals itself by a more or less pro-
nounced swelling of the testicle. As a general rule, the dis-
ease is unilateral in the bull, there being no commonly known
acute systemic infection which tends to involve simultane-
ously both the glands, as observed in the infectious cellulitis
of horses. When orchitis, due to infection, causes definite
changes in the gland itself, they usually occur very promptly,
with much swelling and pain. As a rule, there is loss of ap-
petite with elevation of temperature. The very firm envel-
ope or tunic of the testicle renders any inflammation of the
gland excessively painful. At the same time it prevents
prompt relief by free swelling and tends to cause destruction
of the tissues as a consequence of blood stasis from com-
pression.

A common result of orchitis in the bull is the .formation
of an abscess in which the entire gland, along with the
epididymis, undergoes necrosis and purulent destruction.
In the one instance of abscessation of the testicle of the bull
in the college collection, the abscess has attained a diameter

384 Diseases of the Ge?iital Organs

of about ten inches. The capsule of the abscess, shown in
Fig. 124, consists chiefly of the cremaster muscle and its
fascia. The testicle and epididymis have almost completely
disappeared, though faint traces of the necrotic gland are
found embedded within the pus. A few bands of connective
tissue pass across the abscess cavity from wall to wall.

The biology of orchitis in bulls has not been determined.
Erhardt (Schweizer Archiv. fur Tierheilkunde, Vol. 38, p.
79) records a case of orchitis in a bull due to the vesicular
venereal disease of cattle. Other writers also attribute cases
of purulent orchitis in the bull to the granular venereal dis-
ease, but this view is difficult of verification because the
biology of the malady is unknown. So far as known, the
B. abortus of Bang plays little or no part in the causation
of orchitis.

Necessarily the prognosis of orchitis is highly unfavora-
ble. As a general rule, when the infection is so severe as to
cause definite clinical symptoms, the organ does not re-
cover its physiologic function. The danger to the life of
the animal is not great.

The treatment of orchitis has not been definitely formu-
lated. Theoretically there might be some justification in
local applications intended to lessen the inflammation, such
as ice-packs or the application of cold water, along with
support by means of a suspensorium. Practically I have
not known this plan to accomplish any good and I doubt
very greatly its efficiency. If, however, one has reason to
believe that the orchitis is due to traumatism, the local
treatment should be applied and should promise well. I am
not certain how frequently traumatic orchitis occurs in do-
mestic animals. Many writers give it a prominent place,
though upon what ground is not perfectly clear. Gmelin
(Handbuch der Tieriirztlichen Chir. u. Geburtshilfe, Bayer
und Frohner, p. 432) states that the commonest cause of
orchitis is traumatism, but I have not seen this in any do-
mestic animal save in one case of gunshot wound.

As a general rule, as stated above, the functional life of
the gland is at an end. Whenever this may be assumed, the

Degenerative Epididymitis of Calves 385

most direct and radical method of handling is castration.
When only one gland is involved, its removal does not inter-
fere with the animal's fertility and affords the best and
promptest remedy that we possess. In castrating such an
animal it is to be remembered that the gland is generally
adherent to the parietal peritoneum of the scrotum and,
through it, to the cremaster and its fascia. Therefore it is
more convenient, as well as less dangerous, to castrate by
the covered operation. In this operation the skin and dartos
are freely incised at the lowest part of the scrotum and a
separation made with the handle of the scalpel, or with the
fingers, between the dartos and the cremasteric fascia up
to the inguinal canal. A ligature is then applied to the
spermatic cord covered by the cremaster muscle, and the
testicle, with its coverings, cut away an inch or two beyond
the point of ligation. The ligature should preferably be of
heavy chromatized catgut with a durability of about twenty
days.

B. Epididymitis

1. Degenerative Epididymitis of Calves. Arrest in

Development

In the preceding article upon degenerative orchitis in
calves, it has been mentioned that, when that disease occurs,
the epididymis ordinarily participates in the pathologic
changes. From what I have been able to observe, the epi-
didymitis is probably the more important and primary
lesion.

There are no outstanding clinical symptoms beyond those
already described under orchitis. So far as has been ob-
served, the calf as a nursling presents no symptoms which
attract any attention. This may be due to the fact that,
since the testicles of calves are not observed, changes which
are perfectly visible may occur without being noted. When
the calf comes to breeding age, he is found to be sterile and
when examined critically, as already stated under orchitis,
the testicles, with the epididymes, are found to be small and
?5

38 6 Diseases of the Genital Organs

soft. So far as known, the disease is always bilateral and
apparently dates back to infection during the nursing pe-
riod, as described under orchitis. The condition, which is
beyond remedy, can be prevented only by the protection of
the young calf against the inroads of infection. This will
be more fully discussed under the infections of new-born
calves.

2. Chronic Indurated Epididymal Abscesses of Calves

I have observed one instance, in a young bull of poten-
tially great value, a long-standing, indurated abscess in the
globus minor of each epididymis. The bull, well developed
in all respects, was very vigorous and copulated freely, but
was absolutely sterile from the beginning. Physical exam-
ination revealed a hard enlargement, one inch or more in
diameter, in the globus minor of each testicle. Tuberculosis
of the epididymis was suspected, but he failed to react to
the tuberculin test. One of the glands was then removed
for examination. The epididymis was found to contain a
small abscess with indurated walls, which had something
of the appearance of a tubercular abscess but was without
calcification, and no tubercle bacilli could be found. Later
the bull was slaughtered and the other testicle was found to
be essentially identical.

The diagnosis of chronic indurated abscess of the epidid-
ymis is comparatively simple. So far as we know, the ab-
scess is most liable to occur in the globus minor, which in
the bull projects beyond the lower end of the testicles on its
posterior surface, where it is very readily palpated. If any
doubt arises on the part of an inexperienced examiner, the
comparison of the diseased epididymis with that of a healthy
animal at once reveals the great departure from physiologic
condition. Both the enlargement and the hardness are well
marked and not readily mistaken for anything else. Should
the abscesses occur at other points in the epididymis, they
are quickly recognized by the same general symptoms. The
head of the epididymis is readily palpated except for the
covering of the cremaster, as shown in Fig. 2 on page 5.

Chronic Indurated Epididymal Abscesses of Calves 387

The body of the epididymis is not so easily palpated, as in-
dicated in Figures 3 and 4 on pages 7 and 8. If there is any
material enlargement, however, it should be detected with-
out great difficulty. When the gland has revolved outward,
as shown in the right testicle of Fig. 4, it is brought more
readily into view and can be more definitely palpated.

Fig. 125 — Chronic Abscessation of Epididymis in Young- Bull.

W, Normal testicle from sound bull ; />'. diseased testicle.

/, Testicle ; 2, body of epididymis ; j, tail of epididymis greatly enlarged in

diseased gland ; ?', section through epididymis, showing pus in

the epididymal tubes ; ./, portion of scrotal wall

thrown back showing adhesive bands.

The condition described above appears to be closely re-
lated to the degenerative epididymitis already spoken of. It
appears quite evident that the abscessation occurred during
the nursery period, so that it was well established before the
bull had reached breeding age. Schroeder1 records an in-
stance of abscessation of the epididymis in which the B.

1 Some Facts about Abortion Disease, Jour, of Ag. Research, Vol 9, 1917,
P- '5-

388

Diseases of the Genital Organs

abortus was recognized. He does not state, however, that
no other organisms were present. He reaches the conclu-
sion that the B. abortus was the cause of the abscess. This
is not very clear. It has not been definitely shown that the
B. abortus of Bang is pyogenic when injected into the tis-
sues. We do know, however, that it is associated with sup-
puration in the uterine cavity. Whatever may be the biology
of the disease, the prognosis is hopeless.

FlG. 126 — Orchitis and Epididymitis. Bull.

. /, Left testis ; />', normal left testis for comparison ; C, Right testis.

/, Globus major of epididymis, greatly enlarged and adherent to testis ;

,\ /, tail of epididymis; 5, 6, -, normal globus major, body and globus

minor of epididymis respectively; 8, inflamed globus major; o, parietal

Scrotal peritoneum adherent to testicle, incised and turned back.

3. Epididymitis of Adult Bulls

Epididymitis develops occasionally in adult bulls which
have a history of normal fertility over a somewhat ex-

Spermato- Cystitis 389

tended period. Then without cause there develops, gener-
ally very gradually, an increasing degree of infertility. An
increasingly large percentage of the cows which he serves
fail to conceive. The bull may be apparently vigorous, both
physically and sexually, or there may be hesitancy or diffi-
culty in coitus. It is not known, however, that the epidid-
ymitis causes this hesitancy or difficulty, which may be due,
so far as is now known, to other lesions existing at the same
time. If the semen of such a bull is examined, the sperma-
tozoa are found largely or wholly dead. Upon physical ex-
amination, one or both epididymes are found to be swollen
and tender. As in the indurated abscess of the epididymis
in the young animal, so in the adult bull, the inflammation
is largely concentrated in the globus minor. The swelling
is hard and painful to the touch. The cause of such epidid-
ymitis is unknown, beyond the fact that it is evidently due
to infection. No studies have been made regarding the
character of the infection. It probably differs greatly in
different individuals. It is not generally pyogenic, so far
as yet determined.

So far as known, there is no hope for recovery and noth-
ing to advise in the way of treatment. It is barely possible
that in some cases one might achieve results by the removal
of the diseased gland. However, there is the constant dan-
ger that the other gland is similarly, although not palpably
infected, in which case the removal of one gland would be
of no avail. In other cases I have found clinically that the
seminal vesicle was at the same time similarly inflamed, so
that no good could be expected from removing the diseased
epididymis and testicle while the diseased seminal vesicle
was allowed to remain. The only hope, therefore, in remov-
ing the one gland is that the opposite gland is sound and
that there is no disease of the seminal vesicle or other
glands about the pelvic urethra.

C- Infections of the Glands of the Pelvic Urethra

1. Spermato-Cystitis. Semino-Vesiculitis

Semino-vesiculitis, or inflammation of the seminal vesi-
cles, has attracted scant attention in bulls or other breeding

390 Diseases of the Genital Organs

males. It is therefore impossible at present to make a re-
liable estimate of the frequency of its occurrence. Enough
study has been given the subject recently to show that
semino-cystitis is neither rare nor unimportant in breeding
bulls.

Fig. 127 — Purulent Spermato- Vesiculitis. Bull. ( From same animal

as Figs. 126 and 86).

On the left is included a normal pelvic urethra, urinary bladder,

and seminal bladder for comparison.

/, /, Greatly enlarged vesiculae seminales; .?, 2, enlarged terminal portions

of vasa deferentia ; ,'. urinary bladder ; /. pelvic urethra covered by

Wilson's muscle and prostate gland : 5, body of prostate.

The symptoms have not yet been clearly defined. In the
cases observed clinically, there was hesitancy in the ejacu-
lation of semen, and a markedly deficient volume of the
seminal fluid. Taking into account the present belief in
the function of the seminal vesicles, the symptoms thus far

Spermato- Cystitis 39 1

observed appear logical and inevitable. In ruminants,
swine and solipeds, the seminal vesicles are the outstanding
subsidiary sex glands connected with the pelvic urethra,
and are believed to supply the chief volume of the semen,
serving as a diluent in which the spermatozoa, arriving
from the testicles, may swim. This facilitates the ejacula-
tion of the highly concentrated mass of spermatozoa. At
the same time it is believed that the physiologic secretion
from the vesicles stimulates and energizes the spermatozoa,
rendering them more active.

In harmony with this view, present studies show that
when the vesicles are inflamed, not only is the ejaculation
tardy and the volume of semen scant, but the spermatozoa
are non-motile or feeble. Spermatozoa taken from the epi-
didymis in a healthy animal are vigorous. Hence it would
appear that in semino-vesiculitis the vesicular fluid from the
diseased organ devitalizes the spermatozoa.

The clinical examination of the bull reveals, upon rectal
palpation, enlargement and irregular, nodular swelling,
with extreme sensitiveness. The physiologic gland, as
shown in Figs. 5-7, page 11, may be freely manipulated
without causing any evidence of pain but, once it is in-
flamed, the bull immediately winces upon the most moderate
pressure. There are few glands or organs in the body which
show such marked sensitiveness when inflamed as do the
vesiculae seminales.

The clinical history of semino-cystitis is a progressive, or
probably sometimes sudden, sterility. Cows fail to conceive
uniformly, or there is total sterility. Naturally the cows
and heifers are examined, and no explanation for sterility
is discovered. Therefore, attention is turned to the bull.
In one bull, the vesiculitis was associated with epididymitis,
presumably due to a common cause. There appeared to be
also some inflammation of the vas deferens. The bull had
been imported from England at high cost for breeding some
very valuable heifers. Seven were bred without a concep-
tion.

It is not improbable that epididymitis and semino-cystitis

392 Diseases of the (ienital Organs

are commonly associated, but whether the epididymitis is
the progenitor of the cystitis, or vice versa, there is no evi-
dence to show. Thus far the affection has been chiefly ob-
served in young bulls, but most bulls are young. There
seems quite a probability, however, that the infection, like
epididymitis, is largely an invasion during the nursery pe-
riod, and that it lies somewhat dormant until unfavorable
hygienic conditions, close confinement, overfeeding, or ex-
cessive coitus arouse the infection to destructive virulence.
On the other hand, the possibility, if not probability, of ac-
quiring the infection through repeated coitus with highly
infected cows, must be frankly acknowledged and the proper
hygienic handling of bulls maintained in order to anticipate
such disease.

Neglect of the study of the genital infections of bulls ren-
ders it impossible to speak with any assurance regarding
the bacteriology of semino-vesiculitis. Buck and others,
searching the vesiculae seminales, vasa deferentia, epididy-
mes and testes of 37 out of a group of 235 bulls, for the B.
abortus, recognized that organism in the vesiculae seminales
of 4. There appears nothing in their communication to in-
dicate that they were interested in the bacteriology of the
organ. Evidently they searched merely for the one organ-
ism, ignoring all others. While they recognized the B. abor-
tus in bulls, they have not stated that the cystitis was due to
that bacterium. The B. abortus probably plays a negligible
part in the causation. Vesicles from bulls, slaughtered be-
cause of sterility but not showing evident enlargement, sub-
mitted to Carpenter, revealed a streptococcus. It would
normally be suspected that the infections of the vesiculae
seminales and epididymea would be analogous to those of the
oviducts, in which streptococci appear to be the commonest
offenders.

The prognosis, from the standpoint of reproduction, is
highly unfavorable. It seems improbable at present that,
once well established, semino-cystitis can recover, although
further observation may modify such a view.

There is no effective method known for handling the dis-

Balanitis. Balano-PostJiitis 393

ease. It is beyond the reach of the surgeon. It is not known
that any internal disinfectant can efficiently reach the or-
gan. With the bacteriology virtually undetermined, vac-
cines, bacterins, and other biologic products can not be ad-
vocated. The most that can be suggested thus far is sexual
rest and good general hygiene with, as a rule, eventual
slaughter.

2. Diseases of the Prostate and Cowper's Glands

The pathology of the prostate glands of animals has not
been studied except in the dog, where apparently the gland
suffers frequently from disease. While the gland is an ex-
tensive one in the bull, it is so enveloped by Wilson's muscle
that it is not directly palpable. There is nothing in veteri-
nary literature indicating to what, if to any appreciable ex-
tent the prostate of cattle becomes diseased.

In the bull Cowper's glands lie deeply buried beneath the
ischio-cavernosus muscles, where they are not palpable un-
less enormously enlarged. I find no record of disease in
them.

D. Balanitis. Balano-Posthitis

In Chapter XII, under "The Nodular Venereal Disease,"
balanitis and balano-posthitis have been quite fully discussed
as one of the practically universal results of that infection
or lesion in ruminants and swine. While other infections
(aside from tuberculosis and actinomycosis) may invade
these parts, they offer nothing of special interest so far as
is known at present. The general principles of control in-
dicated for the nodular venereal disease are applicable to
any infections of a general character which may be added
to or associated with it.

39+ Diseases of the Genital Organs

II. GENERAL INFECTIONS OF THE GENITAL
ORGANS OF HEIFERS AND COWS

A. Diseases of the Ovaries. Ovaritis

Simple ovaritis, or oophoritis, is not often clearly distin-
guishable as a clinical entity in animals. In the preceding
chapter the invasion of the ovary by such infections as ac-
tinomycosis and tuberculosis has been recorded. Rarely
also one encounters abscessation of the ovary.

The diseases of the ovaries of cattle (and other animals)
have not been scientifically studied. A few very superficial
histo-biologic studies have been begun, but abandoned be-
fore any material knowledge was gained or any correlation
between the findings and clinical observations established.
Much has been written concerning the clinical aspects of
ovarian diseases. Between these two fields of study are the
macroscopical findings upon post-mortem examination. The
knowledge of ovarian diseases (and the diseases of other
genital organs may well be included in the generalization)
is consequently superficial and fragmentary. Therefore any
statements, aside from the few clearly demonstrated facts
which may be presented, are to be accepted with very liberal
reservations and it must be confidently expected that ade-
quate study will modify numerous assumptions and beliefs.

In general it appears that the ovaries of cattle are fre-
quently the habitat of varieties of infection of a type which
may exist indefinitely in the gland without causing notable
disease but which may, under certain conditions, acquire a
force competent to bring about disturbances in structure
and function. Bacteria (micrococci, streptococci, etc.) are
found in the ovaries of heifer calves and of aged cows, with-
out evidence or suggestion that the infection in the ovary of
the aged cow did not acquire its ovarian habitat while the
animal was yet in the nursery. Many clinical and post-
mortem changes are seen in the ovaries, so associated with
disturbances of ovarian function as observed clinically that
certain conclusions, assumptions, or surmises are justified.

Atretic Follicles 395

1. Atretic Follicles

There are commonly observed in the ovaries of heifer
calves, heifers, and cows numerous small cysts, varying
from 1/16 to V4 inch in diameter, containing a clear liquid.
They appear to be the remnants of follicles in which the
primitive or permanent ova have perished and the follicular
liquid has persisted, with more or less addition to its volume.
I have stated that they grow as large as V4 inch in diameter.
How much larger they may grow is at present difficult to
state. They may grow much larger but, should they do so,
become confused with cysts of other origin and lose their
identity. That is, when a larger cyst is encountered and
neither clinical nor histological evidences of origin are
forthcoming, accurate differentiation is impracticable.

The significance of these small cysts is unknown. If
they elaborate important secretions (endocrines) or in any
other manner modify the sexual functions, or if they affect
in any way the reproductive functions, the fact has not
been demonstrated. They are quite as numerous in ovaries
which function normally as in those which do not.

2. Cystic Degeneration of the Ovisacs. Nymphomania

There occurs in all species of domestic animals, though
preeminently in the cow, a type of cystic degeneration of
the ovaries accompanied by nymphomania. So far as can
be determined at present, the degeneration is one involving
the unruptured ovisacs. Apparently this undergoes dis-
tension, the follicular liquid becomes enormously increased,
the ovum perishes, and there is little tendency for the cystic
follicle to rupture and recover spontaneously.

It would appear quite certain that the cystic disease is
one of the ovisac itself, because, so far as I have been able
to determine, there is never any lutein tissue in the cyst
wall. In nearly all adult ovaries there are vestiges of cor-
pora lutea, but in nymphomania they are purely vestigial
and are not connected with, or visibly related to the cysts.

I have not known nymphomania to develop in a pregnant
animal. There are large and small cysts in the ovaries of

396 Diseases of the Genital Organs

pregnant cows, but not of the nymphomaniac type. The
cysts of nymphomania develop at times when physiologically
the animal should ovulate. That is, she has reached breed-
ing age and is not at the time pregnant. No corpora lutea
are present to exclude estrum. There are no recognizable
lesions in the genital tract or elsewhere which would tend to
inhibit estrum, except the nymphomaniac cysts themselves.
It appears justifiable, therefore, to believe that the nympho-
maniac cyst is a pathologic process occurring in an ovisac
which is nearing maturity.

The cysts of nymphomania are exceedingly variable in
size. They are rarely less than one inch, and with equal
rarity exceed three inches in diameter. When larger cysts
appear, like those desiribed on page 257, nymphomania is
not present, and as a rule the cyst inhibits fertility upon the
involved side only, while the other ovary functions and the
animal breeds. When the cyst of nymphomania is present,
however, fertility is in abeyance.

The number of nymphomaniac cysts which may simulta-
neously exist varies from one to three or four. The pres-
ence of one nymphomaniac cyst does not prevent, nor tend
to prevent, the formation of others. The cysts are multiple,
not multilocular. That is, each cyst arises separately, so
far as can now be determined, from individual ovisacs, and
remains distinct throughout its existence. Hence one ovary
may have two or three contiguous, nymphomaniac cysts.
The cysts frequently involve both ovaries, although some-
what frequently only one is affected. However, the sterility
is as complete with only one ovary involved as when the dis-
ease is bilateral.

There is wide variation in the thickness of the cyst walls.
In some cases they burst upon very slight digital pressure
when being examined per rectum. As a general rule, they
require moderate pressure before they are ruptured. In a
majority of eases, the cyst wall is so dense that it is unsafe
to rupture it by rectal pressure and it requires in some in-
stances all the force the operator can command to rupture
it through the vagina. In rare cases, the cysts can not be

Cystic Degeneration of the Ovisacs

397

ruptured by manual pressure from the vagina and their
contents can be removed only by puncture.

The large nymphomaniac cysts necessarily project far be-
yond the general surface of the ovary. In very rare cases,

FlG. i 28 — /, Nymphomaniac cysts ; 2, cystic oviduct and corpus luteuru.
a, Cystic pavilion ; b, cystic oviduct ; c, cornu ; d, cystic corpus luteum with
faint girdle of lutein tissue ; j, <?, encapsuled corpus luteum ; f, ostium
abdominale of oviduct.

small nymphomaniac cysts are centrally located, giving to
the ovary a somewhat spheroidal or merely plump form.

The symptoms of nymphomania are usually very pro-
nounced and characteristic. The cow or heifer bellows a
great deal, more frequently perhaps than when in estrum.

398 Diseases of the Genital Organs

There is such a distinct modification in the voice that it can
scarcely be distinguished from that of a bull. The female
appears to be in estrum of an exaggerated type. She will
mount other cows whenever opportunity offers and, when
free with other cows which are in estrum, she will ordinarily
permit them to mount her. As a rule she will copulate at
any time with the bull, but there are notable exceptions.
Although the animal shows every evidence of an erratic
estrum, in some cases she will not copulate. The manifesta-
tion of the erratic sex desire is not confined to other cows or
to the bull. The nymphomaniac cow may mount any animal,
or for that matter man, if he is not on his guard. In some
cases, cows kept in stalls with low partitions will mount the
partition.

After the disease has progressed for a time, usually not
more than a few weeks, notable changes take place in the
pelvic ligaments. The postero-superior border of the sacro-
sciatic ligament, where it passes from the tuberosity of the
ischium upward and forward to the sacrum, becomes re-
laxed, soft and flaccid. The broad expanse of the ligament
suffers similarly and sinks into the pelvis, so that the gluteal
muscles drop inward toward the median line of the cavity,
causing a deep excavation. The relaxation of the ligaments
causes marked deformation of the pelvis : the tuberosity of
the ischium becomes elevated and the tuberosity of the ilium
depressed. The sacrum participates in this change of posi-
tion. Its caudal end becomes greatly elevated and its lum-
bar end depressed. The result is a sharp depression at the
sacro-lumbar articulation, with a very marked elevation of
the caudal end of the sacrum. The interosseous ligaments
1m -tween the ilium and sacrum share in the relaxation, so
that the sacro-ilial articulation is relaxed. This results in
an uncertain, rolling or wobbling gait. If one stands near
the animal when she is walking, he will now and then hear
a loud grating sound caused by the slipping of the ilium
upon the sacrum, which may be heard with considerable
uniformity if the external tuberosities of the ilium are
grasped and the rump of the cow is pushed back and forth.

Cystic Degeneration of the Ovisacs

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400 Diseases of the (renital Organs

The unsteadiness and inaccuracy of the gait, combined with
the frequent mounting of other cows, ultimately brings
about fractures of the pelvis in a large percentage of cases.
The fracture is usually through the shaft of the ilium.

By studying Fig. 128a, it will be observed that the sacro-
sciatic ligament (1, 1', 3) is apparently designed to hold
passively in proximity the sacrum, ilium, and ischium. At
the same time it affords the chief base of support for the
long vastus and gluteal muscles. If, therefore, the ischial
tuberosity (Is) moves upward toward the sacrum, the liga-
ment loses its bone-like rigidity and the long vastus and
gluteal muscles drop inward, as shown in 2 and 3 of Fig.
129. The relaxation of the sacro-sciatic ligament deprives
the long vastus and gluteal muscles of their normal fixed
insertion and adds to the uncertainty of the step already
mentioned as resulting directly from the relaxation of the
ligaments. The anatomo-pathologic mechanism of the de-
formity is not .quite clear. The direction of the pelvis in re-
lation to the spinal axis is chiefly maintained by the sacro-
iliac ligaments, the psoas group of muscles, and the pre-
pubian tendon (linea alba). When the prepubian tendon
gives way, the ischial tuberosity moves upward and the iliac
tuberosity downward, but the sacrum moves in harmony
and the sacro-sciatic ligament retains its tone and tension ;
there is no sinking in.

The basic cause of the ligamentous relaxation is yet more
difficult to determine. It has been compared with the pel-
vic relaxation upon the approach of parturition, but it is
utterly different. There appears to be some toxic substance
elaborated within the diseased ovaries which, acting upon
the central nervous system, causes these very remarkable
changes.

In spite of good feeding, the cow frequently loses condi-
tion rapidly; the hair loses its lustre, and emaciation is very
marked. These changes are well portrayed in 2 and 3 of
Fig. 129.

The disease occurs but rarely in heifers and is observed
chiefly in young cows. It attacks especially highly pedi-

Cystic Defeneration of the Ovisacs

401

Fig. 129 — Nymphomania.
/, Cow in health at close of official milk and-butter test ; 2, rear view after
nymphomania became established ; j, side view, do : 4, recovery of fertility
and health, the pelvic ligaments remaining sunken. 26

402 Diseases of the Genital Organs

greed dairy cows which are undergoing severe tests for
official records in the production of milk and butter fat.
Therefore it is preeminently a disease of the highest class
of dairy cows and has closed the breeding careers of many
renowned animals. The effect of nymphomania upon lacta-
tion is usually very marked ; the dairying efficiency is greatly
decreased. Generally the milk flow is exceedingly erratic.
In some cases a nymphomaniac may yield one day thirty or
forty pounds of milk, and the next day, five or ten. One day
her milk may contain 8 per cent, or more of butter fat and
the next day, 2 or 3 per cent. In such cases there is abso-
lutely no way by which a person may judge from the be-
havior of the cow one day what it will be the next.

Upon examining the genital tract, the most marked
change will be found in the ovaries. Palpation of these re-
veals one, two, or three cysts in one or both ovaries. No
recognizable corpus luteum is present. In very rare cases,
as stated above, there may be a small central cyst sur-
rounded everywhere by glandular tissue. The unwary prac-
titioner may fail here in his diagnosis. When the symptoms
of nymphomania, as described above, are present, the ex-
aminer will do well to search very carefully for a central
cyst in case of the absence of the large peripheral type.
The presence of the central cyst is to be diagnosed by very
careful palpation. The involved ovary, which is abnor-
mally large for the size and breed of the animal, approaches
the spheroidal shape. If the ovary is carefully palpated,
one gets the sensation of a very thick-walled, tense cyst in
its center. The uterus is much enlarged and extremely flac-
cid. It nearly always contains an increased amount of mu-
cus or muco-pus. This is readily revealed by douching.
The cervix is flaccid and atonic. The cervical canal is di-
lated so that it will ordinarily permit the ready passage of
one and frequently of two or three fingers. The vagina and
vulva participate markedly in the general atony of the geni-
tal tract. The vulva is large, flabby, and readily dilated.
Occasionally prolapse of the cervix through the vulva re-
sults from the general atony. In such cases the cervix be-

Cystic Degeneration of the Ovisacs 403

comes badly befouled with feces and litter and greatly in-
fected, so that the mucous membrane is much swollen and
usually soft.

The affection generally appears without warning. Al-
brechtsen contends that it is one of the results of metritis
or pyometra. This I can not verify. It occurs in heifers
which are not known to have been pregnant and in which
no history of metritis is obtainable. Possibly it existed un-
observed, as metritis so frequently does. I have also seen
the disease of a severe type within fifteen days after an ap-
parently normal parturition without clinical manifestations
of metritis. I believe it more logical to reverse this belief
and attribute the endometritis regularly accompanying
nymphomania to the atony due to the ovarian disease. In
severe cases the sinking of the pelvic ligaments occurs
within a few days after the commencement of the nympho-
mania ; in the milder cases the sinking of the ligaments may
not be notable until after several or many weeks have
elapsed.

The disease is extremely chronic and shows scant ten-
dency to spontaneous recovery. Just how long it may con-
tinue is quite unknown. I have seen cases where the nymph-
omania has existed constantly for from four to five years.
By that time the patience of the breeder generally becomes
exhausted and the animal is destroyed. Apparently nymph-
omania never directly causes the death of the patient but,
indirectly, by destroying the vigor and tone, may render
the animal an easy prey to intercurrent maladies.

Next to rabies, nymphomania in cows is the most inter-
esting scientifically, and most important economically
amongst the diseases of animals characterized by notable
mental aberration. It strikes most frequently the greatest
dairy cows, and all too often ruins them, thus causing a
severe economic loss to the owner and, worst of all, strik-
ing down the very cows which, by their potential ability to
yield great quantities of milk and butter and to grow prog-
eny equally capable, are of greatest value to the state.

The prognosis is unfavorable. Numerous writers have

404 Diseases of the Genital Orga>is

held the opposite view but have failed to substantiate it
with extended clinical data. In my experience, less than 50
per cent, recover and many of these quite tardily. My cases
have been chiefly of long standing, which depresses the
prognosis. In numerous cases, especially when coming un-
der treatment very early, the animals respond immediately
and permanently. In other cases, if severe and neglected
for a year or more, recovery becomes a matter of great
doubt. I have found no criteria, except the duration of the
disease prior to handling, upon which to base the prognosis
in a given case. Some of my worst cases, like that portrayed
in Fig. 129, have recovered their fertility. Hess and others
have expressed the dictum that, when the cyst is too dense
for manual rupture and can be emptied only by instru-
mental puncture, the case is hopeless and the animal should
be slaughtered. This is not entirely correct, as I have had
several cases in very valuable cows which, like Fig. 129,
have recovered fertility after I had punctured the cysts once
or several times. If a cow is highly valuable and there is
present no recognizable lesion, aside from the cysts, which
constitutes an absolute bar to fertility, the case should not
be pronounced hopeless.

The handling consists chiefly of the evacuation of the
cysts as rapidly as they form. Many of them can be rup-
tured safely and readily by digital compression per rectum.
The ovary should be manipulated carefully per rectum until
free from any chance covering or entanglement within the
mesosalpinx or mesometrium, so that the cyst comes into
immediate contact with the peritoneal wall of the rectum.
The cyst is then to be grasped between the thumb and two
or more fingers, and steady pressure exerted upon it with
the ball of the thumb. The thumb pressure should be con-
centrated upon the center of the cyst, and the hand should
encompass only as much of the cyst wall as essential to a
re grasp. That is, the greater the area of the cyst free
from compression, and the more concentrated the compres-
sion upon a limited area, the more certainly the cyst may
be ruptured. I have found it advantageous sometimes to

Cystic Degeneration of the Ovisacs 405

place the ovary against the bony wall of the pelvis and then
exert pressure against the opposite side with the hand, thus
impinging the ovary between the hand and the pelvic bone.
The rupture of ovarian cysts per rectum must always be
carried out with prudence. The fingernails should be
trimmed to the quick and carefully smoothed in order to in-
sure the maximum of safety against injury to the rectum.
Pressure must not be exerted upon the cyst when the rec-
tum is contracting. If, during the compression, the pa-
tient begins to strain, the pressure must be relaxed and, if
necessary, the ovary released in order to avoid rectal lacera-
tion or rupture.

Unless the cyst can be ruptured safely and readily per
rectum, the effort should be promptly abandoned and the
operation carried out per vaginam. The ovary should be
picked up per rectum and carried backward over the vaginal
roof. The operator then inserts his other hand into the
vagina and grasps the cystic gland through the vaginal
wall, the ovary being pushed down by the hand in the rec-
tum into the hand in the vagina. It is then grasped per
vaginam, while the hand within the rectum lends security to
the grasp by continuing a hold upon the mesometrium at its
attachment to the ovary and maintains a pressure down-
ward, while the hand in the vagina presses upward. The
operator may also with safety avail himself of the assist-
ance of a colleague or a layman in his efforts to rupture the
cysts per vaginam. Any intelligent layman can be trusted
under proper supervision to exert pressure per vaginam.
His nails should be trimmed as noted above, and if his
hands are horny from manual labor they should be softened
with warm, antiseptic solution. The veterinarian should
locate the cystic ovary per rectum, obtain a secure grasp
upon it and draw it back over the vagina. The assistant
should then insert his hand, well lubricated, into the vagina,
with his palm upward. The veterinarian pushes the ovary
into his open hand from above and maintains his grasp upon
the ovarian attachment. He then pushes downward and
steadies the gland while the assistant pushes upward

406 Diseases of the Genital Organs

against the operator's hand, grasps the ovary, and exerts
the degree of pressure required to rupture the cyst. The
vaginal wall will withstand securely the maximum digital
compression, if prudently applied, which a powerful man
can exert.

Sometimes the cyst wall is so dense and resistant that,
however powerful the man may be, he can not rupture the
cyst by digital compression. If, after a reasonable effort,
it is not ruptured, it is best to desist and resort to the easier
and safer operation in such cases, of stabbing the cyst and
thus evacuating its contents. The operator, if right-handed,
inserts his right hand into the rectum, grasps the cystic
ovary, and draws it back over the vagina. The left hand is
then inserted into the vagina and a secure hold upon the
ovary obtained by passing the hand forward with the palm
downward, the index finger passing to the left of the gland

Fig. 129a— Ovarian Scalpel. 1 Length q'j inches. )

and the thumb to the right. The ovary is then pressed down
with the right hand between the thumb and finger of the
left hand, and the broad ligament beyond the ovary securely
grasped so that the ovary with the cyst rests in the palm of
the hand. The right hand is then withdrawn from the rec-
tum and an attendant quickly washes off the feces. The
ovarian scalpel (Fig. 129a) is grasped and, guarded, is
pushed carefully along the forearm and palm of the left
hand until the end of the blade is against the vaginal wall
over the center of the cyst. When sure that the end of the
scalpel is properly placed and directed toward the center of
the cyst, the guard is released and the scalpel given a quick
thrust forward through the vaginal wall and the wall of the
cyst. The moment the scalpel enters the cyst, the latter col-
lapses. The scalpel is then withdrawn and the pressure
continued upon the cyst until its contents are fully evacu-
ated. Care should be taken, when grasping the ovary from

Cystic Degeneration of the Ovisacs 407

the vagina, that no viscera and no part of the mesometrium
(broad ligament of the uterus) lie between the vagina and
the cyst. Since the cyst is regularly upon the anterior or
free border of the ovary, the anterior border of the gland
should be turned over upward, backward, and then down-
ward so that, when ready for the stab, the anterior or con-
vex border of the ovary shall be directed downward and
backward, thus bringing the cyst wall into direct contact
with the peritoneal surface of the vaginal roof. The scalpel
thus passes through the vaginal roof and the cyst wall only.
If the vaginal wall is tensely stretched over the ovary, the
stab wound in it is reduced to a minimum, so that, when the
cyst collapses and the vaginal wall is released and returns
to its normal state, the stab wound is but a fraction of the
width of the scalpel blade in extent. If, through error, the
mesometrium lies between the cyst and the vaginal wall,
the scalpel may wound it, causing an extensive hemorrhage
in the broad ligament or in the peritoneal cavity. If a com-
petent assistant is available, it is in better accord with sur-
gical principles for the assistant to grasp the ovary per rec-
tum, carry it back, and pass it to the operator's hand in the
vagina, so that the latter may have his other hand unsoiled
and ready to use the scalpel. Sometimes this would prove
a material advantage because the cow may strain while the
hand which has been used in the rectum is being washed,
causing the operator's hold to slip. The time lost may con-
sequently bring about failure in a given attempt and necessi-
tate a repetition.

When common cows become nymphomaniac early in lac-
tation, the veterinarian should consider the prudence of
handling by castration. The removal of the ovaries stops
the nymphomania, stabilizes lactation, and tends to cause
the animal to fatten rapidly as the lactation period nears
its close, enabling the dairyman to dispose of the animal
profitably for beef. When an animal is dry or lactation un-
profitable and the patient has become extremely emaciated,
as indicated in Fig. 129, the veterinarian should be cautious
about advising ovariotomy. The operation can not succeed

4oS Diseases of the Genital Organs

economically unless the owner has at hand an abundance of
good food of low cost. Thus an emaciated nymphomaniac
might be profitably spayed in the spring when an abundance
o.f cheap pasturage is available, but spaying in the autumn
and attempting to fatten upon expensive grain might prove
a serious economic blunder. The operation of spaying has
already been described in Chapter XI.

When recovery occurs, the nymphomania abates, the gen-
eral condition improves, the hair recovers its lustre, and the
deformation of the pelvis becomes lessened or disappears.
In mild or recent cases, recovery of fertility is signalized
by the return of the pelvis to its normal form. Long-stand-
ing, severe cases do not recover wholly from the pelvic de-
formity, but do improve in form with the restoration of fer-
tility. This is well shown in Fig. 129, where the cow is
shown in health in 1, the disease at its maximum in 2 and 3,
and the partly recovered form of the pelvis in 4. The im-
pression given by the figure in 4 may be somewhat exag-
gerated because she had just calved, at which period there
is regularly some relaxation of the pelvic ligaments, but the
photograph is essentially true to clinical observation.

A nymphomaniac should on no account be permitted to
copulate, since this definitely intensifies the malady.
Neither should she be permitted to consort with other
cattle because, in repeatedly mounting or attempting to
mount them, she is very liable to injure herself (fractures
of pelvis, etc.) or other animals. She is a great annoyance
in a herd of dairy cows, constantly disturbing them, inter-
fering with their feeding, and hence with the milk yield.

When the cow improves and apparently recovers, care
should be taken in permitting copulation. When the
nymphomania ceases and the general condition improves,
she should not be bred during the first appearance of es-
trum, as this may be false and a mere recrudescence of the
nymphomania. Even if it is due to the ripening of an ovi-
sac, copulation should not be permitted. The breeder
should wait until the advent of a second normal estrum.
The two periods have a normal interval of 20 to 22 days.

Intra- Follicular Hemorrhage 409

So long as the estrual period is irregular, she should not be
bred. Until the recovery is complete, copulation generally
precipitates the return of the nymphomania in a severe
form, with a copious discharge of muco-pus from the vulva.
If regular and normal in estrum and in the length of the
inter-estrual period, the cow may be bred at the second
estrum and then watched closely to see that all is going well.
The treatment of nymphomania through the internal ad-
ministration of therapeutic agents has not been given suffi-
cient study to afford ground for the expression of any
opinion. Upon the hypothesis that the disease is due to in-
fection within the ovary, it would seem not improbable
that the internal administration of powerful disinfecting
agents might bring about relief from the disease. I have
used salvarsan to a very limited extent. Apparently it
brought about some amelioration of the disease, but the
experiments were brought to a close on account of the pro-
hibitive expense of the drug. In a very few cases the in-
travenous administration of trypan blue seemed to benefit
the animals greatly ; in other instances no apparent benefit
was derived from it. Quite as interesting from the stand-
point of research with nymphomania, is the use of corpus
luteum or ovarian extract, but so far as I know, this field
of experimentation has not been extensively invaded. I
have used liberal amounts of corpus luteum extract upon
two nymphomaniacs, without visible effect. It is possible
that extracts of other ductless glands might affect this dis-
ease profoundly.

3. INTRA-FOLLICULAR HEMORRHAGE

I have in my collection the genital tract from an abattoir
heifer, illustrated in Fig. 130, in which the right ovary con-
tains a number of large cysts which have increased its di-
ameter to four inches and its weight to about two pounds.
Some of the cysts contain a clear lymph. Others contain
blood and lymph mixed in varying proportions, some of
them being filled almost entirely with blood. No lutein
tissue is recognizable. I have not recognized the condition

410 Diseases of the Genital Organs

clinically. As I have no clinical history of the animal, the
significance of the condition is uncertain. The genital or-
gans are those of a heifer which has not been pregnant.
The specimen suggests, as do many ovarian diseases, cau-
tion upon the part of the veterinarian. In the handling of
cows for sterility, as in most new fields, arbitary practices
have developed. One of the outstandingly dangerous fads
in sterility of cattle is the massaging of the ovaries and
uterus per rectum, the rupturing of cysts, and the dislodg-
ment of corpora lutea — a massaging and crushing program.
Although the healthy genital organs of cows will endure

PlG. 130 — Intra-Follicular Hemorrhage. Abattoir heifer.
/, Right ovary ; 2. j, uterine cornua ; ,\ gelatinized cystic- fluid ; /, hem-
orrhage into cystic fluid.

without great injury a remarkable amount of insult, their
limit of endurance is promptly exceeded in many cases of
disease. Any cyst of extraordinary volume or presenting
other unusual features, or any other lesion, the nature of
which is not clear, calls for careful consideration and for-
bids hasty action. A rupture of the cysts illustrated would
in all probability have led to fatal hemorrhage. Fig. 67
illustrates further this important point. In this animal,
where clinical history was available, spontaneous rupture
of the ovary occurred, with profuse hemorrhage. Had an
imprudent veterinarian "ruptured the cyst" in that case,

Post- Ovulation Hemorrhage into the Follicular Crater 411

death from hemorrhage would have been almost certain
and the over-rash operator would have received severe and
well merited censure. Unusual cysts or other enlargements
or lesions should always be handled with extreme caution,
and no irretraceable step made until a reliable diagnosis
has been reached. It is well in doubtful cases of cysts or
tumors always to palpate the ovarian artery carefully. It
may be enlarged, which clearly forbids any form of pro-
cedure inviting hemorrhage unless the operation provides
for absolute control of it.

4. post-ovulation hemorrhage into the follicular

Crater

Immediately after ovulation there is physiologically a
slight hemorrhage into the crater of the ruptured ovisac,
to form a very small hematoma which occupies for a brief
time the center of the corpus luteum and then disappears,
as indicated in Fig. 26.

Pathologically there occurs not infrequently an amount
of hemorrhage into the ovulations crater far in excess of
the physiologic volume. Clinically I have encountered ex-
tensive blood clots marking the site of the crater, which are
readily detached so that they drop freely into the peritoneal
cavity. In one instance the hematoma was more than 3
inches in diameter. Presumably considerable blood had
escaped into the peritoneal cavity in addition to that which
remained attached to the ovary as a hematoma. The cause
is not definitely known. Apparently it is due to a disturb-
ance of the circulation dependent upon general atony of the
ovary. Just how serious it may prove at times is unknown.
Now and then a cow appears quite unwell at the close of her
estrual period. It is not improbable that hemorrhage from
the follicular crater may at times be responsible for the
symptoms. It is a well-known fact that in rare cases
severe and even fatal hemorrhage follows the dislodgment
of a corpus luteum. The two occurrences may be similar
in their fundamental character. The clot, which is fairly
firm, breaks up under digital compression with a charac-
teristic grating.

412 Diseases of the Genital Organs

When the hematoma is discovered during the examination
of the genital organs, it is doubtful just what course is best
to pursue. I have followed the plan of dislodging it and
turning it free into the peritoneal cavity, but have always
taken the precaution of applying digital compression to the
ovary for some minutes after the dislodgment of the hema-
toma, and watching very closely to see that the hemorrhage
did not recur. This appears to me to be the better course
because, unless the hematoma is dislodged, so far as I am
able to determine, it will result in a hemorrhagic corpus
luteum, which will undergo cystic degeneration and will
inhibit estrum for a long period of time.

The cause of this excessive hemorrhage is undetermined,
but it is apparently due to the presence of an infection in
the ovary which has depressed the tonicity of the blood ves-
sels, causing them to bleed freely upon the slightest inter-
ference. So far as I have observed, the prognosis is good.

5. Hemorrhagic Corpus Luteum

The excessive hemorrhage into the crater of the ruptured
ovisac, described in the preceding paragraph, when left un-
disturbed, regularly leads to a hemorrhagic corpus luteum,
so far as I am able to determine. Eventually, also, the
hemorrhagic corpus luteum generally, if not always, results
in cystic degeneration. The lutein tissue itself, under these
conditions, ordinarily acquires its normal volume, or may
exceed it somewhat. Accordingly the blood clot adds to the
volume of the corpus luteum, so that in numerous instances
it reaches, as palpated per rectum, a diameter of one to two
or more inches (Hypertrophied Corpus Luteum). Between
the physiologic blood clot in the corpus luteum and the maxi-
mum amount of blood described, there is every possible
gradation in amount.

Clinically it is impossible to diagnose directly the hemor-
rhagic corpus luteum. A tentative diagnosis may be made,
based upon the increased size of the corpus luteum. The
hemorrhagic corpus luteum tends to persist for an indefinite
period, inhibiting estrum until it finally disappears by cystic

Hemorrhagic Corpus Luteum

413

degeneration. Its precise nature has not been made clear.
The cystic corpus luteum is so generally associated with in-
fection as to suggest that the hemorrhage causing this path-
ologic type of corpus luteum may be due to atony in the
gland, referable to infection. At present it seems that as a
rule of practice it is best to dislodge such corpora lutea in
order that their inhibitory power may be destroyed and the
ovaries caused to resume their function. The veterinarian
should always be very careful, when dislodging such a cor-
pus luteum, to compress the crater for some minutes and
watch carefully for a brief period afterward to see that a
new hemorrhage is not established. At the same time due
attention should be given to other conditions existing within

Fig. T31 — Hemorrhagic Corpus Luteum.

the genital tract, because there is ordinarily a correlation
of these diseases and no one lesion should be treated as be-
ing wholly independent of other pathologic conditions which
may be present.

6. Cystic Degeneration of the Corpus Luteum

Probably the commonest disease of the ovary observed in
cattle is the cystic degeneration of the corpus luteum. At
the same time, although the condition has not been thor-
oughly studied, it is quite safe to say that it is one of the
most serious types of ovarian infection seen. Cystic de-
generation of the corpus luteum occurs very rarely in a

414 Diseases 0/ the Genital Organs

pregnant cow, and when it does occur the cyst is usually
very small. It is a very common condition in sterile cows
and is almost universal in complete adhesion of the ovary
within the pavilion of the oviduct or within the ovarian
pocket in the broad ligament.

In the abattoir one encounters every possible degree of
cystic degeneration of the corpus luteum. At first there is
frequently a small cyst not much larger than an ordinary
pinhead. On the other hand, there occur cystic corpora
lutea in which the cysts are two to three inches or more in
diameter. Frequently the cystic degeneration destroys the
lutein tissue until there is merely a yellow band about the
periphery of the cyst. Sometimes the lutein tissue disap-
pears from all of the wall except a very small area. In other
cases, where the corpus luteum has been hemorrhagic, there
will be seen at the periphery of the cyst at one point a trace
of lutein tissue and at another a trace of the old hematoma.
Finally all traces of lutein tissue or hemorrhage disappear
and there is left behind a cyst that cannot be differentiated
structurally from that of nymphomania, though it does not
cause that disease.

When examining a sterile cow clinically, one may recog-
nize the cystic character if the cyst occupies one-third to
one-half the volume of the corpus luteum. If pressure is
applied to the corpus luteum, the cyst ruptures and the
fluid escapes, after which, if the digital compression is con-
tinued, the lutein mass itself is pressed out and the cavity
feels like an empty bag. When the cystic degeneration has
extended to an extreme degree, the examiner merely recog-
nizes the cyst. It should be distinguished clinically from
the nymphomaniac cyst, because of the nymphomania itself.
It is further distinguishable in many cases by the fact that,
after rupturing the cyst and then applying digital compres-
sion to the crater, a small amount of hard tissue is detached
and forced out which is recognizable as the peripheral por-
tion of the corpus luteum. How large these cysts may grow
is wholly unknown. In discussing benign tumors in Chap-
ter XI. there have been included a number of large ovarian

Cystic Degeneration of the Corpus Luteum 415

cysts which have their principal danger for the animal in
their mechanical interference with other viscera. Their
origin is unknown. It is not improbable that a considerable
proportion of them have their origin in the cystic degenera-
tion of the corpus luteum.

The origin of the cystic corpus luteum has not been ex-
tensively studied. Judging from clinical and post-mortem
studies, it appears quite justifiable to say that the disease
is referable to an infection which enters the crater of the
freshly ruptured ovisac from the oviduct. Hence the cystic
corpus luteum is seen with great frequency in instances of

3 3a

6 7 8

Fig. 132 — Cystic Corpora Lutea.

/, 2, Twin corpora lutea of pregnane}' ; 3, ja,

4, 5, cystic corpora lutea.

chronic salpingitis. In fact a large percentage of cows and
heifers persistently sterile because of salpingitis suffer sim-
ultaneously from cystic degeneration of the corpus luteum.
When the ovary becomes adherent within the pavilion of the
tube, cystic degeneration of the corpus luteum is essentially
constant.

The bacteriology of the cystic degeneration of the corpus
luteum has been but scantily studied. Thus far the studies
have revealed chiefly the presence of a streptococcus of the
viridans group.

In many sterile animals, the cystic degeneration of the
corpus luteum advances somewhat rapidly, causing no ma-
terial enlargement of the corpus luteum but gradually de-
stroying the lutein tissue, until finally it no longer inhibits

Diseases of the Genital Organs

Cystic Degeneration of the Corpus Luteum 417

ovulation. Sometimes ovulation and estrum are regular
and the duration of the disease is approximately the same
as in the normal cycle of estrum. In many cases, however,
cystic degeneration interrupts the normal estrual cycle so
that, if the degeneration is very rapid, the animal may be in
estrum again in eight to fifteen days, or it may be delayed
until thirty days or more. So far as I have been able to
judge by clinical study, it is the principal cause of irregu-
larity in the estrual cycle. Not only does it interrupt the
estrual cycle in the non-pregnant animal, but sometimes it
involves the pregnant animal, bringing about a recurrence
of estrum in spite of the presence of a normally developing
fetus.

The prognosis of cystic degeneration of the corpus luteum
is unfavorable because, so far as at present understood, it
is largely dependent upon an irremediable infection in the
oviduct. If it involves only one ovary and oviduct, the prog-
nosis may be good because of the freedom of the other side,
but unfortunately cystic degeneration of the corpus luteum
and tubal infection are usually bilateral. Some cases re-
cover, but when it is once clearly recognizable one needs to
give a very guarded or unfavorable prognosis.

There is no well-established method for handling cystic
degeneration of the corpus luteum which promises favorable
results. It has been the habit with many, especially in the
beginning of the work with sterility in cattle, to dislodge the
cystic corpus luteum, but when one views the question from
the standpoint of the etiology as interpreted above, it would
appear that tampering with such a condition is not usually
justifiable. If one dislodges the corpus luteum, there is a
new wound which offers an excellent avenue for invasion
from the oviduct. It may be thoroughly justifiable to dis-
lodge the corpus luteum, or at least to compress it sufficiently
to rupture the cyst in its center in order to make a diagnosis.
When the diagnosis has been made, however, and the veteri-
narian is aware that the difficulty is due to this cystic de-
generation and understands that it is almost certainly ac-
companied by salpingitis, the more prudent course in the
27

41 8 Diseases of the Genital Organs

present state of our knowledge is to let the body alone, un-
less it is greatly prolonging the estrual period, and to hope
that there may be a spontaneous control of the condition,
possibly assisted by giving careful attention to the cervix
and uterus if they are participating in the general infection
present.

7. Hypertrophy of the Corpus Luteum

Much has appeared in the writings of some veterinarians
regarding hypertrophy of the corpus luteum in cattle. They
have not as a rule defined precisely what is meant by the
term. In examining thousands of cattle in the abattoir, I
have observed but one true case of hypertrophy of the cor-
pus luteum, and in that case the body was black instead of
yellow and the cow was pregnant. This enlarged corpus
luteum is shown in Fig. 131.

There is another type of corpus luteum, however, which
has been described in the two preceding paragraphs as
hemorrhagic corpus luteum and cystic degeneration of the
corpus luteum, in which the gross volume of the body may
attain an indefinite size. I have not been able to observe
that the actual volume of true lutein tissue has been ma-
terially increased. It is impossible, however, to differen-
tiate clinically between a true increase of lutein tissue and
an increase in the size of the corpus luteum because of the
presence of an old, hard blood clot of such consistence that
it cannot be distinguished from lutein tissue. It is well
then to retain the designation ''hypertrophy of the corpus
luteum," as a clinical phenomenon, whether it is due to the
addition of a blood clot in the lutein tissue or to cystic de-
generation in the center. When such a corpus luteum is
present, it is almost invariably associated with sterility and
inhibits est rum for an indefinite period. Upon clinical ex-
amination the operator recognizes in one of the ovaries an
abnormally large corpus luteum. In many of these cases,
if he will palpate very carefully, cystic degeneration may be
recognized, although not yet far advanced. Such corpora
lutea attain a diameter of one to two and one-half inches or

Hypertrophy of the Corpus Luteum

419

even somewhat greater. When the corpus luteum contains
a blood clot, it always, so far as I have seen, ultimately un-
dergoes cystic degeneration, but the degeneration may be
very slow and the presence of the corpus luteum may inhibit
estrum month after month.

Fig. 134 — Cystic Corpus Luteum.

/, /, Pair of ovaries, the one on the left having a very large cystic corpus

luteum, showing at the lower right periphery a remnant of

lutein tissue, X ; P, P, paired ovaries of pregnancy.

The prognosis is good. As a general rule, once the en-
larged corpus luteum is dislodged, estrum returns within
three to five days and there is fair opportunity for concep-
tion. It appears that the long rest of the genital tract,
caused by the inhibition of estrum by the enlarged body,
tends to bring about a healthy condition of the genital sys-
tem, so that when the inhibiting body is dislodged the ova-

420 Diseases of the Genital Organs

ries function normally. In one heifer which had aborted at
six months and five or six months later had not been seen in
estrum, I dislodged a corpus luteum fully two inches in di-
ameter, which immediately reformed in the old crater. I
dislodged it a second time, about fifteen days later, after
which the animal came in estrum and conceived at the first
service.

FlG [35 Adherent Ovary with Very Large Cystic Corpus Luteum.

/, Apex of coruu ; _\ gelatinized <-'vsl fluid ; ,\ thin layer of lutein tissue ;

/, hematoma displacing lutein tissue. Lutein (.issue and

olrl blood clot alternate about periphery of cyst

The dislodgment of the hypertrophied corpus luteum
should preferably be accomplished by compression from the
vagina. Frequently it is so difficult to dislodge that, if the
operation is attempted per rectum, there is danger of in-
jury. Moreover, there is always danger that hemorrhage
may follow or that the dislodgment may be incomplete. It
is then best to pass one hand into the rectum, bring the ovary
back over the vagina, grasp it with the other hand through

Persistent Corpus Luteum

421

the roof of the vagina, and dislodge the corpus luteum care-
fully and completely. When this has been done, the com-
pression should be continued upon the ovary for some min-
utes, in order to anticipate any possibility of serious hemor-
rhage. Ordinarily estrum occurs within three to five days,
when, if other conditions are favorable, breeding may occur.

8. Persistent Corpus Luteum

Writers upon the subject of sterility describe very fre-
quently a persistent corpus luteum. In the preceding sec-

Fig. 136 — Cystic Degeneration of Corpus Luteum.

Left figure, CL, corpus luteum of pregnancy for comparison ; ri^ht figure

with 2 cysts, C, C, the left cyst having remnant of lutein tissue at CL.

tion, it has been mentioned that, when the corpus luteum is
hemorrhagic or when it undergoes cystic degeneration, its
destruction and absorption may be indefinitely delayed. In
the following paragraph (9) the question of the central or
imbedded corpus luteum will be discussed. There is, how-
ever, a third group of corpora lutea which, although appar-
ently sound and normal in volume, tend to remain indefi-
nitely without undergoing either atrophy or degeneration.
The only symptom of such condition is that the animal has
not been bred or has not conceived and does not come in
estrum. Upon examination, the genital tract in general may

4-? 2 Diseases of the Genital Organs

be normal, the health of the patient is apparently perfect,
and there is present in one of the ovaries a typical corpus
luteum of ordinary size, form, and consistency. Under
these conditions, persistent corpus luteum is diagnosed. The
diagnosis may be subject to question. It is quite possible
that in many cases estrum has been overlooked. Since some
cattle are not demonstrative and some attendants are not
very alert in recognizing estrum, it is not improbable that
many cases diagnosed as persistent corpus luteum are really
instances of failure upon the part of the attendant to ob-
serve estrum. However frequent error may be, the condi-
tion does occur and should be promptly recognized by the
veterinarian. I have observed cows where every opportu-
nity was given for them to exhibit symptoms of estrum and
where they had shown no such signs over a period of six
months or more. Upon examination, the entire genital sys-
tem is found to be normal, including an apparently normal
corpus luteum in one of the ovaries. The general health of
the animal is beyond criticism, and no apparent reason ex-
ists for failure of ovulation and estrum. Under these condi-
tions the dislodgment of the corpus luteum causes the
prompt appearance of estrum, and as a general rule the ani-
mal conceives readily. The long inhibition of estrum has
apparently served as a definite and valuable period of rest,
so that, when the barrier is overcome and the genital or-
gans function, conception is prompt.

0. The Central or Embedded Corpus Luteum. The
Corpus Luteum of Pyometra and Fetal Retention

When an ovisac approaches maturity, it pushes its way, in
the cow, toward the convex, free surface of the ovary, to
protrude eventually beyond the general ovarian surface.
It then ruptures and the corpus luteum which forms in its
ciatcr, when grown, also projects above the ovarian level.
Such projection persists throughout the physiologic career
of the body, until it atrophies preparatory to a new ovula-
tion, when it may (or may not) sink more deeply into the
gland as it gradually disappears.

The Central or Embedded Corpus Luteum 423

Pathologically, when there is extensive pyometra follow-
ing closely upon parturition, or retention of a fetus with
putrid maceration or desiccation, the corpus luteum, with-
out undergoing either material reduction in size or cystic
degeneration, commonly sinks deeply into the ovarian tissue
and comes to rest in a comparatively central position, to re-
main unchanged for an indefinite period of time. Ordina-
rily its presence does not directly call for clinical diagnosis,
because it is a mere adjunct to a grosser, more striking con-
dition. The presence of an embedded corpus luteum may,
therefore, be diagnosed usually with fair safety by the pres-
ence of the retained fetus or the pyometra. If the ovary is
palpated, the corpus luteum may not be very evident to the
inexperienced practioner. The ovary is spheroidal and un-
naturally plump, but the corpus luteum is so deeply em-
bedded that it is not clearly palpable. Careful and deliber-
ate palpation finally enables the examiner to detect a firm
central body or "core" in the gland which, in conjunction
with the retained fetus or pyometra, leads to a positive diag-
nosis. In one or two instances I have encountered clini-
cally an embedded corpus luteum without retained fetus or
pyometra. It then had the significance of the ordinary re-
tained corpus luteum ; it inhibited estrum over an indefinite
period. Professor Hess was first to draw definite attention
to the inhibitory pawer of retained and embedded corpora
lutea. They not only inhibit estrum but at the same time
inhibit the spontaneous expulsion of the fetal cadaver or
the pus contained in the uterus.

The embedded corpus luteum, like the retained yellow
body, should be located and, in order to accelerate uterine
contraction, should be dislodged. The removal of the cor-
pus luteum, the best method known for causing the expul-
sion of a desiccating fetal cadaver, adds materially to the
efficacy of other agencies in the handling of pyometra.
Often the removal of the corpus luteum is far from easy.
The coordinate disease of the uterus, with the increased
weight and volume, drags the ovary downward and for-
ward into the abdomen, where it is difficult to reach. Since

424 Diseases of the Genital Organs

it is ordinarily held too far forward to permit it to be car-
ried back above the vagina, dislodgment must be attempted
by compression per rectum. The ovarian tissue more or
less completely surrounds it with firm tissue which can be
ruptured only with great force.

Whenever possible, the dislodgment of the corpus luteum
should be made per vaginam. In pyometra the uterine con-
tents should first be siphoned out, when ordinarily the ovary,
containing the yellow body, may be brought back over the
vagina and the dislodgment undertaken from there with
safety. The mechanism of dislodgment is essentially that
of rupturing cysts. The compression should be concentrated
upon the base of the ovary by its ligament, leaving the con-
vex border free to break and permit the escape of the yel-
low body. Care should be taken to get all of the lutein tis-
sue, that the body may not reform without ovulation. In
■one instance, where fortunately the ovary could be brought
back over the vagina, I could not dislodge the yellow body
by compression and was forced in the end to stab the ovary,
as described in connection with the cysts of nymphomania.
When the ovarian capsule and overlying ovarian tissue are
incised, although the stab is very narrow, the incision
weakens the structure, the cut extends under compression,
and the yellow body is forced out.

Although I have not met such cases, it probably occurs
in some instances that the operation cannot be carried out
per rectum or per vaginam. Then, especially in desiccated
fetus, laparotomy is indicated when the ovary can be acted
upon directly.

10. Abscess of Ovary

I have not observed primary ovarian abscess. In connection with
tubal infections, tuho-ovarian abscesses are not rare. Where trace-
able, they originate secondarily from pyosalpinx subsequent to mar-
t;:nal adhesion of the pavilion of the tube to the gland. The lesion
i- consequently one of pyosalpinx, in which the pus first surrounds
ary and then destroys it. This will be considered later under
tubal infection.-.

Parovarian Cysts

425

11. Corpora Nigra

I have seen two instances of black instead of yellow bodies in the
ovaries of pregnant cows. One was of normal size, form, and con-
sistency; the other was greatly enlarged, as shown in Fig. 137. The
bodies were a dark blue-black. Aside from the excessive size of one
and the color of both, they appeared perfectly healthy. No signs of
disease were observed in any part of the genital system or else-
where. Neither the cause nor the significance of the condition was
apparent. It is probably a mere "sport" without relation to sexual
health or efficiency.

Fig. 137 — Corpora Lutea of Pregnancy. For comparison with
Cystic Corpora Lutea.

/, 'Adherent ovary ; 2, corpus nigrum of pregnancy ; J, corpus luteum of

pregnancy ; 7, mate to 3 ; 5, 6, corpora lutea of pregnancy ; 8,

enlarged corpus nigrum ; g, to, twin corpora lutea ;

i2y fresh corpus luteum.

12. Parovarian Cysts

Cysts occur now and then in close proximity to the ovaries, ap-
parently due to cystic changes in remnants of the Wolffian bodies
or of the Wolffian ducts. In the mare, as illustrated in Fig. 70,
Chapter XI, these cysts may become a menace to the health or to
the life of the animal. This I have not observed in the cow al-
though it may evidently occur. Instead I have observed usually
small coiled tubular cysts without known significance for the ani-
mal. Their chief interest lies in their close proximity to the ovi-
ducts and their confusing likeness to hydrosalpinx, which may lead
the veterinarian to pronounce a perfectly fertile animal incurably

426

Diseases of the Genital Organs

sterile. They are to be differentiated, so far as my collection indi-
cates, by the fact that in the cow hydrosalpinx usually involves the
entire length of the oviduct and presents the other characters de-
scribed under that heading. The parovarian cysts are usually small
— much smaller than the hydrosalpinx generally — and can be picked
up in the mesosalpinx. Careful palpation should recognize the
healthy tube not far away, enabling one to differentiate the two
structures.

B. Tubal Infections1

In cattle the diseases of the oviducts constitute a very fer-
tile cause of sterility and play an unknown role in the oc-
currence of abortion. The oviducts constitute highly com-

PlG. 1 j8 Cross Section of Normal Oviduct Near the Ampulla.
Showing Uk- Number and Complexity of the Mucous Folds.

plex anatomo-physiologic barriers between the peritoneal
and uterine cavities. Technically, the peritoneal cavity of
the female communicates with the exterior through the

r the normal and pathologic histology and for the bacteriology
of the oviducts, I am indebted chiefly to the work of Dr. Herbert L.
Oilman, graduate student, and to my colleague, I>r. C. M. Carpenter.

Tubal Infections

427

Fig. 139— Section of Normal Oviduct near the middle.

Fig. 140— Section of Normal Oviduct near the Uterine End.

Showing the Simpler Mucous Folds and the

Thickness of the Muscular Coat.

428 Diseases of the Genital Orga?is

genital tube, with the oviducts interposed as highly com-
plex, sinuous, narrow tubules. While the oviducts are
highly efficient in preventing the migration of infection
from the uterus and more external areas into the peritoneal
cavity, the same complexity makes of them a lodging-place
for infection which, once attained, is unusually refractory
to dislodgment by physiologic, medicinal, or surgical agen-
cies. Since, in probably more than 90 per cent, of cases of
infection in the oviducts, the condition is bilateral, the du-
plication of ovaries and oviducts avails little ; when disease
in one oviduct constitutes an insurmountable obstacle to
conception, there are nine chances in ten that the other tube
is likewise barred. Consequently tubal infection generally
closes permanently the reproductive career of the animal.
The clinician and the animal husbandman are further baf-
fled in the present state of knowledge by the difficulty in
many cases of making an early diagnosis, causing incurable
animals to be held for long periods at great economic loss
before the character of the disease is clearly revealed. The
anatomic and histologic lesions caused by tubal infection
are endless in variety. Three outstnding types occur.

1. Salpingitis Unaccompanied by Enlargement of the

Ducts of a Degree Clinically Recognizable by

Palpation, or Macroscopically Visible

upon post-mortem examination

Salpingitis, or inflammation of the oviducts, without ma-
terial enlargement, is the commonest and most important
type of disease of these organs. Ordinarily the infection
does not cause a sufficient degree of enlargement to enable
the veterinarian to make a diagnosis by palpation per rec-
tum. Upon post-mortem inspection, the oviduct shows little
macroscopic evidence of disease. The principal clinical evi-
dences of salpingitis are persistent sterility without palpable
lesions in the genital tract, as a rule associated with cystic
degeneration of the corpus luteum, with irregular estrual
cycles, and later with adhesion of the pavilion of the tube to
the ovary.

Salpingitis 429

Cystic degeneration of the corpus luteum has already
been discussed under "The Diseases of the Ovary." It is
not certain that cystic degeneration of the corpus luteum
occurs, except with salpingitis, although it cannot be proven
that salpingitis is the sole cause. It appears, however, that
salpingitis is at least the predominant cause. When the
ovisac is about to rupture, it is believed that the pavilion of
the tube invests it, with the ostium abdominale in proximity
to the ovisac. When ovulation occurs, infection may ap-
parently escape from the oviduct, invade the crater left be-
hind by the rupture, and set up disease, which eventually
brings about the destruction of the yellow body. The de-
struction of the corpus luteum by cystic degeneration does
not cause the sterility, but the infection which exists in the
oviduct causes alike the sterility and the cystic degeneration
of the corpus luteum. It follows, therefore, that cystic de-
generation of the corpus luteum may occur in spite of con-
ception : that is, spermatozoa may be able to live in the in-
fected tube and fertilize the ovum, which may be able to
pass through the infected oviduct, reach the uterine cavity,
and develop. As a rule, however, cystic degeneration
of the corpus luteum does not occur in pregnancy.
From my abattoir investigations, I would estimate that
not more than one or two per cent, of corpora lutea
of pregnancy suffer from cystic degeneration. Perhaps
the facts would be more clearly expressed by stating
that, when the oviduct is so virulently and abundantly in-
fected that the infection will escape from the tube and in-
vade the freshly ruptured ovisac, the spermatozoa, and the
non-fertilized or fertilized ovum will probably be destroyed.
Sometimes, however, the spermatozoon and ovum run the
gauntlet of the infected tube although the crater of the ovi-
sac is invaded. Then follows, at least in some cases, cystic
destruction of the corpus luteum of pregnancy, with recur-
rence of estrum in the pregnant animal. The cystic degen-
eration of the corpus luteum interrupts more or less seri-
ously the estrual cycle. Sometimes the estrual period will
return within seven to fifteen days ; sometimes the cycle may

430 Diseases of the Genital Organs

be prolonged so that the estrum does not recur for thirty
or more days. In some cases the estrum is comparatively
regular. The clinical recognition of the cystic corpus lu-
teum has already been discussed in dealing with the ovary.
When pavilionitis becomes established, with adhesions of
the pavilion to the ovary, the diagnosis of salpingitis be-
comes positive. So far as known, adhesions of the ovary
within the pavilion must be attributed to salpingitis. The
clinical recognition of such adhesions is usually simple. The
operator should pick up the ovary per rectum and pass the
index finger into the ovarian pocket in front of the gland.
If any adhesions are present, they are readily detected in
the earlier stages as delicate threads which may be torn
asunder with slight pressure. The inflammation gradually
extends, the adhesive bands grow in volume and number,
and, if the disease is very severe, the ovary becomes com-
pletely and firmly adherent within the pavilion and within
the ovarian pocket, or bursa. The ovary becomes masked
so that it can not be palpated directly, but only through its
adherent covering. It is then either very large, owing to
cystic degeneration of the corpus luteum, or, if of long
standing, is small, hard, sclerotic, and deeply buried in the
adhesions, where in some cases it is recognized only with
difficulty. The cystic degeneration of the corpus luteum,
the erratic estrual cycle, the recognition of the pavilionitis
as evidenced by the adhesions, with the persistent sterility,
each justifies a diagnosis of salpingitis; when two or more
of these are taken collectively, the diagnosis is rendered
positive. The diagnosis may be complicated and hampered
by the presence of other lesions of a gross character and
readily recognizable.

Salpingitis is frequently associated with cervicitis in a
confusing manner. When cervicitis of an intense type is
rampant in a herd (I have seen it involve 60 to 75 per cent,
of large herds) salpingitis eventually forces the slaughter
of a discouraging number of cows after the visible cervicitis
has been brought under control. Whether the cervicitis
~ed the salpingitis or vice versa, or whether the two in-

Salpingitis

43 1

Fig. 141-

Highly Magnified Section of Normal Mucous
Fold of Oviduct.

Fig. 142— Section of Oviduct from a Six-Weeks-Old Calf.
Showing the Comparative Thickness of the Mucosa.

43- Diseases of the Genital Organs

fections, ordinarily identical, arise simultaneously from a
common center, can not be stated. Judging from clinical
observation in a few herds, it appears that the source of the
infection in these notable outbreaks was the herd bull, and
that the infection was transmitted in coitus, attacking pri-
marily the cervix and, before that was brought under con-
trol, invading secondarily the oviducts. It seems clear that
not all cases of salpingitis are explainable upon such a hy-
pothesis. Frequently heifers are absolutely sterile from
salpingitis, though served by bulls which appear genitally
sound and to which other females have been bred without
exhibiting clinical evidences that they are dangerous car-
riers of infection.

The oviducts are narrow, tortuous ducts about 21 to 28
mm. long, leading from the ovaries to the corresponding
uterine horns. They serve as a path for the passage of
spermatozoa to the pavilion and as excretory ducts in the
conveyance of the ova from the ovaries to the uterus. Each
tube is rather loosely invested by a fold of the peritoneum
derived from the broad ligament, which is called the meso-
salpinx. It is divided into a broad, funnel-shaped, fimbri-
ated end, or pavilion, a constricted neck, an ampulla of con-
siderable diameter, and a narrow isthmus at the uterine end.
At the bottom of the pavilion, is a very small opening, the
ostium abdominale, through which the lumen of the tube
opens into the peritoneal cavity. Here exist two unusual
anatomical conditions — a break in the continuity between a
gland and its excretory duct, and an opening between a
serous cavity and the exterior. From this constriction, the
tube becomes distended to about 3 to 5 mm. in diameter, to
form the ampulla, and from here to the uterine end gradu-
ally diminishes to 0.8 to 1 mm. at the isthmus.

The epithelium is pseudo-stratified. The mucosa is thrown
into longitudinal wrinkles or folds, lined by a pseudo-strati-
fied epithelium, which increase in height and number from
the uterine to the abdominal ends and are without glands.
At the uterine end there are usually four or five folds, com-
paratively low and broad, which do not branch. Toward

Salpingitis

433

the ampulla, however, they increase in number and height,
with the formation of numerous secondary folds, so that at
the ampulla the otherwise broad lumen becomes almost oc-
cluded. At the fimbriated end, the folds widen and are con-
tinued out on the free ends of the fimbriae, forming ridges
which branch freely, giving the pavilion a more or less
honeycombed appearance. Not infrequently one finds the
folds ramifying elaborately, particularly at their bases,
forming cavities lined by a sort of flattened stratified epi-
thelium, sometimes even attaining the appearance seen in
Fig. 143. These cavities are also found in chronic catarrhal

Fig 143— Normal Section of Oviduct Showing the Formation of
Cyst-Like Cavities by Coalescence of the Folds.

salpingitis, but usually in greater numbers and accompanied
by other pathological changes. The superficial layer of the
epithelium consists of tall cells, most of which are ciliated,
though there is much difference of opinion as to the propor-
tion of the latter. In older animals, there are but two or
three layers of cells under the superficial one ; while in young
28

434 Diseases of the Genital Organs

calves (six weeks) the layers are very numerous, and in
some the mucosa is so thick that there is little or no space
between the individual folds and the lumen is narrowed
considerably, as in Fig. 142. The muscular wall is formed
of two layers of smooth fibers, a broad, inner, circular, and
a thin, outer, longitudinal layer. A third inner layer of lon-
gitudinal fibers and bundles is seen in most sections, espec-
ially near the uterine end, either as a distinct layer or in
crescent-shaped bundles, as in Fig. 144.

FlG. i-H Chronic Catarrhal Salpingitis with a Distinct Crescent-
Shaped Inner Longitudinal Muscular Coat.

So far as known, all inflammatory changes in the oviducts
are due to bacterial invasion. In the milder forms of sal-
pingitis the mucosa alone is affected ; in the severer types the
process spreads to the deeper layers and even to the serosa.
In the former case there is congestion, some exudation into
the basement membrane, local loss of cilia, and frequently
more or less desquamation of the superficial epithelium. In
the deeper layers there may be hyperaemia. slight exudation

Salpingitis

435

Fig. 145 — Chronic Catarrhal Salpingitis, Showing the Epithelium
About to be Cast Off, and Edema of the Wall.

Fig. 146 — Chronic Catarrhal Salpingitis, with Marked Edema
of the Wall.

436 Diseases of the Genital Organs

and more or less swelling of the parts. There is usually a
profuse exudate in the lumen. The mucosa may be thick-
ened by a small-celled infiltration and the epithelium show
cloudy swelling, fatty degeneration, desquamation, or, as is
often the case, total destruction. Owing to cellular infiltra-
tion and the formation of granulation tissue, the folds may
become thickened and often fuse, with the production of
cyst-like cavities lined by epithelium. In some cases the
greatly increased blood vessels show hyaline or amyloid in-
filtration of their walls, as shown in Fig. 151. The muscular
coat often shows hypertrophy and small-celled infiltration,
either diffusely or in collected areas.

The exudate into the lumen is probably discharged into
the uterus, where it may cause metritis or cervicitis. If the
secretion is unable to escape readily in that direction, either
through swelling of the parts or atresia of the uterine osti-
um, it is discharged on the fimbria or ovary, with subse-
quent inflammation of the parts. Here it may produce a
simple serous inflammation, though more often it assumes a
fibrinous character, with the resulting formation of adhe-
sions, fibrinous strands between the fimbriae and ovary, or
closure of the ostium abdominale. Not infrequently the en-
tire pavilion becomes adherent to the ovary, in which case
there may result a tubo-ovarian cyst or abscess. If the dis-
ease spreads farther, there may occur a fibrinous peri-sal-
pi ngitis with the formation of numerous fibrous strands
running from the tube to the neighboring parts of the broad
ligament. With closure of both the ostium abdominale and
uterine ostium, the result is very often an accumulation of
the contents, with the formation of hydrosalpinx or pyosal-
pinx.

The lesions may vary greatly according to intensity and
duration. In the simpler type of the early stages, the mu-
cosa is swollen, congested, and the seat of small-celled infil-
tration. The lumen may contain fibrinous exudate mingled
with desquamated epithelium, as shown in Fig. 150. The
desquamation involves loss of cilia. With added severity of
the infection, the epithelial layers are destroyed one after

Salpingitis

437

Fig. 147 — Chronic Catarrhal Salpingitis. The Mucous Folds have
been Destroyed and the Lumen of the Tube Filled with Debris.

Fig. 148— Chronic Catarrhal Salpingitis.
With Well Advanced Occlusion of the Lumen of the Tube.

43S Diseases of the Genital Organs

the other until all disappear. The destruction of the epithe-
lium ordinarily occurs first at the summits of the longitudi-
nal folds and last at their bases. The denuded mucous folds
tend to adhere and to cause thereby small cavities between
their bases, lined with epithelium.

In bacteriologic studies of over eighty pairs of oviducts,
Gilman found that a streptococcus of the viridans group
was the dominant organism, staphylococcus albus and au-
reus were common, and in one instance only did he recognize
an organism closely resembling B. abortus.

The prognosis is virtually hopeless. In more than 90 per
cent, of cases, the infection is bilateral. It is possible that
in some cases the tubes recover spontaneously, but there is
no evidence which fully justifies one in asserting that this
occurs. The duct is beyond surgical interference under any
known technic, and there is no known medicinal remedy.

The prevention of salpingitis must be based upon the
avoidance of infection in other parts of the genital tract.
The infection probably advances into the oviduct from the
cervix and uterus. At least we know clinically that, in herds
where cervicitis is common, a large proportion of the ani-
mals become incurably sterile from salpingitis, in spite of
the fact that the cervicitis may almost always be overcome.
If, therefore, salpingitis is to be prevented, it is essential
that the measures taken shall be timely. Many heifers, suf-
fering from salpingitis prior to breeding age, are conse-
quently incurably sterile. So far as can be determined now,
such infection in heifers should be referred to the nursery
period and its prevention based upon keeping the calf in a
high state of health. The belief has been expressed else-
where that, during dysentery or pneumonia in calves, or
when slighter infection exists in the alimentary or pulmo-
nary tract, bacteria escape and, entering the blood stream,
become lodged in the genital tract, for which they have an
affinity. Later, when the animal comes to breeding age, it
seems perfectly clear at present that an infection which may
bring about salpingitis may be carried by the bull and intro-
duced during coitus. This may not interfere with concep-

Salpingitis

439

Fig. 149— Chronic Catarrhal Salpingitis.

With Almost Total Occlusion. Vestiges of tube lumen are shown

by two small black areas bordered by white.

■p1G I5o— Highly Magnified Fold of the Mucosa in the Acute Stages
of Inflammation, Showing Congestion, Exudation, etc.

44Q

Diseases of the Genital Organs

FlG. 151 — Highly Magnified Fold of the Mucosa in

Chronic Catarrhal Inflammation.

Showing Destruction of the Epithelium, thickening by newly-formed

Connective Tissue, and Amyloid or Hyaline Infiltration

of the Blood Vessels.

FlG. 152— Section of the Tube Wall in Hydrosalpinx.
Showing the Slightly Changed Epithelium, and the Loose, Mcmhranous
Character of the Wall.

Salpingitis

441

tion, but may cause salpingitis during pregnancy, with in-
curable sterility, while the uterus contains a living and ap-
parently healthy fetus. In such cases the animal may calve
apparently well and appear to be sound during her puerperal
period, but is bound to be absolutely and incurably sterile.

More frequently salpingitis follows cervicitis and metri-
tis. It is especially apt to follow retained afterbirth. Ac-
cordingly it is essential, if salpingitis is to be prevented,
that the genital tube shall be closely watched during the
puerperal period, and any infection present in the cervix or

Fig 153— Section of Part of the Wall in an Old Case

of Tubercular Salpingitis.

Near the center of the section are seen three cavities lined with epithelium,

which have resisted the necrotic processes.

uterus promptly overcome if possible. The veterinarian
and breeder should clearly understand that a retained after-
birth is a perilous thing for the integrity of the oviducts.
Consequently, retained afterbirth should be watched, not
only from the standpoint of saving the life of the animal or
of merely preventing a severe metritis, but because of the

442

Diseases of the Genital 0>ga?is

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Pavilionitis

443

danger from salpingitis owing to the infection extending
from the uterine cornua forward into the tubes.

Treatment. Since the prognosis is so nearly hopeless,
there is but little which can be suggested in the way of
treatment, once the disease has become established. If it
can be determined, or if it can be reasonably hoped that the
disease is unilateral and is causing irregularity in sexual
life, the offeding oviduct, with the ovary, may be removed.
If the ovary and oviduct are sufficiently mobile, it may be
possible in some cases to operate through the vagina, but as

Fig. 155— Adherent Ovary. Cow. Dorsal surface viewed from behind.
/., Ovarian ligament ; O, ovary ; Oi\ oviduct.

444

Diseases of the Genital Organs

a general rule laparotomy upon the side of the animal where
the diseased tube is located is safer. In performing laparoto-
my, the incision should be made in the middle of the flank.
If it is attempted to operate high up in the flank, it is well-
nigh impossible to draw the ovary and duct out through the
laparotomy wound. It is difficult even to carry out the oper-
ation when the laparotomy wound is in the middle part of
the flank. When the operation is decided upon, care should
be taken to remove the entire oviduct and to make the am-
putation through the apex of the cornu, avoiding as far as

FlG. 156 Adhesion of Right Oviduct to Ovary. Double Left
Ovary with Pregnancy.

/, Vagina ; «?. fetal membranes in left horn ; ,\ j, transverse Bepta in

uterine cavity ; ./, corpus lutemn in median portion <>f left ovary ; J, lateral
• :i of left ovary ; 6, pedunculated old corpus luteuin which had been
imperfectly dislodged : ,~, right adherent ovary ; 8, ostium abdominale of
oviduct.

Pyosalpinx 445

possible escape of the infection into the peritoneal cavity.
Consequently it is best to secure the cornu carefully upon
either side of the point of the intended amputation and take
ample precautions against escape of any infection into the
peritoneal cavity. The stump of the cornu should be closed
as in the operation for appendicitis in man. That is, the
mucosa should be sutured or ligated and pushed back into
the lumen of the horn, and then the serosa and musculosa
drawn together over the mucosa with durable gut sutures.
The operation of spaying has been described in Chapter XI.

2. Pyosalpinx

In the simple salpingitis which is described in the pre-
ceding paragraph, no appreciable amount of pus is formed.
Sometimes, however, there is a considerable volume of pus
formed in the oviduct, which definitely distends it, rendering
it palpable. In some cases the duct is moderately enlarged
and the walls very thick, hard, and readily palpable per rec-
tum. In other cases which I have encountered, there is a
considerable distension of the oviduct, its walls become thin
and paretic, and the tube becomes soft and fluctuant. In
such cases, as a rule, at least in the specimens in my collec-
tion, the pavilion of the tube is adherent about the ovary or
to the mesosalpinx or mesometrium and the pus surrounds
the ovary more or less completely, and causes its partial or
total necrosis.

In a third group, which is illustrated in Figures 157, 158,
a large tubo-ovarian abscess forms, sometimes containing
eight to ten or fifteen ounces of thick pus. In these cases,
neither ovary nor tube is recognizable, but in their stead is
a great sclerotic abscess with very heavy, thick walls. In
many cases the abscess does not become firmly adherent to
other organs and does not point and break. In some of my
specimens, where adhesions are very extensive, it seems
probable that in the complex abscessation there have been
tubo-ovarian abscesses wnich have emptied into the neigh-
boring organs, but the destruction has been so great that
the question can not be clearly determined.

446

Diseases of the Genital Organs

The prognosis for pyosalpinx and for tubo-ovarian ab-
scess is necessarily hopeless, so far as the diseased side is
concerned. It is highly important that a careful diagnosis
should be made, so that pyosalpinx, or tubo-ovarian abscess,
shall not be mistakenly treated for some other lesion, at
great peril to the animal. In some tubes distended with
pus, and perhaps in some cases of large tubo-ovarian ab-
scesses, the walls could be readily ruptured by pressure per
rectum, causing a fatal peritonitis. Therefore it is highly
important that the veterinarian shall not mistake tubo-
ovarian abscesses for ovarian cysts and rupture the ab-
scesses into the peritoneal cavity, with fatal results. As a
general rule, the prudent veterinarian will let pyosalpinx
alone. In exceptional cases, where the pus seems to be well
walled off, is confined to one side, and is inhibiting ovulation

FiG. is; Tubo-Ovarian Abscess. Cow.
/, Vagina and cervix seen from ventral side ; j, left uterine cornu ; j, tubo-

is section of oviduct filled with pus.

Pyosalpinx 447

on the sound side, it may be possible to remove the suppu-
rating tube, with its ovary, by laporatomy. In valuable
breeding animals it may be worth while to take the risk of
such an operation. The technic of the operation would natu-
rally be the same as that for salpingitis and adherent ovary,
though the peril to the animal would be very much greater,
and the owner should have the risks thoroughly explained
prior to venturing upon so hazardous a procedure.

Fig. 158 — Tubo Ovarian Abscess with Pelvic Adhesions. Horizontal

section through top of uterus viewed from above.

/, Cervix ; 2, sclerotic uterus with pus iu uterine cavity ; j, right

ovary ; 4, cross section through the left oviduct at the ovary. The

figure 4 is in the centre of large hematoma and at lower border

of this is seen pus ; 5, left ovary completely adherent.

448 Diseases of the Genital Organs

3. Hydrosalpinx and Dropsy of the Pavilion of the

Oviduct

Hydrosalpinx, which is comparatively common in cattle,
constitutes one of the common causes of incurable sterility
in heifers. It is apparently as common in heifers which
have never conceived as it is in cows. The period of inva-
sion of the disease in heifers is not definitely known. Prob-
ably it occurs during the nursery period and passes unob-
served until breeding age, when it causes sterility, and is
then recognized by clinical examination. The disease also
arises during pregnancy, although how frequently can not

I'n, 159 Cystic Pavilion of the Oviduct.

O, Right ovarj ; O*, left ovary ; UC, cornua ; C, cystic pavilion

adherent t<> ovary-

Hydrosalpinx and Dropsy of the Pavilion of the Oviduct 449

Fig. 160 — Cystic Oviducts and Corpus Luteum.
A, Dorsal view ; B, ventral view.
/, Uterine body ; 2, cornu ; 3, cystic corpus luteum of right ovary, sec-
tioned ; 4, girlde of lutein tissue : 5, sectioned left ovary, cystic ; 6, cystic
left oviduct ; 7, ostium abdominale of oviduct ; 8. ventral surface of right
ovary, with cystic corpus luteum ; 9, cystic right oviduct, buried underneath
right cornu and ovary. 29

45°

Diseases of the Genital Organs

be determined. I have not observed bilateral hydrosalpinx
in a pregnant cow, either clinically or in the abattoir. In
the sow, however, I have one example, shown in Fig. 161,
which indicates very clearly that the disease does occur in
the pregnant sow, and presumably in pregnant animals of
all species. Frequently it follows retained afterbirth and
other types of puerperal infection. Since hydrosalpinx is
almost always bilateral, its chief clinical manifestation is

] ii, 1 6 1 — Extreme Bilateral Hydrosalpinx.
/, /, Section through cystic, adherent ovaries (cystic defeneration of
corpus luteutn); 2, enormously distended oviduct. About % of total
length lies underneath the portion shown ; 3, section through the smaller
oviduct.

absolute sterility of the patient. The disease assumes a va-
riety of types. Generally, when hydrosalpinx is established,
adhesion of the ovary within the pavilion of the tube has al-
ready occurred. The mesosalpinx is also commonly adher-
ent to the ovary, as shown in Figs. 154, 155 and 156, so that
the cystic oviduct is thrown into a convoluted mass in front
of and lateral to the ovary, and in some cases above the

Hydrosalpinx and Dropsy of the Pavilion of the Oviduct 45 1

gland. In other instances, the margin of the pavilion ad-
heres to the ovary while the general mucous surface of the
funnel remains free. It then participates in the cystic dis-
tension and in some cases becomes enormously enlarged, as
shown in Fig. 159. In other types of hydrosalpinx, the tube
and pavilion remain perfectly free. The ostium abdominale
of the oviduct becomes occluded and the pavilion of the ovi-
duct recurved over the ampulla, leaving a knob-like enlarge-
ment at the end of the oviduct. It is still adherent by one
or two fimbriae to the lateral end of the ovary, but these
fimbriae, on account of the weight of the oviduct, may be
very greatly elongated so that the cystic oviduct may drop
far forward and lie lower down in the abdominal cavity.
In order that this may occur, the mesosalpinx must also be-
come greatly stretched as a consequence of the weight of
the cystic fluid. Amongst these three most distinctive types
there is every possible variation. The condition is almost
invariably associated with either a cystic degeneration of
the corpus luteum or a fibrous degeneration — sclerosis — of
the ovary as a whole. Presumably these changes in the
ovary are the result of a passage of infection by contact into
the ovary, generally through the wound caused by the rup-
ture of the ovisac at the time of ovulation prior to the pe-
riod of complete closure of the oviduct.

The diagnosis of hydrosalpinx should be based upon the
enlargement of the oviduct as described. Sometimes the
cystic condition involves chiefly a small segment of the ovi-
duct ; sometimes it involves with great uniformity the en-
tire length. The size of the cystic oviduct will vary between
a trifling enlargement beyond normal up to three-quarters
to seven-eighths of an inch in diameter or possibly larger.
The length of the oviduct is also enormously increased — at
times 8 to 10 inches long — especially when the entire duct is
free. Extensive adhesions tend to restrain the duct from
becoming greatly elongated and throw it into very compli-
cated convolutions. A cystic condition of the pavilion is to
be diagnosed largely by its extreme softness and its posi-
tion as related to the ovary. As shown in Fig. 159, the

452 Diseases of the Genital Organs

ovary lies behind the cystic duct. Sometimes when the
duct is closely convoluted and the convolutions held firmly
by adhesions, the mass may be mistaken for a very large
ovary. This error should constantly be avoided. The cystic
pavilion also is frequently mistaken for an ovarian cyst.
This is an unfortunate error because it leads to a false prog-
nosis. Cystic ovaries are not hopeless, but cystic distension
of the pavilion of the oviduct is beyond remedy. The veteri-
narian is also apt to err when the oviduct is free and, owing
to extensive degeneration, drops forward beneath the ovary,
as indicated in Fig. 160, where it is detected with great diffi-
culty. In one instance I diagnosed hydrosalpinx upon one
side, but failed to detect it upon the other side because the
oviduct was enormously enlarged and the mesosalpinx so
elongated that the oviduct dropped far downward and for-
ward beneath the gland. The result was that an incurably
sterile animal was retained in the herd for about a year.

Hydrosalpinx is bilateral in approximately 90 per cent, of
cases. Since the prognosis is utterly hopeless, so far as the
involved tube is concerned, it follows that the prognosis of
hydrosalpinx in general is very bad. In some cases the dis-
ease may be confined to the oviduct, and the animal may
breed, and occasionally does, upon the sound side. In such
a case there is no call for interference. In other cases the
disease, especially when complicated with a large cystic
corpus luteum, may inhibit ovulation upon the sound side.
Relief may be had in such instances through amputation of
the diseased tube with the ovary. The veterinarian needs
to be very careful in making his diagnosis and to remember
that the condition is nearly always bilateral. Therefore it
is essential that he examine both sides with very great care.
If both ducts are involved, the case must be abandoned. The
operation for the removal of the tube and ovary is the same
as described in the preceding paragraphs.

1. Cysts in the Mesosalpinx

Occasionally one finds small cysts in the mesosalpinx. Some-
they are located about the ampulla of the oviduct and are due

Uterine Infections 453

to cystic changes in remnants of the Wolffian bodies. Since clinically
these small cysts may closely resemble hydrosalpinx, they should be
examined with very great care. So far as I know, they are never of
any consequence in the cow, although in the mare they may become
very large and interfere in a variety of ways with the physical well-
being of the animal, as already related in Chapter XI.

C. Uterine Infections

1. The Diseases of the Uterus of the Heifer Calf and
Virgin Heifer

A. Intra-Uterine Infection and Endometritis
Numerous heifers, arriving at breeding age, are found to
be absolutely sterile. In many of these cases it is impossible
to determine the date of invasion. Sometimes, where the
records are defective, conception may have occurred and
abortion has followed early, though the embryo was not of
sufficient size to be recognized. Sometimes, probably, the
embryo has not been expelled, but has broken down and has
been absorbed. Sometimes the infection may have been
transmitted to the heifer by the bull in coitus. In any of
these cases the fundamental clinical fact is that, so far as
can be seen, the heifer is sterile when she reaches the age
for breeding. Upon examining such an animal, little may
be found clinically to indicate the character of the disease.
The genital organs appear normal upon palpation. Upon
post-mortem examination of such animals, the uterus, as
well as the oviducts, which have already been discussed, is
found to contain infection, and histologic changes have oc-
curred in the genital mucosa. If the heifer is kept over a
long period of time and repeatedly bred to the bull, lesions
gradually develop which are clinically recognizable. The
first of these is an enlargement and atony of the uterus, as
shown in Fig. 162, testifying to the existence of endometri-
tis. Clinical examination generally reveals also the pres-
ence of cervicitis with thickening and sclerosis of the annu-
lar mucous folds of the cervix. These deform and press
aside the cervical canal so that it is difficult to pass a sound

454

Diseases of the Ge?iital Organs

or other instrument into the uterine cavity. Eventually
the ovary and oviduct participate in the changes which be-
come clinically recognizable.

The diagnosis of endometritis in the heifer, pending the
enlarged flabby condition of the uterus, is not practicable
except for the history of sterility and the absence of other
evidences of disease. In this respect one finds it impossible
to differentiate between endometritis and salpingitis. As a

FlG. [62 —Chronic Endometritis in Five-Year- Old. Non-Fregnant

Heifer which had Never Conceived.

/, Cervix ; j, cornua ; ,\ small ri^ht ovary ; ./, left ovary with

large, persistent corpus luteum.

general rule, they probably coexist, since the essential differ-
ence is that, when the disease changes are limited to the cer-
vix and uterus, each of which is somewhat amenable to in-
terference, there is hope for the breeding power of the
heifer. The principal evidence upon which one may tenta-
tively differentiate endometritis from salpingitis is by the
presence or absence of cystic degeneration of the corpus
luteum and the irregular estrual cycle dependent upon that

Uterine Infections

455

degeneration. If cystic degeneration of the corpus luteum,
with irregular estrual cycle, is present, salpingitis may be
diagnosed with considerable confidence. At the same time,
endometritis is probably present. If, along with the per-
sistent sterility, the corpus luteum does not undergo cystic
degeneration and the estrual cycle is regular, one may be
warranted in diagnosing endometritis or cervicitis without

Fig. 163 — Complete Pelvic Adhesions with Uterus, Cornua, Oviducts,

and Ovaries Firmly Bound Together. Heifer.

/, Cervix ; 2, uterine body ; 3, cornua ; ./, left ovary with

cystic corpus luteum.

salpingitis, and a more favorable prognosis may be given.

The treatment needs to be based on disinfection of the
uterine cavity. Admittedly it is technically impossible to
disinfect the uterine mucosa without destroying it, but there
is much that can be done to favor disinfection by indirect
methods. Endometritis is almost always associated with
cervicitis and largely dependent thereon. Not only does the

45'1 Diseases of the Genital Organs

cervicitis furnish a permanent center for the infection, but
the swelling of the annular folds of the cervix compresses
the cervical canal and interferes with the proper drainage of
the uterine cavity, so that infected secretions are held back.
Therefore one should dilate the cervical canal in order to
bring about improvement of the cervix itself through the
application of antiseptics, to establish a practical path
through which one can reach the uterus to disinfect it, and,
more important still, to obtain a freer opening for the es-
cape of the infection from the uterine cavity.

The dilation of the cervical canal is sometimes exceed-
ingly difficult in these animals. In some cases I have found
it necessary to make repeated attempts with the uterine
dilators before succeeding in passing through the cervical
canal. One must, therefore, have great patience and per-
severe in the work until the object is attained. Once the
dilator has passed through the cervical canal, it can be
gradually dilated by opening the instrument. One should
not attempt to dilate the canal completely by a single open-
ing of the dilator, but should open it for a time, then close
it, revolve it a short distance upon its long axis, and open
it again. This process should be kept up until pressure has
been brought to bear upon every part. While the jaws of
the dilator are forced apart, the instrument should be care-
fully withdrawn by exerting moderate traction so that the
dilation is extended throughout the length of the canal.
When the dilation has been satisfactorily completed, the
uterus may be douched and the re-flow should be examined
carefully for the presence of muco-pus or other evidence of
disease. The uterine cavity should then be disinfected, for
which purpose 2 per cent. Lugol's solution or y2 per cent,
chlorazene solution may be used. These must be carefully
drained off from the uterus.

Probably a better plan for disinfecting consists of plac-
ing in the uterus a heavy, virtually insoluble disinfectant,
such as iodoform and bismuth. I have had apparently good
results from a heavy suspension of iodoform and bismuth
subnitrate in white mineral oil, injected (one or two ounces)

Ulerive Infections

457

Fig. 164 — Arrested Excavation of Muellerian Ducts with

Cystic Uterus.

A, Viewed from above ; />', ventral view.

/, Cervix ; 2, body of uterus, divided by transverse septa ; j, corinia,

separated from uterine body by septa ; ./, right ovary ;

5, left ovary.

458 Diseases of the Genital Organs

into the uterus and left there. It should be heated to the
temperature of the body before introducing. It remains
in the uterine cavity for ten to fifteen days, undergoing
very gradual solution, tending constantly to disinfect the
uterine cavity and at the same time exerting a favorable
influence upon the infection in the cervix. The treatment
may be repeated several times and, when the uterus and
cervix seem to be in good condition, may be discontinued
for three or four weeks until the iodoform and bismuth
have disappeared. The animal may then be bred. The
heavy suspension of iodoform and bismuth in oil are best in-
troduced with a metallic syringe, as shown in Fig. 196. The
conical nozzle may be used, inserted into the end of the small
uterine catheter, and the suspension forced through this
into the uterus. If more convenient, the long curved nozzle,
which closely simulates the catheter itself, may be used and
the suspension injected directly into the uterine cavity with
the syringe.

In conjunction with the injection into the uterus, any
cervicitis present should have attention. Sometimes there
may be present a retained corpus luteum which is interfer-
ing with the normal functions of the uterus. In such cases
the corpus luteum should be dislodged. If the estrual cycle
is normal and the estrum is apparently normal, the corpus
luteum should not be disturbed.

B. Pyometra

Pyometra occurs in heifers which are not known to have
conceived. There are several types :

(1) There occurs from time to time an arrest in the de-
velopment of the ducts of Mueller, to which allusion has
been made in Chapter IV, by which the cervical canal Or
the canal of the uterus or one of the horns does not become
excavated, and consequently there occurs an accumulation
of menstrual debris, which sometimes becomes infected and
takes on the general character of an abscess of the uterine
horn. Presumably the infection is lodged within the cavity
of the horn or uterus during fetal life or in early calt'hood
and has finally become active in the presence of large vol-

Uterine Infections 459

umes of menstrual debris. In some cases the infection may
invade the cystic horn after puberty, but this cannot be
definitely determined.

Clinically the condition is recognized by rectal palpation.
Ordinarily attention is drawn to the genital tract by steril-
ity. Sometimes, when the occluded horn becomes greatly
distended, it inhibits estrum ; sometimes estrum occurs, but
conception fails and an examination is made. I have not
observed pregnancy in the anatomically sound horn when
the other horn is cystic and occluded at its base. It is not
quite clear why this should be so if the one horn is normal.
Upon rectal palpation the examiner finds one horn normal
while the other horn has a narrow hard area at its base and
the apex may be distended very greatly with fluid. Those
which I have seen have contained from 8 to 25 or 30 ounces
and are very tense. It is difficult in some cases to get a
clear tracing of the condition, because the cystic horn bulges
out over the normal one and covers its own base, rendering
accurate palpation very difficult. Therefore it requires pa-
tience to reach a proper diagnosis. The ovaries are usually
normal.

The actual condition varies greatly. It is to be regarded
fundamentally as an arrest in the development in the ducts
of Mueller, as has already been described in Chapter IV and
illustrated in Fig. 164, which shows a non-infected uterus
with several transverse septa in the horns. In the next
figure, 165, is shown a typical case of cystic cornu of the
type which occasionally becomes infected, the contents be-
coming purulent.

The prognosis has not been definitely learned for cases in
general. It would appear that the removal of the cystic
horn with the ovary should bring about favorable results.
In one instance I amputated a cystic cornu in which the
cyst contents had undergone purulent changes. The animal
had not been in estrum for a great many months. As soon
as she recovered from the operation, estrum returned regu-
larly, but the result of breeding has not been learned. So
far as I could see, she should breed.

460

Diseases of the Genital Organs

The amputation was made by performing laparotomy in
the middle flank region upon the corresponding side, as far
posterior as possible. The cystic cornu and the correspond-
ing ovary were removed. Recovery from the operation was
prompt and uneventful. This is probably the only effective
way to handle the malady.

PlG. 165 — Atresia of Uterine Horn at Base, with Cystic Distension.
Vagina, cervix, anil left uterine horn laid open. Top of right cystic horn

laid open, showing the floor of the cyst. Viewed from right side

/, Cervix ; 2, left horn laid open ; j, cvstic hase of right horn at point of

atresia ; ./, apex of cystic right horn, partly separated from J by

a transverse septum ; 5, corpus luteutn in right ovary.

(2) Pyometra also occurs in the heifer because of imper-
forate hymen. I have seen a two-year-old heifer suffering
greatly from genital trouble which was causing severe
straining. There was marked emaciation and general ill
health. During the severe expulsive efforts a portion of
the genital system protruded between the lips of the vulva.
Upon clinical examination it was found that the vulva was

Uterine Infections 46 1

open and normally developed but the vagina could not be
entered, as the hymen was very thick and imperforate.
Upon rectal examination the vagina was found to be greatly
distended with pus. The distension of the genital tube in-
volved the uterine cavity as well. The hymen was incised,
and about a gallon of highly fetid thin pus escaped. Re-
covery was slow. The ultimate result of the operation, so
far as breeding is concerned, is unknown to me, but it is
highly improbable that she will breed. The probabilities are
that, under the great mechanical pressure of the contents,
the pus was forced into the oviduct to cause pyosalpinx.
Had the condition been recognized early and relief given,
the prognosis should presumably have been good.

(3) Other isolated cases of pyometra occur in heifers
the precise nature of which cannot be readily determined.
In one instance, when I was called in consultation with a
colleague, a valuable heifer was found to have voluminous
pyometra with complete paralysis of the uterus and passive
retention of the pus. The uterus had dropped far forward
into the abdomen, where it could not be efficiently palpated.
The cervical canal was open. There was no history of any
discharge from the genital tract. Apparently the pus lay
passively in the paretic uterus. The clinical history of the
animal was uncertain. She had been purchased by the
owner some months previously as a pregnant animal. It
was impossible to determine whether she had ever been
pregnant, since an accurate clinical history of such an ani-
mal ordinarily ceases to exist with change in ownership.

My colleague had diagnosed pregnancy because the uterus
was enlarged and had dropped far forward in the abdomen
and because there was no evidence of pyometra in the way
of genital discharge. When it was attempted to examine
the uterus by douching in order to determine the character
of the trouble, a soft rubber horse catheter was introduced
deeply into the uterine cavity and a normal and physiologic
salt solution introduced into the uterus by gravity. After
two or three quarts had been introduced, the introduction
was suspended and an effort made to siphon out the con-

462 Diseases 0/ the Genital Organs

tents, but when the distal end of the catheter was lowered
no fluid was obtained. I began to wonder why it should
behave in this way. More fluid was then introduced into
the uterus and, while it was still flowing in, the distal end
of the catheter was compressed, lowered, and then released.
Pus commenced to siphon out and the uterus was relieved
of three to four gallons. I have had similar experience in
cows where the same error has been made with the siphon
and the veterinarian led to believe that no pus or other
pathologic contents is present. The difficulty is that, when
the fluid is being introduced by gravity, if the veterinarian
is not cautions, it all passes at once into the paretic uterine
cavity, exhausting the column of fluid in the catheter essen-
tial to the process of siphoning.

The prognosis of this rather rare condition is highly un-
favorable. I have not had an opportunity for post-mortem
examination, but suspect that it originates as hydrometra
(which see) and later the fluid becomes infected and puru-
lent, the uterus remaining absolutely paretic. The uterine
mucosa is probably completely destroyed, and hence the
animal is absolutely sterile. If one has reason to believe
otherwise, the only treatment which can be suggested at
present is to siphon out the contents frequently, douche the
cavity well with disinfectants, such as 2 per cent. Lugol's
solution, which must be carefully removed, and then intro-
duce slow-dissolving disinfectants, such as iodoform and
bismuth, in the hope that the diseased condition may in this
way be overcome.

2. The Infections of the Gravid Uterus

A. Apical Endometritis with Necrosis of the
Apices of the Fetal Sac

When considering the development of the fetal membranes
in Chapter I, it was noted that the tips of the fetal sacs of
ruminants and swine regularly become necrotic, as shown in
Figs. 34, 35. This is regarded as normal by some embryolo-
gists, but careful study in the abattoir denies this assump-
tion. The necrotic tip is regularly of a dirty yellowish-

Infections of the Gravid Uterus 463

brown color and frequently desiccated. It varies in extent
from one-fourth inch or less to eight or ten inches. The
necrosed part lies free within the horn, surrounded by a
dirty yellowish or yellowish brown flocculent exudate, some-
times watery, sometimes of pap-like consistency. Some-
times the necrotic tip is flat, crumpled and desiccated ; some-
times it is soft and pliable, and its lumen persists in continu-
ity with the allantoic sac. Rarely the amniotic tips partici-
pate in the necrosis and become adherent in the necrotic
allantoic area. The extremities of the amnion thus become
fixed in the apices of the allantois, the amnion is incapable
of contracting about the embryo, the tension upon the am-
nion at its attachment to the ventral floor of the embryo be-
comes too great, the embryo everts, and schistocormus re-
flexus follows.

Associated with such necrosis of the membranes, there
exists as a rule a macroscopically recognizable endometritis
of the contiguous uterine mucosa. The mucosa, definitely
thickened and edematous, generally bears upon the surface
dirty yellowish or reddish sediment, resembling brick-dust
and closely adherent. There are wide variations. In nu-
merous cases the exudate is of a dirty yellowish-brown
color, tenacious and abundant. In some cases, as shown in
Colored Plate III, the exudate fills the non-gravid horn from
apex to base and presents the characters of "the exudate of
contagious abortion." Between the extremes named every
grade of endometritis is seen. The volume and type of en-
dometritis correspond with the necrosis of the tip of the
fetal sac. The necrosis of the tip and the endometritis are
regularly greatest in the non-gravid horn. It is possible
that in some cases the pre-conceptional infection is so great
in one horn that fertilization on that side is blocked and
pregnancy occurs on the side of least infection. In such
case the lesions would naturally be most marked upon the
non-gravid side. I think, however, that this hypothesis ex-
plains few cases. The more probable cause of the variation
is the lesser vitality of the membranes in the non-gravid
horn. They are far less vascular and, in harmony with

464 Diseases 0/ the Genital Organs

general rules of bacterial invasion, should afford less re-
sistance.

The histology of apical endometritis has not been studied.
The bacteriology has had almost no attention. My col-
leagues, Carpenter and Hagan, have obtained chiefly strep-
tococci of the viridans type and paracolon organisms.

The date of invasion of the cornual apices is apparently
pre-conceptional. The infection probably enters frequently
from the oviducts. Evidently it may also proceed from the
cervix. Its significance is not fully understood. When as
virulent as shown in Plate III, it must have serious peril
for the health of the embryo and apparently endangers the
uterus itself. The chief danger to the embryo is the inva-
sion of the fetal fluids through the necrotic area. Since
the allantoic fluid regularly extends into the necrotic tips,
its contamination is unavoidable. Once the infection has
invaded the allantoic fluid, it may grow through the amnion
and, reaching the amniotic fluid, be swallowed by the em-
bryo during its constant physiologic process of swallowing
its amniotic fluid. It is not necessary that bacteria shall
penetrate the amnion in order to reach the amniotic fluid.
They may instead be borne in the fluid, through the urethra,
bladder and urachus, to the amniotic fluid, and eventually
be swallowed.

Apical endometritis of pregnancy, since it is not clini-
cally diagnosable, offers no field for therapeutic effort. So
far as known, its prevention is dependent upon the funda-
mental principle that the health of an embryo is primarily
dependent upon the soundness of the genital organs of both
parents at the time of coitus.

B. Diffuse Endometritis of Pregnancy. The
" Dystocia of Contagious Abortion

There is observed in the abattoir an endometritis of the
pregnant uterus in which the disease processes are quite
evenly diffused throughout the entire uterine cavity. Some-
times the endometrium is swollen and edematous and its
els are visibly engorged. A yellowish, yellowish-brown,

Infections of the Gravid Uterus 465

or greenish-brown exudate of an extremely viscid, sticky-
character covers the non-placental portions of the uterine
mucosa and the chorion. The fetus may be apparently
healthy. In other instances the fetus shows evidences of
having long been dead. The fetal and maternal placentae
have separated and the fetal membranes are necrotic, soft,
and non-resistant. The fetus is soft and only faintly odor-
ous. The uterus is edematous, flaccid, and paretic. The
utero-chorionic space is occupied by dirty, grayish, floccu-
lent exudate. There is little evidence of any tendency to
expel the fetus.

Clinical observations appear parallel to those of the abat-
toir. In my companion volume1 I have held that most dys-
tocia in cows is due to a uterine atony dependent upon intra-
uterine infection in which the fetus participates. Whether
the fetus be alive or dead, the uterus contracts feebly, caus-
ing tardy dilation of the cervical canal and delayed expul-
sion of the fetus. Preceding, accompanying, or following
the expulsion of the fetus, an exudate in varying amounts
is expelled by the uterus. The fetus may perish, to undergo
later maceration or emphysema. This type of metritis of
pregnancy is usually not diagnosed clinically until its pres-
ence is revealed by the advent of dystocia. Its handling
then logically falls within obstetrics, where it has already
been considered. After the dystocia has been overcome, the
metritis is to be handled as advised under "Diseases of the
Puerperal Uterus."

C. Cervical Endometritis

Cervical endometritis, which constitutes the essential
basis in the phenomenon of abortion, is the primary lesion
which finally arouses contractions of the ovarian end of the
uterus with the expulsion of the uterine contents. Less
frequent than apical endometritis, it plays a larger role in
interfering with reproduction. Cervical endometritis con-
sists of an ascending or centripetal infection advancing
from the cervical toward the ovarian end of the uterus. In

1 Veterinary Obstetrics, 191 7. 30

466 Diseases of the Genital Organs

many, probably in most cases, cervical endometritis is the
result of an extension of infection from the cervical mucosa
forward. In the most outstanding cases, the infection evi-
dently extends from the cervical canal, as illustrated in Fig.
174, in which the cervical seal has failed to form and a me-
tritis has served to destroy the placental relations about the
os uteri internum, so that portions of the chorion, some of
which are necrotic, protrude through the cervical canal into
the vagina. At the same time the embryo may be living
and not visibly involved, but ultimately the fetus must par-
ticipate in the infection and abortion follow.

Cervical endometritis is not always clinically recognizable,
but in many cases it is very evident. Frequently the uterine
seal is imperfect, is wanting in resistance or density, or
may be discolored. In some cases, like Fig. 174, portions of
the fetal sac protrude into the vagina. The protruding
parts are usually necrotic, but moderate traction ordinarily
brings living vascular membranes into view. Such cases
are well advanced on the road to abortion.

Cervical endometritis is sometimes diagnosable by means
of rectal palpation, owing to the atony of the pregnant
uterus. Physiologically the gravid uterus is tonic to the
sense of touch, but in some cases of disease the organ is
clearly atonic, soft, paretic, and flabby.

So far as known, the infection of cervical endometritis
exists within the cervical end of the uterus or in the contin-
uous cervical canal at the time of conception. The infection
may exist at the time of coitus or may be transmitted by
coitus as a seminal contamination.

In studying the bacteriology of cervical endometritis,
most investigators have searched for the B. abortus only,
and when they have not recovered that organism have re-
ported the findings as negative. A few investigators have
reported the finding of paracolon or paratyphus bacilli, B.
iene8, streptococci, etc. The B. abortus, according to
recorded observations, is frequently present and apparently
plays an important part in the metritis, but just what part
is not precisely known, because the other organisms present

Infections of the Gravid Uterus 467

have not been studied in connection with it. The researches
of my colleagues, Carpenter and Hagan, have thus far indi-
cated that in the cases investigated by them the B. abortus
is not the dominant organism.

The prognosis of cervical endometritis is unfavorable.
The fetus, which inevitably participates in the invasion,
may perish and be expelled, may be born highly infected, or
with large numbers of bacteria included within the meco-
nium and later break down with septicaemia, dysentery,
pneumonia, or pyaemia. In the cow the metritis inevitably
persists into the puerperal period or beyond, frequently
complicated with retained placenta. Cervical endometritis
is not amenable generally to handling during pregnancy.
When clearly recognized, in such cases as that illustrated in
Fig. 174, where abortion is clearly foretold, the emptying
of the diseased uterus should be the first aim. I have prac-
ticed, and recommend, douching the uterus with a weak
antiseptic solution, such as 0.5 per cent. Lugol's solution,
through the open cervical canal. This tends to detach the
fetal sac from the maternal placentules and to cause the
prompt expulsion of embryo and embryonic sac. Once the
uterus is empty, the diseased uterus may be handled and re-
stored to health. The prevention of the cervical endometri-
tis of pregnancy is fundamentally dependent upon the mat-
ing of two animals with clean sexual organs.

D. Septic Metritis of Pregnancy with Uterine Gangrene
Septic metritis of the pregnant uterus with uterine gan-
grene is not rare. It bears a close relationship to the dif-
fuse endometritis of pregnancy and represents a more viru-
lent course of infection. As a rule, the existence of intra-
uterine infection passes unnoted clinically until suddenly the
disease breaks out in a storm and its presence becomes evi-
dent. Usually it appears at or near the close of the physio-
logic duration of pregnancy, showing itself in two types.

Most commonly the animal unexpectedly becomes dull.
There may be some atonic expulsive efforts. Usually the
cervix relaxes and necrotic fetal membranes protrude from

}(>s Diseases of the Genital Organs

the vulva. Uterine paresis ensues so quickly that there can
be no uterine contractions. Should expulsive efforts be
present, they are confined to the contractions of the abdomi-
nal walls. The efforts are feeble and futile. If the fetal
cadaver is removed, the membranes with the uterine cotyle-
dons, which are necrotic, come away together. The uterine
walls are hard and thick. Involution fails ; instead, the
uterus collapses in response to compression by the surround-
ing viscera. The uterine cavity may contain an indefinite
amount of a thin, black or reddish-black exudate which ap-
pears to consist chiefly of disintegrated red blood cells. The
exudate is usually fetid.

The prognosis in this group is very unfavorable. A com-
paratively large percentage of cows survive, but very few
recover. Eventually most survivors must go to the butcher
because of incurable sterility. The indications for handling
consist of the surgical evacuation of the uterus, followed by
the general plan for handling puerperal metritis, to be de-
scribed later.

The other, and less frequent group of gangrenous metri-
tis of pregnancy presents the cardinal symptoms of the gan-
grenous metritis of the puerperal period, except for the
presence of the fetal cadaver with non-dilation or imperfect
dilation of the cervical canal. The patient is apparently
well and in good condition, until suddenly she appears to be
critically ill. The general appearance is one of great de-
pression bordering upon collapse. The pulse is rapid and
very weak. The respiration is quickened and shallow. The
temperature is erratic and is frequently subnormal. The
eyes are sunken and the cornea appears dry and opaque.
Tears mixed with muco-pus flow down over the cheeks and
face. There is a copious discharge of mucus from the nos-
trils and of saliva from the mouth. Severe diarrhea is usu-
ally present, the feces being watery, dirty black, and very
fetid. The animal moves only under compulsion, and then
totters. In some cases the cow or heifer is found down and
unable to rise only fifteen or twenty hours after she ap-
peared well. Sometimes necrotic fetal membranes protrude

Infections of the Gravid Uterus 469

from the vulva. In other cases vaginal examination reveals
necrotic membranes protruding from the cervical canal.
Sometimes the cervical canal is dilated little or none at all,
but may be open, and the examiner may find that the uterine
seal is absent or breaking down and mixed with thin, black,
fetid exudate. The cervix is comparatively sound; the
uterus, wholly necrotic, is powerless to dilate the cervix.
Rectal palpation generally reveals an enormously enlarged,
emphysematous fetus which crepitates under manipulation.
The massive fetal cadaver may be palpable from the exterior
through both flanks.

The prognosis is hopeless. The animal dies within twelve
to forty-eight hours.

E. The Placentitis of Pregnancy

Endometritis can not readily occur without participation
of both the placental and non-placental areas. Generally
the non-placental areas suffer primarily while the placental
structures show an interesting degree of resistance. So
there is observed an intercotyledonal endometritis with
great volumes of exudate in the utero-chorionic space, while
the placental structures are apparently intact and the fetus
is alive and healthy. But it is difficult to understand how
an important infection can exist for a long period, when of
large volume or high virulence, without involving also the
placental structures. It appears certain that as a rule the
placental areas are the most resistant of the uterine mucosa,
and, so far as investigators have proceeded, this view is well
supported. In studying the pregnant uterus in the abattoir,
interesting lesions are recognizable which serve to explain,
or to add interest to, some clinical phenomena.

(a) Peripheral placentitis. As a rule some, many, or all
placentules in the gravid uterus show peripheral dehiscence.
The chorionic tufts have become detached and lie outside
the placental crypts. The separation is usually apparent
after the sixth month of pregnancy and becomes increas-
ingly prominent as pregnancy nears its close. Some of the
smaller placental areas about the os uteri internum become

47°

Diseases of the Genital 0 roans

wholly detached, but further forward the larger cotyledons
show merely a very few peripheral chorionic tufts displaced
from the placental crypts. The displaced tufts are white or
grayish-white, due apparently to anemia owing to the inter-
ruption of the physiologic placental contact. The phenome-
non is so nearly universal that, like the necrotic tip of the
fetal sac, it may be designated normal in the sense that is is
generally present. Its significance is unknown.

(b) Inter-placental hemorrhage with fetal desiccation is
a more interesting and at present more important clinical
manifestation of placental disease. It has not been shown

PlG. r66 Inter-Placental Hemorrhage with Desiccation of Fetus, in Early Stages.
Cervical canal; //, hematoma filling uterus and covering fetal sac; C, chorion incise
and turned back ; F, fetus; CL, corpus luteum.

to be dependent upon disease of the non-placental uterine
areas.

In the abattoir I have observed marked inter-placental
hemorrhage involving uniformly all cotyledons. In one well
marked case none of the blood had escaped into the utero-
chorionic space, the peripheral tufts having maintained their
contact. In a manner this is a reversal of the peripheral
dehiscence described in the preceding paragraph.

It seems perfectly clear that this phenomenon is the ini-
tial stage of desiccation or mummification of the fetus. In

Infections of the Gravid Uterus

47i

the second stage the hemorrhage is greater, the inter-pla-
cental hemorrhage forces the fetal and maternal placentae
apart, and the blood forces its way in great volume to every
part of the uterine cavity, enveloping the fetal sac in a vast
incapsulating hematoma, as shown in Fig. 166. The fetus
at once perishes from asphyxia. If bacteria are present,
they are non-pyogenic. After the cessation of the hemor-
rhage, the blood serum is slowly absorbed and the absorption
of the amniotic, allantoic, and tissue fluids gradually follows.
Finally there remains a hard, dry, rigid, and distorted dark
brown fetal cadaver, consisting of the dried skin, bones, and
other skeletal tissues with a thin parchment-like membrane

""^ *

G.L.

/

■y>>"

Fig. 167— Inter-Placental Hemorrhage with Desiccation of Fetus'

The desiccation has progressed farther than in Fig. 166.

/, Hematoma in non-gravid horn ; 2, fetal ribs cut across ; j, hematoma in

uterine body and gravid horn ; 4, cranial bone (parietal?) of fetus,

5, vagina ; CL, embedded corpus luteuin of fetal retention.

over them representing the fetal sac, with vestiges of the
hematoma. The cervical canal remains sealed ; the corpus
luteum of pregnancy sinks into the center of the ovary (em-
bedded corpus luteum) there to remain indefinitely, usually
as a permanent inhibitory force preventing the expulsion of
the desiccated cadaver, and inhibiting ovulation and estrum.
This is observed mostly in heifers.

Since the animal has been bred and estrum does not recur,
pregnancy is assumed. If the hemorrhage occurs late in
pregnancy, the patient shows the abdominal enlargement of
pregnancy and the fetus may be recognizable by ballotte-

472

Diseases of the Genital Organs

ment. If a heifer, her udder enlarges, verifying the assump-
tion of pregnancy. Then comes a recession in the evidences
of approaching parturition. The abdominal enlargement re-
cedes imperceptibly for week after week, the enlarged udder
slowly resumes its pre-conceptional volume and appearance,
and the time for parturition draws near and passes by with-
out trace of sexual function of any kind. The general health
is unaffected.

Vaginal exploration reveals a typical uterine seal of preg-
nancy. Rectal palpation, if by chance made soon after the
occurrence of the hemorrhage, reveals the uterus filled with
a rather firm, doughy, even mass, deeply embedded within
which a fetal cadaver (or sometimes twins) may be recog-
nized. As desiccation proceeds, every stage is encountered

tv

FlG. i6S— -Complete Desiccation of Fetus following Inter-
Placental Hemorrhage.

up to the completion of the process, shown in Fig. 168. Then
one may palpate per rectum the limbs, ribs, head, hollow
orbits, and all skeletal details. The completion of the desic-
cation will naturally vary. In a fetus twenty-four inches
long from nose to base of tail. I think the completion of the
s r< quires six to eight months.
Bang has procured cultures of the B. abortus from the
desiccated debris. He does not state that other bacteria
were or were not present. I am not aware of other bacterial
search.

Infect 'tons of the Gravid Uterus 473

The prognosis is fair under surgical interference, but
highly unfavorable when left to natural resources.

The removal of the fetal cadaver by mechanical interven-
tion is unjustifiable and highly dangerous. Any attempt to
dilate the cervix mechanically and to extract the rigid, an-
gular cadaver is very difficult and full of peril. Pituitary
extract has not been tried, so far as I have seen recorded.
In large doses, should it cause uterine contractions of a se-
vere type, it would be highly dangerous. Dislodgment of
the corpus luteum has promptly and uniformly caused the
expulsion of the cadaver in from five to twelve days. The
action is very gradual and unaccompanied by any visible
danger. In most cases the ovary can be drawn back over
the vagina and the corpus luteum dislodged by compression
through the vaginal walls. When fetal death occurs late, the
ovary may be dragged too far forward for the vaginal meth-
od. Removal must then be attempted very cautiously per
rectum. It is to be remembered that in long-standing cases
the yellow body is deeply embedded and requires firm com-
pression for its dislodgment. Since the resistance of the
rectal walls is low, the operator must exercise great care in
order to avoid rupture. Using care, I have succeeded in each
case without injury to the rectum.

If the dislodgment of the Corpus luteum can not be accom-
plished safely by rectal manipulation", laparotomy should be
performed upon the involved side and the ovary directly
compressed. Care should be taken to dislodge all lutein tis-
sue, since any remnant may continue to inhibit estrum and
serve as a foundation for the formation of a new corpus lu-
teum, which may necessitate a second operation.

After the cadaver has been expelled, the uterus should be
closely watched and any remedial measures applied which
may be indicated by the conditions present. The expulsion
of the desiccated fetal cadaver inevitably causes contusions
and abrasions of uterus, cervix, vagina, and vulva. The
most prudent action which can be suggested at present is
to introduce into the uterine cavity four to eight ounces of
white mineral oil or liquid paraffin, to which has been added

474 Diseases of the Genital Organs

one-half ounce each of iodoform and bismuth subnitrate.
This serves to soften and to disinfect any debris left in the
uterine cavity, and finally to cause its expulsion.

The prognosis is uncertain. I have been unable to follow
my cases properly and have not known accurately the re-
sults. They should largely recover their breeding power.

(c) Incarcerating placentitis of pregnancy constitutes
the essential basis of retained fetal membranes during the
puerperal period. It is unrecognizable during pregnancy
and is first revealed when parturition or abortion has oc-
curred. Its intensity and degree of development during
pregnancy largely determines the intensity and duration of
the retention of the fetal membranes after calving or abort-
ing. Like cervical endometritis, it regularly has its incep-
tion at the cervical end of the uterus and radiates toward
the ovarian extremity. In abortion occurring the first few
months of pregnancy the course of the placentitis and the
detachment of the membranes are completed early and the
embryo is expelled surrounded by its membranes. Exten-
sive placentitis (cotyledonitis) during pregnancy is incom-
patible with birth, because the disease causes fetal death.
The tendency, therefore, is for the duration of the placen-
titis of pregnancy and that of the puerperal period to be in-
verted— the longer the placentitis has existed during preg-
nancy, the shorter its course after calving or aborting. This
rule is greatly disturbed, however, by the termination of
pregnancy. The birth or abortion, by causing extreme dila-
tion of the cervical canal, vagina, and vulva, opens the way
for fresh infection from without, and causes vital changes
in the supply of oxygen to the uterine cavity, with modifica-
tions of bacterial activity. The contusions and abrasions
incident to the expulsion of the fetus increase the opportu-
nity for bacterial multiplication.

(d) Necrosis of tin cotyledons at the cervical end of the
uterus occurs but rarely during pregnancy, and then only
to a limited extent, without seriously imperilling the life of
the fetus. In the non-gravid horn, however, all the cotyle-
dons may become necrotic, as shown in Colored Plate III,

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Infections of the Gravid Uterus 475

without notable injury to the fetus. This is analogous to
the observations upon swine embryos, in which extensive
necrosis commonly occurs at both ends of the embryonic
sacs without invading the essential placental structures. In
this manner the peril to the embryo is limited chiefly to the
passage of bacteria through the necrotic area, while the
placenta continues to function physiologically. Rarely, the
placentitis of pregnancy is of such virulence that all cotyle-
dons become necrotic simultaneously or in rapid succession.
The fetus then perishes, the uterine walls are paretic, and,
if the mother survives, the embryo macerates or the uterus
undergoes abscessation.

(e) Adventitious 'placental structures regularly follow
the necrosis of the cotyledons, whether it occurs during or
after pregnancy. Adventitious placentae are not seen in
heifers, but are common in cows, where they serve as proof
of the prior necrotic destruction of cotyledons. In the
uterus of the pregnant heifer, placental contact is regularly
limited to the distinctive cotyledonal or placental areas.
With each succeeding pregnancy, there is an increased
probability of necrosis of some of the cotyledons about the
os uteri internum. In the area denuded of cotyledons, ad-
ventitious placental structures develop, presenting macro-
scopically the appearance of the diffuse placenta of the mare.
When cotyledons are destroyed, there is no visible effort at
compensational hypertrophy of the remaining cotyledons,
but the compensation is effected through adventitious ac-
tivity of the intercotyledonal endometrium.

The adventitious placental structures tend to invade the
endometrium about the os uteri internum and to form over
the os a virtually continuous placental contact, constituting
in effect a placental seal, separating the cervical canal from
the utero-chorionic space. When parturition begins, the
adventitious placental structures must give way before the
cervical canal can dilate and the parturient rent occur in
the chorion. The adventitious placental structures ordi-
narily radiate from the os uteri internum for only four to
ten inches, though occasionally they involve the entire uter-

47 6 Diseases of the Genital Organs

ine body cavity and may extend deeply into one horn. In
one abattoir cow I observed a complete adventitious (dif-
fuse) placenta involving the entire endometrium. While
adventitious placentae are always the consequence of coty-
ledonal necrosis, extensive death of the cotyledons is not or-
dinarily followed by adventitious placenta; instead, the ex-
tensive disease commonly includes the endometrium and
either kills the patient or renders her absolutely sterile.

(f) Calcification of the placenta occurs very rarely. I
have observed but one case, that being in an abattoir ani-
mal. The calcification, which was very marked, involved
uniformly all cotyledons. The placental stratum was pale
yellow, resistant and gritty. There was no evidence that
the calcification had interfered with embryonic development.
The cause was not clear. It was possibly the result of inter-
placental hemorrhage stopping short of placental dehiscence
and embryonic death. Had parturition occurred, retained
fetal membranes with necrosis of the cotyledons would
probably have followed.

(g) Specific placentitis, due to placental tuberculosis and
actinomycosis, doubtless occurs rarely and, when pregnancy
terminates, leaves behind an obstinate retention of the fetal
membranes, the character of which is not clinically appar-
ent. Naturally the specific disease promptly leads to in-
curable sterility.

3. Infections of the Ovum, Embryo, and Fetus

A. Death of the Fertilized Ovum

The death of the fertilized ovum is not directly recog-
nizable clinically, but its occurrence must be admitted.
Ovarian infection evidently causes death of the ovum within
the ovisac. When an ovum passes from the ovisac into a
virulently infected oviduct, the cell is immediately placed in
great peril and may perish prior to fertilization. Examina-
tion of infected oviducts after slaughter of the patient shows
that the highly motile spermatozoa move through the badly
infected tube and reach the pavilion ready to fertilize the
ovum as soon as it is discharged. Presumably this occurs

Infections of the Ovum, Embryo and Fetus 477

often, but the newly fertilized egg has little, if any, more
power of resistance than the spermatozoon and unfertilized
ovum each possessed prior to their union. It is an indisput-
able clinical fact that salpingitis generally prevents recog-
nizable pregnancy. This renders it reasonably clear that
the infection in the oviducts or uterus kills the spermato-
zoon or ovum. The recognizable destruction of the embryo
or fetus is so common that the unseen death of its earliest
stages must also be frequent. Any infection capable of
causing the death of an embryo or fetus must logically be
more readily able to cause death of the far less resistant
organism. Thus a heifer is bred possibly eight to ten or
more times at regular or irregular intervals. Sometimes
she may appear pregnant for one to two or more months.
Finally she recognizably conceives and pregnancy contin-
ues one hundred to two hundred or more days, when she is
observed to expel a fetal cadaver. One death of a fertilized
egg has been observed, while many deaths during the earlier
periods have passed unseen. The deaths of the spermatozoa
and of the unfertilized or fertilized ovum are far more nu-
merous and cause infinitely greater economic losses than do
abortions. In many valuable herds of pedigreed cattle, an
average of three copulations is necessary for each recog-
nizable pregnancy : there is an initial failure in 67 per cent,
of attempts at reproduction.

The farce of curing the disease or preventing the death
of the ovum, spermatozoon, or fertilized egg by measures
taken after coitus, as is so common with abortion, has not
become established. The avoidance of such death clearly
lies in the fundamental principle that the physiologic re-
production of young rests upon the sexual contact of two
healthy individuals.

B. Death of the Embryo with Persistence of the
Embryonic Sac. Cystic Mole

As soon as the embryo has formed and its sac has ac-
quired recognizable dimensions, embryonic death may be
clinically observed if accurate attention is given at the criti-

478

Diseases of the Ge>iitaf Organs

cal period. The recognition becomes largely a question of
chance. Most embryonic deaths pass unseen. In such early
deaths the embryonic sac is by far the greatest and most
conspicuous part. Frequently the embryo dies and all traces
of it disappear while its sac persists and apparently con-
tinues to grow. The embryonic sac retains its usual form,
but is without evident placental structure, and apparently
maintains its growth and existence by absorption of liquids
from the uterine cavity. One of these is illustrated in Fig.

Fig. 169 — Cystic Mole.
Total length 46 inches ; circumference, 7 inches. At the top of the gravid
branch of the fetal sac is seen a thickened spot, apparently marking the
former location, of the embryo. Compare with colored plate II. At the
cervical end of the uterus, the embryonic sac is necrotic and desiccated.
The necrotic tips are prominent. .Sac removed 200 days after conception.

169. In this instance there remains a thickened area which
faintly suggests the prior location of the embryo. The cow
was examined at about sixty days after coitus and pro-
nounced pregnant. The cervical canal was sealed, the uterus
enlarged and distended in a manner typical of pregnancy of
that duration, a typical corpus luteum of pregnancy was
present, and estrum was absent. The general signs of preg-
nancy failed to advance parallel to the duration of time.
Later an examination disclosed the nature of the condition,
and the "mole" was removed.

Infections of the Ovum, Embryo and Fetus 479

The cystic mole grows slowly and soon fails to maintain
the degree of distension of the uterus characteristic of the
advancement of pregnancy. Finally its growth becomes
halted and its size may continue static for an indefinite
period unless the uterine seal is imperfect or becomes de-
stroyed. Then its expulsion follows. The expelled cyst
commonly shows two unequal parts representing the gravid
and non-gravid horns, joined by a narrow, sometimes ne-
crotic, isthmus, representing the area contiguous to the os
uteri internum.

Fig. 170 — Desiccated Mole. Cow.

The embryo had perished at probably thirty days or less ; the sac later

became necrotic and desiccated. In douching the uterus

it was caught in the fenestrum of the catheter.

More frequently the cystic mole becomes necrotic quite
early and undergoes a desiccation similar to the necrosis of
the tips of the embryonic sac. The elongated sac collapses,
dries and shrivels until it becomes a flattened, wrinkled,
yellowish-brown cord. In such case the uterine seal is ab-
sent, either having failed to form or, if formed, having been
destroyed. Clinically I have seen the desiccated sac protrud-

480 Diseases of the Genital Organs

ing from the cervical canal into the vagina. In douching a
uterus, the dry structure is sometimes drawn into the fenes-
trum of the uterine catheter, and when the instrument is
withdrawn the structure is pulled out.

In all cases of desiccated mole I have seen, there was
present a well marked pyo-cervicitis with slight purulent
endometritis. When recognized, the mole should be re-
moved and the associated cervicitis and endometritis
handled according to indications. It is evidently imprudent
to breed such an animal until after thorough disinfection
of the uterus and cervix.

C. Death and Maceration of the Embryo or Fetus

As a rule, when infection advances from the ovarian end
of the uterus or exists in the central area and causes death
of the embryo or fetus, the cadaver is not expelled because
the uterine walls are rendered paretic. The same result is
attained when infection, advancing from the cervical end of
the uterus, proceeds so rapidly that uterine paresis is in-
duced quickly. The embryo or fetus then undergoes mace-
ration. If the mother survives, either the pyometra of fetal
decomposition or uterine abscessation follows.

(a) The pyometra of embryonic or fetal decomposition is
comparatively common in cattle. It occurs at any time
after pregnancy is clinically recognizable, up to the com-
pletion of the ordinary duration of pregnancy. When occur-
ring very early, the pyometra may be quite limited. There
may be an inconspicuous purulent discharge, absence of
estrum, and non-interference with general health. It is
most frequently seen in heifers. In the heifer rectal pal-
pation generally reveals a small uterus, distended and
rounded by purulent contents. The uterus is ordinarily
free from adhesions. No trace of a fetal cadaver is recog-
nizable clinically. Upon post-mortem the uterus is found
distended with pus and containing skeletal fragments, such
as the tiny elongated ossification centers of the long bones.
I have seen these less than one-half inch long. In one case
the heifer had been bred about one year previously and had

Infections of the Ovum, Embryo and Fetus

48 1

been supposed pregnant until near the time for parturition.
The pus was thick and fetid. The pyometra had extended
into the oviducts (pyosalpinx) and had irrevocably de-
stroyed her breeding life.

Embryonic maceration with pyometra probably causes
those cases of extensive pyometra in heifers, to which allu-
sion has already been made, and those in cows accompanied
by such complete uterine paralysis that no genital discharge

Fig. 171 — Maceration of Fetus.

/, Cervical lips ; 2, greatly enlarged, sclerotic annular fold pushed across the cervical canal

j, vagina ; 4, parietal bone of embryo ; CL, embedded corpus luteum

of pyometra. The uterine walls are sclerotic.

3i

is evident. In these cases, if the pyometra is due to embry-
onic maceration, the embryo is so small at the inception of
the pyometra that its skeletal debris is not recognizable
clinically during douching.

When fetal death and maceration occur later in preg-
nancy, copious discharge of fetid pus commonly follows.
The fetal debris is too gross and angular to be discharged
with the pus. The soft tissues of the cadaver dissolve or

482 Diseases 0/ the Genital Organs

become suspended to constitute part of the pus. The bones
separate at their epiphyses but fail to dissolve. I have ob-
served cases where fetal death had occurred two years prior
to the examination. The condition of the fetal bones ap-
peared static. The bones become closely packed together in
a somewhat irregular oblong mass in the base of one horn.
The interstices between the bones are largely filled with
thick, desiccated, intensely fetid pus.

The diagnosis of this type of fetal maceration is compara-
tively simple when the general outlines of the condition are
known, but is often quite difficult for the beginner. There
is a history of apparent pregnancy following breeding.
Later the progress of pregnancy apparently halts and a
highly fetid purulent genital discharge ensues. Estrum is
absent. The genital discharge may be sanious, owing to
pieces of the jagged fetal bones lacerating the endometrium
and causing hemorrhage. Palpation of the uterus per rec-
tum reveals a hard, irregular enlargement in one horn (ex-
cept in maceration of bicornual twins). A careful study of
the enlargement shows that the parts of the tumor move
upon each other with definite crepitus. The cervical canal
is generally narrow, and the cervix hard. If a catheter is
introduced and the uterus douched, the pus may be largely
washed out and the size of the mass rendered slightly more
distinct. The bones then move more freely when palpated,
rendering the diagnosis clearer. In one instance, in a tu-
berculin reactor, the fetal mass was mistaken for uterine
tuberculosis. Uterine tuberculosis, however, is usually sym-
metrical. The actual differentiation lies in the recognition
of the fetal bones. In another case the admixture of blood
with the pus caused a diagnosis of uterine tumor. This
error should have been avoided by more careful palpation.
In the earlier stages fetal maceration and fetal desiccation
may be confused. In desiccation the hematoma dims or
completely hides the outlines of the fetal cadaver ; in early
maceration the fetal outline remains. In maceration the
cervical canal is generally or always unsealed; in desicca-
tion the uterine seal is ordinarily perfect. The progress of

Infections of the Ovum, Embryo and Fetus 483

desiccation is illustrated in Figs. 166-168. An old uterine
hematoma of puerperal origin may also lead to confusion in
diagnosis. The uterine hematoma is firm, doughy, and gen-
erally regular in outline. I have met one old, greatly desic-
cated, tesselated hematoma of the uterus which clinically
might well have given trouble in diagnosis and might have
been mistaken for the skeleton of a fetus. But the crepitus
is absent. The history that the animal has or has not been
bred may aid, though this is sometimes erroneous and adds
to the confusion. The prognosis in advanced fetal macera-
tion is virtually hopeless for the breeding life of the ani-
mal. When it has continued for some months, the endome-
trium is ordinarily destroyed and the suppurative process
has extended into the oviducts, inducing incurable pyo-
salpinx. I have not known a cow to conceive after having
suffered from prolonged fetal maceration. Possibly some
of them may breed.

The handling of fetal maceration offers many difficulties.
The cervix is usually extensively inflamed and sclerotic, and
the dilation of its canal is difficult and dangerous. Forcible
dilation is liable to cause serious lacerations, or the sclerotic
tissues may rupture, causing an opening into the peritoneal
cavity. Uterine contractions tending to expel the cadaver
may be induced by dislodging the corpus luteum, but the
corpus has sunken deeply into the center of the gland (the
embedded corpus luteum of pyometra) and is difficult to
dislodge. Sometimes the ovary is dragged far downward
and forward in a manner to render it difficult to carry the
ovary back over the vagina through the wall of which vig-
orous compression can be exerted without danger. The
corpus may be dislodged by compression per rectum, but
this requires extreme care in order to avoid severe or dan-
gerous rectal lesions. The corpus may always be dislodged
by performing laparotomy, inserting the hand into the peri-
toneal cavity, and compressing the ovary directly. But the
succeeding uterine contractions will generally fail to expel
the cadaver. The jagged bones become caught in the uter-
ine walls, causing wounds and preventing expulsion. The

484 Diseases of the Genital Organs

same difficulties face the veterinarian when he attempts to
bring about the expulsion by the administration of pituitary
extract. The contractions of the uterus can be induced,
but they fail to evacuate its contents. I have removed the
skeletal debris by hysterotomy, but the operation was diffi-
cult and the result was failure. Possibly further efforts at
hysterotomy, or rather hysterectomy, may develop a practi-
cal technic associated with success. From my experience I
believe the more hopeful plan to be the amputation of the
involved horn with its oviduct and ovary, leaving repro-
duction to the other horn and ovary, which may have
escaped hopeless injury. When this is undertaken, great
care must be exercised to avoid the escape of any of the
uterine contents into the peritoneal cavity. The abdominal
incision must be made upon the involved side as far poste-
rior as practicable upon the middle line of the flank. That
is, the abdominal incision must be made as near to the uter-
ine attachments as possible. Even then, it is difficult to lift
the involved uterine horn out through the wound, and vir-
tually impossible to operate within the abdomen.

Attempts at handling with a view to the restoration of
breeding should not be undertaken except in animals of
great value. Others should be prepared for slaughter by
the most economic source. Where there is old-established
maceration of the fetus, the animal is frequently in good
beef condition and the repulsive skeletal cadaver is so walled
off that there is no logical objection to the use of the meat as
human food. The uterus should be regarded as an abscess
cavity.

(b) Abscessation of the gravid uterus occurs when the
fetus macerates and the cervical canal undergoes atresia to
such a degree as to prevent the escape of pus through the
genital passage. The occlusion of the cervical canal occurs
by two distinct processes.

(1) Ahsn ssation of the uterus, with fetal retention, oc-
curs when the fetus dies and the cervical canal becomes
closed as a result of severe cervicitis. The occurrence is at
first without notable clinical symptoms. The animal has

Infections of the Ovum, Embryo and Fetus 485

been bred and is presumably pregnant, but the symptoms
of advancing pregnancy are absent or, if the pregnancy is
well advanced when the fetus dies, the symptoms are retro-
grade. In one of my cases the cervical atresia was incom-
plete and some portions of the fetal membranes protruded
from the vulva, but the constricted cervical canal afforded
insufficient exit. The cervical canal became blocked, possi-
bly by a large portion of the fetal cadaver. The uterus ad-
hered to, and finally opened into the rumen. Fetal debris
passed into the rumen and caused several attacks of fetid
diarrhea. Whole grains of corn (maize) and oats entered
the uterus. The heifer suffered little in her general health,
milked fairly, grew fat, and was sold for beef. In a second
case, from the abattoir, the uterus adhered to the urinary
bladder, as illustrated in Fig. 172. The general tendency
appears to be for the uterus to adhere to, and rupture into,
one of the hollow viscera. Which one, will depend some-
what upon the stage of pregnancy at which maceration and
abscessation occur. In early pregnancy the bladder or rec-
tum forms the most probable outlet; later in pregnancy,
after the fetus drops forward, the rumen is the most logical
viscus into which the uterus may empty its contents.

(2) Uterine torsion regularly causes occlusion of the
cervical canal. Most patients die unless surgically relieved,
but rarely the cow survives and the fetal cadaver macerates.
In some instances there occurs a transverse rupture of the
genital tube in the vagina, cervix, or uterine body, and the
uterus with the fetus drops downward upon the abdominal
floor. The fetus macerates but the ruptured end of the
uterus is closed by the enveloping uterine ligaments like
the mouth of a bag tied with twine. The uterine walls re-
tain some life through one or more of the uterine vessels,
the organ adheres to the abdominal floor, and finally the ab-
scess points externally and the fetid fetal debris drops out.
Abscessation of the gravid uterus is hopeless so far as the
breeding life of the animal is concerned. The adhesions in-
cident to the abscessation bring about serious nutritive dis-

486

Diseases of the Genital Organs

PlG. 172 Macerating Embryo sloughing into Urinary Bladder.
mbryonic debt is with ]>u-. in body of uterus seen from above
ornua ; /, embryonic debris in the urinary bladder, after sloughing
through its fundus, seen from right Bide after sagittal section ;
muscular walls of urinary bladder.

Infectioyis of the Ovum, Embryo and Fetus 487

turbances which commonly destroy the value of the patient
for other purposes.

D. Emphysema of the Fetus

As a rule the bacteria which infest the utero-chorionic
space of the pregnant cow, and which tend to invade the
fetus and destroy its life, do not form gases. Instead they
most frequently cause a dry necrosis (necrosis of the tips
of the embryonic sac) or induce maceration of the fetus.
The rapid multiplication of gases within the sealed uterine
cavity or the contained fetus is virtually incompatible with
the life of the mother unless the cervical canal is open and
establishes a free vent for the gases. Usually the crisis of
uterine rupture is not reached because the patient succumbs
to sepsis.

Emphysema of the fetus occurs in all species of animals,
usually near, or at the end of the normal duration of preg-
nancy. The emphysema is apparently the result of second-
ary invasion of a recent date. The life of the fetus has or-
dinarily been destroyed and the uterine seal broken down by
other invaders, preparing an open way for the entrance of
the gas producers. When the fetus is emphysematous, the
cervical canal is ordinarily open but not dilated. Some-
times, as in cases of torsion of the uterus with emphysema
of the fetus, the cervical canal is mechanically closed by the
torsion. The mechanical injury to the cervix destroys its
resistance to invasion, and emphysema results. Sometimes
under these conditions the emphysema becomes so great
that the fetus occupies almost the entire abdominal cavity
and rupture of the uterus appears to be averted chiefly by
the support afforded by the contiguous abdominal walls.

The clinical symptoms of fetal emphysema are essentially
those of the uterine gangrene of pregnancy already de-
scribed.

E. The Observed Expulsion of the Fetal Cadaver. Abortion
The term "abortion" has a great variety of meanings. In
veterinary medicine it ordinarily means the observed expul-
sion of a fetal cadaver. If it is stated that twenty per cent.

488 Diseases 0/ the Genital Organs

of cows in a herd have aborted, it is meant that someone has
observed one-fifth of the females expel fetal cadavers. Many
more embryonic or fetal cadavers may have been expelled
unseen, or very small embryos may have become macerated
and absorbed, but these are not included. In this sense
"abortion" has acquired a preeminent place in veterinary
science and the phenomenon is commonly regarded as a
specific disease.

(a) Tin- history of abortion is extensive. Its occurrence
has been noted by biblical and other early writers and was
frequently recorded in medieval times. The occurrence of
abortion has generally caused greatest concern in cattle be-
cause, since their milk and meat have occupied a preeminent
place in the food supply of most nations, any interference
with this supply imperils human life and health. Perhaps
the phenomenon has occurred more frequently in cattle than
in other domestic animals because the conditions favoring
it have been most prominent in cattle. Abortion has been
noted most in highly civilized countries with dense popula-
tions where milk and its derivatives are most highly prized,
and where any interruption of dairying causes a serious
shortage in this highly important human food. Since, where
a regular daily supply is demanded, for economic reasons no
surplus cattle are kept, any serious disturbance with milk
production is immediately felt. With the advancement of
civilization and concentration of population, the ratio of
milk- and meat-producing animals to the population becomes
less and higher efficiency of each individual animal becomes
< ssential. This increases the strain upon the animals, and
the diseases interfering with reproduction become more in-
tense. Accordingly abortion and other interferences with
reproduction are of ever-increasing importance to the state
and call for vigorous measures of control.

At first abortion was frequently attributed to unfavorable
weather, such as unusual dampness or dryness, to bad food,
to emanations from swamps, and to accident. In early his-
tory only a few diseases, such as leprosy, were attributed
to contact. The belief in contact as a cause of disease ad-

Infections of the Ovum, Embryo and Fetus 489

vanced rapidly during the eighteenth century. In the nine-
teenth century Pasteur and others firmly established the
fact that disease is chiefly due to contact and that the under-
lying cause is a living microparasite passing from the dis-
eased to the healthy animal as a result of direct or indirect
contact.

The belief in the infectiousness of abortion has experi-
enced a long and eventful course of development which has
not yet been completed. For a time a few abortions were
ascribed to infection, but these were at first limited to those
cases where ingenuity failed to ascribe any other reason.
At present probably a majority of people believe that most
abortions are due to infection. The observed expulsion of a
fetal cadaver came to be regarded as a disease, and by many
is still so designated. Those abortions believed to be due to
contact accordingly became known as "contagious," "infec-
tious," or "epizootic" abortion and were considered a specific
malady. Many believed, and still believe, that, if a cow
aborts as a result of infection, it must be due to one infecting
agent and one only.

Mammalian existence is divisible into two clearly defined
eras — intra-uterine or ante-natal, and extra-uterine or post-
natal life. In post-natal life an indefinite number of infec-
tions may threaten health or life. On the other hand, it has
been constructively assumed that during intra-uterine life
but one bacterium or other microparasite may threaten the
unborn animal. It is further assumed for all practical pur-
poses that an infection invading the fetus can hot cross the
birth line and continue as a disease of the calf. Neither has
it been commonly assumed that an infection of the pregnant
female can invade the fetus within her uterus. Technically
all pathologists admit that tuberculosis and syphilis may
pass from mother to fetus, but this is not credited with any
important bearing upon "contagious abortion." While the
existence of such belief may be technically denied by the
orthodox contagious-abortionists, they practically teach that
"contagious abortion" is due to an infection which acts
without contact. That is, if a cow aborts in the presence of

49° Diseases of the Genitai ' Orga?is

a healthy cow, the infection passes through the body of the
healthy cow "in bond" and fatally attacks the intra-uterine
young, thus passing through an intermediary organism
without injury, to attack fatally a third individual.

In irreconcilable conflict with such belief, the group of
veterinarians to which I belong hold that the observed ex-
pulsion of a fetal cadaver is a phenomenon devoid of great
mystery — that fetal death is fundamentally like extra-uter-
ine death and occurs in a perfectly analogous way. Not
only is fetal death analogous to post-natal death, but, with a
single limitation, death in the two eras is due to identical
causes. The limitation — and it is a highly important one —
is that many of the important infections of post-natal life
are unable to attain contact with the fetus. The uterine seal
serves as an effective barrier against invasion through the
genital tract, and the placental filter, when healthy, is not
known to permit the passage of any organism competent to
cause disease. No such passage of disease-causing organism
through the healthy placenta to the fetus has yet been re-
corded. Even the ultra-minute disease-producers which
defy the finest filter made by man, such as the virus of hog
cholera, smallpox, and many others, do not destroy the life
of the fetus directly, but only indirectly by destroying the
life of the pregnant female.

I have held that the infections causing the phenomenon of
abortion are far less mysterious than generally claimed and
are in all respects analogous to, and in an important degree
identical with, the infections of extra-uterine life. Every
part of the genital tract of both sexes and of all ages com-
monly harbors bacteria of great variety. Under ordinary
conditions these may not cause evident disease, but under
the numerous and vital changes of function in the genital
tract, they may and do acquire power to cause vital injury.
The uteri of most non-pregnant and pregnant cows and heif-
ers contain bacteria having pathogenic powers. The epi-
didymis and vesiculae seminales of bulla often contain bac-
teria which cause definite lesions in these parts. Under
certain conditions such bacteria are ejaculated with the

Infections of the Ovum, Embryo and Fetiis 491

semen during coitus. If the cows served by such a bull be-
come pregnant, they largely abort. It is quite unnecessary
to invoke mysterious infections to account for any and all
abortions. The infections are present, abundant, and potent.

(b) Abortion is world-ivide and is seen in all mammalia.
According to the highest authorities upon human obstet-
rics, 25 per cent, of pregnant women abort. Statistically
the rate of abortion is far less among domestic animals, but
that may be statistically only. I have previously stated that
the term abortion, as commonly used, signifies the observed
expulsion of the fetal cadaver. Abortion statistics are neces-
sarily based upon the observed phenomenon. Hence the
more accurate the observation, the higher statistically is the
rate of abortion. Such being the case, if the expulsion of
the embryonic or fetal cadaver were of equal frequency in
all mammalia, statistically woman would occupy first place,
the dairy cow next, followed by beef cows and other domes-
tic females in order of the accuracy of observation of those
who are in immediate charge. Available statistics from
dairy herds indicate that approximately 10 to 15 per cent,
of pregnant cows and heifers are observed to abort. How
many fetal cadavers are expelled unseen is pure guesswork,
but, if the opportunity for observation were as good as in
the human family, the probabilities are that the abortion
rate in cows would statistically equal or exceed that recorded
for woman.

The phenomenon of abortion is probably more frequent in
dairy than in beef cattle. Certainly it is more frequently
seen, because the dairy cow is under very much closer ob-
servation than any other domestic animal, except possibly
pet cats and dogs.

If the question is approached from a different angle, and
the reproductive efficiency of animals studied, there is far
greater accord between the various species and strains. If,
for example, the reproductive efficiency of pedigreed dairy
and beef cows be compared, it will be found that there is no
notable difference. In many pedigreed beef herds, especially
show herds, the reproductive ratio drops to 50 per cent, of

492 /diseases of the Genital Organs

the ideal of one calf per cow each year. Pedigreed dairy
herds ordinarily do no worse. If abortion were defined as
the failure to produce young, there would be greater statis-
tical harmony between the various species and classes of
animals.

I have known no herd of cattle, whether of dairy or beef
breed, where abortion has not been observed. I know of no
authentic record of a herd in which abortion is not seen.
The frequency of abortion varies widely in different herds
and at different times. Abortion is one of many phenomena
due to infection within the pregnant uterus. If the forma-
tion of ova or spermatozoa is prevented by infection, if the
genital cells are destroyed after being formed, or if the fer-
tilized ovum or the minute embryo is destroyed, the disaster
passes unseen and statistically becomes sterility. Abortion
is, therefore, logically a phenomenon usually of the fifth to
the seventh month of pregnancy, not because the intra-
uterine young perishes most frequently, or even so often,
at this period, but because the disaster is most frequently
observed at this time. After the seventh month, the fetus
may be expelled alive and the phenomenon is called prema-
ture birth; a fetal cadaver may be expelled at full term and
is called stillbirth; or a fatally infected calf may be born at
full term and die from intra-uterine infection, but that is
known as white scours or pneumonia, or otherwise. So dis-
ease and death throughout the entire reproductive process
is referable to a group of infections and the resulting dis-
aster is differently designated according to the date and
manner of its occurrence, but the final outcome is the same
— non-production.

Abortion is the result of two concurrent phenomena — the
death of the fetus, and the existence of an endometritis of
the pregnant animal of such a character as to cause the
uterus to contract and evacuate its contents. In all recorded
autopsies of cows which had recently aborted or were in the
act of aborting at the time of slaughter, there have been
recognized indisputable evidences of the presence of active
infection. There has always been a definite cervical endo-

Infections of the Ovum, Embryo and Fetrus 493

metritis radiating toward the ovarian end of the uterus.
Pus or other pathologic exudate is constantly present in the
utero-chorionic cavity or, if the fetal membranes have come
away, in the uterine cavity. The exudate and, almost al-
ways, the alimentary tract of the fetus contain bacteria,
recognizable by cultural and staining methods. The utero-
chorionic space of most apparently healthy pregnant cows
and the digestive tube of most new-born, apparently healthy

Fig. 173 — " The Exudate of Contagious Abortion."

Cross section through the cornua of a pregnant uterus, showing exudate

in utero chorionic space.

/, Fetal sac in gravid horn ; 2, fetal sac in non-gravid horn ; j, exudate in

utero chorionic cavity of gravid horn ; 7, large masses of exudate

in non-gravid horn ; 5, section through cotyledon.

calves contain bacteria not differing materially from those
observed in abortion. In abortion, however, the bacteria
are far more abundant. The variation in the abundance of
bacteria is more readily studied in the abort, the fetus, and
the calf, The amount of infection is very notable in the
abort. The prematurely born calf usually bears in its ali-

494

Diseases of the Genital Orga?is

FlG. 17 1 —Impending Abortion, Cervicitis, and Endometritis at

Cervical end, with Protrusion of Fetal Sac into the Vagina.

The cervix has been laid open along its dorsal surface. /, Apparently

healthy chorion protruding into vagina ; -\ ,\ necrotic portions of prolapsed

chorion ; ./, lips of cervix ; (>. right ovary; C, large cyst representing the

left ovary. The left side is sterile ; the ri^iit horn pregnant about 80-90 days.

• Colored Plates III and IV. )

Infections of the Ovum, Embryo and Fehis 495

mentary tract very voluminous infection. When metritis
exists, with or without retained afterbirth, the alimentary
canal of the apparently healthy calf swarms with bacteria
and the calf probably breaks down with spesis, dysentery,
or pneumonia. When the cow calves vigorously and expels
the membranes promptly, the infection in the alimentary
tract of the fetus is scant. All clinical and bacteriological
evidence indicates that the abortion is in each case referable
to infection, and to infection only.

In sharp conflict with all recorded evidence, the term
"contagious abortion" constructively suggests a non-con-
tagious abortion. The fiction of a non-contagious abortion
continues to be supported by many who believe that some
abortions are due to various causes other than infection.

(c) Many believe in traumatic abortion but fail to ex-
plain how mechanical injury can cause the death and ex-
pulsion of a fetus. The bovine fetus lies upon the abdominal
floor, surrounded by the abundant amniotic fluid and almost
completely surrounded by the still more abundant allantoic
fluid (See Colored Plate I). The head of the fetus gener-
ally lies within the pelvic cavity. If in the posterior pre-
sentation, the head usually lies above the sternum of the
cow. When the abdominal floor is struck at a point against
which some part of the fetus rests, it promptly floats away
in its fluids. Fetal life is not dependent upon the same
vital functions as extra-uterine life. Since respiration and
nutrition are provided by the placentae, the sole vital func-
tion of the fetus is the fetal circulation. Fatal injury to
the fetus is, therefore, virtually limited to a traumatism
which can directly stop the fetal heart-beat. It is not known
that such injury is possible.

Placental separation due to mechanical injury is unknown.
I have studied carefully in the abattoir the uteri of more
than two thousand pregnant cows and heifers, and have not
observed an instance of any injury to uterus, fetal mem-
branes, or fetus which, had the animal been permitted to
live might apparently have led to abortion. I have already
described inter-placental hemorrhage with fetal desiccation,

496 Diseases 0/ the Genital 0?-%a"s

but evidently this is not due to mechanical injury. It does
not lead to abortion, but to fetal retention. Hence it may
be stated that up to the present no proven instance of me-
chanical or traumatic abortion has been recorded in the cow
nor in any other animal, and no logical explanation has been
put forward of how mechanical injury can cause abortion,
(d) Food abortion has also been asserted to occur, and
every known food has been blamed. The food is alleged to
be too rich or too poor in proteins or in water, or it was fed
too cold or in improper volume. Much has been charged to
damaged foods. Since nearly all foods are damaged some-
what, bad food can be made to fit most cases of abortion.
Special emphasis has been laid upon foods contaminated
with fungi, such as ergot and smut, although I can find no
authentic record of experimental or other evidence of the
ability of any fungus to cause a healthy female to abort.
McCullom, Hart, and others have experimentally shown
that, by feeding cows upon a restricted kind of food (the
wheat plant alone), although technically all essential food
elements were given in abundance, the animals lost vigor,
the calves born of these animals were weak and unthrifty,
and as the experiments proceeded, abortion ensued, then
conception failed, and finally the cows perished. But this
is the mere decadence of vigor due to nutritive disturbance.
Upon inquiry I was advised that when the experiment cows
aborted they commonly had retained fetal membranes, for
which up to the present there can be but one explanation —
the presence in the uterus of an infection causing placentitis.
The facts recorded by McCullom and Hart are of supreme
and vital interest to breeders of animals. Practically the
food, in a sense, caused the abortion, but the manner in
which the food ration acted should be carefully considered.
It seems to me evident that bacteria were present in the
uteri of the experiment animals (as is commonly true) and
that the devitalizing food ration given so lowered the vitality
of the animals that the resident infection increased in viru-
lence and caused disaster. The contention that all abortions
are basically referable to infection is neither an argument

Infections of the Ovu?n, Embryo and Fetus 497

nor admission that the proper feeding of animals does not
play a vital part in reproduction. While abortion occurs
only in the presence of intra-uterine infection, infection of
both uterus and fetus is common without causing, or visibly
threatening to cause abortion. The bacteria commonly pres-
ent in the gravid uterus and in the contained fetus cause no
visible injury in many cases. If intra-uterine bacteria uni-
formly prevented birth, the bovine species would soon be-
come extinct. Under good hygienic conditions, if the bac-
terial content of the uterus is low, a degree of resistance
may be acquired sufficient to hold in leash the bacteria pres-
ent. In the presence of menstrual blood or of an embryo,
the virulence of the bacteria may increase and injury follow.
If the resistance of the animal is lowered by faulty feeding
or otherwise, infection within the utero-chorionic space be-
comes more active. The amount of food may be deficient or
excessive. It may be damaged by fungi. The ration may
be badly balanced, or, as in the experiments of McCullom
and others, though the food may contain all necessary ele-
ments in the quantities technically required, may fall short
in variety ; then reproduction is faulty or absent. Repro-
duction is dependent upon a nutritive surplus beyond other
body requirements. If the nutritive supply is barely suf-
ficient to maintain the general functions of the body, ova
and spermatozoa are not formed. If the nutritive supply is
somewhat greater, the reproductive cells form, but tend to
perish later, either before or after fertilization. In this de-
struction bacteria play an important part.

Other factors influence reproduction. Pregnant cows or
heifers moved from one establishment to another are far
more liable to abort, to calve prematurely, or to suffer from
metritis, probably with retained membranes, and the calf is
more apt to suffer from dysentery than if the pregnant fe-
males had been left at home with otherwise equally good
care. The interferences with reproduction are not the re-
sult of inferior care nor of exposure to a present infection,
but of the lowering of their power of resistance to a present
infection. Twin pregnancy is far more liable to interrup-

32

498 Diseases of the Genital Organs

tion than the normal single fetus, not because bovine (or
equine) twins are unnatural but because the increased
drain upon the nutritive supply of the mother lowers her
resistance and permits the intra-uterine infection to multi-
ply disastrously.

However important food and environment may be to re-
production, so far as known, bacterial invasion of the utero-
chorionic space of the cow is absolutely essential to abor-
tion, retained afterbirth, and 99 per cent, of sterility.

(e) The biology of abortion. It is now generally con-
ceded technically, though largely denied practically, that
abortion may be caused by an unknown variety of bacteria.
Any microorganism which may exist within the pregnant
uterus, and which is capable of causing metritis and the
death of the fetus, may cause abortion. Chronologically the
chief infections which have been alleged to cause an im-
portant amount of abortion in cows are as follows :

(1) The micrococcus and short bacillus of Nocard.1 In his
researches Nocard recognized a short bacillus (probably
paracolon or paratyphus) and a micrococcus in the utero-
chorionic space of aborting cows, and in the digestive tube
of the abort. He concluded that one or both organisms
found were the cause of abortion in the cases investigated
by him. He believed that abortion was primarily a disease
of the fetus, but that the infection was derived from the
uterus. He further expressed the very important view that,
if the invaders failed to kill the fetus, they persisted in the
individual through birth into extra-uterine life and consti-
tuted the basic cause of dysentery in young calves, thus as-
serting his belief in the continuity of infection between
intra- and extra-uterine life. The views of Nocard were
virtually discarded. Something more striking was being
sought and demanded. Lehnert, in 1878, and Brauer, in
1880, believed that they had promptly and reliably induced
abortion by experimental infection. In England, also,
Woodhead, Aitken, McFadyean, Campbell and others as-

1 E. Nocard. Avortement epizootique des Vaches. Rec. de Med.
Y. ., Vol. Ill, p. 669.

Infections of the Ovum, Embryo and Fetus 499

serted they had experimentally caused abortion. Nocard
had made no such claim for his investigations. Chiefly, if
not wholly upon this ground, his work was practically ig-
nored. It was everywhere demanded that, ere any given in-
fection might be accepted as a cause, or the cause, of abor-
tion, its power to cause abortion must be clearly demon-
strated experimentally.

(2) The nodular venereal disease of Isepponi.1 In 1887,
Isepponi, then Canton veterinarian in Chur, published the
results of his clinical studies of the hitherto undescribed in-
fectious vaginitis which he thought a new and rapidly
spreading contagion, and which he believed to be the cause
of the serious sterility and abortion in the cattle of his dis-
trict. For reasons which seem to me ample, I have placed
this among the specific venereal diseases in Chapter XII,
where it is discussed at length.

(3) The Bacterium Abortus of Bang.

In 1896, Bang and Stribolt discovered in the uterus of a
cow, destroyed in the act of abortion, a small Gram-negative
bacterium which they succeeded in cultivating in gelatin-
agar serum. The finding of the bacterium in large numbers
in the utero-chorionic space and in the fetal cadaver justi-
fied! a suspicion that it had to do with the abortion. Bang
inoculated seven cows with pure cultures of the organism.
Prior to inoculating them, he did not learn whether they
would or would not probably abort if left alone, and he did
not know, and had no means of learning, whether they al-
ready had the bacterium in their uteri. They were presum-
ably taken from their normal habitat and placed under ex-
perimental conditions favorable to abortion, closely guarded,
so that the expulsion of a fetal cadaver would almost cer-
tainly be seen. One (14 per cent.) of the seven cows
aborted, which rate is no higher than would be expected
without inoculation. Her uterus contained a bacterium not
differentiable from the one used for inoculation.

'Beitrage z. d. Ursach. d. Unfruchtbarkeit d. Kiihe. Schw. Archiv.
fur Tierheilkunde, 1887.

500 Diseases of the Genital Organs

So much emphasis has been placed upon the power of the
B. abortus of Bang to cause abortion during the pregnancy
existing at the time of inoculation, that a brief review of the
recorded evidence is permissible.

The Experimental Evidence of the Power of B. Abortus
to Cause Abortion

The dictum of Bang1, "Through these two experiments
we have submitted the complete proof that the bacilli dis-
covered by us are the cause of epizootic abortion," has
exerted, and still exerts a profound influence upon the cur-
rents of thought regarding abortion in animals. Two basic
ideas are included in the quotation from Bang. First, abor-
tion is a specific, contagious disease, like tuberculosis or
smallpox, caused always by one and the same organism and
by one microparasite only. Second, the bacillus described
by Bang is the cause and the only cause as proven by his ex-
periments.

For many years the dictum of Bang was generally ac-
cepted without reservation. Cattle abortion was regarded
as a specific disease apart from all other diseases of cattle,
and the B. abortus was considered the specific agent. It is
confidently stated that Bang and Stribolt "produced abor-
tion in cows with it (B. abortus)" ; "The fact seems to be
clearly established that the specific cause of infectious abor-
tion in cattle is the organism isolated by Bang and Stribolt" ;
"That the Bacillus abortus of Bang is capable of producing
abortion experimentally in cattle by feeding and by intra-
venous injections has been satisfactorily proven by Bang,
McFadyean and Stockman, Macneal and Kerr, Good, and
others" ; "Abortion disease is a specific infectious disease
which is caused by a small germ known as the Bacillus abor-
tus of Bang"; "The cause of abortion is a short, oval-shaped
germ (Bact. abortus)" ; "The inoculation of pregnant cattle

. . . produces abortion after a variable length of time";

'"Durch diese beiden Versuche haben wir somit den vollen Beweis
dafiir prefiihrt, dass die von uns cefundenen Bacillen die Ursache des
peuchenhaften Verwerfens Bind."

Infections of the Ovum, Embryo and Fetus

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502 Diseases of the Genital Organs

"A microorganism or minute germ (the abortion bacillus
of Bang) is known to be the sole cause of contagious abor-
tion."

Such positive assertions . that the specific character of
cattle abortion has been absolutely proven experimentally
and that the Bacterium abortus is the cause, have served to
prevent a critical examination of the evidence which has
been alleged to prove the specific abortifacient action of the
B. abortus. Most writers upon abortion in cattle refer to
the experimental production of abortion in pregnant cattle
as the corner stone for the positive statements that the B.
abortus is the specific agent in abortion. Little has been
written concerning the actual recorded evidence.

In the succeeding table the available recorded data of the
experimental efforts at producing abortion with the B.
abortus have been assembled, with direct and indirect con-
trols. Numerous objections may be urged against their
fairness. Tabulation demands brevity and inevitably leaves
opportunity for misconception.

(1) The seven animals consisted of:

a. Two pregnant cows inoculated in vagina with pure cul-

tures and killed, one nineteen days, the other twenty-
nine days after inoculation.

b. Two pregnant cows inoculated per vaginam with after-

birth from an aborter, the one killed thirty-three, the
other thirty-five days after exposure.

c. Two pregnant cows, four and seven years old, a second

inoculation being made thirty-nine days later, and a
third dose twelve days after the second. Seventy-one
days after the first inoculation, the seven-year-old cow
aborted a five-months fetus. B. abortus and a micro-
coccus were found in the placenta.

d. A six-year-old cow was inoculated per vaginam with pure

cultures. She calved eighty days later. /.'. abortus
bacilli were found in uterine contents of the COW.

(2) Out of the twenty-eight experiments recorded by McFadyean

and Stockman. Experiments Nos. 7. 1 1, 15, 18, 22, 24 and 25
(7) were followed by abortion. In Experiment 13 the fetus
underwent desiccation following death but was not expelled.
Other animals were killed prior to the termination of preg-
nancy, and some miprht have aborted had they not been killed.

Infections of the Ovum, Embryo and Fetus 503

(3) Thirty-nine heifers in first pregnancy were alleged to have been

chased by a dog. Some months later eleven of them aborted.
McFadyean testified that the abortions were not due to con-
tagion.

(4) These experiments were carried out under the auspices of Sir

Stewart Stockman with material furnished by the Board of
Agriculture and Fisheries.

(5) The nine cows were all recent purchases. Five came from a

herd where abortion had raged the previous year and were
all pregnant when bought. Two had aborted the previous year,
two were sterile or had aborted unseen, and one had calved.
After inoculation all aborted. The history of the other four
was unknown. Three were pregnant when purchased, the
fourth was bred after buying. All nine were recent arrivals
on the experimental premises, which increased the tendency
to abort.

(6) The heavy percentage of abortions in inoculated cows is caused

by the high rate of the five cows of Moore, only one of which
was known to have calved the previous year.

(7) The 100 per cent, of abortions in controls is admittedly of no

moment, but, since the one heifer is the only control of which
I can find record, the figures are technically correct.

(8) The Thurebylille herd consisted of about 130. milk cows and

about 30 heifers, and the data extend from 1885 to 1896, in-
clusive, or a period of twelve years.

(9) The data given here are for uninoculated cows and heifers kept

as controls in vaccination against abortion, as shown in
Table IV, page 353, Report Tenth International Veterinary
Congress.

(10) Owing to errors in diagnosis, Bland unintentionally inoculated

five pregnant cows and nine pregnant heifers with living
bacilli. (Herd A, two cows, four heifers; Herd M, one cow;
Herd Q, one cow; Herd R, one cow; Herd B2, five heifers.
Total, fourteen.)

(11) The two cows which aborted following inoculation had also

aborted in the pregnancy before inoculation. See also (5).

(12) Bland, on page 9 of his first report in his experiments to con-

trol abortion by vaccinating the non-pregnant animal, kept
as "controls" 296 non-pregnant cows and heifers, thirteen of
which were not known to have conceived. Bland's percentage
of abortion (18.2) is based upon 296 animals, while the per-
centage here given (19.1) is based upon 296 — 13, 283 animals.

(13) Second report,' page 15.

(14) In the Bland reports the number of animals of prior year is

not given and total under experiment is used, with percent-
ages for prior years.

504 Diseases of the Genital Organs

(15) The data cover twenty-two years, 217 cows and heifers and the

645 pregnancies recorded.
(1-6) The data cover thirty-one months.

(17) The data cover ten years and include sixty-seven cows and
heifers.

Bibliography
I. Bang, Prof. B., Die Aetiologie des seuchenhaften ("infec-
tiosen") Verwerfens, Zeitschrift f. Tiermedicin, Vol. I, p.
241.
II. McFadyean and Stockman, Rep. Departmental Com. Bd. of
Ag. and Fisheries, Great Britain, on Epizootic Abortion,
1909.

III. Testimony of Sir John McFadyean in litigation of Chadwick

vs. Gorman, Vet. Rec, March 30, 1912, p. 621.

IV. Stockman, Sir Stewart, Epizootic Abortion, Rep. Tenth In-

ternational Veterinary Congress, Vol. II, p. 343.
V. Bland, G. R., First and Second Reports by the Agricultural
Organizer of Oxford County, England, on the Epizootic
Abortion Experiments carried out in 27 herds, 1911 to 1916,
Oxfordshire, England.
VI. Moore, V. A., and Fitch, C. P., Rep. N. Y. State Vet. Col. at

Cornell University, 1912-1913, p. 89.
VII. Williams, W. L., Rep. N. Y. State Vet. Col. e.t Cornell Univer-
sity, 1911-1912, p. 79.
VIII. Williams, W. L., The Granular Venereal Disease and Abor-
tion in Cattle. Bulletin of the U. S. Dept. Agr., No. 106,
Sept. 12, 1914, p. 49.
IX. Williams, W. L., Abortion and Sterility in Cattle. Rep. N. Y.

State Vet. Col. at Cornell University, 1913-1914, p. 136.
X. Williams, W. L., Abortion and Sterility in Cattle. Rep. N. Y.
State Vet. Col. at Cornell University, 1911-1912, p. 85,
Herd A.
XI. Williams, W. L., Abortion and Sterility in Cattle. Rep.
State Vet. Col. at Cornell University, 1911-1912,
Herd B.
XII. WILLIAMS, W. L., Abortion and Sterility in Cattle. Rep.
State Vet. Col. at Cornell University, 1911-1912,
Herd C.
As early as 1912 (VII), I made the following statement:
"It has not been clearly shown that a like number and kind
of pregnant cattle would not have aborted had sterile salt
solution been substituted for the Bang organism."

A critical study of the tabulated data bears out this asser-
tion :

, N,

Y.

P-

87,

N.

Y.

P-

87,

Infections of the Ovian, Embryo and Fetas 505

The 21 cows used for experimental inoculation show the
largest ratio (52.490 of observed abortion. Of the 11
aborters, however, 4 (Bland, 2; Moore, 2) are known to
have aborted, and 2 (Moore) were sterile or aborted unseen
the prior year. Only 1 of those aborting (Moore) is known
to have calved the previous year and 1 (Bang) may have
done so. Omitting the 4 known aborters and the 2 sterile
cows of the previous year, there remain 15 cows which pos-
sibly calved the prior year, and of these, 5 (23.8% ) aborted.
No controls were kept and the ratio is not sufficiently high
to constitute good evidence. It is not known that each of the
cows did not, when the inoculation was made, carry in the
utero-chorionic cavity an infection capable of causing abor-
tion. In the one Moore cow, in the group of 5, this is not
merely a possibility but a definite probability, since she
came from the same herd as the other 4, none of which
calved the previous year.

A study of the available records of experimental inocula-
tion in heifers, of which it has been possible to assemble 48,
shows that 10 (20.8^ ) are recorded as having aborted. I
find only one heifer recorded as having been kept directly
as a control — that in my experiment (IX) — and that one
aborted. A single case can not be accepted as conclusive
nor as valuable evidence, but there is no other way of stat-
ing the recorded fact. The question of controls has been
ignored.

The heifers in the Bland experiments (V) were not in-
oculated to cause, but to 'prevent abortion. The inoculation
occurred through error. The heifers were assumed to be
non-pregnant at the date of inoculation, but later proved to
be pregnant. These are inserted in the table under the as-
sumption that the effect was the same whether the inocula-
tion was made to cause or to prevent abortion. The virtual
controls of Bland — (12), (13) — should be applicable, as
they were definitely used as controls in efforts to prevent
abortion by vaccination of non-pregnant cattle with living
bacilli.

506 Diseases of the Genital Organs

The more voluminous data regarding the frequency of
observed abortions in herds show a higher rate generally
than that recorded in experimental inoculations. The ex-
ception is the data submitted by Bang showing but 7 per
cent, in cows of the Thurebylille herd. When the data upon
heifers in first pregnancy are examined, it is found that
under the prevailing conditions in herds the ratio of ob-
served abortions ( 52.55 'v ) is far in excess of the recorded
abortions following experimental inoculations. When cows
and heifers are taken together, the observed abortions
(19^ ) are but 1.08 per cent, below the ratio reported in the
experimentally inoculated animals.

The objection to these data may be urged that they are
from "infected" or "badly infected" herds, but no data are
available from non-infected herds. One often hears of non-
infected herds, but any attempt to get in contact with such
and secure accurate data for record leaves one with the
feeling that he has been pursuing a mirage. If there are
herds in which no abortions occur and in which each cow or
heifer of breeding age produces a healthy calf each twelve
months, the failure of those having knowledge of the facts
to publish the details serves as an impassable barrier to their
use. The question can be judged or decided only upon the
available recorded data.

The further and pertinent objection may be made that in
many of the experiments the animals were destroyed prior
to the termination of pregnancy and that some or many of
these might have aborted had they not been killed. But it
would be equally erroneous to pick out from the total those
animals kept until after termination of pregnancy and ac-
cept the results in this group alone. The probability of
abortion decreases as the duration of pregnancy advances:
the disease may be present and severe but may result in
premature birth, in retained afterbirth, or in calf scours or
pneumonia.

On the other hand, it may be very properly maintained
that the animals slaughtered prior to the termination of
pregnancy were generally held beyond the alleged "period

Infections of the Ovum, Embryo and Fetus 507

of incubation" of the abortion infection and should mostly,
according to the constructive standards of various experi-
menters, have aborted prior to slaughter if they were to
abort.

Some investigators have also argued that the finding of
the B. abortus in the uterine cavity of the killed animal is
experimental proof that it is the cause of abortion. If that
is true of the B. abortus, then it must be equally true of all
the other microparasites found in the uteri of pregnant
cows. It can be experimentally proven that a given organ-
ism causes a cow to abort only by those cases which actually
abort. It is not necessary to produce infection of the utero-
chorionic space in a pregnant cow to show that the B.
abortus is capable of causing such infection ; Bang proved
that in the first cow in which he recognized the bacillus.
If it existed and multiplied in that cow, it follows, a priori,
that, implanted in another pregnant uterus of identical
species and power -of resistance, it would cause infection
again.

It has been attempted to apply to abortion the postulates
of Koch who assumed as a basis for experimentally proving
the specific character of a bacillus: (1) The organism
needs to be obtained in pure cultures. (2) Inoculation of a
sound animal with pure cultures must cause the typical
symptoms and lesions observed in naturally infected ani-
mals. (3) Pure cultures of the organism must be recov-
ered from the tissues of the experimentally inoculated and
diseased animal. Koch's postulates are inapplicable to
abortion in cattle because the abortion is not the disease nor
is it a lesion ; it is merely one of the possible occurrences in
the course of a disease having the power to destroy the life
of a fetus and to irritate the pregnant uterus in a manner
to cause it to expel the fetus. While the data submitted
fail to justify the dictum of Bang and others that the inocu-
lation of a pregnant cow or heifer with the Bang organism
will cause her to abort during the existing pregnancy and
thus prove that the B. abortus is the specific cause of abor-
tion in cattle, it is not proof that such inoculation is without

508 Diseases of the Genital Organs

injurious result. Neither does it prove, nor tend to prove,
that abortion is not sometimes or frequently caused by the
Bang organism.

I have long held that any attempt to prove experimentally
that a given organism is the cause or a cause of an abortion
occurring during the pregnancy in which the inoculation
was made, is unwarranted and misleading. When Bang
discovered the bacterium which he described, he definitely
showed that it was an intra-uterine and fetal infection. No
beneficent office could be ascribed to it. If capable of ex-
isting in vast numbers in the one cow and fetus, it might
equally well exist in equally great numbers in other uteri
and fetuses of the same species and of similar constitution.
There was present metritis, for which, under ordinary sur-
roundings, no cause except infection is known. Bang recog-
nized in the uterus an infection. If this was the only bac-
terium present or recognizable (upon which point Bang is
not clear) the only justifiable conclusion at which he could
arrive was that the bacterium in question was the cause of
the abortion. Bacterial search of the uterus of another
aborting cow in which some other microorganism was found
would not vitiate nor influence the conclusion reached upon
the one described.

Abortion is not a disease nor the symptom of any one dis-
ease. So far as the fetus is concerned, abortion is death,
and death is a result common to all diseases. The fact that
an adult dies is not proof that it has anthrax, and the fact
that a fetus dies is not proof that it was killed by B. abortus.
In so far as the pregnant female is concerned, abortion indi-
cates endometritis at the cervical end of the uterus. Me-
tritis exists in non-pregnant and pregnant heifers, in preg-
nant cows, in cows in the puerperal stage and during the
interval of rest between a period of calving and the next
conception. The character of the metritis which may occur
at any period in the life of the female varies infinitely and
the number of bacteria capable of causing the metritis is
unknown. A few instances of metritis stand apart, such
as that of uterine actinomycosis and tuberculosis. They

Infections of the Ovum, Embryo and Fetus 509

are specific. But the metritis met in essentially all cases of
abortion bears no mark by which it can be assigned to any
one bacterium. Consequently if several bacteria are pres-
ent, there is nothing in the metritis to indicate which of the
invaders is responsible.

Any contagion competent to injure or destroy an adult
may, so far as known, equally imperil the life of an ovum,
embryo, or fetus if contact occurs. The vast majority of
infections do not and can not reach the intra-uterine young.
The opening of the genital tract through the vulva is her-
metically sealed at the cervical canal by the uterine seal. It
is not known, and there is no reason to suspect, that bacteria
can traverse the cervical canal and enter the utero-chorionic
space of the pregnant cow while the uterine seal is intact.
The mammalian placenta, so long as intact, is not known to
permit the passage of any form of pathogenic organism.
It has not been shown that any disease-producing organism
passes during pregnancy from the blood system of the
mother into the utero-chorionic space. Infection is not
known to invade the uterine cavity of the pregnant female
through the oviducts. There is accordingly no portal of
entry into the sealed uterus of pregnancy through which
bacteria have been known to enter. The orthodox con-
tagious-abortionists positively assert that the B. abortus
enters the uterus during pregnancy, but avoid stating by
what avenue the invasion occurs.

I have held that the infections which prevent or interrupt
reproduction invade the uterus prior to the sealing of the
cervical canal ; either the infection was present in the uterus
at the time of coitus, or it was introduced during that act.

The frequency of abortion in a herd usually corresponds
fairly well with the intensity of infection by B. abortus.
In those herds where abortion and other interferences with
reproduction are common, the agglutination and comple-
ment-fixation tests usually show intense infection with B.
abortus. But such reactions can only show that the B.
abortus is somewhere active (or has been active) and can
not show that it caused a given abortion. If such tests

510 Diseases of the Genital Organs

could show that B. abortus has caused a given abortion, a
typical reaction of an aborting cow to the tuberculin test
would show that the abortion was due to the infection of
tuberculosis. I have seen a high B. abortus agglutination
reaction in a sterile heifer never known to have conceived,
in which, upon autopsy, B. abortus was recovered from the
udder but not from the genital tract. The sterility was ap-
parently due to streptococcic salpingitis. Doubtless her
blood would also have reacted strongly to the streptococcus.
In the researches in my department, the blood of cows in
which harmful genital infections exist reacts to several
species of bacteria, such as paracolon and streptococci, but
the reactions show merely the presence of such bacteria
somewhere in the body, and can not show that they cause
sterility or abortion. The agglutination test for the pres-
ence of B. abortus is in itself fundamentally defective. I
injected living B. abortus cultures in the jugular vein of a
two-year-old pregnant heifer. She probably already had B.
abortus in her utero-chorionic cavity. The agglutinating
power of her blood was followed from 0.02 up to 0.001 and
in its descent until minus at 0.02. Then she aborted and
was promptly destroyed. Her blood was negative at 0.02,
and her uterus was swarming with B. abortus.

A vital defect of the agglutination test for the presence of
B. abortus is the total absence of knowledge of the physi-
ologic agglutinating power of bovine blood. Some consider
an agglutination at 0.02 as proof of infection; others place
the infection-point at 0.01. As a rule the blood of new-born
calves is negative at 0.1 and can be held there experimentally
as long as I have cared to do so. If the calf is fed in the or-
dinary manner, its blood commonly reacts positively at 0.1
or higher within thirty days. I have seen it react at 0.002
at thirteen days. The common practice of fixing upon 0.02
or 0.01 as denoting infection is absolutely arbitrary and un-
supported by any recorded attempt at justification. There
is no more reason for believing that agglutination at 0.02
or 0.01 denotes infection than for declaring that agglutina-
tion at 0.04 or 0.1 indicates infection.

Infections of the Ovum, Embryo and Fetus 511

(4) The Paratyphoid Bacillus of Moussu1

Moussu declares, apparently upon adequate grounds, that
in a large section of France much abortion is due to a short
bacillus of the colon group. The B. abortus is absent.

(5) The Spirillum of Smith- and Others

Smith, in studying a series of aborts from a large dairy
herd, obtained pure cultures of B. abortus in 27 (66%) and
a spirillum or vibrio in 14 (34$). In other aborts Smith
failed to find either the B. abortus or the spirillum, but rec-
ognized bacteria belonging to the colon and other groups.
The lesions in the aborts did not vary with the variations of
the bacteria present, but were fundamentally alike in all.

(6) Miscellaneous Bacteria

Isolated cases of abortion have been attributed to various
bacteria other than those mentioned above. A few have
been attributed to B. pyogenes. Bacterial search of the
tubo-utero-cervical canal reveals a great variety of infec-
tions present in non-pregnant and pregnant animals. A
streptococcus of the viridans group is dominant apparently
in serious tubal infections and perhaps plays an essential
role in the necrosis of the apices of the embryonic sac.
Probably it causes the death of many fertilized ova and of
embryos.

F. The Nature of Abortion

The belief that abortion is generally due to a specific con-
tagion of the pregnant uterus and its contents, inevitably
involves the belief that the infection can not exist in the gen-
ital tract prior to conception and that it must cease to exist
with the termination of pregnancy. Neither can the alleged
specific infection cause other results than abortion. Hence
the orthodox believer in the specific character of abortion de-

]Prof. G. Moussu. Sur l'Avortement Epizootique. Tenth Internat.
Vet. Cong., 1914.

2Theobald Smith. Spirilla associated with Disease of the Fetal
Membranes in Cattle. Jour. Exp. Med., Dec. 1, 1918.

512 /diseases of the Getiital Orgcuis

nies that the infection, sometimes leading to abortion, can
cause sterility, retained afterbirth, or metritis other than the
specific metritis of contagious abortion, which must cease to
exist at the termination of pregnancy, to be succeeded by
another metritis due to other infection. So with the fetus
and the calf. The fetus is invaded by "the specific infection
of contagious abortion," but after the calf is born such in-
fection must terminate, though the calf may promptly die
from sepsis, dysentery, or pneumonia, and though bacteria
which can not be differentiated from those existing in the
digestive tract of the fetus are present in that of the new-
born calf and apparently cause the serious or fatal disease.
This group of writers use constantly the definite article
"the" in connection with the alleged specific contagion, thus
excluding all other infections or contagions as possible
causes of abortion. That is, if the B. abortus of Bang is the
cause of contagious, infectious, or epizootic abortion in
cattle, no other infection or contagion can act as a cause or
as one cause of abortion. If the B. abortus of Bang is the
cause of contagious or infectious abortion of cattle, then the
statement of McFadyean and Stockman, that in one preg-
nant cow which they destroyed they found uterine tubercu-
losis which would soon have caused abortion without the
presence of B. abortus, is erroneous. If B. abortus is the
cause, B. tuberculosis can not be a cause of abortion. But
that is resting the case upon what some may designate a
technicality. More pertinent to the discussion is the state-
ment of McFadyean and Stockman : "It is of great im-
portance to note, however, that two natural outbreaks of
vibrionic abortion, one in Ireland and one in Wales, were
met in cows." (Abortion in Sheep, Part III, page 9.) The
more recent finding by Theobald Smith, in this country, of
spirilla in aborted bovine fetuses, without the B. abortus, is
equally to the point. If B. abortus is the cause of contag-
ious, infectious, or epizootic abortion in cattle, then either
the vibrio of McFadyean and Stockman and the spirillum of
Smith did not cause the abortions attributed thereto, or the
abortions so caused were not "infectious." "contagious," or
"epizootic."

Infections of the Ovum, Embryo and Feins 513

The second group, to which the writer belongs, holds that
abortion is not a specific contagious or infectious disease
like glanders or hog cholera, but that any infection resident
in the cervical end of the uterus, or which during pregnancy
invades the uterus, may, amongst other results, cause abor-
tion. According to this view there are two essential factors
in the causation of abortion : the infection must destroy the
life of the fetus (asphyxia or inanition due to placentitis,
or sepsis due to bacterial invasion of the fetus), and must
arouse such an irritation of the uterus (localized metritis
at the cervical end) as to cause it to contract and expel its
contents. Any infection capable of bringing about these
two conditions may cause abortion, be it the B. abortus, the
bacillus of Nocard, the colon organism of Moussu, the vibrio
of McFadyean and Stockman, or the spirillum (vibrio) of
Theobald Smith.

Under this conception, there is no limitation upon the
number of species of microparasites which may cause abor-
tion, no restrictions upon the variety of lesions and results
of lesions which the infection may cause, and no obligatory
period of invasion or disappearance fixed for the infection.

This conception offers many analogies to wound infection.
In wound infection there is an extended variety of organ-
isms, each capable of producing inflammation, suppuration,
ulceration, necrosis, wound fever, etc. The microorganisms
are normally present upon the body surface and under or-
dinary conditions cause no visible harm to the individual.
When, however, the protective epithelium is destroyed by
physical violence, chemical irritation, or in various ways,
the bacteria upon the surface are pushed into, or otherwise
enter the damaged tissues and wound infection occurs. The
lesion which constitutes the avenue of infection may be visi-
ble or invisible to the unaided eye. The epithelium may be
destroyed or merely so damaged that it wants the power re-
quired to resist the attack.

A knowledge of the identity of the invading organisms is
of great interest but not a vital necessity to the surgeon.
The measures which will exclude streptococci will serve also

33

5 1 4 Diseases of tlie Genital Organs

to bar staphylococci. If the wound is already infected, the
surgeon uses the same means to remove or to destroy micro-
cocci and bacilli. In special cases the surgeon may fear
tetanus infection and take special measures against it, but
that he classifies separately as a specific infectious disease.
Each individual carries upon his body surface bacteria com-
mon to other individuals. A moderately extensive list can
be made of the most prevalent types competent to cause
wound infection.

In every part of the genital tract microorganisms are com-
mon throughout the life of the individual. When estrum
occurs, the genital mucosa is engorged and its epithelium
weakened. If conception fails, menstruation follows, with
denudation of the placental areas and an outflow of blood.
The denuded areas furnish an avenue of invasion and the
blood clots supply nutritive material for the bacteria pres-
ent. Should conception occur, and the fertilized ovum de-
scend into the uterus, it encounters the microorganisms in-
festing the cavity. The embryo has acquired no power to
resist invasion, with the result that bacterial activity is ad-
vanced. Then follows a definite metritis. As soon as the
fetal organs have developed, the infection passes through
the chorion and amnion into the amniotic fluid and is swal-
lowed by the fetus. Accordingly the bacteriologic findings of
Hagan, Carpenter, and others working in, or in collabora-
tion with this department, show parallel infection in the
non-gravid uterus, in the utero-chorionic cavity of the preg-
nant uterus, and in the fetal alimentary tract, and later
when the calf is born the same bacteria are recoverable
from its stomach and intestines. There is then a continuity
of infection in the mother and the intra-uterine invasion of
the fetus.

The results of the infection or infections upon the mother,
fetus, and new-born calf will logically vary with their vol-
ume and virulence. If very severe in the non-pregnant
uterus, conception fails. If the infection is milder and con-
ception occurs, metritis may follow and so irritate the
uterus that it contracts and expels its contents. If the in-

Infections of the Ovum, Embryo and Fetus 515

fection has killed the fetus, and it is expelled, the result is
known as abortion. If the fetus lives and is carried the full
term of gestation and is then expelled, there is metritis pres-
ent and perhaps retained afterbirth. The expulsion of the
fetus leaves a denuded uterus. If the afterbirth is retained,
it is immediately necrotic and decomposes. Then follows
an aggravated metritis. It is not a new disease, but a con-
tinuation of a metritis which existed during pregnancy, ac-
celerated in its course by the uterine denudation of calving
or abortion, aggravated by decomposing afterbirth. The
infected calf when born may break down with calf scours
or pneumonia. It is not usually a new disease or a new in-
fection but the continuation of an infection acquired during
intra-uterine life. During the course of the dysentery, the
alimentary epithelium is damaged or destroyed, permitting
the invasion of the body fluids by the bacteria causing the
intestinal disease. If the calf suffers from pneumonia, the
pulmonary epithelium is damaged or destroyed and bacterial
invasion occurs. The infection had its habitat in the
pregnant uterus, and thence passed to the digestive tract of
the fetus. In the new-born calf apparently the infection
passes through the damaged digestive or pulmonary epi-
thelium, enters the body fluids, and, having an affinity for
the genital tract, regains its habitat there and persists, to
interfere later with first pregnancy. According to this con-
ception, the infections of which abortion is one significant
result constitute an endless chain. They may be intensified
in the uterus of the cow just after parturition or abortion
and additional infections from the exterior be added. The
infection in the new-born calf may be minimized or intensi-
fied by proper or improper feeding, or additional infection
may be supplied to the calf by association with badly dis-
eased calves or by taking milk contaminated by virulent
discharges from badly diseased cows.

On the other hand, the belief that abortion is a specific
disease denies the endless infection-chain above described
and regards sterility, retained afterbirth, calf scours, and
pneumonia as associated or concurrent diseases, but recog-

516 Diseases of the Genital Orga?is

nizes no identity, continuity, or causal relationship. Each
must then be handled separately as distinct maladies, in-
stead of dealing with the entire list as one group, each hav-
ing a continuity with the others.

As in wound infection, so in the infections in which abor-
tion occurs, while no limit can be placed upon the number of
microparasites which may act as the causal agent, certain
varieties are commonest. Thus in abortion, in one area, the
B. abortus may be the predominant cause ; in another, a
streptococcus ; and, in a third, a spirillum. In a given ani-
mal or outbreak, B. abortus may be the cause, but in abor-
tion generally it is merely a cause. Some believers in the
specific character of abortion, when forced by recorded
facts to admit that abortion may be, and is, due to various
organisms, attempt to evade the difficulty by proposing the
name "abortion disease" or "Bang's disease" instead of the
equally misleading terms of "contagious," "infectious," or
"epizootic" abortion. But that does not help matters. It is
still desirable to learn how large a part of the abortions are
evidently due to the B. abortus, and how much to other or-
ganisms.

The second conception of the nature of abortion permits
the handling of the group of infections as a whole. The
losses can be minimized only by breaking or weakening the
endless chain of infection at its most vulnerable point,
which, it is held, is at the commencement of the life of the
individual. It has been advised that the genital organs of
both sexes should be as clean as practicable at the time of
copulation in order to favor conception. When fertilization
has occurred, it is important that the uterine cavity be clean,
so that metritis and infection of the fetus may be avoided.
When the calf is born it should be so handled that the infec-
tion it may have acquired in the uterus shall be restrained
or eliminated, and that no fresh infection shall menace the
calf through contaminated milk or other foods, or by inti-
mate association with badly diseased calves. For example,
the veterinarian handling cervicitis sees before him unmis-
takable and severe inflammation due to some form or forms

Infections of the Ovum, Embryo and Fetus 517

of infection. No matter what the identity of the infection
may be, the problem which he faces is disinfection, and he
elects that method which, in the present state of knowledge,
promises the best results.

G. Symptoms and Diagnosis

The symptoms and diagnosis of abortion are essentially
included in the definition given — the observed expulsion of
a fetal cadaver. The symptoms are those of parturition ab-
breviated. In early pregnancy there is no sinking of pelvic
ligaments, no enlargement of mammae, no marked dis-
charge from the vulva, no visible effort at expulsion. When
abortion occurs late in pregnancy, the pelvic ligaments may
sink as in parturition, the mammary gland may be en-
larged and the vulva may become tumefied. But any of
these phenomena may occur from other causes.

After about the fifth month of pregnancy, in addition to
the observation of the expulsion of the fetal cadaver, there
may be retention of the fetal membranes, indicating that
abortion has occurred or that abortion is then in course.

Abortion may be suspected or determined with confidence
upon other grounds. In the regular control of reproduc-
tion in cattle, pregnancy may be reliably diagnosed at
thirty to sixty days after coitus. If the diagnosis is clear
and definite, as it should ordinarily be, and it is later de-
termined that the pregnancy has ceased to exist and the ani-
mal has not calved, it is clear she has aborted at some time
between the two dates of observation.

The diagnosis of pregnancy may be fairly secure upon
other grounds than clinical examination. If a cow or
heifer is regular in her estrual cycle, is bred, does not men-
struate after coitus, and estrum fails to recur at the regular
interval, it is good evidence that she is pregnant. If, after
a lapse of forty to ninety or one hundred days, estrum re-
curs, it is probable that an embryo has perished and has
been expelled. There are numerous other conditions which
may present the same history, but abortion is by far the
most probable explanation.

518 Diseases of the Genital Orga?is

H. The Date of Invasion

The infection which causes abortion invades the uterus
prior to the establishment of the uterine seal. The ortho-
dox believers in a specific contagious abortion have stoutly
contended that the infection commonly invades the uterus,
fetal membranes and fetus after pregnancy has become es-
tablished, the placenta has formed and the cervical canal
has become hermetically sealed. As already related, they
have attempted to prove, and believe they have proven
their contention by experimentally causing abortion in an
existing pregnancy. In the cow, as discussed in preceding
pages, the experimenters have kept no checks or controls
and their experimental inoculations have been followed by
no higher rate of abortion than is commonly observed in
uninoculated animals. They have further attempted to
prove that a pregnancy already established can be inter-
rupted by artificial infection of pregnant animals of other
species. But, as with cows, no control animals have been
kept. The rate of abortion following inoculation has not
been remarkably higher than common in the species used,
and there is no evidence that an equally high ratio of abor-
tion would not have followed the injection of a sterile, inoc-
cuous substance. It is a perfectly well known clinical fact
that the various species of domestic animals commonly co-
habit on farms. Horses, cattle, swine, dogs and cats are
in intimate contact, but cohabitation fails utterly to cause
the spread of abortion from one species to another. If
abortion were spread by the means alleged by the believers
in "contagious abortion" such as the eating by pregnant
animals of food which has become contaminated by the dis-
charges from an aborter, by the infection carried upon the
boots, hands and so forth of attendants, or by the mere
presence of an abortion, an abort, or the afterbirth of an
abort in a stable or a field, an outbreak of abortion in one
species would be the signal for many pregnant animals of
whatever species to abort. The recorded evidence of the
transmission of "contagious abortion" of cows to all species

Infectio7is of the Ovum, Embryo and Fetus 519

of domestic animals should, before it is accepted as proof,
be supplemented by a new and extensive series of experi-
ments with adequate control animals. Until this is done,
the controversy over the date of invasion of the infection
causing abortion can not be satisfactorily settled.

I have held that there are two notable and important
dates of invasion — the intra-uterine infection of the fetus
and the time of coitus in adults. The latter has already been
consdered earlier in this chapter (I — Infections of the Geni-
tal Organs of Bulls). The first will be considered later (III
— The Congenital Infections of Calves).

I. The Control of Abortion

Under the views already expressed, abortion can not be
directly prevented or controlled, nor is there need for such
prevention or control. Being neither a disease nor a symp-
tom of any one infection, it demands no separate considera-
tion. It can be prevented only by the control of the infec-
tions within the genitalia of both sexes. These are consid-
ered elsewhere.

When abortion came to be looked upon as a specific con-
tagious disease, veterinarians and cattle breeders hoped for
a definite remedy. Before it was believed that the cause of
abortion had been determined, Brauer (1889) thought he
had discovered a specific remedy in the subcutaneous injec-
tion of 2 per cent, carbolic acid to pregnant cows and heifers.
Highly favorable statistics were submitted by Brauer and
his followers in support of the new remedy. The researches
were without controls and very inaccurate. Apparently the
carbolic acid was given in herds where there had recently
been an "abortion storm," in which a notable decrease was
to be expected, or, as occurs frequently, a few animals had
aborted, all or nearly all of those which were in line to abort,
and then the remedy was given. Naturally there would be
no more abortions. But the career of the alleged cure was
short and it was soon found that if the utero-chorionic
space of a pregnant cow was highly infected and contained

520 Diseases of the Genital Organs

a large volume of exudate, she would probably abort, and
that carbolic acid, hypodermically or otherwise, exerted no
recognizable influence.

The belief of Bang and his followers that he had discov-
ered the specific cause of abortion immediately aroused high
hopes that a definite remedy would follow. It was believed
by Bang that the discovery of the cause would be followed
quickly by a cure or by some means for control. The vast
majority of investigators and breeders have concentrated
their efforts since 1896 upon finding a remedy for abortion,
based upon B. abortus as the specific cause. There has been
no more lamentable failure in the annals of veterinary medi-
cine than the attempt to control abortion as a specific con-
tagious disease due to the B. abortus of Bang. The infec-
tions in the genital tract of cattle have increased enormously
in virulence in every country. In America numerous herds
of pedigreed cattle of potentially great value do little more
than maintain their numerical status. Death and disability
from genital diseases of females of breeding age consume
practically all heifer calves reared in the herd. The sur-
plus bull calves carry into the herds where they are sold
virulent infections with which they are saturated at birth.
Despite this evident, pitiably disastrous failure, many in-
vestigators, veterinarians and breeders are clinging tena-
ciously to the belief that abortion in cattle is a specific con-
tagious disease due to the B. abortus and that its control is
to be brought about upon that basis and that alone.

After the failure of the Brauer plan with carbolic acid,
Rich of Vermont believed for a time that he had discovered
an efficient systemic disinfectant in methylene blue, but the
error was promptly recognized and the plan abandoned.

Attempts to disinfect the contents of the pregnant uterus
are contrary to all existing knowledge of its physiology and
that of the embryo. Experiments show that aniline dyes,
like methylene blue, do not reach the embryo, but are caught
or turned back at the placenta. It is not known that any
disinfectant can pass the placental filter in a manner to ex-
ert practical influence. In abortion most of the infection is

Infections of the Ovum, Embryo and Fetus 521

in the utero-chorionic space. Into this space it is not known
that any disinfectant borne in the blood ever enters. It
probably does not. Even should a disinfectant leave the
blood stream and enter the utero-chorionic space, it is in-
conceivable that sufficient would enter to disinfect. The en-
dometrium of a pregnant cow at full term represents ap-
proximately fifteen square feet of mucous membrane, op-
posed to which is the somewhat smaller surface of the con-
tiguous chorion. Between the two there exist, in badly in-
fected cows as revealed in the abattoir, from a few ounces
to several quarts of "abortion exudate." It must require
great confidence in the potency of disinfectants to believe
that a sufficient quantity can enter the utero-chorionic cavity
to disinfect it, or pass the placental filter and, after coursing
through the fetus, be poured into the fetal alimentary canal
and disinfect the meconium. The employment of disinfec-
tants in this apparently hopeless manner has been virtually
abandoned — permanently, it is to be hoped.

The generally accepted theory that abortion in cattle is a
specific contagious disease led many of the subscribers to
that belief to hope for a specific remedy in the form of a
serum, bacterin, vaccine, or other biologic substance. Nota-
ble achievements in this field had been made in a number
of diseases of man and animals and it was assumed that in
abortion a similar victory was probable.

The achievements in the biologic control of disease have
been chiefly among those maladies designated as acute, in
which a definite immunity follows the recovery of the pa-
tient. In chronic infections little progress has been made
in biologic therapy, apparently because the success of these
products is dependent upon their power to produce that
state known as immunity. Infectious diseases are divisible
primarily into acute and chronic. In acute infectious dis-
eases the infection and the patient can not long coexist.
Either the infection kills the patient or there develops with-
in the body of the patient substances which destroy the
infection and which thereafter prevent, for a variable pe-
riod, re-infection. This is known as immunity. In chronic

522 Diseases of the Genital Organs

infections, such as tuberculosis and syphilis, the patient
may survive indefinitely and the infection continue in viable
form. The system of the patient acquires a power of re-
sistance to the ravages of the infection, but not the power
commonly to destroy it or to prevent reinfection.

Those who regard the B. abortus as the specific cause of
abortion in cattle hold confused views as to whether it is
acute or chronic. Those who claim to have induced abortion
experimentally, constructively hold that it is an acute in-
fection. Some believe that they have induced abortion in
five to ten days. At first that was the general belief. Bang
in his first experiments believed he was dealing with an
acute infection having a short incubation period. Experi-
menters believing in the specific character of cattle abor-
tion generally hold that it is an acute infection for guinea
pigs: that is, if the B. abortus is injected into a pregnant
guinea pig, she will abort in five to ten days. Numerous in-
vestigators now hold that the B. abortus infection is virtu-
ally an acute infection in the uterus and a chronic infection
in the mammary glands. That is, the infection can not in-
vade the uterus until pregnancy is definitely established,
and can not continue in the uterus for more than a few
days after the termination of pregnancy. They further hold
that, after one fetal cadaver has been expelled, the uterus
acquires an immunity and the B. abortus can not again
readily invade it and cause a second abortion, but the mam-
mary gland, once invaded, is permanently infected. Schroe-
der thinks that the mammary gland is the permanent hab-
itat of the B. abortus and periodically, during pregnancy,
the infection may in part pass from the mammae to the
uterus, cause abortion, and then promptly disappear from
the uterus. It is reasonably well established that the B.
abortus may be a permanent resident of the milk glands.
So far as I have seen recorded, it has not been searched for
elsewhere than in the genital canal and milk glands. One
cow in my experimental herd, now ten years old, was inocu-
lated in the jugular in her first pregnancy at about seven-
teen months of age. She was probably already infected

Infections of the Oman, Embryo a?id Fetus

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524 Diseases of the Genital Orga?is

when I inoculated her. Her blood still showed a high de-
gree of infection when she was eight years old. Clinically
she has a high degree of genital infection as shown by a very
low rate of reproduction. It appears clear, therefore, that
those who hope to control or eradicate abortion through the
agency of biologic methods must hope for an artificial im-
munity in a chronic infection.

There is a common belief in a natural immunity against
abortion. That is, it is stated that after a cow has aborted
once, she is not so liable to abort again. The assertion has
been made and remade so often and persistently that by
mere repetition it has virtually acquired the force of a
fact. But it is perverted fact. The influence of abortion
upon future reproduction is well shown in Fig. 175. In
this instance eighteen apparently vigorous heifers received
abortion bacterins in their first pregnancies in order to test
experimentally the power of killed bacteria to prevent abor-
tion. The heifers in this herd had for some years averaged
about 30 per cent, of observed abortions. The heifers shown
upon the chart had been handled, except for the bacterins,
the same as prior heifers. As calves they had been grown
in an abominable "nursery" under pest-house conditions.
Dysentery and pneumonia had been virtually universal. The
mortality of calves had been high, but the survivors recov-
ered their general health and were apparently perfectly
sound. Yet this group of vigorous heifers failed to main-
tain its original numbers of fertile females. The losses from
infections within the genital tract were so great that the
female progeny failed utterly to fill the gaps made by dis-
ease. If abortion produces a valuable immunity against fu-
ture abortions, this group of heifers should have acquired
such immunity and have produced, during the period cov-
ered by the chart, a notable excess of healthy females in-
stead of the discouraging deficit so clearly shown.

It is perfectly true that many aborting heifers and cows
do not repeat the abortion the following year, or, if re-
peated, it is not recorded. When an ordinary grade cow is
observed to expel a fetal cadaver, she has usually reached

Infections of the Ovum, Embryo and Fetus 525

the fifth to eighth month of pregnancy. Prior to concep-
tion, probably three to six months had elapsed since the
previous calving. She is consequently nearly or completely
dry and the owner cannot hope for profitable lactation or
for a healthy calf until about twelve more months have
elapsed. Naturally she is sold for beef, or disappears for
some other reason. This is well illustrated in the work of
Bland1, who states that in the herds listed in 1914-1916, to-
talling 1,016 animals, there had been, in 1919, 305 or
30 per cent, of abortions. In the same herds, in 1914-
1916, 160 animals are accounted for which had aborted in
1913; 145, or 48 per cent., of those aborting in 1913 were
not in the herds in 1914. Probably some died, some were
sterile and therefore sold, and some may have conceived
and have been sold to other dairymen but not because the
seller thought them immune to abortion. Of the 160 cows
aborting in 1913 which are reported in 1914-1916, 107, or
67 per cent., calved and 33 per cent, failed to produce calves
during the period of two or three years between 1913 and
1916. Though they were presumably the most promising
of the aborters in 1913, 33 per cent, failed to produce calves.
These data fail to show a valuable immunity.

Infections of the genital tract, like chronic infections of
other organs, are rarely static. During the interval between
weaning (or changing from a milk to a vegetable diet) and
the first coitus, the animal enjoys the most healthful period
of its life, judged by clinical standards. When sex activity
begins, it is difficult to conceive of a static condition of the
bacteria in the genital tract. Abortion signifies one grade
of activity of these bacteria, lower in virulence than sterility
and higher than dysentery and retained fetal membranes.
It should not be expected that in each breeding year an
active, virile infection would maintain throughout a given
level but that it would vacillate from year to year. Should
the intensity increase markedly, causing hydrosalpinx, pyo-
salpinx, or ordinary salpingitis, the animal becomes seri-

1 Bland, G. R., Second Rep. Ag. Organizer, Epizootic Abortion" Exp. ,
1911-1916, Oxfordshire, Eng., page 15.

526 Diseases of the Genital Organs

ously or hopelessly sterile and her breeding career is closed.
This alone renders it impossible for many aborters to abort
again the following year. But the cow may improve, the
uterus gain new vigor, and the infection become largely re-
pressed. Then, if she aborts at all, it will be later in her
pregnancy. If the repression of the infection goes further,
pregnancy may continue to full term and a live calf be born.
The cow may have retained fetal membranes and the calf
may have dysentery, but abortion, as defined, is absent.
The same or a kindred infection, however, is still present
and active. Naturally, therefore, the infection in the geni-
tal tract does not as a rule bring about each year precisely
the same result, except when hopeless sterility has been
reached.

In all data I have been able to obtain, it has been shown
clearly that a given number of cows or heifers which
aborted the previous year are more likely to abort again the
next year than an equal number of animals which have
dropped healthy calves. But the question is to be decided
by the percentage of abortions among those which become
pregnant. A far larger proportion of the aborters fail to
breed. The difference between the two classes is rendered
more clear when the false measure of abortion is discarded
and the results are measured by the percentage of healthy
calves born.

Regardless of the foregoing facts, it is attempted to con-
trol or eradicate abortion, working upon the theory that it
is a specific contagious disease and that one attack produces
a distinct and valuable immunity.

B. abortus serum has been proposed as a remedy and has
failed. I used serum experimentally upon a group of 26
heifers' without result upon abortion, sterility or other in-
terference with reproduction. The animals upon which the
serum was used aborted at virtually the same rate as the
controls and the two groups aborted at the average rate for
the herd in which the abortion rate had for years been vir-
tually static. My results were in harmony with all available
'An. Rep. N. V. Slate Vet, Col., [916-1917.

Infections of the Ovum, Embryo, and Fetus 527

recorded experiences. A few biologic vendors offer abor-
tion serum, but it has attained no popularity. There is no
reason to assume that such a serum can produce favorable
results.

Abortion bacterins (killed cultures of B. abortus) have
been tried by Bang, McFadyean and Stockman, and other
leading investigators. In all recorded tests they have failed
utterly. The phenomenon of abortion lends itself readily to
patent medicine methods. If at the close of an abortion
storm abortion bacterins or distilled water be injected sub-
cutaneously, the abortion ceases or the rate is very low.
The eighteen heifers charted in Fig. 175 were in a herd
where for a number of years the abortion rate in heifers
varied from 30 per cent, to 50 per cent, or upward. After
the use of the bacterins the abortion rate was the most dis-
astrous in the history of the herd. In spite of the clear and
indisputable proofs recorded of the absolute uselessness of
abortion bacterins, several American biologic houses make
and sell them under wholly unjustifiable claims. Some even
offer to refund the sum paid for the preparation for each
cow that aborts after the administration. This is perfectly
feasible, since so far as manufacturing costs are concerned
the vendor can refund upon 50 to 75 per cent, of the animals
and have a good profit. Some abortion bacterins are very
cheaply made. I submitted a number of samples purchased
upon the open market to bacteriologists for examination.
Nearly all were greatly contaminated with other bacteria,
usually a mixture of three, four or more kinds. One sample
consisted of an almost pure growth of a long streptococcus.
As the bacteria were presumably dead, the species probably
made no difference.

Abortion vaccines, or living cultures of B. abortus, given
non-pregnant animals one or two months prior to breeding
have been tried by numerous leading experimenters and
have been recommended by some. Sir Stewart Stockman,
with a group of lay collaborators, has been the chief sup-
porter of this plan. Stockman1 apparently conducted no

1 Sir Stewart Stockman, Epizootic Abortion, Rep. 10th Internat. Vet.
Congress.

528 Diseases of the Genital Organs

researches personally, but states : "a local organization was
set up in each case consisting of members of farmers' so-
cieties and veterinarians," to whom the details of the work
and the reports were entrusted. In the data published by
Stockman, it is not shown upon what plan the herds inves-
tigated were divided into "inoculated" and "controls." It
is quite easy, if one is acquainted with the history of each
animal, to change the face of statistics materially. Stock-
man rests his statistics upon the percentage of abortions
and ignores reproduction. He takes it for granted appar-
ently that if a cow does not abort, or rather is not observed
to abort, nothing else in her career is of interest. Thus, in
his table IX comprising 758 animals, 77.6 per cent, of vac-
cinated animals and 70.2 per cent, of the controls calved.
The efficiency of the controls fell 7.4 per cent, below the
vaccinated. The efficiency was low in both. The weakest
point in the data of Stockman is the failure to state the
time covered by the experiments. If 77.6 per cent, of the
vaccinated cattle calved during one year and were fertile at
the close of the year, the performance was certainly better
than if the period extended over two or three years, because
the efficiency, if the standard is set at one calf per annum,
would be 77.6 per cent., 38.8 per cent., and 25.9 per cent, re-
spectively.

The Bland reports1 offer by far the most valuable data on
record for a critical study of the influence of the vaccina-
tion of non-pregnant cows with living cultures of B. abortus.
The first report is stated to cover experiments during 191 1-
1913. At what date in 1911 the researches began is not re-
vealed, nor is it stated when in 1913 they closed. Since the
second report is stated to apply to 1914-1916, there was pre-
sumably no interval between the two reports. In the 1911-
1913 report it is claimed that of 263 animals vaccinated, 226
(86 per cent.) calved. There is no intimation that during
1911-1913 any cow calved twice or thrice. If the observa-
tions cover two years, the annual reproduction rate is 43

1 Bland, G. R.. Epizootic Abortion Experiments, Oxfordshire County
Council: First Report, 1911-1913; Second, 1914-1916.

Infections of the Ovum, Embryo arid Feins

529

per cent, of the ideal of one calf each twelve months. Dur-
ing the same period the reproduction in the controls was
77.4 per cent., or only 8.6 lower than in the vaccinated. In-
advertently selecting the controls improperly might very
well have made a much greater difference.

Bland compares the abortion rate in 1910 with the rate
upon the same premises in 1911-1913, but the cattle in the
herds of 1910 were not the same as those used in the experi-
ments. In effect, he says, "In 1910 the cow, Rose, aborted
(100 per cent, abortion) and in 1911-1914 the cow, Cherry,
was vaccinated and calved (100 per cent, calves) ; therefore
vaccination reduced the abortion rate from 100 per cent, to

DIAGNOSIS
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Fig. 176 — Chart of Agglutination Test on Three Heifers after Inocu-
lation with B. abortus with failure to react on date of Abortion.

zero." That is, Bland asserts that in 1910, 28.9 per cent, of
671 animals, or 194, aborted, and later he states that 66 of
the 1910 aborters were used in the 1911-1913 experiments,
and 128 aborters disappeared. Forty-three cows which
aborted in 1910 were vaccinated in 1911-1914, and of these
29 (67 per cent.) calved. Evidently the dairymen selected
for holding those aborters which gave the greatest promise

34

530 Diseases of the Genital Organs

of breeding. It is not disclosed whether it took on an aver-
age one, two, or three years for one of the aborters to pro-
duce a calf.

The unreliable character of Bland's experiments is further
indicated by the fact that, while the announced plan was to
vaccinate only non-pregnant animals, he actually did not
know whether they were pregnant or not. As a conse-
quence a number of pregnant heifers and cows were inocu-
lated. Although B. abortus was looked upon as the cause of
abortion and would quite certainly cause abortion if injected
during pregnancy for that purpose, the animals erroneously
inoculated to prevent abortion were benefited the same as
the non-pregnant animals.

In such experiments dairymen sooner or later become
good practical judges of results. Before the 1914-1916 re-
searches began, most of the dairymen owning the herds of
the 1911-1913 experiments had dropped the work; before
the close of 1916 a majority of the animals in the second set
of experiments had been withdrawn.

In defiance of these and all other recorded data, several
American firms make and sell what they represent as abor-
tion vaccines consisting of living B. abortus cultures. Bac-
teriologists to whom I submitted samples purchased in the
open market failed by cultural method to find living abortion
bacteria in any sample. There is probably no alleged thera-
peutic substance upon the market, biologic or proprietary,
which is advertised in a more misleading and unjustified
manner. There is absolutely no justification, so far as I
can find recorded, for the claim that abortion can be econo-
mically decreased by their use. The data of Bland appear
on the surface to decrease the abortion, but the abortion rate
is largely a matter of vision. The number of calves was not
materially increased in the Bland experiments, since the
abortions were statistically lowered by the higher rate of
sterility.

1 believe abortion vaccines (if they really contain living
abortion bacilli) the most dangerous and vicious biologic
product thus far offered to veterinarians and stockmen. It

Infections of the Ovum, Embryo and Fetus 531

is perfectly well known that the B. abortus is a permanent
resident of the mammary gland. It is not known that it is
not a permanent dweller in other parts, once introduced.
Although experimentally it has not been shown clearly that
B. abortus does or can invade the pregnant cow and cause
abortion there is good evidence that it is a dangerous infec-
tion in the genital tracts of cattle and that in the present
state of our knowledge attempts to use it as a therapeutic
agent are little short of criminal. Researches may throw a
more favorable light upon vaccination, but until they do the
prudent veterinarian and dairyman should leave this work
where it belongs — in the hands of experimenters.

Upon the theory that the observed expulsion of a fetal
cadaver is a specific contagious disease, it is repeatedly pro-
posed to control abortion by quarantine restrictions asso-
ciated with disinfection of the aborter and of the premises
occupied by her. Public funds are expended in researches
upon "contagious abortion," and the public demands a visi-
ble return upon the investment. As a consequence the
United States Department of Agriculture, through its Bu-
reau of Animal Industry, and the agricultural experiment
stations of the various states are expected to advise dairy-
men and breeders how to control losses from "contagious
abortion." Not only do laymen who are suffering economic
losses demand a remedy, but they expect measures which
the ordinary dairyman or breeder can successfully apply.
The result is that much advice is given without visible bene-
fit. The owner is advised to quarantine all aborters, but
probably he sees less than one out of three fetal cadavers
which are expelled. Yet inferentially he is taught to believe
that those which he does not see do not matter and that
quarantining the known aborters will eliminate the danger
from the far greater number of unseen expulsions of fetal
cadavers. The abortion is not the disease. Once the fetal
cadaver and its membranes are expelled, that danger ends.
The cause of the expulsion of the dead fetus, the metritis
and cervicitis, continues indefinitely and quarantine does
not affect it in the least. Precisely the same infections

532 Diseases of the Genital Organs

which caused the abortion existed long prior to the final dis-
aster, and they continue indefinitely afterward. Quarantine
does not annul the peril prior to abortion, nor does it render
the animal safe after the common duration of quarantine
has expired. Some of these advisers direct that an aborter
shall be quarantined until all discharge ceases, but no
definition of "discharge" is given. Long after a cow
has aborted and all signs of discharge, as commonly ac-
cepted, have ceased, the cervical canal or uterine cavity may,
and often does, contain a few drops, or quarts, or gallons of
pus. The cow with a few quarts of pus in her uterus is a
safer animal in a herd than one without visible or notable
discharge but which has in the uterus or cervical canal a few
drops of virulent pus associated with inflammation of the
uterine or cervical mucosa. The cow with large volumes of
pus which is being discharged does not generally come in
estrum. In the dairy the pus chiefly drops into the gutter
and disappears. Some of it reaches the milk, but riot as
much when the cow is in the herd as when she is in quaran-
tine, because in the latter state she is neglected.

The cow with a few drops of pus in the uterus or cervix
ovulates and copulates. Coitus intensifies the disease in her
genital tract and endangers the genital health of the bull.
Such a cow either fails to conceive or conceives only after
repeated copulations, with undue sex strain and infection
dangers to both cow and bull. If she conceives, the infec-
tion in the cervical canal or uterus leads to the death of the
embryo or fetus ; or the pregnancy continues to, or near to
full term, a sick calf is born, and the cow has metritis, often
associated with retained fetal membranes. Ordinary quar-
antine— the isolation of aborters from pregnant cows —
neither adds security to nor hastens recovery from the me-
tritis and cervicitis, but the layman, ignorant of the nature
of the disease, is misled into the assumption that quarantine
has therapeutic value. As a matter of fact quarantine, as
ordinarily conducted with aborting cows, is a therapeutic
vice. The cows are denied the food, housing and care con-
ducive to the spontaneous recovery or amelioration of dis-

Infections of tli e Ovum, Embryo and Fetus 533

ease. I have yet to see quarantined cows receive that atten-
tion and care which is accorded the presumably well animals.

The effect of the quarantine of aborters upon the re-
mainder of the herd is nil. The removal of an aborter after
the act, or while it is in course, does not eliminate or modify
any possible injury from the unobserved discharges which
have occurred days, weeks, or months preceding the expul-
sion of the fetus. More important still, the quarantine of
an aborter can not possibly cure or ameliorate the infection
which exists in the uterus or cervix of another pregnant cow
or heifer.

In the quarantine scheme commonly advised, there is in-
cluded only a minority of animals in which the embryo or
fetus dies and is expelled. Up to the fourth or fifth month
of pregnancy in dairy cattle, the expulsion of the embryonic
or fetal cadaver is not observed. In beef cattle, especially
those in extensive pastures, the observation is far less ac-
curate. While the expulsion of fetal cadavers is doubtless
less frequent in beef than in dairy cows, it is equally certain
that the apparent difference is due partly to a difference in
the accuracy of observation.

The quarantine of aborters can not lessen the dangers
from those intensely infected animals which do not abort.
When metritis exists during pregnancy, it necessarily con-
tinues after parturition, frequently with retained fetal mem-
branes. The volume of highly infectious material, identical
with the discharges following abortion, is usually far greater
than that associated with abortion, but the quarantine
scheme generally recommended ignores these. Finally,
many cows which drop apparently healthy calves and are
to outward appearances perfectly well, when professionally
examined sixty, ninety or more days post partum, show an
intense cervicitis with a few drops of pus in the cervical
canal and in the cervical end of the uterine cavity. Noth-
ing but harm can come from attempting to breed such cows,
but quarantine, as commonly advised for aborters, has no
influence whatever upon these animals. I have examined
herds where the abortions recorded did not exceed 15 per

534 Diseases of the (ieiiiial Organs

cent., but 60 per cent, showed intense pyo-cervicitis and
were sterile. The quarantine of the 15 per cent, of aborters
could cure the cervicitis neither in these nor in the 45 per
cent, of cows having cervicitis which had not aborted.
Quarantine could not influence favorably either the quaran-
tined or the remainder of the herd from which the aborters
were removed. Clinically the scheme for controlling abor-
tion by the quarantine of aborters has failed completely.
It has been the common measure applied throughout the
civilized world for more than fifty years, a period during
which the virulence of the infections of the genital organs
and the economic losses sustained have increased enor-
mously. The quarantine of aborters has been attempted by
the most intelligent, earnest and competent dairymen and
breeders, whose losses have been, if anything, greater —
certainly no less — than the losses in the herds of the most
careless and ignorant. Although quarantine of aborters
has been conscientiously and faithfully applied to many
herds since the theory of specific disease became established,
no record is extant, so far as I am aware, where the quar-
antine of aborters has favorably influenced reproduction.
If failure in practice is competent argument against a the-
ory, then the theory that abortion is a specific contagious
disease of cattle, and that quarantine based upon that the-
ory is a valuable sanitary measure, falls to the ground.

Some of the devotees to the theory of the specific charac-
ter of abortion have recently turned to another quarantine
scheme consisting of the diagnosis of the alleged specific in-
fection by the agglutination and complement-fixation tests
of the blood of each animal in a herd. Quite naturally they
have advised that, in assembling herds and in making addi-
tions thereto, these tests should be applied to all purchases.
It has already been pointed out that the line of demarcation
between infected and non-infected, as indicated by these
tests, has been fixed by absolutely arbitrary means and that
the agglutination and complement-fixing power of the blood
from infected and non-infected animals is absolutely un-
known. Even if it were admitted that abortion in cattle is a

Infections of the Ovum, Embryo and Fetus 535

specific disease due to B. abortus, there are ample reasons
for believing that the blood of animals free from the infec-
tion of B. abortus does not react at all to these tests at the
lowest point where they can be applied. It is further evi-
dent that the tests fail at high dilutions when the infection
is abundant. This defect is well illustrated in Fig. 176, in
which the agglutination test was negative upon the day of
abortion. Two prominent advocates of the serologic tests
for the control of abortion, jointly published a bulletin in
1918 in which they said: "The serological tests are an im-
portant aid in the inauguration of preventive measures
against the spread of infectious abortion." Throughout the
publication, the serologic tests appear as the corner stone
in control measures. They advised the test as a means for
isolating the infected from the non-infected animals and for
preventing the introduction of the infection in purchased
cattle of both sexes. In 1919 they had modified their views
and in a second bulletin advocated the disinfection of the
copulatory organs of the bull as the most important meas-
ure of control available, and say: "Our work of the
past five years has convinced us that transmission by
the male is by far the most important means of spread-
ing the disease Proper disinfection of the

sheath, therefore, constitutes the most, if not the only, im-
portant safeguard against the spread of infectious abor-
tion." The italics are mine. They present no data to
show that they accomplished any actual improvement either
under the repudiated first plan or under the second recom-
mendation.

Another important group of believers that abortion is a
specific contagious disease advocate the quarantine of abor-
ters, plus the disinfection of aborting cows, of the external
genitalia of breeding bulls, and of the premises occupied by
aborters. There appeared an undated circular from one of
these sources with a title page printed chiefly in red which
reads in part, "Fight Contagious Abortion in Cattle
. . . Preventable — Controllable . . . Isolate af-
fected animals — Treat aborting cows — Disinfect bulls —

536 Diseases of the (ioiHal Organs

Clean up premises." It was held in the circular that if
breeders and dairymen generally would conscientiously and
vigorously apply the advice contained in a bulletin soon to
appear, "contagious abortion" would be eliminated or con-
trolled.

In 1917 there appeared from the same source a bulle-
tin which was apparently an amplification of the pre-
ceding circular. Among other recommendations the bul-
letin advises that the aborter be isolated and that her
uterus be irrigated daily with antiseptics. "Lugol's so-
lution in a strength of 2 per cent, has been found to
be desirable as a uterine douche. It is not permitted
to remain in the uterus but is flushed out with salt so-
lution." The bulletin was, of course, designed for, and sent
to, laymen who do not know the uterus from the vagina,
cervix, or oviducts. If the afterbirth is retained, neither
the layman nor the skilled veterinarian can possibly douche
the uterus, because it is everywhere covered by the chorion.
If the afterbirth has come away from the aborter, the entire
endometrium is denuded of epithelium. The introduction
of 2 per cent. Lugol's solution into such a uterus is a pro-
fessional crime. It will kill or ruin sexually a large propor-
tion of cows, and injure all. Fortunately most laymen in-
troduce antiseptics into the vagina only, from which they
are sometimes ejected before material harm has resulted.
I have had an opportunity to study a group of 27 aborters,
purebred beef cattle of great value, to which a layman had
attempted to apply these recommendations. Of the 27 ani-
mals, 12 (44.4 per cent.) have atresia of the vagina, unques-
tionably due to the treatment. Two of these twelve (16.7 per
cent.) are again pregnant after about one year. Each has a
severely constricted vagina and will apparently have great,
if not insuperable difficulties at calving time. Six of the re-
maining animals may possibly (bu1 very improbably) con-
ceive, with the probability thai they cannot calve success-
fully. The other four of the twelve are hopeless because of
the vagina] atresia and must go to slaughter. In two of the
four the vaginal atresia is so complete thai mucus is re-

Infections of the Ovum, Embryo and Fetus 537

tainedi in front of the atretic area, causing great disten-
sion. Of the fifteen animals in this group in which vaginal
atresia was not caused, six (40 per cent.) are pregnant, one
possibly pregnant, and eight (53 per cent.) non-pregnant,
with fair prospects for conceiving. The instance affords a
good illustration of the results attained from erroneous ad-
vice given to laymen who, however intelligent and sincere,
fail in their application.

Advising laymen how to handle surgically a cow which
has recently aborted is much like a Doctor of Medicine ad-
vising a carpenter how to diagnose and handle appendicitis
in a member of his family, with the saws, chisels, and other
implements at hand. The owners of cattle view the prob-
lem from another angle. Certain veterinarians are sup-
ported by public funds, and stockowners feel they have a
right to demand of these public servants advice regarding
abortion. These veterinarians have for so long taught the
public to believe in abortion as a specific infectious disease
that they can give no advice of value without clashing vio-
lently with the thoroughly established misconception.

There is nothing known at present beyond general good
care which can in the least exert favorable influence upon
an infection already existing in the utero-chorionic space of
a pregnant heifer or cow. After abortion has occurred and
the uterus, cervix, and vagina are open to surgical invasion,
the skilled veterinarian can do much to cleanse the genital
tract of injurious infections. The good which may be ac-
complished at that time is not based upon the theory that
abortion is a specific infectious disease, but that all abor-
tions are due to an infection or to the joint action of several
infections. At present the known remedies against abortion
are alike effective in all infections which may lead to the
death of the fetus and its expulsion by the uterus. The
handling of the infections of the genital canal calls for the
application of the general principles of surgery. Those
cases of cervicitis and metritis existing during pregnancy
and inevitably continuing after abortion call for the same
method of handling as those not associated with abortion

538 Diseases of the Genital Organs

but dependent upon the presence of the same infection. The
handling of such infections is discussed in the appropriate
places.

4. Puerperal Diseases of the Uterus

When pregnancy terminates, those infections which have
been present in the utero-chorionic space of the gravid
uterus meet with abrupt changes in environment which may
profoundly alter their activity. New forms of bacteria may
also quite readily invade the uterus at this period. If a calf
is born or a fetal cadaver is expelled and the fetal mem-
branes follow promptly, the entire placental area of the
uterus is denuded of its epithelium and the tissues laid open
to attack. The infections present in the utero-chorionic
space have already invaded the placental tissues about the
cotyledonal periphery and are ready to advance rapidly
when epithelial denudation becomes general. If, instead of
being expelled, the fetus dies and macerates, the fetal cada-
ver acts as a vast nutrient reservoir for bacteria which mul-
tiply in it and profoundly involve the contiguous uterus. If
a calf is born or a fetal cadaver is expelled, and the fetal
membranes are retained, the latter are necrotic and, like
the retained fetal cadaver, serve as a great nutrient supply
for infections present. The dilation of the cervical canal,
vagina, and vulva permits a greater supply of air in the
uterine cavity, which may modify favorably or unfavorably
the activities of the bacteria.

It was long believed, and quite generally taught, that the
infections imperilling the life or health of the puerperal fe-
male regularly invade the uterus after the close of preg-
nancy. In an important measure that is true, but by far
the most important infections, measured by their frequency
and economic bearing, are those which are resident within
the pregnant uterus and acquire increased intensity when
pregnancy terminates. The infections of the puerperal
uterus are consequently divisible into two great groups —
tile intrinsic or intra-uterine infections continuing from
pregnancy, and the extrinsic organisms invading the uterus
from without after pregnancy has terminated.

Puerperal Diseases of the Uterus 539

A. Uterine Hemorrhage. Uterine Hematoma.

Hemorrhage into the uterus of the cow during the puer-
perium is of two distinct classes. An insignificant hemor-
rhage regularly follows the prompt dehiscence of the fetal
membranes. Lacerations, especially of the cotyledons, fre-
quently cause slight hemorrhage. Hemorrhage is also
caused by imprudent attempts at removing retained fetal
membranes. These forms are to be handled according to
the general rules of surgery.

Clinically the most interesting and most important type of
uterine hemorrhage is that which is apparently one of the
results of intra-uterine infection. The hemorrhage appears
without warning soon after, but not immediately following
parturition. I have observed it at two to four days post
partum. My cases have occurred in cows in intensely in-
fected herds. As I recall, each patient had given birth to a
calf, but the parturition was tardy, testifying to the pres-
ence of a uterine paresis due to a metritis of pregnancy.
The fetal membranes were not long retained and the pa-
tients were apparently going along favorably, when sud-
denly without warning a very profuse uterine hemorrhage
began. One of my cases had been left at night in a box
stall, apparently well. When the caretaker arrived in the
morning, the cow was weak from loss of blood and her stall
looked like shambles. Bright scarlet blood was spattered
over the walls and bedding, and blood was still trickling
from her vulva. A few hours later I found upon examina-
tion, as nearly as I could estimate, a blood clot in the uterus
equal to two or three gallons. The blood was coagulated,
odorless, and bright scarlet in color. Fearing recurrence,
I proceeded to remove with great care a portion of the clot
each day, until in three days I had completely evacuated the
uterus. It maintained throughout its bright scarlet color.
It underwent no visible decomposition and acquired no spe-
cific odor. The cow recovered and was fertile. In a second
case a colleague removed the blood from the uterine cavity,
first controlling the hemorrhage by the use of adrenalin
chloride hypodermically.

54" Diseases of the Genital Organs

Uterine hemorrhage of the puerperium apparently bears
an interesting relationship to other uterine hemorrhages in
the cow. Elsewhere interplacental hemorrhages from the
pregnant uterus with fetal desiccation have been described.
Presumably in that case infection plays the essential part.
At any rate it is observed chiefly in cattle belonging to
highly infected herds. Unfortunately the initial stages of
interplacental hemorrhage in the pregnant cow are not
available for observation. The desiccation of the fetus is
ordinarily the first step recognized. In fetal desiccation,
as in puerperal hemorrhage, there is no observed tendency
to putrefaction. Apparently it has been thought that fetal
desiccation occurs because the cervix remains closed and
sealed so that bacteria may not invade the hematoma, fetal
membranes, and fetal cadaver. That is evidently incorrect.
Bang and others have recognized the B. abortus in the desic-
cated fetus. That bacterium possesses scant putrefactive
power. In the uterine hemorrhages under consideration
there seems to be something more than a neutral force at
work. When the hemorrhage commences, the uterine cavity
is freely open to the exterior and is certainly heavily in-
fected. The escaped blood, instead of forming a breeding
ground for commonly known bacteria which set up putre-
faction, possesses a unique power to prevent putrefaction.
An ordinary blood clot in the uterus or in a wound is the
signal for the intensification of infection in the part, but
here the opposite occurs. The first suggestion of its unique
character comes with the blood escaping from the vulva,
which is intensely scarlet, much brighter than ordinary ar-
terial blood, and looks much like blood from the lungs.

An interesting fact, also, is that the uterine hematoma of
the puerperal period, if left to itself, apparently desiccates
in a manner similar to the desiccation of the fetus. At leasl
there are sometimes found in the uterus old desiccated blood
clots. I have observed a number of these in the abattoir,
usually involving one uterine horn only (the hemorrhage
having occurred in the gravid cornu alone?), but sometimes
chiefly in the uterine body and projecting into one horn. In

Puerperal Diseases of the Uterus

54i

Fig. 177 — Old Hematoma of Right Uterine Horn.

a, Viewed from above. /, Hematoma ; 2, left cornu apparently healthv ;

3, section through left ovary showing corpus luteuni.

b. Ventral surface. 7, longitudinal section through right horn ; 5, cross

section through right horn, showing hematoma ; 6, section
through normal left horn.

542

Diseases of the Genital Organs

one instance one horn contained a desiccated hematoma and
the other an apparently healthy embryo three or four inches
long. The plan of the hematoma is well illustrated in Fig.
177, in which the right cornu is completely filled by the old
blood clot, while the left horn remains normal and vacant.
The only interpretation which I can place upon the condi-
tion is that, at the termination of the last pregnancy, there
occurred within a few days a voluminous hemorrhage into
the gravid horn. Part of the blood escaped through the
cervix and vagina to the exterior, and part remained behind
to undergo desiccation and to continue, like the better known
desiccated fetus, embedded in the hematoma, as an inert
body which may persist for months and years. The desic-
cated hematoma is a firm, doughy, black, tarry mass. When
the fresh specimen is incised, it is so sticky that it is diffi-
cult to push a knife through it merely because of its adhe-
siveness. Parts of the mass adhere to the knife and are
exceedingly difficult to wash away. It is virtually insoluble

FlG. 17s Tesselated Hematoma in Rig-ht Uterine Horn.

/ ', Vagina; U, uterine body ; I \ l'r, I '. uterine horn : O, ovary.

/, /, /, Hard tesselated masses closelj packed together.

Puerperal Diseases of the Utertis 543

in water. There is a total absence of odor beyond that of
meat. There is no reaction of the endometrium. The desic-
cated blood adheres to it as closely as to the knife or to the
operator's hands. The cervical canal is unsealed, except in
the co-existence of pregnancy.

It appears that with age further changes may occur, the
desiccation proceed further, and finally the hematoma be-
come fragile and, fracturing in places owing to visceral
movements, become tesselated in contour, as shown in Fig.
178. However, it still retains its resistance to putrefaction
and no fetor appears.

As a rule foreign bodies lying within the uterus inhibit
estrum and ovulation. I have had no opportunity to study
the uterine hematoma clinically, but in my collection there
is one example where a hematoma occupies one horn and an
apparently healthy embryo the other. This seems to me
conclusive proof that uterine hematoma does not always
inhibit ovulation. As I interpret the specimen, the hemor-
rhage into one horn, occurring shortly after the close of a
prior pregnancy, did not permanently fill the cavity of the
uterine body, and the cervical canal did not become sealed.
The presence of the hematoma did not inhibit estrum and
ovulation, and the way was left open for conception. I sus-
pect that this case is an exception to the rule and that gen-
erally the hematoma inhibits estrum and ovulation.

The diagnosis of the type of uterine hemorrhage here de-
scribed appears to be comparatively simple. The cow calves
in a manner to attract no special notice. From the condi-
tions which existed in the two herds where I observed it,
the infection of the genitalia is intense, and logically the
parturition atonic and tardy. The fetal membranes pre-
sumably come away without material delay. As I under-
stand the condition, placentitis of that type causing placen-
tal incarceration is incompatible with this type of hemor-
rhage. I believe that the hemorrhage, as in menstruation,
and in the inter-placental hemorrhage with fetal desiccation,
comes wholly from the cotyledons, so that any placentitis
of a type causing stasis and thrombosis in the placental ves-

544 Diseases of the (ienital Organs

sels would prevent the escape of blood in the manner de-
scribed. The first clinical evidence of the hemorrhage is
the escape from the vulva of large volumes of an unusually
bright scarlet blood without history of traumatic injury.
The cow is generally uneasy (the cramps of severe hemor-
rhage?) and moves about restlessly, occasionally lying down
and getting up. The bright scarlet blood escaping from the
vulva stains the bedding, walls, and any object with which
the posterior parts of the cow may come in contact. De-
pending upon the degree of hemorrhage, there is weakness.
An examination of the uterus reveals a great hematoma fill-
ing the recently gravid horn. The clot is moderately firm.

The treatment should consist at first of efforts to control
the hemorrhage. With the very limited knowledge possessed,
I would counsel leaving the clot alone for a time and would
limit efforts at control to the hypodermic administration of
adrenalin chlorid in doses of one-fourth to one-half ounce
of the 1-1000 solution. It should be repeated at intervals
of one-half to one hour if the case demands. Efforts should
be made to keep the patient quiet.

Once the hemorrhage has ceased, the removal of the clot
should be undertaken with the hope of obviating three possi-
ble dangers: (1) If the hematoma is removed too early, the
manipulation may revive the hemorrhage. (2) If permitted
to remain for several days, the cervix may contract, ren-
dering the removal of the clot very difficult. (3) If still
further neglected, the clot becomes desiccated, exceedingly
sticky, virtually insoluble, can not be suspended in water,
and can not readily, by any known method, be removed by
douching. The veterinarian need not hasten the removal
for fear of putrefaction of the clot because, so far as known,
it possesses properties which inhibit purulent destruction.
The closure of the cervical canal sufficiently to offer great
obstruction to the insertion of the hand will not, as a rule,
occur until two or three days have elapsed after the hemor-
rhage. The physiologic uterus closes of course at an earlier
date, but the uterus under consideration is paretic. Other-
wise the hemorrhage would not have occurred. The behav-

Puerperal Diseases of the Uterus 545

ior of the cervix should be watched and the removal of the
clot attempted sufficiently early. The chief mass of the clot
is best removed by carefully breaking it down with the
hand, and flushing out the detached pieces with physiologic
salt solution. The douching should be done with the great-
est possible gentleness, preferably by means of a hospital
irrigator to which is attached the seven-foot pure rubber
catheter designed for douching the sheaths of bulls. This
catheter is soft and pliable, and can not readily damage the
endometrium. Its small calibre, permitting the solution to
enter the uterus slowly, avoids any sudden distension of the
organ. While the salt solution is entering the uterus, the
operator should carefully break up the clot with his fingers.
After the clot has been removed, the uterus should be
watched closely for untoward developments.

The clinical diagnosis of the desiccated hematoma has not
fallen to my lot. Apparently it should be easy. The mass
is doughy and firm, as in the first stages of fetal desiccation.
In the latter case, however, the fetus is usually palpable,
especially its head or the feet, some of which may lie in
close proximity to the uterine wall. Later the desiccated
fetus becomes extremely hard and its skeletal outlines clear.
The cervical canal is sealed in desiccated fetus, but open in
desiccated hematoma, except, as in one instance mentioned
above, when a hematoma was present in one horn and an
embryo in the other. One may meet clinically the very old
tesselated hematoma of Fig. 178. It is almost as hard as a
desiccated fetus, but the skeletal outlines of the mummy are
absent and the hematoma is even in its general contour,
with the small depressions where the clot has become fis-
sured.

I have had no occasion to handle the desiccated uterine
hematoma and know of no rule upon which to proceed.
Evacuating the uterus by douching is well-nigh hopeless,
as the sticky content is virtually insoluble in water. The
dislodgment of the corpus luteum gives little promise be-
cause, in my one observation, the corpus luteum had atro-
phied in order to permit the animal to ovulate from the op-

35

546 Diseases of the (ienital Organs

posite ovary and conceive. Pituitary extract might act
favorably, given hypodermically in small doses. As a final
resort laparotomy may be performed upon the involved
side, the affected horn lifted out and incised, and the clot
mechanically removed. Or one may amputate the involved
horn with the ovary and for breeding rely upon the remain-
ing horn.

B. Puerperal Endometritis

Puerperal endometritis, as here used, signifies a type of
metritis in which the endometrium or uterine mucosa is
most prominently involved. Infection within the uterine
cavity presents illimitable variations in its course and mani-
festations, and it is impossible to group the various types of
puerperal uterine infections so that each class shall be
clearly and definitely separated from the others. It is es-
sential that the variations be grouped in a general manner
in order to facilitate description, but necessarily some cases
will be met upon the border line between any two groups,
which may with equal logic be placed in either one. Any
given case may also, by either progression or retrogression,
shift from one group to another.

The effect of intra-uterine infection is not limited to the
endometrium. Whenever such infection is activated by the
disturbances incident to the termination of pregnancy (just
as holds true of intra-uterine infection during pregnancy),
the changes can not be definitely confined to the endome-
trium, but involve the muscular walls of the organ, caus-
ing paresis, and frequently also involve the serosa. Conse-
quently the term "endometritis." if taken literally, is a mis-
nomer. It may be said to be the simplest and most primitive
type of metritis. Generally speaking it is out of endometri-
tis that the more severe and critical forms of metritis de-
velop. Sometimes the metritis of pregnancy has passed be-
yond the stage designated as endometritis before pregnancy
terminates, sometimes the progress of the infection is so
rapid that no stage is clinically recognizable as endometritis.

A pregnant heifer or cow doomed to abort, to calve pre-
maturely, or to have retention of the fetal membranes has
in her uterus an endometritis which inevitably persists into.

Puerperal Diseases of the Uterus 547

if not through the puerperal period. Even more commonly
there is present in the gravid uterus a slight endometritis
which does not reveal itself in the puerperal animal by abor-
tion, premature birth, or retained fetal membranes, but may
pass unobserved until several days have elapsed after par-
turition, when clinical evidence appears in the form of an
obvious and characteristic genital discharge. In many
other instances the exudate in the uterus is not visibly dis-
charged but eventually undergoes resorption unless recog-
nized and removed by surgical interference. The vast ma-
jority of cases of endometritis during the puerperal period
are unquestionably continuations of the endometritis of
pregnancy, but to these must be added some cases of the in-
vasion of the uterine cavity immediately after the termina-
tion of pregnancy.

The clinical manifestations of endometritis consist chiefly
of the discharge from the vulva of varying amounts of a
scarlet-gray exudate, apparently scarlet blood intimately
mixed with dirty gray or grayish yellow masses of pus or
tissue debris, usually thick like a heavy gruel. It adheres
to the tail, exterior of the vulva and surrounding parts. In
its most typical form the exudate is not fetid, but has a
faintly sweetish odor. The appetite, temperature and lacta-
tion may be slightly or not at all disturbed.

The discharge may be clinically evident during parturi-
tion as soon as the uterine seal gives way and the chorion is
forced against the uterine wall at the cervical end, which
presses out some of the endometritic exudate ahead of the
fetus itself. After the fetus and its membranes have been
expelled, the visible discharge of the exudate is largely de-
pendent upon the volume present and the degree of tone re-
tained by the uterus. Generally the discharge is not promi-
nent until two to five days after pregnancy has terminated.
It may be delayed even longer and, although the exudate
may be present in considerable quantity (one-quarter to
one-half pint), no recognizable discharge may occur.

Ideally, physiologic parturition is completed in the cow or
heifer in one and one-half to two hours, and no recognizable
uterine discharge follows. If examined clinically, the

548 Diseases of the Genital Organs

uterus contains no notable exudate. The time occupied by
the visible act of parturition is fifteen to thirty minutes of
definite expulsive effort, during which the calf is born, fol-
lowed immediately by a period of one to two hours during
which uterine involution progresses rapidly and the fetal
membranes passively separate from the placental areas and
are then expelled by the contractions of the uterus. There is
an active and tonic elimination of the vast uterine cavity
which existed an hour or two before. There is no place
within the uterine cavity for the retention of recognizable
masses of blood or other matter, and the contraction of the
uterine walls inhibits hemorrhage from its mucosa or the
outflow of recognizable quantities of lymph.

When active infection is present in the utero-chorionic
cavity of the pregnant animal, the parturition is tardy. The
expulsion of the fetus may require five, ten or many more
hours. Dystocia may occur as a result of uterine paresis
and necessitate aid. After the fetus has been expelled, the
dehiscence of the fetal membranes is slow and uncertain
and uterine involution is tardy and feeble. Then follows an
exudate into the uterine cavity (or into the utero-chorionic
cavity if the fetal membranes are retained) which tends to
reveal its presence by becoming discharged from the vulva.
The exudate may, however, be detained in the uterus for
several days and may be resorbed without any notable part
of it having appeared externally.

When the discharge appears or for other reasons a clini-
cal examination is made, the scarlet-gray exudate already
described may be found in the vagina or uterus or both. If
the uterus largely retains its tone, the exudate is nearly all
forced out into the vagina promptly instead of accumulating
within the uterine cavity. From one-fourth to one pint may
accumulate in the cervical end of the vagina. If the uterus
is very paretic, up to one gallon or more of the exudate may
accumulate in the cavity while the vagina may be free of
any notable amount. Then the exudate may not be expelled
actively, bu1 be forced out passively when the animal is re-
cumbent, owing to the mechanical pressure of contiguous

Puerperal Diseases of the Uterus 549

viscera upon the paralyzed distended uterus. Thus invol-
untary discharges of large volumes of scarlet-gray exudate
are observed frequently behind recumbent cows which
otherwise appear well. Upon rectal palpation the uterus of
such a cow is enlarged, atonic and flabby. Whatever the
amount of exudate present, the walls of the uterus are not
ordinarily stretched, but lie dormant and powerless. If the
uterine cavity is douched, there may be siphoned or washed
out a variable quantity of scarlet exudate.

In the abattoir endometritis of the type described is com-
mon. Apparently dairymen and breeders frequently dis-
card females which have recently aborted, owing to the com-
mon theory that a cow or heifer which has aborted because
of intra-uterine infection should be isolated in order to pre-
vent the "spread of contagious abortion" to other pregnant
females in the same herd, which already have in large
measure the same infections in their uteri. Every grade of
endometritis is seen. When of an aggravated degree, it is
officially designated "recent parturition" and the carcass is
condemned by the inspectors, but as a matter of fact it is
not a consequence of recent physiologic parturition. The
uterus in these cases is readily recognized by external ap-
pearances. It varies from twenty-four to sixty or more
inches in length along its convex (free) border, and trans-
versely from three to eight or ten inches at the base of the
recently gravid horn. The uterus is flat, collapsed, thin-
walled, and flabby. It collapses from side to side : that is,
it collapses like an empty bag with the line of attachment of
the mesometrium, or broad ligament of the uterus, and the
convex, free border serving as the two margins of the flat-
tened tube. The exterior of the uterus shows scarlet or red
vascular lines, and here and there numerous bright red
hemorrhages beneath the peritoneum. When incised, the
uterine cavity is found to contain variable quantities of
bright red exudate mixed with pus and placental debris of
a dirty grayish-yellow color, which as a rule is not fetid but
has a faintly sweetish odor.

^^o Diseases of the Genital Organs

I am not aware that this exudate has been subjected to
any material study. Hence its composition and the identity
of the bacteria present are unknown. Logically the bacteria
are chiefly those which existed in the utero-chorionic cavity
of the recently pregnant organ, to which organisms from
the exterior may have been added. So far as I have been
able to determine, the exudate consists primarily of blood
due to limited capillary hemorrhage from the placental
areas. This becomes mixed with small masses of pus and
necrotic particles of placental tissue. The blood is scarlet,
similar to that of the severe uterine hemorrhage described
in the preceding article. Perhaps there is a causal rela-
tionship between the two conditions. There is one marked
clinical difference. The gross hemorrhage produces a clot
which, so far as I have seen, tends to desiccate but not to
putrefy. The same tendency is present for a brief interval
in the scarlet-gray exudate of endometritis, but this is of
brief duration and, unless recovery promptly occurs, putre-
faction or suppuration finally takes place. Then follows
septic metritis, pyometra, or other phases of intra-uterine
infection.

Endometritis is exceedingly common in most dairy and
beef herds. In dairy herds where genital infections are se-
vere, endometritis is sometimes essentially universal for
some months. If there are 25 per cent, of observed expul-
sion of fetal cadavers (abortion), careful clinical study will
reveal probably 80 to 90 per cent, of cases of endome-
tritis. Endometritis in the cow is so common that Fleming
and other obstetrists describe it as "normal" and designate
the exudate when discharged from the vulva as "lochia."
The course of puerperal endometritis is technically brief.
Numerous cases recover spontaneously and promptly and
retain their fertility. Perhaps more frequently the puer-
peral infection passes over into the post-puerperal era as a
mild, persistent endometritis with a pernicious tendency to
extend by continuity into the oviducts, causing the various
tubal infections, or into the cervix, inducing cervicitis, with
all that these mean for the future reproductive powers of the

Puerperal Diseases of the Uterus 551

animal. In other cases endometritis passes quickly into
that type of disease I have designated as septic metritis, or
into pyometra.

The prognosis is generally good. If timely attention is
given it can usually be promptly controlled and the fertility
of the patient retained. Sometimes the infection is of high
virulence, or, which amounts to the same thing, the patient
has such low resistance that, in spite of treatment, ruinous
or fatal septic metritis ensues.

The handling of puerperal endometritis is to be based
upon the fact that it is ordinarily a disease persisting from
the pregnant state. Therefore, if it is to be prevented, the
uterus should be rendered as nearly aseptic as is practicable
prior to conception and all available precautions taken
against coital infection by the bull. When genital infec-
tions in a herd have become intense as a result of profes-
sional neglect, each female should be regarded as probably
infected and the presence of endometritis at the close of
pregnancy anticipated. In such instances I have advised
as a general procedure the introduction of iodoform with
boric acid, bismuth, thymol or other antiseptics into the
uterine cavity (or if the fetal membranes are retained, into
the chorionic cavity) . A very satisfactory formula is one-
half ounce each of powdered. iodoform and boric acid, with
five or six grains of powdered thymol enclosed in a gelatin
capsule and deposited deeply in the cavity of the gravid
horn. This should be done within two to five hours after
calving or aborting. This can be done safely by an intelli-
gent herdsman or caretaker, if he has first been carefully
instructed regarding the necessity for cleansing his hands
and shown how and where to deposit the capsule. The
operation must of course be carried out with the greatest
possible care in cleansing and disinfecting the hands, and
the cow's tail, buttocks, and vulva. The same result may
be accomplished, sometimes perhaps better and sometimes
not so well, by suspending the iodoform and boric acid in
white mineral or other bland oil and introducing the prepa-
ration deeply into the uterus by means of a hospital irriga-
tor with the bull-douching catheter attached.

55*

Diseases of the Genital Groans

It has been objected that, if the drugs are introduced in
the gelatin capsules, the latter may become coated with
mucus and fail to dissolve. I do not regard this as a for-
midable objection. I have not observed the result alleged
and think the occurrence so rare that the objection is not
weighty. If the veterinarian fears the non-solution of the
capsule, the defect is readily overcome by turning to the
less convenient suspension in oil. Objection has also been
raised to the use of iodoform because of its odor. The claim
is made that it contaminates the entire dairy, gets into the
milk, etc. I do not regard the objection as well taken. If
iodoform is properly used, all objection regarding its odor
and the tainting of milk disappears. Introduced into the
uterus in a gelatin capsule, none of the drug needs to be
scattered about the stable or premises, and, once deposited
in the uterus, its high specific gravity causes it to drop to
the lowest part of the cavity and to remain there unless dis-
turbed by siphoning fluids from the uterus. When suspended
in oil, the iodoform is quite firmly held and causes little diffi-
culty except that the mixture is slopped about in an untidy
manner. The tainting of the milk of the patient with iodo-
form is a minor complaint when properly handled. The
milk is wholly unobjectionable for the feeding of calves or
other animals. As a rule the milk of a cow which has endo-
metritis should be excluded from the market, and the iodo-
form taint insures the exclusion of the milk for human use
much as the application of kerosene to a condemned car-
cass insures against the sale of the meat for human use.
If proper warning is given the dairyman that the milk
should be carefully tasted by a good taster before it is placed
with market milk, all danger is safely averted. If the dairy-
man ignores the warning, the tainted milk is wholly without
danger to the intended consumer and only brings into dis-
repute products of the careless person. The warning should
1m- direct and complete. The animal should be in isolation
during treatment, a separate pail should be set aside exclu-
sively for her milk, and the milker should milk her last and
then carefully wash his hands with hot water and soap. It

Puerperal Diseases of the Uterus 553

can not be too strongly insisted that the use of iodoform is
perfectly safe and that only its misuse makes trouble.

In highly infected herds it is desirable that a skilled vet-
erinarian shall examine the genital organs of cows in which
pregnancy has recently terminated, where no external evi-
dence of important disease is manifest, in order to deter-
mine the presence or absence of endometritis or other hidden
disease important for the breeding life of the animal. This
examination may occur at any time from the fourth to the
fifteenth day post partum.

When the simple type of endometritis here considered is
recognized by clinical manifestations or through a careful
examination of the uterus, including the douching of its
cavity in order to reveal the state of its interior, the uterus
should be washed clean with sterile 0.6 to 0.7 per cent, salt
solution, after which iodoform and bismuth suspended in
white mineral oil or liquid paraffin may be deposited in the
recently gravid horn, and the treatment repeated after one to
four or more days. Careful watch should be kept upon the
case in order to assure as far as possible prompt and com-
plete recovery with fertility fully maintained. Powerful
antiseptics are to be strictly barred from the genital tract
during the puerperal period, because the freshly denuded
endometrium and partially denuded vaginal mucosa will not
tolerate them. There is no potent disinfectant known which
can be freely and safely used in the puerperal uterus or va-
gina. Insoluble non-irritant drugs, such as iodoform and
bismuth, are well borne and such feeble antiseptics as boric
acid can be tolerated. Here and there some manufacturer of
antiseptics advertises a "non-irritant" drug of higher po-
tency than carbolic acid, but it is non-irritant only upon non-
irritable tissues and not, so far as known to me, upon the
puerperal uterus and vagina. Salt solution is safest. Da-
kin's solution or one of its reliable substitutes in sufficiently
high dilution may be used. No drug should be used which
causes pain or straining. Nothing so intensifies the infec-
tion present as the imprudent use of disinfectants. The con-
stant aim should be to wash out mechanically any deleteri-

554 Diseases of the Genital Organs

ous infection present with a neutral fluid and then, if possi-
ble, to deposit in the organ some long-enduring substance,
like iodoform and bismuth, which, without irritating the
tissues, may tend to inhibit in some degree bacterial activity.
The final effectual disinfection must be a physiologic act
upon the part of the organ itself. When the disease ad-
vances to constitute septic metritis or pyometra, or retreats
to become the endometritis of the post-puerperal period, the
clinical phenomena change, the indications for handling
shift, and the continuing disease is most profitably discussed
under other headings.

C. Septic Metritis

The term "septic metritis" is used here to designate a type
of uterine infection in which the invading organisms break
down the barriers formed by the body of the host, involve
the uterine tissues generally, and gain the blood stream,
where they cause marked sepsis with great peril to the life
of the patient.

Uterine gangrene occurring during pregnancy, associated
with emphysematous decomposition of the fetus, has al-
ready been described and it has been stated that severe sep-
tic metritis or uterine gangrene not infrequently reveals
itself at the time for parturition and serves to delay or pre-
vent the expulsion of the fetus. Most cases of septic metri-
tis occur during the puerperal period and are clinically rec-
ognizable as a rule from two to seven days post partum.

The gangrenous or septic metritis of pregnancy is funda-
mentally identical with the puerperal disease, but is modified
by the presence of the decomposing fetus. Septic metritis
is not ordinarily an initial or basic disease, but rather a
critical phase of metritis growing out of a less virulent
phase of infection. Puerperal septic metritis is not ordi-
narily the result of an invasion during the puerperal period,
but an inheritance from pregnancy, proceeding from sources
identical with those of the uterine gangrene in the preg-
nant cow. After parturition there may be important new
invasions added to the existing infection. These admittedly

Puerperal Diseases of the Uterus

003

complicate, and in many instances doubtless aggravate the
disease already present.

Septic metritis, as seen during the puerperal period, com-
monly follows tardy parturition. There is metritis present
during pregnancy which serves to cause a varying degree
of uterine paresis. The expulsion of the fetus is tardy, re-
quiring five to ten or more hours. Afterward the fetal
membranes frequently remain incarcerated. The clinical
evidences of endometritis, as described in the previous arti-
cle, are present. The endometritis, instead of undergoing
rapid improvement as is commonly observed, becomes ag-
gravated. The exudate in the uterus increases in volume
and becomes fetid. It loses its bright scarlet color with the

Fig. 179 — Septic Metritis, Uterus of Cow, with Great

Thickening of Walls.

C, Cervical canal ; U, uterine cavity ; A, enlarged, thickened uterine

arteries ; B, uterine body walls ; L/C, uterine cornua.

5^0 Diseases of the Genital Organs

dirty yellowish-gray admixture of particles, and frequently
becomes watery, dark reddish-brown or black. Its color
and consistency vary. Sometimes the dark liquid is mixed
with a large proportion of dirty grayish clumps of pus or of
necrotic tissues.

The uterus becomes paretic. There may be little or no
notable discharge from the vulva. The exudate is sometimes
pressed out mechanically when the animal is recumbent,
but in many cases even recumbency fails to crowd the exu-
date out passively. The animal is weak and dull. The
pulse is rapid and extremely weak. The nose, ears and feet
are cold. The animal moves with great reluctance and very
feebly. The respiration is not materially affected. The
temperature is erratic, rarely high, not infrequently normal,
and usually subnormal. The practitioner who is in the habit
of thinking that sepsis always causes fever is greatly de-
ceived : he may err in diagnosis, and far more probably and
seriously in prognosis.

As the disease progresses, the patient shows extreme de-
pression. The eyes sink deeply into the orbits and the cornea
looks cloudy. There is a profuse muco-purulent discharge
from the eyes and nostrils. One of the most marked clini-
cal features is the presence of a profuse diarrhea. The
feces are very thin, fetid, black, and tarry-looking. The
diarrhea is so pronounced and so overshadows other clini-
cal phenomena, especially the evidences of uterine disease
as expressed in discharge from the vulva, that I have seen
unwary practitioners diagnose dysentery and handle the
case empirically for that malady.

The course is usually brief: more than half of my cases
have ended in death within three to six days after the estab-
lishment of the clinical evidence of sepsis. Some cases im-
prove, but very few recover. Peritoneal adhesions, pelvic
abscesses, pyaemic abscesses of the liver, spleen and other
parts, arthritis, and other complications follow, which leave
the animals unthrifty and of little or no value. Those which
apparently recover are very largely sterile and valuable only
for beef.

Puerperal Diseases of the Uterus 557

The disease is usually solitary. There is perhaps one case
during two or three years in a herd of fifty or more cows. I
have observed such solitary cases following twin pregnancy,
apparently due to increased strain caused by twins upon the
infected uterus. Now and then the disease breaks in a herd
as a virulent storm and its ravages are as disastrous as an
outbreak of one of the most dreaded specific diseases. In
one herd of about sixty breeding females, this virulent form
of infection suddenly appeared and raged throughout the
calving period of about ninety days. In that time it had
killed 20 per cent, of the herd and had ruined another 20 per
cent., so they had to be destroyed as worthless or consigned
to the butcher. No evidence could be traced of recent trans-
fer of the infection from one animal to another. The herd
was in two groups — adult cows, and heifers in first preg-
nancy. They were one mile apart and separately attended.
They suffered alike. The heifer group had been separate
from the adults all their lives. The only common point of
contact was that of coitus with the herd bulls. Some of the
cows had retained fetal membranes ; some had not. I was
able to give them close personal attention but was powerless
to ameliorate or modify favorably the course of the disease.
It was as relentless and overpowering as anthrax. I have
known similar but less extensive outbreaks in other herds.
In one herd of famous purebreds, five or six of the most valu-
able animals succumbed in rapid succession without a proper
diagnosis having been made by the attending veterinarian.
A second veterinarian of high repute was called, who also
failed to make a correct clinical diagnosis, and realized his
error only when the death of the patient gave opportunity
for an autopsy. The outbreak then subsided as suddenly as
it had come.

The biology of this type of infection has not been exten-
sively studied. A colleague working briefly in the severe
outbreak under my charge reported chiefly a micrococcus
and a streptococcus. The herds in which I have seen or
known of the severe outbreaks have suffered liberally from
sterility and abortion, but not more than other herds of

558

Diseases of the Genital- Organs

similar size. Abortion was no more common during the
outbreak than at other times.

The prognosis of septic metritis should always be very
bad. first for the life of the patient, and second, if the pa-
tient survives, for her reproductive life.

There is little to be done in the way of handling. If the
fetal membranes are retained and the veterinarian attempts
to remove them, his efforts apparently aggravate the dis-
ease ; if he leaves the membranes alone, the patient dies.
It is impossible to disinfect the uterus ; the infection has
permeated all the layers and involved all tissues. Besides,
the denuded uterine mucosa will not tolerate disinfectants
possessing any material efficiency. If uterine douching is
attempted, without skill and care, disaster follows. The
paretic organ will not empty itself. If the fetal membranes
are retained, they prevent siphoning of the uterine con-
tents by occluding the opening of the tube. If the fluids are
left, they injure the uterus by their weight and afford addi-
tional liquid in which bacteria may grow. If liquid is

PlG. ij'M Large Single-Curved Uterine Catheter. Length 24
inches, diameter <4 inch.

forced into the uterus with a pump, the uterus often rup-
tures and the patient dies. The treatment must be con-
servative and mild. Retained fetal membranes may be re-
moved it" they can be gently detached. The uterus may be
douched by means of a siphon, but not with a double tube.
The amount of fluid — preferably physiologic salt solution —
introduced at one time should be very small, not more than
a quart at first, and immediately siphoned out. If it can not
l)f siphoned out, no more should be added. The best appara-
tus for douching is the seven-foot pure gum catheter, de-

Puerperal Diseases of the Uterus 559

signed for douching the sheath of the bull, attached to a
hospital irrigator. The irrigator should be elevated not
more than 20 to 24 inches above the cow. After douching,
or without having attempted to douche, there may be intro-
duced into the uterine cavity one to two pints of liquid par-
affin or other neutral oil in which there has been suspended
some powdered iodoform, bismuth subnitrate, or other vir-
tually insoluble antiseptic or deterrent of bacterial growth.
The uterus, in severe cases, must not be massaged. A mas-
sage cult has grown up recently in veterinary practice, and
massage is as frequently applied where harmful as else-
where. In septic metritis, it is wholly unjustifiable and ab-
solutely dangerous.

Usually the animal neither eats nor drinks. She should
be permitted plenty of water if she will take it. She may
have a moderate supply of readily digestible food. The pa-
tient may have internally repeated small doses of strych-
nine, but in giving it the practitioner must be on his guard.
She is hyper-sensitive to its action, and will not tolerate
the dosage ordinarily advised by writers upon materia
medica. About one-half the dose which would usually be
given to an animal of the same size is abundant, but it may
be repeated within two hours. Drafts of strong hot coffee
may be used. Camphorated oil hypodermically and other
powerful stimulants may be given. The best that can be
done is to keep the patient comfortable and quiet, adminis-
ter stimulants prudently, and take advantage of every op-
portunity to ameliorate or remove untoward developments.

The biology of this type of disease is too little known to
afford any tangible suggestion in the line of biologic thera-
peutics.

There are certain possibilites for preventing septic me-
tritis. In the first place it may be partly prevented, as may
all genital infections, by the careful growing of calves in
such a manner as to minimize the amount of infection which
may gain a permanent habitat in the genital system. Much
may be done at the time of breeding by the application of
the principles of sex hygiene and by insuring, in so far as

560 Diseases of the Genital Organs

possible, the freedom of the genitalia of both sexes from
dangerous infections. Finally, when genital infections in a
herd are intense, as indicated by such phenomena as abor-
tion, sterility, retained fetal membranes, calf dysentery and
pneumonia, the advent of septic metritis may frequently be
avoided by assuming that each animal is importantly in-
fected and that each should be handled immediately after
the expulsion of the fetus as an infected animal, without
awaiting the development of the material evidences of dis-
ease. It is better practice to assume that each of ten cows
is importantly infected at calving time and so handle them,
even though only one is dangerously infected, than to treat
them as sound and allow the one badly infected animal to
develop mortal disease before notice is taken.

D. Placentitis. Cotyledonitis. Retained Placenta. Retained
Fetal Membranes

Metritis can not readily exist in the pregnant uterus with-
out involving the cotyledons or placentules, nor can the con-
verse well be true — that the cotyledons may become import-
antly infected without the intercotyledonal mucosa partici-
pating. Retained placenta is therefore a type of intra-
uterine infection which has become established during preg-
nancy and becomes clinically recognizable after the fetus.
alive or dead, has been expelled. The cotyledons may be
more notably involved than the inter-cotyledonal or non-
placental mucosa, but the only practical difference between
the various types of puerperal metritis and retained fetal
membranes is that in the latter the endometrium is hidden
everywhere beneath the chorion, the necrotic fetal mem-
branes quickly undergo putrefaction, and the retention of
the membranes imprisons the pus in the utero-chorionic
cavity, thus preventing its discharge and largely concealing
its presence.

When parturition ends, in a healthy cow. the moment that
the umbilic cord pails the life of the chorion ceases. If. as
naturally occurs, the chorionic end of the umbilic cord is let
alone when it has parted, the blood contained within the

Puerperal Diseases of the Uterus

56i

fetal placental arteries, capillaries and veins escapes from
the ruptured umbilic veins, causing the placental capillaries
of the fetus to collapse, become greatly reduced in volume,
and drop away from the capillaries of the maternal placental
crypts. There was at no time any anatomical bond of union,
but only an intimate contiguity maintained by a mutual at-
traction existing between the healthy uterus and living fetal
envelopes. When the umbilic cord ruptures and the chori-
onic end is necrotic, the attraction between it and the uterus
ceases. If it is to be retained, the retention is necessarily
dependent upon a pathologic condition which can not develop
after the expulsion of the fetus, whether alive or dead, but
is dependent absolutely upon the persistence of a metritis
which existed in the pregnant uterus. The expulsion of the
fetus does not cause, nor permit other factors to cause, re-
tention of the membranes, but fetal expulsion reveals the
uterine disease and opens the way for important modifica-
tions and complications in its course.

The bovine placental structures are the most complex seen
in domestic animals. While the placental system of the ewe

Fig. 180— Retained Placenta showing- incarceration and disintegra-
tion of the choriotic tufts ( fot 1 and extensive infiltration with
leucocytes in the maternal portion, some of them already-
broken down, x 310 1 After Pomayer).

36

562

Diseases of the Genital Organs

Fig. 181 — Retained Placenta. The chorionic tufts (fot) degenerated,

the maternal crypt walls (mat. ) becoming disintegrated

and necrotic. (After Pomayer).

PlG. is2 Retained Placenta. Necrotic disintegration of fetal tufts
i and extensive inflammation with infiltration in the
maternal placentae, x 900. (After Pomayer).

also Plate V.)

Puerperal Diseases of the Uterus 563

is similar in plan, the chorionic tufts are not so large and
hence the cotyledonal crypts of the uterus are not so deep
and intricate as in the cow. This is well shown by a study
of the placental systems of the two animals on pages 59 to
66, including Figures 27 to 34. When infection invades the
placental structures, it is virtually impossible for the ma-
ternal crypts to become inflamed without the intimately con-
tiguous chorionic tufts promptly becoming involved. As in
inflammations involving other parts, so in the placental
tissues, the capillaries become engorged, the blood stream
slows and finally stops, the red blood cells heap up and per-
ish, and the white blood cells pass out through the capillary
walls into the intervening spaces. The result is indicated in
Figures 180-182. The accumulation of the red blood cells in
the capillaries and the migration of the leucocytes into
neighboring tissues, with the extravasation of lymph and of
red cells into the parts, increase greatly the volume of the in-
dividual structures, such as the chorionic tufts, and through
this detailed enlargement the volume of the structure as a
whole becomes vastly increased. The inflamed cotyledon is
frequently quadrupled in volume because of the disease. The
result is incarceration of the enlarged, swollen chorionic
tufts within the similarly enlarged placental crypts. The
placenta is retained. The pathologic processes involved in
retention of the fetal membranes probably occur in all cases
of abortion but are not always recognizable. The uterus of
the female bovine fetus shows clearly the placental areas.
When a heifer becomes pregnant, the placental areas have
already been fixed and, as soon as the embryonic sac is es-
tablished, the placental-contact points of the chorion throw
out placental tufts which enter the cotyledonal crypts and
quickly establish a physiologic bond of intimate contiguity.
As pregnancy advances the chorionic tufts grow larger,
longer, and more intricately branched, and the cotyledonal
crypts become constantly deeper and more complex. It is
not probable that a fetus ever dies until some or all pla-
cental areas have undergone serious pathologic changes of
a character essentially identical with retained fetal mem-

564 Diseases of tlic Genital Organs

branes. In the early stages of pregnancy, however, the
chorionic tufts and placental crypts are so primitive that
recognizable incarceration does not occur because the pla-
cental disease quickly runs its course and placental separa-
tion occurs prior to fetal expulsion, so that the abort is ex-
pelled, enclosed within its membranes. As pregnancy ad-
vances, the increasingly complex placental structures invite
an equally increasing incarceration of the chorionic tufts,
until in the sixth or seventh month the expulsion of the
fetal cadaver usually reveals the presence of a severe pla-
centitis, as evidenced by the retention of the fetal mem-
branes. When a cow or heifer aborts, the probability of re-
tention of the fetal membranes increases as she approaches
full term and the intensity of the retention increases
along parallel lines. If the intra-uterine infection is ex-
tensive but fails to accomplish the death of the fetus and
its expulsion, there occurs at birth a retention of fetal
membranes often more severe and perilous than observed
after abortion. When abortion occurs at a late date, reten-
tion of the membranes after the expulsion of the fetal cada-
ver may not occur, because the placentitis has completed its
course up to the point of dehiscence of the chorionic pla-
centae. That is, there is no invariable rule of relationship
between the death of the fetus and its expulsion from the
uterus. They are two separate phenomena. The irritation
in the uterus due to the endometritis may excite uterine con-
t Tactions and cause the expulsion of the fetus while the
latter is yet alive (premature birth). Usually the death of
the fetus and its expulsion from the uterus occur almosl
simultaneously, so that the fetal cadaver is fresh when ex-
pelled. But the fetal cadaver may be detained in the uterus
for an indefinite period for any one of not less than three
different reasons : ( 1 ) The expulsion of the embryo may be
delayed or prevented by cervicitis with sclerosis <»r adhesions
of the cervical tissues. (2) The uterus may be too paretic

•-.pel promptly the fetal cadaver. (3) The expulsion of
the cadaver may be inhibited by the presence in the uterus of

ond living fetus (twins). The latter force is more nota-

Puerperal Diseases of the Uterus 565

ble in the sow, where the fetal cadavers are common in the
uterus and their expulsion inhibited by the presence of liv-
ing embryos. In each of these conditions the placentitis
completes its course, at least up to the point of detachment
of the fetal from the maternal placentae, or the cotyledons
become necrotic and separate from the uterus. Conse-
quently if the cadaver is finally expelled, the fetal mem-
branes do not remain behind in the uterus. Accordingly
when retained fetal envelopes occur, the stage of their de-
velopment varies widely in different cases. In abortion oc-
curring late in pregnancy the placentitis may be far ad-
vanced, so that the fetal membranes are expelled with the
fetal cadaver, or, detained after the expulsion of the cada-
ver, may come away in a few hours, days or weeks.

If a cow calves and the fetal membranes are retained, the
stage of the placentitis may be partly gauged by the health
of the calf. If the calf is feeble and dull, showing severe
sepsis, the placentitis is probably far advanced and the
course of retention nearing completion. If the calf seems
well but breaks down within a few days with dysentery, it
indicates, with certain limitations, that the placentitis was
moderately advanced at the time of birth and that the re-
tention of the membranes will probably continue for the
maximum duration. On the other hand, if placental reten-
tion follows the birth of a quite vigorous calf, the placentitis
is certainly in its first stages and probably involves materi-
ally only a few of the cotyledons located at the cervical end
of the uterus, while the cotyledons at the ovarian end are
healthy. Then the dehiscence of the membranes at the
ovarian end of the uterus may occur at once and these
drag upon the areas of detention, mechanically detaching
the feebly retained portions. Slight retention of the fetal
membranes at the cervical end of the uterus plays an im-
portant part in the phenomenon of their final expulsion.
Ideally it might be expected that the fetal membranes would
be expelled with the placental surface of the chorion on the
outer side, but in a majority of instances the dehiscence oc-
curs first at the ovarian end of the uterus, the detached por-

566 Diseases of the Genital Organs

tion inverts into the cervical portion and finally prolapses,
and the afterbirth comes away with the amniotic surface of
the chorion external.

The duration of the retention of the fetal membranes is
further modified by the virulence of the infection. The mild-
est recognizable type may have only a brief duration be-
cause the involved tissues retain or recover in part their
physiologic functions and act effectively before firm incar-
ceration occurs. At the other extreme, even when a calf is
born, the infection may be so virulent as to cause necrosis of
all the cotyledons with sloughing through their necks within
two or three days after calving, thus ending the retention.

The symptoms of retained fetal membranes are those of
the underlying metritis with the addition of the recognized
presence of the membranes. The retention of the membranes
is usually evident because some portions protrude from the
vulva. The part most commonly protruding is the umbilic
cord, but it may be a portion of the amnion, or the chorion
from the non-gravid horn.

Retained fetal membranes are not always visible. If the
uterus is very paretic so that involution is very imperfect
and the uterus retains approximately its gravid size, the
retention of the membranes at the ovarian end retracts the
stump of the umbilic cord into the vagina or even into the
uterine cavity. The retention then becomes recognizable
only upon clinical examination. This constitutes one of the
most dangerous types of retention because the layman fails
to recognize it, and the veterinarian, unless on his guard,
may err in diagnosis. It finally leads to another interest-
ing phase of retention of the fetal membranes. When the
placentitis has finally run its course to that point where the
membranes are no longer attached to the uterus, whether
detachment has occurred through suppuration within the
crypts or necrosis of the cotyledons, the cervix, which has
not participated extensively in the disease processes, may
have so contracted that the enfeebled uterus is unable to
force out the loose-lying membranes, with perhaps the ne-
crotic cotyledons still attached to the membranes and de-

Puerperal Diseases of the Uterus 567

tached from the uterus. There exists then what may be
designated cervical retention of the fetal membranes. A
condition has developed analogous to retention of the fetal
cadaver. Unless surgically removed, the membranes then
undergo putrid destruction and establish pyometra or other
serious type of disease of indefinite duration.

The biology of the infection causing retention of the fetal
membranes has not been adequately or seriously studied.
The orthodox believers in "contagious abortion" as a spe-
cific contagious disease have neither asserted, admitted, nor
denied that B. abortus causes retention of the fetal mem-
branes. They freely admit and assert that abortion is
"followed" or "complicated" by retention of the fetal envel-
opes. In their directions for the control of "contagious
abortion", however, they constructively deny the identity
of the infection causing abortion, and of that causing the
retained placenta of calving, by advising that aborters be
quarantined and ignoring the cow which has calved and has
retained fetal membranes. Brief researches by my col-
leagues intimate that the chief factor in the causation of
retained fetal membranes is a streptococcus of the viridans
group associated at times with a colon bacillus. The latter
may be largely a secondary invader. Very rarely tubercu-
losis and actinomycosis may cause retention of the fetal
membranes. Reference to this possibility has been made
when considering genital actinomycosis and tuberculosis.
Any infection which may invade or exist within the gravid
uterus and which is competent to cause inflammation may
cause retention of the fetal membranes. After the expul-
sion of the fetus, or rather after the uterine seal disappears
from the cervical canal, an unknown number of species of
bacteria may invade the uterus to complicate and intensify
retained placenta.

The course of retained fetal membranes is ameliorated,
intensified or modified by innumerable factors, and it is im-
possible to predict the outcome of a given case with any as-
surance of correctness. The mortality is high, but the
greatest economic loss arises from decreased dairying effi-

568 Diseases of (he Genital Organs

ciency during the involved lactation period, loss of condi-
tion, delay in conception in the next breeding period, and
very commonly the total destruction of the reproductive
powers. More incurable sterility arises from that type of
metritis where retained fetal membranes exist than from
any other type of disease. It is common to hear or see
statements by veterinarians that under a certain formula
they "cure" promptly and readily all cases of retained pla-
centa. Just what they mean by such statements I do not
know. Retained placenta in the cow is a condition of great
peril, causing enormous losses.

The placentitis or cotyledonitis regularly begins at the
cervical end of the uterus and advances toward the ovarian
extremity. Usually the spread is slow, but it may be very
rapid. Its extension is more readily observed after calving
than after abortion. If the uterus is examined manually a
few hours after calving, it is commonly found that some of
the placentae nearest to the cervix have already become de-
tached or are readily separated. Further toward the ovary
the cotyledons are increasingly enlarged, engorged and firm,
and the chorionic tufts can be detached only with difficulty
or not at all. The uterus is generally atonic, flaccid and col-
lapsed. Sometimes it is highly sensitive, and when the
uterus is manipulated the animal expresses pain and strains
severely. At first, if a calf is born, the membranes appear
fresh and possess no putrescent odor. Sometimes putrefac-
tion does not become marked until several days have elapsed,
after which decomposition proceeds with varying rapidity.
[f daily examinations arc made, it is ordinarily found that
at each time additional cotyledons have separated or are
separable, until finally the last to become detachable are
those in the apex of the gravid horn. This is not constant.
In some cases the infection has spread from cotyledon to
cotyledon with great rapidity, the placentitis is essentially
1111 i form throughout, and finally, when the membranes are
detachable from some cotyledons, they may be removed from
all. In other cases a few cotyledons at the cervical end of
the uterus are moderately inflamed after calving but with a

Puerperal Diseases of the Uterus 569

little care the membranes may be detached. Anterior to
these the parts are essentially healthy and are readily re-
moved. In these cases the placentitis is in its initial stage
and the incarceration of the chorionic tufts within the pla-
cental crypts not fully established. The separation of the
fetal membranes from the diseased uterus occurs in a va-
riety of ways. Each type may be recognized in the same
case, though one tends to prevail.

(1) In the simplest type of retention, lymph or pus ac-
cumulates within the placental crypts of the uterus and
pushes out or detaches the chorionic tufts. In a large meas-
ure the tufts may undergo purulent destruction and the
chorionic base drop away with but few of its placental tufts
intact. This constitutes the most benign type of retention
and ordinarily runs the briefest course. The recovery is
generally prompt, lactation is not seriously disturbed, and
fertility is usually conserved.

(2) The chorionic tufts and the placental crypts of the
uterus become necrotic, the tufts break off from the chori-
onic membranes, and later the placental portions of the
cotyledons, with the chorionic tufts, slough away from the
pedicle of the cotyledons and lie free in the uterine cavity.
If the case is not meddled with in an imprudent attempt to
remove the membranes manually, the chorionic membrane
usually retains its connection with the tufts and the pla-
cental area of the cotyledon becomes detached from the
uterus and remains attached to the chorion. If the animal
survives (the mortality is high) and again conceives (which
is improbable), new placental tissues form upon the cotyle-
donal stalks.

(3) In another well-marked type, which is not very rare,
many or all the cotyledons undergo total necrosis, slough
through the cotyledonal stalk, and remain irremovably at-
tached to the chorion. While this process is being accom-
plished, the cervix may contract; when the sloughing is com-
plete, the fetal membranes with the clinging necrotic cotyle-
dons lie imprisoned within the diseased uterus. When all
cotyledons are thus involved, the patient usually succumbs.

57© Diseases of the Genital Organs

If she survives, she rarely breeds. If but a few cotyledons
at the cervical end undergo necrosis, the prognosis is far
more hopeful and the animal frequently breeds. I have ob-
served in the abattoir one pregnant uterus in which all coty-
ledons had perished completely. When a cotyledon necroses
in toto, placental structures do not again form in that area.
Instead there is a white cicatrix. About this cicatrix (See
Colored Plate V) adventitious placental structures develop.
They lack the fineness of detail shown in Figs. 27 to 34 and
are irregular and defective. They are no longer cotyledonal
in type, but approach roughly the diffuse placenta of the
mare.

(4) Metritis associated with retained fetal membranes is
sometimes so severe that the entire endometrium is de-
stroyed. The uterine epithelium can not then be renewed
and the denuded surface can not heal except possibly by ad-
hesion of the denuded surfaces totally oblitering the cavity.
Possibly this occurs sometimes. What I have observed is
illustrated in Fig. 183. Here the uterine mucosa has been
wholly displaced by granulation tissue which has contracted
until the uterine (and cornual) cavity consists of an irregu-
lar suppurating fistula barely admitting the passage of an
ordinary probe. The uterus was normal on rectal palpation,
the cervical canal was passable for the small uterine cathe-
ter, and attempts at douching the uterus resulted in the re-
turn of a few drops of pus. Probably at one time there had
been sclerotic metritis, as illustrated in Fig. 189, but during
an interval of three years after the termination of her last
pregnancy any sclerosis which may have been present might
well have disappeared to such a degree that it could not be
recognized by rectal palpation.

The handling of retained fetal membranes is a trying
problem to the conscientious practitioner. Not the least
factor in rendering it trying is the frequent bombastic mis-
representation as to how easily it may be overcome by this
or that formula. Rules for handling are laid down by the
score and recommended as essentially infallible. This
creates the utmost confusion. There is no accepted stand-

Puerperal Diseases of the I rierus

57i

Fig. 183. — Total Destruction of Uterine Mucosa.
V, Vagina ; C, cervical canal ; i\ uterine body cavity, virtually disap-
peared ; L/C, walls of uterine coruua ; f C, cavity of uterine cornu,
reduced to a purulent fistula large enough to admit a small
sound ; CL, central corpus luteum.

572 Diseases of tin- Genital Organs

arc! and there is much misinformation. One of the chief
elements of confusion is the belief of the breeder and dairy-
man that a skillful veterinarian can successfully remove a
retained afterbirth at will. Accordingly the owner calls the
veterinarian to "remove" irremovable fetal membranes.
The practitioner is not left free to exercise his judgment
and attempts the impossible.

No chronological date can be fixed upon, at which it is pru-
dent to attempt the manual removal of the fetal membranes.
So many cows have been killed or ruined by attempts at the
removal of the membranes that it has become the fixed
policy of many practitioners to abstain from all attempts
at manual removal, and they have justified their methods
by results attained. I hold that, between the extremes of
non-removal and the arbitrary removal or attempts at re-
moval, there is a middle ground in thorough harmony with
the principles of surgery and fully justified by clinical ex-
perience. Once the fetal membranes become retained within
the uterus owing to the incarceration of the chorionic tufts
within the placental crypts, certain established disease pro-
cesses must continue in their course to their logical end. In
the types described above there is a course and termination
for each, and it is impracticable to modify materially or to
abbreviate that course in a favorable direction. As in other
infections, it is easy to affect its course unfavorably, leading
to disaster. There is always present within the uterus a de-
termined battle between the infection and the powers of
resistance in the uterus and the body as a whole. The in-
fection has a notable advantage in the presence of the ne-
crotic membranes, which afford an inexhaustible nutritive
supply for the bacteria, and the additional advantage of the
presence of the utero-chorionic cavity, with the necrotic
chorion forming one wall and the diseased uterus the other
wall, and the virulent infection lying between the two struc-
tures beyond surgical reach. The tendency is therefore for
each case of retained afterbirth belonging to the first and
most benign type, a group which fortunately contains most
cases, to become more intense and to move into one of the

Puerperal Diseases of the Uterus 573

more perilous types. The least error in the plan of handling
serves to push the case out of the simpler type into the more
serious classes. Everywhere the uterine mucosa is diseased
and its epithelium depressed or destroyed and extremely
sensitive to the faintest abuse. If the practitioner attempts
to detach manually the chorionic from the uterine placenta,
any imprudent stress which tears the walls of the placental
crypts, or merely tears away the already damaged protective
epithelium, creates a favorable avenue for more damaging
bacterial invasion. The damage is not alone to the placental
areas. The non-placental endometrium is largely denuded
of its protective epithelium and is highly sensitive to the
least insult. If the practitioner inserts his hand none too
gently into the uterine cavity and laboriously detaches the
membranes from the cotyledons, his hand constantly abrades
the inter-cotyledonal mucosa and breaks down the feeble
barrier maintained against the invading swarm of bacteria.
The pain endured by the cow induces severe straining, which
in turn further damages the tissues and increases the infec-
tion. Any veterinarian having mediocre powers of observa-
tion can remember clearly how in his own personal experi-
ence he has left his patient evidently worse after having
made an apparently successful attempt, viewed from a me-
chanical standpoint, to remove retained membranes. Equally
disastrous attempts are made to disinfect the uterus and re-
tained membranes. The infected puerperal uterus can not
be disinfected and is utterly intolerant of freely soluble dis-
infectants. The necrotic chorion defies disinfection by any
available means, and lying behind it wholly out of reach is
the great mass of infection proceeding with its destruction,
regardless of any disinfectants placed upon the opposite
surface of the chorion. Such a multitude of errors have
been made and are still being made that it is difficult to lay
down a line of action which may be advantageously followed.
In principle the aim should be to pursue a course devoid of
danger of injury to the diseased parts, which will tend to
lessen the danger of infection passing from the milder type
into one of the more severe, or, in cases where the very se-

574 Diseases of the Genital Organs

vere type is present, to ameliorate it and if possible convert
it into a simpler type.

There is no denying that the presence of the great necrotic
and putrefying mass of membranes is a menace to the health
and life of the patient and that the earlier it is out of the
uterus the better, provided that in the process of removal
no injury is inflicted upon the uterus. It should be borne
in mind that as a rule an afterbirth which can be removed
manually without injury to the uterus will spontaneously
drop away a few hours later. Hence in most instances the
manual removal of the fetal membranes is not of supreme
importance because it can prudently occur but a short time
prior to spontaneous falling away. The gentlest manual re-
moval possible is not superior to the spontaneous dropping
away. There are, however, important limitations to these
general statements which should call into action a high de-
gree of professional skill and judgment. If at a given date
the practitioner finds that the membranes can be prudently
removed, it is best to proceed at once with the operation in
order to be in position as early as practicable to deal di-
rectly and successfully with the underlying metritis.

Before proceeding with manual removal the operator
should thoroughly cleanse and disinfect the tail, vulva and
adjacent parts in order to avoid the danger of pushing into
the genital tract dangerous infections from the exterior.
The operator should very carefully disinfect his hands and
arms as a protection to himself and he should keep at hand
ample disinfectant solutions for frequent use. But the dis-
infectants must be kept out of the genital tract. After dis-
infecting the hands and arms, they should be thoroughly and
frequently anointed with vaseline, liquid paraffin, or other
fat, and liquid paraffin should be introduced in ample
amount into the genital tract. By such means the mechani-
cal irritation from the operation is reduced to a minimum.
The arrangement of the cotyledons, as shown in Plate I,
should be kept in mind, and the dorsal rows of cotyledons
separated first. ( <>mmencing at the cervical end of the uter-
us, the hand should be gently pressed into the utero-chorionic

Puerperal Diseases of the Uterus 575

space and advanced until one of the cotyledons is encoun-
tered. The chorion should then be grasped upon either side
of the cotyledon, from the uterine surface. By exerting
traction upon the placental margins of the chorion these
borders should be pressed toward each other, which tends
to cause the chorionic tufts to pull out of the crypts of the
maternal placentae, as indicated in Figs. 29 and 30, with-
out traction upon the cotyledonal stalk or uterine wall. In
many cases it is found that, after separating a few cotyle-
dons at the cervical end of the uterus, the retention is more
severe anteriorly. The operation needs then to be suspended,
and all or most of the detached membranes left connected
with the undetachable portions. It is especially important
that a goodly mass of membranes be left in the cervical
canal, since their presence tends to insure a continued dila-
tion of the part, enabling the operator to introduce his hand
at future dates. If the detached portions of the membranes
are cut or broken off short, the remaining portions drop
back into the uterus, the cervix contracts, and future man-
ipulations are rendered difficult. The progress of the dis-
ease is then to be carefully watched and the removal of the
membranes completed as early as prudent.

When the membranes are permanently undetachable from
the maternal placental tissues and separate instead by
necrosis either of the placental portion or of the entire
cotyledon, the membranes with the necrotic cotyledons
should be removed early unless they are promptly expelled
by the uterus. The latter is improbable, because as a rule,
when necrosis of the cotyledons occurs, the uterus is so
badly diseased that it is not competent to expel its con-
tents. Usually the necrosis is slow and, before it is com-
pleted and the cotyledons sloughed off, the cervix, the mus-
cular walls of which usually escape the ravages of the dis-
ease, has contracted, closed the cervical canal, and impris-
oned the putrefying mass. Therefore it is important that
the uterus be relieved of necrotic cotyledons with any at-
tached fetal membranes as early as practicable. As in the
ordinary simple type of dehiscence, the actual date at which

576 Diseases of the Genital Organs

it is prudent to remove cotyledons can be determined only
by the person in immediate charge. I attended a cow for
dystocia (the dystocia of uterine inertia) and extracted an
apparently healthy calf. Forty-eight hours later the fetal
membranes were completely retained and all her cotyledons
were enormously swollen and necrotic. Her temperature
was high and her condition critical. All the cotyledons were
readily detachable without pain or hemorrhage. They were
removed with the membranes still attached. The uterus
was then douched. Within twelve hours her temperature
had become normal, her recovery was prompt, and her fer-
tility preserved. This was an extreme case cited to show
the value of the removal of necrotic cotyledons, when prop-
erly done at the right time. In any other cow I have at-
tended, the removal of cotyledons so early after calving
would have been wholly unjustifiable and would have done
incalculable harm. Each case of retained fetal membranes
constitutes an individual problem, the details of which must
be worked out separately. Two principles regarding man-
ual removal appear to me to be applicable generally. First,
whenever the membranes (including necrotic cotyledons)
can be removed completely without injury to the uterus,
this should be done. Second, if the membranes can not be
removed promptly, measures should be taken to delay the
contraction of the cervix and imprisonment of the putrefy-
ing tissues. This precaution preferably consists of permit-
ting or causing portions of the membranes to occupy the
cervical canal. When this can not be done there may be
substituted a tampon of gauze, which may be made in the
form of a gauze bag, two or three feet long, the closed end
pushed into the uterine cavity and then a sufficient amount
of gauze pushed into the closed end from the exterior to
produce an enlargement which will not drop out through
the cervix. The presence of the collapsed portion of the bag
lying in the cervical canal will retard cervical contraction
and afford better opportunity for the manual examination
of the uterus. A similar plan may be used to dilate an al-
ready contracted cervix with imprisoned fetal membranes.

Puerperal Diseases of the Uterus 577

The closed end of the bag may be pushed into the uterine
cavity with a sound, followed by packing the bag through
the open end, filling as well as space will permit that por-
tion of the bag lying within the cervical canal. Prior to
application, the gauze should be saturated with iodoform
oil or vaseline and should be renewed daily until the dila-
tion is sufficient.

In discussing the various types of retention it has already
been pointed out that the placentitis typically begins at the
cervical end of the uterus and advances slowly toward the
ovarian extremity. The retention may be in the very early
stages and the entire mass of membranes may readily be re-
moved soon after calving if the few diseased cotyledons
about the cervical end be manually released. Perhaps my
meaning will be clearer by giving a definite instance. A
colleague in charge of a valuable herd made it a rule to ig-
nore retained fetal membranes until forty-eight hours post
partum, when he would make an effort to remove manually.
I was asked incidentally to examine a cow which had
calved about thirty hours previously. I found nearly all the
fetal membranes detached and hanging from the vulva. A
careful examination revealed the fact that the membranes
were adherent to a few cotyledons at the base of the gravid
horn. The dragging of the detached masses upon one small
area had caused an intussusception of the base of the gravid
horn and its prolapse through the cervix into the vagina.
It can not be denied that I was right in detaching the few
adherent cotyledons and replacing the prolapsed organ.
My colleague had evidently erred. The only means for avoid-
ing the error lay in a careful examination of the patient.

The first step in the handling of retained fetal mem-
branes, as in other diseases, is an early and careful exam-
ination with an accurate diagnosis. The degree of uterine
paresis is to be noted carefully because it indicates more
than anything else the probable severity of the retention.
If the uterus is extremely large and flaccid, the retention
will probably be prolonged and severe. If the uterus is well
contracted, firm and not over-sensitive, the duration of the

37

57 8 Diseases of the Genital Organs

retention will probably be brief and the course favorable.
If the membranes can be easily detached without causing
pain or irritation to the patient, their removal is good sur-
gery because it is only after the removal of the fetal mem-
branes that one can handle with any directness the funda-
mental metritis which caused the retention. The basic ques-
tion is not the desirability of removing from the uterus the
necrotic membranes, but the possibility of removing them at
a given date without causing greater injury and danger
than the retention is already producing. If not prudent to
attempt the removal at the first examination, repeat the ob-
servations at comparatively frequent intervals, at least
every second or third day, and watch the progress of the
disease.

Various plans have been recommended as substitutes for
the manual removal of the membranes, but they have failed.
Numerous drugs have been lauded, such as savin, rue, and
various aromatic substances, but there is no dependable evi-
dence of their value. A few years ago it was proposed to
detach the membranes by injecting into the cavity of the
chorion, where the fetus formerly lay, a weak solution of
hydrogen peroxide, but it could act only upon the inner or
fetal surface of the chorion and could not possibly affect the
part really at fault, as it could not get near it. Next some-
one proposed to detach the membranes by injecting salt
solution into the broken ends of the umbilic arteries and
thence into the capillaries of the incarcerated chorionic
tufts, but the promoters of the plan ignored the fact that
the placental capillaries were blocked by thrombi which
would not permit water to enter, and equally disregarded
the fact that the physiologic detachment of the placentae is
clue, not to distension of the capillaries, but on the contrary
to their becoming empty. If the salt solution could be
forced into the placental capillaries, it would increase their
incarceration.

Much has been said for and against douching the uterus
when the fetal membranes are retained. As a plain matter
of fact, so long as the fetal membranes remain attached to

Puerperal Diseases of the Uterus 579

the cotyledons, the uterus can not be douched by any known
method. Fluid may be introduced into the sac of the adher-
ent chorion where the fetus formerly lay, and in some cases
may be taken out again. The fluid does not reach the uterus
except at points where the membranes have become de-
tached. The uterus is frequently too paretic to expel the
fluid poured into the sac of the chorion. If the veterinarian
attempts to siphon out the fluid, fragments of the amnion,
chorion or umbilic cord block the siphon. Some claim to
guard the intake to the siphon with the hand, but in a very
flaccid uterus the end of the organ is out of reach and the
hand can not effectively guard. For example, in the ex-
treme case of retained membranes following unicornual
twins, if the uterus is severely inflamed it may retain its
length of more than eight feet. It is useless to discuss the
siphoning of fluid out of such a uterus. In many cases fol-
lowing ordinary pregnancy, siphoning fluid out of the chori-
onic sac is impracticable. Even if accomplished, the opera-
tion has very scant, if any value to commend it.

If the uterus is in such condition that the vagina may be
douched without the fluid falling largely into the paralyzed
uterus or into the sac of the chorion it contains, that may be
of value. Perhaps it is also of value, when a portion of the
uterus has been freed from its membranes, to douche that
portion, if conditions render it practicable. But introduc-
ing quarts or gallons of liquid into the sac of the retained
chorion and leaving it there is malpractice. The weight of
the fluid in the paretic organ does great harm. In some
cases the uterus may be so atonic and weak that the me-
chanical weight of the liquid may cause rupture. The dan-
ger of uterine rupture is greatly heightened when the opera-
tor is so imprudent as to use a pump for introducing the
fluid, or when, introducing by gravity, he uses too great a
column of water. The danger is aggravated when the uterus
is very paretic and the cervix contracted. I have ruptured
the uterus very unexpectedly when using the pump, al-
though the rubber tube of the pump passed the cervical
canal freely with abundant room about it. Just what oc-

580 Diseases of the Genital Orga?is

curred I could not determine. Either the uterus ruptured
from the weight of the fluid, the os uteri internum acted as
a collapsing valve and imprisoned the fluid, or portions of
the membranes floated against the cervical opening and
blocked it. In one instance, where the fetal membranes, de-
tached from the uterus, were detained within the uterine
cavity and the cervix had contracted and would not admit
my hand, I introduced a small amount of physiologic salt
solution through a rubber catheter from a hospital irrigator
elevated fifteen or twenty inches. The cow began to make
expulsive efforts, the membranes blocked the cervical canal,
and disaster followed.

Arbitrary rules for douching are accordingly unwise. It
is equally unsound in principle to condemn douching unre-
servedly. When the membranes are firmly retained and are
undergoing putrefactive decomposition, the cervical canal
is often very narrow and the debris is imprisoned. The ne-
crotic cotyledons and placental debris must be removed. If
one undertakes dilation of the cervical canal, the inflamed
cervix yields but little, the force required is great, and both
cervix and vagina are severely injured. The abrading and
stretching open important avenues for infection, the pain
causes straining and exhaustion, and the results are unsat-
isfactory. If the membranes are well broken up, I have had
excellent results in douching carefully with the large, single-
curved uterine catheter shown in Fig. 179a. In such cases
I use an irrigator elevated barely above the back of the cow
and watch carefully for blocking of the return flow. Should
this occur, the inflow is stopped and the catheter withdrawn.
It is commonly found that the catheter is blocked by large
pieces of membranes or by necrotic cotyledons. Pieces of
moderate size can be washed out with this instrument, but
it must be used cautiously. The uterus is frail and the cath-
eter is easily pushed through the walls. If the animal
strains and pressure upon the catheter is felt, it must be
permitted to move backward, or puncture is probable. The
horse stomach tube may be substituted, but it is not as
practical. The tube, especially the heavy type, is as danger-

Puerperal Diseases of the Uterus 581

ous as the metal catheter and must be used as a siphon.
When this is attempted it is quite as readily choked with
membranes and has the additional disadvantage of having
its intake occluded by sucking in the uterine wall.

When the membranes are not broken up and are impris-
oned by a contracted cervix, douching is highly dangerous
and should not be undertaken. The cervix should be gently
dilated until portions of the membranes may be grasped
with the hand or forceps and traction applied. If one-half
to one pint of warm olive oil or liquid paraffin is introduced
into the uterus, it lubricates the uterine walls as well as the
somewhat necrotic tissues and favors removal. The oil also
soothes the irritated endometrium, and in virtue of its lubri-
cating action diminishes the epithelial abrasions inevitable
in such manipulations.

Many cases occur where skilled veterinary attendance at
the proper moment is impracticable or impossible. Proper
veterinary attendance upon retained fetal membranes is
generally economically impossible in cows of low value.
Even animals of great value are frequently so located that
skilled veterinary attendance is not available. Veterinary
service must then be rendered through the layman, and
methods of handling which may be quite proper when ad-
ministered directly by the skilled practitioner may become
wholly improper and acutely dangerous in the hands of the
layman. This group includes at present the majority of
cases of retained membranes, and their proper handling is
a heavy responsibility upon the veterinary profession. Here
a hard and fast rule should be laid down for the layman:
Do not attempt the manual removal of the fetal membranes
or the douching of the uterus. In numerous cases this rule
will work some harm. In rare cases, like the one or two ex-
amples I have cited, it will end in disaster when skillful
handling would have saved the animal. But the peril to the
feiv is more than counterbalanced by avoiding serious injury
to many. The layman would probably fail in any event in
those rather rare cases where manual removal is imperative.

At present the best known course for the layman to

582 Diseases of the Genital Organs

pursue is to introduce deeply within the chorionic sac
a drug of high specific gravity, so that it may not be
thrown out readily, and slow-dissolving, so that it will
not require frequent renewal, which will soothe rather
than irritate any portion of the genital mucosa with
which it may come in contact and which will deter in
some measure the putrid decomposition of the mem-
branes. The two best known drugs in this group are
iodoform and bismuth subnitrate. To these may be added
some of the rapidly-dissolving disinfectants of a non-irri-
tating character. Here the limit is virtually set at boric
acid which may be used without restriction. There are two
methods of application. The more convenient form is the
introduction of the drugs inclosed within gelatin capsules.
An efficient formula is one-half to one ounce each of pow-
dered iodoform and boric acid, with three to five grains of
powdered thymol, inclosed in a large gelatin capsule. The
capsules may be prepared in large numbers. Properly
wrapped, they will keep indefinitely, ready for use when-
ever needed. Bismuth may be added or may be substituted
for the iodoform or boric acid. When retained afterbirth is
diagnosed, one of the capsules should be deposited as deeply
within the uterus, or rather in the sac of the chorion, as
possible. The gelatin quickly dissolves and the heavy drug
drops to the floor of the uterus, where it slowly dissolves
during a period of seven to ten or more days. If the reten-
tion continues, a second capsule may be added three to four
days after the first. When the membranes finally come away,
the drugs previously introduced largely or wholly accom-
pany them, and it is desirable then to introduce another
capsule, which now comes into immediate contact with the
uterus. As this taints the milk badly, it must on no account
be included in market milk or used for making butter or
cheese. Tasting the milk carefully is the only guide as to
when it is (it to market. It is perfectly healthful and may
be used freely for feeding calves. The intelligent layman
can readily learn to introduce the capsule. The tail, vulva
and buttocks of the cow should first be washed and disin-

Puerperal Diseases of the litems 58

fected. The operator should trim his finger nails closely
and smoothly and disinfect and soften his hands in a warm
disinfecting solution. The disinfectant may then be rinsed
off the hand with warm water and the capsule, inclosed
within the hand, carried deeply into the sac of the fetal
membranes and dropped there.

A method which is certainly more efficient in many, and
possibly in most cases is the introduction of the iodoform or
other drug suspended in a neutral oil. Liquid paraffin is
probably in all respects the preferable medium. The drug is
to be placed in a pint or quart bottle, the vessel filled with
the oil, and then shaken until well suspended. It is then to
be poured into a hospital irrigator with the seven-foot rub-
ber catheter designed for douching bulls attached, the end
of the catheter carried by the hand and held as deeply within
the cavity as can be reached, the irrigator elevated two or
three feet above the uterus, and the contents allowed to flow
in. The heavy drug falls down upon the floor of the uterus,
as with the capsule, while the oil floats upon other liquids
which may be present and comes in contact with and soothes
any portions of the inflamed genital mucosa which may be
uncovered. It is more trouble to prepare and apply, and
the average layman is more liable to make some mistake in
the handling of the iodoform and taint the milk from cows
other than the one diseased.

The plan just described should also occupy a large place in
the handling of retained fetal membranes by the skilled vet-
erinarian. In all those cases where at the time of examina-
tion it is not feasible to remove the membranes manually,
the iodoform capsule or the introduction of an iodoform sus-
pension in oil or liquid paraffin constitutes the best line of
treatment at present known.

In practice one occasionally encounters retained placenta
in which the underlying metritis is of a highly irritable type
and the cow evinces much pain by constant and violent
straining. In rare cases this is due to intussusception of the
ovarian end of the gravid horn, which may eventually end
in uterine prolapse, or may telescope for a few inches, be-

584 Diseases of the Genital Organs

come incarcerated there and remain persistently. This
should be searched for when such symptoms are present
and, if discovered, reduced by gentle pressure against it
with the hand. It is not essential to take away the mem-
branes. It is far more important to reduce the intussuscep-
tion and soothe the irritated uterus with oleaginous suspen-
sion of iodoform. Metritis with retained afterbirth, accom-
panied by great pain and straining, is most frequently ob-
served after imprudent attempts at the removal of the mem-
branes. It is believed by many that in such cases the after-
birth must be removed at any cost. The opposite is more
nearly correct : the membranes should be left strictly alone
and the irritated uterus soothed with iodoform-oil or other-
wise.

Once the retained fetal membranes have been taken, or
have come away, the original disease which caused it is still
present. The important change in conditions is that the
uterus is now naked and curative measures directly appli-
cable. The uterus may then be, and as a rule should be,
douched in order to clear away any exudate or remaining
debris. The condition now facing the veterinarian is simple
metritis, and the method of handling is the same as though
the retention of the membranes had not occurred.

The prevention of retained fetal membranes can be ac-
complished only by seeing that a cow at breeding time has a
clean uterus and cervix, and that she is bred to a bull free
from important infection. These matters are discussed in
their proper places.

E. Puerperal Tetanus.

Immediately following parturition the denuded endome-
trium opens an avenue for the invasion of specific infections
not commonly entering by the genital tract. Tetanus infec-
tion occasionally invades the genital organs at this time and
produces the ordinary clinical symptoms of that disease. I
have observed it but once in the cow, associated with re-
tained fetal membranes. It offers nothing special except
that a knowledge of the possibility makes even more de-

Puerperal Laminitis 585

sirable comprehensive precautions against the entrance of
any form of infection from the exterior through the vulva.
The protrusion of the fetal membranes from the vulva in-
creases when the patient is recumbent, and when she rises
they are drawn back somewhat and may drag into the vagina
infections caught by the protruding membranes. Tetanus
infection is also possible when a prolapsed uterus comes in
contact with stable manure.

F. Puerperal Laminitis.

Puerperal laminitis is virtually constant in endometritis
in the mare, but I have observed only one instance in the
cow. The symptoms of puerperal laminitis in the cow are
the same as those of the laminitis of indigestion and of the
corresponding disease in horses. It is quite unnecessary to
describe the symptoms and course of the disease here, but
it is important to bear in mind that puerperal laminitis is
due to the presence of an endometritis instead of an irrita-
tion in the intestinal tract.

In handling puerperal laminitis in the cow the funda-
mental factor is the proper alleviation of the underlying en-
dometritis by the means already advised for that disease.
In addition to these measures, the veterinarian should give
necessary attention to the feet, either by standing the ani-
mal in cold water or by applying ice bags.

G. Puerperal Meningitis

Puerperal meningitis has found no recognized place in
veterinary literature. I have observed one instance only.
The patient was a young cow in a herd reeking with genital
infections. She calved without notable incident and ap-
peared to be progressing favorably for about two days,
when she suddenly developed symptoms of severe menin-
gitis. The patient was exceedingly uneasy, with constant
muscular twitchings. The head was held erect and the gait
was rigid and uncertain. She was readily disturbed, as in
tetanus. The course was stormy and death occurred within
one day. Autopsy showed intense injection of the meninges

586 Diseases of the Genital Organs

without very marked uterine lesions. There is little or noth-
ing to be done for puerperal meningitis. It apparently sig-
nifies that a metastasis from the infected genital tract has
occurred and the matter has already largely passed beyond
control before clinical warning has been given. Chloral or
narcotics might be used to quiet the patient and an effort to
counteract the infection may be made with ounce doses of
formalin or with other agents which tend to act as systemic
disinfectants.

There is little limit to the metastases which may occur
during the puerperium. Infections of the pregnant uterus
are so common, and the endometrium is so largely denuded
at parturition that the intra-uterine infections have an un-
usually favorable opportunity to reach the lymph or blood
stream and be borne to any organ or tissue in the body. The
infection may lodge in the liver, lungs, joints, or in any or-
gan or tissue, and there produce symptoms of disease wrholly
unsuggestive of genital origin unless the observer is fully
cognizant of the possibilities and is on the alert.

5. Post-Puerperal Infections of the Uterus

After the puerperal period, which may be regarded ordi-
narily as comprising ten to fifteen days, there follows ideally
in cows an interval of sixty to ninety days before it is de-
sirable to breed them again. In approximately ninety per
cent, of cows, rebreeding is delayed beyond ninety days be-
cause of disease or for other reasons, and the period is yet
further prolonged in many cows by their failure to conceive
when bred. During this interval infinite changes in the in-
tra-uterine infections may occur. Historically most of the
uterine infections of the post-puerperal epoch are continua-
tions of infections which have persisted through pregnancy
and the puerperal period and have been modified in their in-
tensity and behaviour by the changes in environment.
Sometimes the infections of the puerperal period advance in
intensity in the post-puerperal era. In many instances there
is a strong reaction to the infection present and recovery,
entire or partial, often occurs. Thus many cows which had

Post- Puerperal Uterine Infections 587

during pregnancy so severe an infection that it caused abor-
tion, and during the puerperium outstanding metritis, so
far recover that they again conceive and successfully pass
through pregnancy. On the other hand the infection is
often so mild that an apparently healthy calf is born and no
external evidences of puerperal disease follow. But when
it is attempted to breed such a cow again, she may be tempo-
rarily or permanently sterile, or, having conceived, may
abort owing to the fact that, during the period when many
cows are overcoming infection, her uterus has been over-
come by the infection.

The puerperal period is a critical time in the breeding his-
tory of a cow. It is one of the most important and favorable
periods in the life of a cow in which to attack successfully
genital infections, and the chief aim of the practitioner
should be to deal energetically with the infections during the
puerperium and not to permit them to drag along into the
post-puerperal stage. For example, since retained after-
birth is generally handled simply and wholly as "retained
afterbirth", as soon as the membranes are out of the uterus
the ignorant or careless veterinarian thinks of his task as
completed and allows the fundamental metritis to persist
into the post-puerperal period. Then he faces the difficult
problem of handling chronic endometritis or pyometra, and
perhaps fails to restore the reproductive life of the animal,
thus occasioning irretrievable loss. It is clearly an error in
professional duty to permit avoidably the metritis of re-
tained fetal membranes to continue into the post-puerperal
period.

In the post-puerperal period new infection may invade
the uterus from without. There is nothing to show that there
is great danger of any infection invading the uterus during
this period as a result of ordinary cohabitation. That is,
there is no conclusive evidence that the presence of a cow
which has recently aborted, has retained afterbirth, or is
suffering from other disastrous type of genital infection has
any great or recognizable peril for non-pregnant contact
cows. There is no evidence that harm comes to a healthy

5^s Diseases of the Genital Organs

non-pregnant cow through eating food or drinking water
contaminated by genital discharges from a diseased animal.
It has not been shown that infections discharged from the
genital tract of a diseased cow will traverse the vulva and
vagina of a contiguous healthy cow and cause intra-uterine
disease.

There is abundant clinical evidence that an infected bull
is competent to transmit infection to the uterus of a healthy
cow during coitus and either establish a disease (cervicitis,
metritis, salpingitis) which inhibits conception, or when the
infection is less mild, establish disease within the pregnant
uterus to end finally in abortion or other disaster.

It has apparently been shown experimentally that serious
uterine or other genital infection may be established in
healthy non-pregnant animals by introducing into the blood
stream or into the subcutaneous tissue, and thence indirectly
into the blood stream, pathogenic bacteria having an affinity
for the genital organs. Thus the experiments of Bland1 have
apparently shown that by injecting large doses of B. abortus
cultures into non-pregnant cows and heifers the fertility of
the latter is seriously lowered, that a large percentage of the
animals fails thereafter to conceive, or, if they conceive, the
embryo is absorbed or expelled unseen. This may be appar-
ent only, since the experiments were entirely too inaccurate
to afford a secure basis for judgment. If the experiments
actually caused the apparent harm, it may have been di-
rectly by the B. abortus reaching the genital canal, or indi-
rectly through lowering the resistance of the patient to or-
ganisms already resident in the genital tract. In studying
the infections of the uterus during the post-puerperal period,
it is important to bear in mind their various possible or
probable sources, because evidently the prophylaxis of the
various types of disease occurring during this period must
depend upon the power or desire to eliminate the dangerous
infections existing during the puerperal period, and to
avoid coital infection by excluding seriously diseased bulls.

The variety of organisms which may cause disease of the

'Second Report on the Epizootic Abortion Experiments, L911-1916.

Endometritis 589

non-gravid uterus is infinite. Any organism competent to
cause wound infection may injuriously attack the uterus.
A long list of bacteria has been described as the causes of
various uterine diseases. Perhaps the Streptococcus viri-
dans is the most common and most destructive, but colon-
like bacilli, B. pyogenes, staphylococci, and micrococci are
common. The B. abortus is apparently a common resident
of the uterus during the puerperal period but, according to
most bacteriologists, disappears early after the close of preg-
nancy. In the following discussion of the uterine infections
of this period, explicit reference to the biology will not be
attempted because the present knowledge of the subject does
not warrant it. The classification is arbitrary and merely
intended to aid in arriving at reliable diagnoses and prog-
noses. The classes merge by imperceptible gradations one
into another.

A. Endometritis

The typically healthy uterus passes imperceptibly into the
simplest type of metritis. The imperceptible line of demar-
cation between health and disease is as impossible to fix in
the non-gravid as in the gravid uterus. As previously
stated, there is almost always sufficient infection present in
the apices of the uterine horns to cause a definite necrosis of
the contiguous tips of the embryonic sac. It may be of suf-
ficient virulence to cause necrosis of the entire non-gravid
horn of the fetal sac. But it may not cause disease so far
as any marked peril to the embryo is concerned.

Clinically the non-gravid uterus physiologically runs such
a gamut that it is sometimes perplexing. For some days
prior to estrum the uterus becomes increasingly engorged,
until finally, when estrum is fully developed, the healthy
uterus is enlarged to approximately double its size when at
rest. After the ovisac ruptures, the engorgement slowly
subsides and the uterus regains its typical character of the
inter-estrual pause. The secretions change also. With the
advent of estrual engorgement there is an increased secre-
tion of mucus, but not notable. Most of the mucus of estrum

590 Diseases of the Genital Organs

emanates from the cervix — not from the uterus. Shortly
after ovulation, if conception does not occur, hemorrhage
ensues from the cotyledons (menstruation) which in pass-
ing out becomes incorporated with the mucus of the cervix.
The gradually increasing estrual engorgement requires two
to four days for its maximum development and a similar
period for its decline, so that of the twenty-one days usually
constituting the estrual cycle, the uterus is engorged in vary-
ing degrees approximately one-third of the time, and dur-
ing no two days is the engorgement the same. So it is with
infection. Bacteria may be present — commonly are present
— in considerable numbers without causing recognizable dis-
ease. The infection rarely remains static, but either ad-
vances to cause disease or is almost or wholly overpowered
by the uterus. After a heifer has failed to conceive, until
three years old or less, her uterus slowly loses its tone, en-
larges and becomes flabby. The same rule applies to the post-
puerperal uterus. If the cow fails to conceive with reason-
able promptness, the organ loses its tone (if it had recov-
ered its tone during the puerperal era), enlarges, becomes
flaccid, and drops far forward in the abdomen. Endome-
tritis becomes recognizable by the atony and the enlarge-
ment. By catheterization there is shown to be present in the
uterus muco-pus or, in the milder forms, mucus. The endo-
metritis may be due to infection extending from the cervix,
possibly originally coming from the bull through coitus, or.
as most frequently occurs, persisting in the uterus from the
puerperal period. The chief cause may reside outside the
uterus. Thus in nymphomania, while the disease is pri-
marily ovarian, due to a peculiar type of cystic degenera-
tion, endometritis is a constant result of the ovarian dis-
ease. Clearly the metritis needs to be referred finally to the
presence of bacteria in the uterus, but the ovarian disease
so disturbs the genital system as a whole that existing in-
fections which would otherwise be held under control gain
in virulence and cause harm.

The clinical evidence of endometritis is the recognizable
enlargement of the uterus. Palpated per rectum, the uter-

Endometritis 591

ine horns, enlarged transversely, elongated, and flabby, fall
over the pubic brim to lie upon the abdominal floor. In this
manner they drag the ovaries downward and forward. The
mesometrium loses its tone also and the entire genital group
hangs flabbily from the vulva. If the uterus is douched,
there returns in the fluid in many cases some mucus or muco-
pus. In the abattoir such a uterus is eighteen to twenty-
four or more inches long upon its greater curvature. Its
interior contains a little mucus streaked more or less notably
with pus. The uterine mucosa is thickened, turgid, and en-
gorged. Endometritis passes imperceptibly into pyometra.
Frequently there is found in an otherwise apparently healthy
uterus a few mils of pus somewhat mixed with mucus. In
other cases larger amounts of pus are encountered, until
finally the pus content is of such volume that the disease, is
described as pyometra.

Endometritis of moderate degree is not readily recogniza-
ble during estrum. At that time the flabby uterus partly
regains its tone and there is a flood of mucus which tempo-
rarily conceals evidences of disease. Endometritis is largely
associated with cervicitis at the vaginal end of the uterus,
and with salpingitis or ovaritis or both at the ovarian end.
That is, intra-uterine infection cannot readily be confined to
the uterus for a long period, of time. Since the tube is con-
tinuous, the infection tends to pass from the uterus into the
cervix and the oviduct.

The prognosis of endometritis in itself is good. When
proper handling is delayed and salpingitis has resulted, the
latter is virtually beyond control. So long as the endome-
trium preserves its integrity, endometritis is generally reme-
diable. While technically a mucous membrane can not be
disinfected without destruction, clinically the uterine mucosa
can be rendered sterile or essentially so. In my experience
it has been not only possible but quite practicable to disin-
fect the uterine cavity so far that, if the animal is slaugh-
tered ten to fifteen days later, attempts to grow cultures
from the uterine mucosa fail, while similar efforts with the
oviducts, which are beyond surgical reach, yield bacterial
growths.

592 Diseases of the (ie/iital Organs

The handling of endometritis may be direct or indirect.
The direct treatment consists fundamentally of douching
the cavity with suitable disinfecting fluids and introducing
into the uterus slow-dissolving agents which may serve to
repress bacterial growth. In my experience the compound
solution of iodine (Lugol's solution) in a strength of one
to two per cent, has yielded satisfactory results. The uterus
has a high tolerance for the drug (experimentally I have
used a ten per cent, solution) and it does not coagulate mu-
cus. Its color is such that muco-pus, when douched out in
the fluid, is readily observed as are most kinds of exudate
occurring within the uterus. Some have advised instead a
physiologic salt or soda bicarbonate solution, contending
that the mechanical douching out of the infection is prefer-
able to the use of a disinfectant. I can not agree with this.
Very good authorities claim that, in douching the uterus of
a woman, the fluid may force its way through the oviducts
to the peritoneal cavity. Possibly anaesthesia favors such
penetration. I have no reason to believe that any material
peril of forcing the oviducts accompanies the douching of
the bovine uterus, but the danger may be far greater than I
have suspected. In case of danger a neutral solution has by
far the greater peril because of its tendency to push the in-
fection undamaged into the oviducts and set up salpingitis.

There is always present the danger of puncturing the
uterus with the catheter. When this occurs, a few ounces
of Lugol's solution injected into the peritoneal cavity irri-
tate the peritoneum, there is quickly thrown out an abun-
dance of serum which dilutes the fluid, and it is soon re-
sorbed. If some infection is pushed into the peritoneal
cavity, Lugol's solution tends to neutralize it. but when a
salt or soda solution is used the infection acts unhindered.
I consideT that in all respects it is much safer to use a re-
liable disinfectant rather than neutral fluids when douch-
ing the post-puerperal uterus.

I have used other disinfectants, but have not seen my way
to adopt them. Dakin'a solution and similar chlorine-bear-
ing solutions have been tried but need to be used in very

Endometritis 593

weak solution and with great care. Phenol compounds are
generally too irritant. The sulphates of copper, zinc, and
iron coagulate mucus too promptly.

Of the slow-dissolving agents, iodoform and bismuth are
best known and render good service in many cases. Sus-
pended in oil, either or both may be introduced in a variety
of ways. The uterine syringe shown in Fig. 196 is a very
convenient instrument. By using the conical nozzle, the end
may be pushed into the opening of the uterine catheter and
the suspension injected through it ; by using the long curved
nozzle, the mixture may be readily injected directly into the
uterine cavity.

As a rule the treatment for endometritis should not be
repeated until two or three weeks have elapsed. When im-
portant disease exists in other parts of the genital system,
it should be handled vigorously along. with the endometri-
tis. Thus, if nymphomania is present, no degree of atten-
tion to the uterus alone will give relief. The cystic disease
of the ovaries should receive first attention, accompanied
by the proper handling of the uterus. Professor Hess has
also pointed out that dislodging a retained corpus luteum
arouses physiologic function of the entire genital system.
But that does not mean to press out the corpus luteum when-
ever found in connection with endometritis. If the cow is
regular in estrum or fairly so, the corpus luteum should be
let alone, but when the corpus luteum has persisted for
many weeks and inhibited estrum it should be pressed out,
so that its inhibitory power is brought to a close and estrum
will ensue. With estrum the uterus becomes physiologically
active, tending thereby to disinfect its cavity.

An animal having endometritis should not be permitted to
copulate. Coitus increases the endometritis, endangers the
bull, and generally prevents conception. Should conception
follow, the pregnancy is unsafe and may terminate in abor-
tion, premature birth, retained fetal membranes, or other
disaster.

38

594 Diseases of the Cienital Organs

B. Pyometra.

When pus in large volume is retained within the uterus,
the condition is designated pyometra. It passes by scarcely
discernible gradations on the one hand into endometritis,
and upon the other into sclerotic metritis. Pyometra is
used to designate not only the amount of pus formed within
the uterus but also the approximate degree of uterine atony
and hence the extent of retention of the pus within the uter-
ine cavity. There may be a considerable volume of pus
formed within the uterus, but the muscular coat retains its
function and almost immediately expels it into the vagina.
One frequently encounters several ounces of pus in the va-
gina, but upon douching the uterus finds but little within
that cavity. After making proper allowance for such pus
as may have been formed in the cervix or in the vagina
itself, the volume within the uterus compared with that in
the vagina expresses approximately the general tonicity of
the uterus and the extent of involvement of its various tis-
sues. If the pus lies almost entirely within the vagina, it
indicates that the disease is limited chiefly to the uterine
mucosa or endometrium and may therefore be designated
endometritis. If, however, there is comparatively little pus
encountered in the vagina, but most of it is retained within
the uterus, it is more appropriately designated pyometra.

The chief symptom of pyometra is the presence of a puru-
lent discharge from the vulva. The discharge may be pro-
fuse or scant, and in exceptional cases may be absent. A
discharge issuing from the vulva may emanate, aside from
the uterus, from the cervix, vagina, urinary bladder (and
through the bladder, from the kidney), and from other
sources. The pus discharged may vary infinitely in charac-
ter. It is usually fetid, often extremely so. It is generally
yellowish-white and thick. The pus of pyometra, as the
term is commonly applied, is not ordinarily mixed with
recognizable mucus because suppuration has supplanted
the formation of mucus in the mucous glands of the uterus.
In endometritis the mucus-secreting power of the uterus is
deranged but not destroyed. In some old cases the heavier

Pyometra

595

parts of the pus are precipitated in the lower portions of
the uterine horns while the more liquid parts escape through
the cervix and vulva. Thus there is formed a very dense, in-
tensely fetid, cheesy mass.

The discharge of pus may be constant or intermittent.
This is dependent chiefly upon the degree of atony in the
uterine walls and the obstruction offered by the cervix.
The pus from the uterus, passing over the cervical mucosa,
inevitably causes cervicitis, which in turn aggravates the

Fig. 184 — Pyometra with Granular Mucosa.
U, Uterine wall ; M, mucosa coarsely granular or nodular; C, cotyledon.

pyometra. The effect upon the cervix varies. Sometimes
the cervix becomes atonic and flabby with its canal dilated.
The pus then escapes freely from the uterus whenever the
uterine walls contract, or whenever the uterus is com-
pressed by contiguous viscera while the cow is recumbent.
In these cases there is often an escape of a large volume of
pus each time the animal lies down. When on the contrary
the cervix retains its muscular energy or, as shown in Fig.
185, extensive cervical sclerosis is present, the pus is re-

596

Diseases of the Genital Organs

tained in the uterus until such time as the intra-uterine
tension suffices to dilate the cervical canal, when the pus is
expelled in large volume, succeeding which days or weeks
may pass without purulent discharge. During the post-
puerperal period, as clinically designated, there may occur
pregnancy, the embryo or fetus may perish and be retained
and, as described under "The Infections of the Gravid Uter-
us", there may be established a persistent pyometra and the
pus may be mixed with blood. In rare cases very extensive

Fig. i n,5 -Pyometra. Median Section through Right Cornu.
/, Cervix with sclerotic walls ; .?, utero-cornual cavity
showing nodular mucosa.

Cow.

pyometra occurs without visible discharge. The uterus is
completely flaccid and paretic. It drops far forward into
the abdominal cavity and may lead to error in diagnosis, be-
ing mistaken for pregnancy.

The diagnosis of pyometra is usually simple. Upon in-
spection the vulva, tail and buttocks are soiled with pus.
If the animal is recumbent there is often a tell-tale mass of
pus lying behind her. Vaginal exploration generally reveals
fetid pus in its cervical end. Rectal palpation discloses a
distended, flabby uterus, usually with thickened walls. The
two horns are generally similarly but not identically filled.

Pyometra 597

and the contents may be pressed from the one into the other
horn. The contents are clearly less fluid than lymph or
mucus and are not at all like the fetal fluids. The uterus is
wholly wanting in the tone of pregnancy, no cotyledons are
present, and the uterine arteries are not materially in-
creased in volume.

The accuracy of the physical examination is greatly in-
creased by the application of traction through forceps fixed
upon the vaginal portion of the cervix. This brings the

Fig. 186 — I*yometra.

/, Vagina ; 2, cervix ; 3, cornual cavity filled with, pus ; 4, central corpus

luteutn of pyometra; 5 (insert) corpus luteum of pregnancy.

flabby uterus into or near to the pelvis and tenses it in a
manner which facilitates proper palpation.

The diagnosis is to be completed finally by douching the
uterus. If the case is exceedingly complex or the examiner
unfamiliar with the disease, he should be on the alert re-
garding the presence of a uterine seal. If this appears to
be present, he should study the case more in detail by rectal
exploration. He must not accept the history given by the
owner that the animal has not been bred since the termina-
tion of a prior stated pregnancy. Owners, however care-
ful, do not always know. The veterinarian must accept the
history given by the owner so long as it aids, but must not
be led into error. A false uterine seal occurs in cervicitis,

598 Diseases of the Genital Organs

and, while I have not seen the false seal in pyometra, it may
occur.

The cervix is frequently sclerotic and its canal difficult to
pass. Great patience is often required. First the dilators
should be carefully introduced and the cervix slowly and
liberally dilated. The complete dilation is valuable in diag-
nosis and essential in handling.

When the canal has been well dilated, the small uterine
catheter (Fig. 39) or far better the soft rubber horse cath-
eter or the seven-foot bull-douching catheter is to be intro-
duced. In most cases of pyometra the metal uterine cathe-
ter suffices for diagnosis, but in rare cases, when the uter-
us is unusually paretic, the pus is not douched out with the
catheter even though gallons be present. When fluid is in-
troduced through the metal catheter, it simply disappears
and is irrecoverable with that instrument. This should in-
dicate to the practitioner that he has erred in diagnosis and
is trying to douche a pregnant uterus, that he has erred in
technic and penetrated the peritoneal cavity, or that there
is extensive pyometra dragging the uterus far forward and
downward, and the douche has been added to the content.
Unless one undertakes the imprudent and perilous filling of
the flaccid uterus until it literally runs over, the diagnosis
must be made with the rubber catheter used as a siphon.
The cervix must be well dilated for this purpose, the uter-
ine dilators engaged in the fenestrum of the catheter, and,
with the cervix drawn well back with the uterine forceps,
the catheter introduced carefully through the canal into the
uterus. The catheter is held in place, the uterine dilator
withdrawn, and the catheter gently pushed onward as far
as may be prudent. It is then filled with fluid (salt solu-
tion, Lugol's solution) from an irrigator or otherwise by
gravity, and some of the fluid may be allowed to pass into
the uterus. The distal end of the catheter is to be com-
pressed firmly while completely filled with the fluid. It is
then lowered and the compression removed, when purulent
or other liquid contents siphon out. If the precaution is no1
taken to compress the catheter while elevated and filled with

Pyometra 599

fluid, and the uterus is very flabby, the fluid will drop into
the inert uterus and the siphon be destroyed.

The pathologic changes in pyometra have not been ex-
tensively studied histologically. As observed macroscopi-
cally, the uterine walls are thickened and somewhat sclero-
tic. In the abattoir, when examined on the killing floor, the
mucosa is usually of a dark bluish or bluish-black color,
roughened and showing evidences of partial destruction.
It is only very rarely that the mucosa has undergone total
necrosis. In many cases the mucosa is nodular or granular,
as indicated in Fig. 184. The elevations are pale yellow and
suggestive at first glance of tuberculosis. The most sug-
gestive element seen with the naked eye is the extensive
changes in the uterine mucosa, which will demand for re-
covery a comparatively long time. Brief and fragmentary
bacteriologic studies of pyometra indicate that the pus in-
fection is as varied as that of wounds. There is no evidence
to indicate that the bacteria present are specifically different
from those prevailing in wound infections.

The prognosis of pyometra must be based upon the inter-
pretation of the pathologic changes which are present.
The two immovable barriers to reproductive recovery are
total destruction of the endometrium and the extension of
the infection into the oviducts. Both conditions are diffi-
cult of positive recognition. The outlook for the life and
the general health of the patient is good, and if it may be
safely assumed that the uterine mucosa is not destroyed
and the oviducts not irremediably involved, the breeding
life of the animal can probably be preserved. The treatment
consists essentially of the dilation of the cervical canal, the
removal of the purulent contents, the disinfection of the
uterine cavity, and the removal of the corpus luteum, if
present. The dilation of the cervical canal, as advised
for diagnosis, suffices. The removal of the pus is best
accomplished by means of the seven-foot bull-douching
catheter with a hospital irrigator fitted with a stop-
cock. The catheter is introduced into the uterus as for
diagnosis and sufficient physiologic salt solution gravi-

600 Diseases of the Genital Organs

tated into the uterus to dilute some of the pus and
start the siphon. The distal end is then lowered and
as much of the pus as possible siphoned out. More
of the solution is then introduced and the siphon again
brought into play. The catheter should be pushed cautiously
as far into the apex of the horn as is safe. Heavy pus is to
be cautiously broken up by massage of the uterus per rec-
tum. It should be determined that both horns are being
emptied. Sometimes this may be accomplished by massage
with the catheter in one horn only. Sometimes it is essen-
tial to introduce the catheter into each horn. This may gen-
erally be accomplished by directing the catheter to the right
or to the left with the dilator when introducing it. The
catheter may also be directed into the horn desired by man-
ipulation per rectum. The douching should be continued
until the fluid siphons out clear. The uterus may then be
washed well with j 4 to 2 per cent. Lugol's solution and,
after this has been carefully siphoned out, there may be in-
troduced into the uterine cavity eight to sixteen ounces of
liquid paraffin holding in suspension one-half ounce each of
iodoform and bismuth.

If the pyometra is a direct continuation of infection from
the puerperal period, the corpus luteum of pregnancy is quite
certainly present and has sunk deeply within the ovary. In
most other cases of pyometra, a central retained corpus lu-
teum is present. Professor Hess first drew definite atten-
tion to the inhibitory action exerted upon the uterus by a re-
tained corpus luteum. While repeated douching of the uterus
may finally disinfect it, the dislodgment of the corpus lu-
teum with destruction of its inhibitory power constitutes a
great and essential aid. The dislodgment generally causes
cstrum with uterine engorgement and sharp tonic contrac-
tions which tend to expel pus and diminish the infection.
The technic of pressing out the corpus luteum has already
been discussed under "Central or Embedded Corpus Lu-
teum". The douching of the uterus should be repeated as
frequently as prudent, generally once in two weeks, some-
times more often. Coitus should be excluded as long as the

Uterine Abscess 60 1

pyometra is present and for several weeks thereafter until
the uterus has had an ample rest and has recovered its gen-
eral tone. Early copulation usually causes a recurrence of
the disease.

C. Uterine Abscess

Abscessation of the post-puerperal uterus occurs when
there is a virulent purulent infection within its cavity and
the cervical canal becomes closed by inflammatory adhe-
sions or from other causes. A different type of uterine ab-
scess has already been described under "The Infections of
the Gravid Uterus", in which the putrefying embryo or fetus
is the fundamental cause.

Post-puerperal uterine abscess usually follows badly
handled retention of the fetal membranes or other type of
metritis. It is most commonly one of the results of handling
retained placenta as a definite disease which is considered
as ended when the fetal membranes are supposed to have
been removed. The abscessation ordinarily becomes estab-
lished three to four weeks after the termination of preg-
nancy.

There are no outstanding clinical symptoms of uterine ab-
scess. The cow has usually experienced difficulty in calving
or aborting, and her recovery has been slow. Her general
condition is quite regularly bad, though a fair appetite may
remain and some milk be secreted. The chief clinical symp-
toms are not based directly upon the abscess itself, but upon
the involvement of other organs. If the abscess presses
upon, or points into, the urinary bladder, difficult urination
logically ensues. Later, if the abscess ruptures into the
bladder, the urine contains large volumes of pus. Most fre-
quently the uterine abscess involves the rectum and causes
adhesion to and stricture of the intestine, with difficult defe-
cation, ending finally with rupture of the abscess into the
bowel. The pus is later evacuated with the feces. After-
ward the rectal adhesion remains, as shown at 5 in Fig. 187,
and is readily recognizable upon palpation. When general
pelvic adhesions have not occurred, the diagnosis is ordinari-

602

Diseases of the Genital Organs

ly simple both during the existence of the abscess and, when
rupturing into the rectum, after healing has occurred. When
pelvic adhesions become general, the rupture of an abscess
into the rectum may still be accurately diagnosed, but owing
to the indistinctness of the adherent mass, physical exami-
nation can not determine whether the abscess was uterine or
parametritic. But in either case the breeding life of the
patient is closed so that accurate diagnosis is not imperative.

FlG. [87 — Abscessation of Uterus with Pelvic Adhesions.

Lettering includes that for iS;a.

/. Cervix ; 2, 2, 2, uterine and cornual abscesses; j, walls of urinary

bladder; ./, adhesion of uterine horn to bladder ; 5, adherent rectum

into which uterine abscess has ruptured ; 6, encapsuled ovary with

cystic corpus luteutn ; 7, thin girdle of lutein tissue.

There is no handling to advise for the restoration of the
breeding powers. There remains only the salvaging of the
animal for beef or possibly for a brief dairying period.
Even then there is little of value to do beyond directing good
general care and. where possible, advancing recovery by the
opening of the abscess instead of awaiting its spontaneous
rupture. I have opened the abscess when mature by thrust-
ing a finger through the rectal floor into the abscess cavity.

Absccssation of Uterine Siibmucosa 60 ■

Fig. 187a — For lettering see Fig. 187.

604 Diseases of the Genital Organs

The abscess can be prevented only by closely following cases
of metritis during the puerperal period and seeing that the
infection is not permitted to continue into the post-puer-
peral era.

D. Abscessation of Uterine Submucosa
I have in my collection an abattoir specimen of tiny ab-
scesses in the uterine submucosa, as shown in Fig. 188. The

FlG. i Ss Submucous Uterine Abscesses.
/, Vagina ; 2, cervix ; j, cornual cavity ; /, abscesses.

mucosa is thrown into numerous marked elevations which
when incised reveal an abscess the size of a very small pea,
containing thick yellowish-white pus. The walls of the ab-
scess are not very dense. The character of the disease, the
method of clinical diagnosis, the handling, and the progno-
sis are questions upon which no definite opinion can be ex-
pressed.

Sclerotic Metritis

605

E. Sclerotic Metritis.

Sclerosis of the uterine walls generally accompanies long-
continued metritis, but as a rule the sclerosis is not very
marked. There may be distinguished upon rectal palpation
a definite thickening and hardening of the walls, which does
not constitute an important factor in the prognosis and
handling of the disease. If the uterine mucosa is restored
to health, the sclerosis abates and disappears. There is,
however, an extreme type of sclerosis which is not rare and

Fig. 189 — Sclerotic Metritis with Pyometra.

/, Cervical canal ; 2, sclerotic annular folds of cervix pushing canal far

downward ; j, cavity of uterus and horn containing pus.

Uterine mucosa destroyed.

which it is important to recognize clinically. This type I
have designated as sclerotic metritis. It is characterized
by greatly thickened walls, one-half to one inch in diameter,
very dense and hard. A typical example is shown in Fig.
189. The disease is evidently the result of long-continued
intra-uterine irritation. It may be due to fetal retention,
as shown in Fig. 171. In the definitely post-puerperal cases
I have not been able to trace the disease to its fundamental
cause as all my examples are from the abattoir and hence
without clinical history. It appears fairly safe to attribute
the condition ordinarily to neglected or maltreated retained

606 Diseases of the Genital Oi'gans

fetal membranes, though any intense irritation should be
competent to cause it.

Clinically the symptoms are a constant, usually fetid uter-
ine discharge of limited volume. The sclerotic state of the
walls prevents sacculation of the uterus, with large accumu-
lations of pus, and renders the discharge essentially con-
stant. Clinical examination reveals pus in the vagina and,
by douching, in the uterus. Rectal palpation discloses an
enlarged, very hard, cartilage-like uterus, usually regular in
contour. The hardness is similar to that of some cases of
puerperal metritis, but the history of the recent termina-
tion of pregnancy serves to differentiate. In the latter case
the hardness disappears with the control of the metritis.
In all specimens in my collection the uterine mucosa is to-
tally destroyed and the breeding life of the animal definitely
closed. The condition does not visibly affect the general
health of the animal nor decrease the value of its carcass for
human food. There is probably very little, if anything, to
be gained by treatment.

F. Pelvic Adhesions. Parametritis
Parametritis with pelvic adhesions and abscesses is a
common result of intense intra-uterine infection. The extra-
uterine infections vary widely in origin. Unquestionably
some cases arise from the infection passing through the ovi-
duct and escaping into the peritoneal cavity. These, how-
ever, usually expend their energy in producing cystic de-
generation of the corpus luteum and adhesions of the ovary
in the pavilion of the oviduct and in the ovarian pocket.
This is elsewhere considered. Extensive pelvic adhesions
are the common result of non-mortal rupture of the uterus
with the escape of infectious material, or of the injection of
irritant antiseptics into the peritoneal cavity. Infection also
invades the genital peritoneum from the endometrium
through the muscle layers of the uterus and. having gained
the serous covering, involves by contiguity the adjacent per-
itoneal surfaces, and the contiguous surfaces adhere.

The most potent cause of pelvic adhesions and abscesses

Pelvic Adhesions. Parametritis

607

is the improper effort at removing an irremovable retained
afterbirth. In one herd where six cows had suffered from
retention of the fetal membranes and attempts had been
made by the attending veterinarian to remove them manu-
ally, I sent three (50 per cent.) directly to the butcher on ac-
count of pelvic adhesions and abscesses.

The clinical symptoms of pelvic adhesions and abscesses
are vague and inconclusive. There is ordinarily a history of
disease at the time of parturition, from which recovery has

Fjg. 190 — Adhesion of Uterus to Bladder.

V, Vagina ; B, urinary bladder ; U. uterus ; /, adhesive baud passing from

uterine horn to bladder.

been tardy and imperfect. The animal is rarely in good con-
dition and is generally emaciated, with a lustreless coat.
When the adhesions are quite extensive the movements of
the animal are careful, hesitant and stiff. The back is fre-
quently arched.

Clinical examination by palpation through the rectum dis-
closes adhesions of the uterus, oviducts and ovaries to the
pelvic walls, rectum, bladder, rumen, or other adjacent
structures. It is essential to accurate diagnosis that trac-
tion be applied to the cervix with the uterine forceps. This
affords the examiner a definite base (the cervix) from which
to extend palpation, and the tension brings out, if such re-
sult is possible, the contour, of the diseased uterus. Depend-
ing upon the degree of adhesion, the nature of the lesions

6o8

Diseases of the Genital Organs

may be more or less clearly determined. When very exten-
sive, the identity of uterine horns, oviducts and ovaries be-
comes lost in the adherent masses. Here and there may be
gross sclerotic masses which may with security be diagnosed
as sclerotic abscesses, but it can not be told whether the ab-
scesses are within the uterus or one of the uterine horns, the
oviduct, the ovary, or some intra-pelvic lymph gland or
other structure.

FlG. 191 — Pelvic Adhesions.

/, Cervix ; 2, cornu ; J ( insert 1 cross section of cornu with pus ;

./, cross section of ovary.

Pelvic Adhesions Parametritis

609

Fig. 192 — Extensive Pelvic Adhesions.

/, Uterine body ; 2, cornua ; 3, right ovary, completely encapsuled ;

4, right oviduct, cystic and adherent ; 5, corpus luteum in left ovary ;

6, cyst in corpus luteum

The disease is not amenable to treatment. The animal
should be slaughtered and the carcass used for food or other
disposition made of it according to conditions.

F. Pyemia. Arthritis. Abscesses of the Ductless Glands.

When the intra-uterine infection by its virulence breaks
down or renders non-resistant the protective epithelium of
the uterus, or an imprudent effort is made to remove the
fetal membranes and epithelial wounds or abrasions occur,
an inviting opening is made for the entrance of the intra-
uterine infection into the blood or lymph capillaries, whence

39

610 Diseases of the Genital Organs

it gains the general circulation and may be carried any-
where. In the puerperal period observations upon such in-
vasions of the body fluids by bacteria from the diseased
uterus are limited to the profound sepsis induced, which
generally destroys the life of the patient. If the invader is
less virulent, its effects are not immediately recognized be-
cause the uterine disease is so pronounced that it over-
shadows all else. Later when a small volume ol infection
or infection of only moderate virulence enters the blood
stream, it may finally become lodged in some remote organ
or tissue, establishing lesions and inducing symptoms not
directly referable to the infected genital tract. The conclu-
sion that such lesions are referable to intra-uterine infec-
tion is based upon the fact that they are common in associa-
tion with genital infections but are otherwise rare in cows.

Pyemia of genital origin may occur at almost any period,
probably most often during the puerperium, but, as already
noted, it may then pass unobserved. It is most frequently
observed during the interval following the puerperal period
after the close of one pregnancy up to the date of the next
conception. Generally the clinical symptoms become obvi-
ous at from three to six weeks after the close of pregnancy.
I have observed it in pregnancy while the metritis of preg-
nancy was laying the foundation for abortion which oc-
curred a few weeks later.

In cattle pyemic arthritis is the most striking and fre-
quent type of pyemia due to genital infection. It may in-
volve any joint in the body, but is most frequently seen in
the stifle or femoro-tibial articulation ( pyemic gonitis) . The
lameness is usually intense, but may be of any degree.
There is usually distinct swelling, most readily detected as
a rule at the median side of the femoro-tibial articulation,
or revealed by the distension of the femoro-patellar syno-
vial bursa. Heat and pain upon pressure are usually recog-
nizable by palpation. The uterus shows the presence of in-
fection or there is a definite history of the existence of geni-
tal disease in the recent past. When involving other articu-
lations the symptoms are essentially analogous to those when
tht si ifle is affected.

Pyemia. Arthritis. Abscesses of the Ductless Glands 611

The outlook for recovery from pyemic arthritis is very
poor. Potassium iodide internally has given apparently
good results in some of my cases, but it must be used with
great caution because of the high susceptibility of cattle to
iodine. If pus forms and samples can be aspirated for cul-
tures, autogenous vaccines are worthy of trial. Locally
little can be accomplished. The inflamed articulation may
be fomented or blisters may be applied. Should the presence
of pus be positively diagnosed, it may be aspirated and the
cavity refilled with 20 per cent. Lugol's solution in water or
glycerine. If an abscess forms, it should be opened freely
and the cavity packed with gauze saturated with tincture
of iodine mixed with glycerine, or with some other suitable
disinfectant. Movement of the joint should be restrained in
any manner available.

The uterine cavity, if still an active center of infection,
should receive proper attention. The general care or ine
animal should be of the best.

Abscesses of the liver and other glands are occasionally ob-
served during or subsequent to severe uterine infection.
The clinical symptoms of such abcesses are vague and gen-
erally fail to afford secure ground for diagnosis. The domi-
nant symptom generally is that of ill health with gradual
emaciation. Should the abscess rupture externally, as some-
times occurs when located in the liver or kidney, diagnosis
may be possible. The alert practitioner should always sus-
pect pyemic disturbances when ill health follows the termi-
nation of pregnancy, and should make the most careful
search possible for pyemic abscesses. In such cases labora-
tory examination of the blood is highly important and should
not be neglected.

H. Cystic Degeneration of the Uterine Walls
with Hydrometra.

Hydrometra, or distension of the uterus with liquid, is not
common and is dependent upon a variety of causes. It has
already been noted that mucus and menstrual debris may be
retained in and distend the uterus when the cervical canal

612 Diseases of the Genital Organs

has failed to open, owing to an arrest in the development of
the embryo. It has likewise been stated that, when the hy-
men remains imperforate, the accumulation of mucus and
menstrual debris eventually forces the cervical canal and
distends the uterus. Various changes in the cervix may

Fig. \u\ Cystic Degeneration of Uterine Walls with Excessive

Hydrometra. Uterus contained about 10 gallons of lymph
/. Cervix; 2, cavity of left horn, right in shadow; ,■ (insert) section of
jtic ovary. (Insert, below J Enlarged section of wall (photograph.)

cause a retention of the uterine discharges. It will also be
shown, while dealing with the diseases of the vagina, that
atresia resulting from vaginitis dams back uterine and
cervical secretions and distends the uterus with fluid.

Cystic Degeneration of the Uterine Walls with Hydrometra 613

It is desired here to describe a disease of the uterus
itself resulting in the formation of a large amount of fluid
which is passively retained within the uterine cavity. I
have seen clinically several cases in which the cervical canal
was free and readily admitted the catheter, while the uterus
contained a large volume of clear, odorless, watery fluid.
I have been able to secure the uterus of one of these cases,
illustrated in Fig. 193. This valuable cow had long been
sterile. Upon examination I found the uterus greatly en-
larged, flabby, and dropped far forward so that only the
cervical end could be palpated. No cotyledons were palp-
able and the uterine arteries signified non-pregnancy. The
cervical canal, which was open, though the insertion of the
metal uterine catheter caused but little fluid to escape, was
gently dilated. I introduced a rubber horse catheter and,
using it as a siphon, obtained a large amount of clear,
watery fluid estimated at ten gallons. A few weeks later
I siphoned out about five gallons more. A colleague re-
moved the fluid several times, but there was no improve-
ment and the cow was slaughtered. The uterus was greatly
distended at time of slaughter, showing that the fluid was
quickly renewed. The uterine mucosa, as shown in Fig.
193, is filled everywhere with small transparent cysts. The
normal mucosa has disappeared completely. The fluid con-
tents of the uterus apparently emanated from the cystic
degeneration of the mucosa. So far as known, the disease
is beyond remedy, at least in so far as reproduction is
concerned.

This condition may be responsible for a few of the ex-
treme cases of pyometra I have cited. They might very
well have been identical at first with the case just described,
and colleagues, having unsuccessfully attempted to douche
the uterus, may have carried infection into the vast re-
servoir of fluid and converted the hydometra into pyometra.
The only important element in connection with hydrometra,
according to my observation, is an accurate diagnosis.
Slaughter should follow.

614 Diseases of the Genital Organs

6. Cervical Infections

A. Cervicitis

A careful study of the anatomy of the bovine cervix, as
described on page 33 and illustrated by Figs. 15 and 16,
shows it to be an extremely complex organ, admirably
adapted, at first glance, to act as an important barrier be-
tween the copulatory segment of the genital tube — the
vagina — and the nutritive area in which the embryo is
destined to develop — the uterus. If, however, infection
gains a foothold within its intricate mucous folds, what
appears at first as a highly efficient barrier becomes a very
serious hiding-place for bacteria. The cervix is one of the
most important areas of the entire genital system in re-
lation to serious infections. The cervix of the cow rarely
fails after two or more pregnancies to show at its vaginal
end clinically visible lesions. The changes are so nearly
universal that the milder types of disease constitute the
"normal" cervix of anatomists. The vaginal end of the
cervix of the ordinary virgin heifer should, I believe, be
taken as the standard for that part of the organ and any
material departure from that type regarded as pathologic.

Prior to pregnancy the cervix of the heifer has received
little clinical study. It is difficult to bring it into convenient
position for visual inspection without using an undesirable
amount of force. Until the heifer has failed to conceive
after repeated coitus, she is assumed to be free from genital
disease. After such failure to conceive, if a veterinarian
makes an examination, he frequently finds the cervix dis-
eased. As a rule, however, the disease has not notably
modified the vaginal end of the cervix, so far as can be seen,
the exterior appearing sound, but disease of the deeper parts
of the cervix is recognized by instrumental examination of
the cervical canal. After the termination of pregnancy by
parturition or abortion, changes occur in the vaginal end of
the cervix, readily seen upon clinical examination, which
profoundly alter its appearance and character. The mosl
striking changes are delineated in Fig. 194. in which it is

Cervicitis

615

shown that with breeding the cervical mucosa becomes tume-
fied, and hypertrophied, and finally portions of it evaginate
through the os uteri externum. The prolapsed portions
are described by anatomists as the lips of the cervix. As a
matter of fact they are the hypertrophied rugae of the first
annular fold of the cervical mucosa and are not visible in
the healthy virgin heifer. The actual os uteri externum,
covered with vaginal mucosa, is forced aside by the hyper-
trophied first annular ring. The true lips of the os uteri

&$& H ^p

Fig. 194— Vaginal Ends of Cervices.

Numerals indicate lips of original os uteri externum ; letters signify

protrusion of the first annular folds in varying degrees.

In /, 2, and 8, the fold does not protrude.

externum finally form a pale-colored girdle about the base
of the prolapsed portion of the cervical mucosa. Here,
often one to several inches from the vaginal extremity of
the cervical canal, the pavement epithelium of the vagina
ends and the cervical epithelium with its intricate and ela-
borate mucous glands succeeds. The secretions of the two
areas are wholly unlike. The protruding cervical mucosa,
like that remaining within the cervical canal, takes the
leading part in the elaboration of the thin mucus of estrum
and, in pregnancy, of the uterine seal.

616 Diseases of the Genital Organs

Cervicitis is the result of bacterial invasion of the cervical
mucosa. The origin of the infection and its date of invasion
have not been fully determined. Clinicians know well that
heifers conceive with greater difficulty than cows. That is,
the average number of copulations essential to pregnancy
is greater by 50 to 100 per cent, than is required for cows.
There is present some form of temporary interference with
conception, which is ultimately eluded and pregnancy en-
sues. As a rule, also, abortion and retained fetal mem-
branes occur in heifers in first pregnancy 50 to 100 per
cent, more frequently than in cows. These two conditions
we know are referable to an infection radiating from the
cervical end of the uterus, and it appears quite justifiable
to conclude that in those cases where recognizable fertiliza-
tion has failed these conditions are parallel. Either the
cervicitis present inhibits fertilization for a time, or fertili-
zation occurs and the cervical infection works destruction
so promptly that estrum recurs in its regular cycle or at a
later date.

When clinical examination of a sterile heifer is made,
ovarian or tubal disease is recognized in only a minority of
cases. When exploration of the cervical canal is undertaken,
it is found abnormally tortuous and difficult of passage be-
cause the bases of the mucous folds have become sclerotic
and hypertrophied. Probably there is a bit of muco-pus in
the cervical canal. The diagnosis of cervicitis is unescap-
able, but its source and the date of invasion are not wholly
clear. I cannot logically separate the source and date of
invasion in these cases from those of abortion and retained
fetal membranes. The undeniable clinical fact, that, in a
herd well saturated with genital infections, the heifers abort
50 to 100 per cent, more frequently than cows, though all
are kept under identical conditions in the same stable or field
and are bred to the same bull, testifies that the heifers ar-
rive at breeding age with the infection resident in the
cervix. That is, if in a given herd the observed rate of the
expulsion of fetal cadavers in cows is 10 per cent, and in
heifers 20 per cent., though kept and bred alike, at least 50

Cervicitis 617

per cent, of the heifer abortions should be attributed to
causes existing at conception. Analogous conclusions must
follow regarding cervicitis causing sterility. There are
then three outstanding causes of cervicitis :

1. In cervicitis existing when the heifer reaches puberty,
present observations indicate that infection existing at this
date is referable to invasion of the fetus or of the calf dur-
ing the nursing period, which will be discussed under
"Congenital Infections of Calves."

2. Coital transmission of infection by the bull. This
has been discussed while considering genital infections of
bulls. In one large herd where intense cervicitis involved
over 60 per cent, of the cows, treatment was of little avail
until finally the bulls were examined, slaughtered, and
healthy bulls substituted. The bull is frequently the chief
and by far the most important infection-bearer.

3. Imprudent handling of cows for sterility. I have
observed some very intense outbreaks where the spread of
the infection appeared to be due to the veterinarian who
was handling the cows for sterility. Those veterinarians
who have led themselves to believe that in the post-puer-
peral period it is safer and more effective to douche the
uterus with 0.6 or 0.7 per cent, soda or salt solution, if
they do not sterilize their uterine catheters or other in-
struments before using upon each cow, constitute a serious
peril to the animals they handle, and, so far as I have been
able to understand some outbreaks I have seen, frequently
do incalcuable harm.

Once the infection has become implanted, the chief ele-
ments in intensification are coitus and parturition (or abor-
tion.) I have douched the uteri of several cows two, three
or more days after coitus, and have always obtained muco-
pus in the returned fluid. Whether this is the invariable
rule, I do not kow. The same cows do not have such muco-
pus without coitus. It is not the effect of estrum.

The influence of parturition or abortion upon cervicitis
is very marked. The contractions of the uterine walls force
the fetus against the cervix and push its walls apart. The

618 Diseases of the Genital Organs

force causes a rent in a diseased part already infected in
many cases. More frequently the force abrades the mucous
membrane, affording innumerable openings to bacterial in-
vasion. The peril is frequently accentuated by the presence
of metritis, often with retained fetal membranes which
undergo decomposition so that the cervix is submerged by
infective discharges and putrefying membranes. Under
these conditions each parturition leaves its mark upon the
cervix.

The simplest clinical evidence of cervicitis is a swelling of
the first annular cervical ring, which pushes the margins of
the lips of the os uteri externum apart, so that the ring be-
comes visible lying within the cervical canal, deeply injected
and bright scarlet or dark red in color. Next appears the
prolapse or ectropia of the first mucous ring through the os
uteri externum. As the annular ring prolapses farther and
the infection increases, the longitudinal foldings of the cer-
vical mucosa become increasingly evident, and the hyper-
trophied mucosa of the annular cervical fold evolves into an
encircling series of club-shaped tumors. The second an-
nular ring may participate. Finally the hypertrophy may
become very gross and the tumefied cervical mucosa pro-
trude out into the vagina like a cauliflower, four, six or
more inches in diameter, scarlet or dark red in color, and
highly vascular, bleeding at touch. The extremes are illus-
trated in Fig. 194 and in Colored Plate VI. Between these
extremes every possible variation appears.

The cervical secretions in cervicitis are as variable as
the tumefaction and hypertrophy. If two or more pairs of
uterine forceps are fixed upon the cervix, traction applied,
and the forceps handles spread apart, the vaginal portion
of the cervix, as a rule, is brought freely into view, and the
inflamed cervical mucosa is open to visual examination. In
the milder types illustrated in Fig. 194. no secretion of
notable character is observed. It' the visual examination is
supplemented by inserting the dilator into the cervical canal,
and the jaws are opened, there may ooze out between them
a drop or two of muco-pus. It the uterine catheter is in-

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Cervicitis

619

troduced and exploratory douching attempted, the first fluid
to return is probably a mil or two of muco-pus which has
been caught in the fenestrum of the outer catheter tube as
it passed through the cervical canal.

As the intensity of the disease advances, there appear
two divergent types of secretion — mucous and purulent.
That of the mucous type, in its extreme form, is represented
in Colored Plate VI. The cervical glands in the mucosa of
the great angry red tumor secrete a viscid, tough mucus re-
sembling in varying degrees the uterine seal. It may be

Fig. 196 — Uterine Syringe with Conical and Curved Nozzles.

softer or more resistant than the seal. I have met clin-
ically cases where the secretion was so voluminous and its
resistance so great that it defied my efforts at passing
dilator, catheter, or other instrument through the cervical
canal into the uterus.

In the purulent type, in sharp contrast to the preceding,
abundant pus is formed, chiefly in the vaginal end. The pus
accumulates in varying quantities in the cervical end of the
vagina, from which it is intermittently expelled. The pus,
ordinarily offering nothing remarkable in character, is gen-
erally thin and is yellowish or grayish white. Sometimes it
is very fetid; sometimes non-fetid.

620 . Diseases of the Genital Organs

The intensity of the disease at the vaginal end of the cer-
vix does not furnish a reliable criterion regarding the state
of the cervix in its more anterior portions. Any or all of
the annular mucous folds may be involved, resulting in the
elongation of the free, projecting portion, with sclerosis of
the base of the fold. The swollen free margin projecting to-
ward the vagina fills the canal and interferes with the pas-
sage of the catheter or other instrument, partly by the direct
filling of the canal, but chiefly by the elongated mucous folds
projecting vaginalward, behind which the catheter becomes
engaged. The sclerosis of the base of the annular folds is
one of the commonest and most striking lesions in cervicitis.
When marked, as illustrated in Fig. 189, the sclerotic base
pushes the canal out of its course and forces the opposite
wall of the cervix to yield. The sclerosis thus causes the
cervical canal to bend with varying degrees of abruptness,
dorsalward or ventralward, to the right or to the left, ac-
cording to the location and extent of the sclerosis. Some-
times the fourth or last annular fold at the uterine end be-
comes sclerotic, and, pushing in the direction of least re-
sistance, forms a cone projecting into the uterine cavity,
which, acting as a collapsing valve and imprisoning men-
strual debris, causes uterine distension. Little is known of
the histo-pathologic changes in the cervix. The scanty
studies show that generally there is desquamation of the
external epithelial strata with desquamation of the epithe-
lial lining of the mucus, or, as they might be termed in preg-
nancy, the seal-secreting glands. The desquamation of the
general cervical epithelium tends constantly toward adhe-
sions between the contiguous denuded surfaces, but the reg-
ular physiologic discharge of uterine secretions, especially
at the estrual period, counteracts, at least as a rule, complete
cervical atresia. I have not observed, clinically or in the
abattoir, a complete obliteration of the cervical canal as a
direct result of cervicitis. I have observed clinically three
or four cases, always in heifers in first pregnancy, of adhe-
sions between contiguous denuded surfaces of the first an-
nular ring, which so narrowed the cervical canal as to ren-

Cervicitis 621

der parturition impossible without surgical interference, but
in no case hermetically sealed the canal. I have seen com-
plete atresia of the cervical canal only in uterine abscess un-
less the arrest in development of the cervix in the embryo,
in which the canal fails to become excavated, may be called
atresia.

The bacteriology of cervicitis, in any reliable measure, is
yet to be learned. Thus far the chief invader recognized is
the streptococcus viridans. There is doubtless a wide varia-
tion in bacteria. In purulent cervicitis the streptococcus
viridans is probably not the real offender. In histologic
section of the inflamed mucosa, bacteria are abundant,
especially within the mucous glands, where they mingle with
the epithelial debris.

The prognosis of cervicitis is dependent upon its in-
tensity, type and duration. In itself, cervicitis is gen-
erally remediable, but, if intense and neglected, the in-
fection tends to invade the oviducts and pass beyond surgi-
cal control. Many cases recover spontaneously or are of so
mild a type that the disease does not prevent conception. As
a rule, cervicitis of moderate or great intensity either de-
lays or prevents conception. The exact method by which it
interferes with conception has not been fully determined.
In certain extreme cases the profuse secretion of tenacious
mucus apparently entangles the spermatozoa and inhibits
their migration to the oviduct. In some cases the bacterial
toxins present probably disable and eventually destroy the
spermatozoa, but in a very large measure the copious secre-
tion of mucus during estrum floods the cervical canal and
vagina, washes away or submerges the bacteria, and serves
as a protective bridge over the infected mucosa, in which
the spermatozoa may move freely and safely.

The greatest danger from cervicitis apparently arises
after fertilization. Then the infection tends to inhibit the
prompt physiologic sealing of the canal and is free to attack
the embryo immediately it arrives in the uterine cavity.
Cervicitis is the fundamental lesion in abortion and re-
tained fetal membranes. In all recorded cases of autopsy

622 Diseases of the Genital Organs

following abortion, in which the location of the endometritis
is stated, the abortion-causing metritis has radiated from
the cervical end of the uterus. This has been illustrated in
Fig. 174 and in colored Plates III and IV. Clinically there
is found an unsealed cervical canal with pronounced cervi-
citis and the embryonic sac necrotic at its cervical end.

Cervicitis is not an absolute barrier to pregnancy even
when severe. It is not rare to find severe cervicitis, with
engorged, angry-red and swollen mucosa, when the animal
is pregnant and to all appearances safe. In three instances
I have observed purulent cervicitis at the vaginal end with
copious suppuration and with a pint or two of fetid pus in
the vagina, though the cow was pregnant and calved suc-
cessfully. But in such cases the suppuration was confined
to the vaginal end of the cervix while the uterine end was
successfully resisting the threatened invasion and the an-
terior end of the canal was securely sealed.

Cervicitis is seen in cows of all ages. Severe cervicitis
with great cervical hypertrophy often abates ; the cervix
retains its hypertrophy, but the inflammation ceases and the
cow breeds safely.

The handling of cervicitis is essentially a problem in dis-
infection. As in wound infection, so in cervical infection,
the best results demand prompt and skillful handling. The
inevitable cervicitis of retained fetal membranes and other
forms of metritis accompanied by suppuration should be
given careful attention during the puerperal period, and
the disease not permitted to persist into the post-puerperal
era. At this time the chief weapon against the cervicitis is
the removal of the source of the irritation by properly
handling the metritis. The same is true of many cases of
cervicitis existing at other periods: if uterine disease is
present, its control must precede the direct handling of the
malady.

In the milder types of disease, if 2 per cent, of Lugol's so-
lution is used to douche the uterus, the remnant of the fluid
left in the cavity trickles out through the cervical canal, and
in many case suffices to disinfect it. It is inadvisable to

Cervicitis

623

trust to this. I find it best as a rule in the mild and moder-
ately severe cases to swab the cervical canal throughout its
length with full strength Lugol's solution. For this purpose
I use the uterine dressing forceps. (Fig. 39, 3.) With these
I secure as large a piece of absorbent cotton or gauze as can
readily be pushed through the canal, saturate it with the so-
lution, and pass it through the length of the canal, revolving
the swab to and fro in an effort to touch every part of the
mucosa. Where the cervical mucosa is badly denuded, the
application causes necrosis of the superficial layers of epi-
thelium and arouses a marked reaction in the tissues. When

Fig. 197 — Cervical Abscess.
/, Cervix ; .?, abscesses ; j, hydrosalpinx.

the thin pellicle of dead cells is thrown off, a rapidly-healing
surface remains. A second application may be made in
three weeks if it appears desirable. If the case is not too
severe, the swabbing commonly gives satisfactory results.
In some instances the cervicitis will respond better to the
application of a 10 to 20 per cent, silver nitrate solution.

When discussing the instrumental examination of the
cervical canal on page 99, warning was given that the ex-
aminer should proceed with great caution in passing instru-
ments through it. This becomes of special importance where
the cervical canal is seriously infected. The cervicitis, often
rendering the passing of a sound or catheter exceedingly
difficult, invites accident and the infection present, which is

624

Diseases of the Genital Organs

naturally pushed into any wound, greatly intensifies the
danger. In the worst cases of injury a vast phlegmon de-
velops in the pelvic areolar tissue, imperiling the life and
destroying the value of the animal. In lesser injuries, like
those depicted in Figs. 197, 198 abscesses occur. These in-
fected centers develop about them highly resistant, sclerotic
abscess walls which remove or diminish the peril to life but
are generally beyond practical repair so far as breeding is
concerned.

jI(, 19S— Cervical Abscess from " Opening the Womb." Ventral Side.

/. Cervix; z, abscess with sclerotic walls ; ,\ cross section of healthy

uterine cor nua in shadow. The main volume of cervix, uterus,

and cornua lie behind 1 above) the abscess.

When severe purulent cervicitis exists in pregnant cows,
it should be handled chiefly by vaginal douches, consisting
of 1 1 per cent, of Lugol's solution, chlorazene, or other
equivalent. No radical attempt should be made to eliminate
the suppuration, but an effort made gently to ameliorate it
until the close of pregnancy, when the disease may be '-
tacked with ample vigor.

Tracheoplasty 625

When a fissure occurs in the cervix at time of parturition,
the injury commonly passes unseen until faulty healing has
occurred with a troublesome cicatrix. Sometimes the seri-
ousness of the cervicitis is caused by the imprudent use of
the scalpel to overcome dystocia falsely diagnosed as being
due to atresia or stricture when in fact the cervix is normal
and fails to dilate because the uterus is atonic owing to the
presence of infection. In such instances there is often a
false impression of recovery, the cervix healing with a bad
cicatrix which invites serious cervical infection.

Numerous cases of severe cervicitis without a history of
fissure or incision, which will not yield to the application of
disinfectants, demand for satisfactory handling surgical in-
terference.

Tracheoplasty

Tracheoplasty is indicated in refractory cervicitis and
when there are structural changes which cause sterility,
either directly or by reason of such lesions as cause the cer-
vix to be more prone to disease. Tracheoplasty in itself
plays little part in cervical surgery of the cow, but certain
plastic procedures, intrinsically involved in all cervical sur-
gery, play a very important role in the attaining of satis-
factory results. Tracheoplasty is intended to restore the
cervix as nearly as possible to its normal morphology and
tissue condition. Since most of the cases of cervicitis
result directly from injury or from the succeeding inflam-
mation, the subject is largely covered under succeeding
heads. Where there is an inflammatory process of the mu-
cosa and muscular walls, it has been my experience that a
simple tracheoplastic operation does not give satisfactory
results and in its stead a partial trachelectomy should be
performed.

A marked hypertrophy or elongation of one cervical lip
may call for amputation of this portion. In this case a cir-
cular incision is made through the mucosa around the base
of the elongated lip, and at either side of the base an in-
cision is directed at such an angle into the fibromuscular
tissue that they converge to excise a wedge-shaped piece of
40

626 Diseases of the Genital Organs

the latter tissue. With No. 2 or 3 chromatized catgut, the
endocervical and vaginal mucosa are brought together with
interrupted sutures.

Trachelorrhaphy

The treatment of lacerations of the cervix, although in
general it has received little consideration, is a subject
having no little importance. At the time of parturition,
most cows receive at least minor lacerations or epithelial
abrasions, and a certain percentage of these, dependent upon
the degree of infection present, ultimately develop an endo-
cervical inflammation (See Fig. 199).

Repair of epithelial lacerations should be secured within
a short time after parturition, before inflammatory pro-
cesses have arisen or healing occurred by cicatrix. Such
repairs are almost wholly limited to the region of the first
cervical fold and the parts posterior to it.

In order to remedy such injuries the cervix is retracted
into the vaginal introitus, using strong vulsellum or tenacu-
lum forceps, placed in such a manner as to prevent any en-
docervical injury. The cervix may further be brought into
view by the use of one or more cervico-vaginal speculums,
which serve to push aside the vulvar lips. The cervical lips
are now spread apart, exposing the laceration; if the lips
are much constricted, forming a very small os, the first fold
may be retracted gently with a pair of small tenaculum for-
ce] is and everted slightly to expose the laceration sufficiently
for repair. Using a No. 4 half-circle Mayo catgut needle,
or similar pattern, with No. 0 or No. 1 catgut, the lacera-
tion is closed with either an interrupted or a continuous
suture, but the former will secure a better coaptation in
most cases. The needle is usually best passed through both
margins of the wound at once, from the side which is most
accessible, turned upon its long axis, and the point brought
sufficiently into view that it may be grasped by the needle
holders. Greal care must be taken not to tear the mucosa,
since the replacement of the sutures becomes extremely
difficult. For this reason, the Mayo cervix needle is prefer-
able to others, as it punches rather than cuts a hole. All

Trachelorrhaphy

62"

sutures should be forceps-tied because the suturing is usu-
ally so much within the vaginal introitus or cervical canal
that digital tying exerts too great a strain upon the mucosal
margins.

Tears or lacerations of the cervical lips heal more rapidly
than do those of the endocervix at or anterior to the first
fold. The endocervical mucosa on one side and the vaginal
mucosa on the other soon become fused, with the formation,
however, of considerable eschar tissue. This causes a gap-

FiG. 199 — Laceration of Lips of Cervix Uteri.

/, Vaginal mucosa ; 2, vaginal aspect of cervical lip ; 3, endocervical aspect

of lip ; /, intensely inflamed first annular fold. On the right side are

shown the margins of an old laceration, the posterior angles of

which are held apart by the lower forceps.

628 Diseases of the Genital Organs

ing of the lips with a partial eversion of the first fold, or,
if this fold becomes inflamed, a severe ectropia results. It
is of considerable importance that the normal tissue rela-
tions be maintained or restored, since upon this is depend-
ent to a great extent the future health and physiological fit-
ness of the utero-cervical canal.

The cervix is retracted, as in the former case, well into
the vaginal introitus and tenaculum forceps placed on either
side of the laceration. The margins of the wound are de-
nuded, taking care that fresh surfaces are left in each layer
of mucosa and in the fibro-muscular layer between. All
cicatricial tissue is removed. The surfaces denuded must
be left smooth and even in order to attain a satisfactory
coaptation. When making the denudation, trachelorrhaphy
scissors are found very helpful.

The denuded area on each side presents an inner layer of
endocervical mucosa, an outer layer of vaginal mucosa and,
between these, the dense fibro-muscular tissue. A correct
coaptation of mucosa to mucosa must be obtained. Begin-
ning at the anterior commissure of the wound, interrupted
sutures are placed at intervals of about one-quarter inch.
These are inserted by directing the needle inward through
the vaginal mucosa near its margin on one side, and, after
penetrating deeply into the fibro-muscular tissue, bringing
it out at the margin of the endocervical mucosa without
penetrating it. This order is reversed on the other side of
the laceration. The suture is tied firmly and cut off. leaving
an inch or two of its end so that it may be readily picked up
at a later date for removal. The sutures are thus continued.
at about one-quarter inch intervals to within about one-half
to three-quarters of an inch from the posterior margin of
the lips, where one suture is placed at right angles to the
preceding: that is, piercing the mucosa of the posterior edge
of the lip about one-eighth inch from the edge of the wound,
the needle is directed, anteriorly, deeply into the fibro-mus-
cular tissue, and emerges midway between the endocervical
and vaginal mucosa about one-half to three-quarters inch
anterior to the os. It is passed then in the reverse order

Trachelorrhaphy 629

through the opposite margin of the laceration. This suture,
tied firmly on the posterior margin of the os, prevents gap-
ing of the lips.

Care should be taken that none of the sutures penetrate
the endocervical mucosa because, should this occur, they will
not become buried and a complete healing of the endocervi-
cal mucosa by first intention can not occur. If the sutures
are properly placed they may be removed after ten to fifteen
days without injury to the endocervix. It is important to
bear in mind also, in the attainment of correct coaptation of
surfaces, that the margins of the laceration must be smooth
and straight and that a puckering of the opposing margins
must be prevented.

The fibro-muscular tissue of the cervix is very tough, and
sometimes difficult to penetrate. When suturing this tissue,
a very strong needle with a sharp cutting point is required.
Ferguson's abdominal needles, Dibrell's needles, and Dr.
Howard Crutcher's perineum needle have been found to be
well adapted for this.

When it is desired to use the perineal needle, it should be
threaded with one end of the suture quite short and passed
from the inside, between the endocervical mucosa and fibro-
muscular tissue, outward through the latter and the vaginal
mucosa. The short end of the suture is now caught and the
needle, still threaded, is withdrawn and passed in the same
manner through the opposite margin of the laceration,
whence it is withdrawn unthreaded.

Lacerations through the fibrous structure of the cervix
cause a gaping of the wound, to control which the sutures,
as above described, are subject to considerable tension. A
non-elastic suture such as braided silk is usually the most
suitable. The size of the suture material should be such
that the desired parts can be firmly and permanently
brought into apposition. For the posterior margin of the
lips heavier suture material than for the other portions,
usually No. 4 to No. 8 braided silk, is used. Catgut used
in this region is generally very unsatisfactory, as its elas-
ticity permits the apposed margins to separate sufficiently

630 Diseases of the Genital Organs

that coaptation ceases. When the tear of the lip is very
long, it will not be found advisable to tie the first sutures
until several of them have been placed and it is ascertained
that the margins will not pucker. When a simple dilation
of the lips occurs, without trace of longitudinal laceration,
the lumen is narrowed by the excision of a wedge-shaped
segment from a convenient location in the circumference of
the lip. The piece excised must be of such size and shape
that, when the denuded surfaces are brought together, the
tissue relation is maintained and the organ is restored to as
nearly its normal appearance as possible. The segment is
best removed with right and left trachelorrhaphy scissors,
after which the wound is closed as previously described.

Trachelectomy

The term trachelectomy is used here to denote various de-
grees of cervical amputation. Different conditions of the
cervix call for a somewhat varied type of trachelectomy and
tracheoplasty. Before attempting trachelectomy, the oper-
ator should make himself thoroughly familiar with the nor-
mal structure of the cervix. The operation should accom-
plish the removal of all diseased cervical tissue and attain
as complete a tracheloplasty as possible. Care should al-
ways be taken to protect the healthy cervical tissue, espe-
cially the endocervical mucosa, from injury during the
operation. The operator should bear in mind that the cervi-
cal canal is normally very small and that, when there is any
considerable dilation in the presence of an inflammatory
process, that portion of the endocervical mucosa which lines
the dilated section must usually be considered as diseased.
Although it may not be apparent, in many cases there have
been destructive changes which render it physiologically
functionless.

Excision of the Prolapsed Endocervical Fold

The excision of the first fold, when seriously inflamed, is
frequently indicated. It should be performed only when the
inflammatory process is confined to the first fold and its

Excision of the Prolapsed Endocervical Fold 63 1

base is readily accessible. The cervix is retracted into the
vaginal introitus and the inflamed fold is grasped with a
pair of tenaculum forceps, or, if the margin of this fold is
very ragged, a heavy pair of hemostats may be used, thus
straightening out the unevenness of the part and allowing a
straighter line of incision to be made through the mucosa
parallel to the forceps. The incision is best commenced on
the outer side of the fold and carried through the healthy
mucosa at the margin of the inflammatory area, making an
encircling incision through the mucous membrane at the
base of the piece to be removed. Then, incising a little at a
time, first on the outer, then on the inner side of the fold,
the point of the scalpel being directed towards its base, a
wedge-shaped piece of fibro-muscular cervical tissue is re-
moved. This leaves two free edges of mucous membrane
which are sutured together with No. 0 or No. 1 chromatizecl
catgut, using an interrupted or running suture as conditions
may demand. Healing should occur by first intention. The
needle best adapted for this suturing is a %, or full-curved
cervix needle lVi to 1% inches long. Great care should be
used not to tear out the sutures, because their replacement
is very difficult and proper apposition of the margins is not
so readily attained. Often it is very helpful to place one
suture before the fold is completely removed, or, when re-
moving the fold, to catch up the free margins of the mucosa
with fine spring-catch cilia fixation forceps, thus keeping
the fine margins of mucosa readily available for suturing.

Circular Amputation of the Cervix

When disease of the cervix is of such character that one
of the previous methods can not satisfactorily remove the
inflamed tissue, it becomes necessary to establish by other
means a continuity of the healthy endocervical mucosa.
This may best be accomplished by a partial circular ampu-
tation of the cervix, including in the excision a varied por-
tion of the cervical fibro-muscular tissue along with the dis-
eased mucosa. This operation is extremely well adapted to
the correction of the large ectropic cervix (the so-called

e\2

Diseases of the Genital Organs

cauliflower cervix) and of endocervicitis too extensive to be.
handled by the mere excision of a prolapsed fold.

The cervix is retracted into the vaginal introitus and
seized with a strong pair of vulsellum forceps with one jaw
passed deeply into the cervical canal, or, more satisfactorily,
with a specially constructed forceps (Fig. 200 a, 2), one jaw
having double tenaculae and the other tongue-shaped so that
it may be passed deeply into the canal without injury. The
cervix is freely exposed by the use of retractors and extra
vulsellum and tenaculum forceps which hold aside the vulvar

-Circular Amputation of Cervix Uteri.
The vaginal mucosa has been dissected from and drawn forward over
,\ Ectropic first annular fold : > exposed iil>io-
mus< ul.tr tissue 'it' cervical core.

Circular Amputation of the Cervix 633

lips. The tissues are injected at frequent intervals with a
local anaesthetic to which adrenalin chloride has been added.
A circular incision is now made around the margin of the
true cervical lips, as shown in Fig. 200. The vaginal mu-
cosa is seized at frequent intervals around its free margin
with artery forceps and, applying moderate traction, is care-
fully dissected from the underlying cervical body as far
forward as the endocervical mucosa is diseased. A longitu-

Fig. 200a — Special Instruments for Trachelectomy.
/, Cervical retractor ; 2, Tenaculum forceps.

dinal incision is now made through the core on either side,
dividing it, for the entire length of that portion which has
been freed from the vaginal mucosa, into about equal upper
and lower halves (See Fig. 201) . At this point in the opera-
tion, it should be ascertained that the cervical stump is
firmly grasped by the tenaculum forceps, because at a later
stage their replacement would become very difficult, should
their hold be lost. Each of the two segments of the cervical
core has an inner lining membrane of endocervical mucosa,

634

Dis ases of the Genital Organs

FlG 201 -Circular Amputation of Cervix Uteri.

ore divid( d by longitudinal incisions [6] into superior and inferior

segments, % The internal os, ,-. is shown, bounded posteriorly bj

the nou exposed second annular fold 1 amputation ends at iliis'

point) leavings free margin of endocervical mucosa,

as show n in pig, ...

Circular Amputation of the Cervix 635

outside of which is the fibro-muscular tissue without its
covering of vaginal mucosa. Grasping the superior segment
and pulling sharply upward in order to expose the endocer-
vix to the greatest possible extent, a semi-elliptical incision
is made through the endocervical mucosa, connecting the
anterior ends of the longitudinal incisions. The convexity
of the incision is directed posteriorly. The scalpel is now di-
rected, parallel to the incised margin of the mucosa, towards
the uterus for a short distance in order to free the margin
for the placing of sutures. The directions of the amputating
incisions thus form a more or less V-shaped declivity in the
posterior extremity of the stump, the mucosal margins of
which may be brought together readily with sutures. The
free edge of the endocervical mucosa is now secured by
toothed fixation, or by fine artery forceps. Using chroma-
tized catgut sutures No. 1 to 3, and a % or full-curved needle
with a piercing point, the free margin of the vaginal mucosa
above is brought into apposition with the endocervical mu-
cosa below. Usually four or five sutures are necessary in
apposing these margins. (See Fig. 202.)

When any considerable portion of the cervix has been re-
moved, it leaves the vaginal mucosa, which has been sepa-
rated from it, free from its underlying support. In order
that part of this vacant space may be eliminated, and in or-
der to prevent too great a strain upon the endocervical mar-
gin, a small portion of the fibro-muscular cervical tissue
should be included in each suture (Fig. 203, 204).

The lower segment of the cervical core is now excised and
sutured in the same manner. The endocervix has thus been
brought into coaptation with the vaginal mucosa both above
and below. At the lateral commissures of the os, the vaginal
mucosa sags away from the endocervical mucosa. Lateral
to this, on each side, an excess of vaginal mucosa results
from the marked diminution in the size of the external os —
often a reduction in diameter from as much as 5 or 6 inches
to about V-> inch. Coaptation of the vaginal mucosa to the
lateral margins of the endocervical mucosa is now secured
by passing on each side a suture through the vaginal mu-

636

Diseases of the Genital Organs

FlG. 2' 12 — Circular Amputation of Cervix Uteri.

Showing cervix after superior half of cervical core has been excised.

o, Margin of vaginal mucosa ; /, inferior half of divided core; 8, senii-

elliptical margin of endocervical mucosa; 7. utero -cervical canal.

Between S and 9 the structure consists of the loose paracervical

tissue and the tough cervical fibro-muscular tissue.

Circular Amputation of the Cervix

637

cosa from above about Vs to Vi inch lateralwards from the
previous suture, through the lateral margin of the endocer-
vix and out through the vaginal mucosa below at about %
to 14 mcn laterward from the lateral inferior suture. Now
secure the lateral commissure of the vaginal wound with
tenaculum forceps and, by gentle traction, making the ten-

Fir,. 203 — Circular Amputation of Cervix Uteri.
Showing cervix after excision of both superior and inferior halves of
cervical bod)'. Vaginal mucosal margins brought into apposition above
and below with the endocervix. Angidar sutures at either side bring into
apposition the vaginal mucosa and the lateral margins of the endocervical
mucosa. On the left side the puckered vaginal mucosa is shown free from
its underlying support ; on the right it has been removed, leaving an oval
opening (9) in the mucous membrane. Vaginal sutures are shown on the
right side, each of which includes a small portion of paracervical tissue
along with vaginal mucosa. 7, utero cervical canal.

638

Diseases of the Genital Orga?is

FlG. 204 Circular Amputation of Cervix Uteri.
Operation Completed.

Circular Amputation of the Cervix 639

sion about equal on the upper and lower margins, the extent
of superfluous vaginal mucosa is ascertained. An approxi-
mately oval-shaped portion of the extra vaginal mucosa is
removed with scissors from each side and the margins ap-
posed with interrupted silk sutures, each of which should in-
For purely vaginal sutures silk or linen is best, but if the
suture penetrates the endocervix catgut should generally be
used. If proper coaptation of the parts is secured, healing
should occur by first intention,
elude a small portion of the underlying paracervical tissue.

After the disinfection of the operative area with iodine,
the single pair of forceps which now retract the cervix are
released, allowing the organ to resume its normal position. -
It is left undisturbed for a period of about two weeks, when
the vaginal sutures are removed and the surfaces touched
over with pure Lugol's solution of iodine. At this time, pro-
viding that the technic has been thorough and efficient, the
appearance of the mucosa of the cervix should be normal,
with but slight trace of the operative procedure.

During the operation it will be found advantageous to
maintain a constant supply of i/j to 1 per cent, chlorazene
solution for the irrigation of the operative area. Capillary
hemorrhage should be almost completely controlled by the
use of adrenalin chloride.

Circular amputation, although requiring considerably
more skill and effort on the part of the operator than other
methods of procedure used in the correction of refractory
cervicitis, gives the most satisfactory results of any technic
which the author has used. The patient is usually fit for
service within two to four weeks after operation, and it has
been my experience that, in the absence of coexisting com-
plications in other portions of the genital apparatus, con-
ception usually follows very promptly. In the presence of
other lesions of a severe nature in the genital tract, such as
would in themselves cause sterility of a more or less per-
manent character, a cervical operation is not usually ad-
visable.

640 Diseases of the Genital Organs

B. Retention of Menstrual Debris from Cervicitis1
Uterine distension from cervical disease, due to the uter-
ine end of the cervical mucosa projecting conically into the
uterine cavity and acting as a collapsing valve, imprisoning
the uterine secretions, to which reference has been made
above, is extremely rare. I have observed but two cases,
both clinical. The uterus was firmly distended with fluid as
in pregnancy, but the two horns were symmetrical. A cor-
pus luteum was usually present but shifted from one ovary
to the other (alternation of ovulation at estrum). The uter-
ine arteries were not enlarged. The cervix was not sealed.
The introduction of the uterine catheter, which required
some patience, caused the evacuation of a thin, clear, odor-
less mucus.

1 have not succeeded in restoring such animals to fertility.
Generally it is best to slaughter. In one instance I cathe-
terized the uterus several times and evacuated the fluid. In
another case, in swabbing the cervix, I pushed the swab into
the uterine cavity, beyond the conical projection of the
mucosa. When I attempted to withdraw the swab, the
valve-like projection closed upon it and pulled the swab
from the forceps. The recovery and withdrawal of the swab
gave considerable difficulty. I doubt the efficacy of handling.
With a very valuable animal probably the most hopeful plan
would be a complete trachelectomy, as described in the pre-
ceding paragraph.

'There is a legendary atresia of the cervical canal in cattle, which
has been maintained generation after generation. It has its basis in
the common ignorance of the anatomy of the bovine cervix. A cow-
is sterile, a man attempts to pass his finger through the cervical
canal and naturally fails, and a diagnosis of cervical atresia or
''closure of the womb" is made. The principle is the same as when,
a generation ago, if a cow was ill, a hole was bored in her horn, a
cavity was found and •'hollow horn" diagnosed. Atresia of the
cervix still appears in some textbooks as a disease. Rarely does
cervicitis occlude the cervical canal. More frequently embryologic
t in development occurs and the cervical canal is not formed.
In either case the menstrual debris is imprisoned and the uterus be-
distended. When the veterinarian attempts to pass the dilator,
catheter or other instrument through the cervical canal and fails, if
atresia exists, distension of the uterus inevitably co-exists. If the
-ion of the uterus is not present, a diagnosis of cervical atresia
i< unjustifiable and false. Atresia of the cervical canal without uter-
ine distension can not exist.

Fetal Retention from Cervicitis. Cervical Adhesions 641

C. Fetal Retention from Cervicitis. Cervical Adhesions.

Thrice I have observed fetal retention due to adhesive
inflammation in the cervices of heifers. In one, the fetus
had not been long dead and the cervical canal admitted the
hand. Traction upon the fetus ruptured the cervix. The
heifer recovered her general health and was sold for beef.
In the second case, the fetus macerated and sloughed into
the rumen, and the animal recovered sufficiently to be sold
for beef. The third was neglected until the eight-months
fetus had been dead seven or eight months. The cervix was
dilated by cutting the first annular ring and most of the
fetal cadaver removed. Two fetal bones were later removed
by laparotomy and hysterotomy. The animal recovered her
general health and condition.

So far as I have seen, the partial atresia of the canal has
been in the first or in the first and second rings. All cases
have been in heifers in first pregnancy and, so far as known,
death of the fetus has occurred prior to any effort at expul-
sion. Apparently the infection within the cervix has ex-
tended into the uterus, involved the fetus and caused its
death. In two of the three cases no effort to expel the fetus
was noted by the owner.

The cases offer a very bad prognosis from the standpoint
of reproduction, but the outlook for the restoration of the
general health is fair. As a rule it is desirable or necessary
to dilate the cervical canal by incising the first, or first and
second annular rings. Then pituitary extract may be given
(5 to 10 mils of the Parke, Davis & Co. preparation or its
equivalent of other makes) in an effort to cause efficient
uterine contraction to expel the fetus. Additional aid should
be given according to indications.

Once the fetus has been extracted, the cervix should be
given close attention and healing facilitated. The cervix is
too grossly infected for tracheoplasty at the time. If the
patient is of but ordinary value, the cervix and uterus had
best be kept clean and disinfected until the general condi-
tion has been restored, and the animal then sold for slaugh-
ter. If highly valuable, partial trachelectomy should be
performed.

41

642 Diseases of the Genital Organs

D. Retention Cysts of the Cervix.

Cysts occur somewhat rarely in the vaginal end of the
cervix about the os uteri externum. I have observed them
at the sides of the opening of the cervical canal. They vary
in size from one-half to one inch in diameter. They ordi-
narily contain mucus, which sometimes becomes infected
and purulent. They are apparently retention cysts. It has
been my habit to incise these, when encountered, and cau-
terize their interior with full strength Lugol's solution or
with silver nitrate.

E. Cervical Prolapse.

Prolapse of the cervix consists of a displacement of the
cervix toward or through the vulva. It inevitably involves
a simultaneous displacement of the base of the uterus and
of the cervical end of the vagina toward the vulva. It is
possible in the non-pregnant heifer. It is observed during
pregnancy and at varying periods after its termination.

The symptoms of cervical prolapse are too evident to call
for detailed description. As a rule the prolapse becomes
evident only while the cow is recumbent. It then appears
as a conical tumor, with its base directed forward and its
obtuse apex toward or beyond the vulva. In or near the
center of the obtuse apex is a depression, the os uteri ex-
ternum. The vulvar end of the cervix becomes increasingly
swollen and irritated according to the degree and duration
of protrusion. When protruding beyond the vulva suffi-
ciently to come into contact with the bedding and with feces
or other contaminating substances, the swelling and irrita-
tion increase. The irritation may reach such a degree as to
cause an excessive secretion of mucus, or suppuration and
necrosis of the mucosa may occur.

In the pregnant animal the uterine seal is usually present
but imperfect and showing varying degrees of disease. The
two chief causes of prolapse of the cervix are disease of the
uterine end of the cervical and of the uterine mucosa and a
genera] atony of the genital system. In the first group of
3, bo far as I have yet been able to observe, the primary

Cervical Prolapse 643

cause is an endometro-cervicitis. Both the endometrium
and the endocervical mucosa become inflamed and irritated
in such a manner that abdominal pressure is brought to bear
upon the pelvic contents. When the animal lies down there
is added a passive intra-abdominal compression which
pushes uterus, cervix and vagina backward. The muscular
walls of the cervix retain their tone or are rigid from
disease; the uterine walls are atonic. In the pregnant
animal the fetus and its membranes are not expelled
because the cervix does not relax and the uterine walls
do not contract, to compel the dilation of the canal.
Consequently the cervix is displaced backward. In
other instances, in pregnant animals, the expulsion of the
fetus is inhibited by induration of the cervical walls with
adhesions which prevent that degree of dilation essential to
the expulsion of the uterine contents. During the post-
parturient period, without nymphomania, cervical prolapse
is ordinarily dependent upon a quite severe endometritis
associated with a lingering placental necrosis. In the second
group of cases, the displacement is fundamentally due to
uterine atony dependent upon that type of ovarian disease
regularly causing nymphomania. In these cases the cervix
is relaxed and its canal will permit of the ready passage of
one, two or more fingers. The progress of cervical prolapse
is very slow. In the pregnant animal it tends to become
worse as time for parturition approaches. Each time that
the cervix pushes out beyond the vulva while the patient is
recumbent, the protruding mass becomes soiled with litter,
increasing the irritation and the volume of the tumor, which
in turn cause greater straining and protrusion. Eventually,
if the animal calves, the unloading of the uterus usually
causes the protrusion to disappear. When endometritis
causes cervical prolapse in a non-pregnant cow, the pro-
lapse tends constantly to increase. The prolapse of the cer-
vix, with the displacement of the uterus, imprisons the irri-
tant secretions within the uterus. The cervical prolapse as-
sociated with nymphomania usually disappears when the
cystic condition of the ovaries is brought under control.

644 Diseases of the Genital Organs

The prognosis of cervical prolapse is generally unfavor-
able, because the underlying causes are not often easy to
remove. In the pregnant animal the prolapse, with the as-
sociated cervicitis, not infrequently renders parturition,
abortion or extraction of the fetus difficult and imperils the
life of the patient through sepsis or pyemia. The cervical
prolapse in nymphomania indicates a serious type of ovarian
disease, which is aggravated by the prolapse.

The handling varies according to the state of the patient
and the underlying cause. In the pregnant animal it should
be determined first whether the fetus is alive. This is best
accomplished by rectal palpation. The fetus is usually pal-
pable and some part of it can be grasped. When pressure or
traction is exerted upon a fetal part, if alive, the fetus al-
most invariably attempts to pull the extremity away. If
the fetus is alive, the handling should be purely palliative
and an earnest effort made to get the diseased parts in the
best possible condition for the eventual expulsion or ex-
traction of the fetus. For this purpose the vulvar sutures
described under Vaginal Hernia in Chapter V, and illus-
trated in Fig. 60, can be made to serve the highly useful
purpose of retaining the cervix within the vagina and pro-
tecting it against the irritating effects of desiccation when
exposed to the air, and from becoming contaminated through
contact with bedding and filth. It is best to use heavy silver
wire and secure the apposition of the vulvar lips by merely
hooking the free ends of one side over the wire of the other.
Then, if parturition begins in the absence of the attendant,
the force unbends the hook and releases the suture. At the
same time any existing inflammation may be ameliorated by
douching the vagina, and that portion of the cervix project-
ing into it, with warm 0.25 per cent. Lugol's solution or
saturated boric acid solution, or by applying to the parts an
ointment of bismuth subnitrate, iodoform and petrolatum.
While dressing the parts the sutures should be released in
order that the fluids may be freely expelled.

When time for parturition arrives, it' the cervix is too dis-
eased to permit efficient bloodless dilation, the constricted

Infections of the Vagina 645

portion of the cervix may be incised or abdominal hyster-
otomy performed. If the cow is highly valuable for breed-
ing purposes, hysterotomy is perhaps preferable as a rule.
The operation has been described in the companion volume,
Veterinary Obstetrics. After recovery from the operation,
the cervicitis underlying the difficulty is to receive proper
attention. Usually a partial or complete amputation of the
cervix is indicated. If the animal has no unusual breeding
or dairying value, the dilation of the cervix by incision may
be simpler and the animal may make a prompter recovery,
so far as her general health is concerned, but the cicatrix in
the cervix probably leaves her unfit for breeding. However,
the mutilated cervix may be successfully amputated later if
found desirable. In the non-pregnant cow, when the pro-
lapse is due to intra-uterine infection, the cervical canal is
to be sufficiently dilated to admit readily the uterine cathe-
ter. The uterus is then to be douched with 0.25 to 2 per
cent. Lugol's solution or other disinfectant, and bismuth
and iodoform suspended in oil introduced. The handling
should be repeated at intervals of one to three weeks until
recovery is assured. When the prolapse is referable to
nymphomaniac cysts in the ovaries, the fundamental plan of
handling already advised for nymphomania is to be applied,
with special attention to the uterus and cervix.

7. Infections of the Vagina

A. Vaginitis

Vaginitis is induced in many ways. The nodular venereal
disease, most clearly and readily recognized in the vulva,
commonly extends into the vagina and is revealed by lesions
identical with those in the vulva. This has already been de-
scribed. Reference has also been made to vaginitis caused
by the vesicular venereal disease, coital injuries, and
sadism.

Vaginitis commonly follows parturition and abortion.
Primarily parturition and abortion cause more or less se-
vere contusions and abrasions. The great pressure under
which the fetus is forced through the vagina destroys much
of the protective epithelium, and so injures the underlying
tissues that hemorrhages are common. The lesions are so

646 Diseases of the Genital Organs

nearly universal that they may, in a sense, be designated as
normal. In themselves such injuries are unimportant. They
acquire interest through the fact that they afford inviting
avenues for infection. The abrasions and contusions of the
vagina are often aggravated in cases of dystocia by the im-
prudent and careless use of harsh, dirty cords or other ap-
pliances.

If the fetal membranes are retained and decompose, the
virulent infection present readily invades the injured tis-
sues. When infection exists within the uterus and passes
out through the vagina, it endangers, in passing, the dam-
aged tissues. In metritis quite commonly the highly infec-
tive secretions of the uterus are promptly expelled into the
vagina and lie there for hours before the expulsion from the
genital canal is completed, constantly irritating the mucosa.
One of the commonest and most serious types of vaginitis
is that caused by imprudent or clumsy attempts at douching.
Some laymen think that they may control "contagious abor-
tion" by vaginal douching. Other laymen think that, when
douching the vagina, they are douching the uterus. Many
publications by technically scientific persons advise the use
of powerful disinfectants in the vagina. Frequently the
teaspoon is advised as a standard of measurement, although
teaspoons vary greatly in size and both solids and liquids
may be heaped up in varying degrees, or some of the disin-
fectant may run over into the water. Sometimes a slow-
dissolving salt, such as permanganate of potash, is advised
and douching is attempted before the crystals are dissolved.
The heavy crystals may drop down upon the vaginal floor
and cause necrosis. The vaginal mucosa is extremely vul-
nerable to disinfectants. Solutions borne with impunity by
the uterus and vulva are intolerable for the vagina. This
must always be borne in mind in douching. Whenever the
douche is so irritant that it causes distress, it is injuring the
organ and should not be used. Vaginitis is common as an
extension by continuity of cervicitis, especially in purulent
cervicitis involving the vaginal end. Vaginitis usually fol-
lows coitus in heifers badly affected with the nodular vene-
real disease. The exacerbation of the infection follows coi-

Vaginal Gangrene 647

tus in twenty-four to forty-eight hours. However vagi-
nitis may arise, the general principles of handling demand
the elimination of the cause, followed by the application of
those measures which may allay the irritation. If the vagi-
nitis is a consequence of severe metritis or cervicitis, these
must first be brought under control before any progress can
be made in overcoming the vaginal lesions. When vaginitis
is dependent upon chemical irritants, such as too powerful
disinfectants, they are to be promptly withdrawn and sooth-
ing applications substituted. Of these, douches of warm 0.7
per cent, salt solution (1 oz. salt to 1 gal. boiled water) have
probably the greatest value. In some cases 0.25 per cent,
of Lugol's solution, or 2 to 4 per cent, boric acid may be ad-
vantageously added. When irritant disinfectants have been
introduced, causing denudation of the epithelium, a heavy
ointment or an oil, like liquid paraffin with iodoform, sub-
nitrate of bismuth, or both may be applied with benefit.
Here every effort should be made to counteract the chief
peril — vaginal atresia. This object will be furthered by
dilating the vagina daily with the warm saline solution, fol-
lowed by the oil or ointment with iodoform, etc.

The intense vaginitis often following coitus in heifers is
best prevented by douching the vagina six to twelve hours
after coitus with 0.25 per cent. Lugol's solution, repeating
in twenty-four hours if necessary.

B. Vaginal Gangrene.
There appear from time to time records of vaginal gan-
grene in cows during the puerperal period. In some in-
stances the records almost suggest a special or specific type
of infection, but there is nothing definite upon which to base
a conclusion. In the presence of an intense infection of the
cervix or uterus, associated perhaps with retained fetal
membranes and extensive parturient abrasions in the vagi-
nal walls, gangrene of the vagina is always a possibility.
The tendency to gangrene is increased by rough work in re-
lieving dystocia and by the use of highly irritant vaginal
douches. Although it may sound paradoxical, one of the
easiest ways to cause vaginal gangrene is by the misuse of
powerful antiseptics.

648 Diseases of the Genital Organs

The symptoms consist chiefly of vulvar swellings, profuse
genital discharge, straining and general evidences of pain.
The discharge is often fetid. Manual examination causes
intense pain. The vaginal walls are greatly swollen, render-
ing the introduction of the hand difficult. Portions of the
mucosa are partly detached or are very fragile. By spread-
ing apart the vulvar lips, dark, necrotic areas may be ob-
served.

Nothing of special value has been learned regarding the
bacteriology of the disease. As in other types of genital in-
fections, it appears that in certain herds at a given time
some one form of bacterium acquires special intensity and
induces a prevalent type of lesions.

The handling of gangrenous vaginitis calls first of all for
the control of uterine and cervical infections. I have ob-
served very energetic efforts to control gangrenous vaginitis,
while imprisoned, decomposing fetal membranes which were
the basic cause were overlooked. The vagina itself should
be cleansed by the gentlest available measures, essentially
those mentioned above for vaginitis.

C. Perivaginal Phlegmon.

Parturient contusions and abrasions open the way for
the invasion of infection from the genital tube into the pel-
vic connective tissues. Once the infection passes the barrier
of the vaginal walls and gains the very loose, open areolar
tissue of the pelvis, it tends to spread with great rapidity.
The progress of the infection is often so rapid that the tis-
sues are unable to erect any efficient barrier and suppura-
tion or gangrene advances rapidly. Sometimes imperfect
abscess walls are formed which offer no important degree of
resistance.

The contusions and abrasions are much the same as those
producing vaginitis, but act more upon the deeper tissues.
In some cases the prominent, conical, bony projection at the
anterior end of the pubic symphysis plays an essential part
in causing the original contusion. The vaginal floor becomes
impinged between the summit of the cone and some hard
portion of the fetus; in some instances the vagina becomes

Cysts and Abscesses of Gartner' s Ducts 649

actually perforated. The infection then readily passes out
into the adjacent tissues. The invasion of the pelvic con-
nective tissues causes swelling of the vulva and anus, with
evidences of pain. Usually the patient moves carefully and
hesitatingly, the appetite is poor, and the rectal tempera-
ture may be elevated. Vaginal or rectal palpation discloses
more or less extensive swellings in the pelvis surrounding
the vagina. At some points collections of fluid (thin pus)
are recognizable, but there are no clearly defined limiting
walls.

The course of such infection is usually rapid. As a rule
the patient succumbs, largely because the tissues fail to form
a barrier sufficient to prevent the highly virulent masses of
pus from invading the peritoneal cavity. If the infection
is not too virulent, abscessation may occur and the abscess
may open, or be surgically opened, into the vagina or rec-
tum. It then has the common significance of pyemia as
described under infections of the uterus. The invasion may
sometimes be anticipated if the parturient abrasions are
recognized early. The genital tract may then be cleansed
and iodoform with oil introduced into the uterine cavity.
This, flowing slowly over the abraded parts, may deter pu-
trefaction and bacterial invasion. Once established, the
phlegmon is difficult to control. Repeated warm vaginal
douches of saline solution may aid in checking the infection.
Internal remedies, such as quinine, may be tried, but they
offer little hope.

D. Cysts and Abscesses of Gartner's Ducts.

Gartner's ducts, described on page 39, are frequently the
seat of retention cysts and abscesses. These occur along the
course of the ducts, as shown in Figs. 18-21. They vary in
form and extent, but are usually elongated, with a trans-
verse diameter of one-half inch or less. They may be very
large and spherical. They are of comparatively little impor-
tance except as reminders of the presence of infections
which, invading the duct, cause atresia of its opening, with
cystic or purulent distension. Rarely they may attain such
size as to interfere with coitus. When recognized, the cysts

650 Diseases of the Genital Organs

or abscesses should be laid open freely and the parts disin-
fected.

8. The Infections of the Vulva

The vulva is the most prominent area involved in the vesi-
cular, and in the nodular venereal diseases, as has been noted
already in Chapter XII. The vulva also participates in a
general way in parturient abrasions of the vagina and the
consequent infections, which run a similar course and call
for similar handling. The vulva now and then undergoes
gangrene, especially following neglected dystocia, when the
organ has been subjected to long-continued pressure and
contusion from the fetus. Then follows at times cicatricial
contractions rendering coitus and parturition difficult or
impossible.

In some portions of the Mississippi Valley at one time an
infectious ano-vulvitis of cattle prevailed, not associated
with reproduction. It consisted of a necrotic inflammation
of the anus of the male and of the anus and vulva of the
female. The mortality was high and in non-fatal cases im-
portant deformity of the body openings resulted.

The exact cause of the disease was not clearly determined.
It was referred generally to an invasion by the bacillus ne-
crophorus, which apparently serves as a general designation
for necrotic diseases occurring in various parts of the body
in different species of animals, but not, so far as known,
transmissible from one species to another.

The ano-vulvitis of cattle, which occurs as an enzootic, is
of chief interest in connection with its general results rather
than in connection with reproduction. The disease ordina-
rily arises without a known injury to the parts, as a necro-
tic area about the anus or vulva. The necrosis is progres-
sive, the parts become swollen and indurated, and the sur-
face undergoes extensive, canker-like necrosis, with the
formation of fetid pus.

The handling has not been placed upon a definite basis as
a specific disease, but reliance has been placed upon the gen-
eral principles of surgery — the destruction or ablation of
incurable tissues, the disinfection of the involved areas, and
the isolation of infected animals.

III. THE CONGENITAL INFECTIONS OF CALVES

Calf Septicemia, Calf Dysentery, Dysentery Neonatorum,

Calf Scours, White Scours, Pyemic Arthritis,

Joint 111, Calf Pneumonia

While considering the infections of the ovum, embryo and
fetus, it was pointed out that both the pregnant and the non-
pregnant uterus commonly contain bacteria of various
kinds, and that in the pregnant cow these invade the fetal
membranes, enter the amniotic fluid, are swallowed by the
embryo, and constitute a part of the meconium. Generally
the bacteria are included in the meconium, though they
cause no recognizable disease of the fetus, but in numerous
cases, associated especially with the phenomenon of abor-
tion, they cause diarrhea and sepsis.

Birth can not serve as a line of demarcation between the
infections of ante- and post-natal life. Non-fatal infections
of the fetus inevitably involve the new-born calf. More gen-
erally the bacteria included within the meconium at the time
of birth remain for a time as bacterial inclusion rather than
infection, and may at any period subsequent to birth acquire
force and cause disease. Accordingly calves show a very
wide range of disease phenomena referable to intra-uterine
infection. The clinical symptoms and postmortem lesions
do not admit of the division of these results of infection
into distinct diseases having separate causes and histories :
the various types pass imperceptibly one into the other.
Neither can intra-uterine infections be definitely separated
from post-natal invasions. An infection emanating from
the uterus of a cow and swallowed by her fetus may with
equal facility be swallowed by her new-born calf when the
liberated uterine discharges flow down the thighs of the
cow and reach the teat which the calf sucks. Neither can
there well be any fundamental difference in results, whether
a bacterium is swallowed by the fetus or is taken into the
alimentary tract of the calf shortly after birth. Varying
types of disease phenomena occur, the fundamental cause
of which is the same, so far as known. When the uterus of

652 Diseases of the Genital Organs

a pregnant cow is intensely infected, the fetus inevitably
participates in a large degree. If the fetus resists the in-
fection with such success that it is born, the birth may be
very tardy owing to the paresis of the uterus due to the
metritis present. The fetal membranes may be retained.
Often the uterus contracts so feebly that traction must be
applied to the fetus. Sometimes the feeble action of the
uterus, or illness of the fetus, or the two combined, pre-
vents the fetus from vigorously assuming the proper posi-
tion for birth, the head or a limb deviates from its correct
course, and dystocia results. Finally, if the fetus survives
and is born, it is ill. It may be smeared over with meconium,
indicating that as a fetus it suffered from diarrhea. The
calf is weak and listless. It can not get up and perhaps can
not stand if lifted to its feet. It may or may not have diar-
rhea. The rectal temperature may be abnormal, normal, or
subnormal. The calf may rally after a time and get up, but
usually the depression increases and after two or three to
twenty-four hours it dies. Autopsy reveals hemorrhages
in the liver, spleen, or other viscera, or beneath the pleura
or peritoneum. The lesions are essentially identical with
those observed in aborts. One animal dies within the uterus
and is expelled shortly afterward ; the other is alive when
expelled from the uterus but soon perishes. The difference
between the two is merely the time and place when death
occurs. The cause and origin are the same in both cases.

The dysentery of calves has not been clearly defined. It
merges imperceptibly in one direction with calf septicemia,
is inseparably linked with calf pneumonia, is complicated
by arthritis and other pyemic disturbances, and can not be
separated by any clear line of demarcation from lesser dis-
turbances which can not be included under either of the
types mentioned. Like calf septicemia, dysentery of calves
is a type of infection, or group of infections, rather than a
specific infectious disease. Clearly due to infection, it is
not known to be due to any one disease-producing organism.
Though it is known that several organisms may be recog-
nized associated with the diarrhea, the exact part in the
disease played by any one of the bacteria is unknown.

Congenital Infections of Calves 653

Calf dysentery has long been a fruitful field of contro-
versy as to cause. Its intelligent study has been held back
largely by false theories as to its nature. Many have held
that it was due wholly and directly to improper feeding,
and the claim has been so often repeated that it has ac-
quired the weight of a fact. Some also taught that it was
due entirely to navel infection, and this, too, became a com-
mon belief. All prophylactic and curative efforts based upon
either of these beliefs came to naught, and when these er-
roneous theories had failed the truth largely went unsought.
The theories mentioned above belittled the significance of
dysentery in calves. If merely a matter of feeding, any
person of moderate intelligence should readily control it.
If due wholly to navel infection, ordinary cleanliness would
obviate the difficulty. It was therefore technically an un-
important affair from the standpoint of the pathologist and
a virtually hopeless scourge from the viewpoint of the
breeder whose calves were persistently dying.

Calf dysentery is slowly becoming recognized as one of
the links in an endless chain of infection invading the geni-
tal organs of breeding cattle of both sexes, passing over
from the uterus of the pregnant cow to the digestive tract
of the embryo within her uterus, and, under favorable en-
vironment, capable of causing retained afterbirth in the
mother, or serious or fatal sepsis, dysentery and pneu-
monia in the calf, or of escaping from the digestive
tract to invade permanently other systems or organs.
Under this broader conception, the dysentery of calves
becomes an integral part of one of the most important
diseases among domestic animals. The term is commonly
applied to a diarrhea or dysentery occurring in calves
a few hours to a few days after birth. Some writers
limit the period to the interval between a few hours to three
or four days after birth. Diarrhea occurring in calves at
other times is otherwise designated, but the line of demarca-
tion is not clear and the limitation to such a period as indi-
cated is purely arbitrary.

Diarrhea is common in the fetus. Physiologically, as soon

654 Diseases of the Genital Organs

as the alimentary tract is formed and the pharynx opens,
the fetus commences to swallow but does not defecate. The
amniotic fluid is constantly swallowed along with any ex-
foliated epidermic scales or other solids suspended in the
fluid. Before hairs are macroscopically visible, meconium
examined under a low-power lens reveals tiny short hairs
which have been shed and then swallowed. Bacteria which
have invaded the amniotic fluid are also swallowed. The
swallowed liquor amnii is promptly absorbed by the intes-
tines, enters the fetal lymph or blood stream, and later pre-
sumably returns to the amniotic sac. The solids, such as
hairs, bacteria and epithelial scales, remain behind in the
intestinal canal as in a cesspool, to constitute the meconium.
Since physiologically the fetus does not defecate and con-
stantly swallows its amniotic fluid, filtering it through the
intestinal walls, it follows that this is regularly clear, while
the allantoic fluid is frequently turbid.

But the fetus, like the living calf, does not always travel
serenely along the physiologic path. Nearly half the uteri
of pregnant abattoir cows contain bacteria which have the
power to, and do penetrate the chorion, contaminate the am-
niotic fluid, and are swallowed by the fetus. There are
found, thus swallowed, streptococci, colon bacilli, micro-
cocci, B. abortus, and other bacteria. Physiologically this
should not be. Their presence does not necessarily cause dis-
aster. Up to a considerable volume the walls of the cesspool
— the alimentary epithelium — perhaps aided by the biliary
or other secretions and probably favored by the marked
desiccation of the meconium, render powerless the bacteria
present.

The power of the fetal intestine, like that of the adult, has
its limitations. If the volume of bacteria is too great, or
the virulence too high, the restraining power of the intes-
tine may break down. If the fetus is weakened, owing to a
disturbance of its nutrition, its control over resident infec-
tion may be lost. Thus, when placentitis is present, the nu-
trition of the fetus is crippled and harmful products, due
to the infection in the placenta, reach the fetal circulation.

Congenital Infections of Calves 655

The fetus undergoes partial suffocation. It is not strange,
therefore, to observe that aborts frequently, if not generally,
suffer from diarrhea. It is indeed not improbable that
dysentery of the fetus frequently plays a vital part in caus-
ing fetal death, and hence abortion. In examining aborts
meconic pellets are commonly found in the stomach : that is,
prior to death the fetus had defecated and then swallowed
its excrement.

In the later stages of pregnancy fetal diarrhea is not rare.
I have seen many gallons of diarrheic feces in the amniotic
sac at the time of expulsion of the fetus. More commonly
there is but a moderate amount in the amniotic sac and the
new-born calf is thickly smeared over with soft, sticky,
brownish-yellow feces.

The calf which has suffered in the uterus from dysentery,
and is expelled completely covered with excrement, is fre-
quently vigorous. In some cases calves are born while
dysentery is in active progress. These, under careful hand-
ling, may grow vigorously.

Most cases of severe dysentery develop within a few
hours to a few days after birth, but no time limit can be
fixed. In the research calves of my department, I now and
then see an acute dysentery after ten to fifteen days, but
these cases have been generally, if not always, relapses
after the disease has been brought under control and the
calf has apparently been well for a number of days. So far
as observed, these late cases were etiologically identical
with those occurring earlier. Clinically they presented the
same symptoms and reacted in the same manner to thera-
peutic efforts.

There is no clear line of demarcation between white scours
and health. At one extreme is the ideally healthy calf; at
the other, the calf with fatal dysentery. Between these two
occur every possible gradation of disturbance. Neither does
there exist a clear line of demarcation between white scours
and calf pneumonia. Clinically the two glide imperceptibly
into each other, and etiologically they can not now be dif-
ferentiated.

656 Diseases of the Genital Organs

The etiology of calf scours has not been clearly deter-
mined. Numerous writers regard it as a specific contagious
or infectious disease having one bacillus as the uniform
causative agent, to which is frequently added other compli-
cating organisms. This is difficult to prove or disprove. It
has been noted already that diarrhea is common in abortion.
Most investigators of abortion record only their findings re-
garding the B. abortus. They state generally that they re-
covered the B. abortus from the alimentary tract of the
abort, but fail to state whether other bacteria were present.
According to our investigations the B. abortus is not as com-
mon as some other bacteria in the utero-chorionic space, the
fetal alimentary tract, or the alimentary tract of the calf
with or without diarrhea.

For a number of years following the researches of No-
card, it was taught that calf scours was due to a bipolar
bacillus of the septicemia hemorrhagica group. Later Jen-
sen and others taught — and their views were commonly ac-
cepted— that the basic cause was a colon bacillus. My col-
league, Carpenter, has recently presented strong evidence
tending to show that a streptococcus of the viridans group
is the most prominent organism present. Micrococci are
common, but no connection between them and dysentery has
been traced. Carpenter has generally failed to identify the
colon organism in the intestinal tracts of fetuses and of sick
calves destroyed before death was imminent, but has com-
monly recovered in these cases the streptococcus of the viri-
dans group. Later when the calf is apparently dying, or
has been dead for a few hours prior to the making of cul-
tures, the colon organism becomes very conspicuous. It has
been frequently asserted without qualification that dysen-
tery in calves can be uniformly produced in its typical form
by inoculating with the colon organism. My colleagues,
Hagan and Carpenter, have repeatedly tried in vain to cause
dysentery with this bacterium. This seemed peculiar, espe-
cially since Jensen is regularly cited as having proven
clearly by experiment the specific character of the bacillus.
A critical study of his recorded experiments explains at least

Congenital Infections of Calves 657

partly the apparent contradiction between his researches
and ours. The researches of Jensen were faulty in several
respects :

(1) There is no evidence that the calves selected were
free from alimentary infection when born.

(2) Details, or even general outlines of the feeding are
wholly wanting.

(3) The controls had diarrhea, which was slower in de-
veloping and less fatal than in the inoculated animals, but
otherwise showed no differential characteristics.

Accordingly it appears that the conclusions of Jensen were
based upon wholly unreliable grounds and that he did not in
fact clearly induce dysentery experimentally. So far as I am
aware, calf dysentery can not be caused reliably by any
known bacterium, although, reasoning by analogy and view-
ing it clinically, its infectious character is unquestionable.
The experimenter is faced, as in abortion, with the impossi-
bility of determining in advance the freedom of the experi-
mental animal from the infection under consideration.
When there is added the utter impossibility of clearly de-
fining white scours, the difficulty of securing definite experi-
mental data upon its etiology is apparent. The conclusion
can not well be avoided, since in most cases of calf dysentery
there is an abundance of a comparatively limited variety of
organisms present, and those recognized are reasonably uni-
form in the different patients, that the disease is due to in-
fection, and that the bacteria multiplying disastrously in
the alimentary tract of a sick calf would likewise multiply,
though not necessarily disastrously, when properly placed
in the digestive tract of another calf. Clinically this is ap-
parently true. White scours breaks out in large stables and
pursues the relentless course of a scourge, causing a mor-
tality of ten to one hundred per cent, for months at a time.

Apparently therapeutic evidence also indicates the infec-
tious character of the disease, though this may be mislead-
ing. When a horse, by means of repeated inoculations, is
rendered highly resistant to the dominant organism asso-
ciated with white scours, his blood serum injected into a
42

658 Diseases of the Genital Organs

calf with white scours generally acts specifically to ameli-
orate the disease. I have found no record, however, of any
control experiments to show that the blood serum from a
horse not immunized or fortified by means of artificial in-
oculation with the organism would not have a like effect.
A more direct test perhaps is the use of killed cultures of
artificially grown bacteria. Limited observations seem to
indicate that these act specifically under conditions not yet
fully determined and may give to the calf, under some con-
ditions, a more enduring resistance to diarrhea.

Since white scours is not clearly defined, its symptoms
can not be accurately described. There is no epoch during
which the line of demarcation between health and disease is
as dim and hazy as in young calves. The healthy calf, when
born, has a glossy brilliant coat of hair, soft and velvety to
the touch ; its body is of even contour and plump ; and the
calf is up and playing in an hour or two. Its intestines,
especially the rectum, contain a pound or more of rather
hard, yellowish or greenish to greenish-black meconium
consisting of biliary salts, exfoliated debris, hairs, and fre-
quently a swarm of bacteria. The great variation in size of
the meconial pellets, in their adhesion to each other, and in
their degree of desiccation, sometimes suggest that their
character is largely dependent upon the quantity and nature
of the infection present. Dysentery may exist at birth or
may develop at any hour post-natal. When a cow or heifer
has very severe infection in her uterus, the fetus when born
is exceedingly dull and languid. It is unable to get up or to
stand when helped to its feet. Perhaps no diarrhea is pres-
ent. It may in fact die of calf septicemia. If death is held
in abeyance, the calf generally develops violent dysentery.

Other calves, born apparently well, proceed to break down
with diarrhea in a few hours to eight, ten or more days.
The later in life the attack, the less stormy its course. When
violent dysentery is impending, the first indication of the
coming storm is a sudden rise in temperature. At this epoch
the calf is not notably ill. the feces are not thin, and there is
no marked loss of appetite. But this in severe cases is not

Coyigenital Infections of Calves 659

for long. Soon in many cases there are streaks of blood in
the feces, if any chance to be voided. In one to a few hours
later the storm breaks and the observer frequently sees one
of the most virulent and rapidly fatal diseases in animals,
often destroying- life in ten or twelve hours. When dysen-
tery sets in, the temperature vacillates. Often the anus is
paretic, the rectum is open and flaccid, and the thermometer
reveals little of the actual temperature of the body.

The feces offer the widest possible variation in character.
In the fetus, the diarrheic feces are usually yellowish, green-
ish-black or black. In post-natal dysentery the fecal dis-
charges are much the same as in the intra-uterine diarrhea,
if the storm breaks before the calf has taken milk, or until
the milk or its derivatives have passed through the digestive
tract to modify the excrement. After milk has been taken,
the character of the excrement is necessarily altered. The
milk-filled stomach serves as a large flask filled with an
excellent medium for the multiplication of the bacteria pres-
ent, while the body heat provides an ideal incubative
warmth. The milk undergoes rapid bacterial decomposition
and is hurried along the alimentary tract with great rapid-
ity. The feces may contain some small decomposing milk
particles still retaining some of its white color, but it has
mostly disappeared. The bacteria cause the liberal forma-
tion of highly fetid gases, which, mixed in small bubbles in
the thin feces may lend to it a whitish color. The color
varies greatly, however. Sometimes it is greenish, often
brownish or yellow. In very severe cases the discharges
are extremely thin and watery, mixed with minute particles
of debris, giving it a dirty brown color, and charged with
bubbles of highly fetid gas which escape quickly. In large
stables where numerous calves are suffering from the dis-
ease in various stages, the odor from the calves is highly
repulsive, of a sweetish sickening character.

The general appearance of the calf changes rapidly. The
watery feces are forcibly expelled for a time, but later es-
cape involuntarily through the paretic anal sphincter. The
calf loses weight and volume with enormous rapidity. It

660 Diseases of (he Cieiiital Organs

takes no food or water, while the water of the tissues is
being rapidly withdrawn to constitute the chief volume of
the diarrheic discharges. The calf becomes unable to rise,
lies flat on its side with its head drawn back (opisthotonus) ,
becomes unconscious and dies.

Short of this violent type there is every gradation. In
cases of great virulence, the dysentery may at any time
abate, the calf rally, without definite therapeutic handling
undergo more or less marked improvement, and may per-
haps eventually recover.

Regardless of the grade of alimentary disturbance, there
is a tendency toward the development of pneumonia. Some-
times the pneumonia develops suddenly and violently with
all the clinical symptoms of that affection. Other cases
creep on insidiously with a hacking cough associated with
digestive disturbances. The pulmonary complications ag-
gravate the digestive disturbances by lowering still more
the resisting powers of the animal. In many animals the
only evidence of pulmonary disease is a persistent hacking
cough.

The clinical evidences of pneumonia may appear at any
time from shortly after birth up to ninety or one hundred
days. Like the dysentery, it is more prone to pursue a
stormy course when it develops early. Dysentery and pneu-
monia each tend to conceal and to aggravate the other. The
high temperature of dysentery causes rapid breathing, sim-
ulating pneumonia, and the dyspnea of pneumonia tends to
detract attention from any dysentery present.

Arthritis as a concurrent lesion is not rare, and. like
pneumonia, may be violent or may be of so low a degree as
to be difficult of clinical recognition. The onset of pyemic
arthritis may be extremely sudden. The calf is up and
about, feeding and appearing well. An hour later it may be
so lame in one limb that it refuses, or is unable to bear
weight upon the affected limb. The involved joint is greatly
swollen, tense, hot, and extremely painful when manipulated.
A little later some other .ioint may be equally involved.
When two or more limbs become affected, the calf is un-

Congenital Infections of Calves 66 1

willing or unable to stand. In other cases the affected joints
are neither greatly swollen nor very painful. Several or all
limbs may be involved, causing the calf to walk slowly and
cautiously without marked lameness in any one limb. As
in pneumonia, so in arthritis, lesions are found upon au-
topsy which had not been clinically recognizable.

Pyemic abscesses, which occur somewhat rarely in all or-
gans and tissues of the body, have the same significance as
arthritis. Occasionally a pyemic abscess occurs in the
spinal canal, causing a gradual and finally complete paraly-
sis. In other instances the pyemic abscess is inter-articular
in the spinal column and eventually breaks into the spinal
canal, inducing sudden and complete paralysis suggesting
fracture of the spinal column. Other evidences of disease
appear which are not readily assignable to a logical place in
the course of the basic infection. Prominent among these
are ulcers and abscesses in the lips and cheeks. These ag-
gravate exceedingly the basic malady. The lesions are ap-
parently due to a secondary invader (B. necrophorus?) for
which the basic infection has prepared a vulnerable field.
Rachitic-like enlargements of the bones are not rare, but
their exact relation to the basic invasion is not understood.

When a degree of dysentery, pneumonia or arthritis is
present which clearly imperils the life of the patient, the
presence of disease is not disputed, but the results of vary-
ing degrees of infection in new-born calves offer such in-
finite gradations that it is impossible for a majority of ob-
servers to agree upon a clear line of demarcation between
health and disease. So far as known, the bacteria which
cause dysentery, pneumonia, septicemia, and pyemia in
young calves exist in the bodies of essentially all cattle, and
disease or health is determined, not by the presence or ab-
sence of given bacteria, but by the ratio of bacterial force
to the resistance of the patient. A healthy new-born calf
has lustrous hair, its body is plump and graceful, its eye
bright, its spirits gay, and its body functions are promptly
and evenly performed. The bowels promptly expel the me-
conium, which, as it escapes from the anus, does not adhere

662 Diseases of the Genital Organs

to the tail or surrounding parts. The tufts of hair about the
sheath opening (preputial tuft) and the vulva (vulvar tuft)
over which the urine flows are not stained, matted or dirty.
Experimentally this state can be maintained for several
months, if not indefinitely. Naturally, in range cattle of
high reproductive efficiency, the status at birth tends to be
continued over a long period of time. In dairy herds and
in purebred beef herds, which closely approach dairy herds
in general plans of handling, the calf may soon break down
with dysentery, pneumonia, joint-ill, or other manifestations
of serious or critical disease, or show within five to ten
days notable deviation from the ideal.

The temperature becomes elevated. This is so nearly uni-
versal that writers commonly hold that the temperature of
a young calf is higher than that of an adult. The experi-
ments in my department indicate that this belief is a fallacy
and that the higher temperature of young calves is patho-
logical. The hair soon loses its lustre and becomes dry,
rough and faded. The skin becomes dirty. There are di-
gestive disturbances of great variety. Almost always the
feces are adhesive and stick to tail and buttocks. They are
soft, medium, or hard, but the adhesiveness persists in each
type. The consistency and color vary from day to day. Usu-
ally they are fetid and expelled frequently in small amounts.
The total volume of feces is greater than in health, but the
volume voided at one time is much less. The feces are irri-
tant and frequently cause the matted hairs to fall out, leav-
ing hairless areas on the tail or buttocks.

The calf may be either gaunt or pot-bellied. Its appetite
is capricious, and it may swallow straw, shavings or other
indigestible matter. Its growth is slow and uncertain.
While a typically healthy calf well fed should gain not less
than two per cent, of its body weight per day, the unthrifty
one drops below this standard. There is a hacking cough.
The calf plays but little, in marked contrast with the typi-
cally healthy calf which is one of the gayest rompers among
domestic animals. The preputial or vulvar tuft of hairs lie-
comes stained a deep brown and then black, to remain so

Congenital Infections of Calves 663

for life. The hairs become matted together in hard masses.

These evident deviations from typical health can not be
classed as dysentery, pneumonia, septicemia, or arthritis,
but are due, so far as can now be determined, to the same
infections. The results differ because the ratio of bacterial
force to the resistance of the patient differs. Such calves
finally recover a physiologic appearance at one hundred and
twenty to one hundred and eighty days, when they shift
more or less completely from a milk to a vegetable diet.
The pot-belly or gauntness slowly abates, the feces cease to
adhere to the tail and buttocks, the harsh dry coat regains
its lustre, the masses of epidermal debris in the hair disap-
pear, the animal becomes vigorous and grows rapidly. It
then enters upon a period of unusual good health, which ex-
tends to puberty, and breeding occurs. The only trace of
the adversity through which it has passed is the matting and
staining of the vulvar or preputial tuft and the persistence
of more or less numerous nodular elevations in the vulvar
or preputial mucosa, known as the nodular venereal dis-
ease. The significance of the matting of the hairs and of the
lesions in the mucosa is not accurately known. I do not be-
lieve that during this epoch of apparent good health the ani-
mal has become free from the infection. Instead I believe
that here and there the infection still lingers, but there has
arisen an important power of resistance to the bacteria
which holds them in abeyance and renders them essentially
saprophytic for the time being.

The post-mortem findings vary with the form and
duration of the disease. In calves which succumb to
violent dysentery, the lesions are those of gastro-enteri-
tis and septicemia. Hemorrhages occur in the capsule
of the spleen or the outer and inner walls of the heart
beneath the pleura (See Fig. 205) and elsewhere. The
fourth stomach shows great reddening (congestion) of its
mucosa and the folds are generally edematous. The duode-
num shows similar lesions. The remainder of the alimen-
tary tract is not so markedly altered, as a rule, although
frequently the summits of the rectal folds are intensely con-
gested and sometimes hemorrhagic.

664

Diseases of the Genital Organs

Fig. 205 — Costal Pleura of Abort at Full Term, showing' the Petechiae

and Hemorrhages Commonly seen in Abortion, Calf

Sepsis, and Dysentery.

FlG. 206 Pyaemic Abscess in Spinal Canal of Calf.
Si '. Spinal cord : . /. abs<

Congenital Infections of Calves 665

When the immediate cause of death has been pneumonia,
the principal lesions are naturally found in the lungs. In
most cases only the anterior lobes are involved, but some-
times even the diaphragmatic lobe is largely solidified. The
pneumonic areas are whitish or grayish-white, mottled, and
feel much like the normal pancreas. Pleuritis is seldom
seen. Microscopically the affected area is filled with enor-
mous numbers of polymorphonuclear leucocytes, which give
to the lung its grayish, mottled appearance. The condition
is one of severe purulent broncho-pneumonia. In the milder
cases, associated with hacking cough, there are few to many
small circumscribed pneumonic areas, from the size of a
pinhead to that of a pea. The synovial membranes of the
femoro-tibio-patellar, tarsal and carpal joints may be in-
flamed. The pyemic abscesses usually have weak, atonic
walls. The predominant organism encountered is of the
colon group and offers nothing remarkable in cultures or by
staining.

The period and avenues of invasion of the calf need
to be comprehended before intelligent control is possi-
ble. It has now been made perfectly clear that calf septi-
cemia, dysentery, arthritis, pneumonia, and the other phe-
nomena grading off imperceptibly from these to ideal health,
are due fundamentally to an intra-uterine infection not sep-
arable from the infections causing abortion and fetal diar-
rhea. This has already been discussed. It is equally clear
that post-natal infection occurs, chiefly through the mouth
in contaminated food. Probably some cases are due to navel
infection.

The handling of calf sepsis, dysentery, pneumonia, arth-
ritis, and those types of infection shading off gradually to
health and not definitely perilous to life, has a dual meaning
in animal husbandry which should be fully comprehended.
There are two widely different conceptions of curing a dis-
ease, or some phenomenon called disease. The common
meaning of cure is the rescue of the patient from death. In
such infections as those now under consideration, especially
when dealing with purebred calves designed for breeding

666 Diseases of the Genital Organs

purposes, the saving of the life of a calf is an utterly worth-
less performance unless there be added the safeguarding of
sexual health. Few if any principles regarding the infec-
tions of the genital organs of cattle are clearer today than
that the fertility of a bull or heifer, when arrived at breed-
ing age, has been fixed unalterably during its nursing period.
The most important result to be sought in the rearing of
calves is not the conservation of their lives, but the control
of infection which constantly tends to attain a habitat in the
genital system of both sexes, where it persists until breed-
ing age, when it may prevent reproduction or, infinitely
worse, may prove a serious menace to other animals with
which the infected animal comes into sexual relations. This
danger is disputed by many and ignored by nearly all breed-
ers and veterinarians, but the evidence which has been ac-
cumulated is so strong that it is at least time to give to the
subject thoughtful attention. It is common knowledge that
in large herds where sterility, abortion, metritis, retained
fetal membranes, and other phenomena of this group are
violent, the calves suffer much from dysentery and pneu-
monia. When heifers in these herds reach breeding age, it
is notorious that upon the average it requires more than
twice the number of copulations to produce pregnancy than
is necessary in adult cows. Once pregnant, heifers which
have been unhealthy as calves abort in a ratio two to three
times as high as observed in cows. On the other hand, in
small grade herds where often sterility and abortion are
rare and the calves are healthy, the heifers upon reaching
breeding age conceive as promptly as cows and carry their
calves as safely. There are also reliable statistical data sup-
porting this position, an example of which is shown in the
chart designated Fig. 207. The herd was a large one, the
records are unusually complete and accurate, the duration of
time covered by the data is extensive, and the difference in
the behavior of the two groups of heifers is distinct and re-
markable. They were kept in the same stables and pastures,
were bred to essentially the same bulls, were the progeny of
the same group of cows as nearly as possible, and were in

Congenital Infections of Calves

667

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668 Diseases of the Genital Organs

every way handled alike except that the second group was
more carefully handled and was healthier during the nur-
sery period. Everywhere that I have been able to observe,
this view is supported by clinical facts. It is a principle
which has an application in other species, and parallel evi-
dence is submitted in connection with the disease interfer-
ing with reproduction in swine. Consequently I hold that,
in handling the congenital infections of calves, the conser-
vation of life should not be regarded as an end in itself, but
merely as an essential pre-requisite to guarding the sexual
health and vigor of the future adult.

The handling of dysentery must be founded upon certain
well established basic facts. Since the infections under dis-
cussion are primarily intra-uterine, intelligent endeavor
should be made to prevent or to minimize such invasion.
This is to be accomplished by securing, as far as possible,
the mating of sexually sound animals by such means as have
already been advised in the preceding pages. If conception
occurs in a clean uterus, as the result of coitus with a sexu-
ally sound bull, the calf will be born without serious infec-
tion in its alimentary tract. If the uterus or cervix is badly
infected prior to conception, or if the bull is suffering from
serious genital infection, which is ejaculated with the semen,
the calf when born will be critically infected. During preg-
nancy no remedy now known can ameliorate the infection.
No known substance administered in any manner has been
shown to invade the utero-chorionic cavity and disinfect it,
or to pass through the placental filter and destroy bacteria
in the fetal alimentary tract or other organ. Vendors of
biologies have offered alleged cures or preventatives to be
given pregnant cows, but I know of no ground for asserting
that they have value.

Although the precautions advised in the preceding para-
graph are of great value and are to be urgently recom-
mended, they arc imperfect. Generally no thought is given
to such care until the storm breaks. .Many of the cows are
pregnant and the fetuses critically infected, and the termina-
tion of pregnancy must lie awaited before the infection in

Congenital Infections of Calves 669

the calf (as in the cow) can be attacked directly. In prin-
ciple each calf at the time of its birth should be regarded as
possibly carrying bacteria included in its meconium which
constitute a peril to its life and health. This peril is largely
avoidable and should be anticipated. The chief obstacle to
the adoption of measures to forestall the development of the
included bacteria into an active and perilous infection is the
apparently good or perfect health of the calf. To the lay-
man and to many veterinarians it appears imprudent to
undertake the handling of an apparently healthy calf to pre-
vent serious or mortal illness from included bacteria which
reveal no signs of their presence. There are at present no
known means which can be practically applied by which the
breeder or veterinarian can distinguish between the new-
born calf which does, and that which does not carry in its
digestive tract dangerous bacteria. Choice must therefore
be made between two opposing policies : the assumption that
the calf carries dangerous bacteria in its gastro-intestinal
tract, the development of which shall be forestalled, and the
contrary assumption that the apparently healthy calf does
not carry dangerous bacteria, with the postponement of ac-
tion until after the storm breaks. I favor emphatically the
first assumption. The veterinarian is concerned chiefly with
purebred or high grade calves, because these constitute the
basis of the best herds and the source of supply for breed-
ing stock in the improvement of common cattle. The pure-
bred calves are the most intensely infected and should be
most vigorously handled.

Ordinarily the calves of dairy cows are fed by hand either
from birth or after a very few days. I favor taking the
calf immediately from the cow without permitting the dam
to lick it. By this method there is a total absence of worry
over the parting by either mother or young, the calf is more
readily taught to feed, and the amount of food and intervals
between feedings are under control at the most crtical time.
The calf should be removed to an isolated, clean, comforta-
ble stall, and rubbed dry. Post-natal infection through the
umbilic wound should be guarded against by permitting the

670 Diseases of the Genital Organs

navel cord to be ruptured by the natural method of over-
stretching, by which it parts regularly at two to four inches
from the umbilicus. When permitted to rupture in this
manner, the elastic stumps of the umbilic arteries, dragging
with them the stump of the urachus, recoil into the abdomi-
nal cavity and come to rest two or more inches above and
posterior to the umbilicus. This leaves only the vein and the
the amniotic covering of the cord to consider. The blood in
the umbilic vein drops out promptly and the vein collapses
at once. No tying of the umbilic stump should be attempted,
as this interferes with the escape of blood from the umbilic
vein. The layman should understand that there is no bleed-
ing, in the true sense, from the umbilicus of a normal calf.
The arteries when broken recoil in a manner rendering the
escape of blood impossible. Since, if the umbilic stump is
ligated after having broken naturally, the arteries are not
included in the ligature, ligation could not prevent arterial
bleeding if it were threatened. A ligature can serve only to
retain within the navel veins that blood which inevitably
dies and should escape. If the heart valves are defective,
there may be hemorrhage from the navel veins, but in that
case the death of the young animal is an economic gain. The
stump of the navel cord should be disinfected by some re-
liable plan. I prefer a solution of 1-1000 corrosive subli-
mate. A goblet, cup or large-mouthed bottle is filled with
this solution, then pressed against the abdominal floor, sur-
rounding the umbilicus, thus completely immersing the navel
stump, and held there for ten to fifteen minutes. This may
be repeated in twelve to twenty-four hours if the navel
stump has not dried up. As much of the bacteria-containing
meconium as practicable should be removed promptly from
the rectum and large intestines. So far as I have observed,
the best plan is the use of a warm enema of physiologic salt
solution (1 ounce salt to 1 gallon water). It is adminis-
t< red with a hospital irrigator to which is attached a small
soft rubber horse catheter. The irrigator is held slightly
above the calf and the catheter gently introduced into the
rectum while the enema is slowly flowing in. The catheter

Congenital Infections of Calves 67 1

should be introduced ten to twenty inches. If a suitable
vessel is held beneath the anus, the meconium, as it is ex-
pelled with the enema, may be caught and the bedding not
contaminated. It is well to repeat the enema twice daily
for two days at least.

In all herds where infections of calves are common, and
in those calves in comparatively healthy herds in which the
dam has retained fetal membranes or other type of metritis,
calf scours serum should be administered liberally as soon as
the calf is born. I believe it would be even better in pure-
bred calves of high value to make the administration of calf
scours serum a universal rule. According to observation,
depending upon the probable degree of infection present, it
is well to give at the time of birth 20 to 40 mils of the serum,
and if the calf appears well and the temperature remains
below 102 degrees F., to give 10 to 20 mils each twelve hours
until four doses have been given. Clinical observations ap-
pear to indicate that such handling not only prevents in a
large measure the development of dysentery, pneumonia,
and arthritis, but also invigorates the calf, guards it against
less evident types of the same infections, and is an impor-
tant element in laying a secure foundation for sexual sound-
ness when the calf reaches breeding age.

Food should be completely withheld until the calf is twen-
ty-four hours old, because during this interval most of the
bacteria present in the alimentary tract may be removed by
the enemas and the calf may acquire some degree of resist-
ance to the bacteria remaining. There is an old fallacy that
a calf needs a feed of milk immediately after birth, and
most writers on animal husbandry and veterinary obstetrics
so advise, but it should be clearly understood that, up to the
moment of the severance of the navel cord, the young ani-
mal has been richly fed and its blood is well charged with
reserve nutritive material ample for twenty-four hours and
enough to sustain life for several days. A healthy calf from
an equally healthy mother is not born in a starving condi-
tion, nor even hungry. It is quite true that it knows no
better than to eat and if given an opportunity, will almost

672 Diseases of the Genital Organs

invariably gorge itself with food of which it needs no part.
If one will take the trouble to watch a calf taken from its
dam and kept twenty-four hours without food, no evidence
of hunger will be manifested during that period.

If it could be known that a calf carried no potentially
harmful bacteria in its gastro-intestinal tract, an immediate
feed of milk might not do harm. It certainly can do no good.
But most calves are not thus free from bacteria, for the
growth of which milk constitutes an ideal medium. When a
calf of average health is born in an ordinary dairy herd, its
rectal temperature is below 102 degrees F., and generally
it will remain there so long as the calf is not fed. If given
a feed of milk, its temperature rises (bacterial decomposi-
tion of milk with absorption of bacterial poisons by the
calf) within two to four hours, and the amount of elevation
will be proportionate to the volume of milk fed. The bac-
terial decomposition of milk in the alimentary tract of nurs-
lings is so nearly universal that it has led to the fallacious
teaching that the physiologic temperature of the new-born
is higher than that of the adult. The temperature is indeed
usually higher in the new-born, but it is pathologic, not
physiologic, as the experimental feeding of calves has clearly
and emphatically shown. Since it is unnecessary to feed the
calf during its first twenty-four hours, and such feeding is
accompanied by danger, this period should be looked upon
as one in which to do the utmost to forestall the active
arousal of infection and to prepare the calf by every avail-
able means known for feeding safely and successfully. The
temperature of the calf should be measured two or, better,
three times daily during the first ten days, since an eleva-
tion of temperature is the most constant and valuable sign
of approaching trouble. It is especially important that
the temperature of the calf be measured just before
feeding so that if fever is present the milk may be with-
held. The feces are also to be watched closely with
reference to consistency, color, odor, and the presence
or absence of blood. In most cases of impending
dysentery blood may be seen in the feces. At the end of

Congenital Infections of Calves 673

twenty-four hours the calf should be fed about two per cent,
of its body weight of milk : that is, if a calf weighs fifty
pounds at birth, it should be fed at first one pound of milk
morning and night. This ration should be continued for a
period of four or five days, during which time the calf will
lose weight but will retain its vigor and the lustre of its hair.
At the expiration of this period, the ration should be slowly
and carefully increased by four to eight ounces per feed until
a satisfactory ration is attained. The best source from
which to obtain milk is from its dam. At one time I was led
to believe that the milk should be taken from a healthy cow,
even if the rule excluded that of the dam, but more recent
investigations appear to contradict this view. The age-old
belief, that the dam's milk is better for a young animal than
the milk of another animal of the same or other species, ap-
pears to be supported by important scientific facts. I have
stated that the pregnant uterus generally contains potential-
ly pathogenic bacteria, and that the fetal alimentary tract
usually contains bacteria identical with those in the uterus.
The blood of the cow, as shown by agglutination tests, con-
tains protective substances (antibodies) against the bacteria
in her uterus. These substances do not pass the placental
filter or otherwise enter the fetal circulation. The bacteria
included in the meconium generally cause no active infection
in the fetus, and no antibodies are formed in its blood.
Hence the fetus is commonly born without any acquired re-
sistance to the bacteria in its alimentary tract. The milk
of the mother seems, however, to contain such antibodies,
so that a calf in feeding upon its dam's milk is taking with
it substances equivalent to calf scours serum. There is
something in the milk of the mother which tends to repress
the gastro-intestinal bacteria of the calf. The milk should
be drawn carefully under the best rules of cleanliness in a
sterilized pail. Special care should be taken, in cases of re-
tained fetal membranes or other types of genital discharge,
to wash and disinfect the udder prior to drawing milk for
the calf.

43

674 Diseases of the Genital Organs

No harm will ordinarily come to the cow if left without
milking for twenty-four hours after calving, when, under
the plan advised, the calf will get colostrum in its first feed.
Notwithstanding the assertions of numerous teachers re-
garding feeding, the necessity for feeding colostrum to a
calf is a myth. Experimentally I have fed many calves upon
boiled milk from birth, and colostrum cannot be boiled with-
out coagulating. While a calf can be well grown experi-
mentally upon boiled milk from the outset, it requires very
close watching and skillful handling in most instances. I
prefer that for the first eight or ten days the calf should be
fed the very small ration mentioned of raw milk from its
dam. During this period there is confessedly the danger
from infection borne in her milk, but under usual condi-
tions this is more than counterbalanced by its content of
protective substances of a highly essential character. The
plan has very important limitations. If the dam is tuber-
cular, her raw milk should not be fed to her calf. Either
the milk of a tubercle-free cow should be substituted or the
milk of the dam boiled, fed very sparingly, and the loss of the
antibodies in her milk destroyed by boiling, counterbalanced
by the liberal use of calf scours serum. Similar limitations
apply to diseases of the udder. Perhaps the greatest ob-
stacle to overcome in guarding the health of young calves is
the deeply rooted prejudice of breeders that heavy feeding
from the first is essential and that, at whatever cost, the
calf must grow. Instead I have emphasized securing first a
healthy body, knowing that in the end the healthy calf makes
the greatest and best growth. The rule appears to be that
with a moderate number of bacteria in the gastro-intestinal
tract, a small volume of milk may be digested and assimilated
with a minimum febrile disturbance, but, when the volume
of milk is greater, the febrile reaction is stronger. Diges-
tion may be regarded as a triumph of the digestive ferments
over the bacteria present, by which they convert food eaten
into products which may be absorbed and used by the body
for its maintenance and growth. If the bacteria present
prevail over the digest i\ e ferments, products are formed and

Congenital Infections of Calves 675

absorbed which are toxic for the body and imperil health
and life. Presumably there is no material difference in the
amount of digestive ferments poured out in response to the
presence of a small or a large volume of food. Consequently
it should be expected that, within reasonable limits, the
smaller the amount of milk fed, the greater the ratio of
digestive ferments to the volume of milk, and hence the
prompter and more certain the digestion ; conversely the
greater the volume of milk, the lower the ratio of digestive
ferments and the greater the danger of bacteria attaining
the upper hand and displacing digestion by bacterial de-
composition. Clinically this conception holds true and there
is no more important lesson to be learned in connection with
the growing of calves (or other young) than that feeding
more milk than can or will be digested promptly is a peril to
health and life. All that milk which the digestive ferments
fail to prepare for assimilation and utilization by the body
for its food is broken down by the bacteria and causes harm.
I consider it highly important that the milk fed to dairy
calves, after they are about ten days old, be boiled. It is
virtually always mixed milk coming from a large number of
cows. Often when there is a bad udder or a cow has
aborted or had retained afterbirth, the milk is fed to calves.
Such milk is often badly contaminated with infectious dis-
charges from the uterus which have flowed down the tail and
thighs. It is safe when boiled, but otherwise unsafe. The
same is generally true of mixed raw milk. It contains all
infections reaching the milk of any cow, so that the danger
is multiplied by the number of cows contributing to the
ration of milk fed. There has been much interesting
controversy regarding the comparative virtues of raw and
cooked milk. I consider that it has been proven beyond
dispute that raw milk is in itself a safer food for calves for
a few days after birth than cooked milk. Various explana-
tions have been given. Some have said that the essential
salts of the milk are rendered non-assimilable by cooking.
Others have claimed the change is in the fat, casein, or other
constituent. Recently it has been positively asserted that

676 Diseases of the Genital Orgayis

vitamins are destroyed by cooking and the milk thereby
rendered unfit to sustain life and health.

Experimentally I have fed numerous calves upon thor-
oughly boiled milk. A considerable proportion of these,
probably one-third, lived and grew splendidly ; the others
quickly perished from dysentery, arthritis, or pyemia. Those
which did well showed health and vigor beyond that of
calves fed upon raw milk. The results are partially illus-
trated in Figs. 81 to 84. They are confusing because the
calves thus fed represent the extremes, without that middle
class of health observed in calves fed on raw milk. A fur-
ther study reveals the interesting fact that the calves which
did well upon cooked milk came from clean herds where
harmful genital infections were low or not clinically re-
cognizable, while the calves which promptly sickened and
died came from herds where genital infections were intense.
In other words, the cooked milk was excellent for those
calves which were born comparatively free from bacteria in
the meconium, and highly perilous for those having large
volumes of bacteria in the alimentary tract when born. The
cooked milk was perfect as a food but useless as a bacteri-
cide.

My results were in such sharp contrast with the observa-
tions of others that their reliability was questioned. Some
disbelieved the effectual and reliable boiling of the milk. In
order to meet this objection, I personally removed two calves
from their dams at birth, without the dam's having so much
as licked her young. These were placed upon milk auto-
claved for thirty minutes under fifteen pounds of steam,
equivalent to a temperature of about 240 degrees F., or 28
degrees above boiling. The milk was browned to about the
color of weak coffee. I believed that, if vitamins or other
essential constituents were destroyed by heat, this would
demonstrate the fact. But the calves did phenomenally well.
equalling in health and rapidity of growth any I have ever
observed. The results of the experiment are partly shown
in Figs. 208 to 211 inclusive. Calf 70 was extremely thin,
weak, and sick at birth. She weighed forty-nine pounds.

Congenital Infections of Calves

677

Each calf gained upon an average two per cent, of its body
weight at birth per day during the experiment. The plan
for controlling the dysentery, and at one time threatened
pneumonia, is graphically shown in the charts. Neither
calf at any time lost the lustre of its hair. After the first
few days, they remained plump and were unusually playful.
In order to accomplish these results with boiled milk with
any degree of uniformity, I have found it necessary to ad-

Chart Mol

Chart of

CALF

N0.7O

A6E IN DAYS 1

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44 41-1414*144 » 4 ,4 -J i 4 4j 4666666666,6666666666666616666 6666666

Fig. 208— Chart of Calf No. 70, fed upon autoclaved milk.

67 S

Diseases of the Genital Organs

minister large quantities of calf scours serum, but I cannot
believe that this in any way supplied any nutrient con-
stituent of the milk destroyed by heat. It appears to me
quite clear that the sole result of the serum was the supply-
ing of protective substances which held in control or destroy-
ed bacteria existing in the alimentary canal at birth.
Further clinical evidence regarding the action of heat upon
the healthfulness of milk is furnished by placing the calf

Chart of Calf No 70

Chart Nol Continued

Age in days 51 52 53 5-4

55 06 57 58 59 t

,0 Oi (

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to

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FlG. 209— Continuation of Fig. 208.

Congenital Infections of Calves

679

upon raw milk for ten or twelve days and then placing it
upon boiled milk. Such calves regularly do well, and the
logical explanation would appear to be that the raw milk
allowed for a limited time enables the calf to develop a
resistance to the bacteria present, after which the protective
substances are not required. As a result of these researches
I have advised, and have found the advice good in actual
practice, that the calf be fed raw milk from its dam until

Chart No 2 continued -

CHART

OF

Calf

No 71.

AGE. in Days 51

52 53

.■14-

55

Sh

ft7

58

M)

00

M

ft

2

6S

b4

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68

by

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TEMPERATURE

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CURVE: y,

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j

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Diarrhea

Serum ftren minis

AackrinS ■ -

Hilk fed in lbs 6 6

6 6 66

6

6

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6

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8

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00

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Blood m Feces

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1

Xrum jlimi in mib

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Milk fed in lbs 7 7

7777

7l7

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s

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0

Fig. 210— Chart of Calf No. 71, fed upon autoclaved milk.

68o

Diseases of the Genital Organs

eight to ten days old, at which time it should be placed upon
boiled milk, which may be taken from any cow or cows and
may be whole or skimmed. Pasteurized milk has been ad-
vocated as superior to boiled milk, but I have been unable
to observe any superiority in it, either in experiment calves
or when practically fed in herds.

Each new-born calf should be regarded as a probable car-
rier of infection dangerous for other young calves, should

chart of Calf No 71.

Chart No 2

AGE in DAYS

1

s

?>

4

S

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7

t}\S

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i 1

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t

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,

93

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.

Blood m Feces

♦

+

+

iiarrhea

+ +

f +

+

Serum f/ven ""TMi

Xpd

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w H

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i i

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CURVES i«

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In. j 1 1.— Continuation of Fig. 210.

Congenital Infections of Calves 68 1

direct or indirect contact occur. The proper growing of
calves demands an adequately isolated stall for each until it
has reached a time when its freedom from disease is definite-
ly assured. Each establishment should be provided, as a
necessary part of its equipment, with a sufficient number of
perfectly isolated stalls to accomodate all anticipated calves
until at least ninety days old, and longer if appearances in-
dicate danger, or if it is economically practicable. Most
calf nurseries violate every rule of hygiene in construction,
arrangement, and equipment. They usually fall into two
groups. In many instances the available funds are used in
the construction of an expensive, often extravagant, dairy
stable and the young calves are forced into some decaying
structure unfit for the occupancy of any animal. At the
other extreme, there have been erected recently by very
wealthy breeders extravagant nurseries which in their plans
are equally in conflict with the fundamentals of hygiene es-
pecially because the stall partitions are of open work, so that
from a hygienic standpoint there is no isolation of calves.
The calves may lick each other through the partition, diar-
rheic feces may be ejected into the next stall, and sputum
from a pneumonic calf thrown into it. A yet more unsani-
tary practice is the placing of two or more young calves in a
common stall. When some of these become ill, sputum and
feces soil the bedding, floor, feeding utensils, the exterior of
the calves, the food, stalls, and fixtures. The calves lick and
suck each other and transfer from one to the other any
infections present. Frequently an infected calf will suck
the navel of another and infect it. The infected navel will
be sucked and later the calf which is sucking will move to
the udder and suck it, transferring the infection to the teats.
The infection passes up the teat canal causing a small ab-
scess, and when the heifer is grown and calves, one or more
quarters of the udder are blocked and the animal is of low
value.

The simplest type of nursery to conform to hygienic prin-
ciples is one with two rows of stalls, one row against each
side with a broad aisle between. The stalls for the youngest

682 Diseases of the Genital Organs

calves should be six by eight feet, with larger stalls to which
they may be shifted later, with solid partitions (wood or
concrete) . The aisle side should be open and provision made
at the opposite side for a free opening near the level of the
floor (door or window) , so that in warm weather there may
be a free passage of air through the stall at the floor level.
The floor should be of concrete or other impervious material
which will freely admit of washing and disinfection.

The heating of the nursery has generally proven a failure.
Any attempt to heat the room with overhead steam pipes
has, in my observation, heated the upper air, kept flies alive
all winter, and made concrete and similar floors cold and
damp. An ordinary stove is somewhat better, but it is
dangerous and the heat diffuses slowly and imperfectly.
Neither of these plans supplies warmth where it is most
needed — the cold and usually damp floor — and neither ad-
mits of free circulation of air without most of the heat pass-
ing out of the room. I have found hot water pipes laid be-
neath the concrete floor and properly operated highly satis-
factory. The capacity of the heater should be very low
compared with the cubic content of the room, as a safe-
guard against overheating. The pipe should be large, either
cast iron water pipe or sewer tile carefully laid. There
should be but a single loop of pipe beneath each tier of stalls.
With such a system installed, little heat is required to warm
the floor, and, once it is warmed, heat is retained for a long
period. The floor upon which the calf lies is kept warm
and dry while the general temperature of the stable may be
kept low and the exchange of air abundant. The interior
of the stable, stalls and fixtures should be unpainted, or at
least not painted with lead or zinc. Possibly zinc is not in
itself poisonous, but it is rarely or never free from lead. In
fashionable stables many calves die from licking painted
walls or fixtures, and sometimes feed pails.

Throughout the milk-feeding period the condition of the
calf should be watched closely. It should not be permitted
to become gaunt or pot-bellied. The feces of a sound, vigor-
ous calf do not adhere to its tail and buttocks. Upon the

Congenital Infections of Calves 683

first sign of this, the fault should be corrected. Very largely
it is too much milk, at least too much for the calf in ques-
tion. The milk supply should therefore be decreased and
care should be taken to see that it is clean, and, if boiled,
that the boiling has been efficient. At the same time, if
conditions at all justify, calf scours serum should again be
given or, often with better effect, bacterins made from cul-
tures from its feces or stock cultures from the herd. In
such cases enemas of salt solution, as recommended at birth,
repeated twice daily, are useful.

As an economic measure, in order that the milk may be
sold on the market, substitute foods have been recommend-
ed. There can be no material objection to them if they
maintain the condition of the calf as well as good clean
milk, no more than there should be objection on the part of
the dairyman to synthetic milk or butter placed upon the
market for human use. I think it has not yet been shown
that any substitute can equal good milk in either field,
though a good substitute may be superior to bad milk. The
calf may have supplementary foods very early, perhaps
most profitably oatmeal or linseed meal in moderate amount.
When these infections have been neglected and a calf per-
mitted to become feeble, abscesses occur in the lips and
cheeks. The underlying infection must be handled first.
The abscesses should be opened early and freely and they, or
any ulcers, cauterized with silver nitrate or sulphate of
copper. Calves suffering from dysentery or lesser alimen-
tary disturbances, acquire morbid appetites and swallow
straw, hay, feces, shavings (bedding), and various in-
digestible substances. The abnormality is probably never
seen in a healthy calf. If it proceeds far, there are usually
very severe symptoms, which are often confusing. Some-
times the presence of indigestible material, usually packed
into a large dense mass in the stomach, causes an obstinate
dysentery against which all remedies are futile. Some-
times the masses pass on into the intestine and become im-
pacted there. In some cases the calf has severe convulsions
similar to those due to lead poisoning from licking paint. If

684 Diseases of the Genital Organs

the tendency is discovered early, the danger may be halted
by adequate muzzling. If the rubbish swallowed has been
extensive, it is beyond known remedy unless, if the diagnosis
is clear, one may attempt gastrotomy.

If the breeder insists upon permitting the calf to nurse
the cow, he should be induced, if possible, to milk the cow
almost dry and to wash and disinfect the udder before the
calf is permitted to suck. Where the calf must run with the
cow, the feeding cannot be controlled and the handling of
this group of infections cannot be so satisfactory. In beef
cattle, especially purebreds, and in grade cattle which are
partially milked, the feeding problem may in many cases
be satisfactorily managed. If the cows are gentle, they may
be milked out to that point where approximately the ration
advised is left in the udder, and the calf then permitted to
suck. When the calf is ten days old, it will usually con-
sume with safety and profit all its dam will yield. In beef
cows the milk ration may be reduced at first by feeding the
cow very low or by placing her on very poor pasture.

In some herds of beef cattle I have observed that the con-
genital infections do not tend so strongly to induce diarrhea
as in dairy calves. Instead, the calves appear languid,
breathe rapidly (fever), have little or no appetite, and die.
Upon autopsy, the lesions are the same in general as in
dysentery : that is, there are hemorrhages in various tissues
and the feces are soft and fetid. The calf running in the
open may also acquire a morbid appetite, and may swallow
dry grass or other rubbish, have convulsions and die. For
these reasons I have had occasion to advise, with gratifying
results, the use of calf scours serum, as in the dysentery
of dairy calves, making its administration a general rule in
herds where calves are dying. In purebred beef cattle ex-
cellent results are obtainable by separating the new-born
calf immediately after birth, muzzling it securely, and re-
moving the muzzle twice daily to let the calf suck, after the
dam has been well milked out. When dysentery, arthritis,
pneumonia, or other phenomena are established, or when, in
the hands of the alert breeder the temperature, blood in the

Congenital Infections of Calves 685

feces, or other signs betoken the approaching storm, all
food should be withdrawn. Most persons temporize by re-
ducing the ration. That is not enough. The small ration is
of no value whatever to the calf. Instead, the food is broken
up by the bacteria, producing toxic substances which in-
jure the calf. It is almost impossible to have some persons
understand that milk is food only when digested by the
physiologic ferments and that it is just as imprudent to
feed fresh, clean milk to a calf, when it will undergo bac-
terial decomposition in the stomach, as it would be to inoc-
ulate the milk with the same bacteria, incubate it until
thoroughly and repulsively decomposed, and then compel the
calf to drink it.

The calf should receive immediately large and repeated
doses of calf scours serum. There is no limit to the amount
which may be given. It is best as a rule to give 30 to 50
mils at a dose, and this may be repeated in two or three
hours as long as desired. It is best and most economic to
meet the violent onset of the disease with vigorous opposi-
tion rather than to temporize with small or infrequent doses.
It is safer for the calf and more economical to control the
onset of the disease quickly. If the disease is controllable,
it can be overcome within two to six hours, if the dosage
is sufficiently liberal, and the total volume of serum required
will be less than if used in smaller doses over a period of
twelve to twenty-four hours. Calf scours serum generally
appears to act specifically, and, when administered in time
and in sufficient volume, gives highly favorable results. The
calf, even when lying prostrate upon its side, unconscious,
its temperature subnormal, and fetid watery feces dribbling
away involuntarily, often responds at once and may be on its
feet and well advanced toward recovery within two to four
hours. When severe arthritis is present, heavy dosage may
cause the articular pain and swelling to disappear almost
wholly in a few hours. There are numerous exceptions.
When the disease is not taken in hand until far advanced,
the mortality is unavoidably high. In some outbreaks the
disease appears uncontrollable with serum or other known

686 Diseases of the Genital Organs

remedy. Several reasons have been suggested. In many
cases the failure is unquestionably due to a blind reliance
upon serum without the basic act of withdrawing all food
and attending to other essential features, such as the pre-
vention of the swallowing of rubbish. Numerous writers
have contended that the obstinacy in some outbreaks is over-
powering because the infection is specifically different from
the prevailing cause of dysentery, pneumonia, or arthritis,
the bacteria of which have been used in building up the cura-
tive serum. To prevent this, some biologic houses have as-
sembled a great medley of bacteria, in order to produce a
serum which may quite certainly contain the one specific
cause in any outbreak. It is the continuation of the old
"shotgun" therapy based upon the philosophy that, if the
charge scatters sufficiently, some one shot will hit the mark.
To be perfectly frank in the matter, it has not been shown
that the building up of the resistance of the horse, by in-
jecting various bacteria before drawing the serum, has ex-
erted the least effect upon the value of the serum. Accord-
ing to my observations, calf scours serum acts specifically
and highly beneficially in the cases under consideration, but
no control experiments have been made and it is not known
that serum from an ordinary horse not treated by artificial
inoculation with bacteria is not just as potent and valuable
as the preparations upon the market. Indeed some recent
researches by my colleague, Carpenter, appear to indicate
that this is true. It is not improbable also that the serum
or blood from the dam of the calf is a potent agent, possibly
the best substance available. This too has been tried by
Carpenter with promising results. It has not been shown
that any organism used by the various producers of biologies
in immunizing horses for the production of calf scours serum
has any basic relation to calf dysentery or pneumonia. The
makers of serum have largely depended, for making serum,
upon colon organisms obtained from calves dead of dysen-
tery or pneumonia, instead of going where they clearly
should go, to the fetus, for their ferment. The whole
scheme of serologic handling of calf dysentery and pneu-

General Infections of the Genitalia as a Whole 687

monia rests upon very insecure ground, and may at any
date be supplanted by more effective and economic methods.
Pending definite knowledge of the fundamental biology of
calf dysentery and pneumonia, or the definite establishment
of a more efficient method, the present serum method should
be accepted as the standard, applied intelligently and freely,
and given full credit for its undoubted value, whatever may
be the origin of that value.

The Problem of the General Infections of the
Genitalia as a Whole

Throughout the discussion of the general genital infec-
tions of cattle, the various lesions have been considered
separately and in detail, while striving constantly to re-
gard them as related units expressing variations in the
ravages of the infections according to their virulence, the
organ involved, the period of invasion, and the differences in
environment. It is futile to handle cervicitis in the cow due
to streptococcic spermato-cystitis in the bull with which she
copulates. It is useless to rave over "contagious abortion"
in one cow and ignore retained fetal membranes in another
due to the same organism. It is idle to handle calf dysen-
tery which the calf has acquired from the uterus of its dam,
without trying to heal the diseased uterus.

Many writers cry out that "contagious abortion" is caus-
ing tremendous losses, that its ravages are constantly grow-
ing more serious, and that unless halted it will soon ruin the
dairying and cattle breeding industry. They are right. The
theories they promulgate are the foundation of the peril.
So long as sterility, abortion, retained fetal membranes,
metritis, calf sepsis, dysentery, pneumonia, and the endless
list of other phenomena of this great group are described
as distinct, independent maladies and their relation to each
other denied or ignored, all the phenomena of the group will
increase. The multitude of lesions and phenomena described
in the preceding pages are not distinct diseases in any true
sense. Each of them might better be likened to bricks and
mortar which, when properly combined and arranged, con-
stitute a structure of tremendous importance.

688 Diseases of the Genital Organs

I have purposely given the genital infections of cattle the
first place in this treatise, because they lead in importance in
the economic interests of the owner and the state, and in
regard to human health. At the same time they serve ad-
mirably as a basis for comparative study of the genital infec-
tions of other species.

There is pressing need for the building up of a compre-
hensive plan where the dairyman, cattle breeder, and veter-
inarian may meet upon common ground and intelligently
apply effective measures for the control of these appalling
losses. The problem is many-sided and intricate. Most
lamentable of all, but little is actually known regarding it.
Enough is known however to warrant the unqualified de-
claration that means are at hand, and are being applied in
many cases, which are minimizing the losses in a highly
gratifying degree and giving promise of great advancement
with conscientious study and intelligent cooperation.

In the scheme which has been followed in the preceding
pages and which is summarized below, the B. abortus of
Bang is not recognized as the specific cause of abortion or
other disease, but it is not denied that it may cause abortion.
At the same time it is held that other bacteria within the
genital organs may and do cause lesions not distinguishable
at present from those alleged to be caused by the Bang or-
ganism. The plan for advancing the fertility of cattle has,
therefore, for its aim the destruction or control of all patho-
genic bacteria invading any of the genital organs of either
sex, at any age. Such a plan does not weaken but strength-
ens the efficiency of the control of the B. abortus infection,
and more certainly eliminates or minimizes the latter than
if measures were applied to it alone.

A. The Assembling of Herds. The Addition of Breeding
Animals to Established Herds

The task of selecting animals to constitute the foundation
of a herd and the addition of animals to an established herd
for the purpose of improving it, is a complex and difficult
problem. Most purebred cattle are purchased upon their

The Assembling of Herds 689

pedigrees, including their show and dairy records, and upon
their individual appearance. In purchasing cattle the buyer
should recognize certain fundamental principles.

1. Pedigree is of no value unless supported by fertility.
In order to be fertile the animal must be physically sound.
If any chronic disease, such as tuberculosis, is present, the
fertility of the animal is lowered or destroyed. Some cows
and bulls with tuberculosis breed, it is true, but when a
large number of tubercular animals is assembled the group,
as such, shows low fertility. Besides, the disease is a gen-
eral menace to the herd. The laws and customs of sale
now safeguard the buyer fairly well in many states. The
laws also forbid the sale of animals with such acute infec-
tions as anthrax. There are no laws, and no laws are pos-
sible of enactment, which can adequately protect the buyer
against the diseases of the genital organs which may inter-
fere with or destroy the reproductive power of the animal.
At the same time the genital infections constantly threaten
to pass from a diseased individual to another which is sound
or to one which carries a less perilous infection.

2. The buyer should assume that the cattle in all herds
carry infections in their genital organs which may ulti-
mately lead to sterility, abortion, retained afterbirth, calf
scours, and other unwelcome phenomena. He should further
realize that there are vast differences in the virulence of
infections in the cattle of different herds and of different in-
dividuals in the same herd. In some herds the infections
are so mild that little or no visible harm comes from their
presence; in others the reproductive efficiency falls so far
below the ideal that the herd is economically a dismal fail-
ure. Between these extremes there is every gradation.

3. The prospective buyer should not expect the average
seller to volunteer all information regarding diseases among
his cattle interfering with reproduction. Each herd of size
has cows which have aborted because of contagion, but no
breeder posts a sign on his stable giving notice to the public
that he has "contagious abortion" in his herd. Some bacte-
riologists come to the aid of the breeder by asserting that

44

690 Diseases of the Genital Organs

B. abortus is the cause of abortion and that it disappears
from the uterus of an aborter very shortly after the disaster.
If then a cow aborts and the abort and its membranes are
burned or buried, the stall disinfected, and the cow quaran-
tined for a brief interval, the infection is controlled and
from such standpoint the seller may declare he has no "con-
tagious abortion" on his premises — but he may have an hour
or two later. The buyer should not exercise himself seriously
concerning "contagious abortion," but should try to deter-
mine whether the animals he wishes to purchase are capable
of begetting or of giving birth to healthy calves.

4. Intelligent breeders aim to retain their best cattle and
to discard the least valuable. It is only when a breeder ex-
ceeds his holding capacity for good animals that he becomes
desirous of selling some of them. It is commonly assumed
that the breeder of purebred cattle has a far greater ca-
pacity for profitably holding females than males. The dif-
ference has been vastly overdrawn, owing to reproductive
inefficiency. Thoroughly healthy cows breed regularly up to
twenty years and often beyond. Ideally each cow should
produce one healthy calf each twelve months. If she gives
birth to her first calf at two years and breeds ideally up to
and including her thirteenth year, she will have produced
twelve calves, six of which, upon the average, will have been
males and six females. At the close of the thirteenth year,
it will be necessary to have in reserve one adult from her
six female calves to replace the worn-out original cow, and
there will remain for disposal (or for herd expansion) six
males and five females.

When the average breeding life of the females in a herd
falls below six years and the average number of progeny
falls below four, the preponderance of males over females
offered for sale by the breeder becomes very marked. He
must in the latter case retain fifty per cent, of his female
progeny to replace the toll exacted by disease, whereas,
with the ideal cow of thirteen years with twelve calves, he
retains but 16 2/3 per cent, of his female progeny to main-
tain his herd status. The breeder having a herd of low effi-

The Assemblitig of Herds 691

ciency sells only inferior females, while the owner of an effi-
cient herd must find a market for superior animals. In a
healthy herd the limit for profitably holding cows and heifers
is quickly reached, since ideally the female herd increases
by one half its number of females of breeding age each year.
That is, a herd of one hundred cows should ideally produce
fifty heifer calves, and the second year another fifty. Since
in the third year the first fifty heifer calves are in breeding,
there should be born seventy-five female calves, and the next
year one hundred. The progress in numbers goes on with
increasing momentum. The actually successful breeder must
quickly find a market for his females, and must sell those of
good, as well as of poor quality. When, therefore, the owner
of an old established herd advertises, "No females for
sale," he unwittingly announces very low fertility and a
very dangerous herd from which to buy cattle of any age or
of either sex for breeding.

5. In purchasing a foundation herd the entire group of
animals should, if possible, be purchased from one breeder.
In this manner one avoids the risk of bringing into contact
animals from numerous sources, each source possibly fur-
nishing a different type of infection of the genital organs.
The difficulty of determining the state of health of the pur-
chased animals increases as their sources multiply. Pur-
chasing the foundation stock from a single herd simplifies
the question of warranty. If a heifer or cow fails to con-
ceive, the seller of the group cannot shift the blame to the
bull, since he has made a warranty on him also. This plan
is also best for the seller both in fact and in policy. When a
breeder sells a large group of females without depleting his
herd, he gives indisputable evidence of the sexual sound-
ness of his cattle, which another prospective buyer of a
single sire for his established herd may accept as good evi-
dence that he is being offered a sound bull.

6. The best place for a buyer to go to learn of the health
of the herd from which he contemplates purchasing stock is
to the nursery. If a large number of calves, in proportion
to the number of cows in the herd, is present and the calves

692 Diseases of the Genital Organs

under four months of age are vigorous and healthy, the herd
is a comparatively safe one from which to purchase. If the
number of calves is low, and they are gaunt or pot-bellied,
with dirty rough coats, or their tails are smeared with feces,
the herd is an unsafe one from which to buy. In such herds
no animals may be shown for sale until over three to four
months old, when perhaps they have attained apparent vigor.
This should not deceive the alert buyer. The breeding health
of the herd should be based upon the comparative number of
calves and their health up to one hundred and twenty days
old.

7. The prospective purchaser should regularly guard his
interests by having a skilled veterinarian examine in detail
the genital organs of each animal prior to completing a pur-
chase. If a bull is of breeding age, it is best to add to a thor-
ough manual examination of his genital organs, a micro-
scopic examination of his semen with reference to the num-
ber, motility and conformation of the spermatozoa as well as
a search of his semen for bacteria. The method of making
such examinations has already been considered. The genital
organs of cows and heifers should be examined per vaginam
and rectum. If a heifer has been bred thirty or more days,
or a cow sixty or more days, the veterinarian can determine
if she is pregnant. Such examinations should not displace
or affect warranty. If disease of the genital organs is pres-
ent, the prospective purchaser does not wish the animal,
whatever warranty may be offered. Frequently absolutely
and incurably sterile females are conscientiously sold as
pregnant. Occasionally an animal without genital organs is
sold as a pregnant heifer or as a heifer capable of breeding.
It i s best to settle such cases before purchase occurs.

8. The progressive, conscientious breeder should have
complete orderly breeding records for each animal and for
the herd as a whole. These records should be frankly open
for inspection to any prospective buyer. If a cow has been
bred three or four times in order to secure pregnancy, the
prudent purchaser will not buy, whether she is pregnant or
not, or, if he buys, should weigh fully the risk. Such an ani-
mal should be purchased at a comparatively low figure.

The Assembling of Herds 693

9. The purchaser should demand and receive for each
animal a specific written warranty. If an animal is being
purchased as pregnant, she should be warranted as pregnant
at a stated date and place of delivery, and, failing in the
terms of such warranty, the purchase price should be re-
turned. This may sometimes be modified by agreement at
the time of purchase and made a part of the contract, by
which an alternate animal is named, which, in case the
original fails, may be substituted at an agreed price. The
plan which some breeders try to carry out of substituting
another animal "equally good", in case of breach of war-
ranty, is unsatisfactory, and the buyer should see that no
such condition enter into a bill of sale. If an animal sold
for breeding purposes and so warranted by the breeder is
unfertile, the purchase price morally and legally belongs to
the purchaser and should be paid as promptly as a banker
honors a check against a deposit. A warranty of pregnancy
should ordinarily apply to the date of delivery only if deter-
mined by veterinary examination. If the determination is
not made by such examination, a warranty of pregnancy is
unsatisfactory. If a breeder believes he has sold a pregnant
cow or heifer and the purchaser reports later that she
proved non-pregnant, the breeder may believe that she has
aborted and that consequently the warranty was fulfilled.

Warranty against the phantom disease of "contagious
abortion" is impracticable and may lead to endless litigation.
There is no legal definition of "contagious abortion", no sci-
entific definition of it given or possible, and no means of
diagnosis which is applicable in the exchange of cattle.- This
question has already been discussed at length. I think it
best neither to demand nor give a warranty against abortion.
The warranty had best be limited to one of three conditions :
the female is fertile, she is pregnant, or she will give birth
to a calf at an approximately given date. These three items
are each definable and determinable.

The warranty of fertility should definitely apply to the
point of destination — not to the place of sale. A purchaser
in California has no use for a heifer or bull which is said to

694 Diseases of the Genital Organs

be fertile in Maine but proves to be unfertile after transpor-
tation to the purchaser's premises. In one case, where suit
was brought by a buyer on the Pacific coast against a breeder
on the Atlantic coast, the latter set up the plea that the trans-
continental journey had destroyed the fertility of a young
bull. Many sympathetic breeders were brought into court
who swore that railway journeys frequently render fertile
bulls sterile. The jury failed to agree. Unquestionably the
bull was absolutely sterile on the day of the sale and had al-
ways been sterile. The statutes of the state made the sale
of the bull for breeding purposes a warranty of fertility.
Had there been an explicit written warranty of fertility to
the buyer, whose address was known to the seller, no such
claptrap evidence could have had weight.

In the present state of the health of cattle, the purchaser
should also require a warranty against tuberculosis to the
extent that the animal shall pass a satisfactory tuberculin
test after it has reached its destination. A tuberculin test
upon the breeder's premises is his test for his use. He must
make that now for interstate shipment. A test at destina-
tion is the purchaser's test for his security. The breeder is
entitled to satisfactory assurance that infection in transit
or at destination will not occur and that the tuberculin test
will be fair.

B. The Equipment for Cattle Breeding and Dairying.

Proper equipment is a fundamental necessity in the grow-
ing of healthy cattle or other animals. The plans should be
such as to afford the highest possible general and sexual
health of the animals. There is an irrevocable law that, the
greater the mass of animals and the more intimately they
are brought into contact without special hygienic provisions,
the greater the ravages of disease. If it is desired to establish
a large herd, special provision needs to be made against the
dangers of its largeness. Aside from the highly contagious
maladies like foot-and-mouth disease, which the state regu-
lates, contagious or infectious diseases are chiefly spread
through the eating of contaminated food or through sex con-

Equipment for Cattle Breeding and Dairying 695

tact. The breeder, or dairyman should therefore concentrate
his energies upon these two perilous points of contact, in his
planning for the conduct of a herd. The hygiene of massed
individuals has had by far the highest development in the
human family, where the first principle is that, however near
the individuals of a great mass shall approach each other,
each shall preserve its identity and in an important sense
remain isolated — each shall have separate eating and drink-
ing equipment, the excreta from one individual shall not
contaminate the water or food of the mass, the sputum of
the individual shall not be cast upon the floor or elsewhere
to dry up, turn to powder and be inhaled by others. These
are not principles of human, but of universal hygiene. The
more thoroughly the cattle breeder applies these principles,
the better the health of his cattle. Many cattle may be
safely assembled in a small area, if proper regard is had
for these principles. The number of healthy cattle which
may be safely assembled in close contact is unlimited. The
danger arises from the introduction of one or more animals
which are bearers of disease. In planning an establishment
for cattle breeding or dairying, the plans should receive
greatest emphasis at the chief points of danger. Two of
these demand special thought in relation to equipment — the
nursery and the maternity stable. The nursery has already
been discussed under the "Congenital Diseases of Calves".
Each establishment where cattle are stabled should have
sufficient maternity stalls to accommodate each cow or heifer
at the termination of pregnancy for a period of at least ten
days. The stalls should be commodious, comfortable, and
capable of being readily and efficiently disinfected. As in
the calf stalls, the partitions between the maternity stalls
should be perfectly tight and afford complete isolation. A
properly equipped maternity stable serves a double purpose.
Owing to better opportunity for handling, it protects the
animal against the consequences to herself of any infections
which she may bear in her genital organs, and it guards
against the contamination of premises, food or water by
infectious discharges. As a rule cows at the termination

696 Diseases of the Genital Organs

of pregnancy have genital discharges. After abortion in
advanced pregnancy, and after calving at full term, asso-
ciated with retained afterbirth and metritis, the discharges
of highly virulent pus are very voluminous, reaching quarts
and even gallons daily. If such cows are kept in stanchions
in the milking stable, the discharges largely drop into the
gutter and go out with the manure. However, they are not
wholly disposed of in this safe manner. Portions of the
discharges reach the udder of the affected cow or various
portions of her body and of the bodies of adjacent cows and
may in part, as dust or otherwise, reach the milk, or the
feed and water of the cows. It is yet worse when the af-
fected animal is at pasture and the discharges contaminate
the food of other animals. While I hold it has not been
shown that the eating of such discharges by pregnant cattle
can cause interruption of the existing pregnancy, I regard
it nevertheless as unhealthy and not without peril. I con-
sider it of far greater peril to a young calf which may eat
such contaminated food.

The maternity stable provides greater security against
errors with milk. A conscientious dairyman does not wish
to sell milk from a sick cow, but when such an animal is in
the dairy stable her milk is liable to be sent to market
through error. Sometimes drugs, such as iodoform, which
taint the milk repulsively are being used in uterine dis-
eases, and by error the milk is included with that of the
herd and is sent to market. This would generally be pre-
vented by the use of an adequate maternity stable. The
chief purpose served by such a stable is that it offers the
best possible facility for giving to a puerperal cow that at-
tention which will most safely and promptly restore her
genital health if diseased, and best guard it if well. There
is no time in the life of a cow when care and skill can ac-
complish as much as during the first few days following
the termination of pregnancy.

Systematic Control of Genital Infections in Herds 697

C. The Systematic Control of Genital Infections in Herds.

The handling of each phenomenon occurring in the course
of the genital infections of cattle, including the congenital
infections of calves, each independently of the other, is
wasted effort. Science and economy alike demand a syste-
matic effort aimed at the entire complex group, each effort
having a definite relationship to the activities in combatting
each other phenomenon in the problem as a whole.

(1) When a breeder desires to improve the reproductive
efficiency of his herd, it is essential first to learn definitely
the state of sexual health of each animal of breeding age of
both sexes. The bull or bulls should be examined in detail,
as described on page 73, and under "The Genital Infections
of Bulls". If the bull or bulls are found unfertile or of low
fertility, they should be temporarily or permanently dis-
carded. The genital organs of each female of breeding age
should be examined in detail, as described on page 79, and
the findings recorded approximately as suggested on page
83.

The females should then be arranged in five groups —
pregnant, probably pregnant, ready to breed, under treat-
ment or observation, and incurably diseased. The second
group (probably pregnant) is a tentative one which may be
eliminated sixty days after breeding, when pregnancy can
be diagnosed definitely. The incurably diseased should be
promptly eliminated from the herd. The handling of those
under treatment should be vigorous in order that the ani-
mals may be shifted to the group which is ready to breed as
rapidly as expedient. The first examination having been
recorded as suggested on page 83, each subsequent examina-
tion should be recorded as indicated in Fig. 212, and each
consecutive record attached to the original. Should an ani-
mal fail to respond to the measures applied, she should be
shifted at the earliest date of certainty to the incurable
group and eliminated. In large herds of purebred beef
cattle, the cows and heifers should not only be classified as
suggested, but should be separated into four separate groups
for economic handling, these groups consisting of pregnant,

698 Diseases of the Genital Organs

ready to breed, under treatment, and weaned heifers too
young to breed. The caretakers then have their work sim-
plified. The pregnant herd requires only to be watched for
calvings or abortions. Those ready to breed are to be ob-
served closely for estrum ; when heat is observed, it merely
remains to determine to which bull she is to be bred. Es-

STERILITY-ABORTION

RE-EXAMINATION

Owner Address --

Date of last examination Name or uumber of Animal -

Record of estrum and service since last examination

Character of estrum. regular or irregular

General condition State of lactation -_-

Right broad ligament -Left broad ligament.

Vulva Vagina

Cervix .- Uterus

Right ovary

Right oviduct

Left ovary

Left oviduct

Diagnosis Prognosis.

Treatment applied

Treatment advised — -- -

Remarks :

Fig. 212. — Re-Examination Records for the Genital Organs of Cows.

(See also Fig. 37. )

trum in the heifers too young to breed and in cows under
treatment is of no direct interest. The breeder will gener-
ally profit also by the use of the estrum and service card
suggested in Fig. 213. These filed numerically or alphabeti-
cally by name afford a helpful index in breeding. They show

Systematic Control of Genital Infections in Herds 699

at a glance when each pregnant cow is due to calve. In
non-pregnant cows not yet ready to breed, the duration of
time since last calving is shown, and, in cows which are be-
ing bred, the date when the next estrum is due, giving an
opportunity for close watch.

(2) When pregnancy terminates (parturition or abor-
tion), the genital health of the animal should receive atten-
tion. The uterus should be examined shortly afterward. If
the afterbirth is retained or the animal has aborted, handling
should begin at once. If parturition has been apparently

ESTRUM AND SERVICE RECORD Herd No

Name of Animal

Year of Birth Last pregnancy terminated

Dates of Estrum <" and Service for year

•<

ffi
Id

i

<

>•
<

X

z
5

>•
0

0

3
<

u

i

>

a

Date of Service

Bull Used

Menstruation '

Next eBtrum due

Estimating the duration of pregnancy at 280 days animal should calve
Pregnancy from above service terminated

( Abortion
Result - Bull Call
( Heiier Calf

Disposal ) In hera as Nc
of .v Died
Call ) Sold

(1) Whc

(2) U.e,
|3) Kici

Fig. 213. — Estrum and Service Index Card for Keeping
Breeding Records.

normal, the examination may be deferred until ten to twenty
days post partum. In my experience, however, I find large
volumes of tarry blood with a flaccid, much enlarged uterus
at three to four days post partum, and this regularly ends
in a mild pyometra not recognizable clinically except when
the uterus is examined by douching. If the tarry exudate is
recognized, the pyometra can be anticipated and evaded. In
herds where metritis and retained fetal membranes are com-
mon, it is preferable to assume that metritis is impending in
all cows and to introduce capsules of iodoform or boric acid

700 Diseases of the Genital Organs

and bismuth subnitrate, or these drugs suspended in oil, as
a rule of practice, within a few hours after the termination
of pregnancy. The details are considered under "Puerperal
Infections". Re-examination should be made as conditions
may suggest. At forty to sixty days after calving or abort-
ing, if there is no marked disease, an examination of the
genital system should be made to determine if the patient is
ready to breed. If a corpus luteum is present and early
breeding is desired, the corpus luteum may be dislodged and
estrum induced. Unless there is reason for haste, the cor-
pus luteum should be left undisturbed. If the condition of
the genital organs is satisfactory, she may then be bred.

(3) When a heifer has reached the age to breed, or when
sufficient time has expired since a cow has calved and the
genital organs are healthy, the animal may be bred. The
best time to breed a cow or heifer is the earliest hour in es-
trum when she will stand for coitus without restraint. The
spermatozoa will then have ample time to reach the pavilion
of the oviduct and be ready to fertilize the ovum immediately
it is discharged from the ovary. Prior to coitus it should be
seen that the external genitalia of the female are clean. It
is best to wash the vulva, and especially to free the vulvar
tuft of hairs from dried crusts of pus which may be caught
by the penis and injure it. If the vagina is irritated by the
nodular venereal disease or other cause, it should be douched
with physiologic salt solution or 0.25 per cent. Lugol's solu-
tion. The copulatory organs of the bull should be similarly
cleansed by douching, as has been previously described,
special attention being given to the preputial tuft of hairs.
Coitus may then occur immediately. Immediately after
coitus the copulatory organs of the bull should again be
douched.

The importance of washing or douching the copulatory
organs has been greatly overestimated by many and under-
estimated by others. The douching can not exert any direct
influence upon deeply seated infections. Its value is strictly
limited to superficial infections of the copulatory organs. It
has an important place in sex hygiene. Douching prior to

Systematic Control of Genital Infections in Herds 701

copulation partly eliminates infections lodged in these areas
and tends to minimize the danger of infection passing by sex
contact from one animal to the other. The douching, lessen-
ing the amount of infection in the vagina at the moment of
coitus, lowers the danger to the spermatozoa during their
intra-vaginal existence. When the owner of the bull does not
know the record of a strange cow, the douching immediately
after coitus is an important safety measure, but a good bull
should not be permitted to copulate with a cow not reason-
ably known to be sound.

Vaginal douching immediately after coitus is not compati-
ble, so far as known, with good breeding results. It would
probably prevent conception in a vast majority of cases.
Two or three hours after coitus, douching of the vagina
does not interfere with conception, but may render it more
secure. The spermatozoa quickly pass into and through the
cervical canal, where the vaginal douche can not affect
them. The douche does, however, allay the vaginal irrita-
tion of coitus, especially in heifers with nodular venereal
disease of a severe type. In these the vaginitis of coitus is
very marked, but may be quite obviated by timely douching
with 0.25 per cent. Lugol's solution. Many bulls of low fer-
tility ejaculate bacteria with their semen. The spermatozoa
start rapidly upon their journey and probably largely leave
behind the bacteria, which timely douching may mechani-
cally eliminate.

The highly interesting and probably very valuable
field of post-coital uterine douching has not yet been ade-
quately studied. Cervicitis is one of the commonest, if not
the commonest lesion in the genital organs of the cow, and
constitutes a formidable menace to conception and preg-
nancy. Copulation increases cervicitis and not infrequently
(streptococcic semino-vesiculitis of the bull, etc.) causes cer-
vicitis in cows which were healthy up to the time of coitus.
Although spermatozoa frequently pass unharmed over the
infected cervical mucosa, at this time deeply submerged be-
neath the flood of estrual mucus, if conception occurs, the
fertilized ovum upon its descent into the uterus is exposed

702 Diseases of the Genital Organs

immediately to the bacteria present. The uterine douching
may partly wash the infection out or may chemically destroy
it. In my experience post-coital uterine douching often re-
veals muco-pus in the cervix or cervical end of the uterus.
The healthy vigorous spermatozoa have probably left the
uterus and ascended the oviducts within three to four hours
after coitus. From that time until the fertilized ovum de-
scends into the uterine cavity, uterine douches are without
peril to conception and, if properly done, decrease the perils
of cervical and uterine infections. The unknown element in
this field is the minimum duration of time required for sper-
matozoa to pass through the uterus and enter the oviduct,
and for a fertilized ovum to traverse the oviducts and reach
the uterus. I have stated elsewhere that in one instance I
successfully douched muco-pus from the uterus of a preg-
nant cow thirteen days post coitus. It is reasonably certain
that the fertilized ovum was not in the uterus at that time,
but it is not certain, and I believe is improbable, that the
duration of time in this instance was typical.

The number of copulations which a bull should be caused
or permitted to make has not been sufficiently studied.
There are certainly very wide variations in individuals in
the powers of sexual endurance. Some breeders have at-
tempted to state arbitrarily the number of cows which a bull
may serve. The capacity of a bull should be based upon the
number of copulations it may be prudent to have him make.
The number of cows will then be dependent upon the fer-
tility of the bull and the average fertility of the individual
cows which he is to serve. Reliable data of the average rate
of conception in cattle are wanting, and most persons be-
lieve the conception rate to be far above the facts. In one
extensive purebred beef herd, where both bulls and cows
were grazed throughout the year, and in which the genital
organs were exceptionally healthy, there were recorded
2675 copulations, with 1141 known pregnancies, resulting
in the birth of 1061 (39.66', ) of viable calves, 46 (1.72' |
non-viable calves, 34 (1.31', ) recorded abortions, and 1534
(57.34%) copulations without observed result. The data

Systematic Control of Ge?iital Infections in Herds 703

include copulations with a number of hopelessly sterile
cows, as well as a number of copulations by a sterile bull.
I think these data fairly representative of the more fertile
purebred herds. I know the results are far better than in
some herds. The timely elimination of the hopelessly sterile
cows and the elimination of the sterile bull would have
raised the efficiency notably. A far greater advance would
have been made by taking curably infected cows out of
breeding for a few weeks and giving them proper surgical
attention. As the data stand, they furnish some helpful
suggestions regarding the number of cows which may ordi-
narily be assigned to a bull.

Breeding is carried on by two separate plans — massed or
seasonal breeding when it is desired to have all calves born
during a limited season, and perpetual breeding throughout,
or during nine or ten months of the year. A bull may evi-
dently make with safety a greater number of copulations
during the year if evenly distributed throughout, and can
safely make a greater number of copulations in a short in-
terval (one week or one month) when he is to be sexually
idle the remainder of the year. Such observations as I have
been able to make have led me to regard an average of two
copulations per week throughout the year as the probable
maximum of efficiencj^, measured by the percentage of preg-
nancies, their safety, and the vigor of the young. Taking
the above data as a general average of fertility, a healthy
adult bull would suffice for about forty cows (100 copula-
tions).

When the breeding is massed, the frequency of coitus
should still be held under reasonable control. Probably the
frequency of coitus may be advanced to four or five times a
week for a period of four to six weeks. Bulls have done
more than this, but my studies indicate that usually they
undergo a gradual decline in fertility year by year and go
down so far that they do not eventually regain their initial
sex vigor. When mass breeding is undertaken in pasture,
the ratio of females must be very low, especially if all are
ready to be bred when the bull is placed with them. Under

704 Diseases of the Genital Organs

such conditions the bull may copulate several times with a
cow during one estrum. If twenty-one cows are assigned
to a bull and each has an estrual cycle of twenty-one days,
there will be an average of one cow in estrum daily, with
the inevitable result that on some days several cows will be
in estrum. The number of cows under these conditions
should therefore be below twenty, preferably not over fif-
teen. If the breeding period extends over ninety or more
days, more cows may naturally be assigned to one bull. The
breeding of ordinary grade beef cattle in pasture produces
the maximum ratio of vigorous calves, if the bulls are
healthy and abundant, but, when a perilously infected bull
is used, the disaster is inevitably as great, and may be
greater than by individual, controlled breeding. The ordi-
nary grade beef cow running free at pasture commonly en-
joys the maximum of general and sexual health, but it is
far from sufficient to withstand the shock from a virulently
infected bull. When the bull consorts constantly with the
cows, he immediately recognizes estrum, and coitus occurs
promptly ; in controlled breeding estrum is frequently too
far advanced when discovered for coitus to succeed. Many
estrual periods are completely overlooked. If observations
are made but once daily, a cow may readily come in estrum
shortly afterward and the estrum disappear before the
next search is made. Indeed the healthiest cows have the
shortest duration of estrum, frequently dropping to, or be-
low, fifteen hours. This makes it essential to the highest
success to make observations for estrum at intervals of about
twelve hours. The natural inclination of some breeders to
suspend breeding operations on Sunday reduces the effi-
ciency 14 per cent. If the estrual cycle in the individual is
other than twenty-one days, her estrum may be recognized
at its next appearance. But the cycle in the healthiest cows
is most frequently twenty-one days, and, once in estrum on
Sunday, always in estrum on Sunday, unless the estrual
cycle is broken by pressing the corpus luteum from the
ovary.

The maximum degree of safety in sex hygiene is attained

Systematic Control of Genital Infections in Herds 705

by the permanent mating of one female with one male.
Whenever polygamy or polyandry is substituted, each in-
dividual in the group becomes exposed through sex contact
with each other member of the group. Genital infections
increase in virulence with repeated coitus. The larger a
group of apparently sound breeding animals, the greater
the danger that some one of the group harbors a highly peril-
ous infection. In practice a certain group of cows should
be assigned to a given bull and the assignment rigidly main-
tained. Nothing can well be more imprudent than the prac-
tice of shifting a sterile cow from one bull to another.
I have records where the breeder had used five or six
different herd bulls on one cow during a single year. Each
of the bulls thereby exposes the cow to any genital infec-
tions he may carry, and she in turn exposes each subsequent
bull to the original infections in her own organs and to any
which may have been deposited therein by each preceding
bull. It is sexual pandemonium. If the bull and the cows
assigned to him are rigidly maintained as a distinct unit,
the breeder soon knows of the fertility of the bull. If he is
unfertile the remedy is clear. If nearly all cows conceive
promptly and one is sterile after repeated coitus, she is evi-
dently at fault and the danger from her should be eliminated
promptly by overcoming the infection or by sending her to
slaughter. There is a false assumption that some cows will
not conceive to one bull, but may do so to another of equal
fertility. Bulls show every gradation of fertility, and a
cow is naturally more certain to conceive to the bull of
highest fertility, but the bull of low fertility should be
eliminated instead of used unsuccessfully upon cows and
later supplanting him with a highly fertile bull, in which
case the latter becomes exposed to the infections deposited
by the former.

The permanent assignment of certain cows to a bull may
at times lead to the complication of several of his group
coming into estrum simultaneously or in rapid succession.
This need cause no material embarrassment. The rule
should be made, and supported vigorously, restricting the
45

706 Diseases of the Genital Organs

bull to one coitus per day and only rarely permitting coitus
on two successive days. If estrual periods become massed,
instead of imperilling the sexual health of the bull, break
the estrual cycle in one or more animals by pressing the
corpus luteum from the ovary three to five days before it is
desired to have her come in estrum.

The importance of maintaining the general vigor of breed-
ing animals has already been mentioned, but it may be well
to emphasize some special points. Bulls are largely kept too
closely housed and far too highly fed. The bull needs abun-
dant physical exercise, and should either be given daily
work (which is the most economic and best method for re-
taining physical vigor) or provided with an extensive pad-
dock where he can come and go at will and have abundant
exercise.

The feeding of purebred dairy cattle for high milk and
butter yield is one of the most complex and delicate opera-
tions in animal husbandry. Many breeders are record-mad
and crowd cows beyond their powers of endurance. Many
world-famous cows never breed after making a phenome-
nal record. The breeder is left with a cow which holds the
record in her class for milk or butter and is incapable of
yielding any of either. Nymphomania closes the breeding
career of so many high-record cows that the suspicion may
well be aroused that some of these performances are actu-
ally pathologic, and that the great yield of butter fat is
really the consequence of unseen changes going on in her
ovaries, which later culminate in the obvious cystic ovarian
disease. The destruction of the reproductive powers of a
great cow by imprudent handling in an effort to advance
her record is a crime against the state. The breeder has no
greater right to ruin a highly valuable cow than he has to
burn or otherwise destroy a valuable house which he le-
gally owns.

Analogous conditions prevail among breeders of beef cat-
tle, who, at great peril to the reproductive powers of their
animals, feed them inordinately for show. It is notorious
that cattle which are extensively exhibited largely become

Systematic Control of Genital hifections in Herds 707

sterile. Males and females sometimes win the highest prizes
in breeding or in dairying classes when they are hopelessly
sterile or are dry and will never again yield milk. Much of
the harm now being done could be overcome by the breed-
ers' associations and fair managers by offering prizes for
fertility in individuals and in herds, and by basing all milk
and butter records and all prizes at fairs upon high stand-
ards of fertility. If an animal is shown as a purebred for
breeding purposes, let its fertility be proven beyond doubt.
If a cow is shown in the dairying classes, let it be proven
that she is capable of yielding milk and butter.

The most regrettable feature in the imprudent destruc-
tion of the breeding powers of cattle is the fact that the
ruined animals represent the best individuals of their re-
spective breeds and should by every scientific and moral
consideration be retained as efficient progenitors of their
excellent qualities. Instead, when cattle achieve renown,
they are ruined by a false ambition to push them one more
point. Then the breeder must step downward and back-
ward, begin again with ordinary individuals, and labori-
ously produce another illustrious family, which he may
wreck upon the same shoal.

The handling of the genital infections of cattle by means
of biologic products has been discussed at some length under
abortion and congenital diseases of calves. Nothing could
be more earnestly desired than a convenient specific for this
destructive group of infections, but thus far no notable suc-
cess has been achieved, unless calf scours serum is excepted.
In this instance the question has been raised whether the
success may not be due to the plain serum rather than to the
changes brought about by the bacterial inoculations of the
horse. At present the outlook for great victories with "bi-
ologies" is not hopeful and the representations made by ven-
dors of abortion serums, bacterins, and vaccines are not
warranted by any recorded facts.

Some who believe in "contagious abortion" as a specific
disease, like tuberculosis or hog cholera, advise the enact-
ment of statutory laws placing these general infections

708 Diseases of the Genital Orga?is

among the specific diseases subject to obligatory report to
the state veterinarian or other official, who would quaran-
tine and otherwise restrict the movement of the diseased or
suspected cattle. Indeed such laws already exist in some
states but so far as I have learned the statutes do not clearly
define "contagious abortion", but leave the definition to the
attending veterinarian or the breeder. As a result the stat-
utes and the disease have not come in conflict. Thus far it
has been impossible to define "contagious abortion" in such
a way as to render a law regarding it workable. If it is
defined as the presence of the B. abortus in the bodies of
cattle, its presence in the milk of a large percentage of
dairy cows would render the application of such a law im-
possible without prostrating the dairy industry. Even then
the B. abortus would still flourish in other animals. If a
law is to be made which will apply only to the B. abortus
in the uterus, it is the common view that it persists in the
uterine cavity only for a few weeks after the termination of
pregnancy, and quarantine for those few weeks could not
and would not favorably affect the reproductive powers of
the animal. The chief objection to legal restrictions is that,
if the report of abortion be made compulsory, the breeder
can not afford to call the veterinarian, since his attendance
and report mean quarantine with financial loss or ruin,
while the restrictions placed upon the herd are absolutely
impotent to better conditions.

D. The Genital Infections of Cattle as an Economic Problem.

Xo infection or group of infections of domestic animals
offers at present a more serious or pressing economic prob-
lem. The infections are essentially omnipresent and im-
peril life and fertility at every step. The spermatozoa and
ova must run a gauntlet of threatening infection before fer-
tilization may occur. The fertilized egg has its perils as it
passes through the oviducts, and throughout pregnancy the
peril of infection both to the intra-uterine young and to the
mother never ceases. The danger does not end with par-
turition but the infection, persisting in both the mother and

Genital Infections of Cattle as an Economic Problem 709

the young, continues its destruction. The United States De-
partment of Agriculture has made the estimate that the
phenomenon of abortion costs the nation twenty million
dollars annually. The dairy cow, in order to yield the maxi-
mum amount and quality of milk, should give birth to one
healthy calf each twelve months. The purebred herds drop
to between 50 and 75 per cent, of this ideal during an ap-
pallingly brief breeding career. Including all cattle of
dairy breeds, the reproductive efficiency does not exceed one
calf in each fourteen months, so that each cow is kept upon
an average two functionless months. If the loss is rated at
five dollars per cow per month, the 1,500,000 cows in the
State of New York alone aggregate an annual loss, due to
delay in conception, of $15,000,000. That is but one item of
loss. When the total losses are considered, the sum is many
times the one item noted, making this easily the most de-
structive group of infections of cattle. The statement is
now and then made that, next to tuberculosis, "contagious
abortion" is the most destructive disease of cattle. That con-
clusion is based, if not wholly, at least chiefly, upon the ob-
served expulsion of the fetal cadaver and technically re-
stricted to the damage alleged to be inflicted by B. abortus.

E. The Genital Infections of Cattle in Their
Relation to Human Health.

Milk and its derivatives constitute the most important
food of the human race. Milk has been clearly shown to be
a dangerous carrier of infections, such as scarlatina, ty-
phoid fever, putrid sore throat, and others. These are
largely contaminations occurring outside the udder. After
Koch had discovered the tubercle bacillus and thought bo-
vine and human tuberculosis identical, it was believed for
some years that much human tuberculosis was due directly
to the use of milk from tubercular cows. Later researches
have modified that view, and, while still considered as of
essential importance to human health, bovine tuberculosis
is not thought to be as perilous for man as it was at an
earlier date. More recently, following the discovery of the

710 Diseases of the Genital Organs

B. abortus and the assignment to it of specific abortifacient
powers, the question arose regarding the possibility of the
infection invading pregnant women and causing abortion.
A few inconclusive observations were recorded. Occasion-
ally the blood of men and women agglutinates the B. abortus,
but no extended study of the prevalence of the organism in
the human body has been attempted. Natural infection
with B. abortus has been recorded in swine and guinea pigs,
and experimental infection in all domestic mammals. It
would not be surprising, therefore, if a thorough search
showed the B. abortus to be a very common resident of the
human body without striking evidence of peril to health.
The general infections of the genital tracts of cattle, which
cause such an appalling amount of disease, not only in
adults, but in fertilized ova, the embryo, the fetus and the
calf, probably offer at this time one of the most valuable
fields for the study of animal diseases in connection
with human health. There has been much inconclusive
argument regarding the virtues and vices of raw and
cooked, clean and dirty, rich and poor milk as a health-
ful food for man, especially for children and for the
infirm. It has appeared to me unfortunate that the
primary study of the effect of feeding milk to the
young has been carried out chiefly upon children. There has
been built up a system of dairy inspection based upon cer-
tain theoretical considerations of the outside of the prob-
lem. If that is properly gilded, the deeper facts are ignored.
One often sees "certified" milk being sold at an advanced
price as food for children, while the calves in the dairy, to
which part of the same milk is being fed, are sick and dying.
So our dairy inspection maintains in effect that milk which
is perilously toxic for calves is "certifiable" for infants.

The anatomic position of the mammae of the cow justifies
the general assertion that the milk contains some parts of
any genital discharges which are occurring. Hygienically
this contamination is theoretically reduced to the minimum
through the formal rules for the production of "certified"
milk. In the average dairy, sixty per cent, of the cows, if
examined five days after calving, have two or three ounces

Genital Infections of Cattle in Relation to Human Health 71 1

to as many pints of tarry blood or of pus in the vagina or
uterus. The uterus, which should at this time be firmly con-
tracted and so involuted that it may be picked up per rectum
and held in the hollow of the hand, is instead a great flaccid
organ, hemorrhagic and paretic. There is inevitably a dis-
charge, but this is so common that dairymen and dairy in-
spectors call it "normal". Portions of these disease excre-
tions flow down the tail and thighs, and upon the udder and
teats. The ordinary washing of the udder, as practiced in
certified dairies, does not assure the exclusion of such in-
fections from the milk. This is sharply emphasized by the
clinical fact that mammary infection during the puerperal
period is commonest in the posterior quarters of the udder,
which are most exposed to genital discharges, and that, the
more intense the genital infection (e. g. retained fetal mem-
branes), the more probable is mammary infection. So far
as I am aware, no technical study has been made of the bac-
teriology of intra-mammary milk from cows with intense
genital infection in comparison with milk from cows with
typically healthy genitalia. It is logical to assume, until we
have more definite knowledge, that intra-mammary milk
contains as a rule more bacteria in a cow with severe genital
infection than in one which is healthy. By any practical
method of milking there is inevitably added a variable pro-
portion of the genital discharges which adhere to the exte-
rior of the udder and adjacent regions. The inevitable bac-
terial contamination of milk from genital discharges is not
confined to the puerperal period. I have evacuated quarts
and gallons of fetid pus from the uteri of cows in certified
dairies, when the history indicated undeniably that the ex-
cessively fetid pyometra had existed for more than a year
and the cows had been repeatedly inspected and passed by
the dairy inspectors representing great cities. Much of the
present "skin-deep" dairy inspection is a farce, the price of
which, in human health, can not be accurately computed.

The entire field of the genital diseases of cattle offers a
priceless opportunity for the study and advancement of hu-
man health. The genitalia of cattle offer the most available

j 1 2 Diseases of the Genital Organs

field for the clinical study of the basic phenomena of ovula-
tion, menstruation and fertilization. Slaughtered cattle of
the abattoir furnish inexhaustible material for studying the
bacteriology and pathology of the genitalia of both non-
pregnant and pregnant animals. The fetal membranes af-
ford unsurpassed opportunity for the study of bacterial in-
vasion of the embryonic sac. Within the alimentary tract
of the fetus, as a constituent of the meconium, is stored up,
alive though frequently inert, bacteria the presence of which
affords a reliable history of the bacteriology of the pregnant
uterus and a suggestive prophecy of the pathologic changes
which may follow birth. The new-born dairy calf, fed as it
is by artificial means and upon the milk of dairy cows, of-
fers by far the greatest and most reliable source for an ex-
perimental study of the feeding of milk to the new-born.
The influence of pasteurization and sterilization of milk be-
fore feeding, and the relation of bacteria borne in milk and
of bacteria existing in the meconium of the new-born to each
other and to the health of the calf, are comprehensive prin-
ciples not restricted to the species of animal. The bacteria
commonly resident in the meconium of the new-born calf,
can probably be transferred to the digestive tube of children
and cause in them perilous disease.

SECTION II. THE GENITAL INFECTIONS OF
SHEEP AND GOATS

CHAPTER XV
SPECIFIC VENEREAL DISEASES

The Nodular Venereal Disease

While describing the nodular venereal disease of cattle, it
was stated that the same infection is commonly present in
the copulatory organs of both sexes of sheep and presumably
also of goats. According to my observations the infection
is not as severe in sheep as in cattle, probably because the
sex and maternal relations are of a simpler character. So
far as I have observed, the disease has little if any economic
importance in sheep. Any extended consideration would be
essentially a repetition of what has already been said of the
disease in cattle.

CHAPTER XVI

NON-VENEREAL INFECTIONS WHICH INVADE
THE GENITAL ORGANS

Necrotic Disease of the Genital Organs Associated
With Lip-and-Leg Ulceration

Flook (Jour. Comp. Path, and Therap., Vol. XVI, p. 374)
records an outbreak of a venereal disease among sheep. He
relates that, in a herd of fifty-two yearling ewes and two ram
lambs which had been recently purchased, it was noted that
one of the rams had a discharge from the sheath, while the
other had extensive eruptions about the mouth and nose.
Nothing was seen amiss with the ewes. Afterward the two
rams were taken from the band with which they had been
purchased and placed with a small flock of old ewes. After

7 14 Diseases of the Genital Organs

one week Flook found nine of the old ewes showing great
swelling of the vulvae with raw, bleeding sores upon the
mucous and cutaneous surfaces of the vulvar lips. An ex-
amination of the rams revealed ulcerating sores in the sheath
of one and eruptions upon the upper lip of the other. Ap-
parently the general health of the animals was not dis-
turbed.

The rams had been marked with color upon the breasts
between the forelegs, so that each ewe which was served
could be identified. By this means it seemed to be de-
termined that two had contracted the disease without coition.
Flook suggests that the disease may have been transmitted
by the ram which had the eruptions on his upper lip, through
smelling of the vulvae of these two animals, or that it might
have been caused by flies bearing the disease from one ani-
mal to another, since the affection appeared during the
month of August. The affected ewes were isolated and the
sores dressed with antiseptics. Gradually they all re-
covered.

On the following page of the same journal, Sir John Mc-
Fadyean contributes observations made by himself upon an
outbreak which he considers identical with that described
by Flook. He saw twelve ewes affected in one flock, showing
intense inflammation, swelling and tenderness of the vulva.
The vulvar musosa was inflamed and some ulcers were pres-
ent both on the mucous membrane and the skin. There
was a slight purulent discharge from the vulva. As these
ewes had been served by a hired ram which had been re-
turned to his owner six days previously, McFadyean failed
to see the animal. McFadyean attempted to produce the
disease experimentally by collecting the discharges upon
pledgets of cotton, one of which was introduced into the
vulva of a ewe, another into that of a cow, and a third into
the sheath of a wether.

Though two of these experiments proved negative, a swell-
ing of the sheath was apparent in the wether two days after
the inoculation. This was still further increased on the
fourth day and accompanied by a slight discharge. The

Necrotic Disease of the Genital Organs 715

swelling at this time was sufficient to make the exposure of
the penis impossible. The symptoms continued over a pe-
riod of about two weeks. On the third day there appeared
on the skin near the opening of the sheath a small sore which
was covered with a brownish scab. This sore continued to
spread around the opening of the sheath. On the fifteenth
day after inoculation, two small abscesses had formed on
the prepuce near the primary sore ; these ruptured the next
day, leaving shallow ulcers. At this time a third small
abscess had formed. All the ulcers were covered later with
brownish crusts, after which they began to heal. Attempts
to transfer the disease artifically from this animal to an-
other wether and ewe failed. McFadyean did not succeed
in isolating any organism which he believed to be the cause.
While both outbreaks here mentioned have been compara-
tively mild in their course, McFadyean remarks that the
disease deserves careful observation and that newly pur-
chased rams might well be examined with reference to this
affection before being used for breeding.

G. H. Williams (Vet. Jour., Vol. XVII, p. 64) records two
outbreaks of this disease. In his first, in a flock of eight
ewes and one ram, two ewes and the ram were affected.
There was balanitis and ulceration of the penis. He ap-
plied to the parts chinosol and zinc sulphate in solution.
The animals recovered in about two weeks. In his second
outbreak, three rams and forty ewes, in a flock of fifty,
showed the symptoms described by Flook and McFadyean.
In one ewe eruptions occurred upon the nostril. In some
of his cases, the vulva was greatly swollen and distorted;
in others there were extensive granulations of a dark color
which protruded out through the vulva. The granulations
and ulcers were penciled with silver nitrate and the entire
parts washed with a solution of zinc sulphate and chinosol.

In another flock of ewes, which had not associated with
this one, except that one of the rams had been with them,
it was found that twelve had eruptions about the lips and
noses but no genital affection was present. A second ram
in this lot escaped the disease, so far as seen. In the larger

7 16 Diseases of the Genital Organs

flock of ewes, the rams were isolated and the affected ewes
removed immediately from the herd. Daily inspection was
made of the apparently well ewes and any which developed
the symptoms of the disease were promptly separated. A
few weeks later breeding was resumed without recurrence
of the disease, and in due time the ewes dropped healthy
lambs.

About 1909 an affection not distinguishable from that ob-
served by Flook, McFadyean and others in England be-
came widely prevalent and caused quite serious losses in
condition and wool yield upon the extensive sheep ranges
of the Rocky Mountains. It was attributed by Mohler and
others to B. necrophorus. It was known generally as lip-
and-leg ulceration and was characterized chiefly by the for-
mation of necrotic patches about the feet and lips. When
breeding was attempted, the genitalia became severely in-
volved. The mortality was low, but there was important
loss of condition. I saw one flock of Western sheep which
were quite generally involved after their arrival in the East.
Being feeders, thus excluding coitus, the necrosis was vir-
tually limited to the feet and lips.

The disease is apparently easily controlled by isolation
of the affected, with disinfection of the necrotic areas.
Cauterization of the ulcers with solid silver nitrate appears
especially efficacious. When the disease is present during
the breeding season, breeding should be promptly suspend-
ed until the infection has been brought under control.

CHAPTER XVII

THE GENERAL INFECTIONS OF THE GENITALIA
OF SHEEP AND GOATS

The general infections invading the genitalia of sheep
have received no adequate study and veterinary literature is,
as a consequence, essentially barren of any comprehensive
information. The breeding value of an individual sheep is
ordinarily not great and the attainable salvage by selling a
sterile animal for mutton leaves an unimportant margin of
loss. Consequently ewes which fail to produce young are
ordinarily sent to slaughter without comment. While in
small flocks of large, well-nourished sheep, there may be
at times a reproductive ratio of 200 per cent., this is not
reached in large flocks ; in the smaller breeds the ratio falls
below 100 per cent. The increase frequently drops to 75
or 80 per cent, or even less without causing comment. Fre-
quently also ewes are not bred often, but only for two or
three years, when the matured animals are sent to market
and are replaced by ewe lambs.

The rest periods between births are long, giving ample
time for the recovery of the health of the genitalia. Sheep
are ordinarily bred during a very limited season, the dura-
tion of pregnancy is short, and both sexes quickly attain
rest. The new-born lamb grows usually under exceptional-
ly hygienic surroundings. Born as a rule in temperate
weather, it is constantly on pasture and nurses its mother.
Thus it escapes the filthy housing so often forced upon calves
and is spared the mixed milk containing an abundance of
various bacteria, to which is commonly added infection from
dirty feeding pails and other sources. Accordingly lambs
largely escape the digestive perils to which calves are sub-
jected, and as a consequence grow to sex maturity with
cleaner genital organs. Hence they show higher fertility
in the first breeding season. Regardless of these advan-
tages in environment and the plan of breeding, the infec-
tions of the genitalia sometimes acquire such virulence as to

7 1 S Diseases of the Genital Organs

cause serious and notable economic loss. As in cattle and
other mammalia, the storms of infection attract the atten-
tion, though if the question is carefully studied, there is
seen to be far greater loss in the aggregate constantly oc-
curring in one individual after another. One ewe expels
unseen a small fetus or embryo ; another expels at full term
a cadaver which has just died ; another gives birth to a weak
lamb which succumbs to septicemia, dysentery or arthritis,
or the ewe has retained fetal membranes. These are passed
over as "accidents" in the path of reproduction and the
breeder fails to measure the endless economic leak which is
occurring in his herd and which is very important if once
placed in correct view. When the infection attains high
virulence and a storm breaks, the breeder takes alarm, al-
though perhaps the same infection has long been at work
in his herd, causing important losses while gathering mo-
mentum to break finally with fury.

As in cattle, so in sheep, the most striking result of genital
infection is the observed expulsion of a fetal cadaver — abor-
tion. In the earlier stages of pregnancy the expulsion of a
fetal cadaver is not readily recognized. The embryo is
very small compared to the bovine embryo, and retained
chorion and amnion is not common, but the fetal placentae
break away from the chorion and are often retained within
the cotyledonal chalice of the uterus. The wool obscures the
vulva and any moderate soiling of it. When a large fetal
cadaver is expelled, it is apt to be observed and, if evidently
immature, is characterized as abortion ; if expelled at ap-
proximately full term, it is regarded merely as "a dead lamb"
without significance. If the observed expulsions of fetal
cadavers become numerous as a result of the same infec-
tions, "contagious abortion" is diagnosed.

The diseases of the testes, epididymes, and glands about
the pelvic urethra of the ram have not been studied. The
same is true of the ovaries and oviducts of the ewe. The
principal attention has been paid to the changes going on
within the uterine cavity resulting in the death and expul-
sion of the fetus.

General Infections of the Genitalia of Sheep and Goats 719

The infections which may cause abortion are undeter-
mined and probably quite varied. The B. abortus is capable
of multiplying within the uterine cavity, as has been demon-
strated abundantly by various investigators. The experi-
mental inoculations have not shown, however, that it does
or can with any certainty cause a pregnant ewe to abort,
although some conclude that, if the B. abortus is present, it
can cause abortion. It is a difficult matter to prove.

The organism most frequently alleged to be the cause, or
the most common cause, of abortion in the ewe is a vibrio or
spirillum apparently identical with the vibrio previously de-
scribed as associated with certain outbreaks of cattle abor-
tion. The belief that the spirillum causes the abortion in
those cases where it is recognized is based fundamentally
upon its recognition in abundance in the stomach of the fetal
cadaver. This constitutes valuable presumptive evidence.

McFadyean and Stockman1 have given the vibrio the
most extended study yet published. The organism is S-
shaped or spiral, 1.5 to 3 microns in length. It grows in
various culture media. The colonies present an appearance
like B. abortus. The living organisms are highly motile,
moving rapidly in a spiral. McFadyean and Stockman be-
lieved they had proven by experimental inoculation that the
vibrio they described caused the abortions. In many cases
of abortion following natural exposure, the vibrio could not
be found. In some cases putrefactive bacteria may have
destroyed or veiled the vibrios ; in other instances this did
not appear to be the case. Many pregnant ewes were in-
oculated with the vibrios by various channels. Some of
these aborted, but for the most part they did not. In some
of the aborts and the uteri of the aborters the vibrio could
be identified ; in some it could not. The grounds for assum-
ing that the inoculated ewes did not already carry in utero
the vibrios are not stated, and apparently no controls were
kept. Nothing is submitted to show that these ewes taken
from their familiar suroundings would not have aborted in
the same ratio if not inoculated. The evidence that a preg-

1 Abortion in Sheep. Board of Agriculture and Fisheries. London, 1913.

720 Diseases of tlic Genital Organs

nant ewe can be made to abort during her existing preg-
nancy by inoculating with vibrio or other organism is cer-
tainly far from conclusive. The complexity of experimen-
tal proof is essentially the same as in cattle, which has been
considered at length.

Opportunity was afforded me and my colleague, Car-
penter1, for a brief study of a disease affecting pregnant
ewes, many of which aborted. The owner made a practice
of purchasing Western ewe lambs (that is, lambs grown up-
on the Rocky Mountain plateau) in the stockyard at Chi-
cago or Buffalo, securing purebred rams, breeding them for
two years, marketing the lambs, and finally the matured
ewes. The operations had been remunerative and success-
ful.

In 1917 he purchased 252 ewe lambs and imported from
Canada four purebred Shropshire ram lambs as sires. This
gave to each ram 59 females, involving an average minimum
of 3 ewes in estrum each day for each ram. The result was
209 lambs, or an increase of 89 per cent., which indicated
reasonable sexual health. The ideal ratio would have been
at least 11 per cent, higher. The same rams were used the
next year, no new sheep of either sex having been added. So
far as known there was, with one exception, no contact with
other sheep. Moreover all neighboring flocks, so far as could
be learned, were healthy. The one exception as to contact
was that, a few days prior to the intended breeding opera-
tions, a Tunis ram broke into the premises and copulated
with some of the ewes. Twelve of these, all so far as known
that copulated with the Tunis ram, gave birth to 13 cross-
bred lambs, all of which lived. There remained, according
to the caretakers, 223 ewes, which were bred to the same
Shropshire rams usrd the previous pear. When pregnancy
in these had become sufficiently advanced to render the ex-
pulsion of fetal cadavers obvious, abortions began to be ob-
served. The 223 ewes bred to the Shropshire rams pro-
duced 127 viable lambs (57 per cent.) Some ewes which
failed to produce lambs were not observed to expel fetal
1 Report N. V. State Veterinary College at Cornell Univ., 1918 19, page 125.

General Infections of the Genitalia of Sheep and Goats 7 2 1

cadavers, although perhaps they did so at an early date.
The ewes were generally unthrifty. This may have been
due partly to the food, which, though abundant, did not ap-
pear to be first-class. A formidable objection to attributing
the bad condition of the ewes to low-grade food was the fact
that the ewes with which the Tunis ram had mated were in
good flesh and vigorous, although they were kept in the same
flock throughout and were handled identically, except that
they had conceived a few days earlier to a different ram.

Of the 223 ewes bred to the Shropshire rams 25 (11 per
cent.) perished. Some succumbed after the fetus had per-
ished and macerated in the uterus ; others died at virtually
full term, the fetus being fully developed but showing evi-
dences of disease which proved fatal to it at, or slightly prior
to, the death of the ewe. Other ewes died after parturition
or abortion. The mortality in the ewes was apparently the
result of a general sepsis rather than of local genital lesions.
That is, the genital lesions were macroscopically of a com-
paratively mild degree and failed to impress the observer as
being in themselves extremely perilous.

In general the badly diseased ewes suffered from dysen-
tery. The feces were very thin, fetid, and black. No cause
for the dysentery other than the genital infection was rec-
ognizable. Its general clinical character reminded us of the
dysentery occurring in septic metritis in pregnant and puer-
peral cows, already described. The disease began early in
pregnancy and gained constantly in force until pregnancy
had terminated, when some animals, though not all, gradu-
ally improved. Some which were not pregnant, but perhaps
had been, though the embryo had perished, continued to fail
and eventually died in extreme emaciation without showing
marked genital or other lesions. Those which perished
after lambing or aborting generally showed metritis with
accumulations of exudates varying in volume, color and
consistency.

The expulsion of the fetuses, dead or alive, viable or
mortally ill, was tardy and atonic. The ewes were evidently
weak. Vigorous expulsive efforts were wanting. The fun-
46

722 Diseases of the Genital Organs

damental atony was referable to the uterus. Prior to abor-
tion there was often a dirty sanious discharge from the
vulva for several days, and finally when the fetus was ex-
pelled it had undergone putrefaction and maceration. This
is highly characteristic of the metritis of pregnancy in ewes,
so far as- now known. McFadyean and Stockman in their
observations record that sanious vulvar discharge common-
ly occurs some days prior to the expulsion of the fetal cada-
ver, which, in their experience, was usually putrefying or
macerating.

This is in marked contrast to the observations in cattle
abortion. Generally in cattle the expelled fetal cadaver is
fresh and shows merely traces of the beginning of decom-
position. In exceptional cases, as noted while considering
abortion in cattle, the embryo or fetus macerates or putre-
fies prior to expulsion, or it putrefies and is permanently
retained. The prevailing behavior of the uterus toward a
contained dead fetus is, therefore, essentially reversed in
the cow and the ewe. In the cow the endometritis at the
cervical end of the uterus has a marked tendency to cause
contraction of the walls of the comparatively sound ovarian
end of the uterus, through which the fetus, dead or alive,
is forced into the cervix, dilating the latter and causing in
turn expulsive contractions of the abdominal walls. But,
as pointed out, if the infection within the uterus spreads too
rapidly toward the ovarian end, or begins there and para-
lyzes the muscular walls, expulsion fails and retention with
putrefaction follows. Instead of such maceration being the
exception, it becomes the rule in ewes. This is probably
largely due to an earlier and more severe involvement of the
ovarian end of the ovine uterus. It may be due partly in
some cases to the existence of twin pregnancy. Twins rare-
ly perish simultaneously, and as a rule the first embryo to
perish is retained within the uterus until the second fetus
either perishes or reaches fetal maturity. Then the uterus
contracts and either twin abortion or birth and abortion
concurrently ensue. Thus, in twin abortion, the fetuses are
unlike in development and in post-mortem changes. One

General Infections of the Genitalia of Sheep and Goats 723

twin is smaller than the other. It had perished at an early
date and had undergone partial maceration or desiccation.
Such is the rule in twin abortion in the cow and almost with-
out exception in twin abortion in the mare. The same con-
dition is observed in twin abortion in woman. In swine
(presumably also in carnivora) embryos often perish but,
so long as other healthy embryos exist, the expulsion of the
cadavers is inhibited until all have perished or time for
parturition has been reached. In other instances fetal re-
tention with maceration is apparently referable to an in-
tense sclerotic or adhesive cervicitis which prevents cervical
dilation and thus incarcerates the fetal cadaver. In some
years this becomes somewhat common in certain flocks, and
ewe after ewe succumbs. In these instances there are ex-
pulsive contractions of the abdominal walls without concur-
rent contractions of the uterine walls of such power as to
dilate the cervical canal. The abdominal straining forces
the gravid uterus into the pelvis, pushing the cervix in front
of it through the vulva to the exterior — prolapse of the
cervix.

The studies of Carpenter and myself in the outbreak
mentioned failed to establish clearly the etiology. Carpen-
ter recognized a spirillum in the uteri of three out of eight
slaughtered ewes. Two of the ewes carrying spirilla had
aborted, and one had given birth to a viable lamb. In only
one uterus was the spirillum recognized unassociated with
other bacteria (pure culture). Bacteria were recovered
from the uterus or placentae of each of the eight ewes ex-
amined. The list included, in addition to the spirillum,
colon-aerogenes, streptococci, staphylococci, and short oval
rods in pairs.

Experimentally we failed to establish any important facts.
We purchased two pregnant ewes which were wild and
placed them in my experiment stable, where they were very
timid and uneasy. As is usual, the seller reported that he
had observed no abortions or disease of lambs in his flock.
Each ewe received in her jugular 10 cc. of composite stom-
ach fluids from three fetuses, the fluid from each source con-

724 Diseases of the Genital Organs

taining an abundance of vigorous spirilla. One of the ewes
expelled a macerating fetal cadaver fourteen days after the
inoculation. The maceration indicated that it had died at a
period quite in advance of its expulsion, but how long before
could not be told. It may have been dead when the inocula-
tion was made. The ewe was immediately slaughtered, but
no spirilla were obtained from either uterus or fetus. Cul-
tures showed streptococcus viridans and colon-aerogenes.
The other ewe gave birth to an apparently healthy lamb
thirty-two days after inoculation. Both animals were des-
troyed. Spirilla were recovered from the uterus of the ewe,
but not from the lamb. Consequently the spirillum was re-
covered from the apparently healthy ewe but could not be
found in the aborter or abort.

We also inoculated in the jugular two pregnant cows with
20 cc. of the same material as that used in the ewes. One
of these was 64 days pregnant, pregnancy having been veri-
fied by rectal palpation. She was not observed to abort but
was in estrum forty days after inoculation and her uterus
found empty. Cultures obtained from her uterus with cath-
eter showed staphylococci. Immediately after the inocula-
tion she had shown alarming symptoms resembling anaphy-
laxis, but these passed in two or three hours. She evidently
expelled an embryonic cadaver subsequent to the inoculation
but there was no conclusive evidence of the cause of the
abortion. She had aborted three years before, was out of
an aborting cow, and her sire was in service in a virulently
infected herd. She was pregnant by an apparently healthy
bull.

As the other heifer had been purchased, she was without
hi -lory. She was well advanced in pregnancy and gave
birth sixty-live days after inoculation to a very poor, weak
calf weighing 49 pounds. Fluid siphoned from her stomach
yielded staphylococci. The calf lived and remains in the
herd. Her behavior as a calf is shown in Figs. 208-209.

Our experiments failed to show that the spirillum causes
abortion in sheep, although it probably plays an important
part. These experiments are essentially parallel in results

General Infections of the Genitalia of Sheep and Goats 725

with those of McFadyean and Stockman, though the conclu-
sions drawn from them may vary. We secured no uniform-
ity of result and kept no controls. The spirillum may have
been present in the genital tract of the one ewe prior to in-
oculation. McFadyean and Stockman appear to believe that
the death of the ovine fetus is brought about by one microbe
and its maceration by others. Perhaps this belief is general
in abortion in all animals and possibly is borrowed from ob-
servations upon post-natal death. There a given infection
commonly causes death and other bacteria (usually already
present in the body, as the colon bacilli in the intestines) re-
leased from the restraint of the living tissues quickly break
down the cadaver.

Intra-uterine death presents a quite different problem.
Putrefaction or maceration of the embryo is dependent upon
the invasion of the cadaver by putrefactive bacteria, just as
in post-natal life, but the invasion is subject to important
limitations because the embryo physiologically is hermeti-
cally sealed within the uterus. McFadyean and Stockman
apparently believe that, when the embryo perishes in the
uterus, the cervical canal opens and permits free invasion
from the exterior. My observations lead me to believe that
abortion is associated either with a cervicitis which pre-
vents the formation of the uterine seal or with a cervical
endometritis which destroys the uterine seal. In the first
instance it is highly probable, if not certain, that the bac-
teria of pyocervicitis can cause fetal putrefaction and macer-
ation as well as metritis, chorionitis, fetal dysentery, sepsis
and death. In the second instance the bacteria incarcerated
within the sealed gravid uterus, which have power to cause
endometritis, destruction of the uterine seal and fatal dis-
ease of the fetus, quite certainly possess putrefactive or
macerating powers. This is well illustrated in the macera-
ting embryos in swine. These largely occur at the cervical
or ovarian end of the uterus, but may occur in the middle
of an embryo row, flanked upon either side by apparently
healthy embryos. These macerate, putrefy and, if not too
old, are absorbed, but they are wholly shut off from invasion

- 26 Diseases of the Genital Organs

from the exterior. The bacteria causing death and macera-
tion are apparently identical, and I consider it logical to as-
sume that, as a rule, the destiny of an embryonic cadaver is
largely fixed by the nature of the infection causing its death.
In swine there are plenty of bacteria incarcerated within the
gravid uterus. They regularly cause necrosis with varying
degrees of maceration or desiccation of each fetal sac at its
poles. The same bacteria logically have power to cause solu-
tion of a necrotic embryo. So in the ewe the uterus regu-
larly contains necrosis-producing bacteria which produce
necrosis of the tips of the embryonic sac, and it would be
very difficult to understand why the same bacteria may not
cause maceration of a necrotic embryo. As the evidence
now stands, it appears that the death of the fetus and its
maceration are generally referable to the activities
of the same organism or group of organisms. As in
cattle, so in sheep, the infection already exists in the cervix
or uterus at the moment of coitus, or is introduced as a
component part of the semen during coitus. A little later
the cervical canal, if healthy, is sealed and invasion thereby
inhibited.

In the outbreak of genital disease of ewes studied by Car-
penter and me, the history of the herd points strongly to
the rams as the essential source of the infections and to
coitus as the date of invasion. As related, a Tunis ram
broke into the inclosure and copulated successfully with
some ewes. These remained apparently healthy and pro-
duced vigorous lambs. When the Shropshire rams were
placed with the ewes, the disease began with those which
were still non-pregnant. Those ewes bred to the Shropshire
rams began aborting eight or ten weeks before the Tunis
lambs were born. There was abundant time for a contagion
to spread rapidly by ordinary contact from an aborting ewe
to a healthy pregnant one, but this tailed to occur. The out-
break also suggests that the infection, as a highly destruc-
tive force, developed in what may be termed a spontaneous
manner. That is. the infection existed during the prior
breeding season in low virulence, depressing the reproduc-

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General Infections of the Genitalia of Sheep and Goats 727

tive efficiency of the herd ten per cent, or more below the
ideal, but arousing no alarm. Notable dystocia had been
present, but, in accordance with the general view, was at-
tributed to large lambs as compared with the birth passages
of the young ewes, instead of being referred, as was proba-
bly the fact, to uterine inertia resulting from infection.
When the Shropshire rams were placed with the ewes for the
second breeding season, each ram faced the task of copu-
lating once to several times with each of fifty ewes within a
period of twenty-one days. The infection gathered momen-
tum rapidly and serious disaster followed.

As in cattle, so in sheep, there is, so far as known, nothing
which can be done to check abortion in pregnant ewes. It
can be prevented only by mating males and females which
are genitally sound. Secondarily, all those influences of
food, water, air and exercise which, properly adjusted, in-
sure the highest degree of physical vigor, play an important
part in increasing the resistance of the uterus to the infec-
tions virtually always present in small degree.

Rams should be handled with the greatest possible care in
order to insure their sexual vigor. Plenty of vigorous exer-
cise during the long season of sexual rest is a prime factor
in the promotion of physical and sexual vigor and endur-
ance. It is to be remembered that an adult breeding male,
when at sexual rest, requires very little food and that, un-
less vigorous exercise is in some manner provided, he
quickly becomes atonic, lethargic and obese. In this state
infections present in any organ constantly tend to develop
increasing force. When a male so weakened is subjected to
severe sexual strain, each coitus intensifies any genital in-
fection present and endangers his fertility. Therefore, the
two chief precautions to be taken are the enhancing of physi-
cal vigor during the period of sexual rest, and a safe limita-
tion as to the number of females he is expected to serve.
During the rest period the ram should have a moderate ra-
tion, for which he should be obliged to travel enough to en-
sure vigor. The most practicable plan is to permit the ram
to run with wethers, cattle or other animals than ewes dur-

728 Diseases of the Genital Organs

ing the non-breeding season. During the breeding season
the number of ewes assigned to a ram should be carefully
limited. Ordinarily when the ram is placed with the flock,
all ewes are sexually ready for breeding and will be in es-
trum within three weeks, so that it may be assumed that the
male will copulate at least once with each ewe within that
time and will at first probably copulate several times with
each ewe. According to such observations as I have been
able to make, small flocks constantly show higher reproduc-
tive efficiency and more vigorous offspring than large
ones. Many elements doubtless enter into the problem,
but I believe the most important factor, assuming that the
general care is good, is the proper limitation of the sex
strain upon the ram. The large breeds of sheep are essen-
tially twin breeders and if properly handled may, and some-
times do, average throughout the flock two lambs each. Thus
in one flock twenty-six ewes produced fifty-two vigorous
lambs, there having been enough triplets to counterbalance
singles. It is probable that such a number of ewes is near
to or quite the maximum for one ram, if the highest effi-
ciency is to be maintained. Admittedly instances may be
cited where rams have withstood a far greater sexual strain
with apparent impunity, but it is doubtful policy to assume
that any breeding animal is wholly and technically free
from genital infections. Knowing these to be essentially
universal, and knowing that under prudent sex or physical
strain the infections are generally harmless, it appears to
me best to assume the existence of infection and guard
against its intensification. The cost of the maintenance of
additional rams, beyond the value of the fleece, is not highly
important and does not require many additional lambs to
render the plan economically profitable. Such care in breed-
ing is not merely for the immediate influence upon the next
lamb crop. The progressive breeder must always contem-
plate future generations. Health lines are as important as
blood lines, and it requires as great patience and intelligence
to establish that physical vigor upon which high productive
efficiency depends as it does to build up a satisfactory pedi-

General Infections of the Ge?iitalia of Sheep and (ioats 729

gree. The genital infections of sheep, like those of other
mammals, behave as an endless chain. If a ram is over-
crowded and develops virulent infection, the harm does not
end with the abortions which may follow, the ewes which
may perish, or the slow development of the congenitally dis-
eased lambs. Such lambs may be perilously infected and,
upon reaching breeding age, serve as a new center for the
distribution of dangerous infection.

Wherever it is economically practicable, it is better to
divide large flocks into small breeding units and assign to
each unit a breeding ram. By such means, if there be one
dangerous ram in the flock, he is identified and the infection
limited to his group of ewes. The division of the flock into
small breeding units may be for a brief time only, not ex-
ceeding four weeks, when the breeding should be terminated
and any ewe proving unfertile, assuming that the ram is
sound, should be discarded for breeding because she proba-
bly carries dangerous genital infections which it is well to
avoid.

Death and maceration of the fetus, with prolapse of the
cervix, has been mentioned as occurring frequently in preg-
nant ewes. Usually the cases are disseminated and involve
only a small percentage of a flock, but individual cases often
develop annually. The pathology and bacteriology have not
been studied. The disease reveals itself first by the cervical
prolapse. As in the pregnant cow, so in the ewe, the cervix
is at first visible only when the patient is recumbent, in
which position the intra-abdominal tension is increased and
the inert genital organs mechanically forced out through the
vulva. The cervix becomes befouled with litter, desiccated
and irritated by the air, and inflammation and necrosis fol-
low. Cervical prolapse in the pregnant ewe does not al-
ways indicate fetal death and maceration. I handled one
case in which the ewe gave birth to vigorous twins, but that
is merely an exception. The cervicitis tends constantly to
grow worse. The cervix becomes swollen and indurated,
rendering it more and more difficult for the canal to be
dilated.

730 Diseases of tlie Genital Organs

Xo definite line of treatment has become established. If
it can be determined that the fetus is alive, it may be desira-
ble to try to retain the cervix within the vagina. It should
be kept clean and parturition awaited. The retention may
be secured by the vulvar sutures shown in Fig. 60 for vagi-
nal hernia of cows. Securely retained and protected from
soiling and the irritation of drying in the air, the cervix
may be kept clean and soothed by means of irrigations with
salt solution or with bland oils. This may relieve the cervi-
citis and the induration, causing the cervix to relax and the
uterus to expel its contents. It may be attempted, with
some hope of success, to cause contraction of the uterus with
dilation of the cervix by small repeated doses of pituitary
extract. These failing, gastrohysterotomy may be employed,
as described for the cow, and the uterine contents removed
surgically. ,

Retained Fetal Membranes. The metritis which sometimes
results in abortion in the ewe tends also to cause retention
of the fetal membranes. The character of the cotyledons in
the ewe alters notably the type of the placental retention.
In the cow the cotyledons are intimately attached to the
chorion over a large area, so that the two tissues do not
readily tear apart. The fetal cotyledons of the cow may be
described as sessile; the maternal cotyledons are distinctly
pedunculate. This is reversed in the ewe : the maternal pla-
centa is essentially sessile, while the fetal placenta is dis-
tinctly pedunculate, with a long, slender pedicle. In the
cow the pedicle of the maternal cotyledon often parts and the
maternal placenta falls away ; in the ewe the pedicle of the
fetal cotyledon quickly parts, and the chorion and amnion
drop away, leaving the spherical fetal cotyledons (See Figs.
31, 32) incarcerated in the chalice-like cavity of the mater-
nal cotyledon, as shown in Fig. 214 and in Colored Plate VII.

It is only in a minority of cases of retained placenta in the
ewe that the chorion and amnion are included in the reten-
tion. Usually, therefore, the retention is not evidenced by
the membranes protruding from the vulva. Such cases are
rved, but are usually of short duration. So long as the

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General Infections of the Genitalia of Sheep and Goats 731

chorion remains attached to the cotyledon and hangs from
the vulva, the symptoms render the character of the disease
evident, but the more frequent condition of retained cotyle-
dons, after the falling away of the chorion, is not readily
diagnosable clinically. The genital passages do not admit

Fig. 214. — Retained Placenta in Ewe.
C, Chorion ; U, uterus ; /, fetal (above) and maternal cotyledons (below)
showing hemorrhagic placentae ; 2, cross section through fetal and maternal
cotyledons, showing narrow neck of fetal portion ; 7, fetal cotyledon de-
tached from uterus and showing at its base a hemorrhagic zone ; 5, uterine
cotyledon everted ; 6, uterine cotyledon with fetal placenta removed.

manual examination of the interior of the uterus. The diag-
nosis must then rest upon the presence of the metritic dis-
charge, usually dark red, sanious, mixed with necrotic pla-
cental fragments, and fetid. The diagnosis is clear enough
as to metritis, but not as clear, except for the placental frag-
ments, as to retained placenta. The differentiation, however,
between metritis with or without placental retention is not
profoundly important. They possess essentially the same
dangers and call for analogous handling.

732 Diseases of the Genital Organs

The retained cotyledons can not be removed by any technic
at present known. If a rubber horse catheter can be success-
fully passed into the uterine cavity, the contents may be
diluted with saline solution and siphoned out. This can not
be done safely if the chorion is still attached. A small
amount of iodoform and bismuth (30 to 40 grains of each)
suspended in two to four ounces of liquid paraffin may be
introduced into the uterine cavity. Pituitrin may be tried
in small doses (10 to 20 drops) frequently repeated.

The infections involving the fetus and the new-born lamb,
whatever may be their identity, cause approximately the
same lesions as already described in bovine fetuses and in
calves. A notable result, as in bovine fetuses and new-born
calves, is severe dysentery with gastro-intestinal lesions.
Carpenter, in his autopsies of fetuses which had perished
in utero, records essentially universal diarrhea. The amnio-
tic fluid contained meconium, showing that the fetus had
defecated — a distinctly pathologic act. This is illustrated
in Colored Plate VII, where pellets of meconium are shown
lying between the fetus and the amnion. The existence of
fetal dysentery was further shown by the presence of me-
conium in the stomachs of aborts, which location could be
reached only by the fetus having defecated and later swal-
lowed the meconium suspended in the amniotic fluids. Most
lambs born in the flock were thickly smeared over with me-
conium, indicating clearly that they had, as fetuses, suf-
fered from diarrhea.

Except for the few Tunis lambs previously mentioned,
nearly all lambs born were weak and sick at birth. They
were extremely emaciated and were dull and weak. Cov-
ered as they were with meconium, they were often repulsive
to their dams. The ewes refused to lick their young, leaving
them befouled with meconium. Frequently they would not
permit the lambs to suck, but would butt them over when
they approached. The caretakers in many cases caught and
restrained the ewe each time that the lamb fed.

These observations are interesting, because they possibly
throw light upon other instances where a dam refuses to

General Infections of the Genitalia of Sheep and Goats 733

care for her new-born, or resorts to cannabalism as ob-
served in swine. It is not impossible that the repulsion of
the new-born by its mother is often due to disease — that the
fetus has suffered from dysentery due to an infection pres-
ent in the uterine cavity of the mother and the new-born is
repulsively covered with filth, having an odor unlike that
which is natural to the species. In swine, necrotic embryos
are expelled with pigs. The scavenger sow devours the mac-
erating embryos and the pigs, having the same filth smeared
over them, are also eaten.

The lambs in the flock observed largely suffered from
dysentery. Their development was tardy, partly because of
the intense infection, but largely because the ewes, due to
illness, had little milk. Many of the weaker lambs died
from one to two hours up to three or four days after birth.

The post-mortem appearances of fetuses dead in utero and
lambs which perished shortly after birth were analogous to
those of bovine fetal cavaders and calves dead from dysen-
tery. Outbreaks of disease in new-born lambs are not rare
and run essentially parallel, in cause, symptoms, course, re-
sults and post-mortem findings, to those diseases of the calf
having their foundations in infection during intra-uterine
life. They suffer from dysentery, pneumonia and arthritis.
Each of the three consequences may result from post-natal
infection, but the most basic cause is to be sought in the
intra-uterine infection of the pregnant animal. The infec-
tion grows through the chorion and amnion, gains the am-
niotic fluid, and, being swallowed by the embryo, begins its
destructive career by inducing gastro-enteritis with dysen-
tery or, in some cases, sepsis, whether the storm breaks
ante- or post-natal.

The handling of the infections of new-born lambs is to
be based upon the principles laid down for calves and does
not require repetition here. Serologic handling has not
been placed upon a secure basis, so far as known. The serum
sold for dysentery in calves, given in proper dosage, would
probably prove beneficial. The objection will at once be
raised that such a course would be illogical because in the

734 Diseases of the Genital Organs

"calf scours serum" the bacteria used in preparing the
serum are those of "calf scours" — not of "lamb scours". It
has been pointed out, however, that the bacteriology of
neither has been clearly established, and furthermore that
it has not been demonstrated that ordinary horse serum is
not quite as efficacious as is that from horses "immunized"
against large doses of the presumptive "calf scours" bac-
teria.

Genital infections in goats have been reported from time
to time, but the goat industry is confined to comparatively
small areas except for scattering individuals of nominal
value, and the subject has consequently received no sus-
tained interest. When goats become concentrated in large
numbers and are intensely bred, fed and milked, they tend
ultimately to yield to genital infections similarly to cattle.

Stone and Fisher' have investigated an infection in goats
bearing some resemblance to goat pox, but not identifiable
with that malady. The disease was closely associated with
pregnancy and apparently led in numerous instances to
abortion. In the doe the symptoms of disease, consisting
chiefly of pustules, abscesses and multiple arthritis, usu-
ally followed closely upon parturition or abortion. The cu-
taneous pustules were followed by necrotic areas. The ab-
scesses were generally subcutaneous. Some of them ma-
tured and broke ; others became caseous and indolent. The
multiple arthritis was of the ordinary type so frequent in
cows after intra-uterine infection, and in calves, foals and
other young following intra-uterine and navel infections.
The method of infection was not clearly determined. In
some instances the disease was contracted through a healthy
doe's being sent into an infected herd to be bred, but no evi-
dence was submitted to indicate that the inoculation oc-
curred through coitus. Many does aborted or became ster-
ile, or both. The kids born of the infected does largely de-
veloped the same symptoms, especially the polyarthritis.

In the outbreaks directly covered by the report, Stone and

'A Chronic Pox-like Infection in Goats and Its Successful Treatment.
Jour. Am. Vet, Med. Aas'n, Vol. 8, j>. 536, Aug., 1919.

Genera/ Infections of the Genitalia of Sheep and Goats 735

Fisher regularly obtained, in cultures from the pustules and
abscesses, a pure growth of a staphylococcus. Some individ-
uals showed merely a few pustules, which after a short in-
terval healed, and the animals showed thereafter an imper-
fect immunity. A large percentage of cases did not recover
spontaneously and were obstinate to symptomatic handling,
such as antiseptics, the opening of the abscesses, etc. They
were highly successful, however, in the use of autogenous
bacterins. As the work progressed, they used successfully
bacterins made by combining cultures procured from vari-
ous similar cases.

The relationship, if any existed, between the disease de-
scribed by Stone and Fisher, believed to be due to staphylo-
cocci, and the abortion and sterility was not made clear, but
they believed, upon apparently excellent grounds, that the
interferences with reproduction were basic results of the
malady.

In other instances abortions in goats occur in which the
staphylococcus described can not be found, but other bac-
teria are present. In some instances, also, the fetus per-
ishes and, owing to uterine inertia with cervical induration,
retention of the fetus follows. Then prolapse of the cervix
ensues, having the same general characters as the cervical
prolapse of the ewe already described.

Since the general principles of controlling genital infec-
tions in goats are the same as those advised for cattle and
sheep, repetition is unnecessary.

SECTION III THE GENITAL INFECTIONS OF SWINE

CHAPTER XVIII

SPECIFIC GENITAL INFECTIONS

The Nodular Venereal Disease
Outbreaks of specific venereal diseases in swine have been
recorded at intervals, but the records have been indefinite.
When describing the nodular venereal disease of cattle, it
was stated that the infection is common in cattle, swine,
sheep, and presumably in goats. It has been stated by some
writers that in certain herds the infection caused destruc-
tive outbreaks of abortion and sterility in sows. The facts
appear to be that notable losses occurring in certain herds
of swine caused the veterinarian to search for, and quite
naturally to find, the lesions, and upon this evidence the con-
clusion was reached that the infection causing the lesions
was responsible for the abortion. The assumption may be
true or untrue. What has been said of the infection in cattle
is presumably equally true in swine, and it does not re-
quire repetition.

CHAPTER XIX

NON VENEREAL SPECIFIC INFECTIONS INVADING
THE GENITALIA OF SWINE

Genital Tuberculosis
Genital tuberculosis has been reported but rarely in swine
and probably does not play a very important economic part
in swine husbandry. I have in my collection but one speci-
men of genital tuberculosis of swine — tuberculosis of the
testicle, illustrated in Fig. 215. The gland is from a pure-
bred boar belonging to a herd devoted to growing purebred
swine for breeding purposes. They had a liberal supply of
raw milk from a herd of purebred dairy cattle in which tu-
berculosis was rampant. The symptoms of genital tubercu-
losis in swine arc presumably the same as in cattle. The
tuberculosis of swine is ordinarily of bovine origin. Tuber-
cular invasion of the genitalia of swine is to be avoided by
the general measures for preventing swine tuberculosis.
When present, genital tuberculosis has the same dangers for
other swine that bovine genital tuberculosis has for other
cattle. There is no remedy for the affected animal.

Genital Tuberculosis

1X1

Fig. 215 — Tuberculosis of Testis. Boar.
A, Median section ; B, external side of testicle showing epididymis.
/, Spermatic cord ; 2, head of epididymis ; 3, tubercular masses ; 4, tuber-
cular abscess cavity ; 5, body of epididymis : 6, section through
epididymis revealing tubercular masses.

47

CHAPTER XX

THE GENERAL INFECTIONS OF THE
GENITALIA OF SWINE

The general infections of the genitalia of swine are of far
greater economic importance than has yet been generally
recognized. Adult sows (and probably also gilts) ordinarily
discharge at each estrum twelve to eighteen or more ova.
If each ovum were physiologically healthy, the genital tract
healthy, and the sow copulated with a thoroughly healthy
boar, there would be a vigorous live pig born for each ovum
discharged. It was stated, while considering reproduction
in cattle, that in purebred dairy herds there is born as a
rule about one viable calf for each three copulations, or
that about 67 per cent, of the efforts at reproduction fail.
A similar condition exists in the production of swine, but
the result is screened from general observation. Since the
sow is muciparous, if infection of her genital tract is mod-
erate only, some of the ova may be fertilized, develop, and
be born in viable health. The same is true of the boar. If
infection exists in his genitalia which destroys but a part
of the spermatozoa or later brings about the death of only
a portion of the embryos, some pigs are born, but the num-
ber is depressed in harmony with the amount of the infec-
tion existing within the uterus of the sow at the date of
coitus, plus the infection ejaculated with the semen of the
boar. So far as I am able to estimate, these infections re-
duce the number of pigs born upon the average 50 per cent,
which means that swine breeders maintain two brood sows
to perform the ideal work of one. The swine breeder ordi-
narily does not comprehend the meaning of a litter of four
to six pigs, and unconsciously attributes the low fertility In
some vagary of "nature", but a careful study of gravid
swine uteri in the abattoir permits a quite different inter-
pretation.

Abattoir studies of pregnant swine uteri reveal several
very interesting and important facts which arc highly il-

The General Infections oj the Genitalia of Swine 739

lustrative of some of the fundamental principles of genital
infections and the physiology and pathology of reproduction
in general.

The embryonic sacs of swine testify emphatically to es-
sentially universal intra-uterine infection of significance.
Embryologists have described the necrotic tips of the em-
bryonic sacs of swine as "normal" by which the reader as-
sumes this necrosis to be physiologic. Bonnet apparently
regards the phenomenon as the result of pressure necrosis.
That is, the embryonic sac outgrows the length of the uter-
ine (cornual) cavity and, pressing the apices of the sacs
either against the apex of the cornu or against adjacent em-
bryos, by pressure cuts off the nutrition of the chorion, so
that the part dies. Numerous facts contradict this assump-
tion. It is generally contrary to physiologic development
that an organ or tissue should undergo dry necrosis and be-
come in effect a permanent (during gestation) foreign body.
Instead useless organs or tissues usually undergo cellular
disintegration with resorption. The necrosis at the poles of
the embryonic sacs is inconstant in occurrence and extent.
It is not always present. The necrosis increases with the
advancement of pregnancy, as would be expected of a
chronic infection. When some of the embryos are necrotic,
the necrosis of the tips of the other embryonic sacs contain-
ing live embryos is more extensive than that observed in
uteri where all embryos are apparently healthy. From
whatever angle the phenomenon is viewed, it is difficult to
escape the conviction that the necrosis commonly present at
the two poles of each embryonic sac of swine is the result
of a chronic intra-uterine infection which existed, or was
introduced, at the time of coitus, and that death of swine
embryos is ordinarily referable to an extension of such polar
necrosis. The path of invasion appears to be through the
amnion from the necrotic area, after which the embryo
swallows the bacteria and the active invasion of the embryo
itself begins within the alimentary tract.

There are many scattered records of abortion in swine,
but in most reports it is not made clear what the observers

740 Diseases of the Genital Orgaiis

mean. When considering abortion in cows, it was stated
that commonly the word signified the observed expulsion of
a fetal cadaver. In the sow there may be expelled at one
time macerating embryos of varying sizes and degrees of
decomposition, fetuses recently dead, poorly developed, sick
pigs, and fully developed, viable pigs. Such a medley is
difficult of accurate definition. There are present, in the one
uterine evacuation, phenomena which may be designated as
abortion, stillbirth, premature birth, and birth. Accord-
ingly it is difficult to interpret the precise meaning of a
writer when he says that sows have aborted. In some in-
stances, like those reported by Hayes and Traum1, who re-
cord that, out of seventy sows, twelve aborted at from the
forty-third to the one hundred eighth day of pregnancy, it
seems clear that the uteri of the sows were at the times
named emptied of their embryonic contents and that the
embryos were dead. There is no intimation, however, as to
whether the embryos in a given uterus had perished at vari-
ous dates, as shown by size and degree of maceration, or
whether they had apparently perished simultaneously. Ac-
cording to my abattoir studies and such clinical observations
as have been available, the course and character of genital
infections in swine conform to the basic principles of geni-
tal infections in cattle, modified profoundly in some respects
by the muciparous type of reproduction and significant dif-
ferences in the handling of animals. Probably no animal
carries infections in the genital organs more universally or
in larger volume. The ovaries do not show lesions with the
same frequency as the dairy cow, but the same varieties of
disease are present. Fig. 216 illustrates the physiologic cy-
cles occurring in the ovary with one ovary (2) illustrating
ovarian adhesions as a result of salpingitis. Fig. 217 illus-
trates cystic disease of both ovaries. Without history, the
latter was quite certainly a nymphomaniac and sterile. The
symptoms, as I have observed clinically in other cases, are
essentially the same as described in cattle. There is sex
perversion shown in the behavior of the sow towards other
domestic animals. I have not observed the sinking of the

• ion in Swine caused by B. Abortus (Bang. ) North Am. Vet.,
May, 1920.

The General Infections of the Genitalia of Swine 741

Fig. 216— Ovaries of Sow.
/, Ovary showing 6 ripe ovisacs (on left) with apex of cornu to the right
and above ; 2, small fibrous ovary on left, with adhesions in pavilion. (The
oviduct has been divided just beneath 2) ; 3, ovary showing immature
ovisacs ; 4, 5, ovaries showing corpora lutea ; 6, ovary in rest stage showing
atrophied yellow bodies.

74-'

Diseases of Hit' Genital Organs

FlG. j i 7- Cystic Ovaries. Sow.
/, r, Cystic ovisacs, beneath which are apices of uterine horns seen from
ary, with normal ovisacs introduced as check. I Below .
the a] ' •■" uterine homs with ovaries and cystic oviducts arc shown

from ventral surface) /. a small cy9t in mesosalpinx immediately
th> numeral.

The General Infections of the Genitalia of Sic in e 743

pelvic ligaments in the sow which is so prominent a feature
in the cow.

Hydrosalpinx occurs in swine, as in cows. In Fig. 218
there is illustrated an interesting instance of extreme bilat-
eral hydrosalpinx in a pregnant sow, showing that severe
tubal infection may exist at the date of coitus without in-
hibiting fertilization and then develop so rapidly that long

Fig. 218— Bilateral Hydrosalpinx Developed During

Pregnancy. Sow.

/, /, The cornua each contains a normal embryo 4" long ; 2, abscess in apex

of horn, probably embryonic debris ; j, ovary sectioned, showing small

cysts ; 4, cystic distension of adherent pavilion ; 5, cystic oviduct.

before the end of pregnancy the reproductive life of the sow
has been permanently closed — unless one believes that the
tubal infection was post-coital.

The gravid uterus of the sow, the embryonic envelopes,
and the embryos show essentially all the lesions already de-
scribed for the cow, and it is only necessary to point out
here certain deviations in type due to fundamental differ-
ences in the species. Intra-uterine infection with necrosis
of the poles of the embryonic sacs is so nearly universal

744

Diseases of the Genital Organs

that, as previously stated, it is designated "normal". Ne-
crosis and maceration of embryos is exceedingly common..
I have been able to recognize necrotic embryos not over one-
eighth of an inch long, but naturally such are not often rec-
ognized. They commonly macerate quickly, so far as I have
been able to determine, and are absorbed. This probably
accounts in a large measure for the disparity in numbers

Fig. 219— Desiccated "Mole" in Swine Uterus.

/, Desiccated embryonic sac lying in base of uterine cornu (Tbe opened

vagina and cervix extend to tbe right, above) ; 2, apparently healthy

embryo from same cornu ; ,\ necrotic tip of fetal sac.

between the corpora lutea present in the ovaries and the
embryos in the uterus. Some of the discharged ova presuma-
bly tailed of fertilization. Following the minimum recog-
nizable necrotic embryo, there occurs every possible grada-
tion of necrosis, maceration and desiccation. There are
greal variations in one uterus. Sometimes there is a desic-
cated "mole" in which the minute embryo has perished and
is no longer visible, while the embryonic sac remains as a
desiccated, wrinkled eon I or band, as shown in Fig. 219.

The General Infections of the Genitalia of Swine 745

Then follow various sizes of necrotic embryos which have
undergone varying degrees of maceration or desiccation, as
shown in Figures 220 to 222. One necrotic embryo may be
one-half to one inch long and almost wholly disintegrated,
rendering its identification difficult. A contiguous dead em-
bryo may be two or three inches long with only slight
maceration or desiccation. Neighboring live embryos may

Fig. 220 — Necrotic Swine Embryo (right) with Necrotic Fetal Sac.
The cadaver was expelled at full term with 8 healthy young.

be four to six inches or more in length. The live embryos
show great variations in size — sometimes 100 per cent, vari-
ation in volume. The small fetus, the "runt" to be, is ap-
parently small as a result of nutritive disturbances owing
to the ravages of infection, and when born is wanting in
vigor.

Embryonic death may occur in any order, but as a rule
the liability of the embryo to succumb to intra-uterine in-
fection conforms to the general principles laid down for the
cow. The most vulnerable points are the cervical end of the
uterus and the apices of the cornua. As a rule the first to

746 Diseases of the Genital Organs

perish is the basal embryo — that is, the embryo which is
located in the base of one horn nearest to the cervical canal
and whose embryonic sac extends across the uterine mouth
of the cervical canal into the opposite horn. The embryonic
sac of this basal fetus constitutes the "sentinel" which the
infection, more virulent than elsewhere, must pass in order
to imperil the lives of embryos beyond. This is strikingly
illustrated clinically in the dystocia of the sow dependent
upon fetal maceration and emphysema. The difficulty is
commonly with the basal fetus which, having perished and
undergone maceration at or near full term, since the occu-
pied segment of the uterus is paretic, can not be expelled,
and so bars the path of exit of the fetuses beyond, whether
living or dead. Consequently in a large proportion of cases,
if the basal fetus can be successfully removed, parturition
may proceed favorably.

In multipara the death of one or more embryos has little
or no visible tendency to cause the uterus to contract and
empty its contents, so long as living and comparatively
healthy embryos remain, but the necrotic fetal cadaver or
cadavers, with the envelopes, remain in situ and undergo
maceration or desiccation. That is, the presence of an im-
mature, healthy embryo in the uterus serves to inhibit uter-
ine contractions which would expel indifferently dead and
living embryos. In this manner the reproductive efficiency
of swine is partly maintained although the average number
of young produced at a birth is greatly curtailed.

The infections of the genitalia of swine have not been
comprehensively studied. Good and Smith, Hayes and
Traum, and others have searched for, and have frequently
found, the B. abortus in aborting sows, or have found that
the blood of aborting sows, or of boars to which aborting
sows were bred, reacted to the tests for that organism, and
concluded therefore that in these instances it was the es-
sential cause. Apparently other pathogenic bacteria were
not looked for and the conclusion that the B. abortus was the
causative agent was apparently based upon the assumption
thai tli»' B. abortus is tin specific cause of abortion in cattle,

The General Infections of the Genitalia of Swine 747

Fig. 221 — Necrotic Swine Embryos.

/, 2, Necrotic embryos (the membranes incised to bring them into view)

j, a necrotic embryonic sac in which the embryo can not be found ;

7, 5, healthy fetuses from same uterus.

Fig. 222 — Necrotic and Healthy Swine Embryos from Same Uterus.
/, Necrotic embryo ; 2, healthy embryo; 3, necrotic tips.

748 Diseases of the Genital Organs

and that consequently it causes abortion in other animals
which it may invade. Having carved out the idol of specific
contagious abortion in cattle, it becomes obligatory upon the
part of those who thus believe to have a specific contagious
abortion for each species of mammal in order to account for
intra-uterine death which overtakes and destroys a large
proportion of embryos in every land and in all species of
mammalia. Perhaps no animal furnishes more direct evi-
dence of the non-existence of a specific infection with a di-
rect abortifacient action than the sow. One embryo or five
or six embryos in the uterus of the sow may succumb to in-
fection present, but the infection is impotent to cause the
expulsion of the cadaver or cadavers so long as a healthy
immature fetus remains. If, however, all embryos die or
become seriously ill, the endometrium is generally involved
and the diseased organ revolts and expels its perilous con-
tents. Otherwise the orderly completion of pregnancy pro-
ceeds, and at full term the living fetuses are born and the
cadavers are expelled. The uterus accordingly evacuates its
contents in two ways — the ordinary physiologic birth when
the fruit is ripe, and the pathologic expulsion of its con-
tents when the embryo or embryos and their coverings are
dead or seriously diseased, associated with concurrent dis-
ease of the endometrium identical in cause. Any organism
capable of causing endometritis and placentitis with death
or critical illness of the intra-uterine young may and does
lead to abortion, but no microorganism is yet known which
can directly and specifically cause uterine contractions.

The B. abortus is a common resident of the genital tract
of sows which abort or are sterile. It is common in boars.
It is not known to be uncommon in healthy swine. Its com-
mon presence where abortion and sterility prevail justifies
the belief that it is one of the bacteria which serve to inter-
fere with reproduction. But there are other organisms pres-
ent, along with the B. abortus, which have not been studied
and the significance of which can not now be guessed.

The control of the genital infections of swine is to be at-
tained by the adaptation and application of the principles al-

The General Infections of the Genitalia of Swine 749

ready considered at length for the analogous infections of
cattle. The individual value of swine and the anatomical
conditions largely inhibit individual handling and call for
preventive measures en masse. Swine are largely handled
as scavengers and consumers of foods repulsive to other
domestic animals. Near cities they are fed largely upon
garbage. There is a general tendency to handle swine as
lovers of filth and as immune to dirt.

Throughout history swine have been closely associated
with cattle, have consumed their waste milk, salvaged un-
digested grains from their feces, consumed the viscera of
slaughtered cattle, and devoured the carcasses of diseased
cattle. In this long and intimate association there is a
natural tendency for community of bacteria. It is not
strange therefore to find that B. abortus and other bacteria
common in bovine genitalia are similarly prevalent in swine
and have an analogous significance.

In one interesting clinical study it appeared that this in-
timacy of association exerted an important influence upon
the fertility of swine. In a large herd of purebred dairy
cattle, genital infections were intense. There were heavy
losses from abortion, but heavier losses from sterility due
to cervicitis and salpingitis in the cows, and to epididymitis
and spermato-cystitis in the herd bulls. B. abortus was pres-
ent, but the major role was apparently played by a strepto-
coccus of the viridans type. The establishment also had a
purebred herd of swine, in which the reproductive efficiency
gradually decreased until the herd became a distinct eco-
nomic burden. Little abortion was observed, but a major-
ity of the females were sterile. As it was desired to develop
the pigs as rapidly as possible, their mothers' milk was sup-
plemented by all the dairy milk they would take. I recom-
mended that no further raw dairy milk be allowed to swine
of any age or either sex. All milk was to be boiled. The
herd was divided into three groups. In the first group
were listed all sows which had been used for breeding and
which had disappeared from the herd when the change in
the feeding of dairy milk was made. The second group in-

750 Diseases of the Genital Organs

eluded all females which had been fed raw milk and which,
under the new plan, received boiled milk. The third group
consisted of females born after the recommendation had
gone into force, which had received throughout their lives
only cooked milk.

In the first group there were 11 females which were kept
in the herd a total of 131 months after they had reached
breeding age. They produced 100 healthy pigs — one healthy
pig for each 1.28 months, or 9 1/3 pigs a year. The second
group comprised 25 sows with a total of 438 breeding
months, which had produced 207 healthy pigs, or one for
each 2.11 months, equivalent to 5.68 pigs per year. The
third group comprised 8 sows (at date of making up statis-
tics) which had been kept a total of 92 breeding months and
which had produced 107 healthy pigs, or one pig for each
0.85 months, equivalent to 14.1 pigs per annum. Accord-
ingly the combined efficiency of the two first groups was an
average of 6.48 pigs per sow per year as opposed to 14.1
pigs per annum in the final group. I have been unable to
account for the doubling of the reproductive efficiency ex-
cept by the change in the plan of feeding dairy milk. It ap-
pears, too, that it was not the feeding of the adult sows
which affected the breeding efficiency, but the more hygienic
feeding of the young pigs. This is parallel to my observa-
tions upon the health of nursing calves. If the calf is
healthy, whether male or female, it will be fertile when it
reaches breeding age, but if it has diarrhea or pneumonia
as a young calf its fertility as an adult will be low. I do not
attribute the higher fertility in the third group to the killing
of the Bang organism in the milk fed, nor is there any as-
surance that the bacterial content in the milk was directly
responsible. It may well have been that the living bacteria
in the milk established lesions in the digestive mucosa (mu-
co-enteritis. dysentery) which prepared an open portal of
entry tor bacteria already present in the intestines of the
pig, and that these, passing to the genital tract, persisted to
sex maturity and impaired reproduction.

The General Infections of the Genitalia of Swine 751

The principles, therefore, in controlling losses from geni-
tal infections in swine are to grow pigs under the best known
hygienic rules, being careful not to overfeed, keep them in
the cleanest practicable quarters and, when using cow's milk
or by-products thereof, sterilize the latter before feeding.
In these precautions no sex distinction is to be made. Sows
should be closely watched in parturition and, if necrotic em-
bryos are expelled or the litter is low in number, the sow
should be discarded and her litter go with her. The boar,
too, is to be observed carefully and, if at all suspected,
should be subjected to examination by a skilled veterinarian
along the lines already traced for bulls.

Swine breeders have limited their care in mating too
strictly to the avoidance of hog cholera. The prudent
breeder should use great care in accepting sows from other
herds for breeding because of the ever-present danger from
infections of possibly greater virulence than those existing
within the herd. In selecting males for breeding, one should
be taken from a large litter, indicating thereby that the
dam was healthy and that consequently her pigs were, in
the largest available degree, also sound. The general rules
of care regarding moderate feeding and abundant exercise
should be applied intelligently.

SECTION IV. THE GENITAL INFECTIONS OF HORSES

CHAPTER XXI
THE SPECIFIC VENEREAL DISEASES

A. Dourine
Maladie Du Coit. Beschalseuche

Bibliography. Baldrey, Jour. Comp. Path, and Therap., 1905, Vol. 18, p. 7. de Does,
Jahresbericht, 1902. Hutyra und Marek, Spezielle Pathologie und Therapie. Mohler,
Eichhorn and Buck, The Diagnosis of Dourine by Complement-Fixation, Jour. Ag. Re-
search. Vol. I, No. 2, Nov. 10, 1913. Thanhoffer, Ueber ZuchtHihme. W. L. Williams, Report
Illinois State Board of Live Stock Commissioners, 1887.

Dourine of the horse is the most serious specific venereal
disease known among domestic animals, on account of its
wide geographical distribution and the mortality and loss
caused by it. It is, or has been, widely disseminated in Eu-
rope, Asia, Africa and North America. It has been recog-
nized for more than a century and has appeared in all the
leading countries on the European continent. In English-
speaking countries it was first recognized by the author at
Wapella in DeWitt County, Illinois, in the spring of 1886,
among imported French draft stallions and the mares which
had been served by them. The disease in Illinois apparently
broke out in 1884 or 1885, but its nature was not determined
until 1886, and even then its seriousness was not fully ap-
preciated. It was not until 1887 that vigorous measures
were undertaken for its control and eradication. In the
meantime, numerous animals had been sold from the infected
area and widely disseminated over the country in a manner
which made it impracticable to trace them effectively to
their ultimate destination. When the importance of the
malady became recognized, it was promptly placed under
control in its original center and was so completely eradi-
cated that up to the present time, a period of thirty-five
years, it has not reappeared in that territory.

Since that time the affection has been recognized in Neb-
raska, South Dakota, and the province of Alberta, Canada.

Dour in e 753

In these areas of infection the disease has not been definitely
traced to its source. The outbreak in Illinois was believed
to have been introduced by stallions imported from France,
a conclusion which, although unproven, time has not served
to change. The affected area in Illinois produced consider-
able numbers of grade draft stallions and mares which were
sold to go to the West and Northwest for breeding purposes,
and, although it cannot be clearly shown, there is good reason
to conclude that this outbreak furnished the infection for
the others which have occurred in America.

Nature. Dourine is a highly infectious venereal disease
transmitted naturally by coition only. Experimentally it
may be transmitted by inoculation to other animals than
solipeds. It is due to a protozoan parasite belonging to the
trypanosoma group. This parasite, the trypanosomum
equiperdum, was discovered by Rouget in 1896, and its re-
lation to the disease clearly demonstrated by Schneider and
Buffard in 1899. The trypanosome of dourine is a one-
celled organism provided with a flagellum at the anterior
end. It is about 18 to 26 microns in length and, when ob-
served in the living state, is highly motile. It occurs in the
blood, the spinal fluid, the discharge from the genital
organs, the plaques of the skin, and perhaps in other tissues
and fluids of the infected animal. It multiplies by longitud-
inal division. When removed from an animal and kept
moist, it will live for several days or even a week.

It is not always easily found. It is said to be most readily
discovered in recently formed plaques. Baldrey says, in re-
ference to the appearance of the trypanosoma in the fresh
plaques, "If these appear, then a positive diagnosis can be
made; if not, the case is not dourine." The parasites are
said to disappear quickly from the plaques, so that it is diffi-
cult or impossible to find them after twenty-four hours.
They may be found in the discharge from the vagina or
urethra of the infected animal, but it seems that their exis-
tence here is not as uniform as in the fresh plaques. Some
investigators believe that they are quite uniformly present
in the spinal fluid. It is generally very difficult to discover
them in the blood.
48

754 Diseases of the Genital Organs

This parasite constitutes an exception to the general rule
in the trypanosomic group of diseases, in that it is not
transmitted from animal to animal by the bite of an insect.

Symptoms. The period of incubation following natural
infection is not definitely determined and varies considerably
in different cases. Generally there appear some physical
signs of disease in from eight to ten days after exposure,
but these may not be very marked and may pass unnoticed
by an inexperienced observer.

The symptoms of the disease may be divided into three
important groups : the local lesions of the genital organs and
the contiguous parts ; those of the skin and other mucous
membranes than that of the genital organs; and the symp-
toms which emanate from the central nervous system. The
local symptoms in the genital organs are the first to appear
after infection and usually the last to disappear in case of
recovery.

In the stallion there usually appears, eight to ten days sub-
sequent to infection, a swelling of the penis and prepuce,
with some degree of protrusion of the penis, still covered by
the prepuce. The prepuce shows a tense, elastic swelling
and has a smooth, glistening appearance. If the urethra is
exposed to view, its meatus will be found swollen, dark red,
and intensely injected. From it exudes a small amount of a
thin, dirty, muco-purulent discharge. As the disease pro-
gresses, the tumefaction of the prepuce and penis increases
and extends to the sheath and scrotum, which may eventually
become enormously swollen and remain in an indurated con-
dition for one to two years or more. The animal gradually
becomes less able to retain the penis in its position, and the
swollen organ protrudes farther and farther out of the
sheath, sometimes extending entirely out of the prepuce and
hanging flaccid and fully exposed. The discharge from the
urethra may become somewhat ichorous and, with the gen-
eral soiled condition of the penis and surrounding parts,
may lead to ulcerations and erosions upon these. Later in
the course of the disease, the weakened condition of the
tissues of the pari may lead to purulent infection and the

Do urine

755

formation of abscesses in the sheath, scrotum and inguinal
region. (See Figs. 223 and 224.)

The testicles may undergo inflammation and swelling
which after a time may be followed by atrophy, and they may
be pushed upward by the swelling or abscesses in the scrotum

Fig. 223 — Stallion in Early Stages of Dourine, showing
Edematous Prepuce. ( Baldrey. )

until they rest high up in the inguinal space where they can
not be readily felt. No vesicles or pustules occur upon the
genitalia as an essential part of this disease, but there occurs
with considerable uniformity a depigmentation of the skin
and covering of the penis, so that it may largely lose its
pigment and become white. This depigmentation begins

756

Diseases of the Genital Orga?is

upon the penis and may extend to the prepuce, sheath and
scrotum. In studying this symptom, it is well to bear in
mind that in gray horses and in those having white eyes,
faces or feet, it is quite common to observe an absence of
pigment on the penis, but this is regular in outline, whereas
in dourine the depigmentation spreads out in patches.

hi the mare, about eight to ten days after infection there
appears a well marked swelling of the lips of the vulva. The

Fig. 224 — Dourine showing- Penial Paralysis. 1 Baldrey. )

mucous membrane of the vulva and vagina is intensely in-
jected and swollen, and from the vulva there escapes a more
or less profuse discharge of a mucous or muco-purulent
character, which soils the tail and surrounding parts. The
mare urinates frequently in small quantities, which causes
pain as indicated by straining, stamping with the feet, and
switching of the tail.

There seems to be an increased sexual excitement, which

Do urine 757

may be somewhat misleading, depending largely for its ex-
pression upon the frequent urination, rather than upon genu-
ine sexual desire.

As the disease progresses, the volume of the discharge
tends to increase. In some cases it assumes a dirty gray-
ish color, and may become fetid. The swelling of the vulva
increases, the labiae become much enlarged, tense, elastic,
and glistening. Their margins stand somewhat apart, so
that the vulva is partly open, especially at its lower com-
missure.

Within a few weeks after the advent of the disease, there
appears quite regularly a characteristic loss of pigment in
the skin of the vulva and the neighboring parts. This de-
pigmentation begins along the margins of the vulva, with-
out prior vesicular or pustular eruptions, as simple white
patches, and thence extends in irregular lines or spots, until
it may involve the entire vulva, perineum and anus. The
white patches have irregular borders and are of various
shapes and sizes. They persist for several months and, in
case of the apparent recovery of the animal, tend finally to
disappear, fading first at the periphery, while upon the mar-
gins of the vulvar lips they persist for six months or a year.
(See Fig. 225.)

Of even greater diagnostic significance are the changes
which occur in the clitoris. Comparatively early in the
course of the disease, this organ becomes swollen and, the
vulva being somewhat open at the inferior commissure, be-
comes visible ordinarily without mechanically parting the
labiae. The secretion of sebum in the prepuce of the clitoris
apparently ceases, and the swollen organ becomes dry and
glistening. Depigmentation of the clitoris and its prepuce
occurs early and persists for one to two years in those mares
which apparently recover. In my experience it is the last
symptom to disappear. The swollen, depigmented clitoris
with gaping vulva constitutes one of the most uniform and
persistent symptoms of the malady and gives to the vulva
of a young mare the appearance of extreme old age.

Following closely upon the first appearance of local lesions,

758

Diseases of the Genital O'gans

within a few weeks after infection, there appear peculiar
and pathognomonic cutaneous eruptions in the form of
plaques, or elliptical elevations. These eruptions appeal-
suddenly, largely about the flanks, neck, shoulders, sides and
thighs, as more or less circular elevations, one to several

FiG. 22s Advanced Dourine in Mare with Extreme Emaciation and
Depigmentation of Vulvar Lips. ( Hutyra and Mink, i

inches in diameter. The margins of these are very abrupt
and stand up above the level of the healthy skin like the
eruptions of urticaria. The hairs upon them are erect.
They appear suddenly, usually not in great numbers, but only

Dourine 759

one to five or six at a time, remain a few days and disappear
without leaving a mark, to be succeeded by a new crop. It
is claimed that in these plaques the trypanosomes are very
abundant during the first stages of their existence, but as
the eruptions grow old the parasites rapidly disappear from
them.

It has been stated that the plaques may cause intense itch-
ing and lead the animal to bite or rub the part and that they
sometimes suppurate. I have observed none of these
symptoms.

It is not uncommon to observe in the later stages of the dis-
ease a more or less profuse discharge from the nostrils.
This nasal discharge may in some cases be suggestive of
glanders and superficial ulceration of the mucous mem-
brane may rarely be present. The erosions, when present,
have no specific character and suggest rather a necrosis of
a greatly debilitated tissue as the result of an irritant ap-
plied externally. It must not be forgotten that glanders
and dourine may coexist and that the latter would, naturally
greatly intensify the former.

The general debility or cachexia of the disease shows it-
self clearly in lesions of the skin. Wounds heal tardily.
If the animal is so weak that it is recumbent a large part
of the time, it suffers from extensive decubitis gangrene.

The symptoms, which are largely referable to the nervous
system, appear at about the same time as the plaques. The
first and most pronounced of .this group is usually a pro-
gressive paresis, which is chiefly observable in the hind parts.
At first there is an unsteady gait. The animal brings the
hind feet forward in a difficult and somewhat uncertain
manner. There is a tendency to drag the toe along the
ground or to strike it at the middle of the stride. When
weight is placed upon the foot the toe is usually brought
down first, with the fetlock flexed, and the heel is then
lowered suddenly. While standing, there is a tendency for
the fetlocks to be maintained in a flexed position or some-
what knuckled over. This knuckling over, whether stand-
ing or during progression, is a rather common symptom in
trypanosomic, if not protozoan diseases generally.

760 Diseases of the Genital Organs

The imperfect control may appear in one or both hind
limbs or may alternate between the two, and is subject to
great variation from day to day. In the main the paresis
reminds one of locomotor ataxia of man. Sometimes the
partial paralysis is of a somewhat spasmodic nature, faintly
resembling stringhalt. At times there may be swelling
about an articulation and the animal may seem to be lame
in the joint. As the disease advances, the paresis tends to
increase until there is such complete paralysis that the ani-
mal is unable to rise when down. When the patient becomes
unable to rise, a fatal termination usually occurs in the
course of a few days to several weeks, largely hastened by
the decubitis and the accompanying complications. In other
cases, after being recumbent for days or having had to be
assisted in rising for weeks, the animal improves and event-
ually apparently recovers .

With, and even before, the advent of the paretic symptoms,
there appears a very rapid emaciation, which is especially
prominent in the posterior parts of the body. The emacia-
tion is rendered especially noticeable from the fact that it
occurs in spite of a good appetite, and the allowance of
abundant food with apparently good digestion. It seems
that both the paralysis and the emaciation are largely de-
pendent upon changes taking place within the spinal cord
and that these symptoms naturally become most marked
in those portions of the body posterior to the locality in the
cord where the chief destruction has occurred. The symp-
toms of the disturbances of the nervous system are not con-
fined to any portion of the body, and there is frequently ob-
served a paralysis of an ear or eyelid or of the lips or nose.
In the stallion there is frequently such a marked change
in the voice that he can not whinny naturally.

The sexual desire may remain unaffected throughout the
disease. In many stallions, the power to copulate is but little
impaired, but in the earlier stages, during the tumefaction
of the prepuce and penis, either from excessive erection or
from other cause, the stallion fails in many cases to effect
coition, and, late in the course of disease, the same inability

Dourine 761

may arise from loss of power in the penis or from extreme
paralysis of the posterior parts.

The effect of the disease upon the powers of reproduction
is very profound. In the earlier stages, the stallion may be
capable of impregnating mares, which, if he does not infect
them with the disease, may give birth to healthy foals. As
the disease progresses, while the stallion may still be capable
of copulating, he is usually sterile. The mare which becomes
infected does not generally conceive, or, if she does conceive,
aborts so early that the conception is not observed. In the
Illinois outbreak, it could not be determined that a foal had
been born among one hundred diseased mares. Some writ-
ers claim that occasionally a diseased mare will produce a
healthy foal.

Apparent recovery may, and does, occur even after ex-
treme emaciation, and when paralysis has been so complete
that the animal could not rise without assistance.

The duration of the disease may extend from three months
to as many or more years, and apparent or real recovery
may take place at any intervening time.

In animals which have succumbed to the malady or been
destroyed in its last stages, there is seen, quite uniformly,
an evident degree of anaemia and emaciation. Distributed
throughout nearly every tissue in the body, there is found
a characteristic yellowish exudate of gelatinoid appearance,
especially abundant in the subcutaneous and intermuscular
connective tissue, in the mesentery, and in all parts rich in
connective tissue. Nearly every organ of the body partakes
of the general yellowish tinge. The muscles, especially those
of the thigh and croup, are pale and soft.

The intestines are pale, and, in some cases, show signs of
previous inflammation on their peritoneal surface. The
mesentery is of a pale saffron color, thickened by a gelatin-
ous exudate. The mesenteric lymphatics are enlarged, pale
yellow and friable. The spleen is pale, small, shriveled,
tough and hard. The liver is soft and filled with dark
blood. The kidneys are usually somewhat enlarged, very
pale and edematous.

762 Diseases of the Genital Organs

The genital organs fail to exhibit the extraordinary
changes one would expect to find.

I made autopsies upon several stallions which had been in-
fected for one, two or more years. Aside from the general
changes noted above, there occurred in the genitalia of some
animals gross lesions not directly attributable to the dourine
but apparently the result of secondary infections which had
invaded the weakened tissues.

One very bad case, an imported French draft stallion,
showed great enlargement of the scrotum, which was hard
and unyielding to the touch. The skin of the scrotum was
enormously thickened and pale yellowr. The inguinal glands
of the right side were the seat of extensive abscesses, open-
ing at the upper part of the scrotum. A large abscess, oc-
cupying the usual position of the testicle, was filled with
dark yellow, hard, cheesy pus, which had pushed the gland
from its place up into the inguinal canal. The testicle was
small, atrophied, soft, flabby and pale yellow, with the serous
covering firmly adherent at every part. The surface of the
penis offered no evidence of disease. The urethra contained
a small amount of a dirty, purulent secretion ; the lining
membrane was rough, grayish-yellow, without any appear-
ance of ulcers. The seminal vesicles and enlarged portions
of vasa deferentia contained thin, grayish, purulent accumu-
lations. The left testicle was normal in size, with coverings
firmly adherent at every part. No appearance of ulcers was
found in the urethra or upon the penis of any of the several
stallions examined.

Investigators have observed inconstant changes in the
nervous system, principally injection of the coverings of
the brain and spinal cord, softening of the lower part of
the cord, and occasional extravasation of fluid into the ven-
tricles of the brain. Thanhoffer describes extensive degen-
< ration of the nuclei of the nerve cells in the spinal cord.
The nasal mucous membrane usually shows catarrhal in-
flammation.

Diffi /'' ntial Diagnosis. Few contagious diseases of ani-
mals have been so confusedly described by veterinary writ-
ers. At first there was a very general confusion between

Dourine 763

dourine and genital horse pox, a condition which still con-
tinues in many descriptions of the malady.

The most reliable local symptoms for the diagnosis of
dourine in the stallion consists of the doughy, elastic swell-
ing of the prepuce, with varying degrees of penial paralysis,
the penis hanging somewhat out of its sheath, usually re-
tained within the prepuce. The urethral opening is usually
inflamed and a slight discharge escapes from it, but there
is nothing visible to the naked eye to mark this as differing
from lesions of these parts due to other causes.

Later a depigmentation of the penis and prepuce may
occur — not in small circular spots, as in genital horse pox,
but in large, irregular patches, which gradually spread from
the periphery. In the mare, the most important local symp-
toms for purposes of diagnosis consist of the doughy, edema-
tous swelling of the vulvar lips, the enlargement of the
clitoris, the gaping of the vulva at its inferior commissure,
and the depigmentation of the clitoris and its prepuce, and
of the skin of the vulva, perineum and anus.

Once it is decided that an equine venereal disease exists in
a stud, the presence or absence of specific pustules or vesicles
may serve largely to differentiate between the two maladies.
Eruptions upon the external genitals may, of course, occur
in dourine, but those writers who have mentioned them uni-
formly fail to describe them in a manner to enable one to
differentiate those of dourine from those of genital horse
pox, and, as a rule, it might well be suspected that such
descriptions are based upon diagnostic error. In some cases,
doubtless, erosions or ulcers have appeared as the result of
irritation from ichorous discharges or from the accumula-
tions of filth about the genitals, accompanied by low vitality
in the cutaneous tissues, but such eruptions are devoid of
diagnostic value, and their relation to the disease, so far as
we know, is quite secondary.

Specific eruptions of vesicles or pustules upon the genitals
do not occur. When abundant and specific eruptions occur
on the genitals of the horse, they indicate genital horse pox,
not dourine.

764 Diseases 0/ the Ge?iital Organs

Dourine and genital horse pox may readily coexist, caus-
ing confusion in diagnosis.

Some writers, in describing dourine, accept the presence
of the depigmented areas about the vulva and anus as con-
clusive evidence of precedent ulceration, but depigmenta-
tion of the skin does not necessarily follow vesicular or pust-
ular eruptions, nor does its presence indicate that eruptions
have occurred. I had excellent opportunity for observing,
day by day and week by week, the depigmentation of the
skin of the vulva and anus in dourine, and saw it begin and
gradually spread, without the presence of any visible vesi-
cles, papules or ulcers. It was a depigmentation without
ulceration.

Numerous writers place emphasis upon the presence of
specific eruptions in dourine, but fail to describe their char-
acter, and do not intimate that they have personally ob-
served them. In the extensive Illinois outbreak, among
more than one hundred cases of the disease, no eruptions
were observed, nor could the most diligent inquiry among
owners reveal any history of such in any animal. Baldrey,
after an extensive experience with the malady in India, fails
to record the occurrence of vesicles and pustules.

It seems to me that the apparent differences in observa-
tion and view in reference to vesicles, pustules and loss of
pigment in dourine is due to the constant confusion of the
two wholly distinct veneral diseases and to accepting the
erroneous conclusion that depigmentation indicates prior
pustular or vesicular eruption.

In reference to the alleged occurrence of eruptions it
should be noted that the character of the micro-organism
which causes dourine is contradictory to the appearance of
such lesions. Trypanosoma, in general, have little or no
tendency to produce eruptions or suppuration, and it would
seem unique to expect that, in this one disease, alone, of the
great group, there should occur characteristic vesicles or
pustules.

The elliptical swellings or plaques in the skin of the flanks,
hips and other parts of the body have long held a high place
in diagnostic value, but they do not always exist.

D oarine 765

In the Illinois outbreak, the enlarged and pigmentless
clitoris constituted a noteworthy and highly diagnostic
symptom in the mare, persisting for at least two years after
all other physical signs of the malady had disappeared.

The paresis of dourine is fairly characteristic. Accom-
panied by other lesions and symptoms it is pathognomonic.
The peculiar jerky movements in the hind limbs during pro-
gression, and the knuckling over at the hind pasterns are
rarely seen in other forms of disease.

In addition there is the clinical history of infection by
coition along with the malignancy of the malady.

The finding of the trypanosomum equiperdum in the blood
of the animal serves to establish definitely the diagnosis. In
many cases it seems to be very difficult to find the parasite.
Consequently this proof of the character of the disease is not
always readily produced. More recently the serological
tests have been developed and Mohler, Eichhorn and Buck
have obtained satisfactory results by complement-fixation,
using the surra trypanosome in preparing the antigen. They
thus secured a "group" instead of a species reaction which,
in the absence of other trypanosoma in this country, sufficed.

The mortality from dourine is very great and the loss
amounts, upon the whole, to far more than the total value
of the diseased animals. When it has once become widely
disseminated in a breeding district, it practically suspends
the industry for a time because its character is so insidious
that it is exceedingly difficult to trace in it all its ramifica-
tions. The mortality among the affected animals reaches 60
to 80 per cent., which places it among the most fatal of
infectious diseases. Those which apparently recover do so
very slowly and the time consumed before they are again
fit for work is so great that their value is virtually destroyed.
It is a question whether animals once affected can be bred
again with safety, no matter how completely they may have
apparently recovered or how long a period may have elapsed.

No treatment for dourine has yet been devised which is
economically practicable and which affords proper security
to the state. Recently some of the more complex arsenical

766 Diseases of the Genital Organs

compounds have given encouraging results experimentally,
but it is a question whether the treated animals are so far
recovered that they are without menace. In the Illinois
outbreak several mares apparently made quite complete re-
coveries and performed satisfactory work, but it was deemed
essential to keep them under close breeding quarantine with
the constant danger that, by accident or design, coitus might
be permitted to occur and a fresh outbreak be started. On
the whole, it is more economical that the state should as-
sume the burden and destroy all affected animals. Until
reliable diagnosis has been made, breeding should be sus-
pended and all suspects placed under quarantine restrictions
ample to prevent sexual contact. This means a quite rigid
quarantine, frequently extending over a long period. The
disease is entirely too insidious and dangerous to justify lax
provisions. The castration of suspected animals has been
advocated, but this is not safe against error. A castrated
stallion may copulate with mares. I have known a castrated
mare to be forced into coitus with the stallion ; the owner,
unaware that a prior owner had had her castrated, believed
her in estrum. If a quarantine can be so arranged that it
will fully protect the public interest and not prove an eco-
nomic burden, the apparently recovered animal is efficient
as a worker and, aside from coitus, is without known danger.

B. Genital Horse Pox. Coital Exanthem

Eruptive Venereal Disease of the Horse

Genital horse pox is a highly contagious disease, which,
under ordinary conditions, is transmitted by coition only
and consists of a local infection of the genital organs. It is
far more readily transmitted than dourine and has a shorter
period of incubation.

Symptoms. After a period of two to five days subsequent
to exposure, there appears in the mare an inflammation of
the mucous membrane of the vulva and vagina, in which
there arise small reddish papules, which soon become vesi-
cular <>!• pustular and rupture, leaving small erosions on the
mucosa. From the vulva there occurs a more or less cop-

Eruptive Venereal Disease of the Horse 767

ious, muco-purulent discharge, which soils the tail and
neighboring parts. Urination is somewhat frequent and
the contact of the urine with the denuded mucosa irritates
that membrane and causes straining.

At the same time, similar eruptions appear upon the ex-
ternal surface of the vulva, anus, perineum and surrounding
parts. They behave somewhat similarly to the eruptions
within the vulva and vagina. At first, a small papule arises
in the skin, which soon becomes vesicular and then pustular
and yellowish white. These mature quickly and soon rup-
ture, to be followed by tough, yellow scabs, 1/8 to 3/16 inch
in diameter. After a few days, the crusts drop off, leaving
behind white scars very slightly depressed. These depig-
mented spots are circular in form and, in very severe cases,
may coalesce somewhat. They tend, however, to remain dis-
tinct circular spots. The pigment returns after two or three
weeks, and no visible scar remains. The vesicles appear in
continuous crops over a period of one to three weeks, so that,
at a given examination, there may be eruptions in every
stage.

Accompanying these eruptions, there is a swelling of the
vulva, with some tenderness of the parts. Some writers
have described also a prurigo or intense itching of the parts,
causing the animal to rub violently the tail and vulva. Al-
though I have observed a number of outbreaks, I have not
seen this symptom. Neither have I been able to find in the
literature upon the subject any case where such a symptom
has been recorded as a personal observation.

In the stallion, the symptoms are virtually the same.
Eruptions, of the same character as those described upon
the vulva and anus of the mare, appear upon the penis, pre-
puce and sheath. The opening of the urethra is swollen and
congested and from it there is a muco-purulent discharge.
There is some swelling of the prepuce and possibly, to a
less degree, of the penis. Ordinarily, there are no constitu-
tional symptoms in either sex, there is no loss of appetite
nor appreciable emaciation, and the general condition of the
animal remains undisturbed. I saw one case in which fol-

768 Diseases of the Genital Organs

lowing alleged genital horse pox, there remained a year
afterward a severe chronic inflammation of the vagina and
bladder, which virtually ruined the animal. In this case,
the mucous membrane of the vulva and vagina was greatly
thickened, corrugated, sensitive and bled easily upon touch.
The bladder was highly inflamed and its mucosa greatly
thickened, the urinary salts were deposited over its inner
surface, and its cavity was largely obliterated. The meatus
urinarius was open and the urine dribbled away involun-
tarily, so that the tail and thighs were kept constantly be-
fouled and presented a very repulsive appearance.

The course of the disease is usually mild and brief. Most
cases recover spontaneously in from two to three weeks and,
under proper handling, recovery is hastened and rendered
increasingly certain.

The nature of the disease is not precisely known. A
given outbreak is not usually traceable to any definite source
of origin. The disease seems to become established in a com-
munity without having been imported by a diseased animal.
Once it becomes established, almost every mare bred to an
affected stallion contracts the disease with great uniformity.
Presumably it is just as transmissible to the stallion, but
this is not so often observed, since the mares are not usually
bred to different males during the same season. Experi-
ments have shown that the vesicles and pustules contain the
element of contagion in a virulent form.

Handling. The handling of the disease depends essen-
tially upon a temporary cessation of breeding and upon dis-
infection. Any disinfectant will answer the purpose, but it
should not be highly irritant, since the parts involved are
very sensitive.

The handling of the stallion is most urgent, so that he may
resume service as promptly and safely as possible. I have
come to prefer an antiseptic wash composed of 1 ounce of
carbolic acid with 2 ounces of tannin and 6 ounces of gly-
cerine in 1 gallon of warm water. After washing the penis
and prepuce thoroughly with soap and water, this solution
is applied freely twice daily and a quantity of it is injected
up the urethra until it is supposed to reach nearly to the
bladder.

Eruptive Venereal Disease of the Horse 769

The extent of disease in the urethra has not been investi-
gated. It is only known that there is a urethral inflamma-
tion and dicharge and that it is infective. The mere wash-
ing of the penis and prepuce can not, therefore, bring about
effective disinfection, but the urethra needs be included.
The urethral injection is best made by means of a hospital
irrigator with a small rubber horse catheter attached. The
end of the catheter is inserted into the urethral opening and
retained there while the antiseptic solution is forced upward
by gravity as far as is deemed necessary. Should some of
the fluid reach the bladder, it will not prove dangerous, but
it is well not to overfill the urethral passage, lest the infec-
tive discharges be forced up into the bladder. The external
ulcers resulting from the pustules may be touched lightly
with stick nitrate of silver. The animal needs be kept as
free as possible from sexual excitement, but should be given
gentle exercise, along with a restricted, laxative diet. The
stallion may be returned to the stud as soon as all evidences
of disease have disappeared but it is advisable to continue
the disinfection, especially after each service.

The handling of the mare should be along the same gen-
eral line and should be persevered in until all symptoms
have disappeared. As a general rule, she will recover suffi-
ciently during the interval between two estrual periods that
she may again be bred at the first return of estrum since the
contraction of the disease, should she not prove to be in foal.

The differentiation of this affection from dourine is highly
important, but has already been discussed.

There is little need for police control, since the symptoms
are so prominent that laymen promptly note it and volun-
tarily withdraw the affected animals from breeding until
recovery has occurred. Should there at any time be a ten-
dency to negligence the affected animals should be promptly
quarantined until all danger has passed.

49

CHAPTER XXII

NON-VENEREAL SPECIFIC INFECTIONS WHICH
INVADE THE CENITAL ORGANS OF HORSES

A. Contagious Cellulitis. Epizootic Cellulitis. Pink Eye.
Rheumatic Influenza. Muco-Enteritis

Bibliography. Williams, Epizootic Cellulitis, Principles and Practice of Veterinary Med-
icine. 4th edition, 1888, p. 251. Cave, Pink Eve. Veterinary Journal, 1883. Vol. XVI, p. 336.
Whitworth, Pink Eye Disease, ibid., 1883, Vol. XVII. p. 153. Pottie. Jour. Comp. Path, and
Therap.. Vol. I, p. 37. Clark, ibid.. Vol. V. p. 261. Reeks, The Transmission of Pink Eve
from apparently Healthy Stallions to Mares, ibid., Vol. XIV, p. 159, and Vol. XV, p. 97.

Contagious Cellulitis is a highly contagious acute fever of
the horse, which has been generally ignored except by Brit-
ish veterinary writers, although it seems to be widely dis-
tributed in various countries. It is common in parts of
America, but frequently confused with influenza or catarrhal
fever.

A description of the disease is inserted here because of its
intimate bearing upon the question of horse breeding, which
it affects chiefly in three distinct ways.

Frequently it spreads from apparently healthy stallions
to mares through copulation, in which respect it approaches
the character of a venereal disease, but as a general rule
this is not the method by which it is transmitted from ani-
mal to animal.

It has a relation to sterility because it causes an orchitis
in the stallion which frequently leads to a permanent loss of
function in these glands.

Contagious cellulitis is commonly associated with abortion
in pregnant mares. The manner in which abortion is caused
by the disease is unknown. Since the bacteriology is un-
known, it can not be stated that the infection does or does
not enter the uterus or the fetus and bring about disaster.
The probabilities are that the infection reduces the vitality
of the pregnant mare and enables those bacteria which exist
within the uterus to multiply rapidly and cause abortion.

Symptoms. The symptoms of the disease consist primarily
"i an elevation of temperature, sometimes accompanied by

Contagions Cellulitis. Epizootic Cellulitis 771

chills, dullness and other phenomena, which belong in gen-
eral to acute contagious fevers. The fever appears very sud-
denly, usually ranging from 103 to 105° F. although it may
exceed this. Generally speaking, the temperature is higher
than in influenza and lower than in the contagious pneu-
monia of the horse. The pulse is hard and full and some-
what quickened; respiration is not very greatly disturbed.
Cough is present, though this does not constitute a very
prominent symptom of the affection.

Early in the disease there is a manifestation of pain in the
limbs, which is shown by shifting of the weight from one
foot to another while the animal is standing and by great
stiffness and soreness when forced to move, the movements
being accompanied by a cracking sound in the joints. After
a time the legs begin to swell, commencing at the feet and
extending upward until at times the body is affected. This
tumefaction has its chief seat in the subcutaneous connective
tissue and is at times very great. As the swelling of the
limbs increases, the pain in them tends to abate and at the
same time the fever begins to decrease.

The alimentary tract is greatly disturbed. At first there
is a very marked tendency to constipation, in which the feces
are covered with large quantities of mucus and their color
considerably altered. Defecation causes some pain and
straining. Later there is a tendency to diarrhea, which is
easily and often fatally intensified by the administration of
purgatives, especially of aloes. The conjunctiva becomes
bright pink, swollen and edematous. At times the conjunc-
tivae are so badly swollen that the eyelids become somewhat
everted and the edematous membrane pushed out between
them. The eyes are very sensitive to light and the animal
attempts to keep them closed. There is a profuse secretion
of tears, which flow down over the cheeks. The cornea is
frequently clouded, so that vision may for a time be inter-
rupted. There is some tendency toward pleurisy, pneumonia
and other pulmonary complications.

From a breeding standpoint, the chief interest lies in the
complications of the genital organs. The breeding stallion

-~2 Diseases of the Genital Organs

shows a great tendency to suffer from orchitis. I have seen
in large importing stables 50 to 75 per cent, of the stallions
attacked with pink eye suffering from inflammation of the
testicles. Along with the swelling of the scrotum and
sheath, which accompanies that of the legs, there usually
appears a tense, painful enlargement of the testicles, which
tends to persist for a considerable period after the general
symptoms of the disease have largely disappeared. In some
instances permanent sterility results. In other cases, stal-
lions which have apparently recovered from the disease have
quite uniformly transmitted it, during copulation, to sus-
ceptible mares. These observations are entirely in harmony
with those of Reeks, who records an instance where an ap-
parently sound stallion transmitted the disease to suscepti-
ble mares almost uniformly over a period of two years.

It is notable also that, when the disease attacks a preg-
nant mare, it generally causes abortion or, if attacking her
just prior to parturition, the living foal is likely to succumb
within a few days after birth. Reeks, recording an outbreak
under his charge, relates that four pregnant mares, or mares
which had just foaled, contracted the disease. Two of the
pregnant mares aborted, and the foals of the other two died
suddenly shortly after birth.

Although highly contagious, the affection is of short dura-
tion ; usually runs a favorable course, except in those ani-
mals used for breeding purposes, in from four to six days ;
and leaves the animal but little altered.

No specific treatment has been discovered. The greatest
benefit is to be derived from the administration of diffusible
stimulants, such as nitrous ether or carbonate of ammonia,
along with quinine. Purgatives are to be avoided. Aloes
is especially dangerous. The bland oils might be used in
some cases as aperients, or very small doses of eserine, are-
coline or other alkaloid hypodermic cathartic, taking care to
make the dose sufficiently small to induce no harmful degree
of excitement and barely sufficient to cause gentle purga-
tion. There is naturally much divergence of opinion among
veterinarians in reference to the treatment of this affection,
but its general handling is not of special interest here.

Contagious Cellulitis. Epizootic Cellulitis 773

When the disease appears in a breeding area it should be
handled with the greatest rigor as to quarantine, and the
breeding quarters should receive special consideration. Dis-
eased mares or mares coming from infected premises should
on no account be admitted to the breeding place. Should
the malady become general in a neighborhood, as it usually
does when an outbreak occurs, breeding should be suspended
until the disease disappears.

When a breeding stallion has become infected, aside from
the general handling of the malady, special attention should
be given to reducing to a minimum the dangers from orchitis
and later, after the acute symptoms have passed, to over-
coming the lingering chronic infection, through which he
may continue to spread the disease to mares.

When it is known that a non-immune breeding stallion has
been exposed to this disease, immediate precautions should
be taken to guard the animal against a severe attack. He
should be placed at rest, physically and sexually. The usual
high feeding of breeding stallions should at once be dis-
placed by a very light laxative diet, such as grass, roots and
bran, with an abundance of salt. If these measures do not
induce a prompt unloading of the alimentary tract, the bow-
els should be evacuated by means of small doses of eserine
or arecoline and the system placed in first-class condition to
withstand the onset of the disease. Pending the advent of
the disease, the animal should have regular daily exercise,
though great care should be taken not to continue it after
the appearance of the first symptom of the malady, fever,
has become established, as indicated by thermometry. If
the stallion is attacked without these precautions having
been taken, similar measures should still be adopted. The
ration should be reduced and confined to laxative foods, and
the bowels should be promptly and cautiously evacuated.

The stallion is to be guarded against physical or sexual
excitement. Strange mares should not be allowed in sight
or hearing, and every precaution should be taken against
arousing sexual desire. In most stallions the application of
the stud bridle occasions excitement, which, at such times,
should be avoided.

774 Diseases of the Genital Organs

If orchitis appears, as it frequently does, in addition to
the foregoing measures, including the internal administra-
tion of nitrous ether and quinine, local applications to con-
trol the inflammation in the glands should be applied. First
among these in the early stages is local refrigeration by the
application of cold water or ice. Probably the most efficient
means is the application of broken ice by means of a suspen-
sorium, which serves the double purpose of refrigeration
and supporting the weight of the pendant glands. This treat-
ment should be constantly and faithfully applied until the
crisis of the malady has passed, since the effective handling
of these glands may determine whether the animal is to be
of further value as a breeder. Such remedies as belladonna
and camphor, applied locally, tend to relieve congestion and
overcome the inflammation, but in a critical case the refrig-
eration is probably superior.

Later, when the acute symptoms have passed, chronic in-
fection should be considered, precautions taken against the
spread of the malady to mares, and measures adopted to
eradicate the infection from the system as quickly as possi-
ble. For this purpose an extended course of potassium
iodide at the rate of 1 L> ounce per day for each 1,000 lbs. of
body weight is probably the safest remedy. Some veteri-
narians fear that the prolonged administration of this drug
may induce a harmful atrophy of the testicles, but this is
quite imaginary and without foundation. The iodide should
be continued for three or four weeks, or longer if necessary.

Abundant time should be allowed to elapse, after the dis-
appearance of all visible symptoms of the disease, before
permitting the animal to serve mares. It is advisable, in
case the disease attacks the stallion during the breeding sea-
son, to withdraw him from the stud for the year. In any
case it is wise to begin breeding cautiously and watch closely
for evidences of the transmission of the infection to suscep-
tible mares. When a stallion which has suffered from pink
eye shows evidences of sterility, careful examination of the
genitals and of the semen should be made and, should any
•ration of the breeding powers seem possible, appropri-

Bursattee of the Penis and Pit puce 775

ate measures undertaken, but usually the sterility is per-
manent and irremediable and the animal must be removed
from the stud and, with or without castration, used for
work.

B. Bursattee of the Penis and Prepuce

Genital bursattee presents characters suggesting, to the
inexperienced, a venereal disorder, and constitutes an an-
noying disease in breeding stallions. It is not infrequent
in those countries where this malady prevails in other por-
tions of the body. Bursattee shows a distinct tendency to
attack the penis and prepuce of breeding stallions, especially
of heavy draft animals. Presumably the infection is not
coital but is transmitted by other means — accidental wounds,
flies or other carriers.

The usual symptom of penial bursattee, when first ob-
served by the groom or owner, is the presence about the
urethral opening of an angry-looking fungoid growth, which
bleeds upon the slightest touch and is generally observed to
bleed immediately after coition. Sometimes during erec-
tion blood drips from the tumor. Another fungoid mass of
similar appearance exists at the preputial ring upon the in-
ferior or urethral side near the middle of the organ when
erected — that point where the urethral opening rests when
the penis is fully withdrawn within its prepuce and sheath.
When the penis is at rest, therefore, the growths about the
urethral opening and on the preputial ring are in immediate
contact : the preputial growth has emanated from that about
the urethral opening, as a consequence of contact.

The bursattic growth may begin at other points or may
extend from the seat of infection to neighboring parts. In
one instance, I observed the disease beginning upon the
scrotum.

If the new growth is closely inspected, it is usually possi-
ble to recognize readily with the naked eye the small yellow
concretions or "kunkurs" characteristic of the malady. In
some cases penial bursattee is accompanied by infections
upon the feet or other parts.

776 Diseases of the Genital Organs

I have not seen the disease transmitted to mares through
copulation, though, clinically, it behaves as an infectious
malady and possibly there is danger of transmission to the
mare through the vagina.

The micro-biology of the disease has not been fully de-
termined : some attribute it to mematode worms ; others to
the presence of a fungus.

Like bursattee of other parts, it is active in temperate
countries only during the hot season and undergoes ap-
parent spontaneous recovery upon the advent of winter, to
remain dormant until the return of warm weather. Thus
it incidentally assumes its greatest activity during the
breeding season and interferes seriously with stud duties.
Aside from the remote possibility of transmission, it is
very noticeable, and owners of mares naturally do not care
to breed them to a stallion so evidently diseased. Further-
more, the sexual excitement incidental to breeding greatly
influences the disease and adds to its virulence : each erec-
tion of the penis, with the consequent congestion of the or-
gan, causes the bursattee growth to bleed.

The handling of the disease consists of the destruction or
removal of all infected tissues and the avoidance of venereal
excitement. If undertaken early, the disease is usually con-
fined to the urethral tube, filling it and protruding beyond
the navicular fossa, and may extend up higher in the ure-
thra. Whatever the extent, the diseased tissues are to be
excised or curetted away and the parts well cauterized with
silver nitrate or the thermocautery, after which the wound
may be dressed with iodoform, which apparently exerts a
very beneficial influence upon the course of the disease,
should any infection remain. Care is to be taken not to de-
nude unnecessarily the urethral meatus of its entire mucosa,
since urethral stricture may result, necessitating penial am-
putation. If the pathologic growth involves the entire cir-
cumference of the meatus, the risk of stricture must be
deliberately faced with the assurance that, if stricture fol-
lows, amputation may he made without interfering with the
breeding value of the stallion. The method of amputation
has already been described.

Bursattee of the Penis and Prepuce 777

Before operating, it is well to apply local anaesthesia,
though the sensitiveness of the part is not marked, as is
usually the case with bursattic growths. Successful han-
dling demands the withdrawal of the animal from the stud
and the prevention of sexual excitement. If necessary,
erection of the penis should be prevented by the application
of a stallion guard.

At the preputial ring, at that point where the opening of
the urethral tube rests when the penis is completely with-
drawn, the secondary bursattic growth is more amenable to
management. Here the operator can freely excise the dis-
eased tissue without danger of unpleasant deformity.

After excision or destruction of the diseased tissues, the
parts should be kept scrupulously clean. It is advisable to
wash the penis, prepuce and sheath twice daily with soap
and water, to which one-half to one per- cent, of carbolic
acid may be added. After cleansing, the parts may be
dressed with powdered iodoform, or iodoform ointment.
Before applying the iodoform, any suspicious areas may be
cauterized with stick nitrate of silver.

CHAPTER XXIII

THE GENERAL INFECTIONS OF THE GENITALIA
OF HORSES

The general infections of the genital organs of horses are
quite analogous to those of cattle. Apparently most bacteria
which are capable of acquiring a habitat in the genitalia of
cattle may do so in horses. Those who believe in a specific
"contagious abortion" for cows and another for mares claim
that the organism of "contagious abortion" in the cow will
cause abortion in the mare, and vice versa. They further
claim that the organisms causing abortion in each of these
are potent to cause abortion in ewes, sows, bitches, rabbits,
guinea pigs, etc. They have shown quite conclusively that
the organisms are able to acquire a habitat in numerous
domestic and experiment animals. How frequently the
alleged abortion-producing organisms naturally acquire a
habitat in the uteri of species other than that in which they
are alleged to be the cause of abortion is wholly unknown,
all recorded observations being predicated upon studies of
those animals which had been experimentally inoculated
with the infection.

The subject of "contagious abortion" as a specific disease
in cattle has been discussed at length and any attempt to
discuss "contagious abortion" of mares would be an unwar-
ranted repetition. The evidences regarding the existence of
such specific disease in the mare are the same in principle,
but less voluminous than in the cow. Investigators claim
to have proven the existence of such specific disease in
mares and to have identified clearly the causative organism,
but, as in the cow. they have ignored the two most basic
principles in the experimental production i)\' disease — they
have submitted no evidence of the freedom of the experi-
ment animal from the infection when the experiment was
begun, and no controls were kept. The genital organs of
horses offer analogous diseases throughout, modified by im-
portant variations in their anatomy.

General Infections of the Genitalia of Horses 779

The clinical examination of the genitalia of both
sexes of horses is essentially the same as in the cow.
The stallion offers differences in the size and form of the
seminal vesicles. The act of coitus is more prolonged. The
collection of semen for examination is more readily ob-
tained through the larger vulva of the mare. The semen
may be obtained without vaginal contamination by the use
of a rubber bag upon the penis. In other particulars the
examination of the genitalia, the semen and the spermatozoa
is the same as for the bull.

The ovaries of the mare lie far forward, but are easily
within reach and readily palpated per rectum. The cervix
is short and its canal very dilatable, rendering the uterine
cavity more readily examined.

While describing the general infections of bulls, it was
pointed out that, in the absence of definite general lesions
recognizable by physical examination, there may and do ex-
ist in the testicles, epididymis and seminal bladder infec-
tions which are ejaculated in the semen and carry serious
peril, causing extensive genital disease of the cow and re-
sulting in much sterility and abortion. In discussing con-
tagious cellulitis of horses it has also been pointed out that
the infection may be transmitted to the mare by the stallion
during coitus.

In polygamous reproduction the male is necessarily the

chief factor in the transmission of genital infections, in

part because he comes in sex contact with numerous females,

while the female ordinarily has coitus with but a single

male. The male is a further peril in sex infection because

in polygamous reproduction he is placed under more severe

sex strain, rendering existing infections in his genitalia

more virulent. Schofield1 found that abortion in mares was

chiefly observed in those which had been bred to certain

stallions. It was further noted by Schofield that the foals,

born of mares bred to stallions whose mares largely aborted,

frequently suffered from arthritis. It was thus shown in

' Investigation into Equine Abortion. F. W. Schofield, Ontario Vet. Col.,
1 9 r 5 -

y8o Diseases of the Genital Organs

his observations that the stallion transmitted an infection
which led in many cases to abortion some months later and
which in other cases persisted throughout the span of intra-
uterine life and continued in the foal after birth. This is in
harmony with my observations. Nevertheless some stal-
lions showing no genital lesions clinically are frequently
highly infectious. According to the intensity of the infec-
tion, there follows death of the spermatozoa, ova, fertilized
ova or small embryo (sterility), metritis with death and
observed expulsion of the fetus (abortion), or puerperal
metritis and retained fetal membranes in the mare, and
arthritis, dysentery or other disease of the foal.

The general infections of the genitalia of horses conform,
therefore, so far as can now be seen, to those of cattle and,
what is more important, conform to the fundamental laws
of general genital infections in all mammalia. Among the
genital infections of mammals, certain specific diseases ex-
ist, such as syphilis, dourine, canine venereal tumors, chan-
croid or vesicular venereal diseases of man, horses and cattle,
gonorrhea and others which involve largely or exclusively
one species of animal, producing specific lesions which serve
to differentiate clinically the infection from all others.

There are other infections which invade the genitalia of
all mammals, each of which may and do exist in the genitalia
of several species of animals. They do not necessarily cause
visible harm but, when intensified by bad physical or sexual
hygiene, may attain high virulence and produce a great va-
riety of lesions. They may invade and interfere with the
function of any organ or tissue in the genital system of
either sex of any age. The invasion is not necessarily direct
through the genital tract. The fetus swallows the infection,
derived from the uterus of the mother, with its amniotic
fluid. Again the new-born swallows any infection emanat-
ing from the uterus which may flow down the tail or thighs
and reach the exterior of the teats. In many cases the in-
fect ion enters fhe body of the new-born through the navel
wound, in which case arthritis becomes the outstanding
clinical phenomenon. But the arthritis of navel infection.

General Infections of the Genitalia of Horses 781

except in some cases for the navel lesions themselves, is not
clinically nor bacteriologically differentiable from the arth-
ritis caused by the fetus swallowing the infection emanat-
ing from the utero-chorionic space, or by the new-born swal-
lowing infection in its food.

Unlike the specific venereal diseases mentioned, the gen-
eral infections are commonly present in the genital organs
and elsewhere, their number is unknown, and their lesions
are alike. The lesions in the uterus and fetus attributed to
the B. abortus (Bang) can not be distinguished from those
of the spirillum of Smith, the bacillus of Moussu, or the
B. abortivo-equinus of Good. Each of these is believed to be
capable of living and multiplying in the genital organs of
an extended list of mammals.

As in bulls, when genital infections in stallions become
severe and produce clinically recognizable lesions, they often
lose their peril for the female because the spermatic ducts
are blocked by the lesions and the infection imprisoned. The
infections of the genitalia, therefore, which are recognizable
only by a microscopic study of the spermatozoa, bacterial
search of the semen, or a bio-histologic study of the ovaries
or oviducts, are of far greater importance economically
than the more readily recognizable lesions. The clinically
recognizable lesions of the genitalia of horses are varied
and not rare.

I. THE GENERAL GENITAL INFECTIONS
OF STALLIONS

A. Orchitis and Epididymitis

1. Degenerative Orchitis and Epididymitis of Colts
Colts sometimes suffer from a degenerative or desquama-
tive orchitis in which the epididymis participates. The dis-
ease is apparently identical with that already described in
bull calves. It ordinarily passes unobserved up to breeding
age, w7hen attention is attracted to the genitalia by a total
want of fertility. Clinical examination reveals small, soft,
flabby testicles, about one-fourth to one-half the normal
volume. The animal has normal sexual desire and copulates
promptly, but no spermatozoa are ejaculated. Histologic
examination of the testicles reveals necrosis and desquama-
tion of the germinal epithelium, with corresponding changes
in the epididymis and absence of spermatozoa. The cause
is unknown. Apparently the condition is dependent upon
the invasion of the testicles during the nursing period, as
appears to be the case in calves. The infection probably ex-
ists in the alimentary tract of the foal at birth and acquires
invasive power during dysentery. At least the changes ex-
ist when puberty is reached and their character points to in-
fection as the cause. Since the condition is hopeless, the
animal should be castrated and used for work. Prevention
of the condition lies in the proper rearing of young foals.

'2. Orchitis and Epididymitis of Adult Stallions

Reference has already been made to the concurrence of
orchitis and epididymitis as a common complication of con-
tagious cellulitis in stallions. Orchitis and epididymitis not
referable to any recognized specific infection, is observed
occasionally in stallions. The clinical evidences of the dis-
are swelling of the organs with increased heat and evi-
dent pain upon pressure. The testicle itself is so bound down
by its tunic that it swells only slowly, while the less re-
stricted epididymis swells more rapidly. The line of demar-
cation between the two organs quickly becomes indistinct

Orchitis and Epididymitis

783

and lost, so that as a rule the epididymis and testis can not
be told apart clinically in the presence of acute inflammation.
A clear differentiation between orchitis and epididymitis is
not supremely important, each having essentially like im-
portance for the reproductive life of the animal.

According to the intensity of the disease, fever is present
with loss of appetite and other general symptoms. As a rule
the testicles suffer simultaneously but unequally. The onset
of the disease is generally violent, it continues intense for

Fig. 226 — Orchitis and Epididymitis.
T, Testicle ; E, epididymis.

Stallion.

784 Diseases of the Genital Organs

several days or weeks, and then slowly abates. The glands
do not ordinarily recover in volume or function. The prog-
nosis for the life of the animal is highly favorable, but for
the reproductive functions is usually hopeless.

As will be seen in Figs. 226 and 227, the gross changes
consist chiefly in atrophy of the testicle and hypertrophy of
the epididymis, so that the ordinary relationship in volume

PlG. 227^0rchitis and Epididymitis.

/, Epididymis ; 2, parenchyma of gland : ,\ hemorrhage in epididymis;

/. hemorrhage in testicle.

of the two structures becomes reversed. In the early stages,
as shown in Fig. 227, prominent hemorrhage may occur.
The infection extends to the peritoneal covering, by con-
tiguity involves the parietal peritoneum of the scrotum, and
causes adhesions between the two layers. Histologic and
biologic studies have not been made in sufficient degree to
permit of any conclusions. The colon-like organism ordi-
narily alleged to cause abortion in marcs may logically be
considered as a common cause. At least it is fair to assume

Diseases of the Seminal Vesicles 785

for the present that the organism most commonly causing
abortion in mares is the commonest invader of the testes and
epididymes of stallions. The disease occurs most frequently
at the height of the breeding season, the virulence of the in-
fection already present being aroused by repeated coitus.

The handling of orchitis is a discouraging task. The ani-
mal should be taken out of the stud immediately, sexual
excitement avoided as far as possible, the patient placed
upon scant, laxative diet, and as a rule given an abundance
of gentle exercise. If the inflammation is intense, its course
may be checked by purging promptly with arecolin or eserin.
Benefit may be had from large doses of potassium iodide,
about one-half ounce per thousand pounds of body weight,
once or twice daily. In the first stages the continuous re-
frigeration of the glands by means of a spray of cold water
may be of value. When the infection is intense and has con-
tinued so long that recovery of reproductive functions is
impossible, castration should be performed promptly as the
best and safest method for controlling the disease. If ap-
parently but one testicle is involved, it should be removed
promptly as the best protective measure against the involve-
ment of the other gland. The removal of one gland does not
lower the fertility.

When the animal has apparently recovered, a long sexual
rest should be given before returning him to stud service.
Then a test service should be made with a mare and the
semen examined for spermatozoa and bacteria. If sound in
both respects he may be permitted to resume stud service.

3. Diseases of the Seminal Vesicles.
Semino- Vesiculitis

Veterinary literature reveals no traces of any compre-
hensive study of the infections of the seminal vesicles of
stallions. The studies already made regarding the infections
of these organs in bulls indicate that generally the glands
about the pelvic urethra of the male are highly susceptible
to any infections which may invade seriously the genitalia
of the female, and that the probability of disease rests in a

50

786

Diseases of the Genital Organs

measure upon the comparative development of the given
structure. That is, the seminal vesicles, prostate and Cow-
per's glands will tend to become involved in proportion to
the functional importance of each in the species under con-
sideration. Thus in the bull the seminal vesicle is the most
commonly involved subsidiary sex gland, while in the dog
the prostate gland suffers most frequently and severely.

FiG. vs Enlarged Seminal Vesicles. Gelding.
U, Urinary bladder ; S, S, seminal vesicles.

Since ascending invasions along the urethro-vas deferens
canal naturally tend to become deflected into the subsidiary
sex glands, infections of these structures sometimes occur
without involvement of the testicles or epididymes. Infec-
tious of the subsidiary glands probably as a rule have a
greater peril for genital health than infections of the epidid-
ymis or testicle, because when the latter are involved the
\ ( ry small caliber of the tubules leads to early atresia with
incarceration of the infection, while the structure of the
subsidiary glands is such that infected secretions may read-
ily escape into the urethra and be ejaculated with the semen.

Diseases of the Seminal Vesicles 787

While the seminal vesicles of stallions have not been
studied from a pathologic standpoint, they quite certainly
play an important part in the transmission of infection to
mares during coitus. When serious abortion storms break
in a harem of mares, the most probable source of infection,
reasoning from analogy, is the seminal vesicles of the stal-
lion. Some known facts support this suspicion. Geldings
frequently show purulent semino-cystitis, as shown in Fig.
228, in which the seminal bladders are distended with pus
until their size exceeds that of the empty urinary bladder.
I doubt if castration predisposes to such infection and sus-
pect that a careful study of the seminal vesicles of stallions
would show infections of the vesicles having an important
relation to reproduction.

Clinically I have observed one stallion and have known of
others which presented symptoms justifying the suspicion
of the existence of serious semino-vesiculitis. The stallion,
an imported Percheron, was in splendid general health and
quite amorous. The erection was intense. He would mount
mares promptly, enter the penis into the vagina, hesitate,
and finally dismount without ejaculation and with the penis
greatly erected. From more recent studies upon bulls I be-
lieve that the symptoms were due to inflammation of the
seminal vesicles of a severe type which excluded ejacula-
tion. A safe diagnosis is available in such cases by means
of rectal palpation. The prognosis, if the disease is clearly
recognized, is probably hopeless as to reproduction but
favorable for the life of the animal. No line of treatment
is suggested.

II. THE GENERAL INFECTIONS OF THE
GENITALIA OF MARES

A. Diseases of the Ovaries

1. Atretic Follicles

The ovaries of healthy mares owe their chief volume to
the presence of a number of cysts, reaching a diameter of
one to two or more inches and containing colorless lymph.
They are virtually universal in young, healthy mares, and
at three to four years of age constitute more than seventy-
five per cent, of the ovarian volume. With the advent of old
age the cysts tend to disappear, the volume of the ovary de-
creases greatly, and the gland becomes distinctly senile.
The cysts have not been studied. Apparently they have no
pathologic significance, but on the contrary may serve an
important physiologic office.

2. Nymphomania

Nymphomania in mares bears some analogy to nympho-
mania in cows; but presents some very marked differences.
It has already been stated that nymphomania, as observed
in the cow, is due to a type of cystic degeneration of the
ovary, that no ovulation occurs, and that fertility is in abey-
ance. The disease designated nymphomania in the mare is
not so readily recognizable as being due to cystic degenera-
tion of the ovaries and its existence does not necessarily
cause sterility.

Nymphomania is most commonly seen in mares which are
kept closely confined and are not bred. It is more rarely
observed in mares regularly worked and is well-nigh un-
known in those which are free. It is most commonly seen
in young or middle-aged mares, rarely in aged. It is quite
uncommon in mules, though in one instance I observed the
disease in 80 marked a degree as to render the otherwise
valuable animal worthless until castrated.

Nymphomania 789

The symptoms of nymphomania in the mare usually ap-
pear just prior to estrum or during that period. Estrum
may occur with comparative regularity but, in some cases,
is apparently more frequent, while the duration of the pe-
riod may be so prolonged that the intervals of calm between
the periods of sexual mania may be very brief.

In general, the first symptom of nymphomania, usually
appearing a few days prior to estrum, consists of excita-
bility and irritability of temper.

The patient is usually more or less vicious toward other
horses and toward men. She will bite and kick at her mate
or other horses when approached. Very frequently the pa-
tient will crowd against the pole of the wagon or other ve-
hicle and perhaps lie down upon it in an effort to reach her
mate and inflict injury. She manifests her viciousness by
laying back her ears and switching her tail, while her eyes
and physiognomy in general betoken evil disposition. The
meeting of a strange animal of either sex upon the highway
frequently arouses a maniacal storm ; the mare balks, lies
down upon the pole or thills, urinates and switches her tail ;
the vulva is rapidly opened and closed ; the clitoris is
erected ; and the affected animal may attempt to grip the
reins with the tail, or may kick, rear or run away.

Toward persons her disposition is equally disagreeable
and often decidedly dangerous. Upon entering the stall to
groom, harness, unharness or otherwise handle the animal,
she is liable to kick, bite or trample the attendant without
warning. In hitching or unhitching the animal, especially
when working about her posterior parts, she is very liable
to kick.

In the stable, even when no other animal is near, the pa-
tient may show her vice by kicking the sides of her stall,
striking and stamping with the feet. In one instance in our
clinic, the mania was almost exclusively exhibited when the
mare was alone in the stall. Watched from a distance, she
would stamp her feet and kick the sides of the box stall in
which she was confined. In her maniacal kicking she was
utterly indifferent to the consequences to herself and would

790 Diseases of the Genital Organs

frequently and repeatedly kick one leg viciously with the
other. Her eyes were wild and staring and her whole ap-
pearance and behavior one of violent insanity. If her owner
or other person entered the stall she became calm, began eat-
ing or fondled the person with her nose, and appeared in
every way rational and docile. Turned in a paddock she be-
haved normally. Hitched in the usual manner to a single
wagon, she behaved perfectly. The duration of the periods
of mania and its intensity had increased for some months
until the degree described had been reached and the attacks
continued during seven to ten days. Ovariotomy was fol-
lowed by complete and permanent disappearance of the
mania.

The distinctively sexual symptoms noted consist chiefly
of tumefaction of the vulva, injection of the vulvar mucosa,
and increased secretion of mucus, with some mucous dis-
charge from the vulva.

Urination is frequent, the clitoris is erected and fre-
quently protruded between the vulvar lips. The irritability
of the vulva and vulvo-anal region is markedly increased
and the animal frequently resents violently the handling of
these parts. This is especially true, in many cases, of the
tail ; the animal resents the raising of it in order to apply
the crupper or remove it. While driving, should the patient
either accidentally or intentionally get her tail over the
reins, she often grips them violently, kicks viciously, may
turn abruptly and upset or break the vehicle, or run away.

In some cases the patient is perfectly docile and the only
signs of disease consist of abnormally frequent urination
with repeated opening and closing of the vulva and the pro-
jection of the clitoris, making her unfit for driving purposes
simply from repulsiveness.

In most cases, however, the patient is unreliable or dan-
g< rous and can not be depended upon in moments of emer-
gency. During the periods of nymphomania she is very
liable to be unsteady in draft work and may at any moment
balk and tax the patience of the driver very greatly.

Periodical at first, the vices of nymphomania, such as

JV-i "mphomania 791

kicking, balking and gripping of the reins by the tail, tend
to become constant and permanent, and the animal degener-
ates into an incurable rogue, falls into the possession of low
dealers and finally finds her way into some inhuman hands,
where she succumbs to brutal work.

Examined macroscopically, the ovaries are usually large
and contain one to several cysts, varying in size from V^-2
in. or more in diameter and containing a clear, faintly yel-
lowish lymph. The cyst walls are thick and very firm and
the density of the albuginea preserves to a large extent the
even contour of the ovarial surface, so that it is only in case

A \
\

.

Fig. 229 — Cystic Ovary, Reduced Nymphomania.
A, Normal ovary ; B, cystic gland.

of quite large cysts that they project conspicuously beyond
the general surface of the gland. In some cases, the ovarian
tissue proper vanishes almost completely under the pressure
of large cysts, firmly compressed within the enveloping
tunica albuginea.

In other extremely bad cases of nymphomania there are
found small, atrophied, fibrous ovaries, very hard and dense,
like fibro-cartilage.

The examination of the ovaries of the mare is to be made
upon the standing animal, in essentially the same manner
as that described for the cow. Due precautions are to be
taken, according to circumstances, to avoid injuries to the
veterinarian from kicks and to overcome any probable an-
noyance from movements of the animal. Usually a single
stall, with the animal tied short in it, will suffice, but vicious

792 Disea ses of th e Gen ita I Organs

animals should be secured in stocks, the twitch applied, and
a forefoot held up or one hind foot raised by means of a
sideline.

The hand and arm of the operator should be cleansed and
lubricated with warm oil, lard or liquid paraffin. The rec-
tum of the animal should be emptied of feces. Usually little
progress, if any, can be made while the hand is in the pos-
terior or pelvic rectum. It becomes necessary to push gently
forward into the free portion of the bowel, which can then
be carried to the right or left, up or down, and forward or
backward. The mare often strains somewhat, which should
always be a signal to the operator to cease his palpation un-
til the expulsive effort ceases, but without withdrawing his
hand. Care upon this point decreases the straining and
does much to avoid laceration of the rectal mucosa, asso-
ciated with hemorrhage.

With the palm of the hand directed downwards, the cer-
vix and uterus, about the size of a man's wrist, may be
traced forward to the point of bifurcation, where the cor-
nua, almost as large as the body, are given off at approxi-
mately right angles. Tracing these to the right or left, the
operator can recognize the ovaries at or near the anterior
margin of the broad ligament, an inch or two beyond the
obtuse end of the cornua. The normal gland in the young
or adult mare is elastic, smooth, firm, oblong and about
21/£-31/£ inches in its greatest diameter, by 11/^-2 inches in
its lesser diameter. The diagnosis of cystic or fibrous de-
generation of the ovaries of the mare and the relationship
between these diseases and sterility is not always clear.

How many nymphomaniac mares would conceive if bred,
is not known, but it is known that many breed and that the
nymphomania usually disappears during the span of preg-
nancy, to recur with some degree of regularity after foal-
ing.

The question of overcoming sterility due to cysts or other
ovarian disease, with a view to the restoration of the breed-
ing powers in valuable brood mares, has been quite neg-
lected and attention turned chiefly toward the amelioration

Infections of the Gravid Uterus 793

or cure of the vice attending the malady, in order to restore
the work value of the animal. Since nymphomania in the
mare is chiefly observed in those not used or desired for
breeding, this tendency in handling is natural and sufficient.
It is only when involving animals desired for breeding pur-
poses that cure of the disease is desired. When the aim to
restore fertility is frustrated by insurmountable obstacles,
the duty of the veterinarian remains to preserve to the
owner, as far as possible, any work value which the animal
may possess when relieved of the nymphomania.

Ovariotomy. Oophorectomy. When nymphomania re-
ferable to ovarian disease is present and can not otherwise
be effectively overcome, castration is indicated.

Since in mares not desired for breeding purposes, the cure
of ovarial nymphomania otherwise than by castration is all
too liable to prove ephemeral and unreliable, castration at
once presents itself as the most reliable and enduring rem-
edy. The operation is comparatively simple and not highly
dangerous. It has been fully described on page 263.

B. Intra-Uterine Infections and Infections of the Embryo

1. Infections of the Gravid Uterus

The infections of the gravid uterus are not generally ob-
served directly. Their presence is revealed almost solely at
the termination of pregnancy, at which time the ravages of
infection become apparent. No such opportunity is offered
for the study of the pregnant uteri of mares as is afforded
in the abattoir upon the gravid uteri of cows, sows and ewes.
When pregnancy terminates in parturition or abortion, the
lesions due to infection become apparent, enabling the clini-
cian to construct a picture of the processes as they have oc-
curred. Rarely one has the good fortune to examine oppor-
tunely a pregnant mare about to abort, and secure direct
data upon the behavior of infection within the uterus. In
so far as studied, the behavior of the infection between the
chorion and uterine mucosa in the mare is perfectly analo-
gous to the better known processes taking place in the

794 Diseases of the Genital Organs

gravid uterus of the cow. There is one fundamental differ-
ence in the placental arrangement which changes materially
the method of invasion. The utero-chorionic space of the
cow facilitates the rapid dissemination of infection through-
out the entire cavity without necessarily involving seriously
the placental structures (cotyledons). In the mare there is
no utero-chorionic space, but the endometrium everywhere
participates in the placental functions, so that the endome-
trium and chorion are everywhere in intimate placental
contact. Any advancement of infection along a given path
therefore necessarily destroys the placental relation between
chorion and uterus. The chief habitat of infections within
the gravid uterus of the mare, as revealed by clinical study,
is the same as in the cow. The most destructive location of
infection is at the cervical end of the uterus, from which
point of vantage it causes abortion. Clinical experience
clearly teaches that the second bacterial rendezvous is the
apex of the non-gravid horn where it may develop a local-
ized apical endometritis, revealed at the termination of preg-
nancy by retention of the chorion in the non-gravid horn,
while the remainder of the membranes detach promptly and
their weight causes a rupture across the base of the non-
gravid portion, the major portion of the membranes falling
away while the diseased non-gravid branch remains. If
one has the opportunity to make a clinical examination of a
mare nearing abortion, there is frequently, perhaps always,
an absence or destruction of the uterine seal, the cervical
canal is open and suppurating, and the chorion is detached
from the uterus over a varying area at the cervical end.
This is well illustrated in Fig. 230. The parturient rupture
(1) is slightly at one side of the central axis because there
exists a central hard, somewhat desiccated necrotic area (2)
which possesses greater resistance than the contiguous area.
The photograph reveals at 3 the radiation of the infection
from 2 toward the ovary. In some cases, if not in many.
the veterinarian making an examination at an opportune
time, is able to palpate clearly the necrotic, parchment-like
area of the chorion, and through it to palpate a living fetus

Infections of the Gravid Uterus

795

and cause it to move. So far as I have been able to observe,
the chorion illustrated in Fig. 230 is representative of
prompt abortion. Delayed abortion may cause such disin-
tegration of the chorion as to destroy the plain record here
shown of the progress of infection.

Abortion in mares is accordingly, so far as now known,
always a result of cervical endometritis, combined with a
mortal disease of the embryo or fetus. The invasion of the
fetus is identical with the invasion of the fetus in the cow.

Fig. 230— Fetal Placenta of Abortion.
/, Parturient rent in chorion ; 2, necrotic area opposite the os uteri inter-
num ; j, inflamed area radiating from cervix toward ovarian end of
uterus ; 7, gravid horn ; 5, non-gravid horn.

The infection grows through the chorion at the necrotic cer-
vical area, through the continuous inflamed area (Fig. 230,
3) , or through the inflamed tip of the chorion located in the
non-gravid horn. When the allantoic fluid has been reached,
the invasion may continue through the urachus, but usually
penetrates the amnion and, suspended in the amniotic fluid,
is swallowed by the fetus. Then sepsis or dysentery may
follow, with fetal death. Fetal death may also follow ex-
tensive placentitis owing to asphyxia or to placental sepsis.
The endometritis at the cervical end of the uterus awakens

796 Diseases of the Ge?iital Organs

uterine contractions with the prompt expulsion of the fetal
cadaver.

Intra-uterine infection is more certain to cause abortion
in the mare than in any other domestic animal. Since the
cervix is shorter and its canal more dilatable, less power is
demanded of the uterine walls to force the fetal cadaver
into the cervical canal, at which point the abdominal walls
assume the chief burden of emptying the uterus. The ana-
tomical features of the placenta confine the infection, at least
temporarily, to the cervical end, as indicated in Fig. 230,
concentrate the uterine irritation more definitely at the cer-
vical end, and leave the ovarian end free from disease and
competent to contract vigorously upon the uterine contents.
These anatomical differences modify interesetingly the clini-
cal behavior of intra-uterine infection. While it is not rare
for a bovine fetal cadaver to undergo partial or complete
maceration in the uterus, it is exceedingly rare to observe
this result in the mare. The mare is in some respects more
vulnerable to sepsis than the cow, but if this plays any part
at all it is a minor one. Fetal cadavers (except at or near
full term) almost never undergo putrid decomposition in
the uterus of the mare, but are practically always expelled
promptly. When fetal death occurs at or near full term, the
condition is essentially alike in mare or cow. It is common
in both species, especially when the fetus presents by the
breech, for fetal death and emphysema to occur without
visible effort at expulsion. The phenomenon of abortion in
mares, as one of the results of intra-uterine infection, has
long been an important economic problem in horse-breeding
and up to the present time no outstanding progress has been
made in its control.

Abortion of mares first acquired prominence in the United
States about 1886, when it appeared in several states in the
Mississippi Valley, in which horse-breeding had become a
very important industry. It soon acquired a very extensive
distribution and high degree of virulence. The unorganized
state of veterinary science in the United States prevented
the recording of any definite statistics in reference to the

Infections of the Gravid Uterus 797

losses, but they were certainly enormous. At that time I
was engaged in practice in what was then one of the most
important horse-breeding districts in America. In 1888, in
the area of my practice, involving about 400 square miles,
at least 2500 mares aborted, causing an immediate loss of
not less than $150,000. These losses were typical of those
in other breeding centers. In some townships where horse
breeding constituted one of the principal agricultural pur-
suits, the abortions exceeded seventy-five per cent, of the
pregnant mares. The losses were most marked in large
breeding establishments where highly valuable mares were
kept for breeding purposes alone. The losses were just as
real on small farms where but a few mares were kept,
which, after aborting, could be employed to some extent in
farm work. In one season a client with a highly valuable
herd of about fifty imported draft mares lost every foal
from abortion. In another instance, in the territory of a
neighboring veterinarian, a breeder had 100 pregnant im-
ported draft mares, in which the loss from abortion was
total as to foals and four of the mares perished. Other
similar instances might be related without number which
would give a somewhat vivid impression of the enormous
losses.

As in cows, so in mares, intra-uterine infection may and
does interrupt the reproductive functions at any date. The
spermatozoa, the ova, the fertilized ova, the embryo, the
fetus and the new-born foal may succumb to the infection,
but the most striking phenomenon is the observed expulsion
of the fetal cadaver. Consequently abortion is said to be
most common from the sixth to the tenth month, because
this is the most favorable date for observing the disaster.

The symptoms of abortion in mares are less notable than
in cows. Mares rarely suffer from retention of the fetal
membranes, which constitutes a common landmark of abor-
tion in cows. The diagnosis of abortion in mares is there-
fore usually confined to observing the mare in the act or dis-
covering the fetal cadaver under circumstances which en-
able one to trace it to its source.

798 Diseases of the Genital Organs

The lengthy discussion upon the question of abortion in
cows will serve in a general way for that in mares. Al-
though but recently the belief was general that each domes-
tic animal has a specific infectious abortion, numerous clini-
cal and biologic studies are causing a disintegration of that
theory. Up to the present time bacteriologists have gener-
ally incriminated but one organism as an important cause
of abortion in mares. Smith and Kilborne, Turner, Lign-
ieres, De Jong, Good and Smith, Meyer and Boerner, and
others have described an apparently identical organism,
designated by Good and Smith' Bacillus Cbortwo-equinus,
which they severally believe is the cause, or an important
cause, of abortion in mares. Running through the recorded
investigations are frequent notes of discord. Good and
Smith failed to find the B. abortivo-equinus in fetal cadavers
or elsewhere in an outbreak among Shetland ponies, and
failed to report what other, if any, bacteria were encoun-
tered. In another case the highly suggestive admission is
made that the breeding stallion had orchitis and that from
the testicle was obtained, not B. abortivo-equinus, but B.
pseudomonas pyocyaneus, and that colonies of the same ba-
cillus were obtained from other sources in the outbreak
(fetal cadavers, fetal membranes?). The general attitude
of bacteriologists regarding the infections of the genitalia
of horses has been analogous to that in the investigations in
cattle : if the organism which has been set up as the specific
cause of abortion is present, the proof is complete and other
bacteria present may be ignored ; if it is not present, the
abortion is not "contagious", though an abundance of bac-
teria of other kinds may be present.

The hypothesis of "contagious abortion" in mares as a
specific disease has long held, and continues to hold, all ef-
forts at control in abeyance. There can be no reasonable
doubt at this time that a broader conception of the problem,
parallel to that which is now gaining a secure foothold re-
garding the genital infections of cattle and which has won
a safe place in the battle against these infections, is equally

1 Ky. Ag. Exp. S'a. I'.ul. 204,

Placentitis. Endometritis with Retained Fetal Membranes 799

applicable to the genital infections of horses. If a horse
breeder desires to produce a vigorous colt, let him as the
first step breed a genitally sound mare to a genitally sound
stallion.

The genitalia of the mare are to be examined the same as
those of the cow. Any cervicitis, metritis or other genital
disease discovered is to be handled upon the same funda-
mental principles. Stallions used to serve valuable mares
should be examined at intervals, including their genital or-
gans, semen and spermatozoa. During pregnancy mares
should be guarded (just as non-pregnant mares should be)
against infectious fevers, such as "pink eye", not because
they can apparently cause abortion directly, but rather be-
cause, by lowering the vitality of the pregnant mare, the re-
sistance of her uterus to infections residing therein is low-
ered and disaster invited. The maintenance of the physical
vigor of the stallion and avoidance of sex overstrain should
have thoughtful attention.

2. Infections of the Puerperal Uterus

A. Placentitis. Endometritis with Retained Fetal
Membranes. Puerperal Laminitis.

The diffuse placenta of the mare, spread over a far
greater area than in the cow, causes the placental structures
to be less elaborate and renders retention of the fetal mem-
branes far less probable. The placentitis which may cause
retention of the fetal membranes is probably as common in
mares as in cows, but the chorionic tufts are so short and
simple that the placentitis runs its course quickly and the
dehiscence of the placenta usually occurs before the expul-
sion of the fetus, or the incarceration is so feeble that the
membranes are expelled very soon after the fetus, before
retention is clinically recognizable. The placental arrange-
ments are such that endometritis and placentitis become
identical, the entire endometrium being placental. There
exists in the mare also a remarkable bond between the pla-
cental endometrium and the sensitive laminae and other
horn-secreting structures of the foot, so that when placen-

800 Diseases of the Genital Organs

titis of a severe type develops there occurs promptly as a
rule a severe laminitis. No acceptable explanation, so far
as I know, has been given for this occurrence. Some say it
is metastatic inflammation, but they do not explain what
they mean by metastatic. Puerperal laminitis is common in
the mare and very rare in the cow and ewe. Two types of
placentitis with retained fetal membranes are recognized
clinically. Generally retention of the fetal membranes, in
which the placentitis has led to an incarceration of the
chorionic tufts over most of, or the entire uterine mucosa,
is, according to my observation, very rare. It is rarely seen
in abortion because the placentitis has reached that point
where the chorion is cast off before the fetus is expelled, so
that cadaver and membranes are expelled together, the same
as is observed usually in the cow when abortion occurs in
very early pregnancy. I have seen this type of retention in
premature birth, but the premature birth itself is a rare
phenomenon in mares. The conditions are usually analo-
gous to those in the cow : the retention begins at the cervi-
cal end of the uterus, as illustrated in Fig. 230. The cervi-
cal end of the chorion is detached or detachable soon after
the fetus is expelled, and the retention increases as the
ovarian end of the uterus is approached. The prognosis is
favorable except that it will probably be complicated by
laminitis. The handling is along the general lines advised
for cows. The mechanism of manual removal differs in de-
tail. The margin of the parturient rent at the cervical end
is to be picked up and tensed with one hand while the other
hand is gently pressed between the chorion and uterine
wall, and the two organs carefully pushed apart, or a part
of the chorion may be folded longitudinally, held with one
hand and grasped with the thumb and forefinger of the
other hand, the latter pushed forward against the uterine
wall, and the two organs pressed apart. If the membranes
are not removable without injury, the same rule applies as
in cows. Once the membranes are out, the uterus should be
freely douched with 0.7', salt solution as frequently as may
seem expedient and the iodoform-bismuth-oil treatment, ad-
vised for cows, \\*v^\.

Placentitis. Endometritis with Retained Fetal Membranes Soi

A more common type of metritis with retained fetal mem-
branes is the retention in the non-gravid horn. As a rule
the fetus lies in the uterine body and one of the horns, so
that the non-gravid horn does not develop markedly. As in
the cow, the non-gravid horn habitually suffers more se-
verely from infection present than the gravid horn. Pre-
sumably this is due to the lower vitality of the non-gravid
horn of the chorion, making it more vulnerable to bacterial
attack. It may well be, however, that the cornual apex and
the oviduct are fundamentally worse affected in many cases,
so that pregnancy is barred upon that side but remains pos-
sible upon the less infected side. Whatever may be the cor-
rect explanation, the fact remains that the non-gravid cornu
frequently suffers severely from a localized endometritis,
the crypts are deep and irregular, and the chorionic tufts
gross and uneven, showing great variability in color. At
one point the chorion is intensely red and angry ; at another,
a necrotic-like, dirty gray. The other portions of the endo-
metrium may be healthy. When parturition occurs, there is
prompt dehiscence of the healthy chorion in the gravid horn
and uterine body, but the chorion in the non-gravid horn is
incarcerated. It is usually narrowed at its juncture with
the uterine body and fragile from disease. The weight of
the detached chorion of the gravid horn and the body drags
upon the frail prolongation, it parts, the chief mass drops
away, and the non-gravid prolongation remains incarcerated
and out of sight. Conditions are then ripe for an explosion.
The entire endometrium of the gravid horn and uterine
body, approximately fifteen to twenty square feet in area,
is wholly denuded of protective epithelium and highly vul-
nerable to invasion. There rests in the badly diseased non-
gravid horn a large volume of infection in the presence of
a large mass of necrotic chorion already saturated with in-
fection. The accumulated infection pours out into the uter-
ine cavity and gravid horn, and the necrotic, putrefying
fragment of chorion drops into the uterine cavity. The
spread of the infection is rapid. Marked clinical symptoms
quickly appear. Within twenty-four to forty-eight hours

51

802 Diseases of the (tcnital Organs

the mare is evidently in great distress, she lies down most
of the time, her appetite is poor or absent, and her pulse
weak, though her temperature not markedly elevated, prob-
ably because of relaxation of the anal sphincter which ad-
mits air about the thermometer. There may be an involun-
tary escape of a thin, flaky, dirty grayish pus, flecked with
blood from the vulva. Manual exploration of the uterus re-
veals a paretic organ containing three or four quarts to as
many gallons of thin, dirty gray pus, sometimes almost
odorless, and sometimes fetid. Somewhere floating in the
mass or still lying in the non-gravid cornu may be found the
necrotic, putrefying fragment of chorion. If compelled to
stand, the mare exhibits the clinical picture of laminitis
(puerperal laminitis) with tenderness of the abdomen upon
pressure. The localized endometritis has suddenly devel-
oped into an intense generalized endometritis with severe
laminitis.

The veterinarian in charge of valuable brood mares should
either have the fetal membranes of each mare laid aside for
his prompt inspection, or should teach the caretaker how to
inspect the membranes and determine if all has come away.
If the non-gravid prolongation is wanting, it should be re-
moved manually very promptly, the uterus douched with
salt solution, and iodoform-bismuth-oil introduced. This
will generally prevent the development of severe endometri-
tis and laminitis.

If such precautions are not taken and the intense disease
has developed, the necrotic fragment is to be removed if
found, the pus douched and siphoned from the uterus, and
the iodoform-bismuth-oil introduced ( 1 -_> to 1 oz. each of bis-
muth and iodoform in one quart of olive or salad oil or of
liquid parattin). The treatment should be repeated often
enough to prevent large accumulations in the uterus. The
laminitis must have earnest attention, if the animal ran
stand without great pain or fatigue, she may be placed in a
flowing stream of cool water or stood in an improvised foot
bath kept cold with ice. If she can not stand without great
suffering, packs of broken ice should be kept upon her feet.

Metritis. Metro- Peritonitis 803

There is scant need for internal medication except for the
uterine douchings already described. The disease is based
upon intra-uterine infection. When that is controlled, the
animal usually improves rapidly and recovers completely.
Should symptoms arise demanding medication, the details
should be adapted to the individual case. If the sepsis ap-
pears profound, it can probably best be overcome by large
doses (1 oz. or more) of potassium iodide or quinine. Con-
stipation or intestinal atony can be most safely overcome
with minute doses of eserin or arecolin combined with
strychnine.

B. Metritis. Metro-Peritonitis.

The placentitis or endometritis of the preceding article is
necessarily an intrinsic infection which, so far as known,
has existed within the uterus at least throughout pregnancy.
There occur some cases of metritis differing in type from
that described above and referable to either intrinsic or ex-
trinsic infection. In veterinary practice the practitioner is
not ordinarily responsible for introducing infection, through
imperfect technic, into the genital tract at the time of par-
turition. The veterinarian rarely invades a uterus not al-
ready importantly infected. He interferes in dystocia only,
and dystocia in animals is due chiefly to infection within
the uterus, causing atony of its walls, or to death or serious
illness of the fetus from the same infection which destroys
its power to assume and maintain the correct direction and
position of its extremities. In such cases the veterinarian
does not introduce the primary infection, but may add other
forms of bacteria more perilous than those already present.

When intra-uterine infection causes the death of an al-
most or wholly mature fetus, especially if the fetus presents
by the breech, there may occur no visible effort at expulsion,
but instead the fetus undergoes rapid emphysema. The al-
ready badly inflamed uterus rapidly becomes worse owing
to the presence of the decomposing fetal membranes and
fetus. Under such conditions the walls of the uterus gen-
erally become paretic, greatly thickened and hard. Por-

804 Diseases of the Genital Organs

tions of the decomposing chorion or amnion may protrude
from the vulva, but there are no expulsive efforts. The
uterus is powerless to act upon its contents. The great thick-
ening of the uterine wall is largely confined to the placental
tissues. If the emphysematous fetal cadaver is removed
by embryotomy or otherwise and the uterus douched clean,
the mare probably recovers and may retain her fertility.
The removal of the emphysematous cadaver is described in
the companion volume, Veterinary Obstetrics.

Although puerperal metritis in animals is almost always
the continuation of the metritis of pregnancy into the puer-
peral period, the puerperal metritis is aggravated by the
dehiscence of the chorion and exposure thereby of the entire
denuded area to the infection present. Parturient con-
tusions and lacerations are frequent and are at times peril-
ous. The layman undertaking obstetric work and, still more
dangerously, the careless and dirty veterinarian coming
from other highly infected cases, frequently introduces dan-
gerous types of infection into the uterus with dirty hands,
instruments or apparatus.

One of the most serious parturient contusions is that due
to impingement of the floor of the uterus or cervix between
a firm, bony part of the fetus and the conical protuberance
projecting into the pelvic cavity from the anterior end of
the symphysis pubis. This sometimes perforates the floor
of the genital tract directly, but more frequently so maims
the tissues that necrosis occurs and infection penetrates the
peritoneal cavity. Then a violent metro-peritonitis ensues,
which commonly results in death. Sometimes virulent in-
fection invades the floor of the genital canal through the
Lacerated tissues and, spreading out from the point of in-
vasion, sets up a malignant and fatal phlegmon involving
the utero-cervico-vaginal floor, the urinary bladder and
neighboring parts. The patient then exhibits all the signs of
profound sepsis with great depression, erratic temperature
and disinclination to move because of the great pain in the
pelvis. Vaginal or rectal palpation reveals extensive phleg-
mon or, in mild cases, abscesses in the pelvic tissues, largely

Post- Puerperal Infections of the Uterus 805

lying below the floor of the genital tract. Little of value is
known which may be applied to control or ameliorate the
ravages of the infection. The phlegmon is so erodent that
the exudate generally makes its way into the peritoneal
cavity. If abscesses point toward the vagina or rectum,
they may be opened into either of these, but in my experi-
ence they fail to do this, and I have failed to identify a spot
where it appeared prudent to penetrate the virulent area.
Heavy doses of potassium iodide, quinine or both may be
tried, but without material hope. Prevention is dependent
upon careful obstetric practice which it is not proper to dis-
cuss here.

3. Post-Puerperal Infections of the Uterus

The infections of the pregnant uterus may continue into
the puerperal period, receive additional invasions at that
time, and, with these, persist indefinitely. They are un-
limited in variety, including essentially any bacteria com-
petent to induce wound infection. They may continue into
the next breeding season and prevent conception, or, failing
to do this, may imperil the life of the embryo of fetus, or
finally a portion of the infection may persist in the fetus at
birth, constituting a hazard to the new-born foal, and a part
continue in the uterus of the mare. The most prominent
types are the following :

a. Chronic endometritis ^with mucous oi- muco-purulent
exudates. In such instances the uterus is enlarged, flaccid
and atonic. Estrum may be regular, but conception largely
fails or, if it occurs, the embryo or fetus will probably per-
ish. If the uterus is examined, the cervix is generally found
soft and its canal open. If the uterus is douched, some
muco-pus is probably washed out.

Spontaneous recovery is uncertain, but as a rule the con-
dition will respond to proper handling. The principles of
handling are the same as for the analogous disease of the
cow. The commodious vulva and vagina and the freely dila-
table cervix render handling simpler and easier than in the
cow. In douching the uterus of the mare the practitioner

o 6 Diseases of the Genital Organs

should bear in mind the fact that the very large cornua
leave the uterine body at right angles, or somewhat re-
curved. The ordinary metal catheter used for the cow is
not, therefore, a wholly suitable instrument for the mare
because it can not readily follow the right angle turn from
the cavity of the uterine body into the horn. The soft rub-
ber horse catheter, guided into the base of the uterine horn
with a sound shaped somewhat like the modified Palmer
uterine dilators (Fig. 39, 2) may be safely pushed to the
cornual apex. The cornu may then be cleansed by siphoning
or, owing to the ample cervical canal, may be flushed out,
the return flow escaping alongside the catheter.

b. Uterine abscess not rarely follows severe puerperal
metritis. A severe inflammation of the cervical mucosa oc-
curs at a period when there is little escape of exudate from
the uterine cavity, permitting the contiguous cervical sur-
faces to adhere and block the cervical canal. The imprisoned
pyogenic infection multiplies rapidly and soon distends the
uterus. The distended organ becomes powerless and the dis-
tension grows. Eventually colicky symptoms develop, and
in some cases there are painful and violent expulsive efforts.
Soon two to five or more gallons of pus accumulate and the
patient is in severe distress. If left to itself, in the cases I
have observed, the abscess usually points through the cervi-
cal canal and ruptures into the vagina. In the process the
cervix as a definite structure disappears and most of its
substance constitutes a part of the posterior wall of the ab-
scess. The os uteri externum is firmly closed and marks ap-
proximately the center of the abscess from behind.

The symptoms are those of general ill health until the ten-
sion within the abscess becomes great, when abdominal pain
and expulsive efforts constitute the two pronounced indica-
tions. In conjunction with a history of recent parturition,
especially of dystocia or retained fetal membranes, uterine
abscess should be suspected. Manual exploration through
the vagina causes pain and expulsive efforts. The vagina
may be normal, but is probably shortened owing to the ab-
3 pushing backward. Palpation reveals the tense, fluctu-

Post- Puerperal Infection of the Uterus 807

ating abscess, the posterior wall of which occupies most of,
or the entire lumen of the pelvic cavity. Careful search
usually reveals traces of the os uteri externum, the lips of
which form a ring about the occluded mouth. The cervical
canal is nowhere to be found. Rectal exploration reveals
the presence of a great, tense abscess, continuous with the
anterior end of the vagina.

The prognosis is good for the life of the mare, but essen-
tially hopeless for her fertility. The treatment consists of a
free opening of the abscess with disinfection of its cavity.
Careful palpation by both vagina and rectum should be made
and the position of the os uteri externum located approxi-
mately. In case of doubt a small trocar may be used to ex-
plore and the abscess cavity adequately located. The trocar
puncture may then be dilated by incising, and later the en-
largement may be continued by forcing the hand through
the wound into the abscess cavity. It should then be handled
like any abscess cavity, except that it is to be remembered
that antiseptics in escaping must flow over the vaginal walls
and, if too irritant, may cause serious harm. The opening
must be kept amply dilated until suppuration has ceased.
As a rule the uterine cavity will probably become obliter-
ated.

c. Pyometra. The short, broad and readily dilatable cer-
vix of the mare renders her less subject than the cow to pyo-
metra. So far as I have observed, pyometra may well be
considered as a secondary lesion to cervicitis. The cervix
becomes inflamed and greatly indurated, incarcerating in-
fection within the uterine cavity. The uterine walls parti-
cipate importantly in the process, and ultimately become
quite paretic, and the indurated cervix, encroaching upon
the canal, so narrows it that the pus contents of the uterus
are not actively expelled. The principles involved are illus-
trated in Fig. 231.

The symptoms are chiefly an intermittent, sometimes a
constant, vulvar discharge. Uusually the discharge is fetid
and consists of rather thick, dirty, yellowish pus. In one of
my cases the pus was black and looked like finely pulped

s» -s

Diseases oj the Genital Organs

melanotic tissue suspended in fluid. Pyometra passes im-
perceptibly into uterine abscess. In some cases of pyometra
the discharge ceases for ten to thirty or more days, colic
may appear, and finally the indurated cervix yields to the
intra-uterine pressure and the pus escapes in large quanti-
ties. In many cases the discharge occurs only when the ani-
mal is recumbent, since the escape of the pus is passive, due
to the increased intra-abdominal pressure caused by the
position of the patient. In some cases the incarceration of
the pus is the result of contraction of the cervix. I have
seen great quantities of pus escape from the uterus while
the patient was under complete chloroform anesthesia for

Fig. 231 — Pyometra.
/, Vagina; CI/, greatly thickened, sclerotic cervix; V
( C, cornu ; O, ovary.

uterus

other reasons. The disease shows no tendency to sponta-
neous recovery. The physical health of the animal can al-
most always be restored. I have not known a mare to con-
ceive later. The oviducts are probably blocked. The veteri-
narian should on no account leave the application of the
treatment in the hands of a layman. If the practitioner can
not have the patient under his immediate control, he had
best, for his professional reputation, let it alone. The
handling must be vigorous and continuous in order to assure
satisfactory results.

The treatment consists of the surgical dilation of the cer-
vical canal, wth disinfection of the uterine cavity. The tech-

Post- Puerperal Infections of the Uterus 809

nic of cervical dilation may be varied according to condi-
tions. Frequently the operator may dilate the canal manu-
ally. First one finger is pushed through the canal, then a
second finger, and finally the entire hand. It is not usually
desirable to attempt the complete dilation at one operation,
but the effort should be renewed daily until success is at-
tained. If room permits, after the pus has been washed out
of the uterus, the closed end of a long cheesecloth bag may
be introduced into the uterus and the bag then filled by pack-
ing a continuous long strip of cheesecloth into it by means
of long dressing forceps, uterine dilators, or other instru-
ment. A rubber dilator patterned after those used in human
practice can be used in some instances. The veterinarian
needs to select his method according to circumstances, and
persist day after day until ample dilation has been attained.
I have set my mark at sufficient dilation to permit the pas-
sage of my hand.

Once ample dilation has been accomplished, effort may be
centered upon disinfection of the suppurating cavity. The
disinfection should be largely mechanical, douching out the
pus with physiologic salt solution, boric acid or other very
mild disinfectants. The soft rubber horse catheter may be
used advantageously for douching and siphoning. After
cleansing the uterus as thoroughly as practicable by these
means, improvement may follow the introduction of iodo-
form or bismuth subnitrate, or both, in liquid paraffin. At
first the uterus should be handled daily because the force
used in dilating the cervix accelerates the infection and gen-
erally causes fetor or increases the fetor existing. Later,
as the uterus and cervix soften and approach their normal
size, consistency and function, the handling should be con-
tinuously toned down and finally discontinued, but the pa-
tient should still be examined from time to time for a few
weeks to make sure that no perilous trace of infection has
been left behind.

d. Pyemic abscesses from metritis are rare in mares. I
have observed them occasionally in the pelvic tissues and,
in one instance following dystocia, in the sub-lumbar lymph
glands. There appears to be scant inclination to the pyemic

8io Diseases of the Genital Organs

arthritis so often seen in cows. When pyemic abscesses oc-
cur in or about the pelvis, or in the sublumbar lymph glands,
they are recognizable by means of rectal and vaginal
palpation.

The abscesses may be opened into the rectum or the va-
gina, if adherent to these organs. If not adherent to these,
but closely adherent to the abdominal walls, they should be
opened by external incision. This is safely done with the
mare under complete anesthesia. The operator inserts one
hand into the rectum as a guide and penetrates the abdomi-
nal and abscess walls with a scalpel operated by the other
hand. Most of the incision may be made by an assistant
but, when the peritoneum is reached or closely approached,
the operator with his one hand in the rectum, resting upon
the abscess, can guide the scalpel with his other hand with
greater safety and accuracy than can others. The opening
should be free and the general rules for handling abscesses
applied.

4. Cervicitis

It has already been stated that pyometra in the mare is
largely caused by, or at least intimately associated with cer-
vicitis. On the whole, cervicitis is rare in the mare as com-
pared to ruminants. This is largely owing to the far sim-
pler anatomical plan of the cervix. It is shorter, its canal
broader and its mucosa much simpler. There are fewer of
the highly complex longitudinal and annular mucous folds
in which bacteria may attain a secure habitat. The most
marked exceptions to this rule is met in pyometra, where,
as shown in Fig. 231, the cervical walls are invaded and be-
come greatly thickened and indurated.

In a milder way (catarrhal endocervicitis) the cervix par-
ticipates in the infections of endometritis and apparently
contributes importantly to the production of sterility. It
has generally, however, an effect approximately opposite to
that observed in the cervicitis of cows. Instead of causing
constriction of the cervix, it usually causes paresis of the
walls and dilation of the cervical canal. That is, the cervix
of the mare under the invasion of ordinary infect ions pur-
sues a co sentially parallel to the lesions in the uterus

Vaginitis Sn

suffering from endometritis. Both uterus and cervix be-
come flaccid and atonic. In the cow the uterus becomes
flaccid while the cervix indurates.

The prognosis is good and the handling is to be based
upon the general principles detailed for the cow. The uterus
is to be so handled that it will not be discharging muco-pus
over the cervical mucosa, and the cervix itself is to be dis-
infected the same as in the cow, especially by swabbing the
cervical mucosa with Lugol's solution, silver nitrate, zinc or
copper sulphate.

5. Vaginitis

The specific vaginitis of genital horse pox has already
been described. The organ is sensitive to irritants. Vagini-
tis may be aroused in endless ways. However, mares ap-
parently escape the virtually omnipresent lesions of the nod-
ular venereal disease of ruminants and swine which serve in
them as a foundation for vaginitis which may be aroused by
slight insult.

Parturient contusions and abrasions are the commonest
causes of severe vaginitis. Doubtless imprudent vaginal
douching sometimes causes vaginitis in mares as well as in
cows. In one instance a mare was brought to me suffering
intensely with prolapse of the vaginal floor and the urinary
bladder (vesico-vaginocele) following coitus. She had se-
vere vaginal atresia from prior disease. Since she had
changed ownership (probably because of the unseen dis-
ease) the history leading up to the atresia was not available.
It was not improbably due to imprudent vaginal douching.
I was compelled to produce profound choral narcosis for
several hours in order to control the prolapse.

Vaginitis varies greatly in severity and duration. When
not too severe, it usually tends to recover spontaneously;
when severe, it may tend to persist permanently and cause
either vaginal atresia, as in the instance related, or severe,
intractable pyo-vaginitis which may ruin the value of the
patient. The infection may extend forward to involve the
cervix and uterus, or pus flowing backward over the urethra
may traverse that canal and set up a very serious pyo-cysti-
tis.

812 Diseases of the Genital Organs

The veterinary obstetrist should always anticipate vagi-
nitis in cases of dystocia, retained fetal membranes, metri-
tis, and other diseases of, or injuries to these parts. If se-
vere parturient vaginal abrasions are present, every possi-
ble detail of cleanliness and asepsis should be applied as pre-
ventive measures, such as frequent douches with physiologic
salt solution, a very weak Dakin's solution, or some one of
the approximate substitutes for it. One may apply in con-
junction with these, or alone, one of the bland oils holding in
suspension iodoform or other non-irritant antiseptic. Medi-
cated suppositories of beeswax or soft paraffin may also be
used with advantage.

6. Cystitis

Cystitis occurs in mares as an extension of vaginitis or
vulvitis along the short and broad urethra. I was called to
attend a mare for dystocia after laymen had exhausted their
powers. The fetus presented anteriorly, dorso-sacral posi-
tion, with both hind feet extended beneath its body into the
pelvis. The laymen had bisected the fetus through the chest
without preserving a flap and the torso receded far enough
that the exposed vertebra and ribs lacerated and contused
the vaginal mucosa severely. I removed the torso after a
second bisection. Some weeks later I was called again to see
the mare and found her suffering from severe vaginitis, vul-
vitis and cystitis, The cystitis was the most formidable of
the lesions. The meatus was open and the index finger could
readily be passed into the cavity of the bladder. The walls
of the bladder were thickened and the mucosa was thrown
into extensive folds which were covered by crusts of urinary
salts, mixed with pus. The purulent urine had a very fetid
odor. The cavity of the bladder was small and the thickened
walls paretic and inextensible, so that the urine flowed from
the bladder involuntarily, producing an intense irritation of
the vulva. Dribbling down constantly over the thighs, the
urine kepi these parts repulsively soiled and excoriated and
the tail wet and filthy.

The treatment of purulent cystitis consists essentially of
the disinfection of the vagina, vulva and bladder. This
should be accomplished chiefly by the mechanical removal of

Vulvar Diseases 813

the infections and of the purulent exudates, the precipitated
urinary salts and other debris, by the use of physiologic salt
solution, or other neutral fluid followed by non-irritant anti-
septics (iodoform, bismuth) suspended in bland oil or in-
corporated in suppositories of wax or low-melting paraffin.

7. Vulvar Diseases

The vulva of the mare not infrequently suffers from in-
juries during parturition which lead later to important
infections. Parturient hematoma of the vulva are common.
Usually the blood clots are submucous and, when opened,
heal without serious infection. Not all cases terminate so
fortunately. When parturient abrasions are severe, infec-
tion of an important type is always to be feared and should
be anticipated by taking proper antiseptic measures. It is
highly important when, following abortion, the fetal mem-
branes are retained and lie in contact with parturient abras-
ions, that special precautions should be taken as in retained
fetal membranes in cows, and everything possible done to
avoid serious bacterial invasion.

Twice I have observed vulvar gangrene in the mare fol-
lowing dystocia when the fetus was in the anterior presenta-
tion, dorso-sacral position, and the two posterior limbs ex-
tended underneath the body, engaged beneath the fetal chest
within the maternal pelvis. This caused the fetus to become
tightly jammed in the pelvis, where it pressed upon the in-
ternal pudic vessels and apparently caused a pressure or
anemia necrosis, leading, in one case, to rapid sepsis and
death. In the other case the gangrene caused vulvar atresia
and prevented breeding. Since in each instance the dystocia
developed at night and was not discovered until morning,
the perilous pressure upon the soft parts had been continued
for a long period of time. When such injuries occur, the vet-
erinarian should anticipate vulvitis by means of warm
douches with massage, and such other measures as may sug-
gest themselves in the particular case. It is to be remem-
bered that fatal gangrene is at least possible, and, while
probably preventable by the application of vigorous anti-
septic measures, is not ordinarilv curable.

III. CONGENITAL INFECTIONS OF FOALS

The basic principles that any infections existing within
the gravid uterus may invade the embryo or fetus, and may,
if they fail to kill the intra-uterine young, persist in the new-
born and cause fatal or dangerous illness, apply with the
same force in foals as in other mammals. The manifesta-
tions of intra-uterine infection in the foal present interest-
ing variations in clinical behavior without violating any
fundamental principle.

A. Septicemia of the Foal

When an equine fetus becomes critically infected but is
born, it is weak, listless, can not get up, and, if helped to its
feet, may be unable to stand. If born unattended and a
fragment of amnion chances to be upon its nose, perhaps it
is too weak to free itself and dies with the frail membrane
lying over or about its nostrils, leading to the popular error
that foals often smother in the amnion. While a moribund
foal may so perish, such an occurrence with a healthy foal
is extremely improbable. No studies have been made of the
temperature of the new-born foal suffering from septicemia,
but it is probably elevated. The sepsis generally ends fatally
within a few to twenty-four hours and the post mortem
study reveals substantially the same lesions as those ob-
served in calves.

B. Retention of the Meconium

Calves, and most other new-born mammals which bear se-
rious infection from the uterus, generally show a marked
and early tendency to dysentery. In harmony with the nor-
mal dryness of the feces in the large intestines and rectum,
alike of the fetus and of the adult, the foal often shows a
pathologic impaction of the rectum with very hard masses
of meconium. At first the foal may appear healthy or at
most merely a trifle dull, but after taking milk there appear,
at from twelve to forty-eight hours after birth, symptoms

Dysentery 815

of abdominal pain. This is expressed in part by turning the
nose to the abdomen, kicking at the belly, lying down and
rolling. The most characteristic symptom is the assumption
by the foal of a peculiar extended attitude while standing.
The foal extends its anterior feet far forward, its hind feet
backward, all members being held rigid. This position is
maintained for five to fifteen minutes or more. The layman
believes the foal is attempting to urinate, but it makes no
actual effort either to urinate or to defecate. The tarsus is
not bent as in urination. The pain is intermittent. Between
paroxysms the foal may suck. Unless medical relief is
given, the disease pursues a slow course and ends in death
from sepsis and exhaustion. In the presence of meconic re-
tention, the foal often develops a perverse appetite and swal-
lows large quantities of hay, straw, feces or other indigesti-
ble substances, thereby complicating the disease present.

C. Dysentery

Some writers have stated that retention of the meconium
frequently ends in dysentery. This I have not observed.
Dysentery is not rare in foals, however, and, as in calves,
may be due, and usually is due, to intra-uterine infection,
but may and does arise from extrinsic infection, variously
obtained after birth. The symptoms of dysentery in foals
are essentially parallel to those described in calves. Like
calves, foals exhibit a strong-tendency to swallow hay, straw,
feces and various indigestible substances. These complicate
and intensify the disease, frequently rendering it unavoida-
bly fatal. The course of the disease may be either rapid or
slow. The mortality is high unless active measures are taken
for its control. The behavior of the disease as related to the
feeding of milk has not been investigated, but is presumably
parallel to the observations made upon calves and previously
described.

D. Arthritis. Pyemia

Pyemic arthritis is commoner in foals than in any other
species of domestic animals. This is due chiefly to the fact

816 Diseases of the Genital Organs

that a large proportion of the cases is caused by post-natal
infection through the umbilicus (omphalo phlebitis, pi/o-
septicemia) , owing to the longer and thicker umbilic cord
which breaks with a longer stump. An important part is
played by the long stump by inviting imprudent ligation, so
that the umbilic stump is ligated more frequently in the foal
than in all other new-born animals combined. Umbilic in-
fection is so evidently the cause of many cases of pyemic
arthritis that until quite recently the navel was considered
the sole avenue of invasion. Lately Schofield1 has shown
satisfactorily that arthritis is frequently due to intra-uter-
ine infection and that in etiology it conforms to the basic
principles of pyemic arthritis in calves and may be either
ante-natal or post-natal in origin. Like arthritis in calves,
the arthritis of foals is prominently associated with intense
intra-uterine infection in mares with abundant sterility and
abortion. Bacteriologically there are recognized, in the in-
fected joints or other pyemic centers, streptococci, staphy-
locci, the B. abortivo-equinus, etc. In other words, there
may be present in the diseased joints any bacteria which
may exist (a) in the uterine cavity of the pregnant mare
and may be swallowed by the fetus, (b) in the milk of the
dam and be swallowed by the foal when the alimentary
epithelium has been damaged or destroyed, or (c) externally
and invade the foal through the umbilicus.

The symptoms consist chiefly of the sudden development
of an intense arthritis in one or more articulations, most
commonly the tarsus, carpus and stifle. When the invasion
occurs through the umbilicus, the event is usually recorded
locally by slight swelling of the umbilicus, followed pres-
ently by a discharge from the umbilic veins of a thin, wa-
tery pus often associated with a re-opening of the urachus
with flow of urine.

Prior to the definite appearance of arthritis, there is pres-

en1 a marked elevation of temperature which, as in the calf,

ages the approach of a storm. When the foal is <>ne to

several days old, there develop suddenly centers of pyemic

ofield l . W. tnvestigatioua into Joint-Ill in Foals. Dept. Agr.
Toronto,

Arthritis. Pyemia

817

inflammation, chiefly in the joints. The foal is seen appar-
ently well, and two or three hours later is found breathing
rapidly, greatly dejected, lying down most of the time and,
when caused to rise or helped up, is unable or unwilling to
bear weight upon a limb. The lameness may shift to another
limb very abruptly or may visibly affect one or more joints
in two or more members. The appetite is diminished or de-
stroyed. The involved articulations are swollen, hot and
painful. The synovial sac is tightly distended with reddish
synovia, which may later become purulent. Pyemic ab-
scesses may develop in any organ or tissue.

Pyemic arthritis is commonly associated with alimentary

Fig. 232 — Abscess of Umbilic Vein and Artery. Foal.
B, Urinary bladder ; U, umbilic vein passing from umbilicus into perito-
neal cavity ; UA, ends of ruptured uterine arteries retracted to fundus of
bladder ; IV, umbilic vein. /, Pus cavity in umbilic vein ; 2, abscess in
right umbilic artery ; j, thickened walls of left umbilic artery ; 4, normal
artery ; 5, thrombus in posterior aorta and iliacs.

disturbances ranging from severe diarrhea to obstinate con-
stipation, and as a part of these disturbances there develops
an erratic appetite which causes the foal to swallow hay,
straw and other indigestible materials. Unless the course
of the disease is interrupted by vigorous medical interfer-
ence, it is highly mortal. Almost all severe cases arising
within two or three days after birth are fatal. Many are
left with disabling joint lesions.

The lesions vary widely. When the invasion occurs
through the umbilicus, especially when aggravated by liga-
tion of the umbilic stump, prominent lesions of the umbilic
arteries and veins are probable, as shown in Fig. 232. When
these vessels become involved, the urachus ordinarily par-
52

8i8

Diseases of the Genital Orga?is

ticipates in the pathologic processes, the retracted, closed
canal re-opens and urine dribbles from the umbilicus. It
is not essential, however, that the infection shall invade the
system through the umbilicus in order to cause the umbilic
lesions. There is clearly a bacteriemia present. The re-
cently ruptured veins, arteries and urachus, with retraction
of urachal and arterial stumps into the abdomen and maim-
ing of the tissues, afford an inviting field for the entrance

/

Figs. 233, 234 — Arthritis of Carpus.

233 — Longitudinal section through carpus.

A, Intra-articular abscesses ; B, pre-carpal abscess ; C, post-carpal abscess.

234 — Cross section of 233 showing articular surfaces of carpal bones.

.//>', Purulent destruction of articular cartilage.

of bacteria from the blood stream as well as from the ex-
terior. The opportunity for bacterial invasion from the
blood stream is further favored by the presence of some ne-
crotic blood which escaped into the umbilic connective tis-
sue during the retraction of the umbilic arteries. An even
more dangerous condition exists in the umbilic vein, where
some residual blood invites bacteria and, if in addition the
umbilic stump has been ligated, the entire functionless um-
bilic veins are distended with great masses of blood incar-
cerated by the ligature. The articular lesions consist chiefly
at first of intense synovitis with great distension of the
synovia] sac. There follow later necrosis and erosions of
the articular cartilages, as shown in Figs. 233 and 234. The
synovia may be bloody and turbid, and may contain synovial

Arthritis. Pyemia

819

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820 Diseases of the Genital Organs

clots or become purulent. The necrosis may extend to the
bones, as illustrated in Fig. 235.

E. Re-Opening of the Urachus

The closing of the urachal stump, when it retracts into
the abdomen immediately after the rupture of the navel
cord," is ordinarily secure. It is brought about partly by
the thickening of the walls of the tube in the process of
shortening, partly by the retraction of the surrounding con-
nective tissue sheath, and apparently also by lymph poured
out from the lacerated walls at the point of rupture. If the
urethra is open and the umbilicus escapes infection, no
urine escapes from the umbilicus. If infection invades the
wounded umbilic tissues and the urachal stump is involved,
the urachal canal re-opens and urine flows from the navel.
Apparently it does not matter whether the invasion is ex-
trinsic or intrinsic, the re-opening of the urachus follows.
The umbilicus then becomes saturated and infiltrated with
urine and much decomposition results. It has been assumed
generally that in these cases the urachus has failed to close,
but according to my observations the open urachus (assum-
ing the urethra is open) is uniformly secondary to infec-
tion and never primary.

The handling of this group of infections has not been well
standardized. Fundamentally the principles involved are
identical with those applying to calves. The rule laid down,
that the sole guarantee for the birth of a sound calf is de-
pendent upon the mating of sound parents, is equally appli-
cable to horsebreeding.

It is essential to the safety of a new-born foal that the
expulsion of the meconium should be caused as completely
and early as practicable. The safest means is the high
enema, as recommended for calves. The enemas should be
repeated at least twice daily until the expulsion is complete
and soft meconium is passed. When meconic retention be-
comes evident, it should be attacked vigorously. The enemas
of physiologic salt solution should be frequent and as high
as practicable. Olive or cottonseed oil. or liquid paraffin

Re- Open ing of the Urach us 821

may be substituted for the salt solution or may be given per
mouth. If these fail, resort may be had to 1/20 to 1/12
grain of eserin or arecolin given hypodermically, repeated
hourly if needed. In the meantime the foal should be
watched and any tendency to swallow hay or bedding frus-
trated by muzzling. Although not investigated, it is not
improbable that the hypodermic injection of the blood serum
or defibrinated blood of the mother of the foal in retention
of the meconium would have the same value as in arthritis.

The feeding of foals should be upon the same principles
as that of calves. When a foal is born, the precaution should
at once be taken to draw all milk from the mare's udder in
order that it shall not gorge itself. If abortion in mares, or
dysentery or arthritis of foals is prevalent in the establish-
ment, the development of the two latter should be antici-
pated and vigorous measures taken to frustrate them.
Schofield1 has reported favorably upon the use of bacterins
made from the streptococcus, usually found by him in the
joint lesions, for the prevention and cure of arthritis. He
and others state, however, that in outbreaks associated with
much abortion, the B. abortivo-equinus is present in the
joints and appears to be the causative agent. In such case
that bacillus needs to be added in the making of the bac-
terins.

Forssell, in the Berliner Tierarztliche Wochenschrift, part
12, 1916, and in a later contribution not yet published, ad-
vocates what appears to be a more logical plan for prevent-
ing and handling arthritis in foals (and probably dysentery
as well), by the use of the blood of the foal's dam. His
recommendations have excellent support in clinical data.
In the Schofield plan the results are technically based upon
the causative agent's being used for the making of bacter-
ins. The causative agent is subject to such a wide variation
in species that the selection of bacterins is always a hazard.
Any pyogenic bacteria which may exist within the gravid
uterus or which may invade the foal through the umbilicus,
may cause the disease. In each case the possible number of

'Schofield, F. W. Investigation into Joint-Til in Foals. Dept. Agr.
Toronto, 19 1 6.

822 Diseases of the Genital Organs

bacteria which may serve to cause the disease is unknown
and unestimated.

So far as known, the blood of the dam always carries an-
tibodies to the infections present in her uterus. The blood
of the fetus does not, with rare exceptions, carry such anti-
bodies, but the bacteria of the uterus exist in the meconium
of the fetus, ready after birth to penetrate the alimentary
mucosa and cause septicemia or arthritis. If the blood of
the mother is used as a prophylactic or therapeutic agent,
it is virtually certain that antibodies against all intra-uter-
ine infections are included. It does not assure the inclusion
of antibodies against extrinsic or navel infection. The pro-
phylaxis of this may be attained, however, by the proper
disinfection of the navel stump when the foal is born. At
the same time, the blood of the mare probably contains anti-
bodies against the most common infections invading the
navel.

Forssell at first used the blood serum from the dam, but
found this objectionable because it involved a delay of one
day, which is very undesirable in the most violent cases. He
then turned to the Lewisohn method of using the entire
blood. He found that, by adding neutral sodium citrate,
two parts to one thousand parts of blood, horse blood will
not coagulate. The uncoagulated blood may be given safely
intravenously or subcutaneously. The technic of Forssell
directs that first the phlebotomy needle, the vessel for the
blood, the hypodermic syringe, and other apparatus should
be boiled. The water used for boiling these needs to be free
from lime, because any of this coming in contact with the
blood causes coagulation despite the presence of sodium
citrate.

When ready to draw the blood, one gram of sodium
citrate in fifty grams of water is placed in a flask or other
container and shaken about until the sides of the vessel are
well moistened. This suffices to prevent the coagulation of
500 cc. of blood, which volume, or a trifle less, is used as a
sigle (lose. While the blood is being drawn, it needs to be
agitated constantly or stirred, in order to keep it mixed with

Re- Opening of the Urachus 823

the citrate and prevent coagulation. When used subcutane-
ously, it should be injected along the sides of the neck or
chest, about 50 cc. at a given point. For subcutaneous use,
Forssell states that the mixture of the sodium citrate is not
absolutely essential. If one needle is in the vein of the dam
and a second needle is already in place for the subcutaneous
injection, the blood may be drawn into the syringe and
quickly injected. The needle in the foal is then moved to
another point and the syringe again filled. The syringe must
be kept warm with hot water. When using the non-coagu-
lated blood, it should be kept at body temperature by im-
mersing the container in warm water. The intravenous in-
jection must be made very slowly.

Forssell reports 157 cases handled with the dam's blood or
blood serum, with recoveries in 127 — 81 per cent. Many of
those which died were in a critical condition when the
handling was begun, and more would probably have recov-
ered had the application been made earlier.

Forssell believes that the ideal plan would be to prepare a
stock serum from the bacteria recognized in arthritis which
could be conveniently and promptly given the foal. The ob-
jection exists, however, that the bacteria of foal septicemia,
pyemia, arthritis and dysentery may vary widely, and that
any stock serum may fail to contain the antibodies for the
infection causing disease in a given foal. On the other hand
it is to be remembered that, so far as known at present, the
bacteria causing the infections in new-born foals (except
such specific forms as tetanus bacilli when invading the
navel) including the B. abortivo-equinus, are identical with,
or analogous to the common wound infections, and that
many, perhaps most of them, are normal habitants of the
adult body, either in the alimentary tract, in the udder, or
in the genital organs. Consequently the blood of an adult
horse may, and perhaps does, contain a long list of anti-
bodies which confer upon the animal a degree of resistance
to the entire bacterial group involved — age resistance. In
discussing calf scours serum, it was noted that there is much
evidence tending to show that normal horse serum possesses

824 Diseases of the Genital Organs

similar therapeutic power to the artificially produced calf
scours serum. If this proves, upon further study, to be
true, it would logically follow that the blood of an adult
horse would, as a rule, contain valuable antibodies for those
common or non-specific infections menacing the life of the
new-born foal. Another interesting possibility, in stables
where arthritis and dysentery are common, is that blood
may be drawn from mares in advanced pregnancy a few
days prior to expected parturition, serum prepared, and
with 0.5 per cent, phenol added, retained in a refrigerator
until the foal is born, and then given immediately.

F. Rupture of the Tendons and Synovial Distensions

OF THE NEW-BORN FOAL

There occurs not infrequently an interesting and usually
mortal disease in young foals, expressing itself clinically by
the rupture of the extensor pedis longus tendons, and by dis-
tension of the synovial cavities, especially of the great femo-
ro-tibio-patellar synovial sac. The character of the disease
is as yet unknown. It is unquestionably intra-uterine in
origin. The symptoms become obvious within one to several
days after birth. It is placed among the intra-uterine in-
fections, not so much because of evidence of its infectious
nature, as because its etiology is unknown and because cer-
tain clinical facts vaguely suggest that it is due to infection.
I have observed the disease mostly in localities where uter-
ine infections of mares are common. In one stable under
my care, there were born two foals annually for two years
and each of the four foals suffered from rupture of both ex-
tensor pedis longus muscles. The symptoms observed con-
sist essentially of loss of power to extend the carpus. When
born the foal shows nothing notable so far as yet observed,
except that there is apparent feebleness. It gets up or. if
unable to do so, stands when helped to its feet, but walks un-
steadily, the carpus constantly tending to bend forward.
There is no recognizable anatomical defect in the carpus
such as the ordinary bent carpus often seen in now-born
foals. The entire cause of the symptoms appears to be in the

Rupture of the Tendons of the New Born'JFoal

825

chief extensor of the foot. The carpus is bent forward, as
shown in Fig. 236. If the foal is helped to its feet and pres-
sure applied against the anterior face of the carpus, it
stands steadily and the carpus is straight, but removal of
the pressure permits the carpus to bend forward and may
cause the foal to fall. As the disease progresses the foal
shows decreasing control over the anterior feet, and in the

Fig. 256— Rupture of Extensor Tendons at Carpus, and
Floating Dislocation of Patella.

ci. Patella; />, femoro tibial articulation.

most severe cases becomes unable to rise and even unable to
stand when helped up. When the decubitis becomes con-
stant, the foal generally perishes within a few days.

Apparently an integral part of the malady, but infre-
quently seen, is the distension of the femoro-tibio-patellar

826

Diseases of the (re?iital Organs

synovial sac, as shown in Fig. 236. The two synovial cavi-
ties became so distended, when the foal was two or three
days old, that each patella was pushed away from the troch-
lear groove of the femur, floated above the summit of the
external ridge, and became completely dislocated laterally,
wholly disabling the posterior limb. The foal was therefore
unable to stand erect either before or behind. The disease
is apparently not local, but merely the local evidence of sys-
temic disturbances. In lying down and getting up, the ex-

FPA

Fig. 237 -Rupture of the Extensor Pedis Longus Muscle

in New-Born Foal.

Right anterior linih seen from in front.

EM, Extensor metacarpus; EP, extensor pedis longus; EPA, extensor

pedis longus accessorius ; /. Proximal ruptured end; j, distal

portion of tendon dropped down in sheath, ,\

Rupture of the Tendons of the Nezv-Born Foal 827

tremely long legs of the foal lead to an inordinate strain
upon the extensor pedis longus muscle. The rupture, as
shown in Fig. 237, occurs at the point of union between the
tendon and the belly of the muscle. In this respect it differs
markedly from the ruptures of muscles and tendons com-
monly observed.

The clinical evidences of a rupture rests in the early stages
upon the difficulty or inability of the foal to get up or to walk
because of the want of power to extend the carpus. If the
character of the lesion is suspected, the diagnosis is to be
verified by carefully palpating over the anterior face of the
lower third of the radius, from 1 to 2 in Fig. 237, which re^
veals an empty groove normally occupied by the base of the
tendon, 2. The free end of the tendon is also palpable, freely
movable in its sheath at the upper part of the carpus. In
those animals which survive, reunion between the muscle
and tendon does not occur and the empty groove is perma-
nent. The foot must then be advanced by the accessory ex-
tensor of the metacarpus. This results in a peculiar gait,
the foot being abducted in the stride and carried forward
with a jerky flail-like motion.

The prognosis is exceedingly unfavorable. Although
some cases live, their locomotion is interfered with by the
absence of the extensor pedis longus muscles, and the value
of the animals is consequently greatly lessened except for
slow work. For driving or riding they would inevitably
prove insecure upon their feet. For any fashionable use,
their peculiarity of action would render them unsuitable.

The handling of the malady is uncertain, and apparently
there is little to do beyond taking good care of the animal
and aiding it in getting upon its feet in order to suck. While
the foal is sucking, an assistant should grasp it by the knees,
and, pushing backward, prevent their flexion, thereby as-
sisting it in standing. Unless the foal is of considerable
value, it is advisable in most instances to destroy it at once.

SECTION V. THE GENITAL INFECTIONS
OF CARNIVORA

CHAPTER XXIV

SPECIFIC VENEREAL DISEASES

The Venereal Tumors of the Dog. Venereal Granulo-
mata. Lymphosarcoma

In the dog, there is observed a specific venereal disease
consisting of granulomata upon the genital mucosa. The
disease is somewhat wide-spread in Great Britain and con-
tinental Europe. It is observed in various portions of the
United States, largely in dogs recently imported. In the
male it affects chiefly the penis and prepuce and sometimes
invades the adjacent tissues. Metastatic disease of the in-
guinal glands may follow. In the female it involves pri-

FlG. 2;^ Infectious Venereal Granuloma of Dog-. (C. A Whil

marily and chiefly the vulva. It is naturally transmitted by
copulation only, but may be otherwise spread by artificial
or accidental inoculation.

The Venereal Tumors of Dogs

829

Symptoms. The first symptom usually noted is a bloody
discharge from the prepuce or vulva, accompanied by tume-
faction of the parts. If the penis is exposed at this time,
there are seen pink or grayish red vegetations, largely upon
the glans or at the preputial ring upon which the glans rests
when the penis is retracted, at times, upon other parts of
the mucosa. The tumors are soft and friable and bleed

Fig. 239— Infectious Venereal Granuloma of Bitch. (C. A White. )

freely upon being touched. They may be sessile or some-
what pedunculated, resembling warts. The affection is of
a chronic character and seems to have no definite limitation.
The vegetations continue to increase in size month by month
and finally become firm, lobulated masses, so intensely in-
jected that they assume a dark color.

83o

Diseases of the Genital Organs

In the bitch, the symptoms are very similar. There is
first a bloody discharge from the vulva. Examination of
the vulva and vagina reveals vegetations of the same ap-
pearance as already noted in the male. These appear chiefly
along the floor of the vulva and, when very large, may pro-
trude externally. The discharge from the vulva is usually
fetid. According to French, males sometimes show an
aversion to mating with affected females.

FlG. 240— Infectious Venereal Granuloma of Bitch. (C. A. White.)

Beebe and Ewing (Jour. Med. Research, Sept.. 1906, do.
Vet. Jour., July, 1907) record the presence in these tumors
of spirochete in one out of a series of cases, but failed to
connect their presence with the cause of the malady.

Later, Mcttam (Veterinary Journal, February. 1907) re-
cords the discovery of an organism in this disease belong-
ing to the group of spirochete, which he believes to be the
Specific ran.-'1.

The Venereal Tumors of Dogs 831

Histologically, the tumors consist of large round or polyg-
onal cells, which multiply rapidly and push the contiguous
tissues aside without their becoming involved in inflamma-
tory or other disease changes.

The disease has been repeatedly transmitted experiment-
ally by inoculations in the genital mucosa and other tissues.

In clinical and experimental cases the neoplasms may not
remain confined to the genital organs, but may involve the
skin, the lymphatic glands of various portions of the body,
the liver, spleen and other glands.

The treatment is not highly satisfactory unless undertaken
early. It consists chiefly of excising the vegetations, along
with a small area of the healthy mucosa, after which the
edges of the wound should be drawn together with catgut.

In the male, it may be necessary to divide the prepuce
and, in the female, the perineum, in order to reach all the
diseased parts. Afterwards, these wounds should be su-
tured. It is well to place the animal under general anaes-
thesia for the operation, which should be repeated within
one to three weeks if necessary, and in some cases cautery
may be used. In inveterate cases it may be necessary to
amputate the penis and prepuce. Hobday states that the
disease may be favorably affected by castration.

CHAPTER XXV

THE GENERAL GENITAL INFECTIONS
OF CARNIVORA

Since the general genital infections of dogs and cats have
not been extensively studied, little can be said of them. It
is known that carnivora suffer frequently and seriously
from general genital infections, but their individual value
is so low in many cases, and so few, comparatively, are
valued highly for breeding purposes that this group of dis-
eases has attracted scant attention.

It is well known that dogs suffer virtually universally
from a well marked genital catarrh. It is so common that
it is designated as normal and, so far as known, has had no
serious study. It is assumed to cause no important harm.
It is a repulsive disease in many males, as the genital dis-
charge soils the hairs about the sheath opening and attracts
many flies.

The bacterial flora of the genital tract is quite unknown.
B. abortus (Bang) has been recognized in the genital tract
of the bitch following experimental inoculation. It was not
known that the bacillus did not already exist in the bitch at
the time of inoculation, and it is not known how frequently
the B. abortus exists naturally in either dogs or cats. Since
both feed freely upon cow's milk, which ordinarily contains
B. abortus, it is probably a common habitant of the organs
of carnivora. The infections of the genitalia of carnivora
probably resemble closely, if they are not frequently iden-
tical with, the bacteria invading the genitalia of other spe-
cies. At least they behave in the same general manner and
cause the same clinical phenomena.

Little is recorded concerning the infections of the testicle
and epididymis of carnivora. In the dog, without vesiculae
seminales, the prostate assumes prominence anatomically
and pathologically. Prostatitis is a common malady seen
chiefly in adult and aged dogs. It has not been studied ex-
cept when it causes clinical symptoms consisting of dim-

The General Genital Infections of Carnivora 833

culty in defecation and urination. It naturally renders the
ejaculation of semen difficult. How much clanger it carries
for the bitch in coitus has not been investigated. It may
play an important role in serious abortion storms in valu-
able kennels. When clinical prostatitis of a marked type be-
comes established, as in semino-cystitis in bulls, the dog
probably becomes sterile, but may be innocuous because the
prostatic ducts are occluded and the infection incarcerated.

When difficulty in defecation or urination becomes clini-
cally evident, palpation per rectum reveals the presence of
the enlarged sensitive prostate. When the disease has so far
progressed that it causes clinical discomfort, it is probably
beyond repair so far as fertility is concerned. There re-
mains only the question of prolonging the life of the patient.
In this field little of value has been accomplished. Appar-
ently prostatitis has attracted no attention in relation with
fertility and no operation or other method of handling for
this purpose suggested. Castration tends to cause abate-
ment in the symptoms of non-malignant prostatitis. Much
of the prostatitis is malignant. Prior to reaching such an
advanced stage, careful physical examination or examina-
tion of the semen may reveal the seriousness of the infection
and enable the veterinarian to avert disaster to valuable
breeding bitches.

Diseases of the ovary are apparently less common than in
mares and cows. I observed one instance of nymphomania
in the bitch, associated with cystic degeneration of the
ovary, as shown in Fig. 241. The nymphomania presented
the same general symptoms as in the cow and was relieved
by castration. There are no data recorded suggesting a
hopeful plan for handling nymphomania in the bitch with a
view to the restoration of fertility. The surgical handling
of the ovaries would call for laparotomy.

The infections of the pregnant uterus of the bitch
and cat are numerous enough, but the details of their
behavior have not been recorded. In some kennels the
owners report that over a long period of time essen-
tially all bitches abort, or at least fail to produce liv-

53

834

Diseases of the Genital Orgam

ing young. When abortion is reported, its exact mean-
ing is not clear. Dystocia in carnivora is frequently,
if not generally, due to the death of a fetus or of
fetuses as a result of infection. As a rule, as in the sow,
the basal fetus — the fetus in the base of one horn and near-
est to the vagina — perishes first and undergoes emphysema-
tous decomposition, blocking the genital passage. The dis-

Fig. 241— Normal and Cystic Ovaries of Bitch.

. /, Cystic ovary ; B, normal ovary with the pavilion of the oviduct turned

hack to expose the ovary ; C, normal ovary covered by the pavilion

of the tube, showing the meatus (ill) of the ovarian sac. by

which it communicates with the peritoneal cavity.

position of the gravid uterus of carnivora is typically illus-
trated in Fig. 242. The basal fetus ordinarily lies in the
base of one horn, and the vaginal end of its fetal sac, instead
of protruding into the cervix, passes across the uterine end
of the cervix into the base of the other horn, or practically
into the other uterus, since the bitch has virtually a double
uterus, the two organs communicating at their bases. In
this manner, from ovary to ovary, the two uterine cavities
are made to constitute one continuous tube and each fetal

The General Genital Infections of Carnivora 835

Fig. 242— Gravid Uterus of Bitch In Situ.
U, Direct cornua ; U' ', retrograde portion of cornu.

836 Diseases of the Genital Organs

sac, except of the two apical fetuses, is in contact at each
pole with the next fetal sac. The two apical embryonic sacs
end at the ovarian pole against the mouth of the oviduct, and
at the cervical pole, against the next embryonic sac. Since
the placentae are zonular, infection can not pass directly
along the uterine tube, but must pass between the fetal and
placental structures, destroying the life of the involved em-
bryo, or must pass through the embryonic sac and the con-
tained fluids and kill the embryo more directly. In either
case embryonic death would necessarily occur one after an-
other from the center of infection, and not en masse. If,
on the other hand, there is a specific infection which causes
abortion directly, either by passing from the blood stream
of the pregnant mother to the fetus and destroying its life,
by passing from the blood stream into the interplacental
areas of the uterus and thence through the chorion and am-
nion to destroy the embryo, or by forming bacterial products
anywhere within the animal body which are able to act di-
rectly upon the uterus and cause the expulsion of its con-
tents, then abortion en masse would occur in muciparous
animals such as swine and carnivora. But so far as I have
been able to observe in the abattoir or to learn from litera-
ture, the death of embryos occurs singly and seriatim from
one or more centers of infection. When all embryos have
perished, or the last to become involved are critically ill, the
uterus contracts and expels its contents. Otherwise, if
some embryos have not been mortally infected, they continue
their development and inhibit the expulsion of any fetal
cadavers present. When the living embryos have reached
maturity parturition occurs unless the outlet is blocked by
a macerating, emphysematous cadaver. Along with the
young which are born, there are expelled some or all of the
fetal cadavers, or their debris. If, however, an apical em-
bryo is dead and macerating, all others may be expelled and
the cadaver r< main in the diseased apex of the horn to pro-
duce a persistent pyomel pa.

The prevention of the general infections of the genitalia
of carnivora has not been sufficiently studied to permit the

The General Genital Infections of Car?iivora 837

formulation of a plan. Anatomical limitations prevent the
examinations of the genitalia, so readily applied in cattle
and horses. The testes and the glands of the pelvic urethra
of the male are palpable. Conscientious effort should de-
velop a technic which would enable the veterinarian to ex-
amine satisfactorily, and to apply remedial measures to, the
vagina, cervix and uterus.

The clinical evidences of embryonic death in carnivora are
variable. It is not known that the death of an embryo in-
duces mammary activity, as is observed in the mare and
cow. If the basal fetus of the bitch or cat is healthy, there

Fig. 243 — Pyometra and Pyosalpinx. Cat.
/, Ovary ; 2, abscess of oviduct; j, distended cornua; ./, cervix ; 5, bladder.

838 Diseases of the Genital Organs

can be no genital discharge from necrotic embryos located
upon the ovarian side of it. What, if any, general symptoms
are caused by maceration of embryos anterior to the basal
one has not been recorded. If pregnancy is well advanced
and the maceration is rapid, there should be signs of tox-
emia and blood samples should reveal pyogenic activity.

When the basal fetus becomes necrotic, genital discharge
may occur ; the probability of a visible discharge increases
as pregnancy advances. The discharge is generally fetid,
sometimes evidently purulent, but when the normal dura-
tion of pregnancy has been almost or quite reached, the dis-
charge is usually sanious and distinctly repulsive. Then
there are clinical evidences of sepsis and sometimes appear-
ances of dystocia. Parturition is suspected rather because
of the existence of a completed pregnancy and of a genital
discharge than because of definite expulsive efforts. The
uterus about the necrotic basal fetus is often too paretic to
dislodge the cadaver and force it into the cervix or vagina,
where its presence would cause definite expulsive contrac-
tions by the abdominal walls. Hence the veterinarian diag-
noses dystocia due to a macerating fetus, chiefly from the
presence of the clinical symptoms of sepsis (dullness, lassi-
tude, erratic temperature, weakness) , the presence of a geni-
tal discharge, and the knowledge that the patient is preg-
nant and is at or near the time for parturition. If to these
are added even slight expulsive efforts, the diagnosis is fa-
cilitated. In the advanced stages of pregnancy, the hand-
ling of embryonic death calls for the complete evacuation of
the uterus. This is to be attained chiefly by means of the
administration of pituitary extract or by hysterotomy or
hysterectomy. These are described in the companion vol-
ume, Veterinary Obstetrics.

The infections of the uteri of carnivora during the puer-
peral and post-puerperal periods offer little that is unusual,
so far as recorded. The greatly elongated and sinuous cor-
nua render pyometra very obstinate. The discharge is often
voluminous and extremely fetid. It may be complicated by
retained fetal envelops or by the presence of a macerating

Venereal Disease of Rabbits 839

fetus in the apex of one horn. Occasionally the uterus be-
comes distended similar to an abscess, as shown in Fig. 243.
In the absence of effective technic for disinfecting the
uterus, the chief reliance is to be placed upon hysterectomy.
This is already described in the companion volume.

CHAPTER XXVI

VENEREAL DISEASE OF RABBITS

Friedberger and Frohner (Spezielle Pathologie und Ther-
apie, 1904, page 501), describe an infectious disease of rab-
bits which is transmitted chiefly or wholly through copula-
tion. The affection appeared in an extensive breeding es-
tablishment of rabbits. It consisted of an inflammatory
disease of the organs of copulation. It was transmitted by
coition from buck to doe, and vice versa. There were ex-
tensive swellings of the genital organs in both sexes, accom-
panied by a muco-purulent discharge. The disease was
finally eradicated by injections of a solution of sulphate of
copper, one to two per cent., extending over a period of some
weeks.

This or a very similar disease occurs in large breeding es-
tablishments of rabbits and hares in this country, and
causes very serious losses by lowering or preventing repro-
duction over a long period of time. The only remedy known
is the thorough disinfection of the copulatory organs of both
sexes and the suspension of breeding until the disease is
under control.

INDEX TO ILLUSTRATIONS

COLORED PLATES

Plate I. Gravid Uterus of Cow at full term, laid open
to show Petal Sac with faint outline of
Fetus

Plate II. Fetal Sac of Cow at about ioo days . .

Plate III. Gravid Uterus of Cow at about four months,
showing Abortion Exudate in the Non-
Gravid Horn

Plate IV. Uterine Cornu of Cow laid open showing
"Exudate of Contagious Abortion" in
the Utero-Chorionic Cavity

Plate V. Portion of Chorion of Cow, showing Diffuse
(Adventitious) Placenta following Necro-
sis of Cotyledons

Plate VI. Cervicitis. Cow

Plate VII. Fetal Death. Ewe. The Uterus is laid open
to show the Fetus lying in Anterior Pre-
sentation, Dorso-Sacral Position ....

Plate VIII. Abortion and Retained Placenta in Ewe . .

Frontispiece

Opposite page 66

Opposite page 67

Opposite page 68

Opposite page 474
Opposite page 61S

Opposite page 726
Opposite page 730

Fig.

1.

Fig.

2.

Fig.

3-

Fig.

4-

Figs

i-5

&6,

Fig.

7-

Fig.

8.

Fig.

9-

Fig. 9a.

Fig. 10.
Fig. 11.
Fig. 12.
Fig. 13.
Fig. 14.
Fig. 15.

Fig. 16.

Fig. 17.

ILLUSTRATIONS IN TEXT

PAGE

The Testicle and its Attachments 3

Testicles of Bull 5

Cross Section through Scrotum and Testicles of Bull Calf . 7
Cross Section through Scrotum of Young Bull viewed from

Posterior Side 8

Glands Attached to Pelvic Urethra of Bull viewed from above 1 1

Same as Figs. 5 and 6 with same lettering 13

Penis of Calf with Preputial Sac Unopened 14

Penis of Calf with Sheath forcibly Everted showing un-
opened Preputial Sac x 3. 15
Penises of Steers showing various degrees in the develop-
ment of the Prepuce. 16

Sheath, Prepuce and Retracted Penis of Bull 17

Sheath, Prepuce and Protruded Penis of Bull 18

Non-gravid Uterus of Mare viewed from Dorsal Surface . . 28

Ovaries, Oviducts, Uterus, and Cervix of Cow 30

Genital Organs of Bitch 31

Cervices of Virgin Heifers opened from above on the median

line exposing the Annular Folds of the Mucosa 34

Above. Transverse Section of the Cervix between the An-
nular Folds viewed from the Uterine End 35

Below. Ditto viewed from the Vaginal End 35

842

Illustrations

Fig.

18

Fig.

19

Fig.

20.

Fig.

21.

Fig.

22.

Fig.

23-

Fig.

24.

Fig. 25.

Fig. 26.
Fig. 27.

Fig. 28.

Fig. 29.

Fig. 30.

Fig. 31
Fig. 32

Fig. 33
Fig. 34
Fig. js
Fig. 36
Fig. 37

Fig. 38
Fig. jg

Fig. 40

Fig. 42

Fig. \\.

Fig. 1 1.

Fig. is.

Fig. js-i.

Fl'V. 46.

Fig. 17-

Vulva and Vagina of Cow showing Gartner's Ducts .... 37
Vulva and Vagina of Cow showing Gartner's Ducts and

Bartholin's Glands 39

Vulva and Vagina of Cow 40

Vulva and Vagina of Cow 42

Section of Ovary in Cow showing a Follicle, 0.6 mm., with

Ovum 47

Section of Ovary of Cow showing a Follicle of 2 mm., with

Ovum 48

Section of Ovary of Cow with a nearly ripe Ovum in an Ovi-
sac, 5x7 mm., showing Vacuoles in the Cumulus prepara-
tory to Ovulation 49

Diagram of Ovary of Cow showing comparative Sizes of the

Follicles shown in Figs. 22, 23, 24 50

The Corpus Lvtteum of Pregnancy 57

Section through Chorionic Placenta of Cow showing Chori-
onic Tufts. Enlarged Photograph 59

Fetal Cotyledon of Cow showing Primary and Adventitious

Placenta. Photograph x 4 60

Maternal (bottom) and Fetal (top) Cotyledons of Cow partly

detached 61

Same as Fig. 29, showing a different type of Placental
Crypts with thickened, fibrous partitions possibly due to

prior disease 62

Chorionic Placenta of Ewe 63

Left. Uterine Cotyledon of Ewe. Right. Median Section

of Maternal and Fetal Cotyledon of Ewe 64

Fetal and Maternal Placenta of Cow 65

Same as Fig. 33 x 900. (Pomayer) 66

Necrotic Tips of Petal Sac. Cow 67

Necrotic Tips of Fetal Sacs. Swine 6S

Examination Blank for Recording Findings in the Examina-
tion of the Genitalia of Cows. Reduced 83

Bischoff's Vaginal Dilator S6

Instruments for the Examination of the Genitalia of Cows 100
Median Longitudinal Sections of Cervices of Cows showing

the Windings of the Cervical Canal 101

Rupture of Cervix by an amateur in an effort to "open the
mouth of the womb, " followed by Chronic Abscess of

Cervix 102

Rupture of the Uterus with Uterine Catheter. Cow .... n 4

The Uterine Seal in Early Pregnancy in Heifer 117

The Uterine Seal of an Adult Cow in Advanced Pregnancy ns

The Uterine Seal in Longitudinal Section. Cow 119

Li]).. m. 1 of Mesenteric Fat of Large Intestine. Cow. . . . [37
Arrested Development of the Genital Tract. Bovine. . . 152

Illustrations

843

Fig. 48.
Fig. 49.

Fig. 50.
Fig. 51.
Fig. 52.

Fig. 53-
Fig. 54.
Fig. 55-
Figs. 56,
Fig. 58.
Fig. 59.
Fig. 59a
Fig. 60.
Fig. 61.
Fig. 62.
Fig. 63.

Fig. 64.
Fig. 65
Fig. 67
Fig.
Fro
Fig. 70a,
Fig. 70b
Fig. 71.

Fig. 72.
Fig. 73.

Fig. 74.
Fig. 75-
Fig. 76.
Fig. 77.
Fig. 78.
Fig. 79.

Fig. 80.
Fig. 81.
Fig. 82.

Fig. 83.
Fig. 84.

69.

70.

Arrested Development of Bovine Genital Tract (Freemartin) 153
Same as Fig. 4S with further development of the Muellerian

Ducts 154

Same as Figs. 48, 49 156

Hermaphroditism. Swine 158

Hermaphroditism. Horse. Showing Rudimentary Penis

below a commodious Vulva 159

Uterus Unicornis. Cow 164

Cervix of a Uterus Unicornis 166

Double Cervix. Cow 166

57. Persistent Median Walls of Mueller's Ducts 16S

Large Ventral Hernia preventing Coitus 174

Overgrown Hoofs interfering with Coitus. Bull .... 177

Gunshot Wounds of Testicles. Bull 1S3

Sutures for Vaginal Hernia 187

Rupture of Prepuce. Bull 224

Amputation of Penis 246

Amputation of the Penis showing Needle inserted for a

Suture 247

Amputation of the Penis 248

Sarcoma of Genital Tract. Bitch 250

Angio-Sarcom of Ovary. Heifer '25 1

Cyst-Adenoma of Ovary. Sow. 252

Dermoid Cyst. Cryptorchid Stallion 255

Dermoid Cyst of Ovary. Mare 256

. Cystic Ovary of Mare. Divided 256

Large Ovarian Cyst of Pregnant Cow (above) with pair of
normal Ovaries (below) showing Corpus Luteum of

Pregnancy 258

Parovarian Tumor of Mare, Incarcerating Rectum .... 259
View of Fig. 72 from Left Side, the Tumor Exposed by cut-
ting away part of mesentery 260

Schematic illustration of Method of Incarceration 261

Special spaying ecraseur, 55 cm. long 264

Colin's scalpel 265

Uterine Fibroid. Cow 275

Uterine Fibroid. Mare 275

The Nodular Venereal Disease. Vulva and Vulvar End of

Vagina. Cow. (Hutyra and Marek) 286

Mild Nodular Venereal Disease. Heifer 287

Vulva of Heifer Grown Experimentally upon Boiled Milk . 290
Vulva of Heifer Fed in Ordinary Manner as a Calf, showing

Matting and Staining of Vulvar Tuft 291

Bull Calf grown Experimentally, with Clean Preputial Tuft 296
Bull Calf of same age as Fig. 83, grown in ordinary Manner
on Raw Milk, showing Matted and Stained Preputial Tuft 297

844

Illustrations

FlG. 85. Clans Penis, Prepuce, and Sheath of Bull showing Mild

Nodular Venereal Disease 29S

FlG. 86. Peuis of Bull showing the Nodular Venereal Disease. (From

same bull as Figs. 126, 127) . .' 299

FlG. 87. Glaus Penis of Bull showing severe (confluent) Nodular

Venereal Disease 300

FlG. 88. Section of a single Nodule from the Vestibule of the Vagina

showing an Elevation in the Mucosa. (Thorns) 301

FlG. S9. Section through 4 contiguous Nodules which cause a single,

rather flat Elevation of the Surface. (Thorns) 302

FlG. 90. A knob-like Elevation of the Mucosa due to several contigu-
ous Nodules. (Thorns) 303

FlG. 91. A section from Roof of Vagina showing marked Nodule
Formation without macroscopically visible Elevation of the

Mucosa 304

FlG. 92. Genital Actinomycosis. Cow 31S

FlG. 93. Tuberculosis of Sheath and Prepuce of Bull 323

FlG. 94. Rupture of Prepuce from Coital Violence 325

FlG. 95. Tuberculosis of Glans and Prepuce 325

FlG. 96. Primary Penial Tuberculosis 327

FlG. 97. Tuberculosis of the Glans and Prepuce 330

FlG. 98. Lateral View of Penis of Bull with Tubercular Penial

Adenitis 332

FlG. 99. Sagittal Section of Fig. 98 332

FlG. [oo. Tuberculosis of Ovary and Oviduct 335

FlG. ioi. Serial Horizontal Sections through Ovary and Oviduct,
showing severe Necrosis and Abscessation of Ovary and

Oviduct 336

FlG. 102. Tuberculosis of Oviducts and Cornua 33S

Fig. 103. Tuberculosis of Ovary and Oviduct 339

FlG. [04. Dorsal Surface of Tuberculous Oviducts, Uterus and Vagina,
showing extensive Pelvic Adhesions and Adhesions of
Ovaries in Pavilion of Oviduct and Broad Ligament . . 340
FlG. 105. Horizontal section through Dorsal .Surface of Uterus, Cor-
nua. Ovaries, and oviducts of Fig. 104 342

FlG. 106. Tubercular Genital Tract from a Non-reacting Cow in Ad-
vanced Tuberculosis . . 344

Fig. 107. Exterior of Severely Tubercular Uterus without Pelvic Ad-
hesions . . • 345

Fig. [08. Uterine Tuberculosis, Involving chiefly the Uterine Glands,

the Peritoneum being free. Longitudinal section of Fig. 107 346
Advanced Tub 1 Uterine Tuberculosis with Necrosis of Mu-

1 and i'\ 1 inn tra 347

Fig mo. Miliary Tuberculosis of the Superficial Uterine Mucosa of a

Virgin Heifer . . 349

111. Tuberculosis of the Vaginal Portion of the Cervix .... 351

Illustrations 845

Fig. 112. Sagittal Section of Fig. in 353

Fig. 113. Spermatozoa from Bull No. 4 of Text 365

Fig. i 14. Spermatozoa obtained from Bull No. 4, taken 25 days after
those shown in Fig. 113, during which period the bull had
complete sexual rest. Spermatozoa were still non-motile

but showed better staining qualities 366

Fig. 115. Spermatozoa from Bull No. 5 367

Fig. 116. Spermatozoa from Bull No. 7, with small heads and defi-
cient nucleus 368

Fig. 117. Spermatozoa from Bull No. S 369

Fig. 118. Spermatozoa from Bull No. 9 371

Fig. 119. Spermatozoa from Bull No. n 372

Fig. 12 r. Degenerative or Desquamative Orchitis in Young Bulls . . 376

Fig. 122. Degenerative (Atrophic) Orchitis in Young Bull 377

Fig. 123. Purulent Periorchitis (Empyema of Scrotum) with Necrosis

and Atrophy of Testis 380

Fig. 124. Abscessation of Testicle in Bull 381

Fig. 125. Chronic Abscessation of Epididymis in Young Bull .... 387

Fig. 126. Orchitis and Epididymitis. Bull 388

Fig. 127. Purulent Spermato- Vesiculitis. Bull (From same animal as

Figs. 126 and 86) • 390

Fig. 128. Nymphomaniac Cysts of Ovary 397

Fig. 128a. Pelvis of Cow showing Ligaments 399

Fig. 129. Nymphomania 401

Fig. 129a. Ovarian Scalpel 406

Fig. 130. Intra- Follicular Hemorrhage 410

Fig. 13 r. Hemorrhagic Corpus Luteum 413

Fig. 132. Cystic Corpus Luteum 415

Fig. 133. Cystic Corpora Lutea. Cow 416

Fig. 134. Cystic Corpus Luteum 419

Fig. 135. Adherent Ovary with very large Cystic Corpus Luteum . . 420

Fig. 136. Cystic Degeneration of. Corpus Luteum 421

Fig. 137. Corpora Lutea of Pregnancy. For Comparison with Cystic

Corpora Lutea 425

Fig. 138. Cross section of Normal Oviduct near the Ampulla, showing

the number and complexity of the Mucous Folds . . . 426

Section of Normal Tube near the middle 427

Section of the Normal Oviduct near the Uterine End, show-
ing the simpler Mucous Folds and the thickness of the

Muscular Coat 427

Highly magnified Section of Normal Mucous Fold of Oviduct 431
Section of Oviduct from a 6- weeks-old Calf, showing the

comparative thickness of the Mucosa 431

Fig. 143. Normal Section of the Oviduct showing the formation of

Cyst-like Cavities by Coalescence of the Folds 413

FlG. 144. Chronic Catarrhal Salpingitis, with a distinct crescent-
shaped inner longitudinal Muscular Coat 434

Fig.

139-

Fig.

140.

Fig.

141.

Fig.

142.

846 Illustrations

Fig. 145. Chronic Catarrhal Salpingitis, showing the Epithelium about

to be cast off, and Edema of the Wall 435

Fig. 146. Chronic Catarrhal Salpingitis with marked Edema of the

Wall ' 435

Fig. 147. Chronic Catarrhal Salpingitis, the Mucous Folds having
been destroyed and the Lumen of the Tube filled with

Debris 437

Fig. 148. Chronic Catarrhal Salpingitis with well advanced Occlusion

of the Lumen of the Tube 437

Fig. 149. Chronic Catarrhal Salpingitis, with almost total Occlusion . 439
Fig. 150. Highly magnified Fold of the Mucosa in the acute Stages of

Inflammation, Congestion, Exudation, etc 439

Fig. 151. Highly magnified Fold of the Mucosa in Chronic Catarrhal
Inflammation, showing destruction of the Epithelium,
thickening by newly formed Connective Tissue, and Amy-
loid or Hyaline Infiltration of the Blood Vessels 440

Fig. 152. Section of the Wall in Hydrosalpinx, showing the slightly
changed Epithelium, and the loose, membranous Charac-
ter of the Wall 440

Fig. 153. Section of part of the Wall in an old Case of Tubercular Sal-
pingitis 441

Fig. 154. Pavilionitis. Pair of Adherent Ovaries seen from behind

and above 442

FlG. 155. Adherent Ovary. Cow 443

FlG. 156. Adhesion of Right Oviduct to Ovary. Double Left Ovary

with Pregnancy 444

Fig. 157. Tubo-Ovarian Abscess. Cow 446

Fig. 15S. Tubo-Ovarian Abscess with Pelvic Adhesions. Horizontal

section through top of Uterus viewed from above .... 447

Fig. 159. Cystic Pavilion of the Oviduct 448

Fig. 160. Cystic Oviducts and Corpus Luteum 449

Fig. 161. Extreme Bilateral Hydrosalpinx 450

Fig. 162. Chronic Endometritis in 5-year-old, non-pregnant Heifer

which bad never bred 454

PlG. 163. Complete Pelvic Adhesions with Uterus, Cornua, Oviducts,

and Ovaries firmly bound together. Heifer 455

FlG. 164. Arrested Excavation of Muellerian Ducts with Cystic Uterus 457
FlG. 165. Atresia of Uterine Horn at Base with Cystic Distension . . 460
FlG. 166. Inter-Placental Hemorrhage with Desiccation of Fetus, early

stages 470

Fig. 167. Inter-Placental Hemorrhage with Desiccation of Fetus . . 471
FlG. 168. Complete Desiccation of Fetus following Inter-Placental

Hemorrhage 472

PlG. 169. Cystic Mole 478

FlG. 17". Desiccated Mole. Cow 479

FlG. 171. Maceration of Fetus |8l

PlG. 172. Macerating Embryo sloughing into Urinary Bladder . . . . 486

Illustrations 847

Fig. 173. " The Exudate of Contagious Abortion " 493

Fig. 174. Impending Abortion, Cervicitis, and Endometritis at Cervi-
cal End with Protrusion of Fetal Sac into Vagina .... 494
Fig. 175. Chart showing influence of B. abortus Bacterins upon the

Prevalence of Abortion 523

Fig. 176. Chart of Agglutination Test on three Heifers after Inocula-
tion with B. abortus, with failure to react on date of

Abortion 529

Fig. 177. Old Hematoma of Right Uterine Horn 54*

Fig. 178. Tesselated Hematoma in Right Uterine Horn 542

Fig. 179. Septic Metritis, Uterus of Cow, with great thickening of

Walls 555

Fig. 179a. Large Single-Curved Uterine Catheter 55s

Fig. 180. Retained Placenta showing Incarceration and Disintegration
of the Chorionic Tufts and extensive Infiltration with
Leucocytes in the Maternal portion, some of them already

broken down, x 310. (After Pomayer) 561

Fig. 181. Retained Placenta. The Chorionic Tufts degenerated, the
maternal Crypt Walls becoming Disintegrated and Ne-
crotic. (After Pomayer) 562

Fig. 182. Retained Placenta. Necrotic disintegration of Fetal Tufts
and extensive Inflammation with Infiltration in the Ma-
ternal Placentae, x 900. (After Pomayer) 562

Fig. 1S3. Total Destruction of Uterine Mucosa 571

Fig. 184. Pyometra with Granular Mucosa 595

Fig. 1S5. Pyometra. Median section through Right Cornu. Cow . 596

Fig. 186. Pyometra 597

Fig. 187. Abscessation of Uterus with Pelvic Adhesions 602

Fig. 187a. Abscessation of Uterus with Pelvic Adhesions 603

Fig. 188. Submucous Uterine Abscesses ' " 604

Fig. 189. Sclerotic Metritis with Pyometra 605

Fig. 190. Adhesion of Uterus to Bladder 607

Fig. 191. Pelvic Adhesions 608

Fig. 192. Extensive Pelvic Adhesions 609

Fig. 193. Cystic Degeneration of Uterine Walls with excessive Hydro-

nietra 612

Fig. 194. Vaginal Ends of Cervices 615

Fig. 196. Uterine Syringe with Conical and Curved Nozzles 619

Fig. 197. Cervical Abscesses 623

Fig. 198. Cervical Abscess from "Opening the Womb", ventral side 624

Fig. 199. Laceration of Lips of Cervix Uteri 627

FlG. 200. Circular Amputation of Cervix Uteri 632

Fig. 200a. Special Instruments for Trachelectomy 633

Fig. 201. Circular Amputation of Cervix Uteri 634

FlG. 202. Circular Amputation of Cervix Uteri 636

FlG. 203. Circular Amputation of Cervix Uteri 637

Pig.

2(14.

Fig.

205.

Fig.

206.

Fig.

207.

Fig.

20S.

Fig.

209.

Fig.

210.

Fig

211.

Fig.

212.

S48 Illustrations

Circular Amputation of Cervix Uteri 638

Costal Pleura of Abort at Full Term, showing the I'etechiae
and Hemorrhages commonly seen in Abortion, Calf Sepsis,

and Dysentery . ... 664

Abscess of Spinal Canal in Calf, from Pyemia 664

The Relationship between Calf Dysentery and Pneumonia
and the Prevalence of Abortion in First Pregnancy ... 667

Chart of Calf No. 70, fed upon Autoclaved Milk 677

Continuation of Fig. 208 678

Chart of Calf No. 71, fed upon Autoclaved Milk 679

Continuation of Fiij;. 210 . 680

Re-Examination Records for the Genital Orgains of Cows

(See also Fig. 37) . . . . 69S

Fig. 215. Estrum and Service Index Card for keeping Breeding

Records 699

FlG. 214. Retained Placenta in Ewe 731

FlG. 215. Tuberculosis of Testis. Boar 737

FlG. 216. Ovaries of Sow 741

FlG. 217. Cystic Ovaries. Sow 742

FlG. 21S. Bilateral Hydrosalpinx developed during Pregnancy. Sow 743

FlG. 219. Desiccated "Mole" in Swine Uterus 744

Fig. 220. Necrotic Swine Embryo with Necrotic Fetal Sac 745

Fig 221, Necrotic Swine Embryo 747

Fig. 222. Necrotic and Healthy Swine Embryos from same Uterus . 747
Fig. 223. Stallion in Early Stages of Dourine, showing Edematous

Prepuce. (Baldrey) 755

FlG. 224. Dourine, showing Penial Paralysis. (Baldrey) 756

Fig. 225. Advanced Dourine in Mare with extreme Emaciation and
showing Depigmentation of Vulvar Pips. (Hutyra ami

Marek) . ... 758

l'i'.. 226. Orchitis and Epididymitis. Stallion 783

Fig. 227. Orchitis and Epididymitis 7sl

I'm.. 22V Enlarged Seminal Vesicles. Gelding 786

FlG. 229. Cystic Ovary, Reduced. Nymphomania 791

FlG. 230. Fetal Placenta of Abortion 795

1 re 231. Pyometra

Fig. 232. Abscess of Umbilic Vein and Artery. Foal 817

1 tGS 233 .v 234. Arthritis of Carpus 818

Fig. 235. Pyemia of New-born 819

Fig. 236. Rupture of Extensor Tendons at Carpus and Floating Dis-
location of Patella . 825

Fig. 2^7. Rupture of the Extensor Pedis Longus Muscle in New-born

Foal .'...,.. ... 826

Fig. 238. Infectious Venereal Granuloma of Dog. [C.A.White) 828

239. Infectious Venereal Granuloma of Bitch. (C.A.White) 829

Fig. 240. Infectious Venereal Granuloma of Hitch (C.A.White) . . 830

Fig. 241. Normal and Cystic Ovaries of Bitcb 833

242, Gravid Uterus of Pitch in Situ s;s

•IV Pyometra. Cat 837

ALPHABETICAL INDEX

Aberrations and Arrests in Genital
Development, 151

Asexual, 151

Bisexual, 151

in the Development of the
Penis, 163
Abortion, 487

" Accidental," 495

Artificial, 146

Bacillus of Bang, 499

Bacterins, 527

"Contagious," (See General
Infections of the Genital Or-
gans of Cattle) 356

Control of, 519

" Food," 496

History of, 488

" Infectious " 4S7

in Carnivora 831

in Cattle, 356

in Mares, 77S

in Sheep and Goats, 717

in Swine, 738

Serum, 526

Symptoms and Diagnosis of, 517

The Biology of, 498

The Nature of, 511

" Traumatic," 495

Vaccines, 527
Abscess of Ovary, 424

Uterine, 601

Uterine, Mare, 806
Abscessation of Uterine Submucosa,
604

of Gartner's Ducts, 649

of the Uterus with Fetal Reten-
tion, 4S4
Abscesses, Pyemic, Mare, 809
"Accidental Abortion," 495
Actinomycosis, Genital, of Cattle. 3 1 7
Addition of Breeding Animals to es-
tablished Herds, 688
Adhesions, Cervical, 641

Pelvic, 606

Amputation of the Cervix, Circular,

63'
of Penis, 245

Anatomy and Physiology of Genital
Organs, 1

Apical Endometritis with Necrosis
of the Apices of the Fetal Sac,
462

Arrests and Aberrations in the De-
velopment of the Testes, 160
in Genital Development, 151
in Functional Development of
Scrotal Testes, ( Fetal Testes, )
161
in the Development of the Male
Genitalia, 160
Arthritis in Foal, 815

Pyemic, in Cow, 609
Pyemic, in Calf, 651
Artificial Abortion, 146
Impregnation, 143
Induction of Estrum, 140
Insemination, 143
Interferences with Reproduc-
tion, 140
Asexual Aberrations, 151
Assembling of Herds, 68S
Atretic Follicles, 395

in Mare, 788
Bacterins, Abortion, 527
Bacterium Abortus of Bang, 499
Balanitis, 295, 393
Bang, Bacterium Abortus of, 499
Bartholin's Glands, 44
Benign Tumors of the Female Geni-
talia, 257
of the Genital Organs, 253
of the Male Genitalia, 253
of the Uterus, 274
Biology of Abortion, 498
Bisexual Aberrations, 151
.Bites Causing Contusions of Neck

and Withers, 219
Bladder. Urinary, Alleged Rupture

of the, by the Penis, 217
Breeding Animals, the Addition of,

to Established Herds, 688
" Broken Penis," 219
Bulls, Epididymitis of, 3S5

Nodular Venereal Disease in, 295

Orchitis of, 375

The General Infections of the

Genital Organs of, 358
Spermatozoa of, 362
Bursattee of the Penis and Prepuce,

775
Calf Dysentery, 651

Pneumonia, 651

Scours, 651

Septicemia, 651
Calluses, Pelvic, 190

54

85o

Alphabetical hid ex

Calves, Degenerative Orchitis of, 375
Epididymal Abscesses of, 385
The Congenital Infections of,
651

Carnivora, the General Genital In-
fections of, 831
The Genital Infections of, 828

Cat, the General Genital Infections
of, 831
The Genital Infections of, 828

Cattle Breeding, Equipment for, 694
Nodular Venereal Disease of, 283
The General Infections of the

Genital Organs of, 356
Genital Infections of, 278
Specific Venereal Diseases of, 278
Vesicular Venereal Disease of, 278

Cellulitis, Contagious, of Horse, 770

Central or Embedded Corpus Lu-
teum, 422

Cervical Adhesions, 641

Canal, Examination of the, 99
Endometritis, 465
Infections, 614
Prolapse, 642

Cervicitis, 614

Fetal Retention from, 641

Cervicitis, Mare, 810

Cervix, The, 33

Circular Amputation of the, 631
Double, 165
Lacerations of, 229
Retention Cysts of the, 642
Tuberculosis of the, 350

Chronic Endometritis, Mare, 805

Circular Amputation of the Cervix,

631
Clinical Examination of the Female
Genital ( )rgans, 79
Examination of the Genital Or-
gans, 73
Examination of Male Genital
Organs, 73
Clitoris. The, 4 1
"Closure of the Womb," 640
Coital Exanthem, 766

Injuries, 205
Congenital Defects of the Female
Genitalia, 163
Infections of Calves, 651
"Contagious Abortion," [See Gen-
eral Infections of the Genital
1 Organs of Cattle |, 356
igious Cellulitis of Horse, 770
Control of Abortion, 519

of Genital Infections in Herds,
697
Contusions of Neck and Withers
from Bites, 219

Copulation, 53

False, 210
Corpora Nigra, 425
Corpus Luteum, Central or Embed-
ded, 422

Cystic Degeneration of, 413

Hemorrhagic, 412

Hypertrophy of the, 418

of Estrum, the, 52

of Fetal Retention, 422

of Pyornetra, 422

Persistent, 421

of Pregnane)-, 56
Cotyledon of Cow, 60

of Ewe, 64
Cotvledonitis, 560

Cows, General Infections of the Gen-
ital Organs of, 394

Ovariotomy in, by the Flank,

273
Vaginal Ovariotomy in, 270

Cowper's Glands, 10
Examination of, 76
Diseases of, (Bull), 393
Cryptorchidy, 160
Cystic Mole, 477

Degeneration of the Corpus Lu-
teum, 413
Degeneration of the Ovary,

Mare, 788
Degeneration of the Ovisacs, 395
Degeneration of the Uterine
Walls, 611
Cystitis, Mare, 812
Cysts of Gartner's Ducts, 649
in the Mesosalpinx, 452
Par-Ovarian, 425
Retention, of the Cervix, 642
Dairying, Equipment for, 694
Death and Maceration of the Em-
bryo, 480
of the Embryo with Persistence

of Embryonic Sac, 477

of the Fertilized Ovum, 476

Degeneration, Cystic, of the Ovisacs,

395 .
Degenerative Orchitis of Calves, 375

I desiccation of Fetus, 470

Diagnosis of Estrum, 11 1

of Pregnancy, 31 1
of Twin Pregnancy, 127
Diarrhea, Calf (see Dysentery) 651
Diarrhea, Foal, (see Dysentery) 815
Diffuse Endometritis of Pregnancy,

I'M

Alpha betical hi dex

851

Diseases and Defects, Miscellaneous,

Interfering with Fertility, 172

of Feet and Limbs (Interfering

with Coitus), 177
Systemic, Interfering with Re-
production, 192
Dog, the General Genital Infections,
of, 831
The Genital Infections of, 828
Venereal Tumors of the, 828
Double Cervix, 165
Uterus, 165
Vagina, 167
Douching the Uterus for Diagnosis,

99
Dourine, 752
Dropsy of Joints, Foal, 824

of the Pavilion of the Oviduct,
448
Ducts of Gartner, 39

of Mueller, 22
Duration of Pregnancy, the Diagno-
sis of, 129
Dysentery, Calf, 651

Foal, 815
Embryo, Infections of the, 476

Infections of the, in Mare, 793

Maceration of the, 480
Embryos, Necrotic, of Swine, 738
Embryonic Sac, Persistence of, after

Death of Embryo, 477
Emphysema of the F'etus, 487
Endometritis, Apical, 462

Cervical, 465

Chronic, in Mare, 805

in Heifers and Heifer Calves,

453
Post-Puerperal, 589
of Pregnancy, Diffuse, 464
Puerperal, 546

with Retained Fetal Mem-
branes, Mare, 799
Epididymal Abscesses of Calves, 386
Epididymis, The, 6

The Examination of, 75
Epididymitis of Stallions, 782
of Adult Bulls, 388
of Bulls, 385
" Epizootic Abortion " (see General
Infections of the Genital Or-
gans of Cattle), 356
Equipment for Cattle Breeding and
Dairying, 694

Eruptive Venereal Disease of the

Horse, 766
Estrum, 47

Estrum, The Artificial Induction of,
140
The Corpus Luteum of, 52
The Diagnosis of, 11 1
Eversion of Vagina (see Cervical

Prolapse) 642
Examination of Cervical Canal, 99
Excessive Sexual Use, 200
Excision of the Prolapsed Endocer-

vical fold, 630
Fallopian Tube (see under Oviduct)

25
Fimbriated End of, (see under
Pavilion of the Oviduct) 25
False Copulation, 210
Feet and Limbs, Diseases of (Inter-
fering with Coitus), 177
Female Generative Organs, The, 18
Genital Organs, the Clinical Ex-
amination of, 79
Genitalia, Congenital Defects

of, 163
Genitalia, Tuberculosis of the,

334
Fertility, Miscellaneous Defects and
Diseases Interfering with, 172
Fertilization, 55
Fertilized Ovum, the Migration of

the, 55
Fetal Desiccation, 470
Emphysema, 487
Membranes, The 58
Membranes, Retained, Cow, 560
Membranes, Retained, Mare,

799
Retention, Corpus Luteum of,

422
Retention from Cervicitis, 641
Sac, Necrosis of the Apices of,
462
Fetus, Infections of the, 476

Maceration of the, 480
Fistula, Recto-vaginal, 229
Foal, Septicemia of the, 814

The Intra-Uterine Infections of,
814
" Food Abortion," 496
Follicular Crater, Hemorrhage into

the, 411
Follicles, Atretic, 395
Fractures and Kicks (During Coitus)

206
" Freemartins," 15 r
Gangrene, Uterine, of Pregnancy,
467
Vaginal, 647
Gartner's Ducts, 39

Cysts and Abscesses of, 649

Alphabetical Index

General Genital Infectious of Carni-
vora, 831
Infections of the Genital Organs

of Hulls, 358

Infections of the Genital Organs
of Cattle, "Contagious Abor-
tion," 356

Infectious of the Genital Organs
of Cows, 394

Genital Infections of Stallions,

7'SJ • • \

Infections of the Genitalia of

Horses, 778

Infections of the Genitalia of
Maris, 788

Infections of the Genitalia of
Sheep and Goats, 717

Infections of the Genitalia of
Swine, 738
Generative Organs, The Female, 18
Genital Actinomycosis of Cattle, 317

Development, Arrests and Aber-
rations in, 151

Horse Pox, 766

Infections of Carnivora, the, 828

Genital Infectious of Cattle, 278; as

related to Human Health, 709 ;

as an Economic Problem, 70S

of Horses, 752

of Sheep and Goats, 713

of Stallions, 782

of Swine, 736

The General, of Carnivora, 831
Genital Organs, Anatomy and Phy-
siology of, I

Benign Tumors of the, 253

Infections of the, 278

of bulls, the General Infections
of, 358

of CattK-, the General Infections

of, 356

of Cows, the Genera] Infections

of, 394
The Clinical Examination of, 73
The Clinical Examination of,

Female, 79
The Clinical Examination of,

Male, 73
Tumors ol the, 239
Tuberculosis of, in Catth
Tuberculosis of, in Swine, 736
Genitalia, Female, Congenital In-
fects of. I63

Male, Anatomy of, 1

Male, Arrests in tin- Develop-
on nt of,

Malignant New-Growths of the
Female, 250

• il pat ion ol

The l'lr the, 1 1

( Terminal Spot, 45

(Viands, Bartholin's, 44

Glaus Penis, Tuberculosis of the,

Hull, 326
Goats, Abortion in, 717

General Infections of the Geni-
talia of, 717
Genital Infections of, 713
Retained Fetal Membranes 111,

717

Graafian Follicle (see under Ovnsac)
18

Gravid Uterus, Infections of the, 462

Health, Human, and the Genital In-
fections of Cattle, 709

Heifer Calves, Intra-Uterine Infec-
tion in, 453

Heifers, Intra-Uterine Infection in,

453
Pyometra in, 45S
Hematoma, Uterine, 539
Hemorrhage, Inter-Placental, 470
into the Follicular Crater, 411
Intra-Follicular, 409
Placental, 70
Urethral, in Stallions, 218
Uterine, 539

Vaginal, following Coitus, 218
Hemorrhagic Corpus Luteum, 412
Herds, The Addition of Breeding
Animals to, 688
The Assembling of, 6SS
The Control of Genital Infec-
tions in, 697
I [ermaphroditism, 157
Hernia, Strangulated, 225

Umbilic, Interfering with Fertili-
ty, 172
Vaginal, 1S5

Ventral (Interfering with Fer-
tility), 174
Horizontal Vulva (Interfering with
Coitus ,171

Horse Pox, Genital, 766

Horses, theC.eiier.il Infections of the

( Genitalia of, 778
The Genital Infections of. 752

Hydrometra, 61 1

Hydrosalpinx, | Cow) 4 )S

Hymen, The. 4 1

Persistent, 169
Hypertrophy of the Corpus Luteum,

1 18
Idleness and < >verfeeding, 196
Impregnation, Artificial, \.\\
Indurated Epididymal Abscesses of

Alphabetical Index

353

Infections, Cervical, 6r4

General, of the Genital Organs

of Bulls, 358
General, of the Genital Organs

of Cattle, 356
General, of the Genital Organs

of Cows, 394
Non-Venereal, Invading the

Genitalia of Cattle, 317
of Calves, the Congenital, 651
of Foals, the Intra-Uterine, 814
of the Embryo in Mare, 793
of the Genital Organs, 278
of the Gravid Uterus, 462
of the Gravid Uterus in Mare,

793
of the Ovum, Embryo and

Fetus, 476
of the Puerperal Uterus, Mare,

799
of the Uterus, Post-Puerperal,

Mare, 805
of the Vagina, 645
of the Vulva, 650
Tubal (Cow), 426
Uterine (Cow), 453
"Infectious Abortion" (see General
Infections of the Genital Organs
of Cattle), 356
Vaginitis, 283
Injuries, Coital, 205
Parturient, 22S
Penial, 219

to Genital and Other Organs by
Sexually Psycopathic Men, 23 1
Insemination, Artificial, 143
Intra-Follicular Hemorrhage, 409
Inter-Placental Hemorrhage with

Fetal Desiccation, 470
Intra-Uterine Infection in Foals, 814
Intra-Uterine Infection in Heifers

and Heifer Calves, 453
Inversion of Vagina (see Cervical

Prolapse) 642
Joint-Ill, 651

in Foal (see Arthritis), 815
Kicks and Fractures (during Coitus).

206
Laceration and Rupture of the Va-
gina, 214
of the Cervix, 229
of the Perineum, 228
Laminitis, Puerperal, 585
Puerperal, Mare, 799
Lead Poisoning, (Interfering with

Coitus, ) 179
Lip-and-Leg Ulceration in Sheep and
Goats, 713

Maceration of the Embrvo or Fetus,

480
Male Genital Organs, the Clinical

Examination of, 73
Male Genitalia, 1

Arrests in the Development of,
160

Malignant tumors of, 239
Malignant New-growths of the Fe-
male Genitalia, 250

Tumors, 239

Tumors of the Male Genitalia, 239
Mare, Cystic Degeneration of the
Ovary of, 788

Diseases of the Ovaries of, 78S

Nymphomania in, 788

Ovariotomy in, by the Flank, 273

Pyometra in, 807

Vaginal Ovariotomy in, 263
Mares, Abortion in, 778

General Infections of the Geni-
talia of, 788
Masturbation, 203
Meconium, Retention of the, in

Foal, 814
Membranes, The Fetal, 58
Meningitis, Puerperal, 585
Menstruation, 51
Mesosalpinx, Cysts in the, 452
Metritis, Mare, 803

Sclerotic, 605

Septic, 554

Septic of Pregnancy, 467
Metro- Peritonitis, Mare, 803
Migration of Fertilized Ovum, 55
Miscellaneous Defects and Diseases

Interfering with Fertility, 172
Mole, Cystic, 477
Muellerian Ducts, the, 22
Mummification of Fetus, 470
Mummified Fetus, 470
Nature of Abortion, The, 511
Navel-Ill, Foal, (see Dysentery), 815
Neck, Contusions of, from Bites, 219
Necrosis of the Apices of the Fetal

Sac, 462
Necrotic Embryos of Swine, 738

Tips of Fetal Sac, 65

Venereal Disease in Sheep, 713
Neuters, 151

New-Growths of the Female Geni-
talia, Malignant, 250
Nodular Venereal Disease in Bulls,

295
in Cattle, 283
in Swine, 736
in Sheep and Goats, 713

854

Alphabetical Index

Non-Venereal Infections Invading

the Genitalia of Cattle, 317
Nymphomania, in Cows, 395

in Mares, 788
Obesity ( Interfering with Reproduc-
tion), 194
Onanism, 203
Oophorectomy, Vaginal, in the Mare,

263
Orchitis and Epididymitis of Stal-
lions, 782

Degenerative, of Calves, 375

in Adult Bulls, 379

of Bulls, 375

Traumatic, 181
Ova, Permanent, 45
Ova, Primitive, 45
Ovarian Tuberculosis, 334
Ovaries, Diseases of the, 394

of the Mare, Diseases of, 788
Ovariotomy in the Cow and Mare by
the Flank, 273

Vaginal, in the Cow, 270

Vaginal, in the Mare, 263
Ovaritis. 394
Ovary, The, 18

Abscess of, 424

Cystic Degeneration of, Mare,
'788

Rectal, Palpation of, 95

Tuberculosis of, 334
Overfeeding and Idleness, 196
Overwork ( Interfering with Repro-
duction), 192
Oviduct, Rectal Palpation of, 95
Oviducts, The, 25

Ovisacs, Cystic Degeneration of, 395
Ovulation, 49
Ovum, Fertilized, Death of the, 476

Infections of the, 476

The Migration of the Fertilized,

55
Palpation of Genitalia, Rectal, S9
Paralysis and Plumbism (Interfering

with Coitus 1, 179
Parametritis, 606
Par-Ovarian Cysts, 425
Parturient Injuries, 228
Pavilion of the Oviduct, Dropsy of,

W8
Pelvic Adhesions, 606

Tumors and Calluses, 190
Penial Injuries, 219

Lymph Glands, Tuberculosis of,

Bull, 333
Sheath, Tuberculosis of the, in

Bulls
Tuberculosis of the Bull, 324

Penis, The, 14

Aberrations in the Development
of, 163

Amputation of the, 245

Bursattee of, 775

Tuberculosis of, 324
Perineum, Lacerations of the, 228
Peri- Vaginal Phlegmon, 648
Permanent Ova, 45
Persistent Corpus Lutemn, 421

Hymen, 169
Persistence of Median Walls of
Muellerian Ducts in Vagina,
167
Phlegmon, Peri-Vaginal, 648
Physiology of the Genitalia, The, 44
Pink Eye, 770
Placenta, Retained, 560
Placental Hemorrhage, 70
Placentitis, 560

Mare, 799

of Pregnancy, 469
Pneumonia, Calf, 651

Post-Puerperal Infections of the
Uterus, 586

Infections of the Uterus, Mare,
805
Pregnancy, Diffuse Endometritis of,
464

Placentitis of, 469

The Corpus Luteum of, 56

The Diagnosis of, 113

The Diagnosis of the Duration
of, 129

Tubal, 185

Twin, 15

The Diagnosis of Twin, 127
Prepuce, Bursattee of, 775

Rupture of the, 223
Preputial Tuberculosis in Bulls, 330
Primitive ( )va, 45
Prolapse, Cervical, 642

of Vagina (see Cervical Pro-
lapse) 642
Prostate Gland, 10

Diseases of, (Bull) 393

Examination of, 76
Puerperal Diseases of the Uterus, 538

Endometritis, 5 [6

Laminitis, Cow, 585

Laniinitis, Mare, 799

Meningitis, 585

Tetanus, 584

Uterus, Infections of the, Mare,

799
Pyemia, Foal, 815

Post-Puerperal, 609

Alphabetical Index

855

Pyemic Abscesses, 609

in Mare, 809

Arthritis, 651
Pyometra, Corpus Luteum of, 422

in Heifers, 458

Mare, 807

of Fetal Decomposition, 480

Post-Puerperal, 594
Pyosalpinx (Cow), 445
Rabbits, Venereal Disease of, 838
Rectal Palpation of Genitalia, 89
Recto- Vaginal Fistula, 229
Rectum, Injuries to, from False

Copulation, 210
Reproduction, Artificial Interfer-
ences with, 140
Retained Fetal Membranes, Cow, 560

Mare, 799

in Sheep and Goats, 717

Placenta, 560
Retention Cysts of the Cervix, 642
Retention of the Meconium, Foal,
814

of Menstrual Debris from Cer-
vicitis, 640
Rupture of the Prepuce, 223

of Tendons, Foal, 824

of the Uterus by the Penis of
the Bull, 216

of the Vagina, 214
Sadism and Sodomy, 231
Salpingitis (Cow), 428
Sand, Uterine, 70
Sclerotic Metritis, 605
Scours, Calf, 651

White, 651

in Foal (see Dysentery), 815
Seal, Uterine, 117
Semen, F^xamination of, 77
Seminal Vesicles, 10

Diseases of, Horse, 785

Examination of the, 76

Inflammation of (Bull), 389
Semino- Vesiculitis, Horse, 785

Bull, 389
Septic Metritis, 554

of Pregnancy, 467
Septicemia of Calf, 651

of Foal, 814
Serum, Abortion, 526
Sexual Use, Excessive, 200
Sheath, The, 15
Sheep, Abortion in, 717

Retained Fetal Membranes in,
717

The General Infections of the
Genitalia of, 717

The Genital Infections of, 713
Synovial Distensions, Foal, S24
Sodomy and Sadism, 231

Specific Venereal Diseases of Cattle,
278

of Dog, 828

of Horses, 752
Spermatozoa of Bull, 362

Examination of the, 77
Spermato-Cystitis, (Bull), 389
Stallions, Epididymitis of, 782

Genital Infections of, 782

Orchitis of, 782
Starvation (Interfering with Repro-
duction), 193
Strangulated Hernia, 225
Strictures of Vagina and Vulva, 175
Swine, Abortion in, 738

General Infections of the Geni-
talia of, 738

Genital Infections of, 736

Necrotic Embryos in, 738
Systematic Control of Genital In-
fections, The, 697
Systemic Diseases Interfering with

Reproduction, 192
Tendons, Rupture of the, Foal, 824
Tetanus, Puerperal, 584
Testes, Arrests and Aberrations in
the Development of , 160

Scrotal, Arrest in Functional
Development of, 16 [
Testicle, Torsion of the, 180
Tesicles, and their Excretory Ducts, 1

The Examination of, 74
Testis, Abnormal Position of, in

Scrotum, 161
Torsion of Testicles, 180

of Uterus, 189
Trachelectomy, 630
Trachelorrhaphy, 626
Tracheoplasty, 625
" Traumatic Abortion," 495

Orchitis, 181
Tubal Infections (Cow), 426

Pregnancy, 185

Tuberculosis, 337
Tuberculosis, Genital, in Swine, 736

of Cattle, 319

of the Cervix, 350

of the Female Genitalia, 334

of the Glans Penis, Bull, 326

of the Penial Lymph Glands,
Bull, 333

of the Penial Sheath in the Bull,

329
Ovarian, 334
Penial, of the Bull, 324
Preputial, in Bulls, 330
Tubal, 337
Uterine, 341
Vaginal, 352
Vulvar, 352

856

Alphabetical Index

Tumors, Benign, of the Genital Or-
gans, 253
Malignant, of the Genital Or-
gans, 239
Pelvic, 190

Venereal, of the Dog, 828
Twin Pregnancy, The Diagnosis of,

127
Umbilic Hernia Interfering with

Fertility, 172
Urachus, Re-Opening of the, Foal,

820
Urethral Hemorrhage in Stallions,

218
Urinary Bladder, Alleged Rupture

of the, by the Penis, 217
Uterine Abscess, 601

Abscesses, Mare, S06
Arteries, The, in Pregnancy, 121
Gangrene of Pregnancy, 467
Hematoma, 539
Hemorrhage, Puerperal, 539
Infections (Cow), 453
Infections and Infections of the

Embryo^, Mare, 793
Sand, 70
Seal, The, 1 17
Uterine Submucosa, Abscessation of,
604
Tuberculosis, 341
Walls, Cvstic Degeneration of,
611
Utero-Chorionic Space, The, 69
Uterus, The, 26

Abscessation of the, with Fetal

Retention, 484
Benign Tumors of. 274
Double. [65

Douching the, for Diagnosis, 99
Gravid, Infections of the, 462
One-Horned, 165
Post-Puerperal, Infections of
the, 586
Infections of the, Mare, S05
Puerperal, Diseases of the, 538

Infections of the, in Mare, 799
Rectal Palpation of, 93
Rupture of the, by the Penis of

the Bull, 216
Torsion of the, [89
Unicornis, 165
Vaccines, Abortion, 527

Vagina, The, 36
1 louble, 167

Examination of the, 84
Infections of the, 645
Laceration and Rupture of the,

214
Persistence of Median Walls of

Muellerian Ducts in, 167
Prolapse of (see Cervical Pro-
lapse), 642
Strictures of, 1 75
Vaginal Gangrene, 647

Hemorrhage following Coitus,

218
Hernia, 185
Ovariotomy in the Cow, 270

in the Mare, 263
Prolapse (see Cervical Prolapse*1,

642
Tuberculosis, 352
Vaginitis, 645

Infectious, 283
Mare, 81 1
Venereal Disease

in Sheep, Necrotic, 713
Nodular, in Bulls> 295

in Cattle, 283

in Sheep and Goats, 713

in Swine, 736
of Rabbits, 838
Specific, of Cattle, 278

of Horses, 752

of the Dog, 828
Vesicular, of Cattle, 278
Tumors of the Dog, 828
Ventral Hernia (Interfering with

Fertility), 174
Vesicles, Seminal, the Examination

of, 76
Vesiculae Semihales, Diseases cf, in

Stallions, 785
Inflammation of (Bull), 389
Prostate, and Cowper's Glands,

10
Vesicular Venereal Disease of Cattle.

278

ol Horse, 766
Vulva, The, 4 1

Examination of the, 84
Vulva, Horizontal (Interfering with
Coitus |, 1 7 1

Infections of the, 650

Strictures of, 1 73
Vulvar Diseases in Mare, 813

Tuberculosis, 332
White Scours, 651

Withers, Contusions of, from Bites,
219

PUBLICATIONS BY W. L. WILLIAMS

Professor of Veterinary Obstetrics and T^esearch
'Professor of the Diseases of Breeding Cattle in the New
Yorl^ State Veterinary College at Cornell University

1 . The Diseases of the Genital Organs of Domestic Animals.

(With the collaboration of W. W. Williams, B.A., D.V.M.)
Pn blish ed 1921, Price $10.00

A treatise of 856 + xviii pages, with 8 colored engavings and
over 240 illustrations in the text, nearly all original. The first
effort in any language to arrange systematically the diseases
of the genital organs of animals, and to deal at length with the
diseases causing sterility, abortion and other interferences
with reproduction.

2. Veterinary Obstetrics.

637 + xiv pages, with 3 colored plates and 140 illustrations
in the text. Published ipij , Price $5.00.

Veterhiary Obstetrics is freely recognized as the highest au-
thority extant in this field. It is a companion volume to The
Diseases of the Genital Organs and the two should be studied in
conjunction.

Excerpts from Reviews of Veterinary Obstetrics

"Under the heading of maternal dystocia, we have the most
important chapter in this new work. Here the author treats the
dystocia of contagious abortion, by far the most common form in
the cow. It is a clinical fact that dystocia of cows is on the
increase, and that the majority of cases are easil}- handled.
They are caused by partially dilated cervix, slight deviations,
dead fetus, weak expulsive power, and emphysema. All these
trace back to infection of the uterus, and the consequent uterine

inertia. Non-dilation of the cervical canal, or induration of the
cervix, is viewed from a new angle, and is shown to be uterine
instead of cervical in the majority of cases.

The discussion of uterine inertia is highly interesting and
throws new light upon the ever-increasing number of cases of
dystocia. The author's conclusions are substantiated by clinical
facts. The uterus in dystocia of contagious abortion is easily
contused and abraded, with resulting infection and necrosis.
The author might have pointed out still more emphatically the
results of severe traction and forced extraction in this class of
dystocia.

The outstanding feature of this new work is the fact that the
author has put in concrete form the relation between uterine
infection and dystocia ; he has pointed out that the obstetrist is
constantly working in the midst of a virulent infection.

— /. L. Buchanan i?i The Cornell Veterinarian.''''

" So comprehensive a work can only be reviewed broadly ; and
it may be said at once that the book, while containing much con-
troversial matter, will be very valuable to all veterinarians prac-
ticing in breeding districts. The author often challenges gener-
ally accepted views ; but when his controversial opinions are
closely examined, it will be found that solid reasons are adduced
on behalf of most of them. The book possesses two outstanding
merits. The first is the attention given to the practical details
of parturition work, of the difficulties of which the author has
evidently had great experience.

The second special merit of the book is its constant attempt to
trace out the anatomical and physiological causes upon which
obstetric troubles depend ; and here the practitioner will find the
work exceedingly stimulating and suggestive. The sections
upon such hitherto little-mentioned subjects as rupture of the
prepubian tendon and bi-cornual pregnancy are instances of this.
In this connection an important feature of the work is its insist-
ence on the intimate relation between diseases of the genital
organs and difficulties in parturition ; and here the section upon
the dystocia of contagious abortion — the latter term being used
in its widest sense to include abortions due not only to Bang's

bacillus but also to other microbial infections — is perhaps the
best example of the trend of the author's teaching. It will not
be universally accepted ; but no one will be able to read the book
without being forced to re-examine his views upon many
obstetric questions.

— W. R. C. in the Veterinary Record, Oct. 2J, ipi/."

"This is not a second edition of Williams' Veterinary
Obstetrics published in 1909. It is a new work of much
more manageable proportions, being restricted to the anatomy
and physiology of the generative organs, normal and abnormal
pregnane}', parturition and dystocia, traumatic lesions incidental
to parturition, and, lastly, puerperal laminitis and tetanus, and
certain eclamptic diseases. . . . The point (nomenclature
of positions) is of little importance compared with what Professor
Williams calls the "dystocia of contagious abortion," which
may give rise to some misunderstanding, suggesting the presence
of Bang's bacillus. On the contrary, the expression is used
very broadly to indicate any infection which invades the uterus,
setting up a chronic metritis and imperilling the life of the
foetus, with or without actual abortion. The author appears to
regard any ante-partum infection of the uterus as the chief cause
of both maternal and foetal dystocia in cows. On p. 426 we
find, "formerly it was said that, if a cow suffered from dystocia,
if parturition were tardy, she would probably suffer from reten-
tion of the foetal membranes, or metritis ; now it may be said
that, if metritis exists in the pregnant cow, perhaps revealing its
presence after parturition as retained afterbirth, the parturition
will be tardy — there will be dystocia." Cause and effect are
thus reversed. . . . By the publication of this treatise,
which promises to become a standard work on both sides of the
Atlantic, Professor Williams has enhanced his reputation as an
able obstetrician and teacher. — A. IV. in the 1 'eterinarj' Review.

" In view of the large field of usefulness which veterinary ob-
stetrics affords for the young practitioner, it is apparent that a
modern work on the subject by an author who has had the ad-

vantage of many years' practical experience, as well as devoting
special attention to the scientific aspect of obstetrical knowledge,
will be of marked value to the profession. A perusal of the
work under review leads us to the conclusion that not only will
it prove a most useful and instructive text book for the student,
but it will supply the practitioner with a most valuable manual
for reference in the many difficult problems which are so fre-
quently presented in the practice of obstetrics.
Finally, we may remark that both practitioners and students of
veterinary medicine are under a deep debt of gratitude to Profes-
sor Williams for placing within their reach a work which repre-
sents not only all that is known on the subject, but also the
valuable experiences and observations of a master of the art and
science of obstetrics, written in a concise and lucid style, leavened
by actual practice, and not compiled from the works of other
men nor founded on the dreams of the theorist or ' arm-chair '
thinker." — E. Wall is Hoare, in the Veterinary Nezcs, Jan. 5 , 1918.

"Those who know the keenness with which Professor
Williams has entered into research in connection with contagious
abortion will expect something good in this book, and they will
not be disappointed. There are too few volumes containing a
reasoned and practical survey of the field of obstetrics, written
by scientists with wide and plentiful technical experience.

The man in a busy country practice who has time to read
should take this book on his knee in his spare moments and read
it through and through. However good an obstetrist he may
be, he will find fresh tips, live understanding, and very valuable
information in this work. We think sometimes that an intelli-
gent understanding of the state of affairs in a pregnant uterus is
of more value to the obstetrist than a mere rough-and-ready
overcoming of the difficulty presented. This book tells how to
accomplish the task smoothly and effectively, with the least
injury to the patient and the greatest benefit to the new arrival.
We wish the volume every success ; it is a grand one. We look
forward with pleasure to a book by the same author on " Diseases
of the (lenital Organs."

— (j. .If. in thr \ ',(<■> i>hi> r Journal.

3. Surgical and Obstetrical Operations.

Fourth revised edition.
I With the collaboration of J. N. Frost, Professor of Surgery

in the New York State Veterinary College at Cornell

University.)
196 + x pages, with 74 illustrations.
A concise treatise upon the most common surgical and

obstetrical operations, designed primarily as a laboratory

guide for students and as a compendium for practitioners.

Price $3 00.

The books in the above list are not sold to dealers at a discount
and should be ordered direct from the author.

ster Family Library of Veterinary Medicine
,l of Veterinary Medicine at